<center><form action="https://www.paypal.com/cgi-bin/webscr" method="post" target="_top"> <input type="hidden" name="cmd" value="_s-xclick"> <input type="hidden" name="hosted_button_id" value="2BEVPQR86UJUW"> <table> <tr><td><input type="hidden" name="on0" value="Name">Name</td></tr><tr><td><input type="text" name="os0" maxlength="200"></td></tr> <tr><td><input type="hidden" name="on1" value="Company">Company</td></tr><tr><td><input type="text" name="os1" maxlength="200"></td></tr><tr><td><input type="hidden" name="on2" value="Address">Address</td></tr><tr><td><input type="text" name="os2" maxlength="200"></td></tr> <tr><td><input type="hidden" name="on3" value="Phone">Phone</td></tr><tr><td><input type="text" name="os3" maxlength="200"></td></tr> <tr><td><input type="hidden" name="on4" value="Email">Email</td></tr><tr><td><input type="text" name="os4" maxlength="200"></td></tr> </table> <input type="image" src="https://www.paypalobjects.com/en_US/i/btn/btn_buynowCC_LG.gif" border="0" name="submit" alt="PayPal - The safer, easier way to pay online!"> <img alt="" border="0" src="https://www.paypalobjects.com/en_US/i/scr/pixel.gif" width="1" height="1"> </form></center>