<!DOCTYPE html>
<html>
<body>
<form id="name-surname">
<label for="name">Name: </label>
<input type="text" id="name" name="name"> <br>
<label for="surname">Surname: </label>
<input type="text" id="surname" name="surname"> <br>
<label for="city">City:</label>
<input type="text" id="city" name="city"><br>
<label for="zip">ZIP:</label>
<input type="text" id="zip" name="zip"><br>
<label for="state">State:</label>
</form>
</body>
</html>