munifix-frontend/index.html at gh-pages · CodeForFtL/munifix-frontend · GitHub

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<!DOCTYPE html>
<html>
<head>
    <title>Munifix - Fort Lauderdale, FL</title>
    <meta charset="UTF-8">
    <script type="text/javascript" src="https://cdnjs.cloudflare.com/ajax/libs/jquery/2.1.1/jquery.min.js"></script>

    <!-- Latest compiled and minified CSS -->
    <link rel="stylesheet" href="http://maxcdn.bootstrapcdn.com/bootstrap/3.2.0/css/bootstrap.min.css">

    <!-- our css -->
    <link rel='stylesheet' href='styles/home.css'>
</head>
<body>

    <div class="container">

        <h2>Report Your Issue</h2><hr />

        <form class="form-horizontal" role="search" action="" method="GET" id="search-form">

            <div class="form-group">
                <label for="state" class="col-sm-2 col-md-4 control-label">Street Address</label>
                <div class="col-sm-10 col-md-4">
                    <input type="text" class="form-control" name="address" id="address">
                </div>
            </div>

            <div class="form-group">
                <label for="city" class="col-sm-2 col-md-4 control-label">City</label>
                <div class="col-sm-10 col-md-4">
                    <select name="city" class="form-control">
                        <option value="cocr">Coconut Creek</option>
                        <option value="coci">Cooper City</option>
                        <option value="cosp">Coral Springs</option>
                        <option value="dania">Dania Beach</option>
                        <option value="davie">Davie</option>
                        <option value="deer">Deerfield Beach</option>
                        <option value="ftl">Fort Lauderdale</option>
                        <option value="hall">Hallandale Beach</option>
                        <option value="hills">Hillsboro Beach</option>
                        <option value="holly">Hollywood</option>
                        <option value="ldrlakes">Lauderdale Lakes</option>
                        <option value="LBTS">Lauderdale-by-the-Sea</option>
                        <option value="ldrhill">Lauderhill</option>
                        <option value="lzylake">Lazy Lake</option>
                        <option value="lthspt">Lighthouse Point</option>
                        <option value="mrgt">Margate</option>
                        <option value="mrmr">Miramar</option>
                        <option value="nola">North Lauderdale</option>
                        <option value="okldpk">Oakland Park</option>
                        <option value="pkld">Parkland</option>
                        <option value="pmpk">Pembroke Park</option>
                        <option value="pmpn">Pembroke Pines</option>
                        <option value="pntn">Plantation</option>
                        <option value="pmbc">Pompano Beach</option>
                        <option value="srlks">Sea Ranch Lakes</option>
                        <option value="swrn">Southwest Ranches</option>
                        <option value="snrs">Sunrise</option>
                        <option value="tmrc">Tamarac</option>
                        <option value="wspk">West Park</option>
                        <option value="wstn">Weston</option>
                        <option value="wtmn">Wilton Manors</option>
                    </select>
                </div>
            </div>

            <div class="form-group">
                <label for="state" class="col-sm-2 col-md-4 control-label">State</label>
                <div class="col-sm-10 col-md-4">
                    <input type="text" class="form-control" name="state" id="state" value="FL">
                </div>
            </div>

            <div class="form-group">
                <label for="zipcode" class="col-sm-2 col-md-4 control-label">Zip Code</label>
                <div class="col-sm-10 col-md-4">
                    <input type="text" class="form-control" name="zipcode" id="zipcode">
                </div>
            </div>

            <div class="form-group">
                <label for="phone" class="col-sm-2 col-md-4 control-label">Phone</label>
                <div class="col-sm-10 col-md-4">
                    <input type="tel" class="form-control" name="phone" id="phone" placeholder="954-555-1234">
                </div>
            </div>

            <div class="form-group">
                <label for="name" class="col-sm-2 col-md-4 control-label">Name</label>
                <div class="col-sm-10 col-md-4">
                    <input type="text" class="form-control" name="name" id="name" placeholder="John Doe">
                </div>
            </div>

            <div class="form-group">
                <label for="email" class="col-sm-2 col-md-4 control-label">E-mail</label>
                <div class="col-sm-10 col-md-4">
                    <input type="email" class="form-control" name="email" id="email" placeholder="Yourname@domain.com">
                </div>
            </div>

        </form>
    </div>
</body>
</html>