This is an example of an "order entry" or payment web page. It includes a form that drives the OMARS payment service. You can use this HTML code as the basis of your own payment page. Change all of the places marked with XXX to insert the appropriate data or wording for your store. You can delete the parts marked "optional" if your store does not use them, and you can always rearrange the page and the inputs inside the form. XXX Title of your page

XXX Title Again

XXX Enter a Credit-Card Payment for Bribes and Late Fees

XXX Include some brief instructions here, e.g. "you must enter values in the fields labelled in red". Also include a link to your privacy policy page.
Description of Order:

* Order Classified As:

XXX Order Comments Value:

Customer Name as it appears on credit card:
Name:
Company: (Optional)

Billing Address (where credit card statement is mailed)
Street1:
Street2:
Street3:
City: State: Zip:
Country:
Customer Phone: FAX:
Customer Email:
Payment Information:
* Card number: (XXX Name types of card you accept here, e.g. Amex, Visa)
CVM digits: (Security code from back of card, see instructions.)
* Expires: /
* Subtotal: $
Tax: $
Shipping: $

Line-by-Line Instructions:

Order Classified As: You must choose the category of this order from the list. Consult your store administrator about which category to select. XXX or include an explanation here, or in the form.

CVM digits: "CVM" stands for Card Verification Methods, which use a security code of 3 or 4 extra digits imprinted on the card, but not embedded or encrypted in the magnetic stripe. A customer who supplies this number is much more likely to be in possession of the credit card. CVM is most effective method for reducing fraud from non-USA customers. The CVM code is a 3-digit number located on the signature strip on the back of Visa and MasterCard cards, after the cardnumber. It is on the front of American Express cards, and it is 4 digits long.

Subtotal: The total cost of all goods ordered, excluding shipping and tax, since those are entered on their own lines. Enter the value in decimal dollars, e.g. 4.59.

XXX If you don't use separate line items for tax or shipping, then this is actually the total amount to charge.

Tax: Line item for the total sales tax on the order. If left blank the tax amount will be zero; it is not computed automatically.

Shipping: Line item for the total shipping cost for the order. If left blank the shipping amount will be zero; it is not computed automatically.

Please direct comments or questions to <XXX@XXX.XXX>.