index.html

<!DOCTYPE html>
<html lang="en">
<head>
    <meta charset="UTF-8">
    <title>form</title>
    <link rel="stylesheet" href="https://use.fontawesome.com/releases/v5.8.1/css/all.css">
  <link rel="stylesheet" href="styles.css">
</head>
<body>
<div class="wrapper">
  <div class="title">
    <i class="fab fa-whatsapp text-white fa-2x"></i>
    <h5>Form WA Master Closing</h5>
  </div>
<!--   <button type="button" class="close text-white" arial-label="close">
    <span class="">X</span>
  </button> -->
  <div class="form">
    <div class="input_field">
      <input type="text" placeholder="Nama Lengkap (required)" class="input">
      <i class="fas fa-user"></i>
    </div>
    <div class="input_field">
      <input type="text" placeholder=" Nama panggilan (required)" class="input">
      <i class="fas fa-user"></i>
    </div>
    <div class="input_field">
      <input type="text" placeholder=" Tanggal lahir (required)" class="input">
      <i class="fa fa-cash-register"></i>
    </div>
      <div class="input_field">
      <input type="text" placeholder=" Kota Domisili (required)" class="input">
      <i class="fa fa-map-marked"></i>
    </div>
      <div class="input_field">
      <input type="text" placeholder=" No Telegram/WA (required)" class="input">
      <i class="fab fa-whatsapp"></i>
    </div>
      <div class="input_field">
      <input type="text" placeholder=" Alamat Email Aktif (required)" class="input">
      <i class="fa fa-address-card"></i>
    <div class="btn">
      <a href="#" class="fab fa-whatsapp fa-2x"> KIRIM</a>
    </div>
  </div>
</div>

</body>
</html>