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<!DOCTYPE html>
<html>
<head>
    <title>Simple Payment Page</title>
</head>
<body>
    <h1>Payment Information</h1>
    <form method="post" action="process_payment.php">
        <label for="amount">Amount:</label>
        <input type="text" id="amount" name="amount" required><br><br>
        
        <label for="card_number">Card Number:</label>
        <input type="text" id="card_number" name="card_number" required><br><br>
        
        <label for="expiration_date">Expiration Date:</label>
        <input type="text" id="expiration_date" name="expiration_date" required><br><br>
        
        <label for="cvv">CVV:</label>
        <input type="text" id="cvv" name="cvv" required><br><br>
        
        <input type="submit" value="Submit Payment">
    </form>
</body>
</html>