<form name="customer_details" method="POST"  action="https://test.danamanciagli.com/insert.php">
Your Name: <input type="text" id="customer_name" name="customer_name" /><br />
Your Email: <input type="text" id="customer_email" name="customer_email" /><br />
Sex: <input type="text" name="customer_sex" id="customer_"/><br />
Your Age: <input type="text" id="customer_age" name="customer_age" /><br />
<input type="submit" value="Submit"/>
</form>