<div class="banner-inner-published-form" data-aos="fade-left" data-aos-duration="1500">
    <h4>Start Your Publishing Journey!</h4>
    <form action="webpages/bannerFormController2.php" method="POST" class="myForm">
        <div class="row">
            <div class="col-xxl-12 col-xl-12 col-lg-12 col-md-12 col-sm-12 col-12">
                <div class="form-group">
                    <select name="manuscript-ready" class="form-select" aria-label="Default select example" required>
                        <option selected disabled>Do you have a manuscript ready?</option>
                        <option value="Yes, I'm ready to publish today">Yes, I'm ready to publish today</option>
                        <option value="Yes, I'll be ready to publish in 1 to 3 months">Yes, I'll be ready to publish in 1 to 3 months</option>
                        <option value="Yes, I'll be ready to publish in 3 to 6 months">Yes, I'll be ready to publish in 3 to 6 months</option>
                        <option value="Yes, I’ll be ready to publish in 6 to 12 months">Yes, I’ll be ready to publish in 6 to 12 months</option>
                        <option value="No, I do not have a book or manuscript ready">No, I do not have a book or manuscript ready</option>
                    </select>
                </div>
            </div>
            <div class="col-xxl-12 col-xl-12 col-lg-12 col-md-12 col-sm-12 col-12">
                <div class="form-group">
                    <select name="published-before" class="form-select" aria-label="Default select example" required>
                        <option selected disabled>Have you published before?</option>
                        <option value="Yes">Yes</option>
                        <option value="No">No</option>
                    </select>
                </div>
            </div>
            <div class="col-xxl-12 col-xl-12 col-lg-12 col-md-12 col-sm-12 col-12">
                <div class="form-group">
                    <select name="plan-on-publishing" class="form-select" aria-label="Default select example" required>
                        <option selected disabled>What type of book do you plan on publishing?</option>
                        <option value="Business">Business</option>
                        <option value="Biography">Biography</option>
                        <option value="Inspirational">Inspirational</option>
                        <option value="Non-Fiction">Non-Fiction</option>
                        <option value="How-To">How-To</option>
                        <option value="Autobiography/Memoir">Autobiography/Memoir</option>
                        <option value="Self-Help">Self-Help</option>
                        <option value="Children">Children</option>
                        <option value="Spiritual/Religious">Spiritual/Religious</option>
                        <option value="Fiction">Fiction</option>
                        <option value="Art/Photography">Art/Photography</option>
                        <option value="Cookbook">Cookbook</option>
                        <option value="Other">Other</option>
                    </select>
                </div>
            </div>
            <div class="col-xxl-12 col-xl-12 col-lg-12 col-md-12 col-sm-12 col-12">
                <div class="form-group-select">
                    <h6 class="heading-six">What services are you looking for?</h6>
                    <div class="form-check-flex">
                        <div class="form-check">
                            <input class="form-check-input" type="checkbox" name="Service[]" value="Self Publishing" id="selfPublishing">
                            <label class="form-check-label" for="selfPublishing">
                                Self Publishing
                            </label>
                        </div>
                        <div class="form-check">
                            <input class="form-check-input" type="checkbox" name="Service[]" value="Editing" id="editing">
                            <label class="form-check-label" for="editing">
                                Editing
                            </label>
                        </div>
                        <div class="form-check">
                            <input class="form-check-input" type="checkbox" name="Service[]" value="Cover Design" id="coverDesign">
                            <label class="form-check-label" for="coverDesign">
                                Cover Design
                            </label>
                        </div>
                        <div class="form-check">
                            <input class="form-check-input" type="checkbox" name="Service[]" value="Printing" id="printing">
                            <label class="form-check-label" for="printing">
                                Printing
                            </label>
                        </div>
                        <div class="form-check">
                            <input class="form-check-input" type="checkbox" name="Service[]" value="Interior Formatting" id="interiorFormatting">
                            <label class="form-check-label" for="interiorFormatting">
                                Interior Formatting
                            </label>
                        </div>
                        <div class="form-check">
                            <input class="form-check-input" type="checkbox" name="Service[]" value="Illustration" id="illustration">
                            <label class="form-check-label" for="illustration">
                                Illustration
                            </label>
                        </div>
                    </div>
                </div>
            </div>
            <div class="col-xxl-6 col-xl-6 col-lg-6 col-md-12 col-sm-12 col-12">
                <div class="form-group">
                    <input type="text" name="Name" placeholder="Name:" required>
                </div>
            </div>
            <div class="col-xxl-6 col-xl-6 col-lg-6 col-md-12 col-sm-12 col-12">
                <div class="form-group">
                    <input type="phone" class="countryCode" name="Number" placeholder="Number:" required>
                </div>
            </div>
            <div class="col-xxl-12 col-xl-12 col-lg-12 col-md-12 col-sm-12 col-12">
                <div class="form-group">
                    <input type="Email" name="Email" placeholder="Email:" required>
                </div>
            </div>
            <div class="col-xxl-12 col-xl-12 col-lg-12 col-md-12 col-sm-12 col-12">
                <div class="form-group nda">
                    <input type="checkbox" name="NDA" id="consentCheckbox">
                    <label for="consentCheckbox">By checking this box, I am allowing Barns Nobles send me messages. (You can stop receiving messages from Barns Nobles anytime by sending STOP in the reply or ask for more information by replying HELP. Message frequency varies. Message and data rates may apply). <br> You may review our <a href="privacy-policy" target="__blank">Privacy Policy</a> to learn how your data is used. </label>
                </div>
            </div>
            <div class="col-xxl-12 col-xl-12 col-lg-12 col-md-12 col-sm-12 col-12">
                <div class="form-group form-group-last">
                    <button type="submit" class="submit-btn">Submit</button>
                    <input class="" type="hidden" name="ctry" value="">
                    <input type="hidden" name="pc" value="">
                    <input type="hidden" name="cip" value="" class="form-1-ip">
                    <input type="hidden" name="hiddencapcha" value="">
                    <input type="hidden" name="submitfrombanner" value="">
                    <input type="hidden" id="location" name="locationURL" value="<?php echo 'http://'.$_SERVER['HTTP_HOST'].$_SERVER['REQUEST_URI']; ?>" />
                </div>
            </div>
        </div>
    </form>
</div> 