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<!DOCTYPE html>
<html>
<head>
<title></title>
</head>
<body>
<fieldset><legend>Online order Form</legend>
fields marked with * are requiered
<table align="center" width="100%">
<tr>
<td>Full Name*</td>
<td><input type="text" size="50%" required="required"></td>
<td>Street Address</td>
<td><input type="text" size="50%"></td>
</tr>
<tr>
<td>Town</td>
<td><input type="text" size="50%"></td>
<td>city</td>
<td><input type="text" size="50%"></td>
</tr>
<tr>
<td>Country</td>
<td><input type="text" size="50%"></td>
<td>postal/zipcode</td>
<td><input type="text" size="50%"></td>
</tr>
<tr>
<td>Telephone*</td>
<td><input type="text" size="50%"></td>
<td>Email*</td>
<td><input type="Email" size="50%"></td>
</tr>
<tr>
<td>item 1 *</td>
<td>
<select>
<option>please select</option>
<option>phone cover</option>
<option>phone screem protector</option>
</select>
Qty
<input type="text">
</td>
<td>item 2</td>
<td>
<select>
<option>please select</option>
<option>phone cover</option>
<option>phone screem protector</option>
</select>
Qty
<input type="text">
</td>
</tr>
<tr>
<td>item 3</td>
<td><select>
<option>please select</option>
<option>phone cover</option>
<option>phone screem protector</option>
</select>
Qty
<input type="text">
</td>
<td>item 4</td>
<td><select>
<option>please select</option>
<option>phone cover</option>
<option>phone screem protector</option>
</select>
Qty
<input type="text"></td>
</tr>
<tr>
<td>item 5</td>
<td>
<select>
<option>please select</option>
<option>phone cover</option>
<option>phone screem protector</option>
</select>
Qty
<input type="text">
</td>
<td>item 6</td>
<td>
<select>
<option>please select</option>
<option>phone cover</option>
<option>phone screem protector</option>
</select>
Qty
<input type="text">
</td>
</tr>
<tr>
<td>item 7</td>
<td><select>
<option>please select</option>
<option>phone cover</option>
<option>phone screem protector</option>
</select>
Qty
<input type="text">
</td>
<td>item 8</td>
<td>
<select>
<option>please select</option>
<option>phone cover</option>
<option>phone screem protector</option>
</select>
Qty
<input type="text">
</td>
</tr>
<tr>
<td>item 9</td>
<td><select>
<option>please select</option>
<option>phone cover</option>
<option>phone screem protector</option>
</select>
Qty
<input type="text">
</td>
<td>item 10</td>
<td>
<select>
<option>please select</option>
<option>phone cover</option>
<option>phone screem protector</option>
</select>
Qty
<input type="text">
</td>
</tr>
<tr>
<td>Further instruction</td>
<td colspan="3">
<textarea cols="50" rows="25" placeholder="fdsfdsdsfdsfd">
</textarea>
</td>
</tr>
</table>
<p align="center"><input type="submit" value="Submit Form"></p>
</fieldset>
</body>
</html>