<html>
<head>
<style>
.contact_form{
width:345px;
height:500px;
background:#21ADFA;
}
td {
height: 56px;
margin-top: 50px;
width: 66px;
}
input {
height: 52px;
margin-left: 19px;
padding-left: 17px;
text-align: justify;
width: 300px;
}
textarea {
height: 80px;
margin-left: 17px;
width: 300px;
padding-left: 17px;
padding-top: 29px;
}
button {
background: #ffb049 none repeat scroll 0 0;
border: 1px solid #ffb049;
height: 70px;
margin-left: 17px;
margin-top: 7px;
width: 300px;
}
.content_appointment {
text-align: center;
}
</style>
</head>
<body>
<div class="contact_form">
<div class="content_appointment">
<p>Make An</p>
<h2>Appointment</h2>
</div>
<form name="frm" >
<table>
<tr>
<td><input type="text" name="txtname" placeholder="your name"/>
</td>
</tr>
<tr>
<td><input type="text" name="txtname" placeholder="phone number"/>
</td>
</tr>
<tr>
<td><input type="text" name="txtname" placeholder="email address"/>
</td>
</tr>
<tr>
<td><input type="text" name="txtname" placeholder="Appointment date"/>
</td>
</tr>
<tr>
<td><textarea id="txtmessage" name="txtmessage" placeholder="message"></textarea>
</td>
</tr>
<tr>
<td><button id="btn_submit" name="btn_submit" >Submit</button>
</td>
</tr>
</table>
</form>
</div>
</body>
</html>
Output:-
<head>
<style>
.contact_form{
width:345px;
height:500px;
background:#21ADFA;
}
td {
height: 56px;
margin-top: 50px;
width: 66px;
}
input {
height: 52px;
margin-left: 19px;
padding-left: 17px;
text-align: justify;
width: 300px;
}
textarea {
height: 80px;
margin-left: 17px;
width: 300px;
padding-left: 17px;
padding-top: 29px;
}
button {
background: #ffb049 none repeat scroll 0 0;
border: 1px solid #ffb049;
height: 70px;
margin-left: 17px;
margin-top: 7px;
width: 300px;
}
.content_appointment {
text-align: center;
}
</style>
</head>
<body>
<div class="contact_form">
<div class="content_appointment">
<p>Make An</p>
<h2>Appointment</h2>
</div>
<form name="frm" >
<table>
<tr>
<td><input type="text" name="txtname" placeholder="your name"/>
</td>
</tr>
<tr>
<td><input type="text" name="txtname" placeholder="phone number"/>
</td>
</tr>
<tr>
<td><input type="text" name="txtname" placeholder="email address"/>
</td>
</tr>
<tr>
<td><input type="text" name="txtname" placeholder="Appointment date"/>
</td>
</tr>
<tr>
<td><textarea id="txtmessage" name="txtmessage" placeholder="message"></textarea>
</td>
</tr>
<tr>
<td><button id="btn_submit" name="btn_submit" >Submit</button>
</td>
</tr>
</table>
</form>
</div>
</body>
</html>
Output:-
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