<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" style="margin-top:20px"> <div class="col-xs-12 col-sm-8 col-md-6 col-sm-offset-2 col-md-offset-3"> <form role="form"> <fieldset> <div class="row"> <div class="col-xs-2 col-sm-2 col-md-2"> <img src="http://i67.tinypic.com/d9mx5.png" width="60px"> </div> <div class="col-xs-6 col-sm-6 col-md-6"> <h2>PLN</h2> <span>Prabayar</span> </div> </div> <div class="form-group"> <input type="text" name="phone" id="email" class="form-control input-lg" placeholder="Masukkan nomor meter"> </div> <div class="form-group"> <select name="nominal" id="password" class="form-control input-lg"> <option>Pilih nominal pulsa</option> <option>Rp 22.000,-</option> <option>Rp 52.000,-</option> <option>Rp 102.000,-</option> <option>Rp 202.000,-</option> <option>Rp 502.000,-</option> </select> </div> <div class="row"> <input type="submit" class="btn btn-lg btn-success btn-block" value="PROSES"> </div> </fieldset> </form> </div> </div> </div>