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Added paymentform.html #1345

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73 changes: 73 additions & 0 deletions paymentform.html
Original file line number Diff line number Diff line change
@@ -0,0 +1,73 @@
<!DOCTYPE html>
<html>
<head>
<title>
Payment Form
</title>
</head>

<body>
<form action = "">
<h1>Payment Form</h1>
<hr>

<p>Required Fields are Followed by</p>

<hr>

<h2>Contact Information</h2>
<p> <h3>Name : * <input type = "text" name = "name" required></h3></p>

<fieldset>
<legend><h3>Gender : * </h3></legend>

<p>
Male <input type = "radio" name = "gender" id = "Male" required>
Female <input type = "radio" name = "gender" id = "Female" required>
</p>

</fieldset>

<!--<legend> Address: </legend>-->
<h3> Address:</h3>
<p> <textarea name = "address" id = "address" cols = "50" rows = "8"></textarea></p>


<!--<p><input type = "email" name = "email" id ="email"></p>-->
<h3>Email : * </h3>
<p> <textarea name = "email" id = "email" cols = "30" rows = "5" required></textarea></p>


<p> <h3>Pincode : * <input type = "number" name = "pincode" id = "pincode" required></h3></p>

<hr>
<h1>Payment Information</h1>

<hr>
<p>
<h3>Card Type: * <select name = "Card_type" id = " card_type" required>
<option value = "">--Select a Card Type--></option>
<option value = "visa">Visa</option>
<option value = "rupay">Rupay</option>
<option value = "sbi">SBI Card</option>
<option value = "master card">Master Card</option>
</select> </h3>
</p>
<hr>

<p>
<h3>Card Number : * &nbsp;<input type = "number" name = "card_number" id = "card_number" required></h3>
</p>

<p>
<h3>Expiry Date Of Card : * &nbsp; <input type = "date" name = "exp_date" id="exp_date" required></h3>
</p>

<p>
<h3>CVV : * &nbsp;<input type = "password" name = "cvv" id = "cvv" required></h3>
</p>

<input type = "submit" value = "Pay Now">
</form>
</body>
</html>