Markup

<section class="section-padding">
    <div class="container">
        <div class="row">
            <div class="col-md-8 col-md-offset-2">
                <div class="quote-form-wrap">
                    <img src="assets/img/quote-girl.png" alt="Get a quote">
                    <div class="blue-quote-form">
                        <h3>Get a quote</h3>
                        
                        <form action="index.html">
                            <div class="row">
                                <div class="col-md-6">
                                    <input type="text" name="name" placeholder="Name">
                                </div>
                                <div class="col-md-6">
                                    <input type="email" name="email" placeholder="Email">
                                </div>
                            </div>
                            <p><textarea name="message" id="message" cols="30" rows="10"></textarea></p>
                            
                            <div class="blue-form-submit">
                                <button type="submit">Get a quote</button>
                            </div> 
                        </form>
                              
                    </div>
                </div>
            </div>
        </div>
    </div> 
</section>

 Style

    /* Base CSS */
    .alignleft {
        float: left;
        margin-right: 15px;
    }
    .alignright {
        float: right;
        margin-left: 15px;
    }
    .aligncenter {
        display: block;
        margin: 0 auto 15px;
    }
    a:focus { outline: 0 solid }
    img {
        max-width: 100%;
        height: auto;
    }
    h1,
    h2,
    h3,
    h4,
    h5,
    h6 {
        margin: 0 0 15px;
        font-weight: 700;
    }
    body {
        font-family: 'Lato', sans-serif;
    }
    a:hover { text-decoration: none }
    
    .section-padding {padding: 80px 0}
    
    
    .quote-form-wrap img {
        display: block;
        margin: auto;
    }
    .blue-quote-form {
        background: #2ab6fb none repeat scroll 0 0;
        margin-top: -83px;
        max-width: 750px;
        padding: 25px 100px 50px;
    }
    .blue-quote-form h3 {
        color: #fff;
        font-size: 26px;
        margin-bottom: 50px;
        position: relative;
        text-align: center;
        text-transform: uppercase;
    }
    .blue-quote-form h3::before {
        background: #fff none repeat scroll 0 0;
        bottom: -20px;
        content: "";
        height: 2px;
        left: 50%;
        margin-left: -55px;
        position: absolute;
        width: 110px;
    }
    .blue-quote-form h3::after {
        background: #2ab6fb none repeat scroll 0 0;
        border: 2px solid #fff;
        border-radius: 50%;
        bottom: -25px;
        content: "";
        height: 13px;
        left: 50%;
        margin-left: -6.5px;
        position: absolute;
        width: 13px;
    }
    .blue-quote-form input, .blue-quote-form textarea {
        background: rgba(0, 0, 0, 0) none repeat scroll 0 0;
        border: medium none;
    }
    .blue-quote-form input, .blue-quote-form textarea {
        border-bottom: 1px solid #aae2fd;
        color: #fff;
        padding: 10px 0;
        width: 100%;
    }
    .blue-quote-form textarea {
        height: 100px;
    }
    .blue-form-submit {
        margin-top: 20px;
        text-align: center;
    }
    .blue-form-submit button[type="submit"] {
        background: #fff none repeat scroll 0 0;
        border: medium none;
        border-radius: 5px;
        color: #2ab6fb;
        padding: 10px;
        text-transform: uppercase;
    }