Assignment 1 (Client-side scripting)
 
Please fill in the following information and click on the Submit Order button to submit your order.
 
 
 ORDER APPLICATION 
 
Current Date: 
Order Date: 
Day Month Year
 
 your contact details 
A Name and Address are required.
 
Name:
First Name: 
Middle Initial: 
Last Name: 
 
Address: 
Street(No./Name) 
City: 
Province (optional): 
Country: 
Postal Code: 
 
 your orders 
 
 
 Payment Method 
 
Pay By: 
Bank Check
Master CardVisa Card
Card Number: