<link href="//netdna.bootstrapcdn.com/bootstrap/3.0.1/css/bootstrap.min.css" rel="stylesheet" id="bootstrap-css">
<script src="//netdna.bootstrapcdn.com/bootstrap/3.0.1/js/bootstrap.min.js"></script>
<script src="//code.jquery.com/jquery-1.11.1.min.js"></script>
<div class="container">
<div class="row">
<div class="col-sm-12 col-md-12">
<form class="form-horizontal span6">
<fieldset>
<legend>Payment</legend>
<div class="form-group">
<label class="control-label">Card Holder's Name</label>
<div class="controls">
<input type="text" class="form-control" pattern="\w+ \w+.*" title="Fill your first and last name" required="">
</div>
</div>
<div class="form-group">
<label class="control-label">Card Number</label>
<div class="controls">
<div class="row">
<div class="col-sm-3 col-md-3">
<input type="text" class="form-control" autocomplete="off" maxlength="4" pattern="\d{4}" title="First four digits" required="">
</div>
<div class="col-sm-3 col-md-3">
<input type="text" class="form-control" autocomplete="off" maxlength="4" pattern="\d{4}" title="Second four digits" required="">
</div>
<div class="col-sm-3 col-md-3">
<input type="text" class="form-control" autocomplete="off" maxlength="4" pattern="\d{4}" title="Third four digits" required="">
</div>
<div class="col-sm-3 col-md-3">
<input type="text" class="form-control" autocomplete="off" maxlength="4" pattern="\d{4}" title="Fourth four digits" required="">
</div>
</div>
</div>
