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index.html
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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<title>Payment Form</title>
<link rel="stylesheet" href="style.css">
</head>
<body>
<div class="container">
<h1 class="main_heading">Payment Form</h1>
<h2>User Information</h2>
<p>Name: <input type="text"id="name" value="name" width="50px" placeholder="enter your name" required></p>
<p>Password: <input type="password" id="number" value="number" placeholder="enter your password" required></p>
<fieldset>
<legend>Gender</legend>
<p>Male:<input type="radio"id="gender"name="gender">
<br>
Female:<input type="radio"id="gender"name="gender"> </p>
</fieldset>
<p>Address: <textarea name="address" id="address" cols="30" rows="6" placeholder="enter your address" required></textarea></p>
<p>Email: <input type="email"name="email"id="email" placeholder="enter your email" required></p>
<p>Password: <input type="password" name="number" id="password" placeholder="enter password" required></p>
<p>Pincode: <input type="text" name="number" id="pincode" placeholder="enter pincode" required></p>
<h1>Payment Information</h1>
<p>Card-type:
<select name="Card-type" id="Card-type">
<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="text" name="card-number" id="card-number" placeholder="enter your 16 digits 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>
<input type="submit" value="Pay Now" placeholder="enter cvv">
</div>
</body>
</html>