<link href="//maxcdn.bootstrapcdn.com/bootstrap/4.1.1/css/bootstrap.min.css" rel="stylesheet" id="bootstrap-css"> <script src="//maxcdn.bootstrapcdn.com/bootstrap/4.1.1/js/bootstrap.min.js"></script> <script src="//cdnjs.cloudflare.com/ajax/libs/jquery/3.2.1/jquery.min.js"></script> <!------ Include the above in your HEAD tag ----------> <form class="form-horizontal"> <fieldset> <!-- Form Name --> <div class="container"> <legend>ONLINE PAYMENT</legend> <!-- Select Basic --> <div class="form-group"> <label class="col-md-4 control-label" for="selectbasic">Currency</label> <div class="col-md-4"> <select id="selectbasic" name="selectbasic" class="form-control"> <option value="1">INR</option> <option value="2">EURO</option> <option value="3">GBP</option> <option value="4">USD</option> </select> </div> </div> <!-- Search input--> <div class="form-row"> <div class="form-group"> <label class="col-md-4 mb-4 control-label" for="INR">INR</label> <div class="col-md-4 mb-4"> <input id="INR" name="INR" type="search" placeholder="₹ Amount" class="form-control input-md"> </div> </div> <!-- Search input--> <div class="form-group"> <label class="col-md-4 mb-4 control-label" for="EURO">EURO</label> <div class="col-md-4 mb-4"> <input id="EURO" name="EURO" type="search" placeholder="€ Amount" class="form-control input-md" required=""> </div> </div> <!-- Search input--> <div class="form-group"> <label class="col-md-4 mb-4 control-label" for="GBP">GBP</label> <div class="col-md-4 mb-4"> <input id="GBP" name="GBP" type="search" placeholder="£ Amount" class="form-control input-md" required=""> </div> </div> <!-- Search input--> <div class="form-group"> <label class="col-md-4 mb-4 control-label" for="USD">USD</label> <div class="col-md-4 mb-4"> <input id="USD" name="USD" type="search" placeholder="$ Amount" class="form-control input-md" required=""> </div> </div> </div> <div class="form-row"> <!-- Text input--> <div class="container"> <legend>BILLING DETAILS</legend> <div class="form-group"> <label class="md-4 control-label" for="Tour Name">Name of the Tour</label> <div class="col-md-4"> <input id="Tour Name" name="Tour Name" type="text" placeholder=" Romantic Honeymoon in India " class="form-control input-md" required=""> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="Name">* Name</label> <div class="col-md-4"> <input id="Name" name="Name" type="text" placeholder="First + Middle + Last" class="form-control input-md" required=""> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="Address">*Address</label> <div class="col-md-4"> <input id="Address" name="Address" type="text" placeholder="Complete Address" class="form-control input-md" required=""> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="City">*City</label> <div class="col-md-4"> <input id="City" name="City" type="text" placeholder="New Delhi" class="form-control input-md" required=""> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="ZIP/Postal Code">*ZIP/Postal Code</label> <div class="col-md-4"> <input id="ZIP/Postal Code" name="ZIP/Postal Code" type="text" placeholder="110001" class="form-control input-md" required=""> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="*Country">*Country</label> <div class="col-md-4"> <input id="*Country" name="*Country" type="text" placeholder="India" class="form-control input-md" required=""> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="Email">*Email</label> <div class="col-md-4"> <input id="Email" name="Email" type="text" placeholder="name@company.com" class="form-control input-md" required=""> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="Telephone">*Telephone</label> <div class="col-md-4"> <input id="Telephone" name="Telephone" type="text" placeholder="1-541-754-3010" class="form-control input-md" required=""> </div> </div> <!-- Textarea --> <div class="form-group"> <label class="col-md-4 control-label" for="textarea">Additional Note</label> <div class="col-md-4"> <textarea class="form-control" id="textarea" name="textarea">Remarks</textarea> </div> </div> <!-- Button (Double) --> <div class="form-group"> <label class="col-md-4 control-label" for="button1id"></label> <div class="col-md-8"> <button id="button1id" name="button1id" class="btn btn-success">Submit</button> <button id="button2id" name="button2id" class="btn btn-primary">Reset</button> </div> </div> </fieldset> </form>