ticket form

by jt3k

HTML

<link rel="stylesheet" href="http://twitter.github.com/bootstrap/1.4.0/bootstrap.min.css">
<div class="container">
    <div>
        <h1 class="page-header">Новая заявка <small>создана 13:25:25 12ноя2012г</small></h1>
    </div>
        <div class="row">
            <div class="span4">
                <p>Заполните необходимые поля и нажмите на синюю кнопку ниже.</p>
            </div>
            <div class="span12">
<fieldset>
          <legend>Example form legend</legend>
          <div class="clearfix">
            <label for="xlInput">X-Large input</label>
            <div class="input">
              <input type="text" size="30" name="xlInput" id="xlInput" class="xlarge">
            </div>
          </div><!-- /clearfix -->
          <div class="clearfix">
            <label for="normalSelect">Select</label>
            <div class="input">
              <select id="normalSelect" name="normalSelect">
                <option>1</option>
                <option>2</option>
                <option>3</option>
                <option>4</option>
                <option>5</option>
              </select>
            </div>
          </div><!-- /clearfix -->
          <div class="clearfix">
            <label for="mediumSelect">Select</label>
            <div class="input">
              <select id="mediumSelect" name="mediumSelect" class="medium">
                <option>1</option>
                <option>2</option>
                <option>3</option>
                <option>4</option>
                <option>5</option>
              </select>
            </div>
          </div><!-- /clearfix -->
          <div class="clearfix">
            <label for="multiSelect">Multiple select</label>
            <div class="input">
              <select id="multiSelect" name="multiSelect" multiple="multiple" size="5" class="medium">
                <option>1</option>
                <option>2</option>
                <option>3</option>
                <option>4</option>
         ...