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Example Code
<html>
<body>
<form action="payment.asp" method="post">
  <p>Select Payment Method</p>
  <p>Cash <input type="radio" name="as" value="cash" />
  Credit Card <input type="radio" name="as" value="credit" checked="checked"/>
  </p>
  <p>Number:<input type="text" name="ccnumber"/></p>
  <p>Expiry Date:<input type="text" name="exp"/></p>
  <p><input type="submit"/></p>
</form>
<body>
</html>

Select Payment Method

Cash Credit Card

Number:

Expiry Date: