MENGISI FORM 3

<div class="form-style-3"> <form> <fieldset><legend>Personal</legend> <label for="field1"><span>Name <span class="required">*</span></span><input type="text" class="input-field" name="field1" value="" /></label> <label for="field2"><span>Email <span class="required">*</span></span><input type="email" class="input-field" name="field2" value="" /></label> <label for="field3"><span>Phone <span class="required">*</span></span><input type="text" class="input-field" name="field3" value="" /></label> <label for="field4"><span>Subject</span><select name="field4" class="select-field"> <option value="Appointment">Appointment</option> <option value="Interview">Interview</option> <option value="Regarding a post">Regarding a post</option> </select></label> </fieldset> <fieldset><legend>Message</legend> <label for="field6"><span>Message <span class="required">*</span></span><textarea name="field6" class="textarea-field"></textarea></label> <label><span> </span><input type="submit" value="Submit" /></label> </fieldset> </form> </div>

Personal

Name *
Email *
Phone *
Subject Appointment Interview Regarding a post

Message

Message *