<div class="modaLoader"></div>
<div class="row">
    <div class="col-md-12">
        <div class="form-group">
            <label>nom :</label>
            <input type="text" class="form-control" name="nom" placeholder="nom">
        </div>
        <div class="form-group">
            <label>prenom :</label>
            <input type="text" class="form-control" name="prenom" placeholder="prenom">
        </div>
        <div class="form-group">
            <label>téléphone :</label>
            <input type="tel" class="form-control" name="tel" placeholder="téléphone">
        </div>
        <div class="form-group">
            <label>email :</label>
            <input type="email" class="form-control" name="email" placeholder="email">
        </div>
    </div>
</div>