                    <!-- Dashboard panel -->
                    <div class="dashboard-panel">
                        <form action="#" method="post" name="chekout" class="comment-form">
                            <h2 class="current-bal">Available Balance: <span>$680.95</span></h2>
                            <div class="row">
                                <div class="col-sm-6">
                                    <div class="input-group ">
                                        <label>Twitter Profile:</label>
                                        <input type="text" class="form-control" name="lame" required="">
                                    </div>

                                </div>
                            </div>
                            <div class="input-group ">
                                <div class="radio">
                                    <span class="radio-label">Requested Via: </span>
                                    <label>
                                        <input type="radio" checked="" value="go1" name="group1">
                                        <span class="radio-content">
                                                    <span class="item-content">Paypal</span>
                                        <i aria-hidden="true" class="fa uncheck fa-circle-thin"></i>
                                        <i aria-hidden="true" class="fa check fa-dot-circle-o"></i>
                                        </span>
                                    </label>
                                    <label>
                                        <input type="radio" value="go1" name="group1">
                                        <span class="radio-content">
                                            <span class="item-content">Bank Transfer</span>
                                        <i aria-hidden="true" class="fa uncheck fa-circle-thin"></i>
                                        <i aria-hidden="true" class="fa check fa-dot-circle-o"></i>
                                        </span>
                                    </label>
                                </div>
                            </div>

                            <button class="btn-link-dark dash-btn" name="Submit" type="Submit">SUBMIT</button>

                        </form>

                    </div>