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| 1 | +<!DOCTYPE html> |
| 2 | +<html lang="en"> |
| 3 | +<head> |
| 4 | + <meta charset="UTF-8"> |
| 5 | + <meta http-equiv="X-UA-Compatible" content="IE=edge"> |
| 6 | + <meta name="viewport" content="width=device-width, initial-scale=1.0"> |
| 7 | + <title>Burrito Order Form</title> |
| 8 | +</head> |
| 9 | +<body> |
| 10 | + <form |
| 11 | + action="https://webhook.site/" |
| 12 | + method="POST"> |
| 13 | + |
| 14 | + <h3>Burrito Order Form</h3> |
| 15 | + |
| 16 | + <input placeholder="Enter Your Name" name="greeting" type="text"/> |
| 17 | + |
| 18 | + <input placeholder="Enter passowrd" name=password type="password"/> |
| 19 | +<br> |
| 20 | + |
| 21 | + <input type="date"> |
| 22 | + <input type="Choose Tortilla"> |
| 23 | + |
| 24 | +<br/> |
| 25 | + |
| 26 | + <h2>Tortilla Options</h2> |
| 27 | + |
| 28 | + <label for="White Flour">White Flour</label> |
| 29 | + <input id="White Flour" name="Flourtype" type="radio" value="White Flour" /> |
| 30 | + |
| 31 | + <label for="Wheat Flour">Wheat Flour</label> |
| 32 | + <input id="Wheat Flour" name="Flourtype" type="radio" value="Wheat Flour" /> |
| 33 | + |
| 34 | + <label for="Spinach">Spinach</label> |
| 35 | + <input id="Spinach" name="Flourtype" type="radio" value="Spinach" /> |
| 36 | + |
| 37 | + <label for="Corn">Corn</label> |
| 38 | + <input id="Corn" name="Flourtype" type="radio" value="Corn" /> |
| 39 | + |
| 40 | + |
| 41 | + <br /> |
| 42 | + |
| 43 | + <h2>Rice Options</h2> |
| 44 | + |
| 45 | + <label for="White Rice">White Rice</label> |
| 46 | + <input id="White Rice" name="Ricetype" type="radio" value="White Rice" /> |
| 47 | + |
| 48 | + <label for="Brown Rice">Brown Rice</label> |
| 49 | + <input id="Brown Rice" name="Ricetype" type="radio" value="Brown Rice" /> |
| 50 | + |
| 51 | + |
| 52 | + <br /> |
| 53 | + |
| 54 | + <h2>Bean Options</h2> |
| 55 | + |
| 56 | + <label for="Black Beans">Black Beans</label> |
| 57 | + <input id="Black Beans" name="Beantype" type="radio" value="Black Beans" /> |
| 58 | + |
| 59 | + <label for="Pinto Beans">Pinto Beans</label> |
| 60 | + <input id="Pinto Beans" name="Beantype" type="radio" value="Pinto Beans" /> |
| 61 | + |
| 62 | + <br /> |
| 63 | + |
| 64 | + <h2>Protein Choices</h2> |
| 65 | + |
| 66 | +> <label for="Carnitas">Carnitas</label> |
| 67 | + <input id="Carnitas" name="Chickentype" type="radio" value="Carnitas" /> |
| 68 | + |
| 69 | + <label for="Chicken">Chicken</label> |
| 70 | + <input id="Chicken" name="Chickentype" type="radio" value="Chicken" /> |
| 71 | + |
| 72 | + <label for="Sofritas">Sofritas</label> |
| 73 | + <input id="Sofritas" name="Chickentype" type="radio" value="Sofritas" /> |
| 74 | + |
| 75 | + <label for="None">None</label> |
| 76 | + <input id="None" name="Chickentype" type="radio" value="None" /> |
| 77 | + |
| 78 | + <br /> |
| 79 | + |
| 80 | + |
| 81 | + <h2>Additional Ingredients</h2> |
| 82 | + |
| 83 | + <label for="Cheese">Cheese</label> |
| 84 | + <input id="Cheese" name="Cheesetype" type="checkbox" value="Cheese" /> |
| 85 | + |
| 86 | + <label for="Sour Cream">Sour Cream</label> |
| 87 | + <input id="Sour Cream" name="Cheesetype" type="checkbox" value="Sour Cream" /> |
| 88 | + |
| 89 | + <br /> |
| 90 | + |
| 91 | + <h2>Delivery Instructions</h2> |
| 92 | + |
| 93 | + <textarea name="Route" cols="30" rows="10"></textarea> |
| 94 | + |
| 95 | + <h2>Submit Order</h2> |
| 96 | + <button type="submit">Click Me</button> |
| 97 | + |
| 98 | + </form> |
| 99 | +</body> |
| 100 | +</html> |
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