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HTML

              
                <div class="container">

<div class="row">
    <div class="col-xs-12 col-sm-8 col-md-6 col-sm-offset-2 col-md-offset-3">
		<form role="form">
			<h2>Please Sign Up <small>It's free and always will be.</small></h2>
			<hr class="colorgraph">
			<div class="row">
				<div class="col-xs-6 col-sm-6 col-md-6">
					<div class="form-group">
                        <input type="text" name="first_name" id="first_name" class="form-control input-lg" placeholder="First Name" tabindex="1">
					</div>
				</div>
				<div class="col-xs-6 col-sm-6 col-md-6">
					<div class="form-group">
						<input type="text" name="last_name" id="last_name" class="form-control input-lg" placeholder="Last Name" tabindex="2">
					</div>
				</div>
			</div>
			<div class="form-group">
				<input type="text" name="display_name" id="display_name" class="form-control input-lg" placeholder="Display Name" tabindex="3">
			</div>
			<div class="form-group">
				<input type="email" name="email" id="email" class="form-control input-lg" placeholder="Email Address" tabindex="4">
			</div>
			<div class="row">
				<div class="col-xs-6 col-sm-6 col-md-6">
					<div class="form-group">
						<input type="password" name="password" id="password" class="form-control input-lg" placeholder="Password" tabindex="5">
					</div>
				</div>
				<div class="col-xs-6 col-sm-6 col-md-6">
					<div class="form-group">
						<input type="password" name="password_confirmation" id="password_confirmation" class="form-control input-lg" placeholder="Confirm Password" tabindex="6">
					</div>
				</div>
			</div>
			<div class="row">
				<div class="col-xs-3 col-sm-3 col-md-3">
					<span class="button-checkbox">
						<button type="button" class="btn" data-color="info" tabindex="7">I Agree</button>
                        <input type="checkbox" name="t_and_c" id="t_and_c" class="hidden" value="1">
					</span>
				</div>
				<div class="col-xs-9 col-sm-9 col-md-9">
					 By clicking <strong class="label label-primary">Register</strong>, you agree to the <a href="#" data-toggle="modal" data-target="#t_and_c_m">Terms and Conditions</a> set out by this site, including our Cookie Use.
				</div>
			</div>
			
			<hr class="colorgraph">
			<div class="row">
				<div class="col-xs-6 col-md-6"><input type="submit" value="Register" class="btn btn-primary btn-block btn-lg" tabindex="7"></div>
				<div class="col-xs-6 col-md-6"><a href="#" class="btn btn-success btn-block btn-lg">Sign In</a></div>
			</div>
		</form>
	</div>
</div>
<!-- Modal -->
<div class="modal fade" id="t_and_c_m" tabindex="-1" role="dialog" aria-labelledby="myModalLabel" aria-hidden="true">
	<div class="modal-dialog">
		<div class="modal-content">
			<div class="modal-header">
				<button type="button" class="close" data-dismiss="modal" aria-hidden="true">×</button>
				<h4 class="modal-title" id="myModalLabel">Terms & Conditions</h4>
			</div>
			<div class="modal-body">
				<p>Lorem ipsum dolor sit amet, consectetur adipisicing elit. Similique, itaque, modi, aliquam nostrum at sapiente consequuntur natus odio reiciendis perferendis rem nisi tempore possimus ipsa porro delectus quidem dolorem ad.</p>
				<p>Lorem ipsum dolor sit amet, consectetur adipisicing elit. Similique, itaque, modi, aliquam nostrum at sapiente consequuntur natus odio reiciendis perferendis rem nisi tempore possimus ipsa porro delectus quidem dolorem ad.</p>
				<p>Lorem ipsum dolor sit amet, consectetur adipisicing elit. Similique, itaque, modi, aliquam nostrum at sapiente consequuntur natus odio reiciendis perferendis rem nisi tempore possimus ipsa porro delectus quidem dolorem ad.</p>
				<p>Lorem ipsum dolor sit amet, consectetur adipisicing elit. Similique, itaque, modi, aliquam nostrum at sapiente consequuntur natus odio reiciendis perferendis rem nisi tempore possimus ipsa porro delectus quidem dolorem ad.</p>
				<p>Lorem ipsum dolor sit amet, consectetur adipisicing elit. Similique, itaque, modi, aliquam nostrum at sapiente consequuntur natus odio reiciendis perferendis rem nisi tempore possimus ipsa porro delectus quidem dolorem ad.</p>
				<p>Lorem ipsum dolor sit amet, consectetur adipisicing elit. Similique, itaque, modi, aliquam nostrum at sapiente consequuntur natus odio reiciendis perferendis rem nisi tempore possimus ipsa porro delectus quidem dolorem ad.</p>
				<p>Lorem ipsum dolor sit amet, consectetur adipisicing elit. Similique, itaque, modi, aliquam nostrum at sapiente consequuntur natus odio reiciendis perferendis rem nisi tempore possimus ipsa porro delectus quidem dolorem ad.</p>
			</div>
			<div class="modal-footer">
				<button type="button" class="btn btn-primary" data-dismiss="modal">I Agree</button>
			</div>
		</div><!-- /.modal-content -->
	</div><!-- /.modal-dialog -->
</div><!-- /.modal -->
</div>
              
            
!

CSS

              
                .colorgraph {
  height: 5px;
  border-top: 0;
  background: #c4e17f;
  border-radius: 5px;
  background-image: -webkit-linear-gradient(left, #c4e17f, #c4e17f 12.5%, #f7fdca 12.5%, #f7fdca 25%, #fecf71 25%, #fecf71 37.5%, #f0776c 37.5%, #f0776c 50%, #db9dbe 50%, #db9dbe 62.5%, #c49cde 62.5%, #c49cde 75%, #669ae1 75%, #669ae1 87.5%, #62c2e4 87.5%, #62c2e4);
  background-image: -moz-linear-gradient(left, #c4e17f, #c4e17f 12.5%, #f7fdca 12.5%, #f7fdca 25%, #fecf71 25%, #fecf71 37.5%, #f0776c 37.5%, #f0776c 50%, #db9dbe 50%, #db9dbe 62.5%, #c49cde 62.5%, #c49cde 75%, #669ae1 75%, #669ae1 87.5%, #62c2e4 87.5%, #62c2e4);
  background-image: -o-linear-gradient(left, #c4e17f, #c4e17f 12.5%, #f7fdca 12.5%, #f7fdca 25%, #fecf71 25%, #fecf71 37.5%, #f0776c 37.5%, #f0776c 50%, #db9dbe 50%, #db9dbe 62.5%, #c49cde 62.5%, #c49cde 75%, #669ae1 75%, #669ae1 87.5%, #62c2e4 87.5%, #62c2e4);
  background-image: linear-gradient(to right, #c4e17f, #c4e17f 12.5%, #f7fdca 12.5%, #f7fdca 25%, #fecf71 25%, #fecf71 37.5%, #f0776c 37.5%, #f0776c 50%, #db9dbe 50%, #db9dbe 62.5%, #c49cde 62.5%, #c49cde 75%, #669ae1 75%, #669ae1 87.5%, #62c2e4 87.5%, #62c2e4);
}
              
            
!

JS

              
                
              
            
!
999px

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