<link href="//netdna.bootstrapcdn.com/bootstrap/3.0.1/css/bootstrap.min.css" rel="stylesheet" id="bootstrap-css">
<script src="//netdna.bootstrapcdn.com/bootstrap/3.0.1/js/bootstrap.min.js"></script>
<script src="//code.jquery.com/jquery-1.11.1.min.js"></script>
<form class="form-horizontal">
<fieldset>
<legend>Source address</legend>
<div class="form-group">
<label class="col-md-4 control-label" for="Country">Country</label>
<div class="col-md-5">
<select id="Country" name="Country" class="form-control">
<option value="IR">IR Iran</option>
<option value="USA">United States</option>
</select>
</div>
</div>
<div class="form-group">
<label class="col-md-4 control-label" for="State">State</label>
<div class="col-md-6">
<input id="State" name="State" type="text" placeholder="state" class="form-control input-md" required="">
<span class="help-block">Enter Source state</span>
</div>
</div>
<div class="form-group">
<label class="col-md-4 control-label" for="city">City/Town</label>
<div class="col-md-6">
<input id="city" name="city" type="text" placeholder="city or town" class="form-control input-md" required="">
