139 lines
5.7 KiB
Plaintext
139 lines
5.7 KiB
Plaintext
<html>
|
|
|
|
<head>
|
|
<meta name="GENERATOR" content="Microsoft FrontPage 3.0">
|
|
<base face="Arial">
|
|
<title>Secure Order Form</title>
|
|
</head>
|
|
|
|
<body bgcolor="#FFFFFF" link="#0000FF" vlink="#800000">
|
|
<div align="left">
|
|
|
|
<table border="0" cellpadding="0" cellspacing="0">
|
|
<tr>
|
|
<td width="125"><font color="#FF0000"><big>Aawsom<br>
|
|
Technologies</big></font></td>
|
|
<td width="5"></td>
|
|
<td><h1><font color="#FF0000">Secure Order Form</font></h1>
|
|
</td>
|
|
</tr>
|
|
<tr>
|
|
<td width="125"></td>
|
|
<td width="5" bgcolor="#FFFFFF"></td>
|
|
<td bgcolor="#FFFFFF" align="left"><font face="Arial"><table border="5">
|
|
<tr>
|
|
<td>
|
|
<!-- Start Insert Here -->
|
|
<form action="https://Secure2.Aawsom.net/forms/FormProcessor.asp" method="POST" name="Comment_Form">
|
|
<input type="hidden" name="MailTo" value="CustomerService@YourWebsite.com">
|
|
<input type="hidden" name="MailFromDefault" value="NoEmail@YourWebsite.com">
|
|
<input type="hidden" name="MailFromField" value="Email">
|
|
<input type="hidden" name="MailSubject" value="Contact">
|
|
<input type="hidden" name="MailRedirect" value="www.YourWebsite.com/thanks.htm">
|
|
<%' <input type="hidden" name="MailRedirectSecure" value="Secure2.Aawsom.net/VirtualXXX/YourUsername/secure/thanks.htm">%>
|
|
<input type="hidden" name="Time" value="<%=Now()%>">
|
|
<input type="hidden" name="Browser" value="<%=Request.ServerVariables("HTTP_User_Agent")%>">
|
|
<!-- End Insert Here -->
|
|
<hr width="60%" color="#FF0000">
|
|
<p>Please provide the following ordering information:</p>
|
|
<table>
|
|
<tr>
|
|
<td><strong>QTY</strong></td>
|
|
<td><strong>DESCRIPTION</strong></td>
|
|
</tr>
|
|
<tr>
|
|
<td><input TYPE="TEXT" NAME="Order_Qty0" SIZE="6" MAXLENGTH="6"></td>
|
|
<td><input TYPE="TEXT" NAME="Order_Dsc0" SIZE="45"></td>
|
|
</tr>
|
|
<tr>
|
|
<td><input TYPE="TEXT" NAME="Order_Qty1" SIZE="6" MAXLENGTH="6"></td>
|
|
<td><input TYPE="TEXT" NAME="Order_Dsc1" SIZE="45"></td>
|
|
</tr>
|
|
<tr>
|
|
<td><input TYPE="TEXT" NAME="Order_Qty2" SIZE="6" MAXLENGTH="6"></td>
|
|
<td><input TYPE="TEXT" NAME="Order_Dsc2" SIZE="45"></td>
|
|
</tr>
|
|
<tr>
|
|
<td><input TYPE="TEXT" NAME="Order_Qty3" SIZE="6" MAXLENGTH="6"></td>
|
|
<td><input TYPE="TEXT" NAME="Order_Dsc3" SIZE="45"></td>
|
|
</tr>
|
|
<tr>
|
|
<td><input TYPE="TEXT" NAME="Order_Qty4" SIZE="6" MAXLENGTH="6"></td>
|
|
<td><input TYPE="TEXT" NAME="Order_Dsc4" SIZE="45"></td>
|
|
</tr>
|
|
<tr>
|
|
<td><strong>BILLING</strong></td>
|
|
<td></td>
|
|
</tr>
|
|
<tr>
|
|
<td><em>Credit card</em></td>
|
|
<td><select NAME="Card__Type" size="1">
|
|
<option SELECTED>VISA </option>
|
|
<option>MasterCard </option>
|
|
<option>American Express </option>
|
|
<option>Diner's Club </option>
|
|
<option>Discover </option>
|
|
</select> </td>
|
|
</tr>
|
|
<tr>
|
|
<td ALIGN="right"><em>Cardholder name</em></td>
|
|
<td><input TYPE="TEXT" NAME="Card_Name" SIZE="35"> </td>
|
|
</tr>
|
|
<tr>
|
|
<td ALIGN="right"><em>Card number</em></td>
|
|
<td><input TYPE="TEXT" NAME="Card_Nmbr" SIZE="35"> </td>
|
|
</tr>
|
|
<tr>
|
|
<td ALIGN="right"><em>Expiration date</em></td>
|
|
<td><input TYPE="TEXT" NAME="Card__Exp" SIZE="5" MAXLENGTH="5"> </td>
|
|
</tr>
|
|
<tr>
|
|
<td><strong>SHIPPING</strong></td>
|
|
<td></td>
|
|
</tr>
|
|
<tr>
|
|
<td ALIGN="right"><em>Street address</em></td>
|
|
<td><input TYPE="TEXT" NAME="Addrs_Str1" SIZE="35"> </td>
|
|
</tr>
|
|
<tr>
|
|
<td ALIGN="right"><em>Address (cont.)</em></td>
|
|
<td><input TYPE="TEXT" NAME="Addrs_Str2" SIZE="35"> </td>
|
|
</tr>
|
|
<tr>
|
|
<td ALIGN="right"><em>City</em></td>
|
|
<td><input TYPE="TEXT" NAME="Addrs_City" SIZE="35"> </td>
|
|
</tr>
|
|
<tr>
|
|
<td ALIGN="right"><em>State/Province</em></td>
|
|
<td><input TYPE="TEXT" NAME="Addrs_Stat" SIZE="35"> </td>
|
|
</tr>
|
|
<tr>
|
|
<td ALIGN="right"><em>Zip/Postal code</em></td>
|
|
<td><input TYPE="TEXT" NAME="Addrs__Zip" SIZE="12" MAXLENGTH="12"> </td>
|
|
</tr>
|
|
<tr>
|
|
<td ALIGN="right"><em>Country</em></td>
|
|
<td><input TYPE="TEXT" NAME="Addrs_Ctry" SIZE="25"> </td>
|
|
</tr>
|
|
<tr>
|
|
<td ALIGN="right"><em>Email Address</em></td>
|
|
<td><input TYPE="TEXT" NAME="Email" SIZE="25"> </td>
|
|
</tr>
|
|
</table>
|
|
<div align="center"><center><p><input TYPE="submit" VALUE="Submit Form"> </p>
|
|
</center></div><hr width="60%" color="#FF0000">
|
|
<div align="center"><center><p><font><small>Designed by: <a href="http://www.Aawsom.net/sitedesign">Aawsom Technologies</a></small></font><br>
|
|
<font color="#000000" face="Arial" size="1">Revised: <!--webbot bot="Timestamp" S-Type="EDITED" S-Format="%m/%d/%y %I:%M %p" startspan -->09/10/98 01:52 PM<!--webbot bot="Timestamp" endspan i-checksum="29431" --></font></p>
|
|
</center></div><div align="center"><center><p></font> </p>
|
|
</center></div>
|
|
</form>
|
|
</td>
|
|
</tr>
|
|
</table>
|
|
</td>
|
|
</tr>
|
|
</table>
|
|
</div>
|
|
</body>
|
|
</html>
|