<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>New Request</legend>
<div class="panel panel-primary"> <div class="panel-heading"> <h3 class="panel-title">Information</h3> </div>
<div class="panel-body">
<div class="form-group">
<label class="col-md-4 control-label" for="txtName">Name</label>
<div class="col-md-4">
<input id="txtName" name="txtName" type="text" placeholder="" class="form-control input-md">
</div>
</div>
<div class="form-group">
<label class="col-md-4 control-label" for="txtTitle">Title</label>
<div class="col-md-4">
<input id="txtTitle" name="txtTitle" type="text" placeholder="" class="form-control input-md">
</div>
</div>
<div class="form-group">
<label class="col-md-4 control-label" for="selectEndUser">End Use</label>
<div class="col-md-4">
<select id="selectEndUser" name="selectEndUser" class="form-control">