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index.html
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<!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">
<script src="https://kit.fontawesome.com/55f23628ea.js" crossorigin="anonymous"></script>
<link href="https://cdn.jsdelivr.net/npm/[email protected]/dist/css/bootstrap.min.css" rel="stylesheet"
integrity="sha384-GLhlTQ8iRABdZLl6O3oVMWSktQOp6b7In1Zl3/Jr59b6EGGoI1aFkw7cmDA6j6gD" crossorigin="anonymous">
<link rel="stylesheet" href="styles.css">
<title>Form</title>
</head>
<body>
<div class="container p-4">
<div class="card">
<div class="card-header">
<h3>Payment form example</h3>
</div>
<div class="alert alert-danger m-3" role="alert">
Some fields are missing
</div>
<div class="card-body">
<form>
<div class="row">
<div class="col-5">
<label for="card-number">Card #</label>
<input type="number" class="form-control" id="card-number" placeholder="XXXXXXXXXXXXX">
</div>
<div class="col-3">
<label for="cvc">CVC #</label>
<input type="number" class="form-control" id="cvc" placeholder="0000" min="4" max="4">
</div>
<div class="col-3">
<label for="amount">Amount</label>
<div class="d-flex flex-row gap-1">
<i class="fas fa-dollar-sign mt-2"></i>
<input type="number" class="form-control" id="amount" placeholder="Amount">
</div>
</div>
<div class="row my-2">
<div class="col-6">
<label for="name">First Name</label>
<input type="text" class="form-control" id="name">
</div>
<div class="col-6">
<label for="lastname">Last Name</label>
<input type="text" class="form-control" id="lastname">
</div>
<div class="col-6 p-3">
<label for="city">City</label>
<input type="text" class="form-control" id="city">
</div>
<div class="col-3 d-flex flex-column p-3">
<label class="mr-sm-2" for="inlineFormCustomSelect">State</label>
<select class="custom-select mr-sm-2 h-100" id="inlineFormCustomSelect">
<option selected>Pick a state...</option>
<option value="1">One</option>
<option value="2">Two</option>
<option value="3">Three</option>
</select>
</div>
<div class="col-3 p-3">
<label for="postal-code">Postal Code</label>
<input type="number" class="form-control" id="postal-code">
</div>
<div class="row my-3 ms-2">
<div class="col-6">
<label for="form-check">We accept</label>
<div
class="formcheck d-flex bg-secondary w-50 border border-secondary rounded p-1 my-2">
<div class="form-check form-check-inline">
<input class="form-check-input" type="radio" id="inlineCheckbox1"
value="mastercard" name="payment">
<label class="form-check-label" for="inlineCheckbox1"><i
class="fab fa-cc-mastercard iconwhite"></i></label>
</div>
<div class="form-check form-check-inline">
<input class="form-check-input" type="radio" id="inlineCheckbox2"
value="visa" name="payment">
<label class="form-check-label" for="inlineCheckbox2"><i
class="fab fa-cc-visa iconwhite"></i></label>
</div>
<div class="form-check form-check-inline">
<input class="form-check-input" type="radio" id="inlineCheckbox3"
value="dinersclub" name="payment">
<label class="form-check-label" for="inlineCheckbox3"><i
class="fab fa-cc-diners-club iconwhite"></i></label>
</div>
<div class="form-check form-check-inline">
<input class="form-check-input" type="radio" id="inlineCheckbox4"
value="amex" name="payment">
<label class="form-check-label" for="inlineCheckbox4"><i
class="fab fa-cc-amex iconwhite"></i>
</i></label>
</div>
</div>
</div>
<div class="col-6 ml-4">
<label for="message">Message</label>
<textarea class="form-control" id="message" rows="3"></textarea>
<div id="emailHelp" class="form-text">Add any notes here.</div>
</div>
</div>
</div>
</form>
</div>
</div>
<div class="card-footer d-flex justify-content-end gap-2 p-2">
<button type="button" class="btn btn-secondary">Cancel</button>
<button type="submit" class="btn btn-primary">Send</button>
</div>
</div>
<script src="https://cdn.jsdelivr.net/npm/[email protected]/dist/js/bootstrap.bundle.min.js"
integrity="sha384-w76AqPfDkMBDXo30jS1Sgez6pr3x5MlQ1ZAGC+nuZB+EYdgRZgiwxhTBTkF7CXvN"
crossorigin="anonymous"></script>
</body>
</html>