html sample code

<div class="container">  <!-- Start of the contact Me Form-->
   <div id="contact_form" class="row">
    <h3 id="contactText">DROP ME A LINE </h3>
      <div class="col-sm-8 col-sm-offset-2 col-md-6 col-md-offset-3">
            <form role="form" id="feedbackForm">
              <div class="form-group">
                <input type="text" class="form-control" id="name" name="name" placeholder="NAME">
                <span class="help-block" style="display: none;">Please enter your name.</span>
              </div>

              <div class="form-group">
                <input type="email" class="form-control" id="email" name="email" placeholder="EMAIL ADDRESS">
                <span class="help-block" style="display: none;">Please enter a valid e-mail address.</span>
              </div>

              <div class="form-group">
                <textarea rows="10" cols="100" class="form-control" id="message" name="message" placeholder="MESSAGE"></textarea>
                <span class="help-block" style="display: none;">Please enter a message.</span>
              </div>

              <img id="captcha" src="securimage/securimage_show.php" alt="CAPTCHA Image" />
              <a href="#" onclick="document.getElementById('captcha').src = 'securimage/securimage_show.php?' + Math.random(); return false" class="btn btn-info btn-sm">Show a Different Image</a><br/>
              <div class="form-group" style="margin-top: 10px;">
                <input type="text" class="form-control" name="captcha_code" id="captcha_code" placeholder="For security, please enter the code displayed in the box." />
                <span class="help-block" style="display: none;">Please enter the code displayed within the image.</span>
              </div>

              <span class="help-block" style="display: none;">Please enter the security code.</span>
              <button type="submit" id="feedbackSubmit" class="btn btn-primary btn-lg" style="display: block; margin-top: 10px;">Send Message</button>
            </form>
          </div><!--/span-->
        </div><!--/row-->
      </div><!--/.container-->
    </div>