{include file="includes/header.html"} 
{include file="includes/header-holder.html"}

<main class="main" id="main">
  {include file="includes/menu.html"}

  <div id="fullpagePrimary">
    <section class="section page cart service-form">
      <div class="wrapper">
        <div class="content">
    
          <div class="content-wrapper">
            {include file="includes/breadcrumbs.html"}

            <div class="banner">
              <div class="bg" style="background-image: url({$templates_dir}img/events-bg.jpg);"></div>

              <h1 class="h1 title">serwis</h1>
              
              <div class="page-banner-menu-lg">                              
                <a href="#" class="item">informacje o serwisie</a>
                <a href="#" class="item">FAQ</a>
                <a href="#" class="item active">FORMULARZ zgłoszeniowy</a>
              </div>

              <div class="page-banner-menu-xs">
                <a href="#" class="arrow arrow-left"></a>
                <a href="#" class="item active">wszystkie strefy</a>  
                <a href="#" class="arrow arrow-right"></a>              
              </div>
            </div>

            <div class="form-wrapper">
              <form action="" class="form contact-form">
                <div class="heading">formularz zapytania</div>
  
                <div class="col-wrapper col-wrapper-lg">
                  <div class="col">
                    <div class="form-group">
                      <label class="label required">
                        Imię
                        <input type="text" class="form-control" required>
                      </label>
                    </div>
                    <div class="form-group">
                      <label class="label required">
                        Nazwisko
                        <input type="text" class="form-control" required>
                      </label>
                    </div>
                    <div class="form-group">
                      <label class="label required">
                        firma
                        <input type="text" class="form-control" required>
                      </label>
                    </div>
                  </div>
                  <div class="col">
                    <div class="form-group">
                      <label class="label required">
                        e-mail
                        <input type="text" class="form-control" required>
                      </label>
                    </div>
                    <div class="form-group">
                      <label class="label required">
                        telefon
                        <input type="text" class="form-control" required>
                      </label>
                    </div>
                    <div class="form-group">
                      <label class="label required">
                        strefa
                        <select class="select-selectric">
                          <option value="" desabled></option>
                          <option value="1">strefa 1</option>
                          <option value="2">strefa 2</option>
                          <option value="3">strefa 3</option>
                          <option value="4">strefa 4</option>
                          <option value="5">strefa 5</option>
                        </select>
                      </label>
                    </div>
                  </div>
                  <div class="col">
                    <div class="form-group">
                      <label class="label required">
                        model urządzenia:
                        <select class="select-selectric">
                          <option value="" desabled></option>
                          <option value="1">model 1</option>
                          <option value="2">model 2</option>
                          <option value="3">model 3</option>
                          <option value="4">model 4</option>
                          <option value="5">model 5</option>
                        </select>
                      </label>
                    </div>
                    <div class="form-group">
                      <label class="label required">
                        nr seryjny urządzenia:
                        <input type="text" class="form-control" required>
                      </label>
                    </div>
                  </div>
                </div>
                <!-- /.col-wrapper -->

                <div class="col-wrapper col-wrapper-sm">
                  <div class="col">
                    <div class="form-group">
                      <label class="label required">
                        Imię
                        <input type="text" class="form-control" required>
                      </label>
                    </div>
                    <div class="form-group">
                      <label class="label required">
                        Nazwisko
                        <input type="text" class="form-control" required>
                      </label>
                    </div>
                    <div class="form-group">
                      <label class="label required">
                        firma
                        <input type="text" class="form-control" required>
                      </label>
                    </div>
                    <div class="form-group">
                      <label class="label required">
                        e-mail
                        <input type="text" class="form-control" required>
                      </label>
                    </div>
                  </div>
                  <div class="col">                    
                    <div class="form-group">
                      <label class="label required">
                        telefon
                        <input type="text" class="form-control" required>
                      </label>
                    </div>
                    <div class="form-group">
                      <label class="label required">
                        strefa
                        <select class="select-selectric">
                          <option value="" desabled></option>
                          <option value="1">strefa 1</option>
                          <option value="2">strefa 2</option>
                          <option value="3">strefa 3</option>
                          <option value="4">strefa 4</option>
                          <option value="5">strefa 5</option>
                        </select>
                      </label>
                    </div>
                    <div class="form-group">
                      <label class="label required">
                        model urządzenia:
                        <select class="select-selectric">
                          <option value="" desabled></option>
                          <option value="1">model 1</option>
                          <option value="2">model 2</option>
                          <option value="3">model 3</option>
                          <option value="4">model 4</option>
                          <option value="5">model 5</option>
                        </select>
                      </label>
                    </div>
                    <div class="form-group">
                      <label class="label required">
                        nr seryjny urządzenia:
                        <input type="text" class="form-control" required>
                      </label>
                    </div>
                  </div>
                </div>
                <!-- /.col-wrapper -->
  
                <div class="form-group">
                  <label class="label label-textarea label-100p required">
                    opis usterki:
                    <textarea class="form-control textarea" required></textarea>                        
                  </label>
                </div>

                <div class="form-group">
                  <label class="label label-textarea label-100p required">
                    adres wykonania naprawy:
                    <textarea class="form-control textarea" required></textarea>                        
                  </label>
                </div>

                <div class="form-group">
                  <label class="label label-textarea label-100p required">
                    pełne dane firmy do faktury:
                    <textarea class="form-control textarea" required></textarea>                        
                  </label>
                </div>
  
                <div class="checkbox">
                  <input id="privacy-policy" type="checkbox">
                  <label for="privacy-policy">
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                    <a href="#" class="privacy-policy-link">polityka prywatności</a>
                  </label>
                </div>
                
  
                <div class="form-btn-wrapper">
                  <button type="submit" class="btn btn--text-arrow">
                    wyślij wiadomość
                    <div class="btn btn--arrow"></div>
                  </button>
                </div>
              </form>
            </div>

          </div>
    
        </div>
      </div>
    </section>
  </div>
  <!-- /#fullpage -->
</main>

{include file="includes/footer-holder.html"} 
{include file="includes/footer.html"}