Create a html program that uses a user input interface to en

Create a html program that uses a user input interface to enter your credit card info.

Solution

<div class=\"container\">
<form class=\"form-horizontal\" role=\"form\">
<fieldset>
<legend>Payment</legend>
<div class=\"form-group\">
<label class=\"col-sm-3 control-label\" for=\"card-holder-name\">Name on Card</label>
<div class=\"col-sm-9\">
<input type=\"text\" class=\"form-control\" name=\"card-holder-name\" id=\"card-holder-name\" placeholder=\"Card Holder\'s Name\">
</div>
</div>
<div class=\"form-group\">
<label class=\"col-sm-3 control-label\" for=\"card-number\">Card Number</label>
<div class=\"col-sm-9\">
<input type=\"text\" class=\"form-control\" name=\"card-number\" id=\"card-number\" placeholder=\"Debit/Credit Card Number\">
</div>
</div>
<div class=\"form-group\">
<label class=\"col-sm-3 control-label\" for=\"expiry-month\">Expiration Date</label>
<div class=\"col-sm-9\">
<div class=\"row\">
<div class=\"col-xs-3\">
<select class=\"form-control col-sm-2\" name=\"expiry-month\" id=\"expiry-month\">
<option>Month</option>
<option value=\"01\">Jan (01)</option>
<option value=\"02\">Feb (02)</option>
<option value=\"03\">Mar (03)</option>
<option value=\"04\">Apr (04)</option>
<option value=\"05\">May (05)</option>
<option value=\"06\">June (06)</option>
<option value=\"07\">July (07)</option>
<option value=\"08\">Aug (08)</option>
<option value=\"09\">Sep (09)</option>
<option value=\"10\">Oct (10)</option>
<option value=\"11\">Nov (11)</option>
<option value=\"12\">Dec (12)</option>
</select>
</div>
<div class=\"col-xs-3\">
<select class=\"form-control\" name=\"expiry-year\">
<option value=\"13\">2013</option>
<option value=\"14\">2014</option>
<option value=\"15\">2015</option>
<option value=\"16\">2016</option>
<option value=\"17\">2017</option>
<option value=\"18\">2018</option>
<option value=\"19\">2019</option>
<option value=\"20\">2020</option>
<option value=\"21\">2021</option>
<option value=\"22\">2022</option>
<option value=\"23\">2023</option>
</select>
</div>
</div>
</div>
</div>
<div class=\"form-group\">
<label class=\"col-sm-3 control-label\" for=\"cvv\">Card CVV</label>
<div class=\"col-sm-3\">
<input type=\"text\" class=\"form-control\" name=\"cvv\" id=\"cvv\" placeholder=\"Security Code\">
</div>
</div>
<div class=\"form-group\">
<div class=\"col-sm-offset-3 col-sm-9\">
<button type=\"button\" class=\"btn btn-success\">Pay Now</button>
</div>
</div>
</fieldset>
</form>
</div>