create the following form
customer name
address
month
units
bill
<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<meta http-equiv="X-UA-Compatible" content="IE=edge">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<title>Document</title>
</head>
<body>
<form action="">
<input type="text" placeholder="Customer name">
<input type="text" placeholder="Address">
<input type="text" placeholder="Month">
<input type="text" placeholder="Units">
<input type="text" placeholder="Bill">
</form>
</body>
</html>
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