<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>Form Name</legend> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">Naam Rechthebbende / Client *</label> <div class="col-md-4"> <input id="textinput" name="textinput" placeholder="placeholder" class="form-control input-md" type="text"> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">Naam Gemachtigde of Erfgenaam</label> <div class="col-md-4"> <input id="textinput" name="textinput" placeholder="placeholder" class="form-control input-md" type="text"> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">Naam Partner</label> <div class="col-md-4"> <input id="textinput" name="textinput" placeholder="placeholder" class="form-control input-md" type="text"> </div> </div> <!-- Multiple Radios (inline) --> <div class="form-group"> <label class="col-md-4 control-label" for="radios">Staat de partner ook onder beschermingsbewind?</label> <div class="col-md-4"> <label class="radio-inline" for="radios-0"> <input name="radios" id="radios-0" value="Ja" checked="checked" type="radio"> Ja </label> <label class="radio-inline" for="radios-1"> <input name="radios" id="radios-1" value="Nee" type="radio"> Nee </label> </div> </div> <!-- Multiple Radios (inline) --> <div class="form-group"> <label class="col-md-4 control-label" for="radios">Staat de partner bij Krens Inkomsten-en Uitgavenbeheer onder beschermingsbewind?: </label> <div class="col-md-4"> <label class="radio-inline" for="radios-0"> <input name="radios" id="radios-0" value="Ja" checked="checked" type="radio"> Ja </label> <label class="radio-inline" for="radios-1"> <input name="radios" id="radios-1" value="Nee" type="radio"> Nee </label> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">Zo niet, vul hier de naam organisatie en/of bewindvoerder in</label> <div class="col-md-4"> <input id="textinput" name="textinput" placeholder="placeholder" class="form-control input-md" type="text"> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">Adres *</label> <div class="col-md-4"> <input id="textinput" name="textinput" placeholder="placeholder" class="form-control input-md" type="text"> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">Postcode en Woonplaats *</label> <div class="col-md-4"> <input id="textinput" name="textinput" placeholder="placeholder" class="form-control input-md" type="text"> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">Telefoonnummer *</label> <div class="col-md-4"> <input id="textinput" name="textinput" placeholder="placeholder" class="form-control input-md" type="text"> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">E-mailadres *</label> <div class="col-md-4"> <input id="textinput" name="textinput" placeholder="placeholder" class="form-control input-md" type="text"> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">Naam van uw bewindvoerder *</label> <div class="col-md-4"> <input id="textinput" name="textinput" placeholder="placeholder" class="form-control input-md" type="text"> </div> </div> <!-- Multiple Radios (inline) --> <div class="form-group"> <label class="col-md-4 control-label" for="radios">Hebt u uw klacht al bij uw bewindvoerder neergelegd?*</label> <div class="col-md-4"> <label class="radio-inline" for="radios-0"> <input name="radios" id="radios-0" value="Ja" checked="checked" type="radio"> Ja </label> <label class="radio-inline" for="radios-1"> <input name="radios" id="radios-1" value="Nee" type="radio"> Nee </label> </div> </div> <!-- Multiple Radios (inline) --> <div class="form-group"> <label class="col-md-4 control-label" for="radios">Loopt deze klacht ook bij de rechtbank?*</label> <div class="col-md-4"> <label class="radio-inline" for="radios-0"> <input name="radios" id="radios-0" value="Ja" checked="checked" type="radio"> Ja </label> <label class="radio-inline" for="radios-1"> <input name="radios" id="radios-1" value="Nee" type="radio"> Nee </label> </div> </div> <!-- Multiple Radios (inline) --> <div class="form-group"> <label class="col-md-4 control-label" for="radios">Welke dienst neemt u van de organisatie af?</label> <div class="col-md-4"> <label class="radio-inline" for="radios-0"> <input name="radios" id="radios-0" value="Beschermingsbewind" checked="checked" type="radio"> Beschermingsbewind </label> <label class="radio-inline" for="radios-1"> <input name="radios" id="radios-1" value="Inkomstenbeheer" type="radio"> Inkomstenbeheer </label> <label class="radio-inline" for="radios-2"> <input name="radios" id="radios-2" value="Anders" type="radio"> Anders </label> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">Anders</label> <div class="col-md-4"> <input id="textinput" name="textinput" placeholder="" class="form-control input-md" type="text"> </div> </div> <!-- Multiple Radios (inline) --> <div class="form-group"> <label class="col-md-4 control-label" for="radios">Is het dossier inmiddels beëindigd/gesloten?*</label> <div class="col-md-4"> <label class="radio-inline" for="radios-0"> <input name="radios" id="radios-0" value="Nee" checked="checked" type="radio"> Nee </label> <label class="radio-inline" for="radios-1"> <input name="radios" id="radios-1" value="Ja" type="radio"> Ja </label> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">Zo ja, met ingang van</label> <div class="col-md-4"> <input id="textinput" name="textinput" placeholder="Zo ja, met ingang van" class="form-control input-md" type="text"> </div> </div> <!-- Textarea --> <div class="form-group"> <label class="col-md-4 control-label" for="textarea">Vat hier uw klacht kort samen *</label> <div class="col-md-4"> <textarea class="form-control" id="textarea" name="textarea">Vat hier uw klacht kort samen *</textarea> </div> </div> </fieldset> </form>