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newsletter.html
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newsletter.html
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<!DOCTYPE html>
<html>
<head>
<meta name="viewprort" value="width=device-width, initial-scale=1.0">
<title>Newsletter Subsciption</title>
</head>
<body>
<h1 style="text-align:center;size:50px">Subscribe for the Newsletter Now!!</h1>
<form action="mailto:[email protected]" method="get" encpy="text/plain" >
<fieldset>
<legend> Personal information </legend><br />
First Name:<br />
<input type="text" name="FName" /> <br /><br />
Last name:<br />
<input type="text" name="LName" /> <br /><br />
Age:<br />
<input type="number" name="age" min="0" /> <br /><br />
Sex:
<input type="radio" name="sex" value="male" />Male    
<input type="radio" name="sex" value="female" />Female    
<input type="radio" name="sex" value="other" />other<br /><br />
</fieldset>
<fieldset>
<legend> Contact info </legend><br />
Email:
<input type="email" name="email" /><br />
<br />
Contact Number:
<input type="number" name="ph_number" /><br />
<br />
</fieldset>
<fieldset>
<legend> Work </legend><br />
Occupation:<br />
<select name="occupation">
<option value="Student" >Student</option>
<option value="Teacher">Teacher</option>
<option value="Employee">Employee</option>
<option value="None">None</option>
</select>
<br /><br />
Organization :<br />
<input type="text" name="organization" /><br /><br />
Main interest:<br />
<select name="interest">
<option value="HTML">HTML</option>
<option value="CSS">CSS</option>
<option value="JavaScript">JavaScript</option>
<option value="BootStrap">BootStrap</option>
</select>
<br /><br />
</fieldset>
<fieldset>
<legend> Subscription Details: </legend><br />
How do you want us to send you the newsletter <br />
<input type="checkbox" name="subscription_details" value="mail"/>You can mail me          
<input type="checkbox" name="subcription_details" value="post" />Post it to me<br />
<br />
Which subscription will you take:<br />
<input type="radio" name="subsciption_type" value="weekly" />Weekly(Rs.30 only)      
<input type="radio" name="subsciption_type" value="monthly" />Monthly(Rs.99 only) <br />
<br />
</fieldset>
<fieldset>
<legend>Payment</legend><br />
Select payment method:
<input type="radio" name="payment_gateway" value="visa" /><img src="images/visa.png" alt="visa" width="80px" height="50px" />      
<input type="radio" name="payment_gateway" value="mastercard" /><img src="images/mastercard.png" alt="mastercard" width="90px" height="50px" />
<br />
<br />
Enter your credit/debit card details:<br />
<br />
Card number:
<input type="text" name="card_num" maxlength="16" /> <br />
<br />
Expiry date:
<input type="month" name="exp_date" /><br />
<br />
CVV:
<input type="password" name="CVV" maxlength="3" /><br />
<br />
Name On Card:
<input type="text" name="name_on_card" /><br />
</fieldset>
<input type="submit" value="submit" style="margin-left: 50% " />
<input type="reset" />
</form>
</body>