<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="reciept"> <div class="row" style="margin-top:10px;"> <div class="col-md-8"> <div class="col-md-3"> <img class="media-object img-thumbnail user-img" style="height: 80px;" alt="User Picture" src="http://via.placeholder.com/80x80"></div> <div class="col-md-9 text-right"> <h4 class="heading">Aspirant English Classess</h4> <h5 class="heading">Hanuman Mandir C.C.Road, Deoria</h5> <h6 class="heading">+91 9455078760</h6> </div> </div> <div class="col-md-4"> <div class="form-group"> <label class="col-md-4 control" >Date :</label> <div class="col-md-8"> <input id="" name="name" type="text" placeholder="10-May-2017 02:05 pm" class="form-control"> </div> </div> <div class="form-group"> <label class="col-md-4 control" >Reciept No. :</label> <div class="col-md-8"> <input id="" name="name" type="text" placeholder="12349" class="form-control"> </div> </div> </div> </div> <br/> <div class="row"> <div class="col-md-12"> <div class="form-group"> <label class="col-md-3 control" for="">Student Name :</label> <div class="col-md-9"> <input id="" name="name" type="text" placeholder="Your name" class="form-control"> </div> </div> <div class="form-group"> <label class="col-md-3 control" for="">Course :</label> <div class="col-md-9"> <input id="" name="name" type="text" placeholder="Course" class="form-control"> </div> </div> </div> </div> <div class="row"> <div class="col-md-6"> <div class="form-group"> <label class="col-md-6 control" for="">Section :</label> <div class="col-md-6" style="padding-left:20px;"> <input id="" name="name" type="text" placeholder="Section" class="form-control" > </div> </div> </div> <div class="col-md-6"> <div class="form-group"> <label class="col-md-3 control" for="">Batch :</label> <div class="col-md-9"> <input id="" name="name" type="text" placeholder="Batch" class="form-control"> </div> </div> </div> </div> <div class="row"> <div class="col-md-12"> <div class="form-group"> <label class="col-md-3 control" for="name">Recieve Amount :</label> <div class="col-md-9"> <input id="name" name="name" type="text" placeholder="Amount" class="form-control"> </div> </div> </div> </div> <br/> <div class="row"> <div class="col-md-6"> <div class="form-group"> <label class="col-md-3 control" for="name">Cash :</label> <div class="col-md-9"> <input id="checkbox2" type="checkbox" checked="" class="form-control"> </div> </div> <div class="form-group"> <label class="col-md-3 control" for="name">Cheque :</label> <div class="col-md-9"> <input id="checkbox2" type="checkbox" checked="" class="form-control"> </div> </div> <div class="form-group"> <label class="col-md-3 control">Bank Transfer :</label> <div class="col-md-9"> <input id="checkbox2" type="checkbox" checked="" class="form-control"> </div> </div> </div> <div class="col-md-6"> <div class="form-group"> <label class="col-sm-3 control">Bank Name :</label> <div class="col-sm-9"> <input id="" name="name" type="text" placeholder="State Bank of India" class="form-control"> </div> </div> <div class="form-group"> <label class="col-sm-3 control" >Cheque No :</label> <div class="col-sm-9"> <input id="" name="name" type="text" placeholder="Cheque no" class="form-control"> </div> </div> <div class="form-group"> <label class="col-sm-3 control" >Date :</label> <div class="col-sm-9"> <input id="" name="name" type="text" placeholder="Date" class="form-control"> </div> </div> </div> </div> <br/> <div class="row"> <div class="col-md-12"> <div class="form-group"> <label class="col-md-3 control" for="name">Recieved By :</label> <div class="col-md-9"> <input id="name" name="name" type="text" placeholder="Authorised Person" class="form-control"> </div> </div> </div> </div> <div class="row" style="margin-top:80px;"> <div class="col-md-9"> </div> <div class="col-md-3"> <div class="form-group"> <label class="control" for="name"><u>Authorised Signatury</u></label> </div> </div> </div> </div> </div> </div> </div>

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