html-hello/index.html at main · Danieldaviddf/html-hello · GitHub

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<!DOCTYPE html>
<html lang="en">
<head>
    <meta charset="UTF-8">
    <meta name="viewport" content="width=device-width, initial-scale=1.0">
    <title>Document</title>
    <link rel="stylesheet" href="https://cdn.jsdelivr.net/npm/bootstrap@5.3.3/dist/css/bootstrap.min.css" integrity="sha384-QWTKZyjpPEjISv5WaRU9OFeRpok6YctnYmDr5pNlyT2bRjXh0JMhjY6hW+ALEwIH" crossorigin="anonymous">
    <script src="https://cdn.jsdelivr.net/npm/bootstrap@5.3.3/dist/js/bootstrap.min.js" integrity="sha384-0pUGZvbkm6XF6gxjEnlmuGrJXVbNuzT9qBBavbLwCsOGabYfZo0T0to5eqruptLy" crossorigin="anonymous"></script>
    <link rel="stylesheet" href="https://cdnjs.cloudflare.com/ajax/libs/font-awesome/7.0.1/css/all.min.css">

</head>
<body>
        <div class="container-fluid">
            <div class="card text-left w-50 mx-auto">
                <div class="card-header">
                    Payment form example
                </div>
                <div class="card-body">

                    <div class="alert alert-danger" role="alert">
                    Some fields are missing
                    </div>

                    <form class="row g-3">
                        <div class="col-5">
                            <label for="inputEmail4" class="form-label">Card #</label>
                            <input type="text" class="form-control" id="inputEmail4" placeholder="XXXXXXXXXXX">
                        </div>
                        <div class="col-3">
                            <label for="inputPassword4" class="form-label">CVC #</label>
                            <input type="text" class="form-control" id="inputPassword4" placeholder="0000">
                        </div>
                        <div class="col-4">
                            <label for="inputAddress" class="form-label">Amount</label>
                            <input type="text" class="form-control" id="inputAddress" placeholder="Amount">
                        </div>
                        <div class="col-6">
                            <label for="inputAddress2" class="form-label">First Name</label>
                            <input type="text" class="form-control" id="inputAddress2" placeholder="">
                        </div>
                        <div class="col-6">
                            <label for="inputCity" class="form-label">Last Name</label>
                            <input type="text" class="form-control" id="inputCity">
                        </div>
                        <div class="col-6">
                            <label for="inputState" class="form-label">City</label>
                            <input type="text" class="form-control" id="inputCity">
                        </div>
                        <div class="col-3">
                            <label for="inputState" class="form-label">State</label>
                            <select id="inputState" class="form-select" >
                            <option selected>Pick a State</option>
                            <option>1</option>
                            <option>2</option>
                            <option>3</option>
                            </select>
                        </div>
                        <div class="col-3">
                            <label for="inputZip" class="form-label">Postal Code</label>
                            <input type="text" class="form-control" id="inputZip">
                        </div>
                        <div class="col-6">
                           <label for="inputZip" class="form-label">We accept:</label>
                            <br>
                            <div class="col-6 bg-secondary">
                                <div class="form-check form-check-inline">
                                <input class="form-check-input" type="checkbox" id="inlineCheckbox1" value="option1">
                                <label class="form-check-label" for="inlineCheckbox1"><i class="fa-regular fa-credit-card"></i></label>
                                </div>
                                <div class="form-check form-check-inline">
                                <input class="form-check-input" type="checkbox" id="inlineCheckbox2" value="option2">
                                <label class="form-check-label" for="inlineCheckbox2"><i class="fa-regular fa-credit-card"></i></label>
                                </div>
                                <div class="form-check form-check-inline">
                                <input class="form-check-input" type="checkbox" id="inlineCheckbox3" value="option3">
                                <label class="form-check-label" for="inlineCheckbox3"><i class="fa-regular fa-credit-card"></i></label>
                                </div>
                                <div class="form-check form-check-inline">
                                <input class="form-check-input" type="checkbox" id="inlineCheckbox3" value="option3">
                                <label class="form-check-label" for="inlineCheckbox3"><i class="fa-regular fa-credit-card"></i></label>
                                </div>
                            </div>
                        </div>
                        <div class="col-6">
                            <label for="inputZip" class="form-label">Message</label>
                            <div class="form-floating">
                                <textarea class="form-control" placeholder="Leave a comment here" id="floatingTextarea2" style="height: 100px"></textarea>
                            </div>
                            <label for="floatingTextarea2">Add any note here.</label>
                        </div>
                    </form>
                </div>
                <div class="card-footer text-body-secondary text-center">
                    <a href="#" class="btn btn-secondary">Cancel</a>
                    <a href="#" class="btn btn-primary">Send form</a>
                </div>
            </div>
        </div>
    <script src="https://cdn.jsdelivr.net/npm/bootstrap@5.3.3/dist/js/bootstrap.bundle.min.js" integrity="sha384-YvpcrYf0tY3lHB60NNkmXc5s9fDVZLESaAA55NDzOxhy9GkcIdslK1eN7N6jIeHz" crossorigin="anonymous"></script>
</body>
</html>