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6a.html
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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<title>customer feedback </title>
</head>
<body>
<h1>GOOGLE'S CUSTOMER FEEDBACK FORM</h1>
<form action="" autocomplete="on">
<label for="NAME">NAME:</label>
<input type="text" placeholder="Name" id="NAME"><br><br>
<label for="DOB">DOB:</label>
<input type="date" id="DOB"><br><br>
<label for="email">EMAIL: </label>
<input type="email" id="email"><br><br>
<label for="mob">MOB: </label>
<input type="number" id="mob"><br><br>
<label for="line 1">ADDRESS: </label>
<input type="text" id="line 1" placeholder="LINE 1">
<label for="line 2">ADDRESS: </label>
<input type="text" id="line 2" placeholder="LINE 2"><br><br>
GENDER: MALE <input type="radio" name="GEN"> FEMALE <input type="radio" name="GEN"> OTHER <input type="radio" name="GEN"><br><br>
DO YOU USE GOOGLE?: <input type=checkbox checked disabled><br><br>
ANY SPECIFIC FEEDBACK:<br><textarea cols="20" rows="5"></textarea><br><br>
<input type="submit" >
<input type="reset" >
<input type="image" src="297072.jpg" alt="submit" width="48" height="28">
</form>
</body>
</html>