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form.html
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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<title>Kuza Forms - Sell Anywhere, Grow your Business</title>
<link rel="stylesheet" href="css/custom/style.css">
<link rel="stylesheet" href="css/responsive/responsive.css">
<link rel="stylesheet" href="css/helper.css">
<link rel="stylesheet" href="css/custom.css">
</head>
<body>
<div class="container">
<div class="row">
<form action="" method="POST" role="form">
<div id="leftPage" class="col-lg-7 pd-tb-mini pd-r-50">
<h3 class="mr-b-20">Customer information</h3>
<div class="row">
<div class="form-group col-md-6">
<label for="" class="control-label">First Name</label>
<input type="text" class="form-control" id="" placeholder="Enter your First Name">
</div>
<div class="form-group col-md-6">
<label for="" class="control-label">Last Name</label>
<input type="text" class="form-control" id="" placeholder="Enter your Last Name">
</div>
<div class="form-group col-md-6">
<label for="" class="control-label">Email Address</label>
<input type="text" class="form-control" id="" placeholder="Enter your Email Address">
</div>
<div class="form-group col-md-6">
<label for="" class="control-label">Phone #</label>
<input type="text" class="form-control" id="" placeholder="Enter your Phone #">
</div>
<div class="form-group col-md-12">
<label for="" class="control-label">Company Name</label>
<input type="text" class="form-control" id="" placeholder="Enter your Company Name">
</div>
</div>
<hr>
<h3 class="mr-b-20">Address / Shipping Information</h3>
<div class="row">
<div class="form-group col-md-12">
<label for="" class="control-label">Address</label>
<input type="text" class="form-control" id="" placeholder="Enter your Address">
</div>
<div class="form-group col-md-6">
<label for="" class="control-label">City / Town</label>
<input type="text" class="form-control" id="" placeholder="Enter your City / Town">
</div>
<div class="form-group col-md-6">
<label for="" class="control-label">Region</label>
<input type="text" class="form-control" id="" placeholder="Enter your Region">
</div>
</div>
</div>
<div id="rightPage" class="col-lg-5">
<h3 class="mr-b-20">Buy Outside Insight</h3>
<div class="row prod-info">
<div class="col-md-12">
<img src="https://outsideinsight.com/wp-content/themes/oi-content-portal/images/book-CTA.png" class="pull-left mr-r-20 rd-5" alt="">
<div class="prodInfo">
<h4>Description</h4>
<p>The world today is drowning in data. There is a treasure trove of valuable and underutilized insights that can be gleaned from information companies and people leave behind on the internet - our 'digital breadcrumbs'...</p>
</div>
</div>
</div>
<hr>
<div class="row sm-gutter mr-t-20" v-for="(attendee, index) in attendees" :key="index">
<div class="form-group col-xs-8">
<label for="" class="control-label">Book</label>
<select class="form-control" required="required">
<option value="">-- Select Book --</option>
<option value="">Outside Insight (Paper Back)</option>
<option value="">Outside Insight (Audio Book)</option>
<option value="">Outside Insight (Hard Cover)</option>
<option value="">Outside Insight (E-Book)</option>
</select>
</div>
<div class="form-group col-xs-2">
<label for="" class="control-label">Qty</label>
<input type="text" class="form-control" placeholder="1">
</div>
<div class="form-group col-xs-2">
<label for="" class="control-label">Ghc</label>
<input type="text" readonly class="form-control" placeholder="00.00">
</div>
</div>
<hr>
<div class="row">
<div class="col-md-2 col-xs-2"><img src="images/mtn.png" alt=""></div>
<div class="col-md-2 col-xs-2"><img src="images/vodafone.png" alt=""></div>
<div class="col-md-2 col-xs-2"><img src="images/airtel.png" alt=""></div>
<div class="col-md-2 col-xs-2"><img src="images/tigo.png" alt=""></div>
<div class="col-md-2 col-xs-2"><img src="images/mastercard.png" alt=""></div>
<div class="col-md-2 col-xs-2"><img src="images/visa.png" alt=""></div>
<div class="form-group col-md-12 mr-t-20 text-center">
<button type="submit" class="btn btn-lg btn-primary">Make Payment</button>
</div>
</div>
</div>
</form>
</div>
</div>
</body>
</html>