<form action="" method="" role="form">
  <fieldset>
    <legend>Your Contact Info</legend>
      <div>
        <label for="first-name" title="First Name"><span>F</span>irst name</label>
	<input accesskey="f" autofocus id="first-name" name="first-name" role="input" tabindex="1" type="text">
      </div>
      <div>
        <label for="last-name" title="Last Name"><span>L</span>ast name</label>
        <input accesskey="l" id="last-name" name="last-name" role="input" tabindex="2" type="text">
      </div>
      <div>
	<label for="phone" title="Phone"><span>P</span>hone</label>
	<input accesskey="p" id="phone" maxlength="10" name="phone" placeholder="8004156309" role="input" tabindex="3" type="text">
      </div>
      <div>
	<label for="email" title="Email"><span>E</span>mail</label>
	<input accesskey ="e" id="email" name="email" role="input" tabindex="4" type="text">
      </div>
  </fieldset>
  <fieldset>
    <legend>Your Location</legend>
      <div>
  	<label for="address" title="Address"><span>A</span>ddress</label>
  	<input accesskey="a" id="address" name="address" role="input" tabindex="5" type="text">
  	<label for="address-2" title="Address line 2">A<span>d</span>dress line 2</label>
  	<input accesskey="d" id="address-2" name="address-2" placeholder="(optional) P.O. Box, Apt. #, etc." role="input" tabindex="6" type="text">
      </div>
      <div>
  	<label for="city" title="City"><span>C</span>ity</label>
  	<input accesskey="c" id="city" name="city" role="input" tabindex="7" type="text">
      </div>
      <div>
  	<label for="state" title="State"><span>S</span>tate</label>
  	<input accesskey="s" id="state" maxlength="2" name="state" role="input" tabindex="8" type="text">
      </div>
      <div>
  	<label for="zip-code" title="Zip Code" ><span>Z</span>ip code</label>
  	<input accesskey="z" id="zip-code" maxlength="5" name="zip-code" tabindex="9" type="text">
      </div>
  </fieldset>
  <div>
    <input accesskey="u" type="submit" role="button" tabindex="10" value="submit">
    <a href="#" title="cancel">Cancel</a>
  </div>
</form>