JavaScript Form Submit example 2

* Indicates Required Field
* First Name:   * Last Name:  
* Mailing Address:   * City:    
* U.S. State * Zip Code:  
Email Address:   Daytime Phone Number:  
Photo(s) Being Ordered:

-
Photo Print Sizes & Pricing Guide



* Photo Number:  - Where Do I Find My Photo Number?

Race Date(s):
- Race Date(s) Example

Track or Event Name: - Race Track / Event Name Example

Brief Description of the Photo: - Brief Description Example
More Photo(s) Being Ordered:

(Use Only If Ordering More Than Allowed In The Above Section)  (Otherwise, Simply Leave This Section Blank)

- Photo Print Sizes & Pricing Guide



Photo Number: - Where Do I Find My Photo Number?

Race Date(s):
- Race Date(s) Example

Track or Event Name: - Race Track / Event Name Example

Brief Description of the Photo: - Brief Description Example
More Photo(s) Being Ordered:

(Use Only If Ordering More Than Allowed In The Above Section)  (Otherwise, Simply Leave This Section Blank)

- Photo Print Sizes & Pricing Guide



Photo Number: - Where Do I Find My Photo Number?

Race Date(s):
- Race Date(s) Example

Track or Event Name: - Race Track / Event Name Example

Brief Description of the Photo: - Brief Description Example
* Name On Credit Card:
Exactly As It Appears
 
* Credit Card Number:        
* Card Exp. Date:
Ex. 07 / 2013
   
* CVV Security Code:
3 Digits on the Back
 
* Billing ZIP Code Verification:
The Billing Address ZIP Code Associated With Your Card
 
YOU MUST ADD IN THE SHIPPING & HANDLING FEE ALONG WITH YOUR ORDER TOTAL

If you do not, we will by default...
Photo Order Total: Add This Amount for Shipping & Handling Fee
If Your Photo Order falls on or Between: $40- $99 add $8.00
If Your Photo Order falls on or Between: $100 - $199 add $12.00


- How Do I Obtain My Order Total?
* Order Total:
Total Charge Placed (including Shipping & Handling)
 
- By Submitting This Form, You Agree To These Terms and Conditions
- Please Note: If you see a screen after you click "Submit" showing an error or page cannot be displayed, simply click your browser back button and resubmit the online form until you see the "Conformation Page".
Your card will not be processed or charged until you see the "Confirmation Page". Thank you!