<form>
<div class="form-group loginFormGrp">
<label class="caption">Backup Cloud</label>
<div class="custSelect loginSelect">
<label class="caption">Server URL</label>
<input type="text" aria-label="Server URL" name="serverUrl" class="form-control" placeholder="example.server.com" value="">
</div>
<div class="form-group loginFormGrp">
<label class="caption">Email</label>
<input type="text" aria-label="Email" name="email" class="form-control" placeholder="user@example.com" value="">
</div>
<div class="loginBtnRow">
<button tabindex="0" type="submit" class="lgBtn btn btn-primary btn-block">Continue</button>
</div>
</div>
</form>