How to create a custom form block with CSS

Site URL: https://form-block.squarespace.com/

Hello, I am trying to create a custom form block like the screenshot here.

A few things I am trying to accomplish here and are causing the biggest hurdles.

1. Have a two column form - The only way I see to do this is to use the name form, but then it will say first and last name which I don't want as I want to add custom values. 
2. Add placeholder text to the register form when there is not an option to do so.  
3. Create a different styled drop down then the generic one with SP. (Showed here)

Any help is appreciated,

Thanks!

Dillon

#1. You can use Text Field, instead of Name Field

#2. Placeholder for all fields or dropdown only?

#3. Not possible