|
Server : Apache/2.4.62 System : FreeBSD fbsdweb2.web.rcn.net 14.1-RELEASE FreeBSD 14.1-RELEASE releng/14.1-n267679-10e31f0946d8 GENERIC amd64 User : www ( 80) PHP Version : 8.3.8 Disable Function : NONE Directory : /domains/highlandlabs/cqi-bin/ALFA_DATA/alfasymlink/root/domains/familyplayhouse2/ |
Upload File : |
<html> <head> <meta http-equiv="content-type" content="text/html;charset=iso-8859-1"> <title>"Order Form"</title> <meta name="generator" content="Order Form"> </head> <body text="#0033ff" link="#990033" background="BkgndY.jpg"> <table cool width="785" height="301" border="0" cellpadding="0" cellspacing="0" gridx="16" showgridx usegridx gridy="16" showgridy usegridy> <tr height="1" cntrlrow> <td width="1" height="1"></td> <td width="16" height="1"><spacer type="block" width="16" height="1"></td> <td width="161" height="1"><spacer type="block" width="161" height="1"></td> <td width="95" height="1"><spacer type="block" width="95" height="1"></td> <td width="32" height="1"><spacer type="block" width="32" height="1"></td> <td width="160" height="1"><spacer type="block" width="160" height="1"></td> <td width="192" height="1"><spacer type="block" width="192" height="1"></td> <td width="32" height="1"><spacer type="block" width="32" height="1"></td> <td width="96" height="1"><spacer type="block" width="96" height="1"></td> </tr> <tr height="48"> <td width="1" height="48"><spacer type="block" width="1" height="48"></td> <td width="16" height="48"></td> <td width="161" height="48"></td> <td width="479" height="48" colspan="4" rowspan="1" valign="top" align="left" xpos="177"> <table border="4" cellpadding="0" cellspacing="2" width="400"> <tr> <td> <center> <font size="4"><b>Payment form for Summer Camp 2000</b></font></center> </td> </tr> </table> </td> <td width="32" height="48"></td> <td width="96" height="48"></td> </tr> <tr height="80"> <td width="1" height="80"><spacer type="block" width="1" height="80"></td> <td width="16" height="80"></td> <td width="672" height="80" colspan="6" rowspan="1" valign="top" align="left" xpos="16" content csheight="64">We accept the following payment methods: Credit Cards (MasterCard, Visa or American Express) or personal check/money order. <p>When you place an order via mail or email, please state clearly the name and quantity of the item(s) and provide your name, shipping/billing address, phone and email address.</td> <td width="96" height="80"></td> </tr> <tr height="112"> <td width="1" height="112"><spacer type="block" width="1" height="112"></td> <td width="16" height="112"></td> <td width="256" height="112" colspan="2" rowspan="1" valign="top" align="left" xpos="16" content csheight="43">You may order by telephone (610) 965-7992, fax (610) 966-6007, email or by mailing a check to:</td> <td width="32" height="112"></td> <td width="160" height="112" colspan="1" rowspan="1" valign="top" align="left" xpos="304" content csheight="91">Family Playhouse <p>2773 Evergreen Circle</p> <p>Emmaus, PA 18049-1206</td> <td width="192" height="112"></td> <td width="32" height="112"></td> <td width="96" height="112"></td> </tr> <tr height="16"> <td width="1" height="16"><spacer type="block" width="1" height="16"></td> <td width="16" height="16"></td> <td width="448" height="60" colspan="4" rowspan="2" valign="top" align="left" xpos="16" content csheight="32">If you wish to order with credit card via secure transaction please click the button to initiate the process.</td> <td width="192" height="16"></td> <td width="32" height="16"></td> <td width="96" height="16"></td> </tr> <tr height="44"> <td width="1" height="44"><spacer type="block" width="1" height="44"></td> <td width="16" height="44"></td> <td width="192" height="44"></td> <td width="128" height="44" colspan="2" rowspan="1" valign="top" align="left" xpos="656"><csobj w="36" h="19" t="ActionBox" name> <script><!-- CSAction(new Array(/*CMP*/ '')); // --></script> </csobj></td> </tr> </table> <form name="x_Amount" method="post" action="https://secure.authorize.net/gateway/transact.dll"> <input type="hidden" value="3.0" name="x_Version"></td><input type="hidden" value="playhouse" name="x_Login"></td><input type="hidden" value="PAYMENT_FORM" name="x_Show_Form"><select name="x_Description" size="1"> <option value="Summer Camp">Summer Camp 2000 </select></td><input type="text" value="260.00" size="12" name="x_Amount"><input type="hidden" value="amount goes here" name="x_Amount"></td><input type="hidden" value="19255" name="CUST_ID"></td><input type="hidden" value="587" name="x_Invoice_Num"></td><input type="submit" value="click here for secure payment form" </td> </form> </body> </html> </form> </body> </html> </form> </body> </html>> </form> <table cool width="781" height="201" border="0" cellpadding="0" cellspacing="0" gridx="16" showgridx usegridx gridy="16" showgridy usegridy> <tr height="1" cntrlrow> <td width="1" height="1"></td> <td width="336" height="1"><spacer type="block" width="336" height="1"></td> <td width="16" height="1"><spacer type="block" width="16" height="1"></td> <td width="80" height="1"><spacer type="block" width="80" height="1"></td> <td width="348" height="1"><spacer type="block" width="348" height="1"></td> </tr> <tr height="16"> <td width="1" height="16"><spacer type="block" width="1" height="16"></td> <td width="336" height="16"></td> <td width="16" height="16"></td> <td width="80" height="16"></td> <td width="348" height="16"></td> </tr> <tr height="32"> <td width="1" height="32"><spacer type="block" width="1" height="32"></td> <td width="336" height="32"></td> <td width="96" height="32" colspan="2" rowspan="1" valign="top" align="left" xpos="336" content csheight="32"> <center> <a href="index.html">Home</a></center> </td> <td width="348" height="32"></td> </tr> <tr height="152"> <td width="1" height="152"><spacer type="block" width="1" height="152"></td> <td width="336" height="152"></td> <td width="16" height="152"></td> <td width="80" height="152" colspan="1" rowspan="1" valign="top" align="left" xpos="352"><img height="103" width="40" src="AngelUp.gif"></td> <td width="348" height="152"></td> </tr> </table> </body> </html>