chromium/components/test/data/autofill/autofill_credit_card_form.html

<!DOCTYPE html PUBLIC "-//W3C//DTD HTML 4.01//EN">
<html>
  <!-- The following call prevents the zoom-on-focus animation which caused test flakes. -->
  <meta name="viewport" content="width=device-width, initial-scale=1.0">
  <head>
    <title>Credit Card Test Form</title>
  </head>
  <body>
    <form name="cc1.1" id="cc1" action="https://example.com/" method="post">
      Name on card: <input autofocus="" type="text" name="name" id="credit_card_name"><br>
      Credit card number: <input type="text" name="CCNo" id="credit_card_number"><br>
      Expiry Date: <select name="CCExpiresMonth">
        <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>
      /
    <select name="CCExpiresYear">
        <option value="2010">2010</option>
        <option value="2011">2011</option>
        <option value="2012">2012</option>
        <option value="2013">2013</option>
        <option value="2014">2014</option>
        <option value="2015">2015</option>
        <option value="2016">2016</option>
        <option value="2017">2017</option>
        <option value="2018">2018</option>
        <option value="2019">2019</option>
        <option value="2020">2020</option>
        <option value="2021">2021</option>
        <option value="2022">2022</option>
        <option value="2023">2023</option>
      </select>
      <br>
      CVC: <input name="cvc">
    <br>
      <input type="reset" value="Reset">
      <input type="submit" value="Submit" id="credit_card_submit">
    </form>
  </body>
</html>