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HTML

<!DOCTYPE html>
<html lang="en">

<head>
    <meta charset="UTF-8">
    <meta name="viewport" content="width=device-width, initial-scale=1.0">
    <title>Kyekyeku-tech.com</title>
    <link rel="stylesheet" href="https://cdnjs.cloudflare.com/ajax/libs/font-awesome/5.15.4/css/all.min.css">
 </head>
<body>
<div class="login-form">
  <div class="text">
    AGENT SIGNUP
  </div>
  <form id="signupForm" enctype="multipart/form-data">
    <input 
    type="hidden"
    name="x-sheetmonkey-insert-worksheet"
    value="NEW"
    />
    <div class="field">
      <div class="fas fa-user"></div>
      <input type="text" name="NAME" placeholder="NAME" required>
    </div>
    <div class="field">
      <div class="fas fa-envelope"></div>
      <input type="email" name="Email" placeholder="Email" required>
    </div>
    <div class="field">
        <div class="fas fa-phone"></div>
        <input type="number" name="PHONE_NUMBER" placeholder="Phone Number" required>
      </div>
    <div class="field">
      <div class="fas fa-lock"></div>
      <input type="password" name="PASSWORD" placeholder="Password" required>
    </div>
    <div class="field">
        <div class="fas fa-lock"></div>
        <input type="password" name="confirm_password" placeholder="Confirm Password" required>
      </div>
    <button type="submit">SIGNUP</button>
    <div class="link">
      Are you a member?
      <a href="service.html">Login now</a>
      <p style="color: red;">Please you'll be charge for Agent portal</p>
    </div>
  </form>
</div>
 </body>
</html>

CSS

@import url("https://fonts.googleapis.com/css?family=Poppins&display=swap");
* {
  margin: 0;
  padding: 0;
  font-family: "Poppins", sans-serif;
}
body {
  display: flex;
  height: 100vh;
  text-align: center;
  align-items: center;
  justify-content: center;
 
}
.login-form {
  position: relative;
  width: 370px;
  height: auto;
  background: #1b1b1b;
  padding: 40px 35px 60px;
  box-sizing: border-box;
  border: 1px solid black;
  border-radius: 5px;
  box-shadow: inset 0 0 1px #272727;
}
.text {
  font-size: 30px;
  color: #c7c7c7;
  font-weight: 600;
  letter-spacing: 2px;
}
form {
  margin-top: 40px;
}
form .field {
  margin-top: 20px;
  display: flex;
}
.field .fas {
  height: 50px;
  width: 60px;
  color: #868686;
  font-size: 20px;
  line-height: 50px;
  border: 1px solid #444;
  border-right: none;
  border-radius: 5px 0 0 5px;
  background: linear-gradient(#333, #222);
}
.field input,
form button {
  height: 50px;
  width: 100%;
  outline: none;
  font-size: 19px;
  color: #868686;
  padding: 0 15px;
  border-radius: 0 5px 5px 0;
  border: 1px solid #444;
  caret-color: #339933;
  background: linear-gradient(#333, #222);
}
input:focus {
  color: #339933;
  box-shadow: 0 0 5px rgba(0, 255, 0, 0.2), inset 0 0 5px rgba(0, 255, 0, 0.1);
  background: linear-gradient(#333933, #222922);
  animation: glow 0.8s ease-out infinite alternate;
}
@keyframes glow {
  0% {
    border-color: #339933;
    box-shadow: 0 0 5px rgba(0, 255, 0, 0.2), inset 0 0 5px rgba(0, 0, 0, 0.1);
  }
  100% {
    border-color: #6f6;
    box-shadow: 0 0 20px rgba(0, 255, 0, 0.6),
      inset 0 0 10px rgba(0, 255, 0, 0.4);
  }
}
button {
  margin-top: 30px;
  border-radius: 5px !important;
  font-weight: 600;
  letter-spacing: 1px;
  cursor: pointer;
}
button:hover {
  color: #339933;
  border: 1px solid #339933;
  box-shadow: 0 0 5px rgba(0, 255, 0, 0.3), 0 0 10px rgba(0, 255, 0, 0.2),
    0 0 15px rgba(0, 255, 0, 0.1), 0 2px 0 black;
}
.link {
  margin-top: 25px;
  color: #868686;
}
.link a {
  color: #339933;
  text-decoration: none;
}
.link a:hover {
  text-decoration: underline;
}