<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>