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HTML 

              
                <div class="container">

   <div class="form__container">
      <div class="form__introduce">
         <h1 class="form__title">Register NOW!</h1>
         <form>
            <fieldset>
               <legend>About You</legend>

               <div class="form-row">
                  <div class="form-control">
                     <label>Name</label>
                     <input id="name" type="text" placeholder="What's your name?" />
                  </div>               
                  <div class="form-control">
                     <label>Email</label>
                     <input type="text" placeholder="[email protected]" />
                  </div>
                  <div class="form-control">
                     <label>Phone</label>
                     <input type="text" placeholder="555 555 5555" />
                  </div>
               </div>
            </fieldset>
            <fieldset>
               <legend>Your Company</legend>
               <div class="form-row">

                  <div class="form-control">
                     <label>Company</label>
                     <input type="text" placeholder="Where do you work?" />
                  </div>               
                  <div class="form-control">
                     <label>City</label>
                     <input type="text" placeholder="Where is your company located?" />
                  </div>
               </div>
               <div class="form-row">
                  <div class="form-control">
                     <label>Country</label>
                     <select id="country">
                        <option value="" disabled selected>Select a country</option>
                        <option value="US">United States</option>
                        <option value="EU">United Kingdom</option>
                        <option value="UK">Africa</option>   
                     </select>
                  </div>
                  <div class="form-control">
                     <label>State/Province</label>
                     <select id="state">
                        <option value="" disabled selected>Select a state/province</option>
                        <option value="MD">MD</option>
                        <option value="VA">VA</option>
                        <option value="DC">DC</option>    
                     </select>
                  </div>
               </div>
            </fieldset>
         </form>

         <div class="form__buttons">
            <button id="submitButton">SUBMIT</button>    
         </div>
      </div>
      
      <!-- ****************************************************** -->  
      
      
      <div class="form__review">
         <h1 class="form__title">SENT DATA</h1>
         <fieldset>
            <legend>About You</legend>
            <p>Name: <span id="reviewName">HERE COMES THE NAME</span></p>
            <p>Email: <span>HERE COMES THE EMAIL</span></p>
            <p>Phone: <span>HERE COMES THE PHONE</span></p>
         </fieldset>
         
         <fieldset>
            <legend>Your Company</legend>
            <p>Company: <span>HERE COMES THE COMPANY</span></p>
            <p>City: <span>HERE COMES THE CITY</span></p>
            <p>Country: <span>HERE COMES THE COUNTRY</span></p>
            <p>State/Province: <span>HERE COMES THE STATE/PROVINCE</span></p>
         </fieldset><!--/fieldset-->
      </div>
      
     
   </div>
</div>
!

CSS 

              
                html * {
  -webkit-font-smoothing: antialiased;
  -moz-osx-font-smoothing: grayscale;
}

*, *:after, *:before {
  -webkit-box-sizing: border-box;
  -moz-box-sizing: border-box;
  box-sizing: border-box;
}

html {
   font-size: 62.5%;
}

body {
   text-rendering: optimizeLegibility;
   background: #fff;
}

.container {
   position: relative;
   width: 100%;
}


/* form container */
.form__container {
   display: flex;
   justify-content: space-evenly;
   
   width: 100%;
   height: 100%;
   position: relative;
   background: #fff;
   padding: 5rem 5rem 5rem 5rem;
   overflow: hidden;
}

/* style the close btn */
.form__container .close {
   position: absolute;
   top: 2rem;
   right: 2rem;
}

.form__title {
   color: #293948;
   font-family: 'Varela Round', sans-serif;
   font-weight: 600;
   text-transform: uppercase;
   text-align: center;
   margin-bottom: 2rem;
}

/* flexbox rows */
.form-row {
   display: -webkit-box;
   display: -webkit-flex;
   display: -ms-flexbox;
   display: flex;
   -webkit-box-orient: vertical;
   -webkit-box-direction: normal;
   -webkit-flex-direction: column;
   -ms-flex-direction: column;
   flex-direction: column;
   -webkit-flex-wrap: nowrap;
   -ms-flex-wrap: nowrap;
   flex-wrap: nowrap;
}

/* make it reponsive */
@media (min-width: 700px) {
   .form-row {
      -webkit-box-orient: horizontal;
      -webkit-box-direction: normal;
      -webkit-flex-direction: row;
      -ms-flex-direction: row;
      flex-direction: row;
   }
}

/* row spacing */
.form-control {
   position: relative;
   padding-left: 0.5rem;
   padding-right: 0.5rem;
   -webkit-box-flex: 1;
   -webkit-flex-grow: 1;
   -ms-flex-positive: 1;
   flex-grow: 1;
}

fieldset {
   border: 0;
   margin: 0;
   padding: 0;
   margin-bottom: 2rem;
}

legend {
   font-family: 'Varela Round', sans-serif;
   font-weight: 600;
   text-transform: uppercase;
   letter-spacing: .1rem;
   font-size: .8rem;
   color: #455a64;
   display: block;
   border: 0;
   padding: 0;
   margin-bottom: 2rem;
   overflow: hidden;
   position: relative;
   width: 100%;
}


/* legend divider */
legend:after {
   content: "";
   width: 100%;
   position: absolute;
   height: 1px;
   top: 0.5rem;
   margin-left: 1rem;
   background: #e8ecef;
}

label {
   color: #b0bec5; /*afc7da*/
   display: block;
   font-family: 'Varela Round', sans-serif;
   font-size: 1.2rem;
   letter-spacing: 0.035rem;
   margin-bottom: .5rem;
}

input[type="email"],
input[type="number"],
input[type="search"],
input[type="text"],
input[type="tel"],
input[type="url"],
input[type="password"],
textarea,
select {
   /* main */
   display: block;
   height: 5.3rem;
   padding: .6rem 1rem; /* The 6px vertically centers text on FF */
   width: 100%;
   background-color: #fff;
   border: .1rem solid #c7d6de; /*c7d6de*/
   border-radius: .5rem;
   outline: 0;
   appearance: none;
   box-shadow: 0;
   box-shadow: none;  
   /* typography */
   font-family: 'Nunito', sans-serif;
   font-weight: 400;
   font-size: 1.5rem;
   margin-bottom: 2rem;
   text-align: left;
   color: #141920;
   line-height: normal;
   /* transition */
   transition: all 0.2s ease-in-out;
   -webkit-transition: all 0.2s ease-in-out;
}

select {
   display: inline-block;
   -webkit-appearance: none;
   appearance: none;
   -moz-appearance: window;
   background: url(https://www.pigeonholelive.com/images/chevron-down.png) no-repeat;
   background-size: 15px;
   background-position: right 1.5rem center;
   color: rgba(52, 72, 91, .3);
   font-weight: 400;
}

/* style the focus */
input[type="email"]:focus,
input[type="number"]:focus,
input[type="search"]:focus,
input[type="text"]:focus,
input[type="tel"]:focus,
input[type="url"]:focus,
input[type="password"]:focus,
textarea:focus,
select:focus {
   border: .1rem solid #52a9fd;
   /*ccdfee def0fe brand primary: 4083c4*/
   outline: 0;
}

/* style placeholder text */
input::-webkit-input-placeholder {
   color: rgba(52, 72, 91, .3);
}
input::-moz-placeholder {
   color: rgba(52, 72, 91, .3);
}
input:-moz-placeholder {
   /* Older versions of Firefox */
   color: rgba(52, 72, 91, .3);
}
input:-ms-input-placeholder {
   color: rgba(52, 72, 91, .3);
}

/* Remove awkward default styles on some inputs for iOS */
input[type="email"],
input[type="number"],
input[type="search"],
input[type="text"],
input[type="tel"],
input[type="url"],
input[type="password"],
textarea {
   -webkit-appearance: none;
   -moz-appearance: none;
   appearance: none;
}
input::-ms-clear, textarea::-ms-clear {
  display: none;
}
button {
   width: 200px;
   height: 45px;
   font-family: 'Varela Round', sans-serif;
   font-size: 11px;
   text-transform: uppercase;
   letter-spacing: 1.5px;
   font-weight: 500;
   color: #fff;
   background-color: #4083c4;
   border: none;
   border-radius: 45px;
   box-shadow: 0px 8px 20px rgba(0, 0, 0, 0.2);
   transition: all 0.3s ease 0s;
   cursor: pointer;
   outline: none;
}
button:hover {
   background-color: #2EE59D;
   box-shadow: 0px 15px 20px rgba(46, 229, 157, 0.4);
   color: #fff;
   transform: translateY(-7px);
}
.form__buttons {
   background: #FFF;
   text-align: center;
   padding-top: 2rem;
   padding-bottom: 2rem;
}
!

JS
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