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Text File  |  2001-02-15  |  415 b   |  12 lines
  1. Name on Card: <input type="text" name="cardname" size=30><BR>
  2. Credit Card Type: <SELECT NAME="Options" SIZE="1">
  3. <OPTION SELECTED>Choose One
  4. <OPTION>Visa
  5. <OPTION>Master Card
  6. <OPTION>Discover
  7. <OPTION>American Express
  8. <OPTION>Other
  9. </SELECT>
  10. <BR>
  11. Credit Card Number: <input type="text" name="cardnum" size=20 maxlength=16><BR>
  12. Expiration Date: <input type="text" name="expdate" size=6 value="  /  /  "><BR>