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- <div class="form-group">
- <div class="col-md-6" style="position: relative; left: 0px; top: 0px;">
- <div class="col-sm-12">
- <div class="input-group">
- <input class="form-control" data-label="" id="naam" name="naam" placeholder="Naam" title="" type="text" value=""> <span class="input-group-addon"><a class="editBtn" href="#"><i class="fa fa-edit"></i></a></span> <span class="input-group-addon"><a class="delBtn" href="#"><i class="fa fa-times"></i></a></span>
- </div>
- </div>
- </div>
- <div class="col-md-6" style="position: relative; left: 0px; top: 0px;">
- <div class="col-sm-12">
- <div class="input-group">
- <input class="form-control" data-label="" id="achternaam" name="achternaam" placeholder="Achternaam" title="" type="text" value=""> <span class="input-group-addon"><a class="editBtn" href="#"><i class="fa fa-edit"></i></a></span> <span class="input-group-addon"><a class="delBtn" href="#"><i class="fa fa-times"></i></a></span>
- </div>
- </div>
- </div>
- </div>
- <div class="form-group">
- <div class="col-md-6">
- <div class="col-sm-12">
- <div class="input-group">
- <input class="form-control required digits" data-label="" id="telefoon" name="telefoon" placeholder="Telefoon" title="" type="text" value=""> <span class="input-group-addon"><a class="editBtn" href="#"><i class="fa fa-edit"></i></a></span> <span class="input-group-addon"><a class="delBtn" href="#"><i class="fa fa-times"></i></a></span>
- </div>
- </div>
- </div>
- <div class="col-md-6">
- <div class="col-sm-12">
- <div class="input-group">
- <input class="form-control required email" data-label="" id="email" name="email" placeholder="Email" title="" type="text" value=""> <span class="input-group-addon"><a class="editBtn" href="#"><i class="fa fa-edit"></i></a></span> <span class="input-group-addon"><a class="delBtn" href="#"><i class="fa fa-times"></i></a></span>
- </div>
- </div>
- </div>
- </div>
- <div class="form-group">
- <div class="col-md-12">
- <div class="col-sm-12">
- <div class="input-group">
- <select class="form-control required" data-label="" id="bellen" name="bellen" tabindex="dropdown" title="">
- <option selected="selected" value="">
- ∇Ik bel je als?
- </option>
- <option value="Ik bel je als?">
- Ik bel je als?
- </option>
- <option value="Maak niet uit">
- Maak niet uit
- </option>
- <option value="Voor middag">
- Voor middag
- </option>
- <option value="Na middag">
- Na middag
- </option>
- </select> <span class="input-group-addon"><a class="editBtn" href="#"><i class="fa fa-edit"></i></a></span> <span class="input-group-addon"><a class="delBtn" href="#"><i class="fa fa-times"></i></a></span>
- </div>
- </div>
- </div>
- </div>
- <div class="form-group">
- <div class="col-md-12">
- <div class="col-sm-12">
- <div class="input-group">
- <input class="btn btn-default form-control" type="submit" value="Voorleggen"> <span class="input-group-addon"><a class="editBtn" href="#"><i class="fa fa-edit"></i></a></span> <span class="input-group-addon"><a class="delBtn" href="#"><i class="fa fa-times"></i></a></span>
- </div>
- </div>
- </div>
- </div>
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