<div class="modal-header">
    <button type="button" class="close" data-dismiss="modal">&times;</button>
    <h2 class="modal-title"><?php echo $heading; ?></h2>
    <!--Click to select if we Exceeded, Met or Did Not meet your Expectations-->
</div>

<div class="modal-body">
    <div class="row">
        <div class="form-group-lg form-group-select-plus pull-left width100per">
            <div class="col-sm-6">

                <div class="group"> 
                    <div class="spanclass">Name</div>
                    <input class="inputMaterial" type="text">
                    <span class="highlight"></span>
                    <span class="bar"></span>


                </div>



            </div>

            <div class="col-sm-6">

                <div class="group">    
                    <div class="spanclass">Email-ID</div>
                    <input class="inputMaterial" type="text" >
                    <span class="highlight"></span>
                    <span class="bar"></span>


                </div>



            </div>
        </div>

        <div class="form-group-lg form-group-select-plus pull-left width100per">

            <div class="col-sm-6">

                <div class="group">    
                    <div class="spanclass">Contact Us</div>
                    <input class="inputMaterial" type="text" >
                    <span class="highlight"></span>
                    <span class="bar"></span>


                </div>



            </div>

            <div class="col-sm-6">

                <div class="group">      
                    <div class="spanclass">No of Travelers </div>
                    <span class="bar"></span>
                    <div class="select-style">
                        <select class="inputMaterial" >

                            <option>1</option>
                            <option>2</option>
                            <option>3</option>
                        </select>
                    </div>
                    <span class="highlight"></span>
                    <span class="bar"></span>

                </div>
            </div>
        </div>

        <div class="form-group-lg form-group-select-plus pull-left width100per">


            <div class="col-sm-6">

                <div class="group">      
                    <div class="spanclass"> Check in Date </div>
                    <span class="bar"></span>
                    <div class="select-style">
                        <input class="inputMaterial" type="date" >
                    </div>
                    <span class="highlight"></span>
                    <span class="bar"></span>

                </div>



            </div>


            <div class="col-sm-6">

                <div class="group">    
                    <div class="spanclass">Chackout Date</div>
                    <input class="inputMaterial" type="date" >
                    <span class="highlight"></span>
                    <span class="bar"></span>


                </div>



            </div>

        </div>

        <div class="form-group-lg form-group-select-plus pull-left width100per">


            <div class="col-sm-6">

                <div class="group">      
                    <div class="spanclass">No of Nights </div>
                    <span class="bar"></span>
                    <div class="select-style">
                        <select class="inputMaterial" >
                            <option value="1">1</option><option value="2">2</option><option value="3">3</option><option value="4">4</option><option value="5">5</option><option value="6">6</option><option value="7">7</option><option value="8">8</option><option value="9">9</option><option value="10">10</option><option value="11">11</option><option value="12">12</option><option value="13">13</option><option value="14">14</option><option value="15">15</option>   
                        </select>
                    </div>
                    <span class="highlight"></span>
                    <span class="bar"></span>

                </div>
            </div>

            <div class="col-sm-6">

                <div class="group">      
                    <div class="spanclass">Budget</div>
                    <span class="bar"></span>
                    <div class="select-style">
                        <select class="inputMaterial" >
                            <option value="Rs 10000 - 20000">Rs 10000 - 20000</option>
                            <option value="Rs 21000 - 50000">Rs 21000 - 50000</option>
                            <option value="Rs 51000 - 100000">Rs 51000 - 100000</option>
                            <option value="Rs 100001 - 150000">Rs 100001 - 150000</option>
                            <option value="Rs 150001 - 200000">Rs 150001 - 200000</option>
                            <option value="Rs 200001 - 250000">Rs 200001 - 250000</option>
                        </select>
                    </div>
                    <span class="highlight"></span>
                    <span class="bar"></span>

                </div>
            </div>

        </div>
        <div class="form-group-lg form-group-select-plus pull-left width100per">

            <div class="col-sm-6">

                <div class="group">      
                    <div class="spanclass"> Room Category </div>
                    <span class="bar"></span>
                    <div class="select-style">
                        <select class="inputMaterial" >
                            <option value="1">1 Star</option>
                            <option value="2">2 Star</option>
                            <option value="3">3 Star</option>
                            <option value="4">4 Star</option>
                            <option value="5">5 Star</option>
                        </select>
                    </div>
                    <span class="highlight"></span>
                    <span class="bar"></span>

                </div>



            </div>

            <div class="col-sm-6">

                <div class="group">      
                    <div class="spanclass">Destination </div>
                    <span class="bar"></span>
                    <div class="select-style">
                        <select class="inputMaterial" >
                            <option value="Goa">Goa</option>
                            <option value="Himachal">Himachal</option>
                            <option value="Jammu &amp; Kashmir">Jammu &amp; Kashmir</option>
                            <option value="Kerala">Kerala</option>
                            <option value="New Delhi">New Delhi</option>
                            <option value="North East">North East</option>
                            <option value="Port Blair">Port Blair</option>
                            <option value="Rajasthan">Rajasthan</option>
                            <option value="South India">South India</option>
                            <option value="Uttaranchal">Uttaranchal</option>
                        </select>
                    </div>
                    <span class="highlight"></span>
                    <span class="bar"></span>

                </div>
            </div>



        </div>

        <div class="form-group-lg form-group-select-plus pull-left width100per">

            <div class="col-md-8 no-padding">

                <div class="col-md-8">             
                    <div class="group">  

                        <div class="spanclass"> Enter Captcha  </div>
                        <input class="inputMaterial" type="text" required>
                        <span class="highlight"></span>
                        <span class="bar"></span>


                    </div>

                </div>
                <div class="col-sm-4">
                    <div class="spanclass">Captcha</div>
                    <input type="text" value="1376" id="ran" readonly="readonly" class="captcha form-control valid" aria-invalid="false"></div>

            </div>

            <div class="col-sm-4 text-right">

                <div class="group">      
                    <button class="btn btn-danger" type="submit">Submit</button>
                </div>
            </div>



        </div>

    </div>



</div>
</div>
<div class="modal-footer" style=" padding-top:2px !important;">
    <button type="button" class="btn btn-default" data-dismiss="modal">Close</button>
</div>