purchase.html

<!DOCTYPE html>
<html lang="en">

<head>
    <meta charset="utf-8">
    <meta name="viewport" content="width=device-width, initial-scale=1">
    <meta http-equiv="x-ua-compatible" content="ie=edge">
    <title>My Example</title>

    <!-- CSS -->
    <style>
        .myForm {
            font-family: "Lucida Sans Unicode", "Lucida Grande", sans-serif;
            font-size: 0.8em;
            width: 100em;
            padding: 1em;
            border: 1px solid #ccc;
        }
        
        .myForm * {
            box-sizing: border-box;
        }
        
        .myForm fieldset {
            border: none;
            padding: 0;
        }
        
        .myForm legend,
        .myForm label {
            padding: 0;
            font-weight: bold;
        }
        
        .myForm label.choice {
            font-size: 0.9em;
            font-weight: normal;
        }
        
        .myForm input[type="text"],
        .myForm input[type="tel"],
        .myForm input[type="email"],
        .myForm input[type="datetime-local"],
        .myForm select,
        .myForm textarea {
            display: block;
            width: 100%;
            border: 1px solid #ccc;
            font-family: "Lucida Sans Unicode", "Lucida Grande", sans-serif;
            font-size: 0.9em;
            padding: 0.3em;
        }
        
        .myForm textarea {
            height: 100px;
        }
        
        .myForm button {
            padding: 1em;
            border-radius: 0.5em;
            background: #eee;
            border: none;
            font-weight: bold;
            margin-top: 1em;
        }
        
        .myForm button:hover {
            background: #ccc;
            cursor: pointer;
        }
    </style>

</head>

<body>

    <form class="myForm" method="get" enctype="application/x-www-form-urlencoded" action="pay.py">

        <p>
            <label>Name
                <input type="text" name="customer_name" required>
            </label>
        </p>

        <p>
            <label>Phone 
                <input type="number" name="phone_number">
            </label>
        </p>

        <p>
            <label>Email 
                <input type="email" name="email_address">
            </label>
        </p>
        
        <p>
            <label>Address
                <textarea name="address" maxlength="500"></textarea>
            </label>
        </p>

        <p><button>Place Order</button></p>

    </form>

</body>

</html>