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index.html
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index.html
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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>Payment Form</title>
</head>
<body>
<form action="">
<h1 class="main_heading">Payment Form</h1>
<h2>Conatct Information</h2>
<h2>Reuired Field are followed by * </h2>
<p>Name*:<input type="text"name="name" required placeholder="ABHAY YADAV"></p>
<fieldset>
<legend>Gender*</legend>
<p>
Male <input type="radio" name="gender" required id="male" required >
Female <input type="radio" name="gender" required id="female" required >
</p>
</fieldset>
<p>Address: <textarea name="address" id="address" cols="100" rows="8"placeholder="ENTER YOUR ADDRESS"></textarea></p>
<p>Email: <input type="email" name="email" required id="email" required placeholder="[email protected]"></p>
<p>Pincode:<input type="number" name="Pincode" id="Pincode"> </p>
<br>
<h2> Payment Information*</h2>
<p>
Card Type*: <select name="card_type required " id="card_type" required >
<option value="">------select a card type----</option>
<option value="VISA">VISA</option>
<option value="RUPAY">RUPAY</option>
<option value="MASTERCARD">MASTERCARD</option>
</select>
</p>
<p>
Card Number <input type="number" name="card_number" required id="card_number" placeholder="1234 4567 7890 1258" required >
</p>
<p>
Expiration Date<input type="date"name="Expiration_date" required id="Expiration_date" required >
</p>
<p>CVV <input type="password" name="cvv" required id="cvv" required placeholder="021">
<input type="SUBMIT"value="SUBMIT">
</form>
</body>
</html>