<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 class="row"> <h2>Create your snippet's HTML, CSS and Javascript in the editor tabs</h2> </div> <form class="form-horizontal"> <fieldset> <!-- Form Name --> <legend>Borang Pembelian</legend> <!-- Select Basic --> <div class="control-group"> <label class="control-label" for="selectbasic">Nama Panggilan</label> <div class="controls"> <select id="selectbasic" name="selectbasic" class="input-xlarge"> <option>Encik</option> <option>Puan</option> <option>Cik</option> <option>Dato</option> <option>Datin</option> </select> </div> </div> <!-- Text input--> <div class="control-group"> <label class="control-label" for="nama">Nama</label> <div class="controls"> <input id="nama" name="nama" type="text" placeholder="" class="input-xlarge" required=""> </div> </div> <!-- Text input--> <div class="control-group"> <label class="control-label" for="emel">E-mel</label> <div class="controls"> <input id="emel" name="emel" type="text" placeholder="" class="input-xlarge"> </div> </div> <!-- Text input--> <div class="control-group"> <label class="control-label" for="phone">No. Telefon</label> <div class="controls"> <input id="phone" name="phone" type="text" placeholder="*contoh : 017-1234567" class="input-xlarge" required=""> </div> </div> <!-- File Button --> <div class="control-group"> <label class="control-label" for="bukti">Bukti Pembayaran</label> <div class="controls"> <input id="bukti" name="bukti" class="input-file" type="file"> </div> </div> <!-- Button --> <div class="control-group"> <label class="control-label" for="submit"></label> <div class="controls"> <button id="submit" name="submit" class="btn btn-primary">Hantar</button> </div> </div> </fieldset> </form> </div>