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form { background:#e6e7e8; padding:15px; margin:20px 0px 20px 0px; width:500px; border-radius:5px/5px; font-family:sans-serif; color:#818A8F; margin:auto; box-shadow:5px 2px 20px #999; font-weight:bolder; }
form fieldset label { width:150px; float:left; }
form fieldset input { color:#818A8F; }
form fieldset { border:0; }
<form action="rest.php" method="post">
<fieldset>
<label for="phoneNumber">Phone Number</label>
<input type="phone" id="phoneNumber" placeholder="Enter Phone Number">
</fieldset>
<fieldset>
<label for="emailAddress">Email Address</label>
<input type="email" id="emailAddress" placeholder="Enter Email Address">
</fieldset>
<fieldset>
<label for="zip">Zip Code:</label>
<input type="number" id="zip" placeholder="Enter Zip Code">
</fieldset>
<fieldset>
<label for="gender">Gender:</label>
<select id="gender">
<option name="female">Female</option>
<option name="male">Male</option>
</select>
</fieldset>
<fieldset>
<label for="Retail">Retail</label>
<input type="radio" name="Retail">
</fieldset>
</form>
<!DOCTYPE html>
<html>
<head>
<meta charset="UTF-8">
<title>CodePen · A Pen by dylanburkey</title>
<link rel="stylesheet" href="http://codepen.io/stylesheets/css/normalize.css">
<style>
form { background:#e6e7e8; padding:15px; margin:20px 0px 20px 0px; width:500px; border-radius:5px/5px; font-family:sans-serif; color:#818A8F; margin:auto; box-shadow:5px 2px 20px #999; font-weight:bolder; }
form fieldset label { width:150px; float:left; }
form fieldset input { color:#818A8F; }
form fieldset { border:0; }
</style>
<style>
#codepen-footer, #codepen-footer * {
-webkit-box-sizing: border-box !important;
-moz-box-sizing: border-box !important;
box-sizing: border-box !important;
}
#codepen-footer {
display: block !important;
position: fixed !important;
bottom: 0 !important;
left: 0 !important;
width: 100% !important;
padding: 0 10px !important;
margin: 0 !important;
height: 30px !important;
line-height: 30px !important;
font-size: 12px !important;
color: #eeeeee !important;
background-color: #505050 !important;
text-align: left !important;
background: -webkit-linear-gradient(top, #505050, #383838) !important;
background: -moz-linear-gradient(top, #505050, #383838) !important;
background: -ms-linear-gradient(top, #505050, #383838) !important;
background: -o-linear-gradient(top, #505050, #383838) !important;
border-top: 1px solid black !important;
border-bottom: 1px solid black !important;
border-radius: 0 !important;
box-shadow: inset 0 1px 0 #6e6e6e, 0 2px 2px rgba(0, 0, 0, 0.4) !important;
z-index: 300 !important;
font-family: "Lucida Grande", "Lucida Sans Unicode", Tahoma, sans-serif !important;
letter-spacing: 0 !important;
word-spacing: 0 !important;
}
#codepen-footer a {
color: #a7a7a7 !important;
text-decoration: none !important;
}
#codepen-footer a:hover {
color: white !important;
}
</style>
<script>
// Kill alerts, confirmations and prompts
window.alert = function(){};
window.confirm = function(){};
window.prompt = function(){};
window.open = function(){};
window.print = function(){};
</script>
<script src="http://codepen.io/javascripts/libs/prefixfree.min.js"></script>
</head>
<body>
<form action="rest.php" method="post">
<fieldset>
<label for="phoneNumber">Phone Number</label>
<input type="phone" id="phoneNumber" placeholder="Enter Phone Number">
</fieldset>
<fieldset>
<label for="emailAddress">Email Address</label>
<input type="email" id="emailAddress" placeholder="Enter Email Address">
</fieldset>
<fieldset>
<label for="zip">Zip Code:</label>
<input type="number" id="zip" placeholder="Enter Zip Code">
</fieldset>
<fieldset>
<label for="gender">Gender:</label>
<select id="gender">
<option name="female">Female</option>
<option name="male">Male</option>
</select>
</fieldset>
<fieldset>
<label for="Retail">Retail</label>
<input type="radio" name="Retail">
</fieldset>
</form>
<script src="http://code.jquery.com/jquery-latest.js"></script>
<script src="http://codepen.io/javascripts/libs/modernizr.js"></script>
<div id="codepen-footer">
<a style="color: #f73535 !important;" href="https://codepen.wufoo.com/forms/m7x3r3/def/field14=" onclick="window.open(this.href, null, 'height=517, width=680, toolbar=0, location=0, status=1, scrollbars=1, resizable=1'); return false">Report Abuse</a>
<a href="/dylanburkey/pen/86/2">Edit this Pen</a>
</div>
</body>
</html>