footer.php

<div class="bg3 footer">
      <div class="container">
		  <div class="row contact anchor" data-scroll-index="11">
			  <div class="col-md-1">
				  <h3>CONTACT</h3>
			</div>
			<div class="col-md-5 col-md-offset-1">
				<form class="form-horizontal" role="form">
					<div class="form-group">
						<label for="inputName" class="col-sm-2 control-label">Name</label>
						<div class="col-sm-10">
							<input type="text" class="form-control" id="inputName" placeholder="Name">
						</div>
					</div>
					<div class="form-group">
						<label for="inputEmail" class="col-sm-2 control-label">Email</label>
						<div class="col-sm-10">
							<input type="email" class="form-control" id="inputEmail" placeholder="Email">
						</div>
					</div>
					<div class="form-group">
						<label for="inputCompany" class="col-sm-2 control-label">Email</label>
						<div class="col-sm-10">
							<input type="text" class="form-control" id="inputCompany" placeholder="Company">
						</div>
					</div>
					<div class="form-group">
						<label for="inputPhone" class="col-sm-2 control-label">Phone</label>
						<div class="col-sm-10">
							<input type="text" class="form-control" id="inputPhone" placeholder="Phone">
						</div>
					</div>
					<div class="form-group">
						<label for="inputPhone" class="col-sm-2 control-label">Message</label>
						<div class="col-sm-10">
							<textarea class="form-control" rows="3" placeholder="Message"></textarea>
						</div>
					</div>
					<div class="form-group">
						<div class="col-sm-offset-2 col-sm-10">
							<button type="submit" class="btn btn-default">Submit</button>
						</div>
					</div>
				</form>
			</div> <!-- /col-md-5 -->
			<div class="col-md-4 col-md-offset-1">
				<p>CHATANOOGA</br>100 Cherokee Blvd #320<br/>Chattanooga, TN 37405<br/><br/>phone: (423) 954-7400<br/>fax: (901) 654-7097</p>
			</div>
		  </div>

      <footer>
        <p>&copy; CodeScience <script>document.write(new Date().getFullYear())</script></p>
      </footer>
   </div>
</div> 


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  </body>
</html>