<div class="row">
    <div class="col-lg-1"></div>
    <div class="col-lg-3" style="margin-top: 50px;">
        <div class="panel panel-primary">
            <div class="panel-heading">
                <h3 class="panel-title">Address</h3>
            </div>
            <div class="panel-body">
                C - 7 Balaji Puram, Shahganj, Agra.<br>
                Pincode: 282010.<br>
                Uttar Pradesh, India<br>
                Contact: +91-9557133975<br>
                Email: info@futureheadtech.com
            </div>
        </div>
    </div>
    <div class="col-lg-1"></div>
    <div class="col-lg-6">
        <form class="form-horizontal">
            <legend>Contact us</legend>
                <div class="form-group">
                    <label for="inputEmail" class="col-lg-2 control-label">Name</label>
                    <div class="col-lg-5">
                        <input type="text" class="form-control" id="inputEmail" placeholder="Enter your name">
                    </div>
                </div>
                <div class="form-group">
                    <label for="inputEmail" class="col-lg-2 control-label">Email</label>
                    <div class="col-lg-5">
                        <input type="text" class="form-control" id="inputEmail" placeholder="Enter your email">
                    </div>
                </div>
                <div class="form-group">
                    <label for="inputEmail" class="col-lg-2 control-label">Mobile</label>
                    <div class="col-lg-5">
                        <input type="text" class="form-control" id="inputEmail" placeholder="Enter your mobile no.">
                    </div>
                </div>
                <div class="form-group">
                    <div class="col-lg-5 col-lg-offset-2">
                        <button type="submit" class="btn btn-primary btn-sm">Submit</button>
                        <button type="reset" class="btn btn-default btn-xs">Cancel</button>
                    </div>
                </div>
        </form>
    </div>
</div>
