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<!DOCTYPE html>
<html lang="en">
<head>
  <meta charset="utf-8">
  <title>JS Bin</title>
<body>  
<form action="http://www.cs.tut.fi/cgi-bin/run/~jkorpela/echo.cgi" method="post">
  <h1>Payment form</h1>
  <p>Required fields are followed by <strong><abbr title="required">*</abbr></strong>.</p>
 
  <section>
  <h2>Contact information</h2>
 
  <fieldset>
    <legend>Title</legend>
    <ul>
    <li>
      <label for="title_1">
      <input type="radio" id="title_1" name="title" value="M." />
      Mister
      </label>
    </li>
    <li>
      <label for="title_2">
      <input type="radio" id="title_2" name="title" value="Ms." />
      Miss
      </label>
    </li>
    </ul>
  </fieldset>
 
  <p>
    <label for="name">
    <span>Name: </span>
    <input type="text" id="name" name="username" required />
    <strong><abbr title="required">*</abbr></strong>
    </label>
  </p>
 
   <p>
    <label for="mail">
    <span>E-mail: </span>
    <input type="email" id="mail" name="usermail" required />
    <strong><abbr title="required">*</abbr></strong>
    </label>
  </p>
  </section>
 
  <section>
  <h2>Payment information</h2>
 
  <p>
    <label for="card">
    <span>Card type:</span>
    <select id="card" name="usercard">
      <option value="visa">Visa</option>
      <option value="mc">Mastercard</option>
      <option value="amex">American Express</option>
    </select>
    </label>
  </p>
  <p>
    <label for="number">
    <span>Card number:</span>
    <input type="text" id="number" name="cardnumber" required />
    <strong><abbr title="required">*</abbr></strong>
    </label>
  </p>
  <p>
    <label for="date">
    <span>Expiration date:</span>
    <input type="text" id="date" name="expiration" required />
    <strong><abbr title="required">*</abbr></strong>
    <em>formated as mm/yy</em>
    </label>
  </p>
  </section>
 
  <section>
  <p>
    <button>Validate the payment</button>
  </p>
  </section>
</form>
  </body>
  </html>
 
​
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