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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">
<title>Proyecto Forms</title>
<link href="https://cdn.jsdelivr.net/npm/[email protected]/dist/css/bootstrap.min.css" rel="stylesheet" integrity="sha384-QWTKZyjpPEjISv5WaRU9OFeRpok6YctnYmDr5pNlyT2bRjXh0JMhjY6hW+ALEwIH" crossorigin="anonymous">
<link rel="stylesheet" type="text/css" href="style.css">
<script src="https://kit.fontawesome.com/b232dfea0e.js" crossorigin="anonymous"></script>
</head>
<body>
<div class="card text-center mx-auto mt-3">
<!-- HEADER -->
<div class="card-header">
<h1 class="fw-bold fs-2 text-start">Payment form example</h1>
</div>
<div class="card-body">
<div class="alert alert-danger text-start" role="alert">
Some fields are missing
</div>
<!-- FORM START -->
<form method="get" action="#" class="row g-3">
<!-- ORIGINAL FIRST ROW -->
<div class="col-lg-5 col-md-12 col-sm-12 text-start" >
<label for="inputCard" class="form-label">Card #</label>
<input type="number" class="form-control" placeholder="XXXXXXXXXXXXXXXXX" id="inputCard" required>
</div>
<div class="col-lg-3 col-md-6 col-sm-12 text-start">
<label for="inputSecurityCode" class="form-label">CVC #</label>
<input type="number" class="form-control" placeholder="0000" id="inputSecurityCode" required>
</div>
<div class="col-lg-4 col-md-6 col-sm-6 text-start">
<label for="inputAmount" class="form-label">Amount</label>
<div class="input-group">
<span class="input-group-text">$</span>
<input type="number" class="form-control" placeholder="Amount" id="inputAmount" required>
</div>
</div>
<!-- ORIGINAL SECOND ROW -->
<div class="col-lg-6 col-md-6 col-sm-12 text-start">
<label for="inputFirstName" class="form-label">First name</label>
<input type="text" class="form-control" id="inputFirstName" required>
</div>
<div class="col-lg-6 col-md-6 col-sm-12 text-start">
<label for="inputLastName" class="form-label">Last name</label>
<input type="text" class="form-control" id="inputLastName" required>
</div>
<!-- ORIGINAL THIRD ROW -->
<div class="col-lg-6 col-md-12 col-sm-12 text-start">
<label for="inputCity" class="form-label">City</label>
<input type="text" class="form-control" id="inputCity" required>
</div>
<!-- SELECT LIST -->
<div class="col-lg-3 col-md-6 col-sm-6 text-start">
<label for="inputState" class="form-label">State</label>
<select class="form-select" id="inputState" aria-label="Default select" required>
<option value="" selected disabled>State</option>
<option value="1">California</option>
<option value="2">Texas</option>
<option value="3">Florida</option>
</select>
</div>
<div class="col-lg-3 col-md-6 col-sm-6 text-start">
<label for="inputPostalCode" class="form-label">Postal Code</label>
<input type="number" class="form-control" id="inputPostalCode" required>
</div>
<!-- ORIGINAL LAST ROW && RADIO INLINE LIST -->
<div class="col-lg-6 col-md-12 col-sm-12 pb-3">
<p for="exampleAccount" class="text-start">We accept:</p>
<div class="payment-options bg-secondary text-start p-2 rounded d-flex flex-wrap justify-content-start align-items-center text-light">
<div class="form-check form-check-inline">
<input class="form-check-input" type="radio" name="inlineRadioOptions" id="inlineRadio1" value="MasterCard" required>
<label class="form-check-label" for="inlineRadio1"><i class="fa-brands fa-cc-mastercard"></i></label>
</div>
<div class="form-check form-check-inline">
<input class="form-check-input" type="radio" name="inlineRadioOptions" id="inlineRadio2" value="Visa" required>
<label class="form-check-label" for="inlineRadio2"><i class="fa-brands fa-cc-visa"></i></label>
</div>
<div class="form-check form-check-inline">
<input class="form-check-input" type="radio" name="inlineRadioOptions" id="inlineRadio3" value="DinersClub" required>
<label class="form-check-label" for="inlineRadio1"><i class="fa-brands fa-cc-diners-club"></i></label>
</div>
<div class="form-check form-check-inline">
<input class="form-check-input" type="radio" name="inlineRadioOptions" id="inlineRadio4" value="AmericanExpress" required>
<label class="form-check-label" for="inlineRadio2"><i class="fa-brands fa-cc-amex"></i></label>
</div>
</div>
</div>
<!-- TEXTAREA -->
<div class="col-lg-6 col-md-12 col-sm-12 text-start">
<label for="floatingTextarea2" class="form-label text-start">Message</label>
<div class="form-floating">
<textarea class="form-control" placeholder="Leave a comment here" id="floatingTextarea2" style="height: 100px" required></textarea>
</div>
<p class="comment">Add any notes here.</p>
</div>
</div>
<!-- BUTTONS -->
<div class="card-footer text-body-secondary">
<div class="d-grid gap-2 d-md-flex justify-content-md-end">
<button class="btn btn-secondary me-md-2" type="reset">Cancel</button>
<button class="btn btn-primary" type="submit">Submit</button>
</div>
</div>
</div>
</form>
<script src="https://cdn.jsdelivr.net/npm/[email protected]/dist/js/bootstrap.bundle.min.js" integrity="sha384-YvpcrYf0tY3lHB60NNkmXc5s9fDVZLESaAA55NDzOxhy9GkcIdslK1eN7N6jIeHz" crossorigin="anonymous"></script>
</body>
</html>