1 <form method=
"POST" id=
"frontendForm" name=
"frontendForm" action=
"http://foo.com"><input value=
"DEFAULT" id=
"frontendDisplayMode" type=
"hidden"><input value=
"false" id=
"acceptIbanBic" type=
"hidden"><input value=
"en" type=
"HIDDEN" id=
"frontendLanguage" name=
"frontendLanguage"><input autocomplete=
"off" value=
"VISA" type=
"HIDDEN" id=
"accountBrand" name=
"accountBrand"><input type=
"HIDDEN" id=
"selectedLayer" name=
"selectedLayer" value=
"default"><input type=
"HIDDEN" id=
"paymentType" name=
"paymentType" value=
"DB"><table align=
"center" width=
"100%"><tbody><tr><td><div style=
"display: none;" align=
"center" name=
"loading" id=
"loading"></div><div style=
"display: block;" name=
"defaultData" id=
"defaultData"><table border=
"0"><tbody><tr><td><table border=
"0" id=
"defaultPaymentTable"><tbody><tr id=
"userInfoBlock"><td class=
"frm_box"><table><tbody><tr id=
"salutationRow"><td style=
"width:170px;height:16px;">Salutation and Given Name
2 </td><td style=
"width:222px;"><select id=
"salutation" name=
"salutation" style=
"width:60px;" size=
"1"><option title=
"---" selected=
"" value=
"NONE">---
</option><option title=
"Mr." value=
"MR">Mr.
</option><option title=
"Mrs." value=
"MRS">Mrs.
</option><option title=
"Ms." value=
"MS">Ms.
</option>
6 <input onblur=
"updateHolder()" value=
"" style=
"width:135px;" maxlength=
"50" type=
"TEXT" id=
"givenName" name=
"givenName"></td></tr><tr id=
"familyNameRow"><td style=
"width:170px;height:16px;">Family Name
7 </td><td style=
"width:222px;"><input onblur=
"updateHolder()" value=
"" style=
"width:200px;" maxlength=
"50" type=
"TEXT" id=
"familyName" name=
"familyName"></td></tr><tr id=
"companyNameRow"><td style=
"width:170px;height:16px;">Company
*
</td><td style=
"width:222px;"><input value=
"" style=
"width:200px;" maxlength=
"200" type=
"TEXT" id=
"company" name=
"company"></td></tr></tbody></table></td></tr><tr height=
"5px" id=
"spacer1"><td></td></tr><tr id=
"addressBlock"><td class=
"frm_box"><table><tbody><tr id=
"streetRow"><td style=
"width:170px;height:16px;">Street
8 </td><td style=
"width:222px;"><input value=
"" style=
"width:200px;" maxlength=
"100" type=
"TEXT" id=
"street" name=
"street">
9 </td></tr><tr id=
"cityRow"><td style=
"width:170px;height:16px;">Zip and City
10 </td><td style=
"width:222px;"><input value=
"" style=
"width:60px;" maxlength=
"20" type=
"TEXT" id=
"zip" name=
"zip">
11 <input value=
"" style=
"width:135px;" maxlength=
"50" type=
"TEXT" id=
"city" name=
"city"></td></tr><tr id=
"countryRow"><td style=
"width:170px;height:16px;">Country
</td><td style=
"width:222px;"><select id=
"country" name=
"country" onchange=
"addressCountryChanged()" style=
"width:200px;" size=
"1"><option title=
"" selected=
"" value=
"">Please choose ...
</option><option title=
"Australia" value=
"AU">Australia
</option><option title=
"Austria" value=
"AT">Austria
</option><option title=
"Belgium" value=
"BE">Belgium
</option><option title=
"Bulgaria" value=
"BG">Bulgaria
</option><option title=
"Canada" value=
"CA">Canada
</option><option title=
"Cyprus" value=
"CY">Cyprus
</option><option title=
"Czech Republic" value=
"CZ">Czech Republic
</option><option title=
"Denmark" value=
"DK">Denmark
</option><option title=
"Estonia" value=
"EE">Estonia
</option><option title=
"Finland" value=
"FI">Finland
</option><option title=
"France" value=
"FR">France
</option><option title=
"Germany" value=
"DE">Germany
</option><option title=
"Greece" value=
"GR">Greece
</option><option title=
"Hungary" value=
"HU">Hungary
</option><option title=
"Iceland" value=
"IS">Iceland
</option><option title=
"Ireland" value=
"IE">Ireland
</option><option title=
"Israel" value=
"IL">Israel
</option><option title=
"Italy" value=
"IT">Italy
</option><option title=
"Japan" value=
"JP">Japan
</option><option title=
"Latvia" value=
"LV">Latvia
</option><option title=
"Liechtenstein" value=
"LI">Liechtenstein
</option><option title=
"Lithuania" value=
"LT">Lithuania
</option><option title=
"Luxemburg" value=
"LU">Luxemburg
</option><option title=
"Malta" value=
"MT">Malta
</option><option title=
"Netherlands" value=
"NL">Netherlands
</option><option title=
"Norway" value=
"NO">Norway
</option><option title=
"Poland" value=
"PL">Poland
</option><option title=
"Portugal" value=
"PT">Portugal
</option><option title=
"Russian Federation" value=
"RU">Russian Federation
</option><option title=
"Serbia" value=
"RS">Serbia
</option><option title=
"Slovakia" value=
"SK">Slovakia
</option><option title=
"Slovenia" value=
"SI">Slovenia
</option><option title=
"South Africa" value=
"ZA">South Africa
</option><option title=
"Spain" value=
"ES">Spain
</option><option title=
"Sweden" value=
"SE">Sweden
</option><option title=
"Switzerland" value=
"CH">Switzerland
</option><option title=
"Turkey" value=
"TR">Turkey
</option><option title=
"United Kingdom" value=
"GB">United Kingdom
</option><option title=
"United States" selected=
"" value=
"US">United States
</option><option title=
"---------------------" value=
"ZZ">---------------------
</option><option title=
"AFGHANISTAN" value=
"AF">AFGHANISTAN
</option><option title=
"ALAND ISLANDS" value=
"AX">ALAND ISLANDS
</option><option title=
"ALBANIA" value=
"AL">ALBANIA
</option><option title=
"ALGERIA" value=
"DZ">ALGERIA
</option><option title=
"AMERICAN SAMOA" value=
"AS">AMERICAN SAMOA
</option><option title=
"ANDORRA" value=
"AD">ANDORRA
</option><option title=
"ANGOLA" value=
"AO">ANGOLA
</option><option title=
"ANGUILLA" value=
"AI">ANGUILLA
</option><option title=
"ANTARCTICA" value=
"AQ">ANTARCTICA
</option><option title=
"ANTIGUA AND BARBUDA" value=
"AG">ANTIGUA AND BARBUDA
</option><option title=
"ARGENTINA" value=
"AR">ARGENTINA
</option><option title=
"ARMENIA" value=
"AM">ARMENIA
</option><option title=
"ARUBA" value=
"AW">ARUBA
</option><option title=
"AZERBAIJAN" value=
"AZ">AZERBAIJAN
</option><option title=
"BAHAMAS" value=
"BS">BAHAMAS
</option><option title=
"BAHRAIN" value=
"BH">BAHRAIN
</option><option title=
"BANGLADESH" value=
"BD">BANGLADESH
</option><option title=
"BARBADOS" value=
"BB">BARBADOS
</option><option title=
"BELARUS" value=
"BY">BELARUS
</option><option title=
"BELIZE" value=
"BZ">BELIZE
</option><option title=
"BENIN" value=
"BJ">BENIN
</option><option title=
"BERMUDA" value=
"BM">BERMUDA
</option><option title=
"BHUTAN" value=
"BT">BHUTAN
</option><option title=
"BOLIVIA" value=
"BO">BOLIVIA
</option><option title=
"BONAIRE, SINT EUSTATIUS AND SABA" value=
"BQ">BONAIRE, SINT EUSTATIUS AND SABA
</option><option title=
"BOSNIA AND HERZEGOVINA" value=
"BA">BOSNIA AND HERZEGOVINA
</option><option title=
"BOTSWANA" value=
"BW">BOTSWANA
</option><option title=
"BOUVET ISLAND" value=
"BV">BOUVET ISLAND
</option><option title=
"BRAZIL" value=
"BR">BRAZIL
</option><option title=
"BRITISH INDIAN OCEAN TERRITORY" value=
"IO">BRITISH INDIAN OCEAN TERRITORY
</option><option title=
"BRUNEI DARUSSALAM" value=
"BN">BRUNEI DARUSSALAM
</option><option title=
"BURKINA FASO" value=
"BF">BURKINA FASO
</option><option title=
"BURUNDI" value=
"BI">BURUNDI
</option><option title=
"CAMBODIA" value=
"KH">CAMBODIA
</option><option title=
"CAMEROON" value=
"CM">CAMEROON
</option><option title=
"CAPE VERDE" value=
"CV">CAPE VERDE
</option><option title=
"CAYMAN ISLANDS" value=
"KY">CAYMAN ISLANDS
</option><option title=
"CENTRAL AFRICAN REPUBLIC" value=
"CF">CENTRAL AFRICAN REPUBLIC
</option><option title=
"CHAD" value=
"TD">CHAD
</option><option title=
"CHILE" value=
"CL">CHILE
</option><option title=
"CHINA" value=
"CN">CHINA
</option><option title=
"CHRISTMAS ISLAND" value=
"CX">CHRISTMAS ISLAND
</option><option title=
"COCOS (KEELING) ISLANDS" value=
"CC">COCOS (KEELING) ISLANDS
</option><option title=
"COLOMBIA" value=
"CO">COLOMBIA
</option><option title=
"COMOROS" value=
"KM">COMOROS
</option><option title=
"CONGO" value=
"CG">CONGO
</option><option title=
"CONGO, THE DEMOCRATIC REPUBLIC OF THE" value=
"CD">CONGO, THE DEMOCRATIC REPUBLIC OF THE
</option><option title=
"COOK ISLANDS" value=
"CK">COOK ISLANDS
</option><option title=
"COSTA RICA" value=
"CR">COSTA RICA
</option><option title=
"COTE D'IVOIRE" value=
"CI">COTE D'IVOIRE
</option><option title=
"CROATIA" value=
"HR">CROATIA
</option><option title=
"CUBA" value=
"CU">CUBA
</option><option title=
"CURACAO" value=
"CW">CURACAO
</option><option title=
"DJIBOUTI" value=
"DJ">DJIBOUTI
</option><option title=
"DOMINICA" value=
"DM">DOMINICA
</option><option title=
"DOMINICAN REPUBLIC" value=
"DO">DOMINICAN REPUBLIC
</option><option title=
"EAST TIMOR" value=
"TP">EAST TIMOR
</option><option title=
"ECUADOR" value=
"EC">ECUADOR
</option><option title=
"EGYPT" value=
"EG">EGYPT
</option><option title=
"EL SALVADOR" value=
"SV">EL SALVADOR
</option><option title=
"EQUATORIAL GUINEA" value=
"GQ">EQUATORIAL GUINEA
</option><option title=
"ERITREA" value=
"ER">ERITREA
</option><option title=
"ETHIOPIA" value=
"ET">ETHIOPIA
</option><option title=
"FALKLAND ISLANDS (MALVINAS)" value=
"FK">FALKLAND ISLANDS (MALVINAS)
</option><option title=
"FAROE ISLANDS" value=
"FO">FAROE ISLANDS
</option><option title=
"FIJI" value=
"FJ">FIJI
</option><option title=
"FRENCH GUIANA" value=
"GF">FRENCH GUIANA
</option><option title=
"FRENCH POLYNESIA" value=
"PF">FRENCH POLYNESIA
</option><option title=
"FRENCH SOUTHERN TERRITORIES" value=
"TF">FRENCH SOUTHERN TERRITORIES
</option><option title=
"GABON" value=
"GA">GABON
</option><option title=
"GAMBIA" value=
"GM">GAMBIA
</option><option title=
"GEORGIA" value=
"GE">GEORGIA
</option><option title=
"GHANA" value=
"GH">GHANA
</option><option title=
"GIBRALTAR" value=
"GI">GIBRALTAR
</option><option title=
"GREENLAND" value=
"GL">GREENLAND
</option><option title=
"GRENADA" value=
"GD">GRENADA
</option><option title=
"GUADELOUPE" value=
"GP">GUADELOUPE
</option><option title=
"GUAM" value=
"GU">GUAM
</option><option title=
"GUATEMALA" value=
"GT">GUATEMALA
</option><option title=
"GUERNSEY" value=
"GG">GUERNSEY
</option><option title=
"GUINEA" value=
"GN">GUINEA
</option><option title=
"GUINEA-BISSAU" value=
"GW">GUINEA-BISSAU
</option><option title=
"GUYANA" value=
"GY">GUYANA
</option><option title=
"HAITI" value=
"HT">HAITI
</option><option title=
"HEARD ISLAND AND MCDONALD ISLANDS" value=
"HM">HEARD ISLAND AND MCDONALD ISLANDS
</option><option title=
"HOLY SEE (VATICAN CITY STATE)" value=
"VA">HOLY SEE (VATICAN CITY STATE)
</option><option title=
"HONDURAS" value=
"HN">HONDURAS
</option><option title=
"HONG KONG" value=
"HK">HONG KONG
</option><option title=
"INDIA" value=
"IN">INDIA
</option><option title=
"INDONESIA" value=
"ID">INDONESIA
</option><option title=
"IRAN, ISLAMIC REPUBLIC OF" value=
"IR">IRAN, ISLAMIC REPUBLIC OF
</option><option title=
"IRAQ" value=
"IQ">IRAQ
</option><option title=
"ISLE OF MAN" value=
"IM">ISLE OF MAN
</option><option title=
"JAMAICA" value=
"JM">JAMAICA
</option><option title=
"JERSEY" value=
"JE">JERSEY
</option><option title=
"JORDAN" value=
"JO">JORDAN
</option><option title=
"KAZAKSTAN" value=
"KZ">KAZAKSTAN
</option><option title=
"KENYA" value=
"KE">KENYA
</option><option title=
"KIRIBATI" value=
"KI">KIRIBATI
</option><option title=
"KOREA, DEMOCRATIC PEOPLE'S REPUBLIC OF" value=
"KP">KOREA, DEMOCRATIC PEOPLE'S REPUBLIC OF
</option><option title=
"KOREA, REPUBLIC OF" value=
"KR">KOREA, REPUBLIC OF
</option><option title=
"KUWAIT" value=
"KW">KUWAIT
</option><option title=
"KYRGYZSTAN" value=
"KG">KYRGYZSTAN
</option><option title=
"LAO PEOPLE'S DEMOCRATIC REPUBLIC" value=
"LA">LAO PEOPLE'S DEMOCRATIC REPUBLIC
</option><option title=
"LEBANON" value=
"LB">LEBANON
</option><option title=
"LESOTHO" value=
"LS">LESOTHO
</option><option title=
"LIBERIA" value=
"LR">LIBERIA
</option><option title=
"LIBYAN ARAB JAMAHIRIYA" value=
"LY">LIBYAN ARAB JAMAHIRIYA
</option><option title=
"MACAU" value=
"MO">MACAU
</option><option title=
"MACEDONIA, THE FORMER YUGOSLAV REPUBLIC OF" value=
"MK">MACEDONIA, THE FORMER YUGOSLAV REPUBLIC OF
</option><option title=
"MADAGASCAR" value=
"MG">MADAGASCAR
</option><option title=
"MALAWI" value=
"MW">MALAWI
</option><option title=
"MALAYSIA" value=
"MY">MALAYSIA
</option><option title=
"MALDIVES" value=
"MV">MALDIVES
</option><option title=
"MALI" value=
"ML">MALI
</option><option title=
"MARSHALL ISLANDS" value=
"MH">MARSHALL ISLANDS
</option><option title=
"MARTINIQUE" value=
"MQ">MARTINIQUE
</option><option title=
"MAURITANIA" value=
"MR">MAURITANIA
</option><option title=
"MAURITIUS" value=
"MU">MAURITIUS
</option><option title=
"MAYOTTE" value=
"YT">MAYOTTE
</option><option title=
"MEXICO" value=
"MX">MEXICO
</option><option title=
"MICRONESIA, FEDERATED STATES OF" value=
"FM">MICRONESIA, FEDERATED STATES OF
</option><option title=
"MOLDOVA, REPUBLIC OF" value=
"MD">MOLDOVA, REPUBLIC OF
</option><option title=
"MONACO" value=
"MC">MONACO
</option><option title=
"MONGOLIA" value=
"MN">MONGOLIA
</option><option title=
"MONTENEGRO" value=
"ME">MONTENEGRO
</option><option title=
"MONTSERRAT" value=
"MS">MONTSERRAT
</option><option title=
"MOROCCO" value=
"MA">MOROCCO
</option><option title=
"MOZAMBIQUE" value=
"MZ">MOZAMBIQUE
</option><option title=
"MYANMAR" value=
"MM">MYANMAR
</option><option title=
"NAMIBIA" value=
"NA">NAMIBIA
</option><option title=
"NAURU" value=
"NR">NAURU
</option><option title=
"NEPAL" value=
"NP">NEPAL
</option><option title=
"NETHERLANDS ANTILLES" value=
"AN">NETHERLANDS ANTILLES
</option><option title=
"NEW CALEDONIA" value=
"NC">NEW CALEDONIA
</option><option title=
"NEW ZEALAND" value=
"NZ">NEW ZEALAND
</option><option title=
"NICARAGUA" value=
"NI">NICARAGUA
</option><option title=
"NIGER" value=
"NE">NIGER
</option><option title=
"NIGERIA" value=
"NG">NIGERIA
</option><option title=
"NIUE" value=
"NU">NIUE
</option><option title=
"NORFOLK ISLAND" value=
"NF">NORFOLK ISLAND
</option><option title=
"NORTHERN MARIANA ISLANDS" value=
"MP">NORTHERN MARIANA ISLANDS
</option><option title=
"OMAN" value=
"OM">OMAN
</option><option title=
"PAKISTAN" value=
"PK">PAKISTAN
</option><option title=
"PALAU" value=
"PW">PALAU
</option><option title=
"PALESTINIAN TERRITORY, OCCUPIED" value=
"PS">PALESTINIAN TERRITORY, OCCUPIED
</option><option title=
"PANAMA" value=
"PA">PANAMA
</option><option title=
"PAPUA NEW GUINEA" value=
"PG">PAPUA NEW GUINEA
</option><option title=
"PARAGUAY" value=
"PY">PARAGUAY
</option><option title=
"PERU" value=
"PE">PERU
</option><option title=
"PHILIPPINES" value=
"PH">PHILIPPINES
</option><option title=
"PITCAIRN" value=
"PN">PITCAIRN
</option><option title=
"PUERTO RICO" value=
"PR">PUERTO RICO
</option><option title=
"QATAR" value=
"QA">QATAR
</option><option title=
"REUNION" value=
"RE">REUNION
</option><option title=
"ROMANIA" value=
"RO">ROMANIA
</option><option title=
"RWANDA" value=
"RW">RWANDA
</option><option title=
"SAINT BARTHELEMY" value=
"BL">SAINT BARTHELEMY
</option><option title=
"SAINT HELENA" value=
"SH">SAINT HELENA
</option><option title=
"SAINT KITTS AND NEVIS" value=
"KN">SAINT KITTS AND NEVIS
</option><option title=
"SAINT LUCIA" value=
"LC">SAINT LUCIA
</option><option title=
"SAINT MARTIN (FRENCH PART)" value=
"MF">SAINT MARTIN (FRENCH PART)
</option><option title=
"SAINT PIERRE AND MIQUELON" value=
"PM">SAINT PIERRE AND MIQUELON
</option><option title=
"SAINT VINCENT AND THE GRENADINES" value=
"VC">SAINT VINCENT AND THE GRENADINES
</option><option title=
"SAMOA" value=
"WS">SAMOA
</option><option title=
"SAN MARINO" value=
"SM">SAN MARINO
</option><option title=
"SAO TOME AND PRINCIPE" value=
"ST">SAO TOME AND PRINCIPE
</option><option title=
"SAUDI ARABIA" value=
"SA">SAUDI ARABIA
</option><option title=
"SENEGAL" value=
"SN">SENEGAL
</option><option title=
"SERBIA AND MONTENEGRO" value=
"CS">SERBIA AND MONTENEGRO
</option><option title=
"SEYCHELLES" value=
"SC">SEYCHELLES
</option><option title=
"SIERRA LEONE" value=
"SL">SIERRA LEONE
</option><option title=
"SINGAPORE" value=
"SG">SINGAPORE
</option><option title=
"SINT MAARTEN (DUTCH PART)" value=
"SX">SINT MAARTEN (DUTCH PART)
</option><option title=
"SOLOMON ISLANDS" value=
"SB">SOLOMON ISLANDS
</option><option title=
"SOMALIA" value=
"SO">SOMALIA
</option><option title=
"SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS" value=
"GS">SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS
</option><option title=
"SOUTH SUDAN" value=
"SS">SOUTH SUDAN
</option><option title=
"SRI LANKA" value=
"LK">SRI LANKA
</option><option title=
"SUDAN" value=
"SD">SUDAN
</option><option title=
"SURINAME" value=
"SR">SURINAME
</option><option title=
"SVALBARD AND JAN MAYEN" value=
"SJ">SVALBARD AND JAN MAYEN
</option><option title=
"SWAZILAND" value=
"SZ">SWAZILAND
</option><option title=
"SYRIAN ARAB REPUBLIC" value=
"SY">SYRIAN ARAB REPUBLIC
</option><option title=
"TAIWAN, PROVINCE OF CHINA" value=
"TW">TAIWAN, PROVINCE OF CHINA
</option><option title=
"TAJIKISTAN" value=
"TJ">TAJIKISTAN
</option><option title=
"TANZANIA, UNITED REPUBLIC OF" value=
"TZ">TANZANIA, UNITED REPUBLIC OF
</option><option title=
"THAILAND" value=
"TH">THAILAND
</option><option title=
"TIMOR-LESTE" value=
"TL">TIMOR-LESTE
</option><option title=
"TOGO" value=
"TG">TOGO
</option><option title=
"TOKELAU" value=
"TK">TOKELAU
</option><option title=
"TONGA" value=
"TO">TONGA
</option><option title=
"TRINIDAD AND TOBAGO" value=
"TT">TRINIDAD AND TOBAGO
</option><option title=
"TUNISIA" value=
"TN">TUNISIA
</option><option title=
"TURKMENISTAN" value=
"TM">TURKMENISTAN
</option><option title=
"TURKS AND CAICOS ISLANDS" value=
"TC">TURKS AND CAICOS ISLANDS
</option><option title=
"TUVALU" value=
"TV">TUVALU
</option><option title=
"UGANDA" value=
"UG">UGANDA
</option><option title=
"UKRAINE" value=
"UA">UKRAINE
</option><option title=
"UNITED ARAB EMIRATES" value=
"AE">UNITED ARAB EMIRATES
</option><option title=
"UNITED KINGDOM" value=
"GB">UNITED KINGDOM
</option><option title=
"UNITED STATES" selected=
"" value=
"US">UNITED STATES
</option><option title=
"UNITED STATES MINOR OUTLYING ISLANDS" value=
"UM">UNITED STATES MINOR OUTLYING ISLANDS
</option><option title=
"URUGUAY" value=
"UY">URUGUAY
</option><option title=
"UZBEKISTAN" value=
"UZ">UZBEKISTAN
</option><option title=
"VANUATU" value=
"VU">VANUATU
</option><option title=
"VENEZUELA" value=
"VE">VENEZUELA
</option><option title=
"VIETNAM" value=
"VN">VIETNAM
</option><option title=
"VIRGIN ISLANDS, BRITISH" value=
"VG">VIRGIN ISLANDS, BRITISH
</option><option title=
"VIRGIN ISLANDS, U.S." value=
"VI">VIRGIN ISLANDS, U.S.
</option><option title=
"WALLIS AND FUTUNA" value=
"WF">WALLIS AND FUTUNA
</option><option title=
"WESTERNSAHARA" value=
"EH">WESTERNSAHARA
</option><option title=
"YEMEN" value=
"YE">YEMEN
</option><option title=
"ZAMBIA" value=
"ZM">ZAMBIA
</option><option title=
"ZIMBABWE" value=
"ZW">ZIMBABWE
</option>
13 </select></td></tr><tr id=
"stateRow"><td style=
"width:170px;height:16px;">State
</td><td style=
"width:222px;"><select id=
"state" name=
"state" style=
"width:200px;" size=
"1"><option title=
"" selected=
"" value=
"">Please choose ...
</option><option title=
"Alabama" value=
"AL">Alabama
</option><option title=
"Alaska" value=
"AK">Alaska
</option><option title=
"American Samoa" value=
"AS">American Samoa
</option><option title=
"Arizona" value=
"AZ">Arizona
</option><option title=
"Arkansas" value=
"AR">Arkansas
</option><option title=
"Armed Forces America" value=
"AA">Armed Forces America
</option><option title=
"Armed Forces Europe" value=
"AE">Armed Forces Europe
</option><option title=
"Armed Forces Pacific" value=
"AP">Armed Forces Pacific
</option><option title=
"California" selected=
"" value=
"CA">California
</option><option title=
"Colorado" value=
"CO">Colorado
</option><option title=
"Connecticut" value=
"CT">Connecticut
</option><option title=
"Delaware" value=
"DE">Delaware
</option><option title=
"District of Columbia" value=
"DC">District of Columbia
</option><option title=
"Federated states of Micronesia" value=
"FM">Federated states of Micronesia
</option><option title=
"Florida" value=
"FL">Florida
</option><option title=
"Georgia" value=
"GA">Georgia
</option><option title=
"Guam" value=
"GU">Guam
</option><option title=
"Hawaii" value=
"HI">Hawaii
</option><option title=
"Idaho" value=
"ID">Idaho
</option><option title=
"Illinois" value=
"IL">Illinois
</option><option title=
"Indiana" value=
"IN">Indiana
</option><option title=
"Iowa" value=
"IA">Iowa
</option><option title=
"Kansas" value=
"KS">Kansas
</option><option title=
"Kentucky" value=
"KY">Kentucky
</option><option title=
"Louisiana" value=
"LA">Louisiana
</option><option title=
"Maine" value=
"ME">Maine
</option><option title=
"Marshall Islands" value=
"MH">Marshall Islands
</option><option title=
"Maryland" value=
"MD">Maryland
</option><option title=
"Massachusetts" value=
"MA">Massachusetts
</option><option title=
"Michigan" value=
"MI">Michigan
</option><option title=
"Minnesota" value=
"MN">Minnesota
</option><option title=
"Mississippi" value=
"MS">Mississippi
</option><option title=
"Missouri" value=
"MO">Missouri
</option><option title=
"Montana" value=
"MT">Montana
</option><option title=
"Nebraska" value=
"NE">Nebraska
</option><option title=
"Nevada" value=
"NV">Nevada
</option><option title=
"New Hampshire" value=
"NH">New Hampshire
</option><option title=
"New Jersey" value=
"NJ">New Jersey
</option><option title=
"New Mexico" value=
"NM">New Mexico
</option><option title=
"New York" value=
"NY">New York
</option><option title=
"North Carolina" value=
"NC">North Carolina
</option><option title=
"North Dakota" value=
"ND">North Dakota
</option><option title=
"Northern Mariana Islands" value=
"MP">Northern Mariana Islands
</option><option title=
"Ohio" value=
"OH">Ohio
</option><option title=
"Oklahoma" value=
"OK">Oklahoma
</option><option title=
"Oregon" value=
"OR">Oregon
</option><option title=
"Palau" value=
"PW">Palau
</option><option title=
"Pennsylvania" value=
"PA">Pennsylvania
</option><option title=
"Puerto Rico" value=
"PR">Puerto Rico
</option><option title=
"Rhode Island" value=
"RI">Rhode Island
</option><option title=
"South Carolina" value=
"SC">South Carolina
</option><option title=
"South Dakota" value=
"SD">South Dakota
</option><option title=
"Tennessee" value=
"TN">Tennessee
</option><option title=
"Texas" value=
"TX">Texas
</option><option title=
"Utah" value=
"UT">Utah
</option><option title=
"Vermont" value=
"VT">Vermont
</option><option title=
"Virgin Islands" value=
"VI">Virgin Islands
</option><option title=
"Virginia" value=
"VA">Virginia
</option><option title=
"Washington" value=
"WA">Washington
</option><option title=
"West Virginia" value=
"WV">West Virginia
</option><option title=
"Wisconsin" value=
"WI">Wisconsin
</option><option title=
"Wyoming" value=
"WY">Wyoming
</option>
15 </select></td></tr></tbody></table></td></tr><tr height=
"5px" id=
"spacer2"><td></td></tr><tr id=
"contactBlock"><td class=
"frm_box"><table><tbody><tr id=
"emailRow"><td style=
"width:170px;height:16px;">Email
16 </td><td style=
"width:222px;"><input onblur=
"updateEmail()" value=
"" style=
"width:200px;" maxlength=
"100" type=
"TEXT" id=
"email" name=
"email"></td></tr><tr id=
"phoneRow"><td style=
"width:170px;height:16px;">Phone
*
</td><td style=
"width:222px;"><input value=
"" style=
"width:200px;" maxlength=
"20" type=
"TEXT" id=
"phone" name=
"phone"></td></tr><tr id=
"mobileRow"><td style=
"width:170px;height:16px;">Mobile
*
</td><td style=
"width:222px;"><input value=
"" style=
"width:200px;" maxlength=
"20" type=
"TEXT" id=
"mobile" name=
"mobile"></td></tr></tbody></table></td></tr><tr height=
"5px" id=
"spacer3"><td></td></tr><tr id=
"paymentBlock"><td><table><tbody><tr id=
"paymentSelection"><td><table><tbody><tr><td style=
"width:170px;height:16px;"><b>31.89 USD
</b> by
</td><td style=
"width:222px;"><select id=
"paymentMethod" name=
"paymentMethod" onchange=
"paymentMethodChanged()" style=
"width:200px;" size=
"1"><option title=
"Credit Card" selected=
"" value=
"CC">Credit Card
</option>
18 </select></td></tr></tbody></table></td></tr><tr class=
"paymentContainer" id=
"creditCard"><td class=
"frm_box"><div name=
"ccBlock" id=
"ccBlock"><table><tbody><tr><td><table border=
"0" id=
"cardPane"><tbody><tr id=
"cardTypeRow"><td style=
"width:170px;height:16px;">Card Brand
</td><td style=
"width:222px;"><select id=
"accountBrandDropDown" name=
"accountBrandDropDown" onchange=
"brandChanged()" style=
"width:120px;" size=
"1"><option title=
"Visa" selected=
"" value=
"VISA">Visa
</option>
20 </select><img alt=
"" src=
"images/visa_mc.gif"></td></tr><tr id=
"cardNumberRow"><td style=
"width:170px;height:16px">Card Number
21 </td><td style=
"width:222px;"><input autocomplete=
"off" onblur=
"updateCardNumber()" value=
"" style=
"width:200px;" maxlength=
"20" type=
"TEXT" id=
"cardNumber" name=
"cardNumber"></td></tr><tr id=
"cardOwnerRow"><td style=
"width:170px;height:16px;">Card holder
22 </td><td style=
"width:222px;"><input onblur=
"updateCardHolder()" value=
"" style=
"width:200px;" maxlength=
"50" type=
"TEXT" id=
"ccHolder" name=
"ccHolder"></td></tr><tr id=
"cpfNumber" style=
"display: none;"><td style=
"width:170px;height:16px;">
24 </td><td style=
"width:222px;"><input value=
"" style=
"width:200px;" maxlength=
"50" type=
"TEXT" id=
"identificationValue" name=
"identificationValue"><input value=
"TAXSTATEMENT" name=
"identificationPaper" type=
"hidden"></td></tr><tr id=
"expiryDateRow"><td style=
"width:170px;height:16px;">Expiration Date
</td><td style=
"width:222px;"><select id=
"accountExpiryMonth" name=
"accountExpiryMonth" onchange=
"expirationDateChanged();" size=
"1" style=
"width:100px;
25 "><option value=
"-">-
</option><option value=
"1">01</option><option value=
"2">02</option><option value=
"3">03</option><option value=
"4">04</option><option value=
"5">05</option><option value=
"6">06</option><option value=
"7">07</option><option value=
"8">08</option><option value=
"9">09</option><option value=
"10">10</option><option value=
"11">11</option><option value=
"12">12</option></select><select id=
"accountExpiryYear" name=
"accountExpiryYear" onchange=
"expirationDateChanged();" size=
"1" style=
"width:100px;
26 "><option value=
"-">-
</option><option value=
"2015">2015</option><option value=
"2016">2016</option><option value=
"2017">2017</option><option value=
"2018">2018</option><option value=
"2019">2019</option><option value=
"2020">2020</option><option value=
"2021">2021</option><option value=
"2022">2022</option><option value=
"2023">2023</option><option value=
"2024">2024</option><option value=
"2025">2025</option><option value=
"2026">2026</option></select></td></tr><tr valign=
"top" id=
"cvdRow"><td style=
"width:170px;">Verification Number
<span id=
"verificationcode_mandatory">*
</span></td><td style=
"width:222px;"><input autocomplete=
"off" onblur=
"updateCvv()" value=
"" style=
"width:100px;" maxlength=
"4" type=
"TEXT" id=
"accountVerification" name=
"accountVerification"><br><a href=
"javascript:learnMoreCVD();">Where do I find the verification number?
</a></td></tr></tbody></table></td></tr></tbody></table></div></td></tr><tr class=
"paymentContainer" id=
"debitCard" style=
"display: none;"><td class=
"frm_box"><div name=
"dcBlock" id=
"dcBlock"><table><tbody><tr><td><table border=
"0" id=
"cardPane"><tbody><tr id=
"cardTypeRow"><td style=
"width:170px;height:16px;">Card Brand
</td><td style=
"width:222px;"><select id=
"accountBrandDropDown" name=
"accountBrandDropDown" onchange=
"brandChanged()" style=
"width:120px;" size=
"1">
28 </select></td></tr><tr id=
"cardNumberRow"><td style=
"width:170px;height:16px">Card Number
29 </td><td style=
"width:222px;"><input autocomplete=
"off" onblur=
"updateCardNumber()" value=
"" style=
"width:200px;" maxlength=
"20" type=
"TEXT" id=
"cardNumber" name=
"cardNumber"></td></tr><tr id=
"cardOwnerRow"><td style=
"width:170px;height:16px;">Card holder
30 </td><td style=
"width:222px;"><input onblur=
"updateCardHolder()" value=
"" style=
"width:200px;" maxlength=
"50" type=
"TEXT" id=
"ccHolder" name=
"ccHolder"></td></tr><tr id=
"expiryDateRow"><td style=
"width:170px;height:16px;">Expiration Date
</td><td style=
"width:222px;"><select id=
"accountExpiryMonth" name=
"accountExpiryMonth" onchange=
"expirationDateChanged();" size=
"1" style=
"width:100px;
31 "><option value=
"-">-
</option><option value=
"1">01</option><option value=
"2">02</option><option value=
"3">03</option><option value=
"4">04</option><option value=
"5">05</option><option value=
"6">06</option><option value=
"7">07</option><option value=
"8">08</option><option value=
"9">09</option><option value=
"10">10</option><option value=
"11">11</option><option value=
"12">12</option></select><select id=
"accountExpiryYear" name=
"accountExpiryYear" onchange=
"expirationDateChanged();" size=
"1" style=
"width:100px;
32 "><option value=
"-">-
</option><option value=
"2015">2015</option><option value=
"2016">2016</option><option value=
"2017">2017</option><option value=
"2018">2018</option><option value=
"2019">2019</option><option value=
"2020">2020</option><option value=
"2021">2021</option><option value=
"2022">2022</option><option value=
"2023">2023</option><option value=
"2024">2024</option><option value=
"2025">2025</option><option value=
"2026">2026</option></select></td></tr><tr valign=
"top" id=
"cvdRow"><td style=
"width:170px;">Verification Number
<span id=
"verificationcode_mandatory">*
</span></td><td style=
"width:222px;"><input autocomplete=
"off" onblur=
"updateCvv()" value=
"" style=
"width:100px;" maxlength=
"4" type=
"TEXT" id=
"accountVerification" name=
"accountVerification"><br><a href=
"javascript:learnMoreCVD();">Where do I find the verification number?
</a></td></tr></tbody></table></td></tr></tbody></table></div></td></tr><tr class=
"paymentContainer" id=
"mergedCreditDebitCard" style=
"display: none;"><td class=
"frm_box"><div name=
"mergedCcDcBlock" id=
"mergedCcDcBlock"><table><tbody><tr><td><table border=
"0" id=
"cardPane"><tbody><tr id=
"cardTypeRow"><td style=
"width:170px;height:16px;">Card Brand
</td><td style=
"width:222px;"><select id=
"accountBrandDropDown" name=
"accountBrandDropDown" onchange=
"brandChanged()" style=
"width:120px;" size=
"1"><option title=
"Visa" selected=
"" value=
"VISA">Visa
</option>
34 </select><img alt=
"" src=
"images/visa_mc.gif"></td></tr><tr id=
"cardNumberRow"><td style=
"width:170px;height:16px">Card Number
35 </td><td style=
"width:222px;"><input autocomplete=
"off" onblur=
"updateCardNumber()" value=
"" style=
"width:200px;" maxlength=
"20" type=
"TEXT" id=
"cardNumber" name=
"cardNumber"></td></tr><tr id=
"cardOwnerRow"><td style=
"width:170px;height:16px;">Card holder
36 </td><td style=
"width:222px;"><input onblur=
"updateCardHolder()" value=
"" style=
"width:200px;" maxlength=
"50" type=
"TEXT" id=
"ccHolder" name=
"ccHolder"></td></tr><tr id=
"expiryDateRow"><td style=
"width:170px;height:16px;">Expiration Date
</td><td style=
"width:222px;"><select id=
"accountExpiryMonth" name=
"accountExpiryMonth" onchange=
"expirationDateChanged();" size=
"1" style=
"width:100px;
37 "><option value=
"-">-
</option><option value=
"1">01</option><option value=
"2">02</option><option value=
"3">03</option><option value=
"4">04</option><option value=
"5">05</option><option value=
"6">06</option><option value=
"7">07</option><option value=
"8">08</option><option value=
"9">09</option><option value=
"10">10</option><option value=
"11">11</option><option value=
"12">12</option></select><select id=
"accountExpiryYear" name=
"accountExpiryYear" onchange=
"expirationDateChanged();" size=
"1" style=
"width:100px;
38 "><option value=
"-">-
</option><option value=
"2015">2015</option><option value=
"2016">2016</option><option value=
"2017">2017</option><option value=
"2018">2018</option><option value=
"2019">2019</option><option value=
"2020">2020</option><option value=
"2021">2021</option><option value=
"2022">2022</option><option value=
"2023">2023</option><option value=
"2024">2024</option><option value=
"2025">2025</option><option value=
"2026">2026</option></select></td></tr><tr valign=
"top" id=
"cvdRow"><td style=
"width:170px;">Verification Number
<span id=
"verificationcode_mandatory">*
</span></td><td style=
"width:222px;"><input autocomplete=
"off" onblur=
"updateCvv()" value=
"" style=
"width:100px;" maxlength=
"4" type=
"TEXT" id=
"accountVerification" name=
"accountVerification"><br><a href=
"javascript:learnMoreCVD();">Where do I find the verification number?
</a></td></tr></tbody></table></td></tr></tbody></table></div></td></tr><tr class=
"paymentContainer" id=
"directDebit" style=
"display: none;"><td class=
"frm_box"><div id=
"ddBlock" name=
"ddBlock"><table><tbody><tr><td><table border=
"0" cellspacing=
"0" cellpadding=
"0"><tbody><tr id=
"bankAccountCountryRow"><td style=
"width:170px;height:16px;">Country
</td><td style=
"width:222px;"><select id=
"accountCountry" name=
"accountCountry" onchange=
"ddCountryChanged()" style=
"width:200px;" size=
"1">
40 </select></td></tr><tr id=
"bankAccountOwnerRow"><td style=
"width:170px;height:16px;">Account holder
42 </td><td style=
"width:222px;"><input value=
"" style=
"width:200px;" maxlength=
"50" type=
"TEXT" id=
"bankAccHolder" name=
"bankAccHolder"></td></tr><tr id=
"accountNumberInput" name=
"accountNumberInput"><td style=
"width:170px;height:16px;">Account Number
43 </td><td style=
"width:222px;"><input value=
"" style=
"width:200px;" maxlength=
"40" type=
"TEXT" id=
"accountNo" name=
"accountNo"></td></tr><tr id=
"bankClearingInput" name=
"bankClearingInput"><td style=
"width:170px;height:16px;">Bank Clearing
44 </td><td style=
"width:222px;"><input value=
"" style=
"width:200px;" maxlength=
"20" type=
"TEXT" id=
"accountClearing" name=
"accountClearing"></td></tr><tr id=
"bankCodeInput" name=
"bankCodeInput"><td style=
"width:170px;height:16px;">Bank Code
45 </td><td style=
"width:222px;"><input value=
"" style=
"width:200px;" maxlength=
"20" type=
"TEXT" id=
"accountBank" name=
"accountBank"></td></tr><tr id=
"bankNameInput" name=
"bankNameInput"><td style=
"width:170px;height:16px;">Bank Name
46 </td><td style=
"width:222px;"><input value=
"" style=
"width:200px;" maxlength=
"20" type=
"TEXT" id=
"checkingAccountNumber" name=
"checkingAccountNumber"></td></tr><tr id=
"codeCINInput" name=
"codeCINInput"><td style=
"width:170px;height:16px;">Code CIN
47 </td><td style=
"width:222px;"><input value=
"" style=
"width:100px;" maxlength=
"1" type=
"TEXT" id=
"codeCIN" name=
"codeCIN"></td></tr><tr id=
"codeABIInput" name=
"codeABIInput"><td style=
"width:170px;height:16px;">Code ABI
48 </td><td style=
"width:222px;"><input value=
"" style=
"width:100px;" maxlength=
"5" type=
"TEXT" id=
"codeABI" name=
"codeABI"></td></tr><tr id=
"codeCABInput" name=
"codeCABInput"><td style=
"width:170px;height:16px;">Code CAB
49 </td><td style=
"width:222px;"><input value=
"" style=
"width:100px;" maxlength=
"5" type=
"TEXT" id=
"codeCAB" name=
"codeCAB"></td></tr><tr id=
"codigoEntidadInput" name=
"codigoEntidadInput"><td style=
"width:170px;height:16px;">Codigo de Entidad
50 </td><td style=
"width:222px;"><input value=
"" style=
"width:40px;" maxlength=
"4" type=
"TEXT" id=
"codigoEntidad" name=
"codigoEntidad"></td></tr><tr id=
"codigoOficinaInput" name=
"codigoOficinaInput"><td style=
"width:170px;height:16px;">Codigo de Oficina
51 </td><td style=
"width:222px;"><input value=
"" style=
"width:40px;" maxlength=
"4" type=
"TEXT" id=
"codigoOficina" name=
"codigoOficina"></td></tr><tr id=
"controlDigitsInput" name=
"controlDigitsInput"><td style=
"width:170px;height:16px;">Digitos de Control
52 </td><td style=
"width:222px;"><input value=
"" style=
"width:20px;" maxlength=
"2" type=
"TEXT" id=
"controlDigits" name=
"controlDigits"></td></tr><tr name=
"identificationRow" id=
"identificationRow" style=
"display: none;"><td style=
"width:170px;height:16px;"><select size=
"1" style=
"width:100px;" id=
"identificationPaper" name=
"identificationPaper"><option value=
"IDCARD">Id Card No.
</option><option value=
"PASSPORT">Passport No.
</option><option value=
"TAXSTATEMENT">Tax No.
</option></select></td><td style=
"width:222px;"><input value=
"" style=
"width:200px;" maxlength=
"40" type=
"TEXT" id=
"identificationValue" name=
"identificationValue"></td></tr></tbody></table></td></tr></tbody></table></div></td></tr><tr class=
"paymentContainer" id=
"invoice" style=
"display: none;"><td class=
"frm_box"><div id=
"ivBlock" name=
"ivBlock"><table><tbody><tr><td align=
"center">Paying by 'Invoice' means we will send you an Invoice py post and you will then transfer the money into our account.
<br>Click on the '
54 button to finish the payment.
</td></tr></tbody></table></div></td></tr><tr class=
"paymentContainer" id=
"prePayment" style=
"display: none;"><td class=
"frm_box"><div id=
"ppBlock" name=
"ppBlock"><table width=
"80%" align=
"center"><tbody><tr id=
"prePaymentDescription"><td>With 'Pre-Payment' you have to transfer the amount of the transaction into our bank account in the next few days. As soon as we receive your payment, the transaction is finished.
<br>Click on the '
56 button to finish the payment.On the next page you will get all the information you need to transfer the money into our account.
</td></tr></tbody></table></div></td></tr><tr class=
"paymentContainer" id=
"cashOnDelivery" style=
"display: none;"><td class=
"frm_box"><div id=
"odBlock" name=
"odBlock"><table width=
"80%" align=
"center"><tbody><tr><td>You pay the amount to the carrier on delivery.
<br>Click on the '
58 button to finish the payment.
</td></tr></tbody></table></div></td></tr><tr class=
"paymentContainer" id=
"virtualAccount" style=
"display: none;"><td class=
"frm_box"><div id=
"vaBlock" name=
"vaBlock"><table border=
"0"><tbody><tr id=
"vaBrandRow"><td style=
"width:170px;height:16px;">Provider
59 </td><td style=
"width:222px;"><select id=
"virtualAccountBrand" name=
"virtualAccountBrand" onchange=
"vaBrandChanged()" style=
"width:140px;" size=
"1">
61 </select><span id=
"klarnaLogo"><img style=
"display:none" src=
"images/klarna_invoice.png" class=
"klarnaLogo" id=
"klarnaInvoiceLogo"><img style=
"display:none" src=
"images/klarna_installments.png" class=
"klarnaLogo" id=
"klarnaInstallmentsLogo"></span></td></tr><tr style=
"display:none" id=
"klarnaTerms"><td style=
"width:170px;height:16px;"></td><td style=
"width:222px;"><a id=
"klarnaInvoiceTerms" href=
"https://cdn.klarna.com/1.0/shared/content/legal/terms/EID//invoice?fee=0" onclick=
"window.open('https://cdn.klarna.com/1.0/shared/content/legal/terms/EID//invoice?fee=0','villkor_','width=600,height=550,scrollbars=no'); return false;">
64 </a><a id=
"klarnaInstallmentsTerms" href=
"https://cdn.klarna.com/1.0/shared/content/legal/terms/EID//account?fee=0" onclick=
"window.open('https://cdn.klarna.com/1.0/shared/content/legal/terms/EID//account?fee=0','villkor_','width=600,height=550,scrollbars=no'); return false;">
67 </a></td></tr><tr id=
"vaIdRow"><td style=
"width:170px;height:16px;">Username / Id
68 </td><td style=
"width:222px;"><input value=
"" style=
"width:200px;" maxlength=
"100" type=
"TEXT" id=
"virtualAccountId" name=
"virtualAccountId"></td></tr></tbody></table></div></td></tr><tr class=
"paymentContainer" id=
"userAccount" style=
"display: none;"><td class=
"frm_box"><div id=
"uaBlock" name=
"uaBlock"><table border=
"0"><tbody><tr id=
"uaBrandRow"><td style=
"width:170px;height:16px;">Provider
69 </td><td style=
"width:222px;"><select id=
"userAccountBrand" name=
"userAccountBrand" onchange=
"uaBrandChanged()" style=
"width:200px;" size=
"1">
71 </select></td></tr><tr id=
"uaIdRow"><td style=
"width:170px;height:16px;">Username / Id
72 </td><td style=
"width:222px;"><input value=
"" style=
"width:200px;" maxlength=
"100" type=
"TEXT" id=
"userAccountId" name=
"userAccountId"></td></tr><tr id=
"uaPasswordRow"><td style=
"width:170px;height:16px;">Password
73 </td><td style=
"width:222px;"><input value=
"" style=
"width:200px;" maxlength=
"50" type=
"password" id=
"userAccountPassword" name=
"userAccountPassword"></td></tr><tr id=
"uaPasswordReTypeRow"><td style=
"width:170px;height:16px;">Re-type password
74 </td><td style=
"width:222px;"><input value=
"" style=
"width:200px;" maxlength=
"50" type=
"password" id=
"userAccountPasswordReType" name=
"userAccountPasswordReType"></td></tr></tbody></table></div></td></tr><tr class=
"paymentContainer" id=
"onlineTransfer" style=
"display: none;"><td class=
"frm_box"><div id=
"otBlock" name=
"otBlock"><table border=
"0"><tbody><tr><td style=
"width:170px;height:16px;">Country
</td><td style=
"width:222px;"><select id=
"onlineTransferCountry" name=
"onlineTransferCountry" onchange=
"otCountryChanged()" style=
"width:200px;" size=
"1"><option title=
"" selected=
"" value=
"">Please choose ...
</option><option title=
"United States" selected=
"" value=
"US">United States
</option>
76 </select></td></tr><tr id=
"otInstituteBlock" style=
"display: none;"><td style=
"width:170px;height:16px;">Bank
</td><td style=
"width:222px;"><select size=
"1" style=
"width:200px;" id=
"onlineTransferInstitute" name=
"onlineTransferInstitute"><option value=
"ACHSECUR">ACHSecur
</option></select></td></tr><tr id=
"otAccountBlock"><td style=
"width:170px;height:16px;">Account No.
78 </td><td style=
"width:222px;"><input autocomplete=
"off" value=
"" style=
"width:200px;" maxlength=
"50" type=
"TEXT" id=
"otAccountNumber" onblur=
"otAccountNumberChanged()" name=
"otAccountNumber"></td></tr><tr id=
"otBankcodeBlock"><td style=
"width:170px;height:16px;">Bank Code
80 </td><td style=
"width:222px;"><input value=
"" style=
"width:200px;" maxlength=
"50" type=
"TEXT" onblur=
"otBankCodeChanged()" id=
"otBankCode" name=
"otBankCode"></td></tr></tbody></table></div></td></tr></tbody></table></td></tr><tr id=
"notMandatoryRow"><td>* Optional Information
</td></tr><tr height=
"5px" id=
"spacer4"><td></td></tr></tbody></table><table width=
"100%" border=
"0"><tbody><tr></tr><tr><td>
83 <label><input onclick=
"accepted();" name=
"accept" id=
"accept" type=
"checkbox">I read and understood and I accept the terms in force in
85 <a href=
"javascript:openLink('http://www.ikea.com/ms/en_US/homeshopping/shop_online_terms_conditions.html',500,600);">general sales terms
</a>.
</label></td></tr><tr><td align=
"center"><table width=
"100%" border=
"0" cellspacing=
"0" cellpadding=
"0"><tbody><tr><td class=
"buttonarea" id=
"buttonarea"><input value=
"Cancel" type=
"button" class=
"btn" onclick=
"cancelThis();" id=
"cancel">
91 <input value=
"Pay now" type=
"button" class=
"btn" onclick=
"save(this);" id=
"send" disabled=
""></td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></div><div style=
"display: none;" align=
"center" name=
"waiting" id=
"waiting"><table align=
"center" width=
"80%"><tbody><tr><td><p style=
"height: 100px"> </p></td></tr><tr><td align=
"center"><div id=
"navcontainer"><ul id=
"navlist"><li><a id=
"ba1" href=
"#" style=
"color: rgb(128, 0, 0); background: rgb(240, 231, 215);"> </a></li><li><a id=
"ba2" href=
"#" style=
"color: rgb(128, 0, 0); background: rgb(240, 231, 215);"> </a></li><li><a id=
"ba3" href=
"#" style=
"color: rgb(128, 0, 0); background: transparent;"> </a></li><li><a id=
"ba4" href=
"#" style=
"color: rgb(128, 0, 0); background: rgb(240, 231, 215);"> </a></li><li><a id=
"ba5" href=
"#" style=
"color: rgb(128, 0, 0); background: rgb(240, 231, 215);"> </a></li></ul></div></td></tr><tr><td align=
"center">Your transaction is being processed.... This may take a few seconds.
</td></tr><tr><td><p style=
"height: 100px"> </p></td></tr></tbody></table></div></td></tr></tbody></table></form>