29 lines
1.3 KiB
HTML
29 lines
1.3 KiB
HTML
<!DOCTYPE html>
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<html>
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<head><meta charset="utf-8"><title>Test Signup Form</title></head>
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<body>
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<h1>Open an Account</h1>
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<form>
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<label>First name <input type="text" name="firstname" autocomplete="given-name"></label><br>
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<label>Last name <input type="text" name="lastname" autocomplete="family-name"></label><br>
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<label>Email <input type="email" name="email" autocomplete="email"></label><br>
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<label>Phone <input type="tel" name="phone" autocomplete="tel"></label><br>
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<label>Street address <input type="text" name="address" autocomplete="street-address"></label><br>
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<label>City <input type="text" name="city" autocomplete="address-level2"></label><br>
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<label>State
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<select name="state" autocomplete="address-level1">
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<option value="">Select…</option>
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<option value="CA">California</option>
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<option value="WA">Washington</option>
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<option value="OR">Oregon</option>
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</select>
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</label><br>
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<label>ZIP <input type="text" name="zip" autocomplete="postal-code"></label><br>
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<label>Date of birth <input type="text" name="dob" placeholder="MM/DD/YYYY"></label><br>
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<label>Social Security Number <input type="text" name="ssn" autocomplete="off"></label><br>
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<label>Password <input type="password" name="password"></label><br>
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<button type="submit">Create Account</button>
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</form>
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</body>
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</html>
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