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index.html
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<!DOCTYPE html>
<html lang="es">
<head>
<meta charset="UTF-8">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<title>HTML-Form</title>
<script src="https://kit.fontawesome.com/072e5df971.js" crossorigin="anonymous"></script>
<link rel="icon" href="https://storage.googleapis.com/breathecode-asset-images/5318bde604cf5c915f94897a71b49ab2523101322ea21cb046db1e67c24fa3be.png">
<link rel="stylesheet" href="style.css">
<link href="https://cdn.jsdelivr.net/npm/bootstrap@5.0.2/dist/css/bootstrap.min.css" rel="stylesheet" integrity="sha384-EVSTQN3/azprG1Anm3QDgpJLIm9Nao0Yz1ztcQTwFspd3yD65VohhpuuCOmLASjC" crossorigin="anonymous">
</head>
<body>
<style>
input {
background: none;
border: none;
color: white;
}
</style>
<div class="card w-75 mx-auto mt-1">
<div class="card-header">
<h1>Payment form example</h1>
</div>
<div class="card-body">
<div class="alert alert-danger" role="alert">
Some fields are missing
</div>
<form class="row g-3" method="get" action="#">
<div class="row g-2">
<div class="col-sm-6">
<label for="Card#">Card #</label>
<input type="text" class="form-control" placeholder="1234-5678-9101-1121" aria-label="Card#" required>
</div>
<div class="col-sm-2 mx-2">
<label for="CVC#">CVC #</label>
<input type="text" class="form-control" placeholder="0000" aria-label="CVC#" required>
</div>
<div class="col-sm-3 mx-2">
<label for="Amount">Amount $</label>
<div class="input-group">
<input type="text" class="form-control" placeholder="Amount" aria-label="Amount" required>
</div>
</div>
</div>
<div class="col-md-6">
<label for="inputAddress" class="form-label">First Name</label>
<input type="text" class="form-control" id="inputname" required>
</div>
<div class="col-md-6">
<label for="inputAddress2" class="form-label">Last Name</label>
<input type="text" class="form-control" id="inputlastname">
</div>
<div class="col-md-6">
<label for="inputCity" class="form-label">City</label>
<input type="text" class="form-control" id="inputCity" required>
</div>
<div class="col-md-3">
<label for="inputState" class="form-label">State</label>
<select id="inputState" class="form-select" required>
<option selected>Pick a State</option>
<option value="CALI">California</option>
<option value="TEX">Texas</option>
<option value="FLO">Florida</option>
<option value="ARI">Arizona</option>
<option value="OHI">Ohio</option>
<option value="COL">Colorado</option>
</select>
</div>
<div class="col-md-3">
<label for="inputZip" class="form-label">Postal Code</label>
<input type="text" class="form-control" id="inputZip" required>
</div>
<div class="col-md-6">
We accept:
<div class="bg-secondary p-2 rounded d-flex justify-content-around w-75 mt-2">
<div class="form-check form-check-inline">
<input class="form-check-input" type="radio" name="inlineRadioOptions" id="inlineRadio1" value="option1">
<label class="form-check-label" for="inlineRadio1"> <i class="fa-brands fa-cc-mastercard" style="color: #ffffff;"></i> </label>
</div>
<div class="form-check form-check-inline">
<input class="form-check-input" type="radio"name="inlineRadioOptions" id="inlineRadio2" value="option2">
<label class="form-check-label" for="inlineRadio2"> <i class="fa-brands fa-cc-visa" style="color: #ffffff;"></i> </label>
</div>
<div class="form-check form-check-inline">
<input class="form-check-input" type="radio" name="inlineRadioOptions" id="inlineRadio3" value="option3">
<label class="form-check-label" for="inlineRadio3"> <i class="fa-brands fa-cc-diners-club" style="color: #ffffff;"></i> </label>
</div>
<div class="form-check form-check-inline">
<input class="form-check-input" type="radio" name="inlineRadioOptions" id="inlineRadio4" value="option4">
<label class="form-check-label" for="inlineRadio4"> <i class="fa-brands fa-cc-paypal" style="color: #ffffff;"></i> </label>
</div>
</div>
</div>
<div class="col-md-6">
<p>Message</p>
<div class="form-floating">
<textarea class="form-control " placeholder="Leave a comment here" id="floatingTextarea2" style="height: 100px"></textarea>
<label for="floatingTextarea2"></label>
</div>
</div>
</div>
<div class="card-footer text-body-secondary d-flex justify-content-end">
<button class="btn btn-secondary mx-2">
<input type="reset" value="Cancel">
</button>
<button class="btn btn-primary">
<input type="submit" value="Send">
</button>
</div>
</div>
</body>
</html>