<form method="POST" action="affinitylive.php">

    <fieldset class="checkbox">

        <legend>I need:</legend>

        <label>
            <input type="checkbox" name="selection[]" value="quote">
            A Quote
        </label>

        <label>
            <input type="checkbox" name="selection[]" value ="help">
            Help
        </label>

    </fieldset>

    <fieldset class ="user-input">

        <legend>Contact Info:</legend>

        <input type="text" name="company_name" class="input" placeholder="Company Name">

        <input type="text" name="contact_firstname" class="input"  placeholder="First Name">

        <input type="text" name="contact_surname" class="input"  placeholder="Last Name">

        <input type="email" name="email" class="input" placeholder="Email">

        <input type="tel" name="phone_number" class="input" placeholder="Phone Number">

        <div><button name="submit">Submit</button></div>

    </fieldset>
</form>