- Back to basket

## Form with Validations

First Name:
You must include a first name.
Last Name
You must include a last name.
Your last name must be at least 5 characters long.
Your last name cannot exceed 10 characters.
Gender
You must select a gender.
Male
Female
Activities
Hiking Swimming Running

# SHIPPING ADDRESS

ADDRESS
{{address}}
CITY
{{city}}
STATE
{{state}}
COUNTRY
{{country}}

# PAYMENT METHOD

CARD NUMBER
{{address}}
CARDHOLDER NAME
{{city}}
EXPIRATION DATE
{{state}}
SECURITY CODE
{{country}}

PRODUCT |  | BRAND | PRICE | QUANTITY | COST
--- | --- | --- | --- | --- | ---
|  | ROSLYN |  |  |
|  |  |  |  | TOTAL $ 29,00