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index.html
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<!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>Survey Form</title>
<link rel="stylesheet" href="style_3.css">
<link rel="icon" href="Favicon.jpeg" type="image/jpeg">
</head>
<body>
<form action="https://enw7u145b8im9.x.pipedream.net/" method="post">
<h1>
CUSTOMER SATISFACTION SURVEY
</h1>
<br>
<h2>
Personal Details
</h2>
<hr class="section"><hr class="section"><br>
<b>First Name</b><br>
<input class="box" type="text" name="first_name" maxlength="20" required>
<br><br>
<b>Last Name</b><br>
<input class="box" type="text" name="last_name" maxlength="20" required>
<br><br><hr class="separator"><br>
<b>Address</b><br>
<input class="box" type="text" name="street_address" placeholder="Street Name" maxlength="50" required>
<br><input class="box" type="text" name="city" placeholder="City" maxlength="50" required>
<br><input class="box" type="text" name="State" placeholder="State" maxlength="50" required>
<br><input class="box" type="text" name="pincode" placeholder="Pin-code" maxlength="20" required>
<br><br><hr class="separator"><br>
<b>Contact No.</b><br>
<input class="box" type="number" name="contact_number" onKeyPress="if(this.value.length==10) return false;" title="Enter your 10-digit Mobile Phone Number" required>
<br><br><br>
<h2>
Feedback Rating
</h2>
<hr class="section"><hr class="section"><br>
<b class="ratings">Quality of Products Recieved</b><br>
<label>Excellent<input type="radio" name="quality_of_products_received_rating" value="Excellent"></label>
<label>Good<input type="radio" name="quality_of_products_received_rating" value="Good"></label>
<label>Bad<input type="radio" name="quality_of_products_received_rating" value="Bad"></label>
<br><br>
<b class="ratings">Value for Money</b><br>
<label>Excellent<input type="radio" name="value_for_money_rating" value="Excellent"></label>
<label>Good<input type="radio" name="value_for_money_rating" value="Good"></label>
<label>Bad<input type="radio" name="value_for_money_rating" value="Bad"></label>
<br><br>
<b class="ratings">Delivery</b><br>
<label>Excellent<input type="radio" name="delivery_rating" value="Excellent"></label>
<label>Good<input type="radio" name="delivery_rating" value="Good"></label>
<label>Bad<input type="radio" name="delivery_rating" value="Bad"></label>
<br><br><br>
<button type="submit">Submit</button>
<br><br>
</form>
</body>
</html>