<form class="form-horizontal" action="" method="post">
  <div class="form-row">

      <label for="disabledInput" class="col-sm-4 control-label">Customer ID</label>
      <div class="col-md-6">
        <input class="form-control" id="c_id" type="text" placeholder="" readonly>
      </div>
      <label class="col-sm-4 control-label">Search Customer Name</label>
      <div class="col-sm-6">
        <input class="form-control" name="search" id="search"  type="search" placeholder="Customer Name">
      </div>
	  <label class="col-sm-4 control-label">Invoice #</label>
      <div class="col-sm-6">
        <input class="form-control" name="inv" id="inv" type="text" readonly >
      </div>
	  </div>
	  	  	  <div class="form-row">
<label class="col-sm-2 control-label">Address</label>
      <div class="col-sm-10">
        <input class="form-control" name="address" id="address" type="text" readonly >
      </div>
</div>
	  <div class="form-row">
  <label class="col-sm-2 control-label">CNIC No.</label>
      <div class="col">
        <input class="form-control" name="cnic" id="cnic" type="text" readonly >
      </div>
	  <label class="col-sm-2 control-label">Cell No.</label>
      <div class="col">
        <input class="form-control" name="phone1" id="phone1" type="text" readonly >
      </div>
	  </div>
	  	  <div class="form-row">
  <label class="col-sm-2 control-label">Pkg ID</label>
      <div class="col">
        <input class="form-control" name="pkgid" id="pkgid" type="text" readonly>
      </div>
<label class="col-sm-2 control-label">Current Bill Amount Rs.</label>
      <div class="col">
        <input class="form-control" name="current" id="current" type="text"  readonly>
      </div>
</div>
	  	  <div class="form-row">
   <label class="col-sm-2 control-label">Arear Rs.</label>
      <div class="col">
        <input class="form-control" name="arear" id="arear" type="text" readonly>
      </div>
 	  <label class="col-sm-2 control-label">Total Payable Rs.</label>
      <div class="col">
        <input class="form-control" name="total" id="total" type="text" readonly>
      </div>
	   	  </div> <div class="form-row">
	   <label class="col-sm-2 control-label">Payable Date</label>
      <div class="col">
        <input class="form-control" name="date" id="date" type="text" readonly>
      </div>
	   <label class="col-sm-2 control-label">Billing Month</label>
      <div class="col">
        <input class="form-control" name="month" id="month" type="text" readonly>
      </div>
	  </div> <div class="form-row">
	    <label class="col-sm-2 control-label">Payment Rs.</label>
      <div class="col">
        <input class="form-control col-sm-5" name="payment" id="payment" type="text" placeholder="Enter Amount">
      </div>
    <div class="col-3">
   <input class="btn btn-primary btn-lg" type="submit" name="submit" value="PAID" />
</div>
 </div>
  </form>