<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 class="container">
<div class="row">
<div class="col-md-12">
Authorize w/ Login:</br>
</div>
</div>
<div class="row">
<div class="col-md-12">
<div class="panel panel-default">
<div class="panel-body">
<div class="row">
<div class="col-md-5" >
<div class="row text-center">
<img class="applogo" src="http://placehold.it/64x64"/>
</div>
<div class="row text-center">
<p><b>Test App</b> would like to use:</p>
</div>
<div class="row text-center" style="left: 100px;">
<ul class="appperms">
<li><span class="appperm" style="width:100%;">Your soul</span></li>
<li><span class="appperm" style="width:100%;">Your soul</span></li>
</ul>
</div>
</div>
<div class="col-md-7" style="border-left:1px solid #ccc;height:160px">
<form class="form-horizontal">
<fieldset>
<input id="textinput" name="textinput" type="text" placeholder="Enter User Name" class="form-control input-md">