<form action="<?php echo esc_url( $_SERVER['REQUEST_URI'] ); ?>" method="post">
<p>
Your Name (required) <br />
<input type="text" name="cf-name" pattern="[a-zA-Z0-9 ]+" value="<?php echo ( isset( $_POST["cf-name"] ) ? esc_attr( $_POST["cf-name"] ) : '' ); ?>" size="40" required />
</p>
<p>
Your Email (required) <br />
<input type="email" name="cf-email" value="<?php echo ( isset( $_POST["cf-email"] ) ? esc_attr( $_POST["cf-email"] ) : '' ); ?>" size="40" required />
</p>
<p>
Phone Number<br />
<input type="tel" name="cf-phone" pattern="[0-9+() -]*" value="<?php echo ( isset( $_POST["cf-phone"] ) ? esc_attr( $_POST["cf-phone"] ) : '' ); ?>" size="40" />
</p>
<p>
Document to be Notarized<br />
<input type="text" name="cf-document" value="<?php echo ( isset( $_POST["cf-document"] ) ? esc_attr( $_POST["cf-document"] ) : '' ); ?>" size="40" />
</p>
<p>
Location<br />
<input type="text" name="cf-location" value="<?php echo ( isset( $_POST["cf-location"] ) ? esc_attr( $_POST["cf-location"] ) : '' ); ?>" size="40" />
</p>
<p><input type="submit" name="cf-submitted" value="Send"></p>
</form>