<!DOCTYPE html>
<html>
<body>
<form action="action_page.php">
<fieldset>
<legend>Personal information:</legend>
First name:<br>
<input type="text" name="firstname" value="Mickey">
<br>
Last name:<br>
<input type="text" name="lastname" value="Mouse">
<br><br>
<input type="submit" value="Submit">
</fieldset>
</form>
</body>
</html>