<!DOCTYPE html>
<
html
lang
=
"en"
>
<
head
>
<
meta
charset
=
"UTF-8"
>
<
meta
name
=
"viewport"
content
=
"width=device-width, initial-scale=1.0"
>
<
title
>The Online Payment-Page</
title
>
</
head
>
<
body
>
<
div
class
=
"container mx-auto mt-10"
>
<
form
action
=
"#"
class="max-w-xl mx-auto
bg-white p-8 rounded
shadow-lg">
<
div
class="grid grid-cols-1
md:grid-cols-2 gap-6">
<
div
>
<
h3
class="text-lg font-semibold
text-red-600 mb-4">
Billing Address
</
h3
>
<
div
class
=
"mb-4"
>
<
label
for
=
"name"
class="block text-sm
font-medium text-gray-700">
Full Name:
</
label
>
<
input
type
=
"text"
id
=
"name"
placeholder
=
"Enter your full name"
required
class="mt-1 block w-full
border-gray-300 rounded-md
shadow-sm focus:ring-red-500
focus:border-red-500">
</
div
>
<
div
class
=
"mb-4"
>
<
label
for
=
"email"
class="block text-sm font-medium
text-gray-700">
Email:
</
label
>
<
input
type
=
"email"
id
=
"email"
placeholder
=
"Enter your email ID"
required
class="mt-1 block w-full
border-gray-300
rounded-md shadow-sm
focus:ring-red-500
focus:border-red-500">
</
div
>
<
div
class
=
"mb-4"
>
<
label
for
=
"address"
class="block text-sm font-medium
text-gray-700">
Address:
</
label
>
<
input
type
=
"text"
id
=
"address"
placeholder
=
"Enter your Address"
required
class="mt-1 block w-full border-gray-300
rounded-md shadow-sm
focus:ring-red-500
focus:border-red-500">
</
div
>
<
div
class
=
"mb-4"
>
<
label
for
=
"city"
class="block text-sm font-medium
text-gray-700">
City:
</
label
>
<
input
type
=
"text"
id
=
"city"
placeholder
=
"Enter your city"
required
class="mt-1 block w-full
border-gray-300 rounded-md
shadow-sm focus:ring-red-500
focus:border-red-500">
</
div
>
<
div
class
=
"mb-4"
>
<
label
for
=
"state"
class="block text-sm font-medium
text-gray-700">
State:
</
label
>
<
input
type
=
"text"
id
=
"state"
placeholder
=
"Enter your state"
required
class="mt-1 block w-full
border-gray-300
rounded-md shadow-sm
focus:ring-red-500
focus:border-red-500">
</
div
>
<
div
class
=
"mb-4"
>
<
label
for
=
"zip"
class="block text-sm font-medium
text-gray-700">
Zip code:
</
label
>
<
input
type
=
"text"
id
=
"zip"
placeholder
=
"Enter your zip code"
required
class="mt-1 block w-full
border-gray-300 rounded-md
shadow-sm focus:ring-red-500
focus:border-red-500">
</
div
>
</
div
>
<
div
>
<
h3
class="text-lg font-semibold
text-red-600 mb-4">
Payment
</
h3
>
<
div
class
=
"mb-4"
>
<
label
for
=
"cardName"
class="block text-sm font-medium
text-gray-700">
Name On Card:
</
label
>
<
input
type
=
"text"
id
=
"cardName"
placeholder
=
"Enter card name"
required
class="mt-1 block w-full
border-gray-300 rounded-md
shadow-sm focus:ring-red-500
focus:border-red-500">
</
div
>
<
div
class
=
"mb-4"
>
<
label
for
=
"cardNumber"
class="block text-sm font-medium
text-gray-700">
Credit Card Number:
</
label
>
<
input
type
=
"text"
id
=
"cardNumber"
placeholder
=
"Enter card number"
required
class="mt-1 block w-full
border-gray-300 rounded-md
shadow-sm focus:ring-red-500
focus:border-red-500">
</
div
>
<
div
class
=
"flex justify-between mb-4"
>
<
div
class
=
"w-1/2 mr-2"
>
<
label
for
=
"expMonth"
class="block text-sm font-medium
text-gray-700">
Expiration Month:
</
label
>
<
input
type
=
"text"
id
=
"expMonth"
placeholder
=
"MM"
required
class="mt-1 block w-full
border-gray-300 rounded-md
shadow-sm focus:ring-red-500
focus:border-red-500">
</
div
>
<
div
class
=
"w-1/2 ml-2"
>
<
label
for
=
"expYear"
class="block text-sm
font-medium
text-gray-700">
Expiration Year:
</
label
>
<
input
type
=
"text"
id
=
"expYear"
placeholder
=
"YYYY"
required
class="mt-1 block w-full
border-gray-300
rounded-md shadow-sm
focus:ring-red-500
focus:border-red-500">
</
div
>
</
div
>
<
div
class
=
"mb-4"
>
<
label
for
=
"cvv"
class="block text-sm
font-medium
text-gray-700">
CVV:
</
label
>
<
input
type
=
"text"
id
=
"cvv"
placeholder
=
"Enter CVV"
required
class="mt-1 block w-full
border-gray-300 rounded-md
shadow-sm focus:ring-red-500
focus:border-red-500">
</
div
>
</
div
>
</
div
>
<
input
type
=
"submit"
value
=
"Proceed to Checkout"
id
=
"checkoutBtn"
class="mt-6 px-4 py-2 bg-red-600 text-white
rounded-md hover:bg-red-700">
</
form
>
</
div
>
<
script
>
document.getElementById('checkoutBtn')
.addEventListener('click', function (event) {
event.preventDefault();
alert('Proceeding to checkout.');
});
</
script
>
</
body
>
</
html
>