	<?php include('header.php');?>

    <div class="page-banner-wrap bg-cover" style="background-image: url('assets/img/page-banner.jpg')">
        <div class="container">
            <div class="row">
                <div class="col-12 col-lg-12">
                    <div class="page-heading text-white">
                        <h1>Dealer Enquiry Form</h1>
                    </div>
                    <div class="breadcrumb-wrap">
                        <nav>
                            <ol class="breadcrumb">
                              <li class="breadcrumb-item"><a href="index.php">Home</a></li>
                              <li class="breadcrumb-item active" aria-current="page">Dealer Enquiry Form</li>
                            </ol>
                        </nav>
                    </div>
                </div>
            </div>
        </div>
    </div>
<section class="contact-us-wrapper section-padding  section-padding">
        <div class="container">
            <div class="row">
                <div class="col-12 col-xl-6 col-md-6 offset-md-3 text-center wow fadeInDown" data-wow-duration="1s" data-wow-delay="0.2s">
                    <div class="section-title">
                        
                        <h2>Dealer Enquiry Form
                        </h2>
                        <div class="yellow-bg">
                            <img src="assets/img/home5/yellow-bg.svg" alt="">
                        </div>
                    </div>
                </div>
            </div>
            <div class="row eq-height pt-5">
                <div class="col-lg-8 col-12 offset-2">
                    <div class="contact-form"> 
                        <h4>Please Fill-up below form</h4>                                                       
                        <form action="#" method="POST" class="row" id="contact-form">
                            <div class="col-md-6 col-12">
                                <div class="single-personal-info">
                                    <input type="text" name="name" placeholder="Name">                                         
                                </div>
                            </div>                            
                            <div class="col-md-6 col-12">
                                <div class="single-personal-info">
                                    <input type="email" name="email" placeholder="Email">                                         
                                </div>
                            </div>
                            <div class="col-md-6 col-12">
                                <div class="single-personal-info">
                                    <input type="text" name="phone" placeholder="Contact Number">                                         
                                </div>
                            </div> 
                            <!-- <div class="col-md-6 col-12">-->
                            <!--    <div class="single-personal-info">-->
                            <!--        <input type="text" name="phone" placeholder=" Desired QTY in Litres">                                         -->
                            <!--    </div>-->
                            <!--</div>-->
                                <div class="col-md-6 col-12">
                                    <div class="single-personal-info">
                                          <input list="browsers" name="browser" id="browser" placeholder="Desired QTY in Litres">
                                          <datalist id="browsers">
                                            <option value="1to1k">
                                            <option value="1kto10k">
                                            <option value="10kto1L">
                                            <option value="1L+">
                                           
                                          </datalist>
                                    </div>
                                </div>                                      
                            <div class="col-md-12 col-12">
                                <div class="single-personal-info">
                                 <select class="form-control" id="inputState">
                        <option value="SelectState">Select State</option>
                        <option value="Andra Pradesh">Andra Pradesh</option>
                        <option value="Arunachal Pradesh">Arunachal Pradesh</option>
                        <option value="Assam">Assam</option>
                        <option value="Bihar">Bihar</option>
                        <option value="Chhattisgarh">Chhattisgarh</option>
                        <option value="Goa">Goa</option>
                        <option value="Gujarat">Gujarat</option>
                        <option value="Haryana">Haryana</option>
                        <option value="Himachal Pradesh">Himachal Pradesh</option>
                        <option value="Jammu and Kashmir">Jammu and Kashmir</option>
                        <option value="Jharkhand">Jharkhand</option>
                        <option value="Karnataka">Karnataka</option>
                        <option value="Kerala">Kerala</option>
                        <option value="Madya Pradesh">Madya Pradesh</option>
                        <option value="Maharashtra">Maharashtra</option>
                        <option value="Manipur">Manipur</option>
                        <option value="Meghalaya">Meghalaya</option>
                        <option value="Mizoram">Mizoram</option>
                        <option value="Nagaland">Nagaland</option>
                        <option value="Orissa">Orissa</option>
                        <option value="Punjab">Punjab</option>
                        <option value="Rajasthan">Rajasthan</option>
                        <option value="Sikkim">Sikkim</option>
                        <option value="Tamil Nadu">Tamil Nadu</option>
                        <option value="Telangana">Telangana</option>
                        <option value="Tripura">Tripura</option>
                        <option value="Uttaranchal">Uttaranchal</option>
                        <option value="Uttar Pradesh">Uttar Pradesh</option>
                        <option value="West Bengal">West Bengal</option>
                        <option disabled="" style="background-color:#aaa; color:#fff">UNION Territories</option>
                        <option value="Andaman and Nicobar Islands">Andaman and Nicobar Islands</option>
                        <option value="Chandigarh">Chandigarh</option>
                        <option value="Dadar and Nagar Haveli">Dadar and Nagar Haveli</option>
                        <option value="Daman and Diu">Daman and Diu</option>
                        <option value="Delhi">Delhi</option>
                        <option value="Lakshadeep">Lakshadeep</option>
                        <option value="Pondicherry">Pondicherry</option>
                      </select>                                     
                                </div>
                            </div>                                    
                            <div class="col-md-12 col-12">
                                <div class="single-personal-info">
                              <div class="form-group">
                                             <input id="terms" type="checkbox" onclick="agree()" name="terms" value="on" /> I agree all statements in Terms of service</p>
                                            </div>                                    
                                </div>
                            </div>                                      
                            <div class="col-md-12 col-12">
                                <input class="submit-btn" type="submit" value="Submit Now">
                            </div>                                      
                        </form>
                        <!--<span class="form-message"></span>-->
                    </div>
                </div>
                
            </div>
        
        </div>

        <div class="shaps">
            <img src="assets/img/home5/sap_2.svg" alt="">
        </div>
    </section>

	<?php include('footer.php');?>