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index.html
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54 lines (51 loc) · 1.69 KB
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<!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>Payment Form</title>
<link rel="stylesheet" href="payment.css">
</head>
<body>
<form action="">
<h1 class="heading"><center> Payment Form </center></h1>
<h2></h2>
<div1>Name: <input type="text" name="name" required></div1><br>
<fieldset>
<legend>Gender</legend>
<p>
<label for="Male">
Male <input type="radio" name="gender" id="Male">
</label>
<label for="Female">
Female <input type="radio" name="gender" id="Female">
</label>
</p>
</fieldset>
<p>Address: <textarea name="Address" id="Address" cols="200" rows="0"></textarea></p>
<P>Email: <input type="email" name="Email" id="Email" maxlength="90"></P>
<p>Pin Code: <input type="number" name="Pin Code" id="Pin Code"></p>
<hr>
<h2>Payment Information</h2>
<p>Card Type:
<select name="Card_Type" id="Card_Type">
<option value="">--Select a Card Type--</option>
<option value="Visa">Visa</option>
<option value="Rupay">Rupay</option>
<option value="Mastercard">Mastercard</option>
</select>
</p>
<p>
Card Number: <input type="Card Number" maxlength="16" >
</p>
<div>
Expiration Date: <input type="Date" name="Exp_Date" id="Exp_Date">
</div>
<p>
CVV <input type="password" name="CVV" id="CVV">
</p>
<input type="Submit" value="Pay Now">
</form>
</body>
</html>