<div class="row">
<div class="form-horizontal">
    <div class="form-group col-md-12 col-xs-12">
        <div class="col-md-4 col-xs-12">
            <label class="control-label">Domestic</label>
        </div>
        <div class="col-md-4 col-xs-12">
            <input id="percentage" class="form-control" type="text" placeholder="Percentage">
            <span class="input-group-addon">
                <i class="glyphicon glyphicon-remove-circle"></i>
            </span>
        </div>
        <div class="col-md-4 col-xs-12">
            <input id="flat" class="form-control" type="text" placeholder="Flat (eg. 0.33)">
            <span class="input-group-addon">
                <i class="glyphicon glyphicon-remove-circle"></i>
            </span>
        </div>
    </div>
</div>