diff --git a/input/.gitkeep b/input/.gitkeep
new file mode 100644
index 0000000..e69de29
diff --git a/input/css/.gitkeep b/input/css/.gitkeep
new file mode 100644
index 0000000..e69de29
diff --git a/input/css/styles.css b/input/css/styles.css
new file mode 100644
index 0000000..e06646e
--- /dev/null
+++ b/input/css/styles.css
@@ -0,0 +1,118 @@
+* {
+  margin: 0;
+  padding: 0;
+}
+
+body {
+  /* Positioning */
+  display: flex;
+  flex-direction: column;
+  justify-content: center;
+  align-items: center;
+
+  /* Styling */
+  background-color: #bbedbe;
+}
+
+h1 {
+  /* Positioning */
+  width: 80%;
+  padding: 2vw;
+
+  /* Font */
+  font-size: 8vw;
+  text-align: center;
+}
+
+h3 {
+  font-size: 4vw;
+}
+
+h5 {
+  font-size: 2vw;
+}
+
+h1,
+h3,
+h5,
+p,
+input {
+  color: #0e3610;
+}
+
+#form {
+  /* Positioning */
+  width: 80%;
+  display: flex;
+  flex-direction: column;
+  justify-content: center;
+  align-items: center;
+}
+
+form {
+  /* Form Shape */
+  width: 60%;
+  padding: 2.5vw 5vw 2.5vw 5vw;
+
+  /* Positioning */
+  display: flex;
+  flex-direction: column;
+  justify-content: center;
+  align-items: center;
+}
+
+.row {
+  /* Row Shape */
+  width: 100%;
+  display: flex;
+}
+
+input {
+  /* Input Shape */
+  width: 50%;
+  padding: 1vw;
+  margin: 1vw;
+  border: none;
+  border-radius: 18px;
+
+  /* Styling */
+  background-color: #f1fbf2;
+
+  /* Font */
+  font-size: 1vw;
+  font-weight: 400;
+}
+
+button {
+  /* Button Shape */
+  width: 60%;
+  padding: 1vw;
+  border: none;
+  border-radius: 18px;
+
+  /* Font */
+  color: white;
+  font-size: 1vw;
+  font-weight: 600;
+
+  /* Transition for hover */
+  transition-duration: 500ms;
+
+  background-color: #1c6b20;
+}
+
+button:hover {
+  background-color: #26942D;
+}
+
+#confirmation {
+  width: 60%;
+  padding: 5vw 0 5vw 0;
+  border-radius: 18px;
+  background-color: #57d45f;
+
+  display: flex;
+  flex-direction: column;
+  justify-content: center;
+  align-items: center;
+}
diff --git a/input/img/.gitkeep b/input/img/.gitkeep
new file mode 100644
index 0000000..e69de29
diff --git a/input/index.php b/input/index.php
new file mode 100644
index 0000000..2911a05
--- /dev/null
+++ b/input/index.php
@@ -0,0 +1,54 @@
+<?php
+if (isset($_POST['first_name']))
+    $first_name = $_POST['first_name'];
+if (isset($_POST['last_name']))
+    $last_name = $_POST['last_name'];
+if (isset($_POST['email']))
+    $email = $_POST['email'];
+if (isset($_POST['phone_number']))
+    $phone_number = $_POST['phone_number'];
+?>
+<!doctype html>
+<html lang="en">
+
+<head>
+  <title>Input</title>
+  <link href="css/styles.css" rel="stylesheet" type="text/css">
+  <script src="js/index.js"></script>
+</head>
+
+<body>
+  <h1>Input Assignment</h1>
+  <?php
+if ($first_name || $last_name || $email || $phone_number) {
+    echo '
+      <div id="confirmation">
+        <h3>Thank you for contacting me!</h3>
+        <h5>Your submitted information is:</h5>
+        <div id="information">
+          <p><strong>Name: </strong>' . $last_name . ', ' . $first_name . '</p>
+          <p><strong>Email: </strong>' . $email . '</p>
+          <p><strong>Phone: </strong>' . $phone_number . '</p>
+        </div>
+      </div>
+    ';
+} else {
+    echo '
+      <div id="form">
+        <form method="post">
+          <div class="row">
+            <input name="first_name" type="text" placeholder="Josh">
+            <input name="last_name" type="text" placeholder="Ashton">
+          </div>
+          <div class="row">
+            <input name="email" type="email" placeholder="me@joshashton.dev">
+            <input name="phone_number" type="text" placeholder="123 456 7890">
+          </div>
+          <button>Submit</button>
+        </form>
+      </div>
+';
+}
+?>
+</body>
+</html>
diff --git a/input/js/.gitkeep b/input/js/.gitkeep
new file mode 100644
index 0000000..e69de29
diff --git a/input/js/index.js b/input/js/index.js
new file mode 100644
index 0000000..e69de29
