网上付费表格小窥

笑语UID: 145040

发信人: torlim (饺子--新战役打响), 信区: GoAbroad
标  题: 网上付费表格小窥
发信站: 日月光华站 (Tue Oct 30 14:58:57 2001) , 站内信件

Application Fee Credit Card Payment Form
Enter your credit card information below and select "Authorize" to pay the a
pplication fee of $40.00 via a secure server. You will receive the results o
f your transaction as it occurs.
Please DO NOT click the authorize button twice. Please DO NOT hit the back b
utton.
It may take up to TWO MINUTES for your card to be processed. Please be patie
nt after clicking the authorize button.
If the cardholder is not in the United States, the address should be left bl
ank.
Credit Card Number:
(no spaces between numbers)
Example: 1234567890123456

Card Type:

Credit Card Type
VISA  MASTERCARD DISCOVER

Expiration Date (MM/YY):
Example: 12/01

Name As Displayed On Card:
Address:

City:

State:

Example: CA

Zip:
Example:91359-6698