10/02/2017 3:40pm

Template | Problem -


<form method="POST" action="https://online.ergo.lt/lt/Contracts/step/1?utm_source=ergo-main-page&amp;utm_campaign=privalomasis-draudimas&amp;utm_medium=button" target="_blank" class="custom-form-style">

<fieldset class="form-group form-group-lg pull-left m-r-1">
<label>Įrašykite automobilio valstybinį numerį</label>
<div class="input-autonumber">
<input type="hidden" name="data[Contract][dontValidate]" value="1">
<input type="text" class="form-control" id="automobileNumber" name="data[Contract][car_number]">
</div>
</fieldset>
<fieldset class="form-group form-group-lg pull-left m-r-1">
<label>Įrašykite automobilio valstybinį numerį</label>
<div class="input-autonumber">
<input type="hidden" name="data[Contract][dontValidate]" value="1">
<input type="text" class="form-control" id="automobileNumber" name="data[Contract][car_number]">
</div>
</fieldset>
<fieldset class="form-group form-group-lg pull-left button-wrap">
<button class="btn btn-primary btn-lg">Skaičiuoti kainą</button>
</fieldset>
<fieldset class="form-group form-group-lg pull-left button-wrap">
<label class="invisible"> /</label>
<button class="btn btn-primary btn-lg">Skaičiuoti kainą</button>
</fieldset>
<div class="col-md-12 under-button">
<p class="small">Arba apsilankykite artimiausioje <a href="/kontaktai/" target="_blank">ERGO atstovybėje</a>.</p>
</div>
</form>