Can you code for me

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$$a Car Booking System page for my Website

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Make it similiar if not identical to my design

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$$it should be written in html and css with php for the places where the user inputs data so it goes into my database.

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The writing under location is "Include city with address" and under the pickup time is "Includes Calendar"Logo

$\backslash$table$[[$Car type:,Location:,Duration:,Pick up time:,Drop off time:,Distance:$],[,\backslash$table$[[$Include city with$],[..]],,$Includes Calendar,,$]]$