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index.html
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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<meta http-equiv="X-UA-Compatible" content="IE=edge">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<title>Assignment4</title>
<link rel="stylesheet" href="style.css">
</head>
<body>
<div class="simplifii head">
<img class="logo" src="./assets/Logo.png">
<div id="simplifii">Simplifii Labs</div>
</div>
<div id="main">
<div>
<h1>Survey</h1>
</div>
<form action="https://enw7u145b8im9.x.pipedream.net/" method="post">
<div class="a">
<fieldset class="c">
<h2>Name</h2>
<div class="elements">
<label for="first_name">First Name: </label>
<br>
<input type="text" required name="first_name" placeholder="Eg. John">
</div>
<br>
<div class="elements">
<label for="last_name">Last Name: </label>
<br>
<input type="text" required name="last_name" placeholder="Eg. Wick">
</div>
<br>
</fieldset>
<fieldset class="c">
<h2>Address</h2>
<div class="elements">
<label for="street_address">Street: </label>
<br>
<input type="text" required name="street_address" placeholder="Eg. NH-09 Highway">
</div>
<br>
<div class="elements">
<label for="city">City: </label>
<br>
<input type="text" required name="city" placeholder="Eg. Ghaziabad">
</div>
<br>
<div class="elements">
<label for="state">State: </label>
<br>
<input type="text" required name="state" placeholder="Eg. Uttar Pradesh">
</div>
<br>
<div class="elements">
<label for="pincode">Pincode: </label>
<br>
<input type="tel" required name="pincode" pattern="[0-9]{6}" maxlength="6" placeholder="Eg. 101223">
</div>
<br>
</fieldset>
<fieldset class="c">
<h2>Contact</h2>
<div class="elements">
<label for="contact_number">Contact number: </label>
<br>
<input type="tel" required name="contact_number" pattern="[0-9]{10}" maxlength="10" placeholder="Eg. 1234-123-123">
<br>
</div>
</fieldset>
</div>
<fieldset class="b">
<h2>Rating</h2>
<div class="elements">
<h3>Quality of Products:</h3>
<label for="quality_of_products_received_rating" >Excellent</label>
<input type="radio" required name="quality_of_products_received_rating" value="Excellent">
<label for="quality_of_products_received_rating" >Good</label>
<input type="radio" name="quality_of_products_received_rating" value="Good">
<label for="quality_of_products_received_rating" >Bad</label>
<input type="radio" name="quality_of_products_received_rating" value="Bad">
</div>
<br>
<div class="elements">
<h3>Delivery Rating:</h3>
<label for="delivery_rating" >Excellent</label>
<input type="radio" required name="delivery_rating" value="Excellent">
<label for="delivery_rating" >Good</label>
<input type="radio" name="delivery_rating" value="Good">
<label for="delivery_rating" >Bad</label>
<input type="radio" name="delivery_rating" value="Bad">
</div>
<br>
<div class="elements">
<h3>Value For Money:</h3>
<label for="value_for_money_rating" >Excellent</label>
<input type="radio" required name="value_for_money_rating" value="Excellent">
<label for="value_for_money_rating" >Good</label>
<input type="radio" name="value_for_money_rating" value="Good">
<label for="value_for_money_rating" >Bad</label>
<input type="radio" name="value_for_money_rating" value="Bad">
</div>
<br>
</fieldset>
<div class="elements">
<button type="submit">Submit</button>
</div>
</form>
</div>
</body>
</html>