Posted By

onefastsnail on 05/24/12


Tagged


Versions (?)

form


 / Published in: HTML
 

  1. <form action="" method="">
  2.  
  3. <div class="row"><label for="fname">First Name</label>
  4. <input type="text" class="" value="" id="fname" name="cardholder_first_name"></div>
  5.  
  6. <div class="row"><label for="sname">Last Name</label>
  7. <input type="text" class="" value="" id="sname" name="cardholder_last_name"></div>
  8.  
  9. <div class="row"><label for="personal-email">Email</label>
  10. <input type="text" class="" value="" id="personal-email" name="cardholder_email"></div>
  11.  
  12. <div class="row"><label for="phone-no">Phone number</label>
  13. <input type="tel" class="" value="" id="phone-no" name="cardholder_phone_number"></div>
  14.  
  15.  
  16. <div class="row dob">
  17. <label for="dob_day">Date of Birth:</label>
  18. <select class="" name="dob_day">
  19. <option value="">Day</option>
  20. <option value="1">1</option>
  21. </select>
  22. </div>
  23.  
  24. </form>

Report this snippet  

You need to login to post a comment.