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Survey Form
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@codewithtabani
codewithtabani committed Mar 22, 2024
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Showing 1 changed file with 270 additions and 0 deletions.
270 changes: 270 additions & 0 deletions index.html
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<!doctype html>
<html>
<head>
<title>Survey Form</title>
<style>
.heading{
text-align: left;
}
</style>
</head>
<body style="background-color: black;color: white;">
<form>
<fieldset>
<h1 style="text-align: center;font-size: 40px;">SURVEY FORM</h1><hr width="90%"><br><br>
<h2 class="heading">Customer Name</h2><br>
<label>Enter your First Name: &nbsp </label><input type="text" name=""> &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp <label>Enter your last Name:&nbsp</label><input type="text" name=""><br><br>
<h2 class="heading">Address</h2>
<input type="text" name=""><br>
<label>Street Address &nbsp </label><br><br>
<input type="text" name=""><br>
<label>Street Address 2 &nbsp </label><br><br>
<label>City: &nbsp </label>
<input type="text" name=""> &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp
<label>State: &nbsp </label>
<input type="text" name=""><br><br>
<label>Zip: &nbsp </label>
<input type="text" name=""><br><br>
<input list="country" placeholder="Venezuela">

<datalist id="country">
<option value="">
<optgroup label="A">
<option value="Afghanistan">
<option value="Albania">
<option value="Algeria">
<option value="Andorra">
<option value="Argentina">
<option value=" Australia">
</optgroup>
<optgroup label="B">
<option value="Belgium">
<option value=" Brazil">
<option value="Bhutan">
<option value=" Belgium">
<option value="Bahrain">
</optgroup>
<optgroup label="C">
<option value="Cambodia">
<option value="Cameroon">
<option value="Canada">
<option value="China">
<option value="Colombia">
<option value="Chile">
<option value="Croatia">
</optgroup>
<optgroup label="D">
<option value="Denmark">
<option value="Dominica">
</optgroup>
<optgroup label="E">
<option value="Egypt">
<option value="Estonia">
<option value="England">
</optgroup>
<optgroup label="F">
<option value="Finland">
<option value="France">
</optgroup>
<optgroup label="G">
<option value="Germany">
<option value="Ghana">
<option value="Greece">
<option value="Guinea">
</optgroup>
<optgroup label="H">
<option value="Hungary">
</optgroup>
<optgroup label="I">
<option value="Iceland">
<option value="India">
<option value="Indonesia">
<option value="Iran">
<option value="Iraq">
<option value="Ireland">
<option value="Israel">
<option value="Italy">
</optgroup>
<optgroup label="J">
<option value="Jamaica">
<option value="Japan">
<option value="Jordan">
</optgroup>
<optgroup label="K">
<option value="Kazakhstan">
<option value="Kenya">
<option value="Kyrgyzstan">
</optgroup>
<optgroup label="L">
<option value="Latvia">
<option value=" Lebanon">
<option value=" Liberia">
<option value="Luxembourg">
</optgroup>
<optgroup label="M">
<option value="Malaysia">
<option value=" Mexico">
<option value="Maldives">
<option value="Morocco">
<option value="Madagascar">
<option value="Myanmar">
<option value="Mongolia">
<option value="Mauritania">
</optgroup>

<optgroup label="N">
<option value="Namibia">
<option value="Nepal">
<option value="Netherlands">
<option value="New Zealand">
<option value="Nigeria">
<option value="North Macedonia">
<option value="North Korea">
<option value="Norway">
</optgroup>
<optgroup label="O">
<option value="Oman">
</optgroup>
<optgroup label="P">
<option value="Pakistan">
<option value="Palau">
<option value="Palestine">
<option value="Papua New Guinea">
<option value="Paraguay">
<option value="Peru">
<option value=" Philippines">
<option value="Poland">
<option value="Portugal">
</optgroup>
<optgroup label="Q">
<option value="Qatar">
</optgroup>
<optgroup label="R">
<option value="Romania">
<option value="Russia">
<option value="Rwanda">
</optgroup>
<optgroup label="S">
<option value="Saudi Arabia">
<option value=" Samoa">
<option value="Senegal">
<option value="Singapore">
<option value="Serbia">
<option value="South Africa">
<option value="South Korea">
<option value=" Spain">
<option value="Sri Lanka">
<option value="Sudan">
<option value="Sweden">
<option value="Syria">
</optgroup>
<optgroup label="T">
<option value="Tajikistan">
<option value="Thailand">
<option value="Togo">
<option value="Turkey">
<option value="Turkmenistan">
</optgroup>
<optgroup label="U">
<option value="Uganda">
<option value="Uganda">
<option value="United Arab Emirates">
<option value="United Kingdom">
<option value="United States of America">
<option value="Uzbekistan">
<option value="Uruguay">
</optgroup>
<optgroup label="V">
<option value=" Vietnam">
<option value="Vanuatu">
<option value="Venezuela">
</optgroup>
<optgroup label="Y">
<option value=" Yemen">
</optgroup>
<optgroup label="T">
<option value="Zambia">
<option value="Zimbabwe">
</optgroup>

</datalist><br>
<label> Select Country </label>

<br>

<h2 class="heading">Contact</h2>
<label>Phone: </label> &nbsp
<input type="tel">&nbsp &nbsp &nbsp &nbsp &nbsp &nbsp
<label>Email:</label> &nbsp
<input type="Email"><br>

<h3 class="heading">Personal Details</h3>
<input type="radio" name="Personal Details" id="Male">
<label for="Male">Male</label><br>
<input type="radio" name="Personal Details" id="Female">
<label for="Female">Female</label><br>
<input type="radio" name="Personal Details" id="Other">
<label for="Other">Other</label><br><br>

<h2 class="heading">Ratings</h2>
<label>Rating 1: &nbsp &nbsp &nbsp </label>
<input type="radio" name="ratings" id="Bad">
<label for="Bad">Bad</label> &nbsp &nbsp
<input type="radio" name="ratings" id="Good">
<label for="Good">Good</label> &nbsp &nbsp
<input type="radio" name="ratings" id="Excellent">
<label for="Excellent">Excellent</label> <br><br><br>

<label>Rating 2: &nbsp &nbsp &nbsp </label>
<input type="radio" name="ratings" id="Bad">
<label for="Bad">Bad</label> &nbsp &nbsp
<input type="radio" name="ratings" id="Good">
<label for="Good">Good</label> &nbsp &nbsp
<input type="radio" name="ratings" id="Excellent">
<label for="Excellent">Excellent</label> <br><br><br>

<label>Rating 3: &nbsp &nbsp &nbsp </label>
<input type="radio" name="ratings" id="Bad">
<label for="Bad">Bad</label> &nbsp &nbsp
<input type="radio" name="ratings" id="Good">
<label for="Good">Good</label> &nbsp &nbsp
<input type="radio" name="ratings" id="Excellent">
<label for="Excellent">Excellent</label> <br><br><br>

<label>Rating 4: &nbsp &nbsp &nbsp </label>
<input type="radio" name="ratings" id="Bad">
<label for="Bad">Bad</label> &nbsp &nbsp
<input type="radio" name="ratings" id="Good">
<label for="Good">Good</label> &nbsp &nbsp
<input type="radio" name="ratings" id="Excellent">
<label for="Excellent">Excellent</label> <br><br><br>

<label>Rating 5: &nbsp &nbsp &nbsp </label>
<input type="radio" name="ratings" id="Bad">
<label for="Bad">Bad</label> &nbsp &nbsp
<input type="radio" name="ratings" id="Good">
<label for="Good">Good</label> &nbsp &nbsp
<input type="radio" name="ratings" id="Excellent">
<label for="Excellent">Excellent</label> <br><br><br>

<label>Rating 6: &nbsp &nbsp &nbsp </label>
<input type="radio" name="ratings" id="Bad">
<label for="Bad">Bad</label> &nbsp &nbsp
<input type="radio" name="ratings" id="Good">
<label for="Good">Good</label> &nbsp &nbsp
<input type="radio" name="ratings" id="Excellent">
<label for="Excellent">Excellent</label> <br><br><br>

<label>Rating 7: &nbsp &nbsp &nbsp </label>
<input type="radio" name="ratings" id="Bad">
<label for="Bad">Bad</label> &nbsp &nbsp
<input type="radio" name="ratings" id="Good">
<label for="Good">Good</label> &nbsp &nbsp
<input type="radio" name="ratings" id="Excellent">
<label for="Excellent">Excellent</label> <br><br><br>

<input type="Submit" name="">
</fieldset>
</form>
</body>
</html>

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