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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">
<title>Customized T-Shirt Order Form</title>
</head>
<body>
<h1 align="center">Customized T-Shirt Order Form</h1>
<form action="" method="post">
<fieldset>
<legend>
<h3>Customer Details</h3>
</legend>
<br>
<label>First Name</label>
<input type="text" id="fname" required><br><br>
<label>Last Name</label>
<input type="text" id="lname" required><br><br>
<label>Contact number:</label>
<input type="tel" id="contact_number" name="contact_number" pattern="[0-9]{10}" required>
<small>Format: 10 digits (e.g., 1234567890)</small><br>
<br>
<hr>
<br>
<!-- Tagline input -->
<label>Personalized Text on the shirt:</label>
<input type="text" id="tagline" name="tagline" required><br>
<br>
<!-- Color input -->
<label for="color">Color:</label>
<input type="text" id="color" name="color" required><br>
<br>
<!-- Size input -->
<label for="size">Size:</label>
<select id="size" name="size" required>
<option value="">Select Size</option>
<option value="small">Small</option>
<option value="medium">Medium</option>
<option value="large">Large</option>
<option value="xl">XL</option>
</select><br>
<br>
<!-- Quantity input -->
<label for="quantity">Quantity:</label>
<input type="number" id="quantity" name="quantity" required><br>
<br>
<!-- Delivery date input -->
<label for="delivery_date">Preferred delivery date:</label>
<input type="date" id="delivery_date" name="delivery_date" required><br><br>
<hr>
<br>
<label for="delivery_details">Home Address:</label><br>
<textarea id="delivery_details" name="delivery_details" rows="4" cols="50" required></textarea><br>
<br>
<label for="city">City:</label>
<input type="text" id="city" name="city" required><br>
<br>
<label for="state">State:</label>
<input type="text" id="state" name="state" required><br>
<br>
<label for="pincode">Pincode:</label>
<input type="text" id="pincode" name="pincode" pattern="[0-9]{6}" required>
<small>Format: 6 digits (e.g., 123456)</small><br>
<br>
<!-- Other details of delivery input -->
<br>
</fieldset>
<fieldset>
<legend>
<h3>Payment Details</h3>
</legend>
<label>Payment Mode</label>
<p>
Online <input type="radio" checked>
Offline <input type="radio">
</p>
<hr>
<br>
<p>Card Type
<select name="card_type" id="card_type">
<option value="">---Select Card Type---</option>
<option value="visa">Visa</option>
<option value="mastercaerd">Mastercard</option>
<option value="Rupay">Rupay</option>
</select>
</p>
<p>
Card number <input type="number" name="card type" id="card type">
</p>
<p>
Expiration Date <input type="date" name="expiration date" id="expiration date">
</p>
<p>
CVV <input type="password" name="cvv" id="cvv">
</p>
<input type="submit" value="Pay Now">
</fieldset>
<br>
<input type="submit" value="Place Order">
</form>
</body>
</html>