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CSS

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HTML 

              
                <div class="background">
  <div class="container">
    <div class="screen">
      <div class="screen-header">
        <div class="screen-header-left">
          <div class="screen-header-button close"></div>
          <div class="screen-header-button maximize"></div>
          <div class="screen-header-button minimize"></div>
        </div>
        <div class="screen-header-right">
          <div class="screen-header-ellipsis"></div>
          <div class="screen-header-ellipsis"></div>
          <div class="screen-header-ellipsis"></div>
        </div>
      </div>
      <div class="screen-body">
        <div class="screen-body-item left">
          <div class="app-title">
            <span>CONTACT</span>
            <span>US</span>
          </div>
          <div class="app-contact">CONTACT INFO : +62 81 314 928 595</div>
        </div>
        <div class="screen-body-item">
          <div class="app-form">
            <div class="app-form-group">
              <input class="app-form-control" placeholder="NAME" value="Krisantus Wanandi">
            </div>
            <div class="app-form-group">
              <input class="app-form-control" placeholder="EMAIL">
            </div>
            <div class="app-form-group">
              <input class="app-form-control" placeholder="CONTACT NO">
            </div>
            <div class="app-form-group message">
              <input class="app-form-control" placeholder="MESSAGE">
            </div>
            <div class="app-form-group buttons">
              <button class="app-form-button">CANCEL</button>
              <button class="app-form-button">SEND</button>
            </div>
          </div>
        </div>
      </div>
    </div>
    <div class="credits">
      inspired by
      <a class="credits-link" href="https://dribbble.com/shots/2666271-Contact" target="_blank">
        <svg class="dribbble" viewBox="0 0 200 200">
          <g stroke="#ffffff" fill="none">
            <circle cx="100" cy="100" r="90" stroke-width="20"></circle>
            <path d="M62.737004,13.7923523 C105.08055,51.0454853 135.018754,126.906957 141.768278,182.963345" stroke-width="20"></path>
            <path d="M10.3787186,87.7261455 C41.7092324,90.9577894 125.850356,86.5317271 163.474536,38.7920951" stroke-width="20"></path>
            <path d="M41.3611549,163.928627 C62.9207607,117.659048 137.020642,86.7137169 189.041451,107.858103" stroke-width="20"></path>
          </g>
        </svg>
        Gururaj
      </a>
    </div>
  </div>
</div>
!

CSS 

              
                *, *:before, *:after {
  box-sizing: border-box;
  -webkit-font-smoothing: antialiased;
  -moz-osx-font-smoothing: grayscale;
}

body {
  background: linear-gradient(to right, #ea1d6f 0%, #eb466b 100%);
  font-size: 12px;
}

body, button, input {
  font-family: 'Montserrat', sans-serif;
  font-weight: 700;
  letter-spacing: 1.4px;
}

.background {
  display: flex;
  min-height: 100vh;
}

.container {
  flex: 0 1 700px;
  margin: auto;
  padding: 10px;
}

.screen {
  position: relative;
  background: #3e3e3e;
  border-radius: 15px;
}

.screen:after {
  content: '';
  display: block;
  position: absolute;
  top: 0;
  left: 20px;
  right: 20px;
  bottom: 0;
  border-radius: 15px;
  box-shadow: 0 20px 40px rgba(0, 0, 0, .4);
  z-index: -1;
}

.screen-header {
  display: flex;
  align-items: center;
  padding: 10px 20px;
  background: #4d4d4f;
  border-top-left-radius: 15px;
  border-top-right-radius: 15px;
}

.screen-header-left {
  margin-right: auto;
}

.screen-header-button {
  display: inline-block;
  width: 8px;
  height: 8px;
  margin-right: 3px;
  border-radius: 8px;
  background: white;
}

.screen-header-button.close {
  background: #ed1c6f;
}

.screen-header-button.maximize {
  background: #e8e925;
}

.screen-header-button.minimize {
  background: #74c54f;
}

.screen-header-right {
  display: flex;
}

.screen-header-ellipsis {
  width: 3px;
  height: 3px;
  margin-left: 2px;
  border-radius: 8px;
  background: #999;
}

.screen-body {
  display: flex;
}

.screen-body-item {
  flex: 1;
  padding: 50px;
}

.screen-body-item.left {
  display: flex;
  flex-direction: column;
}

.app-title {
  display: flex;
  flex-direction: column;
  position: relative;
  color: #ea1d6f;
  font-size: 26px;
}

.app-title:after {
  content: '';
  display: block;
  position: absolute;
  left: 0;
  bottom: -10px;
  width: 25px;
  height: 4px;
  background: #ea1d6f;
}

.app-contact {
  margin-top: auto;
  font-size: 8px;
  color: #888;
}

.app-form-group {
  margin-bottom: 15px;
}

.app-form-group.message {
  margin-top: 40px;
}

.app-form-group.buttons {
  margin-bottom: 0;
  text-align: right;
}

.app-form-control {
  width: 100%;
  padding: 10px 0;
  background: none;
  border: none;
  border-bottom: 1px solid #666;
  color: #ddd;
  font-size: 14px;
  text-transform: uppercase;
  outline: none;
  transition: border-color .2s;
}

.app-form-control::placeholder {
  color: #666;
}

.app-form-control:focus {
  border-bottom-color: #ddd;
}

.app-form-button {
  background: none;
  border: none;
  color: #ea1d6f;
  font-size: 14px;
  cursor: pointer;
  outline: none;
}

.app-form-button:hover {
  color: #b9134f;
}

.credits {
  display: flex;
  justify-content: center;
  align-items: center;
  margin-top: 20px;
  color: #ffa4bd;
  font-family: 'Roboto Condensed', sans-serif;
  font-size: 16px;
  font-weight: normal;
}

.credits-link {
  display: flex;
  align-items: center;
  color: #fff;
  font-weight: bold;
  text-decoration: none;
}

.dribbble {
  width: 20px;
  height: 20px;
  margin: 0 5px;
}

@media screen and (max-width: 520px) {
  .screen-body {
    flex-direction: column;
  }

  .screen-body-item.left {
    margin-bottom: 30px;
  }

  .app-title {
    flex-direction: row;
  }

  .app-title span {
    margin-right: 12px;
  }

  .app-title:after {
    display: none;
  }
}

@media screen and (max-width: 600px) {
  .screen-body {
    padding: 40px;
  }

  .screen-body-item {
    padding: 0;
  }
}
!

JS
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