<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Strict//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-strict.dtd"><html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en"> <head> <meta http-equiv="Content-Type" content="text/html; charset=utf-8"/> <title>Example form</title> <style rel="stylesheet" type="text/css" media="screen">form { margin: 3em auto; width: 75%;} </style> </head> <body> <form id="" action="" method="post"> <fieldset id="name"> <legend>Name</legend> <label>Title <select id="title1" name="title1"> <option selected="selected">Mr.</option> <option>Mrs.</option> <option>Ms.</option> </select> </label> <label>First name <input id="first-name" name="first-name" type="text" /> </label> <label>Last name <input id="las-name" name="last-name" type="text" /> </label> <br /> </fieldset> <fieldset id="address"> <legend>Address</legend> <label>Street <input id="street" name="street" type="text" /> </label> <br /> <label>City <input id="city" name="city" type="text" /> </label> <label>State <input id="state" name="state" type="text" /> </label> <label>Zip code <input id="zip" name="zip" type="text" /> </label> <br /> <label>Country <input id="country" name="country" type="text" /> </label> <br /> </fieldset> <fieldset id="payment"> <legend>Payment option</legend> <fieldset id="credit_card"> <legend>Credit card</legend> <label><input id="visa" name="visa" type="radio" /> Visa</label> <label><input id="mastercard" name="mastercard" type="radio" /> Mastercard</label> <label><input id="discover" name="discover" type="radio" /> Discover</label> <br /> </fieldset> <label>Card number <input id="card_number" name="card_number" type="text" /> </label> <label>Expiration date <input id="expiration" name="expiration" type="text" /> </label> <br /> <input class="submit" type="submit" value="Submit" /> <br /> </fieldset> </form> </body> </html>
