Embed

<form style="text-align:left;">
  
<p>
<label>First Name
<input type="text" name="customer_name" required>
</label> 
</p>

<p>
<label>Last Name
<input type="text" name="customer_name" required>
</label> 
</p>
<p>
<label>Phone Number
<input type="text" name="Phone Number" required>
</label> 
</p>

<p>
<label>Email 
<input type="email" name="email_address">
</label>
</p>

<p>
<label>Address
<input type="text" name="Address">
</label>
</p>

<p>
<label>City
<input type="text" name="city" required>
</label>
</p>

<p>
<label>State
<input type="text" name="State">
</label>
</p>

<p>
<label>Zip Code
<input type="text" name="Zip Code">
</label>
</p>

<p>
<label>DOT
<input type="text" name="DOT">
</label>
</p>

<p>
<label>MC
<input type="text" name="MC" required>
</label>
</p>


<fieldset>
<legend>Type of Vehicle Owned?</legend><br>
<p><label> <input type="radio" name="taxi" value="car"> Car </label></p>
<p><label> <input type="radio" name="taxi" value="Suv"> Suv </label></p>
<p><label> <input type="radio" name="Box Truck" value="Box Truck"> Box-Truck </label></p>
<p><label> <input type="radio" name="Semi Truck"value="Cargo-Van"> Semi-Truck</label></p>
</fieldset>
<p>Flexible Schedule<label> <input type="radio" name="Yes" required value="No"> No </label></p>

<p>Previous Delivery Driver Experience<label> <input type="radio" name="Yes" required value="No"> No </label></p>

<p>Do You Possess A CDL?<label> <input type="radio" name="Yes" required value="No"> No </label></p>

<h6>Submit Your Insurance:</h6>

<action="/action_page.php">
  <input type="file" id="myFile" name="filename">

<h6>Submit your Driver License:</h6>

<action="/action_page.php">
  <input type="file" id="myFile" name="filename">

<h6 style="background-color:powderblue;text-align:center;padding:2%;"><button type="submit">Send a message</button></h6>

</form>