<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 ----------> <link rel="stylesheet" href="bootstrap.min.css"> <form class="form-horizontal"> <fieldset> <!-- Form Name --> <legend>Pre-Registration Form [For Students]</legend> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">Name</label> <div class="col-md-4"> <input id="textinput" name="textinput" type="text" placeholder="Your Full Name" class="form-control input-md" required=""> </div> </div> <!-- Select Basic --> <div class="form-group"> <label class="col-md-4 control-label" for="selectbasic">Class</label> <div class="col-md-2"> <select id="selectbasic" name="selectbasic" class="form-control"> <option value="1">IX</option> <option value="2">X</option> <option value="3">XI</option> <option value="4">XII</option> </select> </div> <span class="help-block">If in Class X, "Interested In" would be disabled</span> </div> <!-- Prepended text--> <div class="form-group"> <label class="col-md-4 control-label" for="prependedtext">Mobile Number</label> <div class="col-md-4"> <div class="input-group"> <span class="input-group-addon">+91</span> <input id="prependedtext" name="prependedtext" class="form-control" placeholder="Contact Number" type="text" required=""> </div> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">Email ID</label> <div class="col-md-5"> <input id="textinput" name="textinput" type="text" placeholder="Enter your email" class="form-control input-md" required=""> </div> </div> <!-- Prepended text--> <div class="form-group"> <label class="col-md-4 control-label" for="prependedtext">Alternate Contact Number</label> <div class="col-md-4"> <div class="input-group"> <span class="input-group-addon">+91</span> <input id="prependedtext" name="prependedtext" class="form-control" placeholder="Other contact number" type="text"> </div> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">School</label> <div class="col-md-4"> <input id="textinput" name="textinput" type="text" placeholder="School Name" class="form-control input-md" required=""> </div> </div> <!-- Select Basic --> <div class="form-group"> <label class="col-md-4 control-label" for="selectbasic">State</label> <div class="col-md-4"> <select id="selectbasic" name="selectbasic" class="form-control"> <option value="1">Option one</option> <option value="2">Option two</option> </select> </div> </div> <!-- Select Basic --> <div class="form-group"> <label class="col-md-4 control-label" for="selectbasic">City</label> <div class="col-md-4"> <select id="selectbasic" name="selectbasic" class="form-control"> <option value="1">Option one</option> <option value="2">Option two</option> </select> </div> </div> <!-- Select Basic --> <div class="form-group"> <label class="col-md-4 control-label" for="selectbasic">Interested In</label> <div class="col-md-4"> <select id="selectbasic" name="selectbasic" class="form-control"> <option value="1">HH National</option> <option value="2">HH International</option> <option value="3">HH Both</option> </select> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">Amount</label> <div class="col-md-2"> <input id="textinput" name="textinput" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> <!-- Select Basic --> <div class="form-group"> <label class="col-md-4 control-label" for="selectbasic">Referred By</label> <div class="col-md-4"> <select id="selectbasic" name="selectbasic" class="form-control"> <option value="1">Workshops in School</option> <option value="2">Online</option> <option value="3">By known</option> </select> </div> </div> <!-- Button --> <div class="form-group"> <label class="col-md-4 control-label" for="singlebutton"></label> <div class="col-md-4"> <button id="singlebutton" name="singlebutton" class="btn btn-primary">Pay</button> </div> </div> </fieldset> </form>