This example is to illustrate the credit card purchase.

Total Amount:
First Name:
Last Name:
Zip Code:
Card Holder Name:
Card Type:	-Select- American Express Discover MasterCard Visa
Card Number:
Expiration Date: (month/year)	-Select- 01 02 03 04 05 06 07 08 09 10 11 12 / -Select- 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010