<form name="customer_details" method="POST" action="https://test.danamanciagli.com/customer-details.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="radio" name="customer_sex" value="male">Male <input type="radio" name="customer_sex" value="female">Female<br />
Your Age: <input type="text" id="customer_age" name="customer_age" /><br />
<input type="submit" value="Submit"/>
</form>