<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>
<div class="container">
<div class="row">
<form class="form-horizontal">
<fieldset>
<legend><center>User Service Request Details</center></legend>
<div class="form-group">
<label class="col-md-4 control-label" for="requestid">Request ID</label>
<div class="col-md-4">
<input id="requestid" name="reqid" placeholder="Request Id" class="form-control input-md" required="" type="text">
</div>
</div>
<div class="form-group">
<label class="col-md-4 control-label" for="declineType">Issue Type</label>
<div class="col-md-4">
<select id="issuetype" name="issuetype" class="form-control">
<option value="l">Blumber</option>
<option value="2">Electrician</option>
</select>
</div>
</div>
<div class="form-group">
<label class="col-md-4 control-label" for="dis">Discriptions</label>
<div class="col-md-4">
<textarea class="form-control" id="dis" name="dis"></textarea>