HTML form code

<!DOCTYPE html>
<title>My Example</title>

<p>
<label>Phone 
<input type="tel" name="phone_number">
</label>
</p>

<p>
<label>Email 
<input type="email" name="email_address">
</label>
</p>

<fieldset>
<legend>Which taxi do you require?</legend>
<p><label> <input type="radio" name="taxi" required value="car"> Car </label></p>
<p><label> <input type="radio" name="taxi" required value="van"> Van </label></p>
<p><label> <input type="radio" name="taxi" required value="tuktuk"> Tuk Tuk </label></p>
</fieldset>

<fieldset>
<legend>Extras</legend>
<p><label> <input type="checkbox" name="extras" value="baby"> Baby Seat </label></p>
<p><label> <input type="checkbox" name="extras" value="wheelchair"> Wheelchair Access </label></p>
<p><label> <input type="checkbox" name="extras" value="tip"> Stock Tip </label></p>
</fieldset>

<p>
<label>Pickup Date/Time
<input type="datetime-local" name="pickup_time" required>
</label>
</p>
	
<p>
<label>Pickup Place
<select id="pickup_place" name="pickup_place">
<option value="" selected="selected">Select One</option>
<option value="office" >Taxi Office</option>
<option value="town_hall" >Town Hall</option>
<option value="telepathy" >We'll Guess!</option>
</select>
</label> 
</p>

<p>
<label>Dropoff Place
<input type="text" name="dropoff_place" required list="destinations">
</label>

<p>
<label>Special Instructions
<textarea name="comments" maxlength="500"></textarea>
</label>
</p>

<p><button>Submit Booking</button></p>

</form>