The form was made in the application formees.com
Online tool for creating forms

Header of first part

Place for your descriptions, logo, or maybe some image??

Form title

Another part header

Text

This is just template you can start with. Retype any copy, remove any widgets, or add new ones (drag them from library on right side). You can start with removing this message :-).

Few more tips..

- do you need more space? Bigger page? Go to "Page settings" (top navigation)

- do you want to add third part of form? Or duplicate any part of page? Select more widgets and click "plus" icon. You will duplicate all of them.

- move with more widgets together.. same way (by selecting more widgets)

- need more help? See options under "help" ikon at upper right corner (forum, video tutorials..)