The image shows a computer screen displaying a webpage with a blue header containing text and a logo. The main content of the page is a form with fields labeled "First Name" and "Last Name". Below these fields, there is a section for "Address" with a placeholder text "Enter your address here". The form also includes a button labeled "Submit" and a link to "Contact us" at the bottom. The overall design suggests it is a form for personal information submission, possibly for a registration or account creation process.