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Dealer Application

 

<div class="container">
  <form action="action_page.php">

    <label for="fname">First Name</label>
    <input type="text" id="fname" name="firstname" placeholder="Your name..">

    <label for="lname">Last Name</label>
    <input type="text" id="lname" name="lastname" placeholder="Your last name..">

<label for="cname">Company Name</label>
    <input type="text" id="cname" name="companyname" placeholder="Your Company Name..">
    <label for="country">Country</label>
    <select id="country" name="country">
      <option value="canada">Canada</option>
      <option value="usa">USA</option>
    </select>

    <label for="subject">Subject</label>
    <textarea id="subject" name="subject" placeholder="Write something.." style="height:200px"></textarea>

    <input type="submit" value="Submit">

  </form>
</div>