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jesseangell/gist:d7f4903dba811783c721

Created December 23, 2014 20:34
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cardscan-form
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gistfile1.txt
<!DOCTYPE html>
<html>
<head>
<meta charset="UTF-8">
<title>Credit Card Form</title>
</head>
<body>
<form>
<fieldset>
<label for="ccName">Name on card</label>
<input id="ccName" type="text">
<label for="cc_number">Credit Card Number</label>
<input id="cc_number" type="text" >
<label for="cardExpirationMonth">Expiration Month</label>
<input id="cardExpirationMonth" type="text">
<label for="cardExpirationYear">Expiration Year</label>
<input id="cardExpirationYear" type="text">
<input type="submit" value="Charge">
</fieldset>
</form>
</body>
</html>
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