1<div class="row">
2 <div class="col-75">
3 <div class="container">
4 <form action="/action_page.php">
5
6 <div class="row">
7 <div class="col-50">
8 <h3>Billing Address</h3>
9 <label for="fname"><i class="fa fa-user"></i> Full Name</label>
10 <input type="text" id="fname" name="firstname" placeholder="John M. Doe">
11 <label for="email"><i class="fa fa-envelope"></i> Email</label>
12 <input type="text" id="email" name="email" placeholder="john@example.com">
13 <label for="adr"><i class="fa fa-address-card-o"></i> Address</label>
14 <input type="text" id="adr" name="address" placeholder="542 W. 15th Street">
15 <label for="city"><i class="fa fa-institution"></i> City</label>
16 <input type="text" id="city" name="city" placeholder="New York">
17
18 <div class="row">
19 <div class="col-50">
20 <label for="state">State</label>
21 <input type="text" id="state" name="state" placeholder="NY">
22 </div>
23 <div class="col-50">
24 <label for="zip">Zip</label>
25 <input type="text" id="zip" name="zip" placeholder="10001">
26 </div>
27 </div>
28 </div>
29
30 <div class="col-50">
31 <h3>Payment</h3>
32 <label for="fname">Accepted Cards</label>
33 <div class="icon-container">
34 <i class="fa fa-cc-visa" style="color:navy;"></i>
35 <i class="fa fa-cc-amex" style="color:blue;"></i>
36 <i class="fa fa-cc-mastercard" style="color:red;"></i>
37 <i class="fa fa-cc-discover" style="color:orange;"></i>
38 </div>
39 <label for="cname">Name on Card</label>
40 <input type="text" id="cname" name="cardname" placeholder="John More Doe">
41 <label for="ccnum">Credit card number</label>
42 <input type="text" id="ccnum" name="cardnumber" placeholder="1111-2222-3333-4444">
43 <label for="expmonth">Exp Month</label>
44 <input type="text" id="expmonth" name="expmonth" placeholder="September">
45
46 <div class="row">
47 <div class="col-50">
48 <label for="expyear">Exp Year</label>
49 <input type="text" id="expyear" name="expyear" placeholder="2018">
50 </div>
51 <div class="col-50">
52 <label for="cvv">CVV</label>
53 <input type="text" id="cvv" name="cvv" placeholder="352">
54 </div>
55 </div>
56 </div>
57
58 </div>
59 <label>
60 <input type="checkbox" checked="checked" name="sameadr"> Shipping address same as billing
61 </label>
62 <input type="submit" value="Continue to checkout" class="btn">
63 </form>
64 </div>
65 </div>
66
67 <div class="col-25">
68 <div class="container">
69 <h4>Cart
70 <span class="price" style="color:black">
71 <i class="fa fa-shopping-cart"></i>
72 <b>4</b>
73 </span>
74 </h4>
75 <p><a href="#">Product 1</a> <span class="price">$15</span></p>
76 <p><a href="#">Product 2</a> <span class="price">$5</span></p>
77 <p><a href="#">Product 3</a> <span class="price">$8</span></p>
78 <p><a href="#">Product 4</a> <span class="price">$2</span></p>
79 <hr>
80 <p>Total <span class="price" style="color:black"><b>$30</b></span></p>
81 </div>
82 </div>
83</div>