form

<form action="" method="">
<fieldset>					
 
	<div class="row"><label for="fname">First Name</label>
	<input type="text" class="" value="" id="fname" name="cardholder_first_name"></div>
 
	<div class="row"><label for="sname">Last Name</label>
	<input type="text" class="" value="" id="sname" name="cardholder_last_name"></div>
 
	<div class="row"><label for="personal-email">Email</label>
	<input type="text" class="" value="" id="personal-email" name="cardholder_email"></div>
 
	<div class="row"><label for="phone-no">Phone number</label>
	<input type="tel" class="" value="" id="phone-no" name="cardholder_phone_number"></div>
 
 
	<div class="row dob">
		<label for="dob_day">Date of Birth:</label>
		<select class="" name="dob_day">
			<option value="">Day</option>
			<option value="1">1</option>
		</select>
	</div>
 
</fieldset>
</form>