{assign var=title value="Payment Confirmation"} {include file="header.html"}


{foreach from=$vars key=k item=v} {/foreach}
Please provide the following credit card information.
Name On Credit Card:
CC Statement Address:
Your City:
State:  Zip:
Card Type: Visa Master Card
Credit Card#:
Expiration Date (mmyy):
This is real time authorization... the bank processor is being contacted for authorization.
This process may take 10-40 seconds depending on internet traffic.

This form will be submitted to secure server.
{include file="footer.html"}