OneCompiler

Payement Form

1658
<!DOCTYPE html> <html> <head> <title>Form</title> </head> <body> <form> <h1 class="title"align="center">Payment Form </h1> <hr> <p>Mandatory fields followed by(*)</p> <hr> <h3 align="center">Personal details</h3> <p>Name* :<input type="text"name="name"required </p>
  <fieldset>
    <legend>Gender*</legend>
  <p>Male:<input type="radio"name="gender"id="male"</p>
  <p>Female:<input type="radio"name="gender"id="female"</p>
  </fieldset>
 
  <p>Address:
  <textarea name="address"id="address"cols="40"rows="4">
  </textarea>
  </p>
 
  <p>Email:<input type="Email"name="Email"id="email"</p>
  <p>Pincode:<input type="number"name="pincode"id="pincode"</p>
  
  
  <h3 align="center">Payment Details</h3>
  
  <p>CardType: <select name="card_type"id="card_type">
    <option name=""id="">--Select Card</option>
    <option name="Debit card"id="Debit card">Debit card</option>
    <option name="Credit card"id="Credit card">credit</option>
    <option name="Rupay"id="Rupay">Rupay</option>
    <option name="master"id="master">master</option>
  </select></p>
  
  <p>Card number:<input type="password"name="card number"id="card number"</p>
  
  <p>Expiration date:<input type="date"name"exp_date"id="exp_date"></p>
  
  <p>Cvv: <input type="password"name="cvv"id="cvv"></p>
  
  <input type="submit"value="Pay now">
  </form>
</body> </html>