"rate input discount/extracharge/final percent/fixed"
Bootstrap 3.3.0 Snippet by angekouf

<link href="//maxcdn.bootstrapcdn.com/bootstrap/3.3.0/css/bootstrap.min.css" rel="stylesheet" id="bootstrap-css"> <script src="//maxcdn.bootstrapcdn.com/bootstrap/3.3.0/js/bootstrap.min.js"></script> <script src="//code.jquery.com/jquery-1.11.1.min.js"></script> <!------ Include the above in your HEAD tag ----------> <div class="container"> <div class="row"> <form class="form-horizontal"> <fieldset> <!-- Form Name --> <legend>Form Name</legend> <!-- Button Drop Down --> <div class="form-group"> <label class="col-md-3 control-label" for="buttondropdown">Every extra person</label> <div class="col-md-3"> <div class="input-group"> <div class="input-group-btn"> <button type="button" class="btn btn-default dropdown-toggle" data-toggle="dropdown"> Fixed <span class="caret"></span> </button> <ul class="dropdown-menu pull-left"> <li><a href="#">Fixed</a></li> <li><a href="#">Discount</a></li> <li><a href="#">Extra Charge</a></li> </ul> </div> <input type="number" style="width: 100%" class="form-control" placeholder="amount" required="" min="0"/> <div class="input-group-btn"> <button type="button" class="btn btn-default dropdown-toggle" data-toggle="dropdown"> € <span class="caret"></span> </button> <ul class="dropdown-menu pull-right"> <li><a href="#">%</a></li> <li><a href="#">€</a></li> </ul> </div> </div> <div><label>with Board</label><select style="width: 100%"></select></div> </div> </div> </fieldset> </form> </div> </div>

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