<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 ----------> <div> <form class="form-horizontal"> <fieldset> <!-- Form Name --> <legend>Register</legend> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="name">Vendor Name</label> <div class="col-md-4"> <input id="name" name="name" type="text" placeholder="Vendor Name" class="form-control input-md" required=""> <span class="help-block">Name of buisness</span> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="phone">Phone</label> <div class="col-md-4"> <input id="phone" name="phone" type="text" placeholder="Phone Number" class="form-control input-md" required=""> <span class="help-block">Business Phone</span> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="email">Email</label> <div class="col-md-4"> <input id="email" name="email" type="text" placeholder="Email address" class="form-control input-md" required=""> <span class="help-block">Email will be used for notication messages</span> </div> </div> <!-- Password input--> <div class="form-group"> <label class="col-md-4 control-label" for="password">Password </label> <div class="col-md-4"> <input id="password" name="password" type="password" placeholder="Password " class="form-control input-md" required=""> <span class="help-block">Admin Password </span> </div> </div> <!-- Password input--> <div class="form-group"> <label class="col-md-4 control-label" for="rpassword">confirm</label> <div class="col-md-4"> <input id="rpassword" name="rpassword" type="password" placeholder="Password" class="form-control input-md" required=""> <span class="help-block">Retype pass word</span> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="address1">Address</label> <div class="col-md-4"> <input id="address1" name="address1" type="text" placeholder="Address " class="form-control input-md" required=""> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="address1"></label> <div class="col-md-4"> <input id="address1" name="address1" type="text" placeholder="Address2" class="form-control input-md"> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="city">City</label> <div class="col-md-4"> <input id="city" name="city" type="text" placeholder="City" class="form-control input-md" required=""> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="selectbasic">Select Basic</label> <div class="col-md-4"> <select id="selectbasic" name="selectbasic" class="form-control"> <option value="">Choose State:</option> <option value="AL">Alabama</option> <option value="AK">Alaska</option> <option value="AZ">Arizona</option> <option value="AR">Arkansas</option> <option value="CA">California</option> <option value="CO">Colorado</option> <option value="CT">Connecticut</option> <option value="DE">Delaware</option> <option value="FL">Florida</option> <option value="GA">Georgia</option> <option value="HI">Hawaii</option> <option value="ID">Idaho</option> <option value="IL">Illinois</option> <option value="IN">Indiana</option> <option value="IA">Iowa</option> <option value="KS">Kansas</option> <option value="KY">Kentucky</option> <option value="LA">Louisiana</option> <option value="ME">Maine</option> <option value="MD">Maryland</option> <option value="MA">Massachusetts</option> <option value="MI">Michigan</option> <option value="MN">Minnesota</option> <option value="MS">Mississippi</option> <option value="MO">Missouri</option> <option value="MT">Montana</option> <option value="NE">Nebraska</option> <option value="NV">Nevada</option> <option value="NH">New Hampshire</option> <option value="NJ">New Jersey</option> <option value="NM">New Mexico</option> <option value="NY">New York</option> <option value="NC">North Carolina</option> <option value="ND">North Dakota</option> <option value="OH">Ohio</option> <option value="OK">Oklahoma</option> <option value="OR">Oregon</option> <option value="PA">Pennsylvania</option> <option value="RI">Rhode Island</option> <option value="SC">South Carolina</option> <option value="SD">South Dakota</option> <option value="TN">Tennessee</option> <option value="TX">Texas</option> <option value="UT">Utah</option> <option value="VT">Vermont</option> <option value="VA">Virginia</option> <option value="WA">Washington</option> <option value="WV">West Virginia</option> <option value="WI">Wisconsin</option> <option value="WY">Wyoming</option> </select> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="zip">Zip Code</label> <div class="col-md-4"> <input id="zip" name="zip" type="text" placeholder="Zip Code" class="form-control input-md" required=""> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="contactname">Contact Name</label> <div class="col-md-4"> <input id="contactname" name="contactname" type="text" placeholder="Full Name" class="form-control input-md" required=""> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="contactphone">Contact Phone</label> <div class="col-md-4"> <input id="contactphone" name="contactphone" type="text" placeholder="Phone Number" class="form-control input-md" required=""> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="contactemail">Email</label> <div class="col-md-4"> <input id="contactemail" name="contactemail" type="text" placeholder="Email Address" class="form-control input-md" required=""> </div> </div> <!-- Button (Double) --> <div class="form-group"> <label class="col-md-4 control-label" for="save"></label> <div class="col-md-8"> <button id="save" name="save" class="btn btn-success">Save</button> <button id="cancel" name="cancel" class="btn btn-danger">Cancel</button> </div> </div> </fieldset> </form> </div>