<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>Form Name</legend> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="">Ad-Soyad</label> <div class="col-md-5"> <input id="" name="" placeholder="" class="form-control input-md" required="" type="text"> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="">T.C. Kimlik No</label> <div class="col-md-5"> <input id="" name="" placeholder="" class="form-control input-md" required="" type="text"> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="">Telefon Numarası</label> <div class="col-md-5"> <input id="" name="" placeholder="" class="form-control input-md" required="" type="text"> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="">E-Posta Adresi</label> <div class="col-md-5"> <input id="" name="" placeholder="" class="form-control input-md" required="" type="text"> </div> </div> <!-- Select Basic --> <div class="form-group"> <label class="col-md-4 control-label" for="">İl</label> <div class="col-md-5"> <select id="" name="" class="form-control"> <option value="1">İstanbul</option> <option value="2">Ankara</option> <option value="">İzmir</option> <option value="">Adana</option> <option value="">Adıyaman</option> <option value="">Afyonkarahisar</option> <option value="">Ağrı</option> <option value="">Aksaray</option> <option value="">Amasya</option> <option value="">Antalya</option> <option value="">Ardahan</option> <option value="">Artvin</option> <option value="">Aydın</option> <option value="">Balıkesir</option> <option value="">Bartın</option> <option value="">Batman</option> <option value="">Bayburt</option> <option value="">Bilecik</option> <option value="">Bingöl</option> <option value="">Bitlis</option> <option value="">Bolu</option> <option value="">Burdur</option> <option value="">Bursa</option> <option value="">Çanakkale</option> <option value="">Çankırı</option> <option value="">Çorum</option> <option value="">Denizli</option> <option value="">Diyarbakır</option> <option value="">Düzce</option> <option value="">Edirne</option> <option value="">Elazığ</option> <option value="">Erzincan</option> <option value="">Erzurum</option> <option value="">Eskişehir</option> <option value="">Gaziantep</option> <option value="">Giresun</option> <option value="">Gümüşhane</option> <option value="">Hakkari</option> <option value="">Hatay</option> <option value="">Iğdır</option> <option value="">Isparta</option> <option value="">Kahramanmaraş</option> <option value="">Karabük</option> <option value="">Karaman</option> <option value="">Kars</option> <option value="">Kastamonu</option> <option value="">Kayseri</option> <option value="">Kırıkkale</option> <option value="">Kırklareli</option> <option value="">Kırşehir</option> <option value="">Kilis</option> <option value="">Kocaeli</option> <option value="">Konya</option> <option value="">Kütahya</option> <option value="">Malatya</option> <option value="">Manisa</option> <option value="">Mardin</option> <option value="">Mersin</option> <option value="">Muğla</option> <option value="">Muş</option> <option value="">Nevşehir</option> <option value="">Niğde</option> <option value="">Ordu</option> <option value="">Osmaniye</option> <option value="">Rize</option> <option value="">Sakarya</option> <option value="">Samsun</option> <option value="">Siirt</option> <option value="">Sinop</option> <option value="">Sivas</option> <option value="">Şırnak</option> <option value="">Tekirdağ</option> <option value="">Tokat</option> <option value="">Trabzon</option> <option value="">Tunceli</option> <option value="">Şanlıurfa</option> <option value="">Uşak</option> <option value="">Van</option> <option value="">Yalova</option> <option value="">Yozgat</option> <option value="">Zonguldak</option> </select> </div> </div> <!-- Select Basic --> <div class="form-group"> <label class="col-md-4 control-label" for="">İlçe</label> <div class="col-md-5"> <select id="" name="" class="form-control"> <option value="1">Adalar</option> <option value="2">Arnavutköy</option> <option value="">Ataşehir</option> <option value="">Avcılar</option> <option value="">Bağcılar</option> <option value="">Bahçelievler</option> <option value="">Bakırköy</option> <option value="">Başakşehir</option> <option value="">Bayrampaşa</option> <option value="">Beşiktaş</option> <option value="">Beykoz</option> <option value="">Beylikdüzü</option> <option value="">Beyoğlu</option> <option value="">Büyükçekmece</option> <option value="">Çatalca</option> <option value="">Çekmeköy</option> <option value="">Esenler</option> <option value="">Esenyurt</option> <option value="">Eyüp</option> <option value="">Fatih</option> <option value="">Gaziosmanpaşa</option> <option value="">Güngören</option> <option value="">Kadıköy</option> <option value="">Kağıthane</option> <option value="">Kartal</option> <option value="">Küçükçekmece</option> <option value="">Maltepe</option> <option value="">Pendik</option> <option value="">Sancaktepe</option> <option value="">Sarıyer</option> <option value="">Silivri</option> <option value="">Sultanbeyli</option> <option value="">Sultangazi</option> <option value="">Şile</option> <option value="">Şişli</option> <option value="">Tuzla</option> <option value="">Ümraniye</option> <option value="">Üsküdar</option> <option value="">Zeytinburnu</option> </select> </div> </div> <!-- Textarea --> <div class="form-group"> <label class="col-md-4 control-label" for="">Mahalle/Sokak</label> <div class="col-md-4"> <textarea class="form-control" id="" name=""></textarea> </div> </div> <!-- Select Basic --> <div class="form-group"> <label class="col-md-4 control-label" for="selectbasic">Marka</label> <div class="col-md-5"> <select id="selectbasic" name="selectbasic" class="form-control"> <option value="1">Alcatel</option> <option value="2">Anycool</option> <option value="">Apple</option> <option value="">Arçelik</option> <option value="">Asus</option> <option value="">BlackBerry</option> <option value="">Casper</option> <option value="">General Mobile</option> <option value="">HP</option> <option value="">HTC</option> <option value="">LG</option> <option value="">Microsoft</option> <option value="">Nokia</option> <option value="">Samsung</option> <option value="">Sony</option> <option value="">Turkcell</option> <option value="">Vestel</option> <option value="">Vodafone</option> <option value="">ZTE</option> </select> </div> </div> <!-- Select Basic --> <div class="form-group"> <label class="col-md-4 control-label" for="selectbasic">Model</label> <div class="col-md-5"> <select id="selectbasic" name="selectbasic" class="form-control"> <option value="1">POP 3 İdol</option> </select> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="">IMEI No</label> <div class="col-md-5"> <input id="" name="" placeholder="" class="form-control input-md" required="" type="text"> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">fixplus Aktivasyon Kodu</label> <div class="col-md-5"> <input id="textinput" name="textinput" placeholder="" class="form-control input-md" required="" type="text"> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">Seri No</label> <div class="col-md-5"> <input id="textinput" name="textinput" placeholder="" class="form-control input-md" required="" type="text"> </div> </div> <!-- Button --> <div class="form-group"> <label class="col-md-4 control-label" for=""></label> <div class="col-md-4"> <button id="" name="" class="btn btn-success">Kaydet</button> </div> </div> </fieldset> </form>