<form class="form-horizontal" style="margin-bottom: 0;" id="validateSubmitForm" method="get" autocomplete="off" novalidate="novalidate">

    <div class="well" style="padding-bottom: 20px; margin: 0;">
        <h4>Personal info</h4>
        <hr class="separator">
        <div class="row-fluid">
            <div class="span6">
                <div class="control-group">
                    <label class="control-label" for="firstname">Lastname</label>
                    <div class="controls"><input class="span12" id="firstname" name="firstname" type="text"></div>
                </div>
                <div class="control-group">
                    <label class="control-label" for="lastname">Firstname</label>
                    <div class="controls"><input class="span12" id="lastname" name="lastname" type="text"></div>
                </div>
                <div class="control-group">
                    <label class="control-label" for="inputPhone"><?php echo $translate->_('phone'); ?></label>
                    <div class="controls">
                        <div class="input-prepend">
                            <span class="add-on glyphicons phone"><i></i></span>
                            <input type="text" id="inputPhone" class="span11" placeholder="01234567897" />
                        </div>
                    </div>
                </div>
            </div>
        </div>

        <hr class="separator">

        <div class="form-actions">
            <button type="button" class="btn btn-icon btn-primary glyphicons circle_ok"><i></i>Save</button>
            <button type="button" class="btn btn-icon btn-default glyphicons circle_remove"><i></i>Cancel</button>
        </div>
    </div>

</form>