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HTML Code for Forms Assignment

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May 4th, 2017
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  1. <!DOCTYPE html>
  2. <html>
  3. <head>
  4. <meta charset="utf-8">
  5. <title>Web Form</title>
  6. <link rel="stylesheet" type="text/css" href="form.css">
  7. </head>
  8. <h1>NerdLand Order Form</h1>
  9. <form action="/action_page.php">
  10. <fieldset>
  11. <legend>Personal Information:</legend>
  12. First Name:<br>
  13. <input type="text" name="firstname" value=""> (required)
  14. <br><br>
  15. Last Name:<br>
  16. <input type="text" name="lastname" value=""> (required)
  17. <br><br>
  18. Street Address:<br>
  19. <input type="text" name="streetaddress" value=""> (required)
  20. <br><br>
  21. City:<br>
  22. <input type="text" name="city" value=""> (required)
  23. <br><br>
  24. State:<br>
  25. <input type="text" name="state" value=""> (required)
  26. <br><br>
  27. Zip Code:<br>
  28. <input type="text" name="zipcode" value="" pattern="[0-9]{5}" title="five digit zip code"> (required)
  29. <br><br>
  30. Phone Number:<br>
  31. <input type="text" name="phonenumber" value="" pattern="[0-9]{10}" title="ten digit phone number"> (optional)
  32. <br><br>
  33. Email Address:<br>
  34. <input type="text" name="emailaddress" value=""> (required)
  35. <br><br>
  36. Credit Card Number:<br>
  37. <input type="text" name="creditcardnumber" value="xxxx"> - <input type="text" name="creditcardnumber" value="xxxxxx"> - <input type="text" name="creditcardnumber" value="xxxxx"> (required)
  38. </fieldset>
  39. <br><br>
  40. <fieldset>
  41. <legend>Product Options:</legend>
  42. Select a Product:<br>
  43. <select name="products">
  44. <option value="Plush">Pokemon Center Original Stuffed Litten Plush ($21.54)</option>
  45. <option value="Plush2">Pokemon Center Original Stuffed Rowlet Plush ($27.94)</option>
  46. <option value="Plush3">Pokemon Center Original Stuffed Popplio Plush ($21.99)</option>
  47. <option value="Plush4">Pokemon Center Original Stuffed Rockruff Plush ($35.99)</option>
  48. </select> (required)
  49. <br><br>
  50. Quantity of Product:<br>
  51. <select name="products">
  52. <option value="number1">1</option>
  53. <option value="number2">2</option>
  54. <option value="number3">3</option>
  55. <option value="number4">4</option>
  56. <option value="number5">5</option>
  57. <option value="number6">6</option>
  58. <option value="number7">7</option>
  59. <option value="number8">8</option>
  60. <option value="number9">9</option>
  61. <option value="number10">10</option>
  62. </select> (required)
  63. <br><br>
  64. Would You Like Priority Shipping? (optional)<br>
  65. <input type="checkbox" name="priorityshipping" value="Yes">Yes!<br>
  66. <br>
  67. Would You Like to Be Added To Our Mailing List? (required) <br><br>
  68. <input type="radio" name="option" value="yes"> Yes, I Want to Be Added to The Mailing List!<br>
  69. <input type="radio" name="option" value="no"> No, I Don't Want to Be Added to The Mailing List.<br>
  70. </fieldset>
  71. <br><br>
  72. <input type="submit" value="Submit">
  73. </form>
  74.  
  75. </body>
  76. </html>
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