<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>
<form class="form-horizontal">
<fieldset>
<legend>Currency Counter</legend>
<div class="form-group">
<label class="col-md-8" style="text-align:center;">Notes</label>
</div>
<div class="form-group">
<label class="col-md-4 control-label" for="d100">$100 x </label>
<div class="col-md-2">
<input id="d100" name="d100" type="text" placeholder="notes" class="form-control input-md">
</div>
<label class="col-md-2" for="d100" id="ld100">0</label>
</div>
<div class="form-group">
<label class="col-md-4 control-label" for="d50">$50 x </label>
<div class="col-md-2">
<input id="d50" name="d50" type="text" placeholder="notes" class="form-control input-md">
</div>
<label class="col-md-2" for="d50" id="ld50">0</label>
</div>
<div class="form-group">
<label class="col-md-4 control-label" for="d20">$20 x </label>
<div class="col-md-2">
<input id="d20" name="d20" type="text" placeholder="notes" class="form-control input-md">
</div>