Webpage-Maker/paymentform.html at master · BaldeepRocks/Webpage-Maker · GitHub

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<html>
<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>
    <script src="https://kit.fontawesome.com/f40480f317.js" crossorigin="anonymous"></script>
    <link rel="stylesheet" href="paymentform.css">
</head>
<body>

    <div class="container">
    <form action="">


          <h1 class="main_heading" >  <i class="fa-regular fa-credit-card"></i>  Payment Form</h1>
        <hr>
        <h2>Contact Information</h2>
        <p>Name: * <input placeholder="Nandini Trivedi" type="text"name="name" required></p>
        <fieldset>
        <p>
            Male <input type="radio" name="gender" id="male">
            Female <input type="radio" name="gender" id="female">
        </p>
    </fieldset>
        <p>Address: <textarea placeholder="A-228 vaishali nagar ,jaipur" name="address" id="address" cols="100" rows="8"></textarea></p>
       <p>Email: <input placeholder="nandinitrivedi.jp@gmail.com" type="email" name="email" id="email"></p>
       <p>Pincode: <input placeholder="302021" type="number" name="pincode" id="pincode"></p>

       <hr>

       <h2>Payment Information</h2>
       <p>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="paytm">paytm</option>
        </select>
       </p>
       <p>
           Card Number *<input placeholder="2222-XXXX-XXXX" type="number" name="card_number" id="card_number" required>
       </p>
<p>
     Exp Date *: <input type="date" name="exp_date" id="exp_date" required>
</p>
<p>CVV * <input placeholder="XXX" type="password" name="cvv" id="cvv" required></p>
<input type="submit" value="Pay Now">
    </form>
</div>
</body>
</html>