diff --git a/index.html b/index.html
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+<!doctype html>
+<html>
+<head>
+<title>Survey Form</title>
+<style>
+	.heading{
+		text-align: left;
+	}
+</style>
+</head>
+<body style="background-color: black;color: white;">
+<form>
+<fieldset>
+<h1 style="text-align: center;font-size: 40px;">SURVEY FORM</h1><hr width="90%"><br><br>
+<h2 class="heading">Customer Name</h2><br>
+<label>Enter your First Name: &nbsp </label><input type="text" name=""> &nbsp &nbsp &nbsp  &nbsp &nbsp &nbsp <label>Enter your last Name:&nbsp</label><input type="text" name=""><br><br>
+<h2 class="heading">Address</h2>
+<input type="text" name=""><br>
+<label>Street Address &nbsp </label><br><br>
+<input type="text" name=""><br>
+<label>Street Address 2 &nbsp </label><br><br>
+<label>City: &nbsp </label>
+<input type="text" name=""> &nbsp &nbsp &nbsp  &nbsp &nbsp &nbsp
+<label>State: &nbsp </label>
+<input type="text" name=""><br><br>
+<label>Zip: &nbsp </label>
+<input type="text" name=""><br><br>
+<input list="country" placeholder="Venezuela">
+
+		<datalist id="country">
+         <option value="">	
+		 <optgroup label="A">
+	<option value="Afghanistan">	
+	<option value="Albania">	
+	<option value="Algeria">	
+	<option value="Andorra">	
+	<option value="Argentina">	
+	<option value="	Australia">	
+	</optgroup>
+<optgroup label="B">
+	<option value="Belgium">	
+	<option value="	Brazil">	
+	<option value="Bhutan">	
+	<option value="	Belgium">	
+	<option value="Bahrain">
+ </optgroup>
+ <optgroup label="C"> 
+	<option value="Cambodia">	
+	<option value="Cameroon">	
+	<option value="Canada">	
+	<option value="China">	
+	<option value="Colombia">	
+	<option value="Chile">	
+	<option value="Croatia">
+ </optgroup>	
+  <optgroup label="D">
+	<option value="Denmark">	
+	<option value="Dominica">
+ </optgroup>	 
+ <optgroup label="E">
+	<option value="Egypt">	
+	<option value="Estonia">
+	<option value="England">
+ </optgroup>	
+  <optgroup label="F">
+	<option value="Finland">	
+	<option value="France">
+ </optgroup>	
+  <optgroup label="G">
+	<option value="Germany">	
+	<option value="Ghana">	
+	<option value="Greece">	
+	<option value="Guinea">	
+	</optgroup>	
+	<optgroup label="H">
+	<option value="Hungary">
+</optgroup>	
+	<optgroup label="I">
+	<option value="Iceland">	
+	<option value="India">	
+	<option value="Indonesia">	
+	<option value="Iran">	
+	<option value="Iraq">	
+	<option value="Ireland">	
+	<option value="Israel">	
+	<option value="Italy">
+	</optgroup>	
+	<optgroup label="J">
+	<option value="Jamaica">	
+	<option value="Japan">	
+	<option value="Jordan">	
+	</optgroup>	
+	<optgroup label="K">
+	<option value="Kazakhstan">	
+	<option value="Kenya">	
+	<option value="Kyrgyzstan">	
+	</optgroup>
+	<optgroup label="L">
+	<option value="Latvia">	
+	<option value="	Lebanon">	
+	<option value="	Liberia">	
+	<option value="Luxembourg">
+</optgroup>	
+<optgroup label="M">
+	<option value="Malaysia">	
+	<option value="	Mexico">	
+	<option value="Maldives">	
+	<option value="Morocco">	
+	<option value="Madagascar">	
+	<option value="Myanmar">
+	<option value="Mongolia">	
+	<option value="Mauritania">	
+	</optgroup>	
+	
+<optgroup label="N">
+	<option value="Namibia">	
+	<option value="Nepal">	
+	<option value="Netherlands">	
+	<option value="New Zealand">	
+	<option value="Nigeria">	
+	<option value="North Macedonia">	
+	<option value="North Korea">	
+	<option value="Norway">	
+	</optgroup>
+	<optgroup label="O">
+	<option value="Oman">	
+	</optgroup>
+	<optgroup label="P">
+	<option value="Pakistan">	
+	<option value="Palau">	
+	<option value="Palestine">	
+	<option value="Papua New Guinea">	
+	<option value="Paraguay">
+	<option value="Peru">	
+	<option value="	Philippines">	
+	<option value="Poland">	
+	<option value="Portugal">
+</optgroup>
+	<optgroup label="Q">
+	<option value="Qatar">
+</optgroup>	
+<optgroup label="R">
+	<option value="Romania">	
+	<option value="Russia">	
+	<option value="Rwanda">	
+	</optgroup>	
+	<optgroup label="S">
+	<option value="Saudi Arabia">	
+	<option value="	Samoa">	
+	<option value="Senegal">	
+	<option value="Singapore">	
+	<option value="Serbia">	
+	<option value="South Africa">	
+	<option value="South Korea">	
+	<option value="	Spain">
+	<option value="Sri Lanka">	
+	<option value="Sudan">	
+	<option value="Sweden">	
+	<option value="Syria">	
+	</optgroup>	
+	<optgroup label="T">
+	<option value="Tajikistan">	
+	<option value="Thailand">	
+	<option value="Togo">	
+	<option value="Turkey">	
+	<option value="Turkmenistan">
+</optgroup>		
+<optgroup label="U">
+	<option value="Uganda">	
+	<option value="Uganda">	
+	<option value="United Arab Emirates">	
+	<option value="United Kingdom">	
+	<option value="United States of America">	
+	<option value="Uzbekistan">	
+	<option value="Uruguay">
+	</optgroup>
+<optgroup label="V">	
+	<option value="	Vietnam">	
+	<option value="Vanuatu">	
+	<option value="Venezuela">	
+	</optgroup>
+	<optgroup label="Y">
+	<option value="	Yemen">
+</optgroup>	
+	<optgroup label="T">
+	<option value="Zambia">	
+	<option value="Zimbabwe">	
+	</optgroup>
+	
+		</datalist><br>
+		<label> Select Country </label>
+
+<br>
+
+<h2 class="heading">Contact</h2>
+<label>Phone: </label> &nbsp
+<input type="tel">&nbsp &nbsp &nbsp &nbsp &nbsp &nbsp
+<label>Email:</label> &nbsp
+<input type="Email"><br>
+
+<h3 class="heading">Personal Details</h3>
+<input type="radio" name="Personal Details" id="Male">
+<label for="Male">Male</label><br>
+<input type="radio" name="Personal Details" id="Female">
+<label for="Female">Female</label><br>
+<input type="radio" name="Personal Details" id="Other">
+<label for="Other">Other</label><br><br>
+
+<h2 class="heading">Ratings</h2>
+<label>Rating 1: &nbsp &nbsp &nbsp </label>
+<input type="radio" name="ratings" id="Bad">
+<label for="Bad">Bad</label> &nbsp &nbsp
+<input type="radio" name="ratings" id="Good">
+<label for="Good">Good</label> &nbsp &nbsp
+<input type="radio" name="ratings" id="Excellent">
+<label for="Excellent">Excellent</label> <br><br><br>
+
+<label>Rating 2: &nbsp &nbsp &nbsp </label>
+<input type="radio" name="ratings" id="Bad">
+<label for="Bad">Bad</label> &nbsp &nbsp
+<input type="radio" name="ratings" id="Good">
+<label for="Good">Good</label> &nbsp &nbsp
+<input type="radio" name="ratings" id="Excellent">
+<label for="Excellent">Excellent</label> <br><br><br>
+
+<label>Rating 3: &nbsp &nbsp &nbsp </label>
+<input type="radio" name="ratings" id="Bad">
+<label for="Bad">Bad</label> &nbsp &nbsp
+<input type="radio" name="ratings" id="Good">
+<label for="Good">Good</label> &nbsp &nbsp
+<input type="radio" name="ratings" id="Excellent">
+<label for="Excellent">Excellent</label> <br><br><br>
+
+<label>Rating 4: &nbsp &nbsp &nbsp </label>
+<input type="radio" name="ratings" id="Bad">
+<label for="Bad">Bad</label> &nbsp &nbsp
+<input type="radio" name="ratings" id="Good">
+<label for="Good">Good</label> &nbsp &nbsp
+<input type="radio" name="ratings" id="Excellent">
+<label for="Excellent">Excellent</label> <br><br><br>
+
+<label>Rating 5: &nbsp &nbsp &nbsp </label>
+<input type="radio" name="ratings" id="Bad">
+<label for="Bad">Bad</label> &nbsp &nbsp
+<input type="radio" name="ratings" id="Good">
+<label for="Good">Good</label> &nbsp &nbsp
+<input type="radio" name="ratings" id="Excellent">
+<label for="Excellent">Excellent</label> <br><br><br>
+
+<label>Rating 6: &nbsp &nbsp &nbsp </label>
+<input type="radio" name="ratings" id="Bad">
+<label for="Bad">Bad</label> &nbsp &nbsp
+<input type="radio" name="ratings" id="Good">
+<label for="Good">Good</label> &nbsp &nbsp
+<input type="radio" name="ratings" id="Excellent">
+<label for="Excellent">Excellent</label> <br><br><br>
+
+<label>Rating 7: &nbsp &nbsp &nbsp </label>
+<input type="radio" name="ratings" id="Bad">
+<label for="Bad">Bad</label> &nbsp &nbsp
+<input type="radio" name="ratings" id="Good">
+<label for="Good">Good</label> &nbsp &nbsp
+<input type="radio" name="ratings" id="Excellent">
+<label for="Excellent">Excellent</label> <br><br><br>
+
+<input type="Submit" name="">
+</fieldset>
+</form>
+</body>
+</html>
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