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<div class="insurance-banner" style="background-image: url(<?php echo base_url();?>assets/images/book-service-appointment.jpg)">
<div class="container">
<div class="row">
<div class="col-12">
<div class="banner-title-card">
<!-- <h5>protect your finances with</h5>-->
<h4 class="text-white">BOOK A<br>
TEST DRIVE</h4>
</div>
</div>
</div>
</div>
</div>
<section class="insurance-form py-5">
<div class="container">
<div id='crmWebToEntityForm' class='position-relative'>
<form action='<?php echo base_url();?>testdrivebooking' method='POST' accept-charset='UTF-8'>
<!-- Do not remove this code. -->
<div class="form-row">
<div class="col-md-8 col-12 px-3">
<h3>Please fill in the details :</h3>
<div class="form-row">
<div class="col-md-4 mb-3">
<div class="form-group">
<div class="has-float-label">
<div class='zcwf_row'>
<div class='zcwf_col_lab'>
<label for='Full_Name'>Name<span style='color:red;'>*</span></label>
</div>
<div class='zcwf_col_fld'><input type='text' id='firstname' name='firstname' class="form-control" maxlength='80' required>
<div class='zcwf_col_help'></div>
</div>
</div>
</div>
</div>
</div>
<div class="col-md-4 mb-3">
<div class="form-group">
<div class="has-float-label">
<div class='zcwf_row'>
<div class='zcwf_col_lab'>
<label for='Mobile'>Phone<span style='color:red;'>*</span></label>
</div>
<div class='zcwf_col_fld'><input type='tel' id='phone' class="form-control" name='phone' maxlength='10' minlength='10' required>
<div class='zcwf_col_help'></div>
</div>
</div>
</div>
</div>
</div>
<div class="col-md-4 mb-3">
<div class="form-group">
<div class="has-float-label">
<div class='zcwf_row'>
<div class='zcwf_col_lab'>
<label for='Email'>Email <span style='color:red;'>*</span></label>
</div>
<div class='zcwf_col_fld'>
<input type='email' ftype='email' id='email' name='email' class="form-control" maxlength='100'>
<div class='zcwf_col_help'></div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="form-row">
<div class="col-md-6 mb-3">
<div class="form-group">
<div class="has-float-label">
<label for="name">Car Model <span style='color:red;'>*</span></label>
<select class="custom-select mr-sm-2" id='model' name='model' required>
<option value="">-Select-</option>
<option value="ŠKODA OCTAVIA">ŠKODA OCTAVIA</option>
<option value="ŠKODA KUSHAQ">ŠKODA KUSHAQ</option>
<option value="ŠKODA RAPID">ŠKODA RAPID</option>
<option value="ŠKODA SUPERB">ŠKODA SUPERB</option>
<option value="Other">OTHER</option>
</select>
</div>
</div>
</div>
<div class="col-md-6 mb-3">
<div class="form-group">
<div class="has-float-label">
<label for="name">Outlet <span style='color:red;'>*</span></label>
<select class="custom-select mr-sm-2" id='outlet' name='outlet' required>
<option value="">-Select-</option>
<option value="Faridabad">GURGAON WORKSHOP</option>
</select>
</div>
</div>
</div>
</div>
<div class="form-row">
<div class="col-md-12">
<div class="form-group">
<span class="has-float-label">
<label for="text">Comment <span style='color:red;'>*</span></label>
<textarea rows="4" name="comment" placeholder="" style="width:100%; border-radius:5px; height:auto" id="car-enquiry-comment"></textarea>
</span>
</div>
</div>
<div class="col-md-12">
<input type="checkbox" id="defaultCheck" name="example2" required="">
<label for="defaultCheck" class="declaimer">I Agree to the Privacy Policy and Terms of Service.</label>
<p>Disclaimer: I agree that by clicking the ‘Submit’ button below, I am explicitly soliciting a call / Message from Ring Road Škoda (Masyy Cars Private Limited) or its Representatives on my ‘Mobile’.</p>
</div>
<div class="col-md-12 mb-3">
<input type="hidden" id="zc_gad" name="zc_gad" value="" />
<button class="btn btn-primary formsubmit zcwf_button" id='formsubmit' name="submit" type="submit">Submit </button>
</div>
</div>
</div>
<div class="col-md-4 px-3">
<img src="https://ringroadskoda.com/assets/images/gallery-06.jpg" alt="service-appointment-bg" style="width: 100%;">
</div>
</div>
</form>
</div>
</section>