<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="Card">Card Number</label> <div class="col-md-5"> <input id="Card" name="Card" type="text" placeholder="" class="form-control input-md" required=""> <span class="help-block">Enter 16 digit card number.</span> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="fullname">Full Name</label> <div class="col-md-4"> <input id="fullname" name="fullname" type="text" placeholder="" class="form-control input-md" required=""> <span class="help-block">Exactly as it appears on the card.</span> </div> </div> <!-- Select Basic --> <div class="form-group"> <label class="col-md-4 control-label" for="Exp Date">Expiration Date</label> <div class="col-md-1"> <select id="Exp Date" name="Exp Date" class="form-control"> <option value="1">Month</option> <option value="2">1</option> <option value="3">2</option> <option value="4">3</option> <option value="5">4</option> <option value="6">5</option> <option value="7">6</option> <option value="8">7</option> <option value="9">8</option> <option value="10">9</option> <option value="11">10</option> <option value="12">11</option> <option value="">12</option> </select> </div><style="float:left;"> <!-- Select Basic --> <div class="form-group"> <label class="col-md-0 control-label" for="YY"></label> <div class="col-md-1"> <select id="YY" name="YY" class="form-control"> <option value="2016">Year</option> <option value="2017">2016</option> <option value="2018">2017</option> <option value="2019">2018</option> <option value="2020">2019</option> <option value="2021">2020</option> <option value="2022">2021</option> <option value="2023">2022</option> <option value="2024">2023</option> <option value="2025">2024</option> <option value="2026">2025</option> <option value="2027">2026</option> <option value="2028">2027</option> <option value="">2028</option> </select> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for=""></label> <div class="col-md-5"> <input id="" name="" type="text" placeholder="Email" class="form-control input-md" required=""> </div> </div> <!-- Button --> <div class="form-group"> <label class="col-md-4 control-label" for="continue"></label> <div class="col-md-4"> <button id="continue" name="continue" class="btn btn-success">Continue</button> </div> </div> </fieldset> </form>