<div class="row g-5">
<div class="col-md-5 col-lg-4 order-md-last">
<h4 class="d-flex justify-content-between align-items-center mb-3">
	<span class="text-primary h6">Your cart</span>
	<span class="badge bg-primary rounded-pill">3</span>
</h4>
<ul class="list-group mb-3">
	<li class="list-group-item d-flex justify-content-between lh-sm">
	<div>
		<h6 class="my-0">Product name</h6>
		<small class="text-muted">Brief description</small>
	</div>
	<span class="text-muted">$12</span>
	</li>
	<li class="list-group-item d-flex justify-content-between lh-sm">
	<div>
		<h6 class="my-0">Second product</h6>
		<small class="text-muted">Brief description</small>
	</div>
	<span class="text-muted">$8</span>
	</li>
	<li class="list-group-item d-flex justify-content-between lh-sm">
	<div>
		<h6 class="my-0">Third item</h6>
		<small class="text-muted">Brief description</small>
	</div>
	<span class="text-muted">$5</span>
	</li>
	<li class="list-group-item d-flex justify-content-between bg-light">
	<div class="text-success">
		<h6 class="my-0">Promo code</h6>
		<small>EXAMPLECODE</small>
	</div>
	<span class="text-success">−$5</span>
	</li>
	<li class="list-group-item d-flex justify-content-between">
	<span>Total (USD)</span>
	<strong>$20</strong>
	</li>
</ul>

<form class="card p-2">
	<div class="input-group">
	<input type="text" class="form-control" placeholder="Promo code">
	<button type="submit" class="btn btn-secondary">Redeem</button>
	</div>
</form>
</div>
<div class="col-md-7 col-lg-8">
<h4 class="mb-3 h6">Billing address</h4>
<form class="needs-validation" novalidate="">
	<div class="row g-3">
	<div class="col-sm-6">
		<label for="firstName" class="form-label">First name</label>
		<input type="text" class="form-control" id="firstName" placeholder="" value="" required="">
		<div class="invalid-feedback">
		Valid first name is required.
		</div>
	</div>

	<div class="col-sm-6">
		<label for="lastName" class="form-label">Last name</label>
		<input type="text" class="form-control" id="lastName" placeholder="" value="" required="">
		<div class="invalid-feedback">
		Valid last name is required.
		</div>
	</div>

	<div class="col-12">
		<label for="username" class="form-label">Username</label>
		<div class="input-group has-validation">
		<span class="input-group-text">@</span>
		<input type="text" class="form-control" id="username" placeholder="Username" required="">
		<div class="invalid-feedback">
			Your username is required.
		</div>
		</div>
	</div>

	<div class="col-12">
		<label for="email" class="form-label">Email <span class="text-muted">(Optional)</span></label>
		<input type="email" class="form-control" id="email" placeholder="you@gmail.com">
		<div class="invalid-feedback">
		Please enter a valid email address for shipping updates.
		</div>
	</div>

	<div class="col-12">
		<label for="address" class="form-label">Address</label>
		<input type="text" class="form-control" id="address" placeholder="1234 Main St" required="">
		<div class="invalid-feedback">
		Please enter your shipping address.
		</div>
	</div>

	<div class="col-12">
		<label for="address2" class="form-label">Address 2 <span class="text-muted">(Optional)</span></label>
		<input type="text" class="form-control" id="address2" placeholder="Apartment or suite">
	</div>

	<div class="col-md-5">
		<label for="country" class="form-label">Country</label>
		<select class="form-select" id="country" required="">
		<option value="">Choose...</option>
		<option>United States</option>
		</select>
		<div class="invalid-feedback">
		Please select a valid country.
		</div>
	</div>

	<div class="col-md-4">
		<label for="state" class="form-label">State</label>
		<select class="form-select" id="state" required="">
		<option value="">Choose...</option>
		<option>California</option>
		</select>
		<div class="invalid-feedback">
		Please provide a valid state.
		</div>
	</div>

	<div class="col-md-3">
		<label for="zip" class="form-label">Zip</label>
		<input type="text" class="form-control" id="zip" placeholder="" required="">
		<div class="invalid-feedback">
		Zip code required.
		</div>
	</div>
	</div>

	<hr class="my-4">

	<div class="form-check">
	<input type="checkbox" class="form-check-input" id="same-address">
	<label class="form-check-label" for="same-address">Shipping address is the same as my billing address</label>
	</div>

	<div class="form-check">
	<input type="checkbox" class="form-check-input" id="save-info">
	<label class="form-check-label" for="save-info">Save this information for next time</label>
	</div>

	<hr class="my-4">

	<h4 class="mb-3 h6">Payment</h4>

	<div class="my-3">
	<div class="form-check">
		<input id="credit" name="paymentMethod" type="radio" class="form-check-input" checked="" required="">
		<label class="form-check-label" for="credit">Credit card</label>
	</div>
	<div class="form-check">
		<input id="debit" name="paymentMethod" type="radio" class="form-check-input" required="">
		<label class="form-check-label" for="debit">Debit card</label>
	</div>
	<div class="form-check">
		<input id="paypal" name="paymentMethod" type="radio" class="form-check-input" required="">
		<label class="form-check-label" for="paypal">PayPal</label>
	</div>
	</div>

	<div class="row gy-3">
	<div class="col-md-6">
		<label for="cc-name" class="form-label">Name on card</label>
		<input type="text" class="form-control" id="cc-name" placeholder="" required="">
		<small class="text-muted">Full name as displayed on card</small>
		<div class="invalid-feedback">
		Name on card is required
		</div>
	</div>

	<div class="col-md-6">
		<label for="cc-number" class="form-label">Credit card number</label>
		<input type="text" class="form-control" id="cc-number" placeholder="" required="">
		<div class="invalid-feedback">
		Credit card number is required
		</div>
	</div>

	<div class="col-md-3">
		<label for="cc-expiration" class="form-label">Expiration</label>
		<input type="text" class="form-control" id="cc-expiration" placeholder="" required="">
		<div class="invalid-feedback">
		Expiration date required
		</div>
	</div>

	<div class="col-md-3">
		<label for="cc-cvv" class="form-label">CVV</label>
		<input type="text" class="form-control" id="cc-cvv" placeholder="" required="">
		<div class="invalid-feedback">
		Security code required
		</div>
	</div>
	</div>
	<hr class="my-4">
	<button class="w-100 btn btn-primary btn-lg" type="submit">Continue to checkout</button>
</form>
</div>
</div>