Order

<fieldsetclass="form-group"> <labelfor="name">Name: <inputtype="text"name="name"id="name"class="form-control"required> <fieldsetclass="form-group"> <labelfor="email">E-mail: <inputtype="email"name="email"id="email"class="form-control"required> <fieldsetclass="form-group"> <labelfor="mobile">Mobile: <inputtype="text"name="mobile"id="mobile"class="form-control"required> <fieldsetclass="form-group"> <labelfor="address">Address: <inputtype="text"name="address"id="address"class="form-control"required> <fieldsetclass="form-group"> <labelfor="city">City/Town/Village: <inputtype="text"name="city"id="city"class="form-control"required> <fieldsetclass="form-group"> <labelfor="pin">Pin: <inputtype="text"title="Enter valid PIN"name="pin"id="pin"class="form-control"pattern="[0-9]{6}"required> <fieldsetclass="form-group"> <labelfor="district">District: <inputtype="text"name="district"id="district"class="form-control"required> <fieldsetclass="form-group"> <labelfor="state">State: <inputtype="text"name="state"id="state"class="form-control"required> <fieldsetclass="form-check"> <inputclass="form-check-input"type="checkbox"value="discreet"name="shipping"id="discreet"checked> <labelclass="form-check-label"for="discreet">Discreet Shipping <inputtype="hidden"name="amount"id="amount"value="20.00"required>