<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 ----------> <form class="form-horizontal"> <fieldset> <!-- Form Name --> <legend>İşlem Bilgi Talebi</legend> <!-- Select Basic --> <div class="form-group"> <label class="col-md-4 control-label" for="selectbasic">Ödeme Yöntemi:</label> <div class="col-md-5"> <select id="selectbasic" name="selectbasic" class="form-control"> <option value="1">Kredi Kartı</option> <option value="2">Mobil Ödeme</option> </select> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">Kart Sahibi:</label> <div class="col-md-5"> <input id="textinput" name="textinput" type="text" placeholder="Kart Sahibinin Adı & Soyadı" class="form-control input-md"> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">Kredi Kartı Numarası:</label> <div class="col-md-5"> <input id="textinput" name="textinput" type="text" placeholder="Örneğin: 4444-4444-4444-4444" class="form-control input-md"> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">İşlem Tarihi & Saati:</label> <div class="col-md-5"> <input id="textinput" name="textinput" type="text" placeholder="Örneğin: 23/01/1900 - 12:02" class="form-control input-md"> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">İşlem Tutarı:</label> <div class="col-md-5"> <input id="textinput" name="textinput" type="text" placeholder="Örneğin: 10.05" class="form-control input-md"> </div> </div> <!-- Select Basic --> <div class="form-group"> <label class="col-md-4 control-label" for="selectbasic">Para Birimi:</label> <div class="col-md-5"> <select id="selectbasic" name="selectbasic" class="form-control"> <option value="1">Türk Lirası</option> <option value="2">Euro</option> </select> </div> </div> <!-- Textarea --> <div class="form-group"> <label class="col-md-4 control-label" for="textarea">Talebiniz:</label> <div class="col-md-4"> <textarea class="form-control" id="textarea" name="textarea">Lütfen tüm talebinizi detaylı şekilde yazınız.</textarea> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">Adınız & Soyadınız:</label> <div class="col-md-5"> <input id="textinput" name="textinput" type="text" placeholder="Başvuru yapanın Adı & Soyadı" class="form-control input-md"> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">E-Posta Adresiniz:</label> <div class="col-md-5"> <input id="textinput" name="textinput" type="text" placeholder="Başvuru yapanın E-Posta Adresi" class="form-control input-md"> </div> </div> <!-- Password input--> <div class="form-group"> <label class="col-md-4 control-label" for="passwordinput">Telefon Numaranız:</label> <div class="col-md-5"> <input id="passwordinput" name="passwordinput" type="password" placeholder="Başvuru yapanın Tel. Numarası" class="form-control input-md"> </div> </div> <!-- Button --> <div class="form-group"> <label class="col-md-4 control-label" for="singlebutton"></label> <div class="col-md-4"> <button id="singlebutton" name="singlebutton" class="btn btn-primary">GÖNDER</button> </div> </div> </fieldset> </form>