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><!--*******************************-->