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index.html
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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<title>Document</title>
<link rel="stylesheet" href="bootstrap-5.1.3-dist/css/bootstrap.min.css">
<link rel="stylesheet" href="form.css">
</head>
<body>
<div class="container-fluid">
<div class="container " style="padding: 0;">
<div class="row menu">
<div class="col-xl-6 ">
<div class="input-group Input">
<div class="name">
<label for="">First Name</label>
<input type="text" class="form-control" placeholder="First Name">
</div>
<div class="name">
<label for="">Last Name</label>
<input type="text" class="form-control" placeholder=" Last Name">
</div>
</div>
<div class="input-group input-groupedit">
<label for="Contry">Country</label>
<select name="" id="" >
<option value="Select your option">Select your option</option>
</select>
</div>
<div class="input-group input-groupedit">
<label for="">Address</label>
<textarea rows="5" id="comment" name="text" class="form-control w-100"></textarea>
</div>
<div class="input-group Input">
<div class="name">
<label for="">City</label>
<select name="" id="" class="form-control">
<option value="Select your option">Select your option</option>
</select>
</div>
<div class="name ">
<label for="">Pastol Code</label>
<input type="text" class="form-control w-50" placeholder="Pastol Code">
</div>
</div>
<div class="input-group Input">
<div class="name">
<label for="">Email</label>
<input type="text" class="form-control " placeholder="Email">
</div>
<div class="name ">
<label for="">Phone</label>
<input type="text" class="form-control " placeholder="Phone">
</div>
</div>
<div class="input-group mt-3">
<input type="checkbox" name="" id="">
<label for="">Agree to and condition</label>
</div>
</div>
<div class="col-xl-6 ">
<div class="input-group Input">
<div class="name1">
<label for="">Amount</label>
</div>
<div class="name1">
<input type="checkbox" name="" id=""><label for="">250$</label>
<input type="checkbox" name="" id=""><label for="">50$</label>
<input type="checkbox" name="" id=""><label for="">100$</label>
<input type="checkbox" name="" id=""><label for="">500$</label>
<input type="checkbox" name="" id=""><label for="">10000$</label>
<input type="checkbox" name="" id=""><label for="">2500$</label>
</div>
<div class="input-group input-groupedit">
<label for="">Other Amount</label>
<input type="text" class="form-control w-50" placeholder="Other Amount">
</div>
<div class="input-group input-groupedit">
<label for="">Credit Card</label>
<input type="text" class="form-control w-100">
<div class="groupimg">
<div class="img">
<img src="img card/aba.png" alt="">
</div>
<div class="img">
<img src="img card/ac.jpg" alt="">
</div>
<div class="img">
<img src="img card/master.png" alt="">
</div>
</div>
</div>
<div class="input-group">
<div class="name2">
<label for="">Year</label>
<input type="text" class="form-control" placeholder="Year">
</div>
<div class="name2">
<label for="">Mont</label>
<input type="text" class="form-control" placeholder="Mont">
</div>
<div class="name3">
<label for="">CVV Code</label>
<input type="text" class="form-control" placeholder="CV Code">
</div>
</div>
<div class="input-group mt-3">
<input type="checkbox" name="" id=""><label for="">Agree to terms and conditions</label>
<input type="button" class="form-control btn btn-success" value="Save">
</div>
</div>
</div>
</div>
</div>
</div>
</body>
</html>