Form with Validations

You must include a first name.
You must include a last name.
Your last name must be at least 5 characters long.
Your last name cannot exceed 10 characters.
You must select a gender.

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