"Peça sua capa"
Bootstrap 3.2.0 Snippet by NanaPiber

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<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>
<!------ Include the above in your HEAD tag ---------->
<!-- Form Name -->
<legend>Peça sua Capa</legend>
<!-- Text input-->
<div class="control-group">
<label class="control-label" for="textinput">Nome do Autor</label>
<div class="controls">
<input id="textinput" name="textinput" type="text" placeholder="ex:LollyNiall" class="input-medium" required="">
</div>
</div>
<!-- Text input-->
<div class="control-group">
<label class="control-label" for="textinput">Nome da Fanfic</label>
<div class="controls">
<input id="textinput" name="textinput" type="text" placeholder="ex:Monsoon" class="input-medium" required="">
</div>
</div>
<!-- Password input-->
<div class="control-group">
<label class="control-label" for="passwordinput">Contato</label>
<div class="controls">
<input id="passwordinput" name="passwordinput" type="password" placeholder="e-mail, gmail, Twitter, Facebook" class="input-xlarge" required="">
</div>
</div>
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