Form | Broadacre

Demo

Form headline lorem ipsum

Paragraph egestas tellus rutrum tellus pellentesque eu. Enim ut sem viverra aliquet eget sit.
Partner Rep information
First name*
Last name*
Company name*
Address*
Country
Postal code*
Phone number
Business email
I agree to the Terms of Use and Privacy Policy. You will receive educational information and news about SAP Concur products and services.*
Select one (you will not be able to submit the form without checking one of the below):
The prospective customer named in this form is NOT a Government Entity*
The prospective customer named in this form IS a Government Entity*
*Click to review the definition and additional information regarding the identification of Government Entities. As indicated in the hyperlinked information, Government Entity is a very broad category that includes any agency at any level of government, government-owned and controlled entities, public universities and hospitals, and more.
Options

Usage

<div class=" form-container">
    <div class="form-headline-spacing">
        <h4>Form headline lorem ipsum</h4>
        <p>Paragraph egestas tellus rutrum tellus pellentesque eu. Enim ut sem viverra aliquet eget sit.</p>
    </div>
    <form>
        <div class="mb-3 form-item js-form-item form-type-webform-markup js-form-type-webform-markup form-item-markup1 js-form-item-markup1 form-no-label" id="edit-markup1">Partner Rep information</div>
        <div class="form-item mar-b-4"><label for="edit-c-firstname" class="form-label">First name<span class="form-required" title="This field is required.">*</span></label><input type="text" class="form-control" id="edit-c-firstname" placeholder="First name *" /><span class="input-icon"><i class="icon-check"></i><i class="icon-close"></i></span></div>
        <div class="form-item mar-b-4"><label for="edit-c-lastname" class="form-label">Last name<span class="form-required" title="This field is required.">*</span></label><input type="text" class="form-control" id="edit-c-lastname" placeholder="Last name *" /></div>
        <div class="form-item mar-b-4"><label for="edit-c-company" class="form-label">Company name<span class="form-required" title="This field is required.">*</span></label><input type="text" class="form-control" id="edit-c-company" placeholder="Company name *" /></div>
        <div class="form-item mar-b-4"><label for="edit-c-total-employees" class="form-label">Company name<span class="form-required" title="This field is required.">*</span></label><input type="number" class="form-control" id="edit-c-total-employees" placeholder="Number of employees *" /></div>
        <div class="form-item mar-b-4"><label for="edit-c-address1" class="form-label">Address<span class="form-required" title="This field is required.">*</span></label><input type="text" class="form-control" id="edit-c-address1" placeholder="Address *" /><span class="input-icon"><i class="icon-check"></i><i class="icon-close"></i></span></div>
        <div class="form-item mar-b-4"><label for="edit-c-country" class="form-label">Country</label><select class="form-control" placeholder="Country *" id="edit-c-country" aria-required="true">
                <option value="USA" selected="">USA</option>
                <option value="Abu Dhabi">Abu Dhabi</option>
                <option value="Admiralty Islands">Admiralty Islands</option>
                <option value="Afghanistan">Afghanistan</option>
                <option value="Ajman">Ajman</option>
                <option value="Al Ain">Al Ain</option>
                <option value="Aland Islands">Aland Islands</option>
                <option value="Albania">Albania</option>
                <option value="Algeria">Algeria</option>
                <option value="Andorra">Andorra</option>
                <option value="Angola">Angola</option>
                <option value="Anguilla">Anguilla</option>
                <option value="Antarctica">Antarctica</option>
                <option value="Antigua">Antigua</option>
                <option value="Argentina">Argentina</option>
                <option value="Armenia">Armenia</option>
                <option value="Aruba">Aruba</option>
                <option value="Ascension Island">Ascension Island</option>
                <option value="Australia">Australia</option>
                <option value="Austria">Austria</option>
                <option value="Azerbaijan">Azerbaijan</option>
                <option value="Bahamas">Bahamas</option>
                <option value="Bahrain">Bahrain</option>
                <option value="Bangladesh">Bangladesh</option>
                <option value="Barbados">Barbados</option>
                <option value="Belgium">Belgium</option>
                <option value="Belize">Belize</option>
                <option value="Benin">Benin</option>
                <option value="Bermuda">Bermuda</option>
                <option value="Bhutan">Bhutan</option>
                <option value="Bolivia">Bolivia</option>
                <option value="Bosnia-Herzegovina">Bosnia-Herzegovina</option>
                <option value="Botswana">Botswana</option>
                <option value="Bouvet Island">Bouvet Island</option>
                <option value="Brazil">Brazil</option>
                <option value="British Indian Ocean Territory">British Indian Ocean Territory</option>
                <option value="Brunei">Brunei</option>
                <option value="Bulgaria">Bulgaria</option>
                <option value="Burkina-Faso">Burkina-Faso</option>
                <option value="Burundi">Burundi</option>
                <option value="Byelorussia">Byelorussia</option>
                <option value="Cameroon">Cameroon</option>
                <option value="Canada">Canada</option>
                <option value="Cape Verde">Cape Verde</option>
                <option value="Caroline Islands">Caroline Islands</option>
                <option value="Cayman Islands">Cayman Islands</option>
                <option value="Central African Rep">Central African Rep</option>
                <option value="Chad">Chad</option>
                <option value="Chile">Chile</option>
                <option value="China Peoples Rep">China Peoples Rep</option>
                <option value="Christmas Island">Christmas Island</option>
                <option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option>
                <option value="Colombia">Colombia</option>
                <option value="Comoros">Comoros</option>
                <option value="Congo">Congo</option>
                <option value="Cook Islands">Cook Islands</option>
                <option value="Costa Rica">Costa Rica</option>
                <option value="Croatia">Croatia</option>
                <option value="Cuba">Cuba</option>
                <option value="Cyprus">Cyprus</option>
                <option value="Czech Republic">Czech Republic</option>
                <option value="Democratic Republic of Congo">Democratic Republic of Congo</option>
                <option value="Denmark">Denmark</option>
                <option value="Djibouti">Djibouti</option>
                <option value="Dominica">Dominica</option>
                <option value="Dominican Republic">Dominican Republic</option>
                <option value="Dubai">Dubai</option>
                <option value="East Timor">East Timor</option>
                <option value="Ecuador">Ecuador</option>
                <option value="Egypt">Egypt</option>
                <option value="El Salvador">El Salvador</option>
                <option value="Equatorial Guinea">Equatorial Guinea</option>
                <option value="Eritrea">Eritrea</option>
                <option value="Estonia">Estonia</option>
                <option value="Ethiopia">Ethiopia</option>
                <option value="Falkland Islands">Falkland Islands</option>
                <option value="Faroe Islands">Faroe Islands</option>
                <option value="Fiji">Fiji</option>
                <option value="Finland">Finland</option>
                <option value="France">France</option>
                <option value="French Guiana">French Guiana</option>
                <option value="French Polynesia">French Polynesia</option>
                <option value="French Southern Territories">French Southern Territories</option>
                <option value="Fujairah">Fujairah</option>
                <option value="Gabon">Gabon</option>
                <option value="Gambia">Gambia</option>
                <option value="Georgia">Georgia</option>
                <option value="Germany">Germany</option>
                <option value="Ghana">Ghana</option>
                <option value="Gibraltar">Gibraltar</option>
                <option value="Greece">Greece</option>
                <option value="Greenland">Greenland</option>
                <option value="Grenada">Grenada</option>
                <option value="Guadeloupe">Guadeloupe</option>
                <option value="Guam">Guam</option>
                <option value="Guatemala">Guatemala</option>
                <option value="Guinea">Guinea</option>
                <option value="Guinea-Bissau">Guinea-Bissau</option>
                <option value="Guyana">Guyana</option>
                <option value="Haiti">Haiti</option>
                <option value="Heard &amp; Mc Donald Islands">Heard &amp; Mc Donald Islands</option>
                <option value="Honduras">Honduras</option>
                <option value="Hong Kong">Hong Kong</option>
                <option value="Hungary">Hungary</option>
                <option value="Iceland">Iceland</option>
                <option value="India">India</option>
                <option value="Indonesia">Indonesia</option>
                <option value="Iran">Iran</option>
                <option value="Iraq">Iraq</option>
                <option value="Ireland">Ireland</option>
                <option value="Israel">Israel</option>
                <option value="Italy">Italy</option>
                <option value="Ivory Coast">Ivory Coast</option>
                <option value="Jamaica">Jamaica</option>
                <option value="Japan">Japan</option>
                <option value="Jordan">Jordan</option>
                <option value="Kampuchea">Kampuchea</option>
                <option value="Kazakhstan">Kazakhstan</option>
                <option value="Kenya">Kenya</option>
                <option value="Kirghizia">Kirghizia</option>
                <option value="Kiribati">Kiribati</option>
                <option value="Korea North">Korea North</option>
                <option value="Kuwait">Kuwait</option>
                <option value="Laos">Laos</option>
                <option value="Latvia">Latvia</option>
                <option value="Lebanon">Lebanon</option>
                <option value="Lesotho">Lesotho</option>
                <option value="Liberia">Liberia</option>
                <option value="Libya">Libya</option>
                <option value="Liechtenstein">Liechtenstein</option>
                <option value="Lithuania">Lithuania</option>
                <option value="Luxembourg">Luxembourg</option>
                <option value="Macao">Macao</option>
                <option value="Macedonia">Macedonia</option>
                <option value="Madagascar/Malagasy">Madagascar/Malagasy</option>
                <option value="Malawi">Malawi</option>
                <option value="Malaysia">Malaysia</option>
                <option value="Maldives">Maldives</option>
                <option value="Mali">Mali</option>
                <option value="Malta">Malta</option>
                <option value="Marshall Islands">Marshall Islands</option>
                <option value="Martinique">Martinique</option>
                <option value="Mauritania">Mauritania</option>
                <option value="Mauritius">Mauritius</option>
                <option value="Mayotte">Mayotte</option>
                <option value="Mexico">Mexico</option>
                <option value="Micronesia Fed St">Micronesia Fed St</option>
                <option value="Midway Island">Midway Island</option>
                <option value="Moldavia">Moldavia</option>
                <option value="Monaco">Monaco</option>
                <option value="Mongolia">Mongolia</option>
                <option value="Montserrat">Montserrat</option>
                <option value="Morocco">Morocco</option>
                <option value="Mozambique">Mozambique</option>
                <option value="Myanmar (Burma)">Myanmar (Burma)</option>
                <option value="Namibia">Namibia</option>
                <option value="Nauru">Nauru</option>
                <option value="Nepal">Nepal</option>
                <option value="Netherlands">Netherlands</option>
                <option value="Netherlands Antilles">Netherlands Antilles</option>
                <option value="New Caledonia">New Caledonia</option>
                <option value="New Zealand">New Zealand</option>
                <option value="Nicaragua">Nicaragua</option>
                <option value="Niger">Niger</option>
                <option value="Nigeria">Nigeria</option>
                <option value="Niue">Niue</option>
                <option value="Norfolk Island">Norfolk Island</option>
                <option value="Northern Ireland">Northern Ireland</option>
                <option value="Northern Mariana Islands">Northern Mariana Islands</option>
                <option value="Norway">Norway</option>
                <option value="Oman">Oman</option>
                <option value="Pakistan">Pakistan</option>
                <option value="Palau">Palau</option>
                <option value="Panama">Panama</option>
                <option value="Papua New Guinea">Papua New Guinea</option>
                <option value="Paraguay">Paraguay</option>
                <option value="Peru">Peru</option>
                <option value="Philippines">Philippines</option>
                <option value="Pitcairn">Pitcairn</option>
                <option value="Poland">Poland</option>
                <option value="Portugal">Portugal</option>
                <option value="Puerto Rico">Puerto Rico</option>
                <option value="Qatar">Qatar</option>
                <option value="Ras Al Khaimah">Ras Al Khaimah</option>
                <option value="Republic of Korea">Republic of Korea</option>
                <option value="Reunion Island">Reunion Island</option>
                <option value="Romania">Romania</option>
                <option value="Russian Federation">Russian Federation</option>
                <option value="Rwanda">Rwanda</option>
                <option value="Samoa American">Samoa American</option>
                <option value="Samoa Western">Samoa Western</option>
                <option value="San Marino">San Marino</option>
                <option value="Sao Tome &amp; Principe">Sao Tome &amp; Principe</option>
                <option value="Saudi Arabia">Saudi Arabia</option>
                <option value="Senegal">Senegal</option>
                <option value="Republic of Serbia">Republic of Serbia</option>
                <option value="Republic of Montenegro">Republic of Montenegro</option>
                <option value="Seychelles">Seychelles</option>
                <option value="Sharjah">Sharjah</option>
                <option value="Sierra Leone">Sierra Leone</option>
                <option value="Singapore">Singapore</option>
                <option value="Slovakia">Slovakia</option>
                <option value="Slovenia">Slovenia</option>
                <option value="Solomon Islands">Solomon Islands</option>
                <option value="Somalia">Somalia</option>
                <option value="South Africa">South Africa</option>
                <option value="South Georgia">South Georgia</option>
                <option value="South Sandwich Islands">South Sandwich Islands</option>
                <option value="Spain">Spain</option>
                <option value="Sri Lanka">Sri Lanka</option>
                <option value="St Helena">St Helena</option>
                <option value="St Kitts-Nevis">St Kitts-Nevis</option>
                <option value="St Lucia">St Lucia</option>
                <option value="St Pierre">St Pierre</option>
                <option value="St Vincent">St Vincent</option>
                <option value="Sudan">Sudan</option>
                <option value="Suriname">Suriname</option>
                <option value="Svalbard &amp; Jan Mayen Islands">Svalbard &amp; Jan Mayen Islands</option>
                <option value="Swaziland">Swaziland</option>
                <option value="Sweden">Sweden</option>
                <option value="Switzerland">Switzerland</option>
                <option value="Syria">Syria</option>
                <option value="Taiwan">Taiwan</option>
                <option value="Tajikstan">Tajikstan</option>
                <option value="Tanzania">Tanzania</option>
                <option value="Thailand">Thailand</option>
                <option value="Togo">Togo</option>
                <option value="Tokelau">Tokelau</option>
                <option value="Tonga">Tonga</option>
                <option value="Trinidad &amp; Tobago">Trinidad &amp; Tobago</option>
                <option value="Tunisia">Tunisia</option>
                <option value="Turkey">Turkey</option>
                <option value="Turkish Rep. of N. Cyprus">Turkish Rep. of N. Cyprus</option>
                <option value="Turkmenistan">Turkmenistan</option>
                <option value="Turks &amp; Caicos Islands">Turks &amp; Caicos Islands</option>
                <option value="Tuvalu">Tuvalu</option>
                <option value="U.S. Virgin Islands">U.S. Virgin Islands</option>
                <option value="Uganda">Uganda</option>
                <option value="Ukraine">Ukraine</option>
                <option value="Umm Al Qaiwain">Umm Al Qaiwain</option>
                <option value="United Arab Emirates">United Arab Emirates</option>
                <option value="United Kingdom">United Kingdom</option>
                <option value="United States Minor Outlying Islands">United States Minor Outlying Islands</option>
                <option value="Uruguay">Uruguay</option>
                <option value="Uzbekistan">Uzbekistan</option>
                <option value="Vanuatu">Vanuatu</option>
                <option value="Vatican City">Vatican City</option>
                <option value="Venezuela">Venezuela</option>
                <option value="Vietnam">Vietnam</option>
                <option value="Virgin Islands UK">Virgin Islands UK</option>
                <option value="Wake Island">Wake Island</option>
                <option value="Wallis &amp; Futuna Island">Wallis &amp; Futuna Island</option>
                <option value="Western Sahara">Western Sahara</option>
                <option value="Yemen Arab Republic">Yemen Arab Republic</option>
                <option value="Yemen South">Yemen Sout</option>
                <option value="Zambia">Zambia</option>
                <option value="Zimbabwe">Zimbabwe</option>
            </select><span class="input-icon"><i class="icon-expand-more"></i><i class="icon-check"></i><i class="icon-close"></i></span></div>
        <div class="form-item mar-b-4"><label for="edit-c-zip-postal" class="form-label">Postal code<span class="form-required" title="This field is required.">*</span></label><input type="text" class="form-control" id="edit-c-zip-postal" placeholder="Postal code *" /><span class="input-icon"><i class="icon-check"></i><i class="icon-close"></i></span></div>
        <div class="form-item mar-b-4">
            <div class="input-group phone-number-group"><label for="exampleInputPhoneNumber1" class="form-label">Phone number</label><button class="btn btn-phone-number-dropdown dropdown-toggle" type="button" data-bs-toggle="dropdown" aria-expanded="false"><object class="phone-number-flag-icon" data="/images/flag_icons/flag-united-states-rectangle.svg" type="image/svg+xml"></object>+1</button>
                <ul class="dropdown-menu">
                    <li><a class="dropdown-item" href="\/"><object class="phone-number-flag-icon" data="/images/flag_icons/flag-united-states-rectangle.svg" type="image/svg+xml"></object>+2</a></li>
                    <li><a class="dropdown-item" href="\/"><object class="phone-number-flag-icon" data="/images/flag_icons/flag-united-states-rectangle.svg" type="image/svg+xml"></object>+3</a></li>
                    <li><a class="dropdown-item" href="\/"><object class="phone-number-flag-icon" data="/images/flag_icons/flag-united-states-rectangle.svg" type="image/svg+xml"></object>+4</a></li>
                </ul><input type="tel" class="form-control" id="exampleInputPhoneNumber1" placeholder="Phone number" />
            </div>
        </div>
        <div class="form-item mar-b-4"><label for="exampleInputEmail1" class="form-label">Business email</label><input type="email" class="form-control" id="exampleInputEmail1" placeholder="Business email" /></div>
        <div class="form-item mar-t-5 mar-b-5 form-check"><input type="checkbox" class="agree_t_and_c form-check-input required" id="edit-agree-t-and-c" name="agree_t_and_c" value="1" aria-required="true" /><label class="option form-check-label" for="edit-agree-t-and-c">I agree to the <a href="/en-us/termsandconditions.html">Terms of Use</a> and <a href="https://www.concur.com/en-us/processor-privacy-statement">Privacy Policy</a>. You will receive educational information and news about SAP Concur products and services.<span class="form-required" title="This field is required.">*</span></label></div>
        <div class="form-item mar-t-5 mar-b-5 form-check">
            <fieldset data-drupal-selector="edit-referralformdata3-c" aria-describedby="edit-referralformdata3-c--wrapper--description" id="edit-referralformdata3-c--wrapper" class="radios--wrapper fieldgroup form-composite webform-composite-visible-title js-webform-type-radios webform-type-radios js-form-item form-item js-form-wrapper form-wrapper" data-once="webform-radios-required">
                <legend id="edit-referralformdata3-c--wrapper-legend"><span class="fieldset-legend">Select one (you will not be able to submit the form without checking one of the below):</span></legend>
                <div class="fieldset-wrapper">
                    <div id="edit-referralformdata3-c" class="js-webform-radios webform-options-display-one-column">
                        <div class="form-item js-form-item form-type-radio js-form-type-radio form-item-referralformdata3__c js-form-item-referralformdata3__c"><input type="radio" data-drupal-selector="edit-referralformdata3-c-no" aria-describedby="edit-referralformdata3-c--wrapper--description" id="edit-referralformdata3-c-no" name="referralformdata3__c" value="No" class="form-check-input form-radio" /><label for="edit-referralformdata3-c-no" class="option">
                                <p class="gov-entity-check sm">The prospective customer named in this form is NOT a <a target="_blank" href="government-optin">Government Entity*</a></p>
                            </label></div>
                        <div class="form-item js-form-item form-type-radio js-form-type-radio form-item-referralformdata3__c js-form-item-referralformdata3__c"><input type="radio" data-drupal-selector="edit-referralformdata3-c-yes" aria-describedby="edit-referralformdata3-c--wrapper--description" id="edit-referralformdata3-c-yes" name="referralformdata3__c" value="Yes" class="form-check-input form-radio" /><label for="edit-referralformdata3-c-yes" class="option">
                                <p class="gov-entity-check sm">The prospective customer named in this form IS a <a target="_blank" href="government-optin">Government Entity*</a></p>
                            </label></div>
                    </div>
                    <div class="description">
                        <div id="edit-referralformdata3-c--wrapper--description" data-drupal-field-elements="description" class="webform-element-description">*Click to review the definition and additional information regarding the identification of Government Entities. As indicated in the hyperlinked information, Government Entity is a very broad category that includes any agency at any level of government, government-owned and controlled entities, public universities and hospitals, and more.</div>
                    </div>
                </div>
            </fieldset>
        </div><button class="btn btn-primary " data-bs-target="#undefined" href="" title="">Button</button>
    </form>
</div>