<!DOCTYPE html> <html> <head> <meta http-equiv="Content-Type" content="text/html; charset=utf-8"> </head> <body> <form id="testform" method="post"> <table> <tbody> <tr> <td> <label for="name">Name on Card</label> </td> <td> <input size="40" id="name" /> </td> </tr> <tr> <td> <label for="number">Card Number</label> </td> <td> <input size="40" id="number" name="card_number" /> </td> </tr> <tr> <td> <label>Expiration Date</label> </td> <td> <input size="2" id="expiration_month" name="ccmonth"> <input size="4" id="expiration_year" name="ccyear" /> </td> </tr> </tbody> </table> <input type="submit" value="Submit"> </form> </body> </html>