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<!DOCTYPE HTML>
<html>
<head>
<meta charset="UTF-8">
<title>Form Example 1</title>
<style>
fieldset{
background-color:rgb(255,246,205);
border:1px solid rgb(233,69,0);
margin:10px 0px 30px 2.5%;
width:46%;
}
</style>
<script>
</script>
</head>
<body>
<form autocomplete="false">
<fieldset id="custInfo">
<legend>Customer Information</legend>
<label for="custname"> Name:</label>
<input name="custname" id="custname" />
<label for="street">Street address:</label>
<input name="street" id="street" />
<label for="city">City:</label>
<input name="city" id="city" />
<label for="state">State (abbr.):</label>
<input name="state" id="state" />
<label for="zip"> Postal code</label>
<input name="zip" id="zip" />
<label for="phone"> Phone number:</label>
<input name="phone" id="phone" />
<label for="email">E-mail:</label>
<input name="email" id="email" />
</fieldset>
<fieldset id="experience">
<legend>Share Your Experience</legend>
<label for="visitdate">Date of visit:</label>
<input name="visitdate" id="visitdate" />
<label for="receipt">Reciept number:</label>
<input name="receipt" id="receipt" />
</fieldset>
</form>
</body>
</html>