Payment_Form.html

<!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>
        <p>Required Fields are followed by *</p>
        <h2>Contact Information</h2>
        <p>Name: * <input type="text" name="name" required></p>
        <fieldset>
            <legend>Gender * </legend>
            <p>
            Male <input type="radio" name="gender" id="male" required> female <input type="radio" name="gender" id="female" required>
            
            </p>
        </fieldset>
        <p>Address: <textarea name="address" id="address" cols="100" rows="8"></textarea></p>
        <p>Email: * <input type="email" name="email" id="email" required></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="">--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="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>
        <input type="submit" value="Pay Now">

    </form>
</body>
</html>