<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 ----------> <form class="form-horizontal"> <fieldset> <!-- Form Name --> <legend>Pedido de Orçamento</legend> <!-- Multiple Checkboxes --> <div class="control-group"> <label class="control-label" for="checkboxes">Modelos de caixas</label> <div class="controls"> <label class="checkbox" for="checkboxes-0"> <input type="checkbox" name="checkboxes" id="checkboxes-0" value="Caixa 1: TPM Alívio"> Caixa 1: TPM Alívio </label> <label class="checkbox" for="checkboxes-1"> <input type="checkbox" name="checkboxes" id="checkboxes-1" value="Caixa 2: SHI Alívio"> Caixa 2: SHI Alívio </label> <label class="checkbox" for="checkboxes-2"> <input type="checkbox" name="checkboxes" id="checkboxes-2" value="Caixa 3: " amar="" é""=""> Caixa 3: "Amar é" </label> </div> </div> <!-- Text input--> <div class="control-group"> <label class="control-label" for="textinput">Quantidade de caixas</label> <div class="controls"> <input id="textinput" name="textinput" type="text" placeholder="quantidade de caixas" class="input-large"> <p class="help-block">Ex.: 25</p> </div> </div> <!-- Text input--> <div class="control-group"> <label class="control-label" for="textinput">Nome Completo</label> <div class="controls"> <input id="textinput" name="textinput" type="text" placeholder="nome completo" class="input-large"> <p class="help-block">Ex.: Maria dos Santos Silva</p> </div> </div> <!-- Password input--> <div class="control-group"> <label class="control-label" for="passwordinput">Endereço Completo</label> <div class="controls"> <input id="passwordinput" name="passwordinput" type="password" placeholder="endereço completo" class="input-large"> <p class="help-block">Ex.: Rua Central, 100 - Bairro ABC</p> </div> </div> <!-- Text input--> <div class="control-group"> <label class="control-label" for="textinput">Complemento de Endereço</label> <div class="controls"> <input id="textinput" name="textinput" type="text" placeholder="complemento de endereço" class="input-large"> <p class="help-block">Ex.: Bl 01 Ap 01 - Prédio ABC</p> </div> </div> <!-- Password input--> <div class="control-group"> <label class="control-label" for="passwordinput">Cidade/UF</label> <div class="controls"> <input id="passwordinput" name="passwordinput" type="password" placeholder="cidade/uf" class="input-large"> <p class="help-block">Ex.: Fortaleza/CE</p> </div> </div> <!-- Text input--> <div class="control-group"> <label class="control-label" for="textinput">CEP</label> <div class="controls"> <input id="textinput" name="textinput" type="text" placeholder="cep" class="input-large"> <p class="help-block">Ex.: 12.345-678</p> </div> </div> <!-- Button --> <div class="control-group"> <label class="control-label" for="singlebutton">Pedido</label> <div class="controls"> <button id="singlebutton" name="singlebutton" class="btn btn-primary">Enviar pedido</button> </div> </div> </fieldset> </form>