for(x=0; x < thisform.amount.length; x++) {
if(thisform.amount[x].checked == true) {
amtsel = true;
if(thisform.amount[x].value == “custom”) {
if(isNaN(thisform.customamount.value) || thisform.customamount.value == “” || thisform.customamount.value == null)
error = error + “Invalid dollar amount.\n”;
else
thisform.transaction_amount.value = roundNumber(thisform.customamount.value, 2);
} else {
thisform.transaction_amount.value = thisform.amount[x].value;
}
}
}

if(!amtsel)
error = error + “Please choose an amount.\n”;

if(error != “”) {
alert(error);
return false;
} else {
subbut.disabled = true;
thisform.client_reference_number.value = thisform.name.value + ” “ + thisform.address.value + ” “ + thisform.city.value + ” “ + thisform.state.value + ” “ + thisform.phone.value;
thisform.invoice_number.value = thisform.customer_email.value; return true;
}
}

function roundNumber(num, dec) {
var result = Math.round(num*Math.pow(10,dec))/Math.pow(10,dec);
return result;
}
</script>

<form method=“POST” action=“https://www.merchante-solutions.com/jsp/tpg/secure_checkout.jsp” onsubmit=“return doSubmit(this)“ name=“theForm”>
<input type=“hidden” name=“profile_id” value=“9410000xxxxx000000xx”>
<input type=“hidden” name=“transaction_amount” value=“” size=“8”>
<input type=“hidden” name=“css_url” value=“http://www.domain.com/default.css”>
<input type=“hidden” name=“cancel_url” value=“http://www.domain.com/cancel.html”>
<input type=“hidden” name=“return_url” value=“http://www.domain.com/checkout.html”>
<input type=“hidden” name=“logo_url” value=“http://www.domain.com/example.png”>
<input type=“hidden” name=“invoice_number” value=“”>
<input type=“hidden” name=“client_reference_number” value=“”>
<input type=“hidden” name=“merchant_email” value=“merchant@address.com”>

<div>Billing Information</div>

<table border=“0”>
<tr>
<td><span>*</span> Name:</td>
<td><input type=“text” name=“name” size=“30” maxlength=“40”></td>
</tr>
<tr>
<td><span>*</span> Address:</td>
<td><input type=“text” name=“address” size=“30” maxlength=“40”></td>
</tr>
<tr>
<td><span>*</span> City:</td>
<td><input type=“text” name=“city” size=“30” maxlength=“40”></td>
</tr>
<tr>
<td><span>*</span> State:</td>
<td>
<select name=“state”><option value=“” selected=“selected”>Select a State</option>
<option value=“AL”>Alabama</option><option value=“AK”>Alaska</option>
<option value=“AZ”>Arizona</option><option value=“AR”>Arkansas</option>
<option value=“CA”>California</option><option value=“CO”>Colorado</option>
<option value=“CT”>Connecticut</option><option value=“DE”>Delaware</option>
<option value=“DC”>District Of Columbia</option><option value=“FL”>Florida</option>
<option value=“GA”>Georgia</option><option value=“HI”>Hawaii</option>
<option value=“ID”>Idaho</option><option value=“IL”>Illinois</option>
<option value=“IN”>Indiana</option><option value=“IA”>Iowa</option>
<option value=“KS”>Kansas</option><option value=“KY”>Kentucky</option>
<option value=“LA”>Louisiana</option><option value=“ME”>Maine</option>
<option value=“MD”>Maryland</option><option value=“MA”>Massachusetts</option>
<option value=“MI”>Michigan</option><option value=“MN”>Minnesota</option>
<option value=“MS”>Mississippi</option><option value=“MO”>Missouri</option>
<option value=“MT”>Montana</option><option value=“NE”>Nebraska</option>
<option value=“NV”>Nevada</option><option value=“NH”>New Hampshire</option>
<option value=“NJ”>New Jersey</option><option value=“NM”>New Mexico</option>
<option value=“NY”>New York</option><option value=“NC”>North Carolina</option>
<option value=“ND”>North Dakota</option><option value=“OH”>Ohio</option>
<option value=“OK”>Oklahoma</option><option value=“OR”>Oregon</option>
<option value=“PA”>Pennsylvania</option><option value=“RI”>Rhode Island</option>
<option value=“SC”>South Carolina</option><option value=“SD”>South Dakota</option>
<option value=“TN”>Tennessee</option><option value=“TX”>Texas</option>
<option value=“UT”>Utah</option><option value=“VT”>Vermont</option>
<option value=“VA”>Virginia</option><option value=“WA”>Washington</option>
<option value=“WV”>West Virginia</option><option value=“WI”>Wisconsin</option>
<option value=“WY”>Wyoming</option></select>
</td>
</tr>
<tr>
<td><span class=“req”>*</span> Zip Code:</td>
<td><input type=“text” name=“zip” size=“5” maxlength=“5”></td>
</tr>
<tr>
<td><span class=“req”>*</span> Email Address:</td>
<td><input type=“text” name=“customer_email” size=“30” maxlength=“40”></td>
</tr>
<tr>
<td><span>*</span> Phone Number:</td>
<td><input type=“text” name=“phone” size=“30” maxlength=“14”></td>
</tr>
</table>

<div>Gift Information</div>

<table border=“0”>
<tr>
<td><span>*</span>Select Gift Amount:</td>
<td><input type=“radio” name=“amount” value=“20.00”>$20.00</td>
</tr>
<tr>
<td></td>
<td><input type=“radio” name=“amount” value=“35.00”>$35.00</td>
</tr>
<tr>
<td></td>
<td><input type=“radio” name=“amount” value=“50.00”>$50.00</td>
</tr>
<tr>
<td></td>
<td><input type=“radio” name=“amount” value=“100.00”>$100.00</td>
</tr>
<tr>
<td></td>
<td><input type=“radio” name=“amount” value=“500.00”>$500.00</td>
</tr>
<tr>
<td></td>
<td><input type=“radio” name=“amount” value=“custom”>$ <input type=“text” name=“customamount”></td>
</tr>
<tr>
<td></td>
<td><input type=“submit” class=“formFields” value=“Continue” name=“subbut”></td>
</tr>
<tr colspan=“2”>
<td><span>*</span> Required Fields</td>
</tr>
</table>

</form>