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Payment_Form.html
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Payment_Form.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>Payment Form</h1>
<h2>Contact Information</h2>
<p>Required fields are followed by *</p>
<p>Name : * <input type="text" required></p>
<p>
<legend>Gender * </legend>
Male <input type="radio" name="Gender" id="Male" required>
Female <input type="radio" name="Gender" id="Female" required>
</p>
<p>Email : * <input type="email" name="Email" id="Email" required></p>
<p>Address : <textarea name="Address" id="Address" cols="50" rows="8"></textarea></p>
<p>Pincode : * <input type="number" name="Pincode" id="Pincode" required></p>
<h2>Payment Information</h2>
<p>Card Type : * <select name="Card_Type" id="Card_Type" required>
<option value="">--Please Select A Card Type--</option>
<option value="Visa">Visa</option>
<option value="Rupay">Rupay</option>
<option value="Debit">Debit</option>
<option value="Credit">Credit</option>
<option value="Paytm">Paytm</option>
</select></p>
<p>Card Number : * <input type="number" name="Card_Number" id="Card_Number" required></p>
<p>Expiration Date : * <input type="date" name="Exp_date" id="Exp_date" required></p>
<p>CVV : * <input type="password" name="CVV" id="CVV" required></p>
<p><input type="submit" value="Pay Now"> <input type="reset" value="Reset"></p>
</form>
</body>
</html>