Add small form to bootstrap template

Good afternoon freelancers, this project requires a [BOOTSTRAP EXPERT] if you do not qualify here, please move on. The website ([login to view URL]) requires an additional form directly below the above-the-fold content. Nothing fancy, just using pre-existing elements. It should be a simple job, and be bug-free on all devices. Check out the mock-up screenshot to get an idea of how it should work. I believe this is a micro-job that will take about an hour so I will offer $20 for the finished product. Anti-spam question (I won't respond to any submissions that skip this): What is your favorite time of day? Thanks!