Adding a custom form in addition to the contact page

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I am working on a website for selling furniture. We have a program where you can sign up for a trade account, and I'd like to implement the application with a form on its own page with the same style as the contact page. I know HTML/CSS and I'm currently learning Liquid. I would like to do this by coding it myself without an external app. I've attached a photo of the form I'd like to embed so you can see what I'd like to achieve: inline checkboxes, etc.

If someone could point me in the right direction, that would be great. Thanks