Secure Payment Form

[MM_Form type=’checkout’] [MM_Form_Message type=’error’]

[MM_Form_Data name=’productDescription’]

[MM_Form_Section type=’accountInfo’]

Your Information

[MM_Form_Field name=’phone’ type=’hidden’]

[MM_Form_Field name=’billingCountry’]

[MM_Form_Field type=’input’ name=’firstName’]

[MM_Form_Field type=’input’ name=’lastName’]

[MM_Form_Field type=’input’ name=’email’]

[MM_Form_Field type=’input’ name=’password’]

[/MM_Form_Section] [MM_Form_Section type=’billingInfo’]

Payment

Fill in your credit or debit card details, or use PayPal.

[MM_Form_Field name=’billingAddress’ type=’hidden’] [MM_Form_Field name=’billingCity’ type=’hidden’] [MM_Form_Field name=’billingState’ type=’hidden’] [MM_Form_Field name=’billingZipCode’ type=’hidden’]

[MM_Form_Field name=’ccNumber’]

[MM_Form_Field name=’ccSecurityCode’]

[MM_Form_Field name=’ccExpirationDate’]

Click the “Check out with PayPal” button below to sign into your PayPal account and pay through their secure website.

Check out with PayPal

[/MM_Form_Section]
[MM_Form_Section type=’shippingInfo’] [MM_Form_Field name=’shippingMethod’ type=’hidden’] [MM_Form_Field name=’shippingSameAsBilling’] [MM_Form_Subsection type=’shippingAddress’] [MM_Form_Field name=’shippingAddress’ type=’hidden’] [MM_Form_Field name=’shippingCity’ type=’hidden’] [MM_Form_Field name=’shippingState’ type=’hidden’] [MM_Form_Field name=’shippingZipCode’ type=’hidden’] [MM_Form_Field name=’shippingCountry’ type=’hidden’] [/MM_Form_Subsection] [/MM_Form_Section] [MM_Form_Section type=’coupon’] [MM_Form_Field name=’couponCode’] [/MM_Form_Section]
 Official PayPal Seal 
[/MM_Form]