<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>
<div class="container">
<form class="form-horizontal" role="form">
<fieldset>
<legend>Payment</legend>
<div class="form-group">
<label class="col-sm-3 control-label" for="card-holder-name">Name on Card</label>
<div class="col-sm-9">
<input type="text" class="form-control" name="card-holder-name" id="card-holder-name" placeholder="Card Holder's Name">
</div>
</div>
<div class="form-group">
<label class="col-sm-3 control-label" for="card-number">Card Number</label>
<div class="col-sm-9">
<input type="text" class="form-control" name="card-number" id="card-number" placeholder="Debit/Credit Card Number">
</div>
</div>
<div class="form-group">
<label class="col-sm-3 control-label" for="expiry-month">Expiration Date</label>
<div class="col-sm-9">
<div class="row">
<div class="col-xs-3">
<select class="form-control col-sm-2" name="expiry-month" id="expiry-month">
<option>Month</option>
<option value="01">Jan (01)</option>
<option value="02">Feb (02)</option>
<option value="03">Mar (03)</option>
<option value="04">Apr (04)</option>
<option value="05">May (05)</option>
<option value="06">June (06)</option>
<option value="07">July (07)</option>
<option value="08">Aug (08)</option>
<option value="09">Sep (09)</option>