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forms.html
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63 lines (48 loc) · 1.92 KB
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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<title>Register With Us</title>
</head>
<body>
<header>
<h1>Register your Veridian account today!</h1>
</header>
<form method="post" action="https://request-inspector.glitch.me/">
<label for="username">Username:</label>
<input id="username" name="username" type="text" placeholder="you@yourmail.com">
<br>
<label for="password">Password:</label>
<input id="password" name="password" type="password" value="password">
<br>
<br>
<label for="bio">Real quick: tell us about <em>you!</em></label>
<br>
<textarea name="bio" id="bio" rows="15" cols="45" placeholder="This helps us understand what you'd like to see from us - let us know about you and your unique needs."></textarea>
<br>
<br>
<h3>How'd you hear about Veridian Dynamics? (Choose all that apply)</h3>
<label for="billboard">
<input id="billboard" type="checkbox" name="marketing_penetration1" value="billboard"> Billboards
</label>
<br>
<label for="fmam"><input id="fmam" type="checkbox" name="marketing_penetration2" value="fmam">
Radio Advertisements</label>
<br>
<label for="internet"><input id= "internet" type="checkbox" name="marketing_penetration3" value="internet"> On the internet</label>
<br>
<label for="other"><input id="other" type="checkbox" name="marketing_penetration4" value="other"> Other</label>
<br>
<br>
<br>
<label for="current_browser">What's your current browser?</label>
<select id="current_browser" name="current_browser">
<option value="firefox">Firefox</option>
<option value="microsoft_browsers">Internet Explorer or Edge</option>
<option value="chrome" selected>Google Chrome</option>
<option value="safari">Safari</option>
</select>
<button type="submit">Register your new customer account</button>
</form>
</body>
</html>