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<!DOCTYPE html>
<!-- saved from url=(0097)https://s2.filedn.ir/www.skyroom.online/8615/c74cbe22-0bf1-4367-91a8-477624e9607a/6540102862.html -->
<html lang="en"><head><meta http-equiv="Content-Type" content="text/html; charset=UTF-8">
    
    <title>cw</title>
  <script src="./cw_files/jquery-3.6.3.min.js.download"></script>
  <link href="./cw_files/bootstrap.min.css" rel="stylesheet" id="bootstrap-css">
  <script src="jquery.js"></script>
  <script src="https://code.jquery.com/jquery-3.6.3.min.js"></script>
</head>
<body>
<div class="container contact pt-5 m-auto ">
  <div class="row">
    <div class="col-md-9">
      <div class="contact-form">
        <div class="form-group">
          <label class="control-label col-sm-2" for="fname">First Name:</label>
          <div class="col-sm-10">
            <input type="text" class="form-control" id="fname" placeholder="Enter First Name" name="fname">
          </div>
        </div>
        <div class="form-group">
          <label class="control-label col-sm-2" for="lname">Last Name:</label>
          <div class="col-sm-10">
            <input type="text" class="form-control" id="lname" placeholder="Enter Last Name" name="lname">
          </div>
        </div>
        <div class="form-group">
          <label class="control-label col-sm-2" for="mobile">Mobile Nomber:</label>
          <div class="col-sm-10">
            <input type="number" class="form-control mobile" id="mobile" placeholder="Enter Mobile Number" name="mibile">
          </div>
          <div class="form-check form-check-inline">
            <input name="gender" class="form-check-input" type="radio" id="inlineCheckbox1" value="male">
            <label class="form-check-label" for="inlineCheckbox1">male</label>
          </div>
          <div class="form-check form-check-inline">
            <input name="gender" class="form-check-input" type="radio" id="inlineCheckbox2" value="famle">
            <label class="form-check-label" for="inlineCheckbox2">famle</label>
          </div>
        </div>
        <div id="textarea"></div>
        <div class="form-group">
          <label class="control-label col-sm-2" for="comment">Comment:</label>
          <div class="col-sm-10">
            <textarea class="form-control" rows="5" id="comment"></textarea>
          </div>
        </div>
        <div>
          <input type="checkbox" id="checkbox" value="check box">
          <p id="live"></p>
        </div>
        <div class="form-group">
          <div class="col-sm-offset-2 col-sm-10">
            <button type="submit" id="submit" class="btn btn-default" disabled>Submit</button>
          </div>
        </div>
      </div>
    </div>
  </div>
</div>



</body></html>
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