<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> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="name">Name</label> <div class="col-md-4"> <input id="name" name="name" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="surname">Surname</label> <div class="col-md-4"> <input id="surname" name="surname" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="contact">Phone Number</label> <div class="col-md-4"> <input id="contact" name="contact" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="email">Email Address</label> <div class="col-md-4"> <input id="email" name="email" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="location">City/Suburb</label> <div class="col-md-4"> <input id="location" name="location" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="make">Make</label> <div class="col-md-4"> <input id="make" name="make" type="text" placeholder="" class="form-control input-md"> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="model">Model</label> <div class="col-md-4"> <input id="model" name="model" type="text" placeholder="" class="form-control input-md"> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="year">Year</label> <div class="col-md-4"> <input id="year" name="year" type="text" placeholder="" class="form-control input-md"> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="bookingdate">Booking Date</label> <div class="col-md-4"> <input id="bookingdate" name="bookingdate" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> <!-- Button Drop Down --> <div class="form-group"> <label class="col-md-4 control-label" for="damage">Which of your windows is damaged?</label> <div class="col-md-4"> <div class="input-group"> <input id="damage" name="damage" class="form-control" placeholder="Select" type="text" required=""> <div class="input-group-btn"> <button type="button" class="btn btn-default dropdown-toggle" data-toggle="dropdown"> Please Select <span class="caret"></span> </button> <ul class="dropdown-menu pull-right"> <li><a href="#">Windscreen</a></li> <li><a href="#">Side Window</a></li> <li><a href="#">Rear Window</a></li> </ul> </div> </div> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="regno">Registration Number</label> <div class="col-md-4"> <input id="regno" name="regno" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> <!-- Textarea --> <div class="form-group"> <label class="col-md-4 control-label" for="comments">Comments</label> <div class="col-md-4"> <textarea class="form-control" id="comments" name="comments"></textarea> </div> </div> </fieldset> </form> <a href="#" class="btn btn-primary btn-primary">Submit</a> </div> </div>