<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 ----------> <form class="form-horizontal"> <fieldset> <!-- Form Name --> <legend>Bevat-OUT OF OFFICE</legend> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="Name">Name</label> <div class="col-md-4"> <input id="Name" name="Name" type="text" placeholder="" class="form-control input-md"> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="Date">Date</label> <div class="col-md-4"> <input id="Date" name="Date" type="text" placeholder="" class="form-control input-md"> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="ACTUALTIMEIN">ACTUAL TIME IN (Office or Work Place)</label> <div class="col-md-4"> <input id="ACTUALTIMEIN" name="ACTUALTIMEIN" type="text" placeholder="" class="form-control input-md"> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="ACTUALTIMEOUT">ACTUAL TIME OUT FROM (Office or Work Place)</label> <div class="col-md-4"> <input id="ACTUALTIMEOUT" name="ACTUALTIMEOUT" type="text" placeholder="" class="form-control input-md"> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="DRIVERNAME">DRIVER NAME / VISITING WITH WHOM</label> <div class="col-md-4"> <input id="DRIVERNAME" name="DRIVERNAME" type="text" placeholder="" class="form-control input-md"> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="VEHICLENo">VEHICLE NO. & STARTING KILOMETER</label> <div class="col-md-4"> <input id="VEHICLENo" name="VEHICLENo" type="text" placeholder="" class="form-control input-md"> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="CUSTOMERNAME">CUSTOMER NAME,CONTACT NO. LOCATION & PURPOSE OF VISIT</label> <div class="col-md-4"> <input id="CUSTOMERNAME" name="CUSTOMERNAME" type="text" placeholder="" class="form-control input-md"> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="EXPECTEDTIMEIN">EXPECTED TIME IN</label> <div class="col-md-4"> <input id="EXPECTEDTIMEIN" name="EXPECTEDTIMEIN" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="COMPANYCOSTCODE">COMPANY COST CODE</label> <div class="col-md-4"> <input id="COMPANYCOSTCODE" name="COMPANYCOSTCODE" type="text" placeholder="" class="form-control input-md"> </div> </div> <!-- Textarea --> <div class="form-group"> <label class="col-md-4 control-label" for="DATEREMARKS">DATE & REMARKS / SUMMARY OF PREVIOUS DAY VISITS</label> <div class="col-md-4"> <textarea class="form-control" id="DATEREMARKS" name="DATEREMARKS"></textarea> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="ACTUALTIMEIN">ACTUAL TIME IN & DISTANCE TRAVELED IN KILOMETERS</label> <div class="col-md-4"> <input id="ACTUALTIMEIN" name="ACTUALTIMEIN" type="text" placeholder="" class="form-control input-md"> </div> </div> <!-- Button --> <div class="form-group"> <label class="col-md-4 control-label" for="submit"></label> <div class="col-md-4"> <button id="submit" name="submit" class="btn btn-primary">Submit</button> </div> </div> </fieldset> </form>