<!DOCTYPE html>
<html>
<head>
<meta charset="utf-8">
<meta name="viewport" content="width=device-width">
<title>JS Bin</title>
</head>
<body>
<form>
<input type="text" name="fio">
<input type="text" name="phone">
<input type="text" name="data-birthday">
<input type="button"> Отправить
</form>
</body>
</html>