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    <path d="M362.904 72.7999C362.297 71.4651 361.583 70.1812 360.769 68.9606C358.909 66.0675 356.323 63.7093 353.269 62.1196L350.623 61.5367L345.883 60.4914L343.385 57.6974L339.289 53.1211H325.188L323.301 57.6974L321.717 61.5367L321.038 63.1716L308.965 69.1951C308.959 69.1951 308.959 69.1951 308.952 69.2018C309.113 70.4079 309.272 71.6072 309.429 72.7999C309.771 75.3929 310.093 77.9547 310.396 80.4851C310.55 81.7716 310.698 83.0514 310.839 84.3244C311.289 88.3178 311.676 92.2419 312 96.0969C312.289 99.5408 312.52 102.936 312.692 106.281C313.112 113.88 313.143 121.494 312.786 129.096C312.692 130.885 314.471 132.922 314.33 134.671C314.095 137.525 311.886 140.058 311.497 142.785C311.255 144.46 311.362 146.242 310.939 147.823C310.822 148.286 310.646 148.732 310.416 149.15C310.416 149.157 310.409 149.157 310.409 149.163C305.574 157.78 309.368 153.666 308.918 155.602L309.133 155.656C309.234 155.683 309.543 155.763 310.04 155.877C312.88 156.554 324.59 145.585 332.453 145.585C337.174 145.585 349.67 153.331 353.853 153.894C357.163 154.336 360.118 154.738 361.877 153.19C362.388 152.739 362.778 152.168 363.012 151.529L363.032 151.468L363.025 151.408L362.857 149.163L362.757 147.823L361.32 128.593C360.517 127.6 360.01 126.403 359.856 125.137C359.702 123.871 359.906 122.587 360.447 121.431L360.742 120.808L359.655 106.281L359.453 103.568L359.379 102.65V102.643L358.856 95.6278L360.118 91.7952V91.7885L362.575 84.3244L363.838 80.4851L364.63 78.073L364.684 77.9122C364.261 76.1537 363.665 74.4413 362.904 72.7999Z" fill="#6A64F1"/>
    <path d="M375.154 142.089L361.618 107.179L355.331 94.4321L367.42 87.7676L377.157 104.886L383.684 140.653C384.712 141.353 385.506 142.344 385.965 143.497C386.424 144.651 386.527 145.916 386.26 147.128C385.994 148.341 385.37 149.446 384.469 150.302C383.568 151.158 382.431 151.726 381.205 151.932C379.978 152.139 378.718 151.975 377.585 151.461C376.453 150.947 375.5 150.107 374.85 149.049C374.199 147.991 373.881 146.763 373.935 145.523C373.989 144.282 374.414 143.087 375.154 142.089H375.154Z" fill="#9F616A"/>
    <path d="M257.165 128.205L284.857 102.955L294.481 92.4844L305.09 101.309L292.635 116.573L261.6 135.616C261.319 136.825 260.682 137.923 259.771 138.769C258.86 139.614 257.717 140.168 256.488 140.36C255.259 140.552 254 140.373 252.874 139.846C251.748 139.319 250.805 138.467 250.167 137.402C249.529 136.336 249.225 135.104 249.295 133.865C249.364 132.625 249.802 131.435 250.555 130.446C251.307 129.458 252.338 128.716 253.516 128.317C254.694 127.917 255.965 127.878 257.165 128.205H257.165Z" fill="#9F616A"/>
    <path d="M314.33 84.3255L314.277 80.4862L314.176 72.8009L314.136 69.8193L314.021 69.7389C313.396 69.3296 312.687 69.0641 311.947 68.9617C311.295 68.8539 310.631 68.8539 309.979 68.9617C309.636 69.0147 309.297 69.0931 308.965 69.1962C308.959 69.1962 308.959 69.1962 308.952 69.2029C306.961 69.9159 305.204 71.1577 303.869 72.7942L303.862 72.8009C301.848 75.1911 300.064 77.7641 298.531 80.4862C297.772 81.7726 297.047 83.0725 296.368 84.3255C293.803 89.0894 291.957 93.2168 291.923 93.2905L284.255 103.227L284.363 103.408L286.048 106.282L292.226 116.822L293.206 118.497L295.71 117.164C298.63 115.609 300.932 113.109 302.237 110.075L303.13 106.671L303.459 106.282L312 96.0979L314.444 93.1766L314.33 84.3255Z" fill="#6A64F1"/>
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    </svg>

    <form action="https://formbold.com/s/FORM_ID" method="POST">
      <div class="formbold-input-wrapp formbold-mb-3">
        <label for="firstname" class="formbold-form-label"> Name </label>

        <div>
          <input
            type="text"
            name="firstname"
            id="firstname"
            placeholder="First name"
            class="formbold-form-input"
          />

          <input
            type="text"
            name="lastname"
            id="lastname"
            placeholder="Last name"
            class="formbold-form-input"
          />
        </div>
      </div>

      <div class="formbold-mb-3">
        <label for="age" class="formbold-form-label"> Age </label>
        <input
          type="text"
          name="age"
          id="age"
          placeholder="ex:25"
          class="formbold-form-input"
        />
      </div>

      <div class="formbold-mb-3">
        <label for="dob" class="formbold-form-label"> Date of Birth </label>
        <input type="date" name="dob" id="dob" class="formbold-form-input" />
      </div>

      <div class="formbold-mb-3">
        <label class="formbold-form-label">Gender</label>

        <select class="formbold-form-input" name="occupation" id="occupation">
          <option value="male">Male</option>
          <option value="female">Female</option>
          <option value="others">Others</option>
        </select>
      </div>

      <div class="formbold-mb-3">
        <label for="email" class="formbold-form-label"> Email </label>
        <input
          type="email"
          name="email"
          id="email"
          placeholder="example@email.com"
          class="formbold-form-input"
        />
      </div>

      <div class="formbold-mb-3">
        <label for="address" class="formbold-form-label"> Address </label>

        <input
          type="text"
          name="address"
          id="address"
          placeholder="Street address"
          class="formbold-form-input formbold-mb-3"
        />
        <input
          type="text"
          name="address2"
          id="address2"
          placeholder="Street address line 2"
          class="formbold-form-input"
        />
      </div>

      <div class="formbold-mb-3 formbold-input-wrapp">
        <label for="phone" class="formbold-form-label"> Phone </label>

        <div>
          <input
            type="text"
            name="areacode"
            id="areacode"
            placeholder="Area code"
            class="formbold-form-input formbold-w-45"
          />

          <input
            type="text"
            name="phone"
            id="phone"
            placeholder="Phone number"
            class="formbold-form-input"
          />
        </div>
      </div>

      <div class="formbold-input-flex">
        <div>
          <label for="post" class="formbold-form-label"> Post/Zip code </label>
          <input
            type="text"
            name="post"
            id="post"
            placeholder="ex:8976"
            class="formbold-form-input"
          />
        </div>
        <div>
          <label for="city" class="formbold-form-label"> City </label>
          <input
            type="text"
            name="city"
            id="city"
            placeholder="ex: New York"
            class="formbold-form-input"
          />
        </div>
      </div>

      <div class="formbold-mb-3">
        <label for="upload" class="formbold-form-label">
          Upload Signature
        </label>
        <input
          type="file"
          name="upload"
          id="upload"
          class="formbold-form-input formbold-form-file"
        />
      </div>

      <div class="formbold-checkbox-wrapper">
        <label for="supportCheckbox" class="formbold-checkbox-label">
          <div class="formbold-relative">
            <input
              type="checkbox"
              id="supportCheckbox"
              class="formbold-input-checkbox"
            />
            <div class="formbold-checkbox-inner">
              <span class="formbold-opacity-0">
                <svg
                  width="11"
                  height="8"
                  viewBox="0 0 11 8"
                  class="formbold-stroke-current"
                  fill="none"
                  xmlns="http://www.w3.org/2000/svg"
                >
                  <path
                    d="M8.81868 0.688604L4.16688 5.4878L2.05598 3.29507C1.70417 2.92271 1.1569 2.96409 0.805082 3.29507C0.453266 3.66742 0.492357 4.24663 0.805082 4.61898L3.30689 7.18407C3.54143 7.43231 3.85416 7.55642 4.16688 7.55642C4.47961 7.55642 4.79233 7.43231 5.02688 7.18407L10.0696 2.05389C10.4214 1.68154 10.4214 1.10233 10.0696 0.729976C9.71776 0.357624 9.17049 0.357625 8.81868 0.688604Z"
                    fill="white"
                  />
                </svg>
              </span>
            </div>
          </div>
          I agree to the defined
          <a href="#"> terms, conditions, and policies</a>
        </label>
      </div>

      <button class="formbold-btn">Submit</button>
    </form>
  </div>
</div>
<style>
  @import url('https://fonts.googleapis.com/css2?family=Inter:wght@400;500;600;700&display=swap');
  * {
    margin: 0;
    padding: 0;
    box-sizing: border-box;
  }
  body {
    font-family: 'Inter', sans-serif;
  }
  .formbold-mb-3 {
    margin-bottom: 15px;
  }
  .formbold-relative {
    position: relative;
  }
  .formbold-opacity-0 {
    opacity: 0;
  }
  .formbold-stroke-current {
    stroke: #ffffff;
    z-index: 999;
  }
  #supportCheckbox:checked ~ div span {
    opacity: 1;
  }
  #supportCheckbox:checked ~ div {
    background: #6a64f1;
    border-color: #6a64f1;
  }

  .formbold-main-wrapper {
    display: flex;
    align-items: center;
    justify-content: center;
    padding: 48px;
  }

  .formbold-form-wrapper {
    margin: 0 auto;
    max-width: 570px;
    width: 100%;
    background: white;
    padding: 40px;
  }

  .formbold-img {
    display: block;
    margin: 0 auto 45px;
  }

  .formbold-input-wrapp > div {
    display: flex;
    gap: 20px;
  }

  .formbold-input-flex {
    display: flex;
    gap: 20px;
    margin-bottom: 15px;
  }
  .formbold-input-flex > div {
    width: 50%;
  }
  .formbold-form-input {
    width: 100%;
    padding: 13px 22px;
    border-radius: 5px;
    border: 1px solid #dde3ec;
    background: #ffffff;
    font-weight: 500;
    font-size: 16px;
    color: #536387;
    outline: none;
    resize: none;
  }
  .formbold-form-input::placeholder,
  select.formbold-form-input,
  .formbold-form-input[type='date']::-webkit-datetime-edit-text,
  .formbold-form-input[type='date']::-webkit-datetime-edit-month-field,
  .formbold-form-input[type='date']::-webkit-datetime-edit-day-field,
  .formbold-form-input[type='date']::-webkit-datetime-edit-year-field {
    color: rgba(83, 99, 135, 0.5);
  }

  .formbold-form-input:focus {
    border-color: #6a64f1;
    box-shadow: 0px 3px 8px rgba(0, 0, 0, 0.05);
  }
  .formbold-form-label {
    color: #536387;
    font-size: 14px;
    line-height: 24px;
    display: block;
    margin-bottom: 10px;
  }

  .formbold-checkbox-label {
    display: flex;
    cursor: pointer;
    user-select: none;
    font-size: 16px;
    line-height: 24px;
    color: #536387;
  }
  .formbold-checkbox-label a {
    margin-left: 5px;
    color: #6a64f1;
  }
  .formbold-input-checkbox {
    position: absolute;
    width: 1px;
    height: 1px;
    padding: 0;
    margin: -1px;
    overflow: hidden;
    clip: rect(0, 0, 0, 0);
    white-space: nowrap;
    border-width: 0;
  }
  .formbold-checkbox-inner {
    display: flex;
    align-items: center;
    justify-content: center;
    width: 20px;
    height: 20px;
    margin-right: 16px;
    margin-top: 2px;
    border: 0.7px solid #dde3ec;
    border-radius: 3px;
  }

  .formbold-form-file {
    padding: 12px;
    font-size: 14px;
    line-height: 24px;
    color: rgba(83, 99, 135, 0.5);
  }
  .formbold-form-file::-webkit-file-upload-button {
    display: none;
  }
  .formbold-form-file:before {
    content: 'Upload';
    display: inline-block;
    background: #EEEEEE;
    border: 0.5px solid #E7E7E7;
    border-radius: 3px;
    padding: 3px 12px;
    outline: none;
    white-space: nowrap;
    -webkit-user-select: none;
    cursor: pointer;
    color: #637381;
    font-weight: 500;
    font-size: 12px;
    line-height: 16px;
    margin-right: 10px;
  }

  .formbold-btn {
    font-size: 16px;
    border-radius: 5px;
    padding: 14px 25px;
    border: none;
    font-weight: 500;
    background-color: #6a64f1;
    color: white;
    cursor: pointer;
    margin-top: 25px;
  }
  .formbold-btn:hover {
    box-shadow: 0px 3px 8px rgba(0, 0, 0, 0.05);
  }

  .formbold-w-45 {
    width: 45%;
  }
</style>