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index.html
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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<link href="https://cdn.jsdelivr.net/npm/[email protected]/dist/css/bootstrap.min.css" rel="stylesheet" integrity="sha384-QWTKZyjpPEjISv5WaRU9OFeRpok6YctnYmDr5pNlyT2bRjXh0JMhjY6hW+ALEwIH" crossorigin="anonymous">
<link href="https://cdnjs.cloudflare.com/ajax/libs/font-awesome/6.5.1/css/all.min.css" rel="stylesheet">
<title>Formulario2</title>
</head>
<body>
<div class="card text-center w-50 mx-auto mt-5 ">
<div class="card-header text-start fs-2 fw-bold">
Payment form example
</div>
<div class="card-body">
<div class="alert alert-danger text-start" role="alert">
Some fields are missing
</div>
<div class="container mt-5">
<form>
<div class="row">
<!-- Número de tarjeta -->
<div class="mb-3 col-md-5 text-start">
<label for="numeroTarjeta" class="form-label ">Card #</label>
<input type="number" class="form-control" id="numeroTarjeta" placeholder="XXXX XXXX XXXX XXXX" maxlength="19" required>
</div>
<!-- CVC -->
<div class="mb-3 col-md-3 text-start">
<label for="codigoSeguridad" class="form-label">CVC #</label>
<input type="number" class="form-control" id="codigoSeguridad" placeholder="0000" maxlength="5" required>
</div>
<!--Amount-->
<div class="mb-3 col-md-4 text-start">
<label for="amount" class="form-label">Amount</label>
<div class="input-group">
<span class="">
<i class="fa-solid fa-dollar-sign"></i>
</span>
<input type="number" class="form-control" id="amount" placeholder="Amount" maxlength="19" required>
</div>
</div>
</div>
<div class="row">
<!-- Nombre -->
<div class="mb-3 col-md-6 text-start">
<label for="firstName" class="form-label">First Name</label>
<input type="text" class="form-control" id="firstName" required>
</div>
<!-- Apellido -->
<div class="mb-3 col-md-6 text-start">
<label for="lastName" class="form-label">Last Name</label>
<input type="text" class="form-control" id="lastName" required>
</div>
</div>
<div class="row">
<!-- City-->
<div class="mb-3 col-md-6 text-start">
<label for="ciudad" class="form-label">City</label>
<input type="text" class="form-control" id="ciudad" required>
</div>
<!-- State -->
<div class="mb-3 col-md-3 text-start">
<label for="state" class="form-label">State</label>
<select class="form-select" id="state" required>
<option selected disabled>Pick a state</option>
<option value="CA">California</option>
<option value="TX">Texas</option>
<option value="FL">Florida</option>
<option value="NY">New York</option>
<option value="IL">Illinois</option>
</select>
</div>
<!--Postal Code-->
<div class="mb-3 col-md-3 text-start">
<label for="postalCode" class="form-label">Postal Code</label>
<input type="text" class="form-control" id="postalCode" maxlength="10" required>
</div>
</div>
<div class="row text-start">
<div class="w-50">
<p>We accept:</p>
<div class="mb-3 col-6 bg-secondary w-30 rounded d-flex justify-content-between p-2 ms-1">
<input type="radio" name="botonitos" id="label1"><label for="label1"><i class="fa-brands fa-cc-mastercard bg-secondary text-white fs-6"></i></label>
<input type="radio" name="botonitos" id="label2"><label for="label2"><i class="fa-brands fa-cc-visa bg-secondary text-white fs-6"></i></label>
<input type="radio" name="botonitos" id="label3"><label for="label3"><i class="fa-brands fa-cc-diners-club bg-secondary text-white fs-6"></i></label>
<input type="radio" name="botonitos" id="label4"><label for="label4"><i class="fa-regular fa-credit-card bg-secondary text-white fs-6"></i></label>
</div>
</div>
<div class="mb-3 col-6">
<label for="comentarios" class="form-label">Message</label>
<textarea class="form-control col-6" id="comentarios" rows="3"></textarea>
<p class="text-secondary">Add any notes here</p>
</div>
</div>
</div>
</form>
</div>
<div class="card-footer text-muted text-end">
<div class="botones">
<button type="submit" class="btn btn-secondary b1">Cancel</button>
<button type="reset" class="btn btn-primary b2">Send</button>
</div>
</div>
</div>
<script src="https://cdn.jsdelivr.net/npm/[email protected]/dist/js/bootstrap.bundle.min.js" integrity="sha384-YvpcrYf0tY3lHB60NNkmXc5s9fDVZLESaAA55NDzOxhy9GkcIdslK1eN7N6jIeHz" crossorigin="anonymous"></script>
</body>
</html>