Can you help me make a form looking like this?

http://s32.postimg.org/ydgyx4wlx/screenshot_194.jpg

can you advice me how to make like this?

It is not clear from the image what kind of functionality you are looking on the form, but in order to have the same form fields as displayed there, you can simply add:

- Two Drop Down fields.

- I'm not sure what kind of field should "Harga Pulsa" be, but if your users are going to be entering a value in there themselves, you can use a Text Box field. If it is something you will be calculating on the form, you can use a Form Calculation field instead:

https://www.jotform.com/help/259-How-to-perform-calculation-in-the-form

- If the last type of the field is a phone number field, simply use our Phone field.

You can position fields on your form by following this guide:

https://www.jotform.com/help/90-Field-Positioning

On the left of your provided image, the three elements saying "Pulsa", "Packet Data", and "PLN" appear to possibly be tabs, to display a different page based on which of these three is clicked. If that is so, you can re-create a similar setup by using the Page Break tool to split your form into multiple pages, and then use our Form Tabs widget to turn the pages into tabs:

https://www.jotform.com/help/252-How-to-Add-a-Widget-to-your-Form

If you need further assistance in setting it up, please let us know.

http://www.elevenia.co.id/browsing/PulsaMain/index.do

see that link please

on there any condition about choice

how about that?

Hi,

I took a look at the link you provided. Based on my testing, the options in the second field under Jenis Pulsa change depending on the value selected from the first field. The Harga Pulsa field is a read-only field that is calculated based on the selected values from Jenis Pulsa fields. If you can give us the calculations or conditions for these fields, that would be great.

Also, as suggested by my colleague, you can proceed with the adding of two Drop Down fields and a Phone field to your form.

We will wait for your reply.