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- <html>
- <head>
- <meta charset="utf-8">
- <meta name="viewport" content="width=device-width, initial-scale=1.0">
- <title>Daisy's Dairy Order Form</title>
- <style>
- body
- {
- font-family: verdana, arial, helvetica, sans-serif;
- font-size: 12px;
- box-sizing: border-box;
- }
- label
- {
- padding: 10px;
- }
- .formFrame
- {
- width: 200px;
- padding: 10px;
- }
- .firstColumn
- {
- float: left;
- width: 50px;
- padding: 10px;
- }
- .column
- {
- width: 80px;
- padding: 10px;
- }
- </style>
- </head>
- <body>
- <div class="formFrame">
- <form method="POST" action="order.php">
- <fieldset>
- <legend>Customer Details</legend>
- <label>First name:<br>
- <input type="text" name="FirstName">
- </label><br>
- <label>Last name:<br>
- <input type="text" name="LastName">
- </label><br>
- <label>Email:<br>
- <input type="text" name="Email">
- </label><br>
- <label>Phone:<br>
- <input type="text" name="Phone">
- </label><br>
- <fieldset>
- <legend>Address</legend>
- <label>Street number<br>
- <input type="text" name="StreetNum">
- </label>
- <label>Street name<br>
- <input type="text" name="StreetName">
- </label>
- <label>Town or suburb<br>
- <input type="text" name="Suburb">
- </label>
- <label>Postcode<br>
- <input type="text" name="Postcode">
- </label>
- </fieldset>
- </fieldset>
- <fieldset>
- <legend>Order Details</legend>
- <label><div class="firstColumn">Milk:</div>
- <div class="column">
- <select name="Milk">
- <option value="1">1 litre</option>
- <option value="2">2 litre</option>
- <option value="3">3 litre</option>
- <option value="4">4 litre</option>
- </select>
- </div>
- </label>
- <br>
- <label><div class="firstColumn">Bread:</div>
- <div class="column">
- <select name="Bread">
- <option value="1">1 loaf</option>
- <option value="2">2 loaves</option>
- <option value="3">3 loaves</option>
- <option value="4">4 loaves</option>
- </select>
- </div>
- </label>
- <br>
- <label><div class="firstColumn">Butter:</div>
- <div class="column">
- <select name="Butter">
- <option value="250">250 g</option>
- <option value="500">500 g</option>
- </select>
- </div>
- </label>
- <br>
- <label><div class="firstColumn">Cheese:</div>
- <div class="column">
- <select name="Cheese">
- <option value="250">250 g</option>
- <option value="500">500g</option>
- <option value="1000">1 kg</option>
- </select>
- </div>
- </label>
- <br>
- <label><div class="firstColumn">Eggs:</div>
- <div class="column">
- <select name="Eggs">
- <option value="6">Half a dozen</option>
- <option value="12">A dozen</option>
- </select>
- </div>
- </label>
- <br>
- <input type="submit" value="Submit Order">
- </fieldset>
- </form>
- </div>
- </body>
- </html>
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