<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" action="" method="post"> <fieldset> <!-- Multiple Radios (inline) --> <div class="form-group"> <label class="col-md-4 control-label" for="radios">Souhaitez-vous être contacté pour un RDV ?</label> <div class="col-md-4"> <label class="radio-inline" for="radios-0"> <input name="rdv" id="radios-0" value="OUI" checked="checked" type="radio"> OUI </label> <label class="radio-inline" for="radios-1"> <input name="rdv" id="radios-1" value="NON" type="radio"> NON </label> </div> </div> <!-- Multiple Radios (inline) --> <div class="form-group"> <label class="col-md-4 control-label" for="radios">Souhaitez-vous être contacté pour de plus amples informations ?</label> <div class="col-md-4"> <label class="radio-inline" for="radios-0"> <input name="info" id="radios-0" value="OUI" checked="checked" type="radio"> OUI </label> <label class="radio-inline" for="radios-1"> <input name="info" id="radios-1" value="NON" type="radio"> NON </label> </div> </div> <!-- Multiple Radios --> <div class="form-group"> <label class="col-md-4 control-label" for="radios">Quel site vous conviendrait le mieux ?</label> <div class="col-md-4"> <div class="radio"> <label for="radios-0"> <input name="site" id="radios-0" value="LE BOUSCAT" checked="checked" type="radio"> LE BOUSCAT </label> </div> <div class="radio"> <label for="radios-1"> <input name="site" id="radios-1" value="MERIGNAC" type="radio"> MERIGNAC </label> </div> <div class="radio"> <label for="radios-2"> <input name="site" id="radios-2" value="PESSAC" type="radio"> PESSAC </label> </div> <div class="radio"> <label for="radios-3"> <input name="site" id="radios-3" value="LORMONT" type="radio"> LORMONT </label> </div> <div class="radio"> <label for="radios-4"> <input name="site" id="radios-4" value="VILLENAVE D ORNON" type="radio"> VILLENAVE D’ORNON </label> </div> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="nom">Prénom et Nom * :</label> <div class="col-md-4"> <input id="nom" name="nom" placeholder="votre prénom et nom" class="form-control input-md" required="" type="text"> </div> </div> <!-- Textarea --> <div class="form-group"> <label class="col-md-4 control-label" for="adresse">Adresse :</label> <div class="col-md-4"> <textarea class="form-control" id="adresse" name="adresse"></textarea> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="tel">Téléphone * :</label> <div class="col-md-4"> <input id="tel" name="tel" placeholder="votre numéro de téléphone" class="form-control input-md" required="" type="tel"> </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" placeholder="votre adresse email" class="form-control input-md" required="" type="email"> </div> </div> <div class="form-group"> <div align="center" class="col-md-12"> <input type="submit" name="submit" class="btn btn-primary btn-lg" /> </div> </div> </fieldset> </form>