"); list($firstname,$lastname,$address1,$address2,$city,$state,$zip,$country,$ccnum,$security_num,$ccexp,$cardtype) = mysql_fetch_row($result); $sql3 = "SELECT email,phone FROM store_users WHERE(uid = '$uid')"; $result3 = mysql_query($sql3) or die("Error: ".mysql_error()."
"); list($email,$telephone) = mysql_fetch_row($result3); } ?>

Billing Address
First Name
Last Name
Address Line 1
 
City
State
Zip Code
Country
Phone Number
E-mail Address

Payment Information
Credit Card Type:
Credit Card Number
Security number
Exp. Date (ex: 0104)

Shipping Options
Standard Shipping $
Express Shipping
Please provide shipping quote

 

Shipping Address
Shipping Address Same "); list($firstname,$lastname,$address1,$address2,$city,$state,$zip,$country,$ccnum,$ccexp,$cardtype) = mysql_fetch_row($result2); ?>
First Name
Last Name
Address Line 1
 
City
State
Zip Code
Country

Special Instructions or Gift Card Information