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    © All Rights Reserved
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    0 views2 pages

    Document

    Uploaded by

    flashharry599

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    of 2

    <!

    DOCTYPE html>

    <html>

    <head>

    <title>payment form</title>

    </head>

    <body>

    <form>

    <h1>please fill the content</h1>

    <h2>personal information </h2>

    <p>Name:

    <input type ="text" name="name" id= "name" required>

    </p>hhcg

    <p>Address:

    <textarea name="address" id="address" cols="8" rows="8"></textarea>

    </p>

    <fieldset>

    <legend>Gender:</legend>

    <p>

    Male:<input type ="radio" name="gender" id="male">

    Female:<input type ="radio" name="gender" id="female" required>

    </p>

    </fieldset>

    <p>Email:

    <input type ="email" name="email" id="email" required>

    </p>

    <p>Pincode:

    <input type ="number" id="Pincode" name="Pincode">

    </p>

    <h2>Card Information </h2>

    <p>Card Type:

    <select>
    <option value="">--select a card type--<option>

    <option value="visa">Visa</option>

    <option value="PayPal">PayPal</option>

    <option value="phonepay">phonepay</option>

    </select>

    </p>

    <p>Card Number:

    <input type="number" name="card_number" id="card number" required>

    </p>

    <p>Exp. Date:

    <input type="date" name="exp._date" id="exp._date" required>

    </p>

    <p>CVV:

    <input type="password" name="cvv" id="cvv" required>

    </p>

    <input type="submit" value="Pay Now">

    <input type="reset" value="Clear all">

    </form>

    </body>

    </html>

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