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HTML

              
                .container
  form
    .row
      h4 Account
      .input-group.input-group-icon
        input(type="text", placeholder="Full Name")
        .input-icon
          i.fa.fa-user
      .input-group.input-group-icon
        input(type="email", placeholder="Email Adress")
        .input-icon
          i.fa.fa-envelope
      .input-group.input-group-icon
        input(type="password", placeholder="Password")
        .input-icon
          i.fa.fa-key
    .row
      .col-half
        h4 Date of Birth
        .input-group
          .col-third
            input(type="text", placeholder="DD")
          .col-third
            input(type="text", placeholder="MM")
          .col-third
            input(type="text", placeholder="YYYY")
      .col-half
        h4 Gender
        .input-group
          input(type="radio", name="gender", value="male", id="gender-male")
          label(for="gender-male") Male
          input(type="radio", name="gender", value="female", id="gender-female")
          label(for="gender-female") Female
    .row
      h4 Payment Details
      .input-group
        input(type="radio", name="payment-method", value="card", id="payment-method-card", checked="true")
        label(for="payment-method-card")
          span
            i.fa.fa-cc-visa
            | Credit Card
        input(type="radio", name="payment-method", value="paypal", id="payment-method-paypal")
        label(for="payment-method-paypal") 
          span
            i.fa.fa-cc-paypal
            | Paypal
      .input-group.input-group-icon
        input(type="text", placeholder="Card Number")
        .input-icon
          i.fa.fa-credit-card
      .col-half
        .input-group.input-group-icon
          input(type="text", placeholder="Card CVC")
          .input-icon
            i.fa.fa-user
      .col-half
        .input-group
          select
            option 01 Jan
            option 02 Jan
          select
            option 2015
            option 2016
    .row
      h4 Terms and Conditions
      .input-group
        input(type="checkbox", id="terms")
        label(for="terms") I accept the terms and conditions for signing up to this service, and hereby confirm I have read the privacy policy.
              
            
!

CSS

              
                @import "lesshat";

// MIXINS

.clearfix() {
  zoom: 1;
  &:before, &:after{
    content: "";
    display: table;
  }
  &:after{
    clear: both;
  }
}

.col() {
  padding-right: 10px;
  float: left;
  &:last-of-type {
    padding-right: 0;
  }
}

.transition(@speed, @easing) {
  transition: all @speed @easing;  
}

// VARIABLES

@white: #fff;
@grey-lightest: #f9f9f9;
@grey-light: #e3e3e3;
@grey: #e5e5e5;
@grey-dark: #b9b9b9;

@purple: #c68eaa;
@green: #7ed321;
@emerald: #04BDBD;
@blue: #04AEC5;
@blue-dark: #0F6CC9;
@color-primary: @green;
@color-primary-strong: darken(saturate(@color-primary, 5%), 10%);

@br: 3px;

@fast: 0.35s;

@ease: ease-in-out;

// GENERAL

* {
  &, &:before, &:after {
    box-sizing: border-box;
  }
}

body {
  padding: 1em;
  font-family: 'Open Sans', 'Helvetica Neue', Helvetica, Arial, sans-serif;
  font-size: 15px;
  // font-size: 1vw;
  color: @grey-dark;
  background-color: @grey-light;
}

// TYPOGRAPHY

h4 {
  color: @color-primary;
}

// FORM

input {
  width: 100%;
  padding: 1em;
  line-height: 1.4;
  background-color: @grey-lightest;
  border: 1px solid @grey;
  border-radius: 3px;
  .transition(@fast, @ease);
  &:focus {
    outline: 0;
    border-color: @color-primary-strong;
    & + .input-icon {
      i {
        color: @color-primary;
      }
      &:after {
        border-right-color: @color-primary;
      }
    }
  }
  &[type="radio"] {
    display: none;
    & + label {
      &:extend(input);
      display: inline-block;
      width: 50%;
      text-align: center;
      float: left;
      border-radius: 0;
      &:first-of-type {
        border-top-left-radius: @br;
        border-bottom-left-radius: @br;
      }
      &:last-of-type {
        border-top-right-radius: @br;
        border-bottom-right-radius: @br;
      }
      i {
        padding-right: 0.4em;
      }
    }
    &:checked + label {
      background-color: @color-primary;
      color: @white;
      border-color: @color-primary-strong;
    }
  }
  &[type="checkbox"] {
    display: none;
    & + label {
      position: relative;
      display: block;
      padding-left: 1.6em;
      &:before {
        &:extend(input);
        position: absolute;
        top: 0.2em;
        left: 0;
        display: block;
        width: 1em;
        height: 1em;
        padding: 0;
        content: "";
      }
      &:after {
        position: absolute;
        top: 0.45em;
        left: 0.2em;
        font-size: 0.8em;
        color: @white;
        opacity: 0;
        font-family: FontAwesome;
        content: "\f00c";
      }
    }
  }
  &:checked + label {
    &:before {
      &:extend(input[type="radio"]:checked + label);
    }
    &:after {
      opacity: 1;
    }
  }
}

select {
  &:extend(input[type="radio"] + label);
  height: 3.4em;
  line-height: 2;
  &:first-of-type {
    border-top-left-radius: @br;
    border-bottom-left-radius: @br;
  }
  &:last-of-type {
    border-top-right-radius: @br;
    border-bottom-right-radius: @br;
  }
  &:focus, &:active {
    outline: 0;
    &:extend(input[type="radio"]:checked + label);
  }
  option {
    &:extend(input);
    background-color: @color-primary;
    color: @white;
  }
}

.input-group {
  margin-bottom: 1em;
  .clearfix();
}

.input-group-icon {
  position: relative;
  input {
    padding-left: 4.4em;
  }
  .input-icon {
    position: absolute;
    top: 0;
    left: 0;
    width: 3.4em;
    height: 3.4em;
    line-height: 3.4em;
    text-align: center;
    pointer-events: none;
    &:after {
      position: absolute;
      top: 0.6em;
      bottom: 0.6em;
      left: 3.4em;
      display: block;
      border-right: 1px solid @grey;
      content: "";
      .transition(@fast, @ease);
    }
    i {
      .transition(@fast, @ease);
    }
  }
  
}

// STRUCTURE

.container {
  max-width: 38em;
  padding: 1em 3em 2em 3em;
  margin: 0em auto;
  background-color: @white;
  border-radius: @br * 1.4;
  box-shadow: 0px 3px 10px -2px rgba(0,0,0,0.2);
}

.row {
  .clearfix();
}

.col-half {
  .col();
  width: 100% / 2;
}

.col-third {
  .col();
  width: 100% / 3;
}

@media only screen and (max-width: 540px) {
  .col-half {
    width: 100%;
    padding-right: 0;
  }
}
              
            
!

JS

              
                // INSPIRED BY SEB KAY'S 'SIGN UP FORM'
// https://dribbble.com/shots/1776663-Purple-Sign-Up-Form
// https://dribbble.com/shots/1779149--Free-PSD-Purple-Sign-Up-Form-Payment-Details

// DO YOU HAVE A SPARE DRIBBBLE INVITE? I'D	APPRECIATE IT!
// dribbble.com/josec
              
            
!
999px

Console