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

Second part header

Here is place for some descriptions...
maybe your logo, or some image?

Form title

Text

First part header..

Something

Something

Something

Describe it, whatevet it is

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 :-).