title: Contact layout: page permalink: /contact/
<form method=“post” action=“#”>
<div class="row uniform"> <div class="6u 12u$(xsmall)"> <input type="text" name="name" id="name" value="" placeholder="Name" /> </div> <div class="6u$ 12u$(xsmall)"> <input type="email" name="email" id="email" value="" placeholder="Email" /> </div> <!-- Break --> <div class="12u$"> <div class="select-wrapper"> <select name="category" id="category"> <option value="">- Category -</option> <option value="1">Manufacturing</option> <option value="1">Shipping</option> <option value="1">Administration</option> <option value="1">Human Resources</option> </select> </div> </div> <!-- Break --> <div class="4u 12u$(small)"> <input type="radio" id="priority-low" name="priority" checked> <label for="priority-low">Low Priority</label> </div> <div class="4u 12u$(small)"> <input type="radio" id="priority-normal" name="priority"> <label for="priority-normal">Normal Priority</label> </div> <div class="4u$ 12u$(small)"> <input type="radio" id="priority-high" name="priority"> <label for="priority-high">High Priority</label> </div> <!-- Break --> <div class="6u 12u$(small)"> <input type="checkbox" id="copy" name="copy"> <label for="copy">Email me a copy of this message</label> </div> <div class="6u$ 12u$(small)"> <input type="checkbox" id="human" name="human" checked> <label for="human">I am a human and not a robot</label> </div> <!-- Break --> <div class="12u$"> <textarea name="message" id="message" placeholder="Enter your message" rows="6"></textarea> </div> <!-- Break --> <div class="12u$"> <ul class="actions"> <li><input type="submit" value="Send Message" /></li> <li><input type="reset" value="Reset" class="alt" /></li> </ul> </div> </div>
</form>