<link href="//netdna.bootstrapcdn.com/bootstrap/3.2.0/css/bootstrap.min.css" rel="stylesheet" id="bootstrap-css">
<script src="//netdna.bootstrapcdn.com/bootstrap/3.2.0/js/bootstrap.min.js"></script>
<script src="//code.jquery.com/jquery-1.11.1.min.js"></script>
<div class="container">
<div class="row">
<h2>Multiple fields contact form</h2>
<div class="col-md-4">
<div class="contacts">
<label>Contacts:</label>
<div class="form-group multiple-form-group input-group">
<div class="input-group-btn input-group-select">
<button type="button" class="btn btn-default dropdown-toggle" data-toggle="dropdown">
<span class="concept">Phone</span> <span class="caret"></span>
</button>
<ul class="dropdown-menu" role="menu">
<li><a href="#phone">JUSA - Jawatan Terbuka</a></li>
<li><a href="#fax">Fax</a></li>
<li><a href="#skype">Skype</a></li>
<li><a href="#email">E-mail</a></li>
<li><a href="#www">Web</a></li>
</ul>
<input type="hidden" class="input-group-select-val" name="contacts['type'][]" value="phone">
</div>
<input type="text" name="contacts['value'][]" class="form-control">
<span class="input-group-btn">
<button type="button" class="btn btn-success btn-add">+</button>
</span>
</div>
</div>
</div>
</div>
</div>
</div>