"Renewal form"
Bootstrap 3.3.0 Snippet by azlanidris

<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 id="loginbox" style="margin-top:50px;" class="mainbox col-md-6 col-md-offset-3 col-sm-8 col-sm-offset-2"> <div class="panel panel-info" > <div class="panel-heading"> <div class="panel-title">Renewal Payment</div> </div> <div style="padding-top:10px" class="panel-body" > <div class="panel-body"> <div style="margin-bottom:10px;" align="center"> Your subscription has expired on <font color="red">Jan 27, 2017</font>. Please renew your subscription to continue using our service. </div> <table class="table"> <tbody> <tr> <th>Name</th> <td>Michael</td> </tr> <tr> <th>Email</th> <td>micahael@michael.com</td> </tr> <tr> <th>Package Subscription</th> <td><select class="form-control"> <option value="1" selected="selected">1 year subscription = RM150</option> <option value="2">2 years subscription = RM250</option> </select></td> </tr> </tbody> </table> <div class="button text-center"> <a class="btn btn-success btn-lg" rel="nofollow" data-method="patch" href="#">Pay Now</a> </div> <a class="white shadowed link-styling" rel="nofollow" data-method="delete" href="#">Back</a> </div> </div> </div> </div> </div>

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