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<div class="form-group float-label-control">
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<div class="form-group float-label-control">
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<select class="form-control" name = "state" placeholder="State">
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<select class="form-control" name = "state" placeholder="State">
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<option value=" ">State</option>
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<option value=" ">State</option>
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<option value="Andaman and Nicobar Islands">Andaman and Nicobar Islands</option>
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<option value="Andhra Pradesh">Andhra Pradesh</option>
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<option value="Arunachal Pradesh">Arunachal Pradesh</option>
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<option value="Assam">Assam</option>
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#foreach($stateName in $stateNames)
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<option value="Bihar">Bihar</option>
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<option value="Chandigarh">Chandigarh</option>
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<option value="Chhattisgarh">Chhattisgarh</option>
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<option value="$stateName">$stateName</option>
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<option value="Dadra and Nagar Haveli">Dadra and Nagar Haveli</option>
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<option value="Daman and Diu">Daman and Diu</option>
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<option value="Delhi">Delhi</option>
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<option value="Goa">Goa</option>
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#end
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<option value="Gujarat">Gujarat</option>
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<option value="Haryana">Haryana</option>
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<option value="Himachal Pradesh">Himachal Pradesh</option>
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<option value="Jammu and Kashmir">Jammu and Kashmir</option>
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<option value="Jharkhand">Jharkhand</option>
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<option value="Karnataka">Karnataka</option>
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<option value="Kerala">Kerala</option>
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<option value="Lakshadweep">Lakshadweep</option>
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<option value="Madhya Pradesh">Madhya Pradesh</option>
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<option value="Maharashtra">Maharashtra</option>
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<option value="Manipur">Manipur</option>
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<option value="Meghalaya">Meghalaya</option>
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<option value="Mizoram">Mizoram</option>
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<option value="Nagaland">Nagaland</option>
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<option value="Orissa">Orissa</option>
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<option value="Pondicherry">Pondicherry</option>
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<option value="Punjab">Punjab</option>
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<option value="Rajasthan">Rajasthan</option>
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<option value="Sikkim">Sikkim</option>
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<option value="Tamil Nadu">Tamil Nadu</option>
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<option value="Tripura">Tripura</option>
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<option value="Telangana">Telangana</option>
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<option value="Uttaranchal">Uttaranchal</option>
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<option value="Uttar Pradesh">Uttar Pradesh</option>
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<option value="West Bengal">West Bengal</option>
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</select>
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</select>
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</div>
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</div>
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<div class="form-group float-label-control">
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<div class="form-group float-label-control">
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<label for="">Email1</label>
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<label for="">Email1</label>
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