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Create test_anu.html #3

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93 changes: 93 additions & 0 deletions test_anu.html
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Original file line number Diff line number Diff line change
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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>Document</title>
</head>
<body>

<fieldset>
<h1>Payment form</h1>
</fieldset>
<br>
<h3>Contact Information</h3>
<P>Mandatory fields are marked in *</P>
<label for="name">Name:*</label>
<input type="text" id="name" name="name">
<br>
<br>
<fieldset>
<legend>GENDER*</legend>
<br>
<p style="text-align: center;">
<label for="male">Male</labl>
<input type="radio" id="male" name="gender" required>
<label for="female">Female</label>
<input type="radio" id="female" name="gender" required>
<label for="others">Others</label>
<input type="radio" id="others" name="gender" required>
</p>
<br>
</fieldset>
<br>
<label for="add" style="font-size: large;">Address:</label>
<br>
<textarea name="add" id="add" cols="30" rows="10"></textarea>
<br>
<br>
<label for="email" style="font-size: large;">Email:</label>
&nbsp;
&nbsp;
&nbsp;
<input type="email" id="email" name="email" placeholder="asc15.lko@gmail.com">
<br>
<br>
<label for="pincode" style="font-size: large;">Pincode:*</label>
<input type="number" id="pincode" name="pincode" placeholder="226025">
<br>
<br>
<hr>
<br>
<h2>Payment Information</h2>
<br>
<label for="Card Type:*">Card Type:*</label>
&nbsp;
&nbsp;
&nbsp;
&nbsp;
<select name="Card Type" id="Card Type" required>
<option value="">Select Card Type--</option>
<option value="visa">VISA CARD</option>
<option value="master">MASTER CARD</option>
<option value="debit">DEBIT CARD</option>
</select>
<br>
<br>
<label for="card no">Card Number:*</label>
&nbsp;
<input type="number" id="card no" name="card no" maxlength="10" required>
<br>
<br>
<label for="expiration date">Expiration date:*</label>
<input type="date" id="expiration date" name="expiration date" required>
<br>
<br>
<label for="cvv">CVV:*</label>
&nbsp;
&nbsp;
&nbsp;
&nbsp;
&nbsp;
&nbsp;
&nbsp;
&nbsp;
<input type="password" name="cvv" id="cvv" maxlength="4" required>
<br>
<br>
<input type="submit" value="Pay Now" class="submit-btn">
<input type="submit" value="Reset" class="Reset">

</body>
</html>