-
Notifications
You must be signed in to change notification settings - Fork 1
/
form.html
60 lines (57 loc) · 1.68 KB
/
form.html
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
<!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>Document</title>
</head>
<link rel="stylesheet" href="style.css">
<body style="background-color: rgb(10, 66, 10);color: white;">
<h1><center>REGISTER FOR EVIFY</center></h1>
<h3><CENTEr> FILL IN YOUR DETAILS</CENTEr></h3>
<div style="text-align:center;">
<label><h4> NAME:</h4>
<input type="text" width="100" placeholder="SURNAME">
<input type="text" width="100" placeholder="FIRSTNAME">
<input type="text" width="100" placeholder="OTHER NAMES"></label>
<p>
<h4>NATIONALITY</h4>
<input type="text" width="300" placeholder="Your Country">
</label>
</p>
<p>
<h4>STATE</h4>
<input type="text" width="300" placeholder="Your State">
</label>
</p>
<p>
<h4>RESIDENTIAL ADDRESS</h4>
<input type="text" width="300" placeholder="Residential Address">
</label>
</p>
<p>
<h4>DATE OF BIRTH:</h4><div>
<input type="date" name="birthday" id="birthday"></div>
</label>
<p>
<h4>ID NO.</h4></p>
<input type="text" width="300" placeholder="ID No">
</label>
<div>
<p>
<h4>ID ISSUANCE DATE</h4></p>
<input type="text" width="300" placeholder="ID Issuance Date">
</label>
<h5>ID EXPIRY DATE</h5>
<input type="text" width="300" placeholder="ID Expiry Date">
</label>
<p>
</div>
</div> <br> <br>
<center><button style="color: rgb(21, 4, 4);"> <a href="#"></a> SUBMIT</button> </center> <br> <br> <br>
<div><center><a href="./index.html" style="color: white;">
← Go Back</a></center>
</div>
</body>
</html>