Sindbad~EG File Manager

Current Path : /home/numerotech/www/tnoa-payments.tnoa.info/public/
Upload File :
Current File : //home/numerotech/www/tnoa-payments.tnoa.info/public/sample-membership.html

<!DOCTYPE html>
<html lang="en">
<head>
    <meta charset="UTF-8">
    <meta name="viewport" content="width=device-width, initial-scale=1.0">
    <title>Payment Form</title>
</head>
<body>

    <h2>Payment Form</h2>
    
    <form action="payment-membership.php" method="POST">
        <div>
            <label for="name">Full Name:</label>
            <input type="text" id="name" name="name" required>
        </div>
        <br>
        
        <div>
            <label for="email">Email Address:</label>
            <input type="email" id="email" name="email" required>
        </div>
        <br>
        
        <div>
            <label for="mobile">Mobile Number:</label>
            <input type="tel" id="mobile" name="mobile" required>
        </div>
        <br>
        
        <div>
            <label for="amount">Amount:</label>
            <input type="number" id="amount" name="amount" required>
        </div>
        <br>
        
        <div>
            <label for="unique_id">Unique ID:</label>
            <input type="text" id="unique_id" name="unique_id" required>
        </div>
        <br>

        <div>
            <button type="submit">Submit Payment</button>
        </div>
    </form>

</body>
</html>

Sindbad File Manager Version 1.0, Coded By Sindbad EG ~ The Terrorists