div#reissue_input_form {
  overflow: hidden;
}

div#reissue_input_form div.input_title {
  float: left;
  text-align: center;
  background-color: #DDD;
  width: 32%;
  height: 90%;
  border-style: solid;
  border-width: 1px;
  border-color: #AAA;
  padding: 12px 0px 12px;
}

div#reissue_input_form div.input_form {
  float: left;
  text-align: left;
  width: 65%;
  border-style: solid;
  border-width: 1px;
  border-color: #AAA;
  padding: 10px 5px 11px;
  background-color: #EEE;
}