<script src="vendor/minitauros/odf/js/odf.js"></script>
<link rel="stylesheet" href="public/css/admin/admin.css">

 <div style="padding:10px;">
 
	<div class="card">
							
		<div class="card-block">

			<div class="row">
					
				<div class="alert alert-info" role="alert">
		
					<p>Fill out your contact details and receive price quotes in your Inbox.</p>
					
				</div>
			</div>
		
		</div>
							
		<div class="card-block">

			<div class="row">
			
				<div>
					<form action="xa/products/buy" method="post"  class="large odf_ajax">
	<input type="hidden" name="combo_id" value="582">
<input type="hidden" name="product_id" value="399">
<input type="hidden" name="product_title_text" value="Viability/Cytotoxicity Assay Kit for Animal Live & Dead Cells (Biotium)">
	<table class="key_value">
		<tbody>
									<tr class="">
							<th>
								<label for="qDmYRoxQ17437810584601">Product</label>
																							</th>
							<td >
								<span >Viability/Cytotoxicity Assay Kit for Animal Live & Dead Cells (Biotium)</span>
							</td>
						</tr>
												<tr class="">
							<th>
								<label for="MdlUHI17437810584602">Your name</label>
																	<span class="required_input">*</span>
																							</th>
							<td >
								<input type="text" name="name" value="" placeholder="Your name">
							</td>
						</tr>
												<tr class="">
							<th>
								<label for="p2FKZvf517437810584603">Your E-mail</label>
																	<span class="required_input">*</span>
																							</th>
							<td >
								<input type="text" name="email" value="" placeholder="Your E-mail">
							</td>
						</tr>
												<tr class="">
							<th>
								<label for="jsu5B6ComH17437810584603">Your phone number</label>
																							</th>
							<td >
								<input type="text" name="phone" value="" placeholder="Your phone number">
							</td>
						</tr>
									<tr>
				<th></th>
				<td><button type="submit" class="btn btn-success btn-large">Submit</button></td>
			</tr>
		</tbody>
	</table>
</form>
				</div>
				
			</div>
		
		</div>

	</div>
</div>