{javascript}

www.netbilling.com

Credit Card Number
Expiration Date / MMYY
Card Security Number What is this?

You will be billed as Netbilling Services.
Your IP address of {REMOTE_ADDR} will be recorded.
All fradulent transactions will be investigated and prosecuted in accordance with applicable law.
I agree to the Terms and Conditions

TERMS
>> You are purchasing a {DAYS} day
trial for ${PRICE}
>> You will be billed ${PRICE2}
every {RECUR_DAYS} days.
>> Your subscription will
automatically be renewed for
your convenience until you
cancel.

-- Cancellation info goes here --

{POST_DATA}