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  • Payment Form

    Uploaded by

    Sandeep Bhardwaj
    33 views1 page
    The document contains a payment form requesting personal details such as name, date of birth, address and gender. It also requests bank details including card type, CVV, card number and expiration date. Users can submit or reset the form.

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    Original Title

    payment form

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    © © All Rights Reserved

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    The document contains a payment form requesting personal details such as name, date of birth, address and gender. It also requests bank details including card type, CVV, card number and expiration date. Users can submit or reset the form.

    Copyright:

    © All Rights Reserved
    Download as TXT, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    33 views1 page

    Payment Form

    Uploaded by

    Sandeep Bhardwaj
    The document contains a payment form requesting personal details such as name, date of birth, address and gender. It also requests bank details including card type, CVV, card number and expiration date. Users can submit or reset the form.

    Copyright:

    © All Rights Reserved
    Download as TXT, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    <!

    DOCTYPE html>
    <html lang="en">
    <head>
    <meta charset="UTF-8">
    <meta name="viewport" content="width=device-width, initial-scale=1.0">
    <title>Document</title>
    </head>
    <body>
    <h1>Payment Form</h1>
    <h1>Personal Details</h1>
    <form action="">
    <p> Name: <input type="text" name="name of candidate">
    </p>
    <p> Date of Birth: <input type="date" name="Date of Birth"></p>
    <p> Address: <textarea name="address" id="" cols="30" rows="10"></textarea></p>
    <fieldset><legend>Gender</legend>
    <p><input type="radio" name="gender">Male</p>
    <p><input type="radio" name="gender">Female</p>
    </fieldset>
    <h1>Bank Details</h1>
    <p> Select: Card Type <select name="card type" id="">
    <option value="">---select card type---</option>
    <option value="mastercard">mastercard</option>
    <option value="rupay card">rupay card</option>
    <option value="visa card">visa card</option>
    <option value="Debit card">Debit card</option>
    <option value="Credit card">Credit card</option>
    </select>
    </p>
    <p>CVV: <input type="text"name="CVV"></p>
    <p>Card Number: <input type="text"name="Card Number"></p>
    <p>Exp Date: <input type="text"name="Exp Date"></p>
    <input type="submit">
    <input type="reset">
    </form>
    </body>
    </html>

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