File: /var/www/html/labs/chatbot2/chat-verification.php
<!DOCTYPE html>
<html lang="en-US" class="no-js">
<head>
<?php require("head.php"); ?>
<style>
.error
{
color:red;
}
</style>
</head>
<body class="home page-template page-template-template page-template-home-page page-template-templatehome-page-php page page-id-5 wp-embed-responsive group-blog responsive-menu-slide-left">
<div class="main_banner">
<div class="menu">
<div class="container">
<div class="col-sm-3 col-md-3">
<a href="https://labsinitiative.com/"><img src="https://labsinitiative.com/wp-content/themes/labsinitiative/images/logo.png" class="menu_logo"></a>
</div>
<div class="col-sm-9 col-md-9">
<div class="menu_all_items">
<div class="user-link"></div>
<div class="menu-main-menu-container">
<ul id="menu-main-menu" class="main-menu">
<li id="menu-item-162" class="menu-item menu-item-type-post_type menu-item-object-page menu-item-has-children menu-item-162">
<a href="https://labsinitiative.com/transparency/">Transparency</a>
<ul class="sub-menu">
<li id="menu-item-2463" class="menu-item menu-item-type-post_type menu-item-object-page menu-item-2463"><a href="https://labsinitiative.com/factory-status-and-assessment-reports/">Factory Status & Assessment Reports</a></li>
<li id="menu-item-2464" class="menu-item menu-item-type-custom menu-item-object-custom menu-item-2464"><a href="https://labsinitiative.com/transparency/#remediations_update">Remediations Update</a></li>
</ul>
</li>
<li id="menu-item-163" class="menu-item menu-item-type-post_type menu-item-object-page menu-item-163"><a href="https://labsinitiative.com/how-we-work/">How we work</a></li>
<li id="menu-item-164" class="menu-item menu-item-type-post_type menu-item-object-page menu-item-164"><a href="https://labsinitiative.com/participants/">Participants</a></li>
<li id="menu-item-161" class="menu-item menu-item-type-post_type menu-item-object-page menu-item-161"><a href="https://labsinitiative.com/resources/">Resources</a></li>
<li id="menu-item-1535" class="menu-item menu-item-type-post_type menu-item-object-page menu-item-1535"><a href="https://labsinitiative.com/the-latest/">The Latest</a></li>
<li id="menu-item-165" class="menu-item menu-item-type-post_type menu-item-object-page menu-item-165"><a href="https://labsinitiative.com/join-us/">Join us</a></li>
<li id="menu-item-167" class="lrm-login nmr-logged-out menu-item menu-item-type-custom menu-item-object-custom menu-item-167"><a href="#">LOGIN</a></li>
</ul>
</div>
</div>
</div>
</div>
</div>
<div class="orange_line"></div>
</div>
<span class="responsive-menu-box">
<span class="responsive-menu-inner"></span>
</span>
<button id="responsive-menu-button" tabindex="1" class="responsive-menu-button responsive-menu-boring
responsive-menu-accessible" type="button" aria-label="Menu">
<span class="responsive-menu-box">
<span class="responsive-menu-inner"></span>
</span>
</button>
<div id="responsive-menu-container" class="slide-left">
<div id="responsive-menu-wrapper" role="navigation" aria-label="main-menu">
<ul id="responsive-menu" role="menubar" aria-label="main-menu" >
<li id="responsive-menu-item-162" class=" menu-item menu-item-type-post_type menu-item-object-page menu-item-has-children responsive-menu-item responsive-menu-item-has-children" role="none"><a href="https://labsinitiative.com/transparency/" class="responsive-menu-item-link" tabindex="1" role="menuitem">Transparency<div class="responsive-menu-subarrow">▼</div></a><ul aria-label='Transparency' role='menu' class='responsive-menu-submenu responsive-menu-submenu-depth-1'><li id="responsive-menu-item-2463" class=" menu-item menu-item-type-post_type menu-item-object-page responsive-menu-item" role="none"><a href="https://labsinitiative.com/factory-status-and-assessment-reports/" class="responsive-menu-item-link" tabindex="1" role="menuitem">Factory Status & Assessment Reports</a></li><li id="responsive-menu-item-2464" class=" menu-item menu-item-type-custom menu-item-object-custom responsive-menu-item" role="none"><a href="https://labsinitiative.com/transparency/#remediations_update" class="responsive-menu-item-link" tabindex="1" role="menuitem">Remediations Update</a></li></ul></li><li id="responsive-menu-item-163" class=" menu-item menu-item-type-post_type menu-item-object-page responsive-menu-item" role="none"><a href="https://labsinitiative.com/how-we-work/" class="responsive-menu-item-link" tabindex="1" role="menuitem">How we work</a></li><li id="responsive-menu-item-164" class=" menu-item menu-item-type-post_type menu-item-object-page responsive-menu-item" role="none"><a href="https://labsinitiative.com/participants/" class="responsive-menu-item-link" tabindex="1" role="menuitem">Participants</a></li><li id="responsive-menu-item-161" class=" menu-item menu-item-type-post_type menu-item-object-page responsive-menu-item" role="none"><a href="https://labsinitiative.com/resources/" class="responsive-menu-item-link" tabindex="1" role="menuitem">Resources</a></li><li id="responsive-menu-item-1535" class=" menu-item menu-item-type-post_type menu-item-object-page responsive-menu-item" role="none"><a href="https://labsinitiative.com/the-latest/" class="responsive-menu-item-link" tabindex="1" role="menuitem">The Latest</a></li><li id="responsive-menu-item-165" class=" menu-item menu-item-type-post_type menu-item-object-page responsive-menu-item" role="none"><a href="https://labsinitiative.com/join-us/" class="responsive-menu-item-link" tabindex="1" role="menuitem">Join us</a></li><li id="responsive-menu-item-167" class="lrm-login nmr-logged-out menu-item menu-item-type-custom menu-item-object-custom responsive-menu-item" role="none"><a href="#" class="responsive-menu-item-link" tabindex="1" role="menuitem">LOGIN</a></li>
</ul>
<div id="responsive-menu-search-box">
<form action="https://labsinitiative.com" class="responsive-menu-search-form" role="search">
<input type="search" name="s" title="Search" tabindex="1" placeholder="Search" class="responsive-menu-search-box">
</form>
</div>
<div id="responsive-menu-additional-content"></div>
</div>
</div>
<div class="headertop"></div>
<div class="container cmwidth-600">
<div class="col-md-12">
<h2>Chat with Us</h2>
<p>The LABS support team is ready to assist you.</p> <br/><br/>
</div>
<div class="col-md-12">
<form>
<div class="form-row">
<div class="form-group col-md-6">
<label for="inputEmail4">Full Name <span class="error">*</span></label>
<input type="email" class="form-control" id="inputEmail4" placeholder="Name">
</div>
</div>
<div class="form-row">
<div class="form-group col-md-6">
<label for="inputAddress2">Phone <span class="error">*</span></label>
<input type="text" class="form-control" id="inputAddress2" placeholder="Phone">
</div>
</div>
<div class="form-row">
<div class="form-group col-md-6">
<label for="inputAddress">Category </label>
<select id="inputState" class="form-control">
<option selected>Choose...</option>
<option value="Labs">LABS</option>
<option value="NonLabs">Non LABS</option>
</select>
</div>
<div class="form-group col-md-6">
<label for="inputAddress2">Sub Category</label>
<select id="inputState" class="form-control">
<option selected>Choose...</option>
<option>...</option>
</select>
</div>
</div>
<div class="form-row">
<div class="form-group col-md-12 text-center" >
<a href="home.php" class="btn btn-primary">Back</a> <a href="chat-form-step-2.php" class="btn btn-primary">Next</a>
</div>
</div>
</form>
</div>
</div>
</body>
</html>