1 <!DOCTYPE html PUBLIC "-//W3C//DTD HTML 4.01//EN">
2 <!-- https://secure.kneedraggers.com/cart/ -->
8 <form method="post" name="cart" id="cart_form" action="https://secure.kneedraggers.com/cart/">
16 </div><!--*******************************-->
19 <span>First Name</span>
22 <input maxlength="30" name="user[billing][firstname]" value="" id="BILL_FIRSTNAME">
25 </div><!--*******************************-->
28 <span>Last Name</span>
31 <input maxlength="30" name="user[billing][lastname]" value="" id="BILL_LASTNAME">
34 </div><!--*******************************-->
37 <span>Billing Address</span>
40 <input maxlength="35" name="user[billing][address_first]" value="" id="BILL_ADDRESS1">
43 </div><!--*******************************-->
46 <span>Billing Suite/Apt #</span>
49 <input maxlength="35" name="user[billing][address_second]" value="" id="BILL_ADDRESS2">
52 </div><!--*******************************-->
55 <span>Billing City</span>
58 <input maxlength="30" name="user[billing][city]" value="" id="BILL_CITY">
61 </div><!--*******************************-->
64 <span>State/Province</span>
67 <select name="user[billing][state]" disabled="disabled" id="SHIP_STATE">
74 <option value="APO AA">
77 <option value="APO AE">
80 <option value="APO AP">
98 <option value="CA" selected>
242 </div><!--*******************************-->
245 <span>Billing Postal Code</span>
248 <input disabled="disabled" maxlength="30" name="user[billing][zip]" value="94043" id="BILL_POSTAL">
251 </div><!--*******************************-->
254 <span>Billing Country</span>
257 <select disabled="disabled" name="user[billing][country]" id="BILL_COUNTRY">
258 <option value="US" selected>
295 Bosnia and Herzegovina
483 </div><!--*******************************-->
486 <span>Phone Number</span>
489 <input maxlength="30" name="user[phone_first]" value="" id="PHONE1">
492 </div><!--*******************************-->
495 <span>Email Address</span>
498 <input maxlength="165" name="user[email]" value="" id="EMAIL">
501 </div><!--*******************************-->
504 <span>Confirm Email Address</span>
507 <input maxlength="165" name="user[email_confirm]" value="" id="EMAIL_CONFIRM">
510 </div><!--*******************************-->
522 Your Payment Information:
523 </div><input name="payment[method]" type="hidden" id="PAY_METHOD_CC" value="creditcard">
526 <span>Credit Card Number</span>
529 <input type="text" name="payment[cc_number]" id="CC_NUMBER" value="" size="20" maxlength="19">
532 </div><!--*******************************-->
535 <span>Expiration Month</span>
538 <input type="text" name="payment[cc_expmo]" id="CC_EXPMO" size="3" maxlength="2" value=""> <font>MM (TWO DIGIT MONTH)</font>
541 </div><!--*******************************-->
544 <span>Expiration Year</span>
547 <input type="text" name="payment[cc_expyr]" id="CC_EXPYR" size="4" maxlength="4" value=""> <font>YYYY (FOUR DIGIT YEAR)</font>
550 </div><!--*******************************-->
553 <span>CVV2/Panel Code</span>
556 <input name="payment[sigpanel]" id="CC_SIGPANEL" value="" size="4" maxlength="4"> <font><a href="#">What's this?</a></font>
559 </div><!--*******************************-->