nitya8086 / webdev

<title>Payment form</title>

Payment form

---

Required feilds are followed by *

User information

First Name : *

Last Name :

Gender

Female Male

    <p>Address  :<textarea name="address" id="address" cols="100" rows="8" placeholder="enter your address"></textarea></p>
    <p>Email   : *<input type="email" name="email" id="eamil"required placeholder="enter your email"></p>
    <p>Pincode :* <input type="number" name="pincode" id="pincode"required placeholder="enter pincode"></p>
    <h3>Payment information</h3>
    <p>Card type *
        <select name="card_type" id="card_type"required>
            <option value="">----select card type----</option>></option>
            <option value="Visa">Visa</option>
            <option value="Debit card">Debit card</option>
            <option value="Credit card">Credit card</option>
            <option value="Rupay">Rupay</option>

        </select>
    </p>
    <p>
        Card Number <input type="number" name="card_number" id="card_number"required placeholder="enter card number">
    </p>
    <p>
        Expiration Date: * <input type="date" name="expr_date" id="expr_date"required placeholder="enter expri date">
    </p>
    <p>CVV : * <input type="password" name="cvv" id="cvv"required placeholder="enter cvv number"></p>

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

    </form>

</div>