Below is the HTML source for this page. The merchant simply provides all
the required information in hidden variables and the Paysafe server handles the rest.
Fill out the demo form above and press the pre-submit button.
<FORM METHOD="post" ACTION="https://www.paysafe.com/cgi-bin/paysafe.cgi">
<INPUT NAME="PAYSAFE_ACTION"
TYPE="HIDDEN" VALUE="GET_INVOICE_FORM">
<INPUT NAME="PAYSAFE_MERCHANT_ID"
TYPE="HIDDEN" VALUE="1010">
<INPUT NAME="PAYSAFE_MERCHANT_TAXRATE"
TYPE="HIDDEN" VALUE="8.25">
<INPUT NAME="PAYSAFE_MERCHANT_STATE"
TYPE="HIDDEN" VALUE="CA">
<INPUT NAME="PAYSAFE_MERCHANT_CARDS"
TYPE="HIDDEN" VALUE="MS,VS,AE">
<INPUT NAME="PAYSAFE_FORM_TITLE" TYPE="HIDDEN" VALUE="Paysafe Invoice Demo">
<INPUT TYPE="HIDDEN" NAME="PAYSAFE_FORM_TITLE"
VALUE="Paysafe Secure Data Services Payment Form">
<INPUT TYPE="HIDDEN" NAME="PAYSAFE_CARD_NAME"
VALUE="Bill Clinton">
<INPUT TYPE="HIDDEN" NAME="PAYSAFE_CARD_ADDR"
VALUE="1600 Pennsylvania Avenue">
<INPUT TYPE="HIDDEN" NAME="PAYSAFE_CARD_CITY"
VALUE="Washington">
<INPUT TYPE="HIDDEN" NAME="PAYSAFE_CARD_STATE"
VALUE="DC">
<INPUT TYPE="HIDDEN" NAME="PAYSAFE_CARD_ZIP"
VALUE="20500">
<INPUT TYPE="HIDDEN" NAME="PAYSAFE_CARD_COUNTRY"
VALUE="USA">
<INPUT TYPE="HIDDEN" NAME="PAYSAFE_CARD_TEL"
VALUE="(202) 456-1414">
<INPUT TYPE="HIDDEN" NAME="PAYSAFE_CARD_FAX"
VALUE="(202) 456-2883">
<INPUT TYPE="HIDDEN" NAME="PAYSAFE_CARD_EMAIL"
VALUE="president@whitehouse.gov">
<TABLE border=4 cellpadding=5>
<tr>
<th>Album</th>
<th>Item No.</th>
<th>Description</th>
<th>Retail Price</th>
<th>Order Qty.</th>
<th>Category</th>
</tr>
<tr>
<td>The Child Within</td>
<td>PM 1001-2</td>
<td>CD - World Music Contemporary</td>
<td> $12.98</td>
<INPUT NAME="item1p" TYPE="HIDDEN"
VALUE="12.98">
<td><INPUT NAME="item1q"
TYPE="TEXT" ROWS=1 SIZE=3></td>
<INPUT NAME="item1d" TYPE="HIDDEN"
VALUE="PM 1001-2">
<td>World Contemporary</td>
</tr>
<tr>
<td>The Child Within</td>
<td>PM 1001-4</td>
<td>TP - World Music Contemporary</td>
<td> $9.98</td>
<INPUT NAME="item2p" TYPE="HIDDEN"
VALUE="9.98">
<td><INPUT NAME="item2q"
TYPE="TEXT" ROWS=1 SIZE=3></td>
<INPUT NAME="item2d" TYPE="HIDDEN"
VALUE="PM 1001-4">
<td>World Contemporary</td>
</tr>
<tr>
<td>Sound Mind</td>
<td>DI - 001-2</td>
<td>CD - Contemporary Jazz</td>
<td>$12.98</td>
<INPUT NAME="item3p" TYPE="HIDDEN"
VALUE="12.98">
<td><INPUT NAME="item3q"
TYPE="TEXT" ROWS=1 SIZE=3></td>
<INPUT NAME="item3d" TYPE="HIDDEN"
VALUE="DI - 001-2">
<td>Contemporary Jazz</td>
</tr>
</table>
<CENTER><INPUT TYPE="SUBMIT"
value="Pre-submit Order">
<INPUT TYPE="RESET" VALUE="Reset
Order">