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: / home3 / encodto1 / public_html /
Filename : payonlineform1.php
back
  <form action="payonline.php" method="post" autocomplete="off">
                              
                                        <label for="name">Name:</label>
                                        <input type="text" id="name" name="name" required>
                                     
                                       
                                        <label for="mobile">Phone Number:</label>
                                        <input type="text" id="mobile" name="mobile" required>
                                                                     
                                  
                                     
                                            <label for="email">Email</label>
                                            <input type="email" placeholder="Your Email" id="email" name="email" required />
                                       
                                   
                                  
                                       
                                       
                                            <label for="amount">Amount</label>
                                            <input type="number" name="amount" id="amount" placeholder="5000" required />
                                        
                                       
                                            <button type="submit" class="theme-btn" name="submit" value="paynow" >Pay Now</button>
                                       
                                   
                                  

                             
                                
                            </form>