<link href="//netdna.bootstrapcdn.com/bootstrap/3.0.0/css/bootstrap.min.css" rel="stylesheet" id="bootstrap-css"> <script src="//netdna.bootstrapcdn.com/bootstrap/3.0.0/js/bootstrap.min.js"></script> <script src="//code.jquery.com/jquery-1.11.1.min.js"></script> <!------ Include the above in your HEAD tag ----------> <form class="form-horizontal"> <fieldset> <!-- Form Name --> <legend>Total Revenue</legend> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">POC PPM</label> <div class="col-md-6"> <input id="textinput" name="textinput" placeholder="POC PPM logged on page" class="form-control input-md" type="text"> </div> </div> <!-- Select Basic --> <div class="form-group"> <label class="col-md-4 control-label" for="selectbasic">Zone</label> <div class="col-md-6"> <select id="selectbasic" name="selectbasic" class="form-control"> <option value="1">APAC</option> <option value="2">COPEC</option> <option value="3">EUR</option> <option value="4">LAN</option> <option value="5">LAS</option> <option value="6">MAZ</option> </select> </div> </div> <!-- Select Basic --> <div class="form-group"> <label class="col-md-4 control-label" for="selectbasic">Country</label> <div class="col-md-6"> <select id="selectbasic" name="selectbasic" class="form-control"> <option value="1">China</option> <option value="2">Korea</option> <option value="3">Belgium</option> <option value="4">UK</option> <option value="5">Italy</option> <option value="6">Spain</option> <option value="7">Mexico</option> <option value="8">Brazil</option> <option value="9">Argentina</option> <option value="10">Chile</option> <option value="11">Paraguay</option> <option value="12">Colombia</option> <option value="13">Uruguay</option> </select> </div> </div> <!-- Select Basic --> <div class="form-group"> <label class="col-md-4 control-label" for="selectbasic">Model Type</label> <div class="col-md-6"> <select id="selectbasic" name="selectbasic" class="form-control"> <option value="1">Brew Pub</option> <option value="2">Pub</option> <option value="3">Mini Pub</option> <option value="4">Scalables</option> <option value="5">Bottle Shop</option> </select> </div> </div> <!-- Select Basic --> <div class="form-group"> <label class="col-md-4 control-label" for="selectbasic">Segment</label> <div class="col-md-6"> <select id="selectbasic" name="selectbasic" class="form-control"> <option value="1">ABI Spec Beer</option> </select> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">Total Revenue</label> <div class="col-md-6"> <input id="textinput" name="textinput" placeholder="Total Revenue from Segment selected" class="form-control input-md" type="text"> </div> </div> <!-- Button (Double) --> <div class="form-group"> <label class="col-md-4 control-label" for="button1id"></label> <div class="col-md-8"> <button id="button1id" name="button1id" class="btn btn-success">Save</button> <button id="button2id" name="button2id" class="btn btn-danger">Cancel</button> </div> </div> </fieldset> </form>