<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 id="fullscreen_bg" class="fullscreen_bg"/>
<form class="form-signin">
<div class="container">
<div class="row">
<div class="col-md-4 col-md-offset-4">
<div class="panel panel-default">
<div class="panel-body">
<h3 class="text-center">
Add Account </h3>
<form class="form form-signup" role="form">
<div class="form-group">
<div class="input-group">
<span class="input-group-addon"><span class="glyphicon glyphicon-pencil"></span>
</span>
<input type="text" class="form-control" placeholder="Name" />
</div>
</div>
<div class="form-group">
<div class="input-group">
<span class="input-group-addon"><span class="glyphicon glyphicon-lock"></span></span>
<input type="password" class="form-control" placeholder="Password" />
</div>
</div>
<div class="form-group">
<div class="input-group">
<span class="input-group-addon"><span class="glyphicon glyphicon-question-sign"></span></span>
<select id="subject" placeholder="Type"
class="form-control" required="required">
<option value="suggestions">Secretary</option>
<option value="product">Assistant</option> </select>
</div>