<section class="content white-bg">
<div class="container">
<div class="col-sm-12">
<div class="content">Thanks for visiting us again. To take up your offer of your first month's storage space for only R1* please complete the form below.<br /><br />
<table>
<tbody>
<tr>
<td>First name :</td>
<td><input style="width: 100px; height: 22px;" type="text" /></td>
</tr>
<tr>
<td>Surname :</td>
<td><input style="width: 100px; height: 22px;" type="text" /></td>
</tr>
<tr>
<td>Email :</td>
<td><input style="width: 100px; height: 22px;" type="text" /></td>
</tr>
<tr>
<td>Cellphone :</td>
<td><input style="width: 100px; height: 22px;" type="text" /></td>
</tr>
<tr>
<td>Preferred store :</td>
<td><input style="width: 100px; height: 22px;" type="text" /></td>
</tr>
</tbody>
</table>
<input style="width: 100px; height: 22px;" type="submit" /><br /><br /><select style="width: 100px; height: 22px;">1 2 3</select><br />* Terms and conditions apply</div>
</div>
</div>
<p></p>
</section>

First name :
Surname :
Email :
Cellphone :
Preferred store :