<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"> <form class="form-horizontal"> <fieldset> <!-- Form Name --> <legend>Add Card</legend> <!-- Text input--> <div class="form-group col-lg-6"> <label class="col-md-4 control-label" for="textinput">Card Number:</label> <div class="col-md-8"> <input id="NameonCard" name="textinput" type="text" placeholder="Enter Card Number" class="form-control input-md"> </div> </div> <div class="form-group col-lg-6"> <label class="col-md-4 control-label" for="textinput">Name on Card:</label> <div class="col-md-8"> <input id="NameonCard" name="textinput" type="text" placeholder="Enter Name on Card" class="form-control input-md"> </div> </div> <div class="form-group col-lg-6"> <label class="col-md-4 control-label" for="textinput">Exp Date:</label> <div class="col-md-8"> <div class='col-md-6' style="padding-left:0px"> <select class="form-control input-md"> <option>MM</option> </select> </div> <div class='col-md-6' style="padding-right:0px"> <select class="form-control input-md"> <option>YY</option> </select> </div </div> </div> </fieldset> <fieldset style='background-color: #F0F0F0;padding-top: 25px; margin-bottom:15px;'> <div class="form-group "> <label class="col-md-2 control-label" for="textinput">Address 1:</label> <div class="col-md-10"> <input id="Address" name="textinput" type="text" placeholder="Enter Address" class="form-control input-md"> </div> </div> <div class="form-group col-lg-6"> <label class="col-md-4 control-label" for="textinput">City:</label> <div class="col-md-8"> <input id="City" name="textinput" type="text" placeholder="Enter Card Numbe" class="form-control input-md"> </div> </div> <div class="form-group col-lg-6"> <label class="col-md-4 control-label" for="textinput">Country:</label> <div class="col-md-8"> <select class="form-control input-md"> <option>Select Country</option> </select> </div> </div> </fieldset> <fieldset> <div class="form-group col-lg-6"> <label class="col-md-4 control-label" for="textinput">Card Nick name:</label> <div class="col-md-8"> <input id="CardNickName" name="textinput" type="text" placeholder="Enter Card Nick Name" class="form-control input-md"> </div> </div> </fieldset> <fieldset> <!-- Button (Double) --> <div class="form-group"> <div class="col-md-12 text-center"> <button id="cancel" name="cancel" class="btn btn-primary">Cancel</button> <button id="save" name="save" class="btn btn-primary">Save</button> </div> </div> </fieldset> </form> </div>