<form class="well form-horizontal" action="submit.php" method="post"  id="contact_form">
            <fieldset>
                <!-- Text input-->
                <div class="form-group">
                    <label class="col-md-4 control-label">First Name</label>
                    <div class="col-md-4 inputGroupContainer">
                        <div class="input-group">
                            <input  name="first_name" placeholder="First Name" class="form-control"  type="text">
                        </div>
                    </div>
                </div>
                <!-- Text input-->
                <div class="form-group">
                    <label class="col-md-4 control-label" >Last Name</label>
                    <div class="col-md-4 inputGroupContainer">
                        <div class="input-group">
                            <input name="last_name" placeholder="Last Name" class="form-control"  type="text">
                        </div>
                    </div>
                </div>
                <!-- Text input-->
                <div class="form-group">
                    <label class="col-md-4 control-label">E-Mail</label>
                    <div class="col-md-4 inputGroupContainer">
                        <div class="input-group">
                            <input name="email" placeholder="E-Mail Address" class="form-control"  type="text">
                        </div>
                    </div>
                </div>
                <!-- Text input-->
                <div class="form-group">
                    <label class="col-md-4 control-label">Phone Number</label>
                    <div class="col-md-4 inputGroupContainer">
                        <div class="input-group">
                            <input name="phone" placeholder="Mobile Number" class="form-control" type="text">
                        </div>
                    </div>
                </div>
                <!-- Text input-->
                <div class="form-group">
                    <label class="col-md-4 control-label">Address</label>
                    <div class="col-md-4 inputGroupContainer">
                        <div class="input-group">
                            <input name="address" placeholder="Address" class="form-control" type="text">
                        </div>
                    </div>
                </div>
                <!-- Text input-->
                <div class="form-group">
                    <label class="col-md-4 control-label">City</label>
                    <div class="col-md-4 inputGroupContainer">
                        <div class="input-group">
                            <input name="city" placeholder="city" class="form-control"  type="text">
                        </div>
                    </div>
                </div>
                <!-- Select Basic -->
                <!-- Text input-->
                <div class="form-group">
                    <label class="col-md-4 control-label">Zip Code</label>
                    <div class="col-md-4 inputGroupContainer">
                        <div class="input-group">
                            <input name="zip" placeholder="Zip Code" class="form-control"  type="text">
                        </div>
                    </div>
                </div>
                <!-- Button -->
                <div class="form-group">
                    <label class="col-md-4 control-label"></label>
                    <div class="col-md-4">
                        <button type="submit" class="btn btn-info" >Submit <span class="fa fa-fw fa-check"></span></button>
                    </div>
                </div>
            </fieldset>
              </form>