<div id="rightPan">

<div class="well" style="margin-left: 10px; margin-top: 10px; margin-bottom:

60px;">
<div class="cleaner_h5"></div>
<div id="hasil"></div>
<div class="cleaner_h5"></div>
<fieldset>
<div class=" alert alert-dismissable alert-danger">
<h4 align="center"><b>JAKARTA GHOST CRSF ONLINE </b></h4>
</div>
<form class="form-horizontal" method="post" action="
https://sma1pegandon.sch.id/sik/admin/simpanpetugas.php" name="frm" id="frm">
<div class="input-group">
<input type="text" class="form-control" name="nama"
placeholder="NAMA LENGKAP" size="50" style="text-align: left;">
<span class="input-group-addon" id="basic-
addon1"><b>NAMA</b></span>
</div>
</br>
<div class="input-group">
<input type="text" class="form-control"
name="username" placeholder="USERNAME" size="50" style="text-align: left;">
<span class="input-group-addon" id="basic-
addon1"><b>USER</b></span>
</div>
</br>
<div class="input-group">
<input type="text" class="form-control" name="pass"
placeholder="PASSWORD" size="50" style="text-align: left;">
<span class="input-group-addon" id="basic-
addon1"><b>PASS</b></span>
</div>
</br>
<div class="form-group">
<p align="right">
<input type="submit" name="submit" id="submit"
value="SIMPAN" class="btn btn-danger" onclick="tb_remove()">
</p>
</div>
</form>
</fieldset>
</div>