redcomani.org/portalcautivo2/cutof.html

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HTML

<!-- <div class="form-group">
<input type="text" class="form-control" placeholder="First Name *" value="" />
</div>
<div class="form-group">
<input type="text" class="form-control" placeholder="Last Name *" value="" />
</div>
<div class="form-group">
<input type="password" class="form-control" placeholder="Password *" value="" />
</div>
<div class="form-group">
<input type="password" class="form-control" placeholder="Confirm Password *" value="" />
</div>
<div class="form-group">
<div class="maxl">
<label class="radio inline">
<input type="radio" name="gender" value="male" checked>
<span> Male </span>
</label>
<label class="radio inline">
<input type="radio" name="gender" value="female">
<span>Female </span>
</label>
</div>
</div> -->
<!-- <div class="col-md-6">
<div class="form-group">
<input type="email" class="form-control" placeholder="Your Email *" value="" />
</div>
<div class="form-group">
<input type="text" minlength="10" maxlength="10" name="txtEmpPhone" class="form-control" placeholder="Your Phone *" value="" />
</div>
<div class="form-group">
<select class="form-control">
<option class="hidden" selected disabled>Please select your Sequrity Question</option>
<option>What is your Birthdate?</option>
<option>What is Your old Phone Number</option>
<option>What is your Pet Name?</option>
</select>
</div>
<div class="form-group">
<input type="text" class="form-control" placeholder="Enter Your Answer *" value="" />
</div>
<input type="submit" class="btnRegister" value="Register"/>
</div> -->
<!-- <div class="col-md-6">
<div class="form-group">
<input type="text" class="form-control" placeholder="First Name *" value="" />
</div>
<div class="form-group">
<input type="text" class="form-control" placeholder="Last Name *" value="" />
</div>
<div class="form-group">
<input type="email" class="form-control" placeholder="Email *" value="" />
</div>
<div class="form-group">
<input type="text" maxlength="10" minlength="10" class="form-control" placeholder="Phone *" value="" />
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<input type="password" class="form-control" placeholder="Password *" value="" />
</div>
<div class="form-group">
<input type="password" class="form-control" placeholder="Confirm Password *" value="" />
</div>
<div class="form-group">
<select class="form-control">
<option class="hidden" selected disabled>Please select your Sequrity Question</option>
<option>What is your Birthdate?</option>
<option>What is Your old Phone Number</option>
<option>What is your Pet Name?</option>
</select>
</div>
<div class="form-group">
<input type="text" class="form-control" placeholder="`Answer *" value="" />
</div>
<input type="submit" class="btnRegister" value="Register"/>
</div>
</div> -->
<!-- <button type="button" class="btn btn-default btn-circle btn-xl"><i class="glyphicon glyphicon-ok"></i></button>
<button type="button" class="btn btn-primary btn-circle btn-xl"><i class="glyphicon glyphicon-list"></i></button>
<button type="button" class="btn btn-success btn-circle btn-xl"><i class="fas fa-images"></i></i></button>
<button type="button" class="btn btn-info btn-circle btn-xl"><i class="fab fa-wikipedia-w"></i></i></button>
<button type="button" class="btn btn-warning btn-circle btn-xl"><i class="glyphicon glyphicon-remove"></i></button>
<button type="button" class="btn btn-danger btn-circle btn-xl"><i class="fab fa-youtube"></i></button> -->