<!DOCTYPE html>
<html lang="en">

<head>
  <meta charset="UTF-8">
  <meta http-equiv="X-UA-Compatible" content="IE=edge">
  <meta name="viewport" content="width=device-width, initial-scale=1.0">
  <title>Direct.asda.com</title>
</head>

<body>
  <form class="card-form">
    <div class="form-group"><label class="label" for="cardNumber">Card number</label>
      <div>
        <div class="input-group"><input class="form-control error" name="cardNumber" type="tel" autocomplete="on"
            data-id="input-payment-add-card-number" value=""></div><span data-id="input-payment-add-card-number"
          class="error">Please enter a card number</span>
      </div>
    </div>
    <div class="form-group"><label class="label" for="cardHolder">Name on card</label>
      <div>
        <div class="input-group"><input class="form-control" name="cardHolder" type="text" autocomplete="on"
            data-id="input-payment-add-card-name-on-card" value=""></div>
      </div>
    </div>
    <div class="grid__list card-grid">
      <div class="form-group cvv-form-group"><label class="label" for="cvv">CVV number</label>
        <div>
          <div class="input-group flex-grid flex-grid--center"><input class="form-control" name="cvv" type="tel"
              autocomplete="on" data-id="input-payment-add-card-cvv" value=""><span class="icon cvv-code-icon"><svg
                xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink" width="36" height="24">
                <defs>
                  <rect id="cvv-dep-a" width="36" height="24" rx="2.182"></rect>
                </defs>
                <g fill="none" fill-rule="evenodd">
                  <rect width="36" height="24" fill="#D8D8D8" fill-rule="nonzero" rx="2.182"></rect>
                  <mask id="cvv-dep-b" fill="#fff">
                    <use xlink:href="#cvv-dep-a"></use>
                  </mask>
                  <path fill="#191919" fill-rule="nonzero" d="M0 0h36v5.526H0z" mask="url(#cvv-dep-b)"></path>
                  <rect width="6.545" height="4.435" x="26.727" y="9.282" stroke="#D8365A" stroke-width="1.091"
                    rx=".545"></rect>
                  <path fill="#FFF" fill-rule="nonzero" d="M2.182 8.737H24v5.526H2.182z"></path>
                </g>
              </svg></span><span class="icon cvv-code-helper"><svg xmlns="http://www.w3.org/2000/svg" width="24"
                height="24">
                <g fill="none" fill-rule="evenodd">
                  <circle fill="#191919" cx="12" cy="12" r="12"></circle><text font-family="Arial-BoldMT, Arial"
                    font-size="15" font-weight="bold" fill="#FFF">
                    <tspan x="7" y="17.235">?</tspan>
                  </text>
                </g>
              </svg></span></div>
        </div>
      </div>
      <div class="grid__list adjust-date"><label class="label">Expiry date</label>
        <div>
          <div class="flex-grid--inline">
            <div class="flex-grid--inline">
              <div class="form-group expiry-month">
                <div>
                  <div class="input-group"><input class="form-control" name="month" type="tel" placeholder="MM"
                      data-id="input-payment-add-card-expiry-month" value=""></div>
                </div>
              </div><span class="date-separator">/</span>
              <div class="form-group expiry-year">
                <div class="input-group">
                  <div>
                    <div class="input-group"><input class="form-control" name="year" type="tel" placeholder="YY"
                        data-id="input-payment-add-card-expiry-year" value=""></div>
                  </div>
                </div>
              </div>
            </div>
            <div></div>
          </div>
        </div>
      </div>
      <div class="save-card-text">
        <div>
          <div class="checkbox-section size-normal"><input class="checkbox-field" name="save" id="save"
              data-id="checkbox-payment-save-card" type="checkbox"><label for="save"
              class="custom-checkbox"></label><label for="save" class="checkbox-label">Save card</label></div>
        </div>
      </div>
    </div>
  </form>
</body>

</html>
