<div class="well well-sm">
<form action="/tr/form/1/25" method="post">
<div class="row">
<div class="col-md-12">
<div class="form-group"><label for="name">İsim Soyisim</label> <input class="form-control" id="name" name="form_1" placeholder="İsim Soyisim" required="required" type="text" /></div>
<div class="form-group">
<label for="email">E-Posta Adresiniz</label>
<div class="input-group"><input class="form-control" id="email" name="form_2" placeholder="kullanici@domain.com" required="required" type="email" /></div>
</div>
<div class="form-group"><label for="subject">Konu </label> <select class="form-control" id="subject" name="form_3" required="required"><option selected="selected" value="Konu Yok">Seçiniz:</option><option value="Hizmet">Hizmet</option><option value="Ürün">Ürün</option><option value="Öneri / Şikayet">Öneri / Şikayet</option></select></div>
</div>
<div class="col-md-12">
<div class="form-group"><label for="name">Mesajınız </label><textarea class="form-control" cols="25" id="message" name="form_4" placeholder="Mesajınızı giriniz..." required="required" rows="9"></textarea></div>
</div>
<div class="col-md-12"><button class="btn btn-primary pull-right" id="btnContactUs" type="submit">Mesajı Gönder</button></div>
</div>
</form>
</div>