<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 vertical-offset-100">
<div class="col-md-4 col-md-offset-4">
<div class="panel panel-default">
<div class="panel-heading">
<h3 class="panel-title">User Service Request</h3>
</div>
<div class="panel-body">
<form accept-charset="UTF-8" role="form">
<fieldset>
<div class="form-group">
<select class="form-control" name="housetype">
<option>Single family home</option>
<option>Condo or Townhouse</option>
<option>Other</option>
</select>
</div>
<div class="form-group">
<input class="form-control" placeholder="Address" name="email" type="text">
</div>
<div class="form-group">
<input class="form-control" placeholder="Zip Code" name="email" type="text">
</div>
<div class="form-group">
<input class="form-control" placeholder="E-mail" name="email" type="text">
</div>
<input class="btn btn-lg btn-success btn-block" type="submit" value="Send me my free solar report">
</fieldset>
</form>
</div>
