1 <form name=
"billing_form" id=
"id_billing_form" >
3 Billing Information
</div>
6 All fields required unless marked optional
</span>
10 <label for=
"id_billing_firstname" >
13 <input type=
"text" id=
"id_billing_firstname" name=
"billing_firstname" maxlength=
"40" size=
"25" minlength=
"2" onkeypress=
"skApp.billingShippingKeypress(event);" onchange=
"skApp.hasErrorVerification(event);">
17 <label for=
"id_billing_lastname" >
20 <input type=
"text" onkeypress=
"skApp.billingShippingKeypress(event);" onchange=
"skApp.hasErrorVerification(event);" name=
"billing_lastname" id=
"id_billing_lastname" maxlength=
"40">
24 <label for=
"id_bill_addr_lookup">
25 Address Lookup:(optional)
</label>
27 <input type=
"text" name=
"bill-addr-lookup" autocomplete=
"on" id=
"bill_addr_lookup" onkeyup=
"addressLookup('bill_addr_lookup','bill')">
31 <label for=
"id_billing_street" >
34 <input type=
"text" onkeypress=
"skApp.billingShippingKeypress(event);" onchange=
"skApp.hasErrorVerification(event);" name=
"billing_street" id=
"id_billing_street">
38 <label for=
"id_billing_suite" >
39 Address
2:(optional)
</label>
41 <input type=
"text" onkeypress=
"skApp.billingShippingKeypress(event);" onchange=
"skApp.hasErrorVerification(event);" id=
"id_billing_suite" name=
"billing_suite">
45 <label for=
"id_billing_city" >
48 <input type=
"text" onkeypress=
"skApp.billingShippingKeypress(event);" onchange=
"skApp.hasErrorVerification(event);" name=
"billing_city" id=
"id_billing_city">
52 <label id=
"id_stateString">
54 <select name=
"billing_state" id=
"id_billing_state" data-role=
"none" onchange=
"skApp.hideBillCounty(event);">
56 Choose a state
</option>
74 District of Columbia
</option>
100 Massachusetts
</option>
116 New Hampshire
</option>
124 North Carolina
</option>
126 North Dakota
</option>
134 Pennsylvania
</option>
136 Rhode Island
</option>
138 South Carolina
</option>
140 South Dakota
</option>
154 West Virginia
</option>
160 Armed Forces-America
</option>
162 Armed Forces-Europe
</option>
164 Armed Forces-Pacific
</option>
169 <label for=
"id_billing_zipcode" >
172 <input type=
"tel" onkeypress=
"skApp.billingShippingKeypress(event);" onchange=
"skApp.hideBillCounty(event)" name=
"billing_zipcode" id=
"billing_zipcode">
175 <div id=
"billcounty-container">
179 <label for=
"billing_phonenum" >
180 Contact Phone:
</label>
182 <input type=
"tel" onkeypress=
"skApp.billingShippingKeypress(event);" onchange=
"skApp.hasErrorVerification(event);" id=
"billing_phonenum" name=
"billing_phonenum">
186 <div id=
"email-container">
187 <div id=
"email_id_kcmMailContent">
188 <div data-role=
"controlgroup" aria-disabled=
"false" data-disabled=
"false" data-shadow=
"false" data-corners=
"true" data-exclude-invisible=
"true" data-type=
"vertical" data-mini=
"false" data-init-selector=
":jqmData(role='controlgroup')">
190 <div id=
"email_id_kcmEmailAddr">
191 <label for=
"email_id_kcmEmail_Txt">
195 <input type=
"email" onkeypress=
"skApp.billingShippingKeypress(event);" onchange=
"skApp.hasErrorVerification(event);" id=
"email_id_kcmEmail_Txt" name=
"email_Txt" maxlength=
"70" placeholder=
"sample@example.com" >
199 <div id=
"email_id_kcmReEmailAddr">
200 <label for=
"email_id_kcmRe_Email_Txt">
201 Confirm Email Address
</label>
204 <input type=
"email" onkeypress=
"skApp.billingShippingKeypress(event);" onchange=
"skApp.hasErrorVerification(event);" id=
"email_id_kcmRe_Email_Txt" name=
"re_Email_Txt" maxlength=
"70" placeholder=
"sample@example.com" >
210 (E-mail address is required to place an order)
</div>
212 <div data-role=
"fieldcontain">
215 <label for=
"email_kcmWS" value=
"true" data-theme=
"c" data-corners=
"true" data-shadow=
"false" data-iconshadow=
"true" data-wrapperels=
"span" data-icon=
"checkbox-on" data-mini=
"false">
218 Yes, sign me up for Sale Alerts. (optional)
</span>
223 <input type=
"checkbox" onkeypress=
"skApp.billingShippingKeypress(event);" id=
"email_kcmWS" name=
"emailOutPutStatus" checked=
"checked" value=
"true">
227 Yes, sign me up for Sale Alerts. (optional)
</label>
240 Credit Card Information
</label>
246 <div id=
"payment_id_nonEditCrdTyp">
248 <div id=
"id_cardType" >
249 <select id=
"payment_id_kcmselectPMtype" data-role=
"none" name=
"paymentType" onchange=
"skApp.changePaymentDisplay(event);">
251 Choose a card
</option>
252 <option value=
"KOHLS">
253 Kohl's Charge
</option>
254 <option value=
"AMEX">
255 American Express
</option>
256 <option value=
"DISC">
257 Discover Network
</option>
260 <option value=
"VISA">
267 Name on Card:
</label>
268 <div id=
"payment_id_kcmcard_name_div">
269 <label for=
"payment_id_kcmcrdName_Txt">
273 <input type=
"text" id=
"payment_id_kcmcrdName_Txt" onkeypress=
"skApp.onEnterPaymentKeypress(event);" name=
"nameOnCard" value=
"" autocorrect=
"off">
279 <div id=
"payment_id_kcmcard_number_div">
280 <label for=
"payment_id_kcmcrdNumber_Txt" >
284 <input type=
"tel" id=
"payment_id_kcmcrdNumber_Txt" name=
"cardNumber" maxlength=
"16" value=
"">
287 <div id=
"payment_id_nonEditCrdNum" idx=
"">
294 <div id=
"payment_id_kcmgrid1_div">
296 Expiration Month:
</label>
297 <select id=
"payment_id_kcmselct_expMonth" name=
"expMonth" data-role=
"none">
326 <div id=
"payment_id_kcmgrid2_div">
328 Expiration Year:
</label>
329 <select id=
"payment_id_kcmselct_expYear" data-role=
"none" name=
"expYear">
332 <option value=
"2013">
334 <option value=
"2014">
336 <option value=
"2015">
338 <option value=
"2016">
340 <option value=
"2017">
342 <option value=
"2018">
344 <option value=
"2019">
346 <option value=
"2020">
348 <option value=
"2021">
350 <option value=
"2022">
352 <option value=
"2023">
354 <option value=
"2024">
356 <option value=
"2025">
358 <option value=
"2026">
360 <option value=
"2027">
362 <option value=
"2028">
364 <option value=
"2029">
366 <option value=
"2030">
368 <option value=
"2031">
370 <option value=
"2032">
372 <option value=
"2033">
374 <option value=
"2034">
376 <option value=
"2035">
378 <option value=
"2036">
380 <option value=
"2037">
382 <option value=
"2038">
384 <option value=
"2039">
386 <option value=
"2040">
388 <option value=
"2041">
390 <option value=
"2042">
392 <option value=
"2043">
394 <option value=
"2044">
396 <option value=
"2045">
398 <option value=
"2046">
400 <option value=
"2047">
402 <option value=
"2048">
404 <option value=
"2049">
406 <option value=
"2050">
408 <option value=
"2051">
410 <option value=
"2052">
412 <option value=
"2053">
414 <option value=
"2054">
416 <option value=
"2055">
418 <option value=
"2056">
420 <option value=
"2057">
422 <option value=
"2058">
424 <option value=
"2059">
426 <option value=
"2060">
428 <option value=
"2061">
430 <option value=
"2062">
436 <div id=
"savedPayMethList">
438 <div id=
"payment_id_kcmcard_id_div">
439 <label for=
"payment_id_kcmNPcrdId_Txt">
440 Credit Card ID
</label>
443 <input type=
"tel" id=
"payment_id_kcmNPcrdId_Txt" name=
"creditCardID" maxlength=
"4" value=
"">
446 <div onclick=
"skApp.loadWhatsMyCreditCard();">
447 What's my Credit Card ID?
</div>