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<!DOCTYPE html>
<html lang="en">
<head>
<meta name="generator" content="HTML Tidy for HTML5 for Mac OS X version 5.4.0">
<meta http-equiv="content-type" content="text/html; charset=utf-8">
<meta charset="utf-8">
<meta http-equiv="X-UA-Compatible" content="IE=edge,chrome=1">
<meta name="viewport" content="width=device-width, minimum-scale=1.0, maximum-scale=1.0, user-scalable=no">
<title>Checkout</title>
<meta property="og:type" content="Website">
<meta property="og:image" content="http://sphotos-b.xx.fbcdn.net/hphotos-ash4/229244_10150189115584236_162217_n.jpg">
<meta property="og:site_name" content="Walmart.com">
<meta property="fb:app_id" content="105223049547814">
<meta property="twitter:card" content="summary">
<meta property="twitter:image" content="https://pbs.twimg.com/profile_images/616833885/walmart_logo_youtube_bigger.jpg">
<meta property="twitter:site" content="@walmart">
<meta property="og:title" content="Checkout">
<meta property="twitter:title" content="Checkout">
</head>
<body>
<form>
<label>
<span>
<span>Promo code
(optional)</span>
</span>
</label>
<div>
<input name="promoCode">
</div>
<button type="submit">
<span>Apply</span>
</button>
</form>
<form>
<div>
<div>
<div>
<div>* required field</div>
<div>
<label for="firstName">
<span>First name on
card*</span>
</label>
</div>
<div>
<div>
<label for="firstName">
<input id="firstName" value=""
name="firstName"
title="First name" autocomplete="section-payment given-name" maxlength="25">
</label>
</div>
</div>
<div>
<label for="lastName">
<span>Last name on
card*</span>
</label>
</div>
<div>
<div>
<label for="lastName">
<input id="lastName" value=""
name="lastName"
title="Last name" autocomplete="section-payment family-name" maxlength="25">
</label>
</div>
</div>
<div>
<label for="creditCard">
<span>Card
number*</span>
</label>
</div>
<div>
<div>
<label for="creditCard">
<input id="creditCard" pattern="[0-9]*" inputmode="numeric" name="creditCard" autocomplete="section-payment cc-number" maxlength="16">
</label>
</div>
</div>
<div>
<div>
<div>
<label>
<span>Expiration date*</span>
</label>
<div>
<span>
<label for="month-chooser">
<svg width="11" height="6">
<polygon fill="#027DC3" points="5.5,6 0,0 11,0">
</polygon>
</svg>
<select id="month-chooser" name="month-chooser" autocomplete="section-payment cc-exp-month">
<option selected="selected" value="" disabled="disabled">
MM
</option>
<option value="01">01</option>
<option value="02">02</option>
<option value="03">03</option>
<option value="04">04</option>
<option value="05">05</option>
<option value="06">06</option>
<option value="07">07</option>
<option value="08">08</option>
<option value="09">09</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
</select>
</label>
</span>
</div>
<span> / </span>
<div>
<span>
<label for="year-chooser">
<svg width="11" height="6">
<polygon fill="#027DC3" points="5.5,6 0,0 11,0">
</polygon>
</svg>
<select id="year-chooser" name="year-chooser" autocomplete="section-payment cc-exp-year">
<option selected="selected" value="" disabled="disabled">
YY
</option>
<option value="2017">17</option>
<option value="2018">18</option>
<option value="2019">19</option>
<option value="2020">20</option>
<option value="2021">21</option>
<option value="2022">22</option>
<option value="2023">23</option>
<option value="2024">24</option>
<option value="2025">25</option>
<option value="2026">26</option>
<option value="2027">27</option>
</select>
</label>
</span>
</div>
</div>
</div>
<div>
<input
title=" " name="brwsrAutofillText" type="text">
<input
title=" " name="brwsrAutofillPassword" type="password">
<div>
<div>
<label for="cvv">
<span>
<span>
<span>Security code*</span>
</span>
</span>
</label>
<div>
<label for="cvv">
<button type="button">
<label for="cvv">
<span name="help" size="1" alt="Icon for help">
</span>
</label>
</button>
</label>
</div>
</div>
<div>
<div>
<input id="cvv" name="cvv"
title="cvv" value="" autocomplete="section-payment cc-csc" maxlength="3" pattern="[0-9]*" inputmode="numeric" type="password">
</div>
</div>
</div>
</div>
</div>
<div>
<label for="phone">
<span>Phone number*</span>
<span>Ex: (415)
444 - 5555</span>
</label>
</div>
<div>
<div>
<label for="phone">
<input id="phone" value="" name="phone"
title="Phone" autocomplete="section-payment tel" maxlength="14" type="tel">
</label>
</div>
</div>
</div>
</div>
<div>
<div>
<div>
<label>
<input checked="checked" type="checkbox">
</label>
<div>
<label>
<span>Same as shipping</span>
</label>
</div>
<div>
<p>
<span>22F., No.55, Haiiu 1st Rd., Bafu Dist.,</span>
<br>
<span>
<span>San Bruno</span>
<span>,</span>
</span>
<span>
<span>CA</span>
</span>
<span>94066</span>
</p>
</div>
</div>
</div>
</div>
</div>
<div>
<div>
<button type="button">
<span>Review Your
Order</span>
</button>
</div>
</div>
</form>
</body>
</html>