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HTML

              
                <head>
    <link href='https://fonts.googleapis.com/css?family=Work+Sans:400,700,800' rel='stylesheet' type='text/css'>
    <link rel="stylesheet" href="https://maxcdn.bootstrapcdn.com/font-awesome/4.6.1/css/font-awesome.min.css">
    <meta name="viewport" content="width=auto">
    <link href='https://fonts.googleapis.com/css?family=Josefin+Sans' rel='stylesheet' type='text/css'>
    <script src="https://ajax.googleapis.com/ajax/libs/angularjs/1.5.6/angular.min.js"></script>
    <script src="https://cdnjs.cloudflare.com/ajax/libs/angular-ui-mask/1.8.5/mask.min.js"></script>
</head>

<body ng-app="paymentForm">
    <div class="wrapper">
        <div class="background"></div>
    </div>
    <div class="container">
        <div class="back-panel">
            <h1 class="card-type">visa</h1>
            <div class="order-total">
                <div class="product-title"> everlane </div>
                <span class="product-name"> The Twill Snap  <br> Backpack One </span>
                <div class="product-price">
                    <span> order total</span>
                    <div class="price">
                        <span> 87.41</span>
                    </div>
                </div>
            </div>
            <div class="save-confirm">
                <input type="checkbox" name="safe" id="safe-field" checked>
                <label for="safe-field">Save my information for later</label>
            </div>
            <div class="input-container">
                <section class="input-wrapper">
                    <div class="product-info-wrapper">
                        <div class="product-info">
                            <p> <i class="fa fa-search" aria-hidden="true"></i>mouseover for detailes</p>
                            <img src="http://www.blacksides.ru/upload/resize_cache/iblock/f23/218_274_1/f233d979dac82d3f26b2a1ad686fff06.jpg">
                            <div class="product-reviews">
                                <i class="fa fa-star" aria-hidden="true"></i>
                                <i class="fa fa-star" aria-hidden="true"></i>
                                <i class="fa fa-star" aria-hidden="true"></i>
                                <i class="fa fa-star" aria-hidden="true"></i>
                                <i class="fa fa-star" aria-hidden="true"></i>
                            </div>
                            <p class="reviews">see all reviews </p>
                        </div>
                    </div>
                    <div class="payment-form-wrapper">
                        <h1 class="small-card-type">visa</h1>
                        <form class="payment-form">
                            <div class="cardholder">
                                <label> Name
                                    <input value="Hannah Cochran" />
                                </label>
                            </div>
                            <div class="card-number">
                                <label class="">Credit Card Number
                                    <input  type="text" name="credit-card" ng-model="cardNumber" ui-mask=" 9999 - 9999 - 9999 - 9999" />
                                </label>
                            </div>
                            <div class="expires">
                                <label class="month"> expires
                                    <select >
                                        <option>January </option>
                                        <option>February</option>
                                        <option>March </option>
                                        <option>April </option>
                                        <option>May </option>
                                        <option>June </option>
                                        <option>July </option>
                                        <option>August </option>
                                        <option>September </option>
                                        <option>October </option>
                                        <option>November </option>
                                        <option>December </option>
                                    </select>
                                </label>
                              <label class="year">
                                <select >
                                    <option>2016</option>
                                    <option>2017</option>
                                    <option>2018</option>
                                    <option>2019</option>
                                </select>
                              </label>
                               <label class="ccv"> ccv
                                    <input  ui-mask="999" ng-model="ccv" />
                                </label>
                            </div>
                        </form>
                    </div>
                    <button class="buy-btn"> buy now</button>
                </section>
            </div>
        </div>
    </div>
</body>
              
            
!

CSS

              
                * {
  margin: 0px;
  padding: 0px;
  font-family: Work Sans;
}

button {
  cursor: pointer;
}

body {
  background-color: rgb(236, 240, 242);
}

.wrapper {
  position: relative;
  height: 100%;
  width: 1300px;
  border: 1px solid red;
  border-style: none;
}

.background {
  position: absolute;
  top: 0%;
  right: 0%;
  width: calc(100% + 1000px);
  height: 0px;
  overflow: hidden;
  transform: rotate(-45deg);
  transform-origin: 80% 10%;
  border-bottom: 60px solid rgb(222, 134, 101);
  border-top: 100px solid rgb(246, 152, 116);
  z-index: -1;
}

.back-panel {
  position: relative;
  margin: 100px auto;
  width: 800px;
  height: 700px;
  background-image: linear-gradient(to right bottom, rgb(100, 109, 122), rgb(63, 70, 83));
  box-shadow: 6px 6px 2em 0.1px rgba(100, 109, 122, .9);
}

.back-panel .input-container {
  position: absolute;
  width: 670px;
  height: 450px;
  background-color: white;
  left: 300px;
  top: 150px;
  box-shadow: 6px 6px 2.5em 0.1px rgba(100, 109, 122, .5);
}

.input-wrapper {
  position: relative;
}

.input-wrapper .buy-btn {
  position: absolute;
  border-radius: 0;
  border: none;
  padding: 25px 45px;
  background-color: rgb(238, 144, 108);
  top: 410px;
  left: 430px;
  font-size: 15px;
  font-weight: 700;
  text-transform: uppercase;
  color: #B35F40;
}

.input-wrapper .buy-btn:hover {
  box-shadow: 7px 7px 1.5em 0.1px rgba(238, 144, 108, .9);
}

.card-type {
  font-size: 150px;
  opacity: 0.05;
  text-transform: uppercase;
  font-style: italic;
  line-height: 0.7;
}

.order-total {
  width: 300px;
  letter-spacing: 2px;
  margin-left: 30px;
  margin-top: 90px;
  line-height: 1.5;
  position: relative;
}

.product-title {
  color: rgb(239, 146, 110);
  font-size: 18px;
  font-weight: 700;
  text-transform: uppercase;
}

.product-name {
  color: rgb(254, 254, 255);
  font-size: 23px;
}

.product-price {
  position: absolute;
  top: 300px;
  width: 230px;
  border-top: 1px solid rgba(255, 254, 255, 0.2);
  color: rgba(149, 145, 154, 0.9);
  text-transform: uppercase;
  font-size: 18px;
  font-weight: 700;
  padding-top: 20px;
}

.price span {
  font-size: 70px;
  font-weight: 700;
  color: rgb(255, 254, 255);
  text-shadow: 0px 5px 5px rgb(63, 70, 83);
}

.save-confirm {
  position: absolute;
  bottom: 45px;
  right: 130px;
  color: rgba(149, 145, 154, 0.9);
  font-weight: 400;
  font-size: 16px;
  letter-spacing: 1.5px;
  vertical-align: top;
}

input[type=checkbox] {
  display: none;
}

input[type=checkbox]:not(checked) + label:before {
  content: '';
  position: absolute;
  top: 0px;
  right: 280px;
  width: 20px;
  height: 20px;
  background: #5E6773;
  line-height: 20px;
}

input[type=checkbox]:checked + label:before {
  content: "\2713";
  font-size: 16px;
  color: #F59C79;
  text-align: center;
  font-weight: 800;
}

.payment-form {
  display: inline-block;
  width: 59%;
  height: 100%;
}

.product-info {
  padding-top: 35px;
  padding-left: 20px;
  text-align: center;
}

.product-info p {
  color: rgba(149, 145, 154, 0.4);
  text-transform: uppercase;
  font-size: 16px;
  font-weight: 700;
}

.product-info .reviews {
  padding-top: 10px;
}

.product-info img {
  padding-top: 20px;
}

.product-info-wrapper {
  float: left;
  width: 40%;
}

.product-reviews .fa-star {
  color: #F4CE82;
  padding-top: 20px;
}

.product-reviews i:nth-child(5) {
  opacity: 0.4;
}

.payment-form-wrapper {
  padding: 30px 40px;
}

.small-card-type {
  font-size: 40px;
  text-transform: uppercase;
  font-style: italic;
  line-height: 0.7;
  color: rgba(109, 119, 143, 0.9);
  text-align: right;
}

.payment-form-wrapper label,
.payment-form-wrapper input,
.payment-form-wrapper select {
  display: block;
  color: rgba(149, 145, 154, 0.8);
  text-transform: uppercase;
  font-size: 16px;
  font-weight: 700;
  border: none;
}

.payment-form-wrapper input,
.payment-form-wrapper select {
  border-bottom: 1px solid rgba(109, 119, 143, 0.8);
  width: 100%;
  padding: 15px 0;
  margin-bottom: 40px;
  font-family: "Josefin Sans";
  text-transform: none;
  font-size: 20px;
  color: #7683A2;
  letter-spacing: 4px;
}

input::-webkit-input-placeholder {
  color: #7683A2;
}

*:focus {
  outline-color: transparent;
  outline-style: none;
}

input:focus {
  opacity: 1;
  transition: all .15s $curve;
  margin-bottom: 39px;
  border-bottom: 3px solid rgb(246, 152, 116);
}

label.month {
  width: 35%;
  float: left;
}

label.year {
  width: 30%;
  float: left;
  margin-top: 18px;
  padding-left: 25px;
}

label.ccv {
  width: 20%;
  float: right;
}

.ccv input {
  text-align: center;
}
              
            
!

JS

              
                var app = angular.module("paymentForm", ["ui.mask"]);


              
            
!
999px

Console