diff --git a/src/registrar/forms/application_wizard.py b/src/registrar/forms/application_wizard.py
index 855a24106..5b7a2806d 100644
--- a/src/registrar/forms/application_wizard.py
+++ b/src/registrar/forms/application_wizard.py
@@ -89,38 +89,52 @@ class DotGovDomainForm(forms.Form):
 class PurposeForm(forms.Form):
     purpose_field = forms.CharField(label="Purpose", widget=forms.Textarea())
 
+class YourContactForm(forms.Form):
+    given_name = forms.CharField(label="First name/given name")
+    middle_name = forms.CharField(
+            required=False,
+            label="Middle name (optional)",
+            )
+    family_name = forms.CharField(label="Last name/family name")
+    title = forms.CharField(label="Title or role in your organization")
+    email = forms.EmailField(label="Email")
+    phone = forms.CharField(label="Phone")
+
 
 # List of forms in our wizard. Each entry is a tuple of a name and a form
 # subclass
 FORMS = [
     ("organization", OrganizationForm),
-    ("contact", ContactForm),
+    ("org_contact", ContactForm),
     ("authorizing_official", AuthorizingOfficialForm),
     ("current_sites", CurrentSitesForm),
     ("dotgov_domain", DotGovDomainForm),
     ("purpose", PurposeForm),
+    ("your_contact", YourContactForm),
 ]
 
 # Dict to match up the right template with the right step. Keys here must
 # match the first elements of the tuples in FORMS
 TEMPLATES = {
     "organization": "application_organization.html",
-    "contact": "application_contact.html",
+    "org_contact": "application_org_contact.html",
     "authorizing_official": "application_authorizing_official.html",
     "current_sites": "application_current_sites.html",
     "dotgov_domain": "application_dotgov_domain.html",
     "purpose": "application_purpose.html",
+    "your_contact": "application_your_contact.html",
 }
 
 # We need to pass our page titles as context to the templates, indexed
 # by the step names
 TITLES = {
     "organization": "About your organization",
-    "contact": "Your organization's contact information",
+    "org_contact": "Your organization's contact information",
     "authorizing_official": "Authorizing official",
-    "current_sites": "Website for your organization",
+    "current_sites": "Organization website",
     "dotgov_domain": ".gov domain",
     "purpose": "Purpose of your domain",
+    "your_contact": "Your contact information",
 }
 
 
diff --git a/src/registrar/templates/application_contact.html b/src/registrar/templates/application_org_contact.html
similarity index 100%
rename from src/registrar/templates/application_contact.html
rename to src/registrar/templates/application_org_contact.html
diff --git a/src/registrar/templates/application_purpose.html b/src/registrar/templates/application_purpose.html
index 0903880e7..6a7682b63 100644
--- a/src/registrar/templates/application_purpose.html
+++ b/src/registrar/templates/application_purpose.html
@@ -21,6 +21,9 @@
       <span class="usa-character-count__message" id="with-hint-textarea-info with-hint-textarea-hint"> You can enter up to 500 characters </span>
     </div>
   </div>
+
+  {{ block.super }}
+
 </form>
 
 {% endblock %}
diff --git a/src/registrar/templates/application_your_contact.html b/src/registrar/templates/application_your_contact.html
new file mode 100644
index 000000000..490f334b5
--- /dev/null
+++ b/src/registrar/templates/application_your_contact.html
@@ -0,0 +1,53 @@
+<!-- Test page -->
+{% extends 'application_form.html' %}
+{% load widget_tweaks %}
+{% load static %}
+
+{% block backnav %}
+  {% with form_name="step__ao" %}
+    {{ block.super }}
+  {% endwith %}
+{% endblock %}
+
+{% block form_content %}
+
+<div id="instructions">
+  <p> We’ll use the following information to contact you about your domain request and, once your request is approved, about managing your domain.</p>
+
+  <p>If you’d like us to use a different name, email, or phone number you can make those changes below. Changing your contact information here won’t affect your login.gov account information.</p>
+
+  <p>The contact information you provide here won’t be public and will only be used for the .gov registry.</p>
+<div>
+
+<p>All fields are required unless they are marked optional.</p>
+
+<form class="usa-form usa-form--large" id="step__ao" method="post">
+  {{ wizard.management_form }}
+  {% csrf_token %}
+
+  <fieldset class="usa-fieldset">
+    {{ wizard.form.given_name|add_label_class:"usa-label" }}
+    {{ wizard.form.given_name|add_class:"usa-input"|attr:"aria-describedby:instructions" }}
+
+    {{ wizard.form.middle_name|add_label_class:"usa-label" }}
+    {{ wizard.form.middle_name|add_class:"usa-input"|attr:"aria-describedby:instructions" }}
+
+    {{ wizard.form.family_name|add_label_class:"usa-label" }}
+    {{ wizard.form.family_name|add_class:"usa-input"|attr:"aria-describedby:instructions" }}
+    
+    {{ wizard.form.title|add_label_class:"usa-label" }}
+    {{ wizard.form.title|add_class:"usa-input"|attr:"aria-describedby:instructions" }}
+
+    {{ wizard.form.email|add_label_class:"usa-label" }}
+    {{ wizard.form.email|add_class:"usa-input"|attr:"aria-describedby:instructions" }}
+
+    {{ wizard.form.phone|add_label_class:"usa-label" }}
+    {{ wizard.form.phone|add_class:"usa-input usa-input"|attr:"aria-describedby:instructions" }}
+  </fieldset>
+
+
+  {{ block.super }}
+
+</form>
+
+{% endblock %}