<!DOCTYPE html>
<html lang="en">
   <head>
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      <meta name="viewport" content="width=device-width, minimum-scale=1.0, maximum-scale=1.0, user-scalable=no">
      <title>Checkout</title>
      <meta property="og:type" content="Website">
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      <meta property="twitter:site" content="@walmart">
      <meta property="og:title" content="Checkout">
      <meta property="twitter:title" content="Checkout">
   </head>
   <body>
      <form>
         <label>
<span>
<span>Promo code
         (optional)</span>
</span>
</label>
         <div>
<input name="promoCode">
</div>
         <button type="submit">
<span>Apply</span>
</button>
      </form>
      <form>
         <div>
            <div>
               <div>
                  <div>* required field</div>
                  <div>
<label for="firstName">
<span>First name on
                     card*</span>
</label>
                  </div>
                  <div>
                     <div>
<label for="firstName">
<input id="firstName" value=""
                        name="firstName"
title="First name" autocomplete="section-payment given-name" maxlength="25">
</label>
</div>
                  </div>
                  <div>
<label for="lastName">
<span>Last name on
                     card*</span>
</label>
                  </div>
                  <div>
                     <div>
<label for="lastName">
<input id="lastName" value=""
                        name="lastName"
title="Last name" autocomplete="section-payment family-name" maxlength="25">
</label>
</div>
                  </div>
                  <div>
<label for="creditCard">
<span>Card
                     number*</span>
</label>
                  </div>
                  <div>
                     <div>
<label for="creditCard">
<input id="creditCard" pattern="[0-9]*" inputmode="numeric" name="creditCard" autocomplete="section-payment cc-number" maxlength="16">
</label>
</div>
                  </div>
                  <div>
                     <div>
                        <div>
                           <label>
<span>Expiration date*</span>
</label>
                           <div>
                              <span>
                                 <label for="month-chooser">
                                    <svg width="11" height="6">
                                       <polygon fill="#027DC3" points="5.5,6 0,0 11,0">
</polygon>
                                    </svg>
                                    <select id="month-chooser" name="month-chooser" autocomplete="section-payment cc-exp-month">
                                       <option selected="selected" value="" disabled="disabled">
                                          MM
                                       </option>
                                       <option value="01">01</option>
                                       <option value="02">02</option>
                                       <option value="03">03</option>
                                       <option value="04">04</option>
                                       <option value="05">05</option>
                                       <option value="06">06</option>
                                       <option value="07">07</option>
                                       <option value="08">08</option>
                                       <option value="09">09</option>
                                       <option value="10">10</option>
                                       <option value="11">11</option>
                                       <option value="12">12</option>
                                    </select>
                                 </label>
                              </span>
                           </div>
                           <span>&nbsp;/&nbsp;</span>
                           <div>
                              <span>
                                 <label for="year-chooser">
                                    <svg width="11" height="6">
                                       <polygon fill="#027DC3" points="5.5,6 0,0 11,0">
</polygon>
                                    </svg>
                                    <select id="year-chooser" name="year-chooser" autocomplete="section-payment cc-exp-year">
                                       <option selected="selected" value="" disabled="disabled">
                                          YY
                                       </option>
                                       <option value="2017">17</option>
                                       <option value="2018">18</option>
                                       <option value="2019">19</option>
                                       <option value="2020">20</option>
                                       <option value="2021">21</option>
                                       <option value="2022">22</option>
                                       <option value="2023">23</option>
                                       <option value="2024">24</option>
                                       <option value="2025">25</option>
                                       <option value="2026">26</option>
                                       <option value="2027">27</option>
                                    </select>
                                 </label>
                              </span>
                           </div>
                        </div>
                     </div>
                     <div>
                        <input
title=" " name="brwsrAutofillText" type="text">
                        <input
title=" " name="brwsrAutofillPassword" type="password">
                        <div>
                           <div>
                              <label for="cvv">
<span>
<span>
<span>Security code*</span>
                              </span>
</span>
</label>
                              <div>
<label for="cvv">
<button type="button">
<label for="cvv">
<span name="help" size="1" alt="Icon for help">
</span>
</label>
</button>
</label>
</div>
                           </div>
                           <div>
                              <div>
<input id="cvv" name="cvv"
title="cvv" value="" autocomplete="section-payment cc-csc" maxlength="3" pattern="[0-9]*" inputmode="numeric" type="password">
</div>
                           </div>
                        </div>
                     </div>
                  </div>
                  <div>
<label for="phone">
<span>Phone number*</span>
<span>Ex: (415)
                     444 - 5555</span>
</label>
                  </div>
                  <div>
                     <div>
<label for="phone">
<input id="phone" value="" name="phone"
title="Phone" autocomplete="section-payment tel" maxlength="14" type="tel">
</label>
</div>
                  </div>
               </div>
            </div>
            <div>
               <div>
                  <div>
                     <label>
<input checked="checked" type="checkbox">
</label>
                     <div>
<label>
<span>Same as shipping</span>
</label>
</div>
                     <div>
                        <p>
<span>22F., No.55, Haiiu 1st Rd., Bafu Dist.,</span>
<br>
                           <span>
<span>San Bruno</span>
<span>,</span>
</span>
                           <span>
<span>CA</span>
</span>
<span>94066</span>
                        </p>
                     </div>
                  </div>
               </div>
            </div>
         </div>
         <div>
            <div>
<button type="button">
<span>Review Your
               Order</span>
</button>
            </div>
         </div>
      </form>
   </body>
</html>
