<!DOCTYPE html>
<html lang=”en-us”>
<head>
<meta charset=”UTF-8″>
<meta name=”robots” content=”noindex”>
<title>Island Seas Investments</title>
<style media=”screen”>
body {
font-family: ‘Verdana’,’Arial’,’Helvetica’, sans-serif;
color: #000000;
background-color: #D4D7E4;
}
table {
border: none;
border-spacing: 0px;
}
a,
a:visited,
a:active {
color: #000080;
}
</style>
<script>
<!–
var submitted = false;
function submitform()
{
if(submitted) {
return false;
}
submitted=true;
document.epayform.submitbutton.value=’Please Wait… Processing’;
return true;
}
// –>
</script>
</head>
<body>
<form name=”epayform” action=”[UMformURL]” method=”POST” onSubmit=”return submitform()”>
<input type=”hidden” name=”UMsubmit” value=”1″>
<input type=”hidden” name=”UMkey” value=”[UMkey]”>
<input type=”hidden” name=”UMredirDeclined” value=”[UMredirDeclined]”>
<input type=”hidden” name=”UMredirApproved” value=”[UMredirApproved]”>
<input type=”hidden” name=”UMhash” value=”[UMhash]”>
<input type=”hidden” name=”UMmd5hash” value=”[UMmd5hash]”>
<input type=”hidden” name=”UMmd5key” value=”[UMmd5key]”>
<input type=”hidden” name=”UMcommand” value=”[UMcommand]”>
<input type=”hidden” name=”UMamount” value=”[UMamount]”>
<input type=”hidden” name=”UMtax” value=”[UMtax]”>
<input type=”hidden” name=”UMinvoice” value=”[UMinvoice]”>
<input type=”hidden” name=”UMcustid” value=”[UMcustid]”>
<input type=”hidden” name=”UMrecurring” value=”[UMrecurring]”>
<input type=”hidden” name=”UMaddcustomer” value=”[UMaddcustomer]”>
<input type=”hidden” name=”UMbillamount” value=”[UMbillamount]”>
<input type=”hidden” name=”UMcustreceipt” value=”[UMcustreceipt]”>
<input type=”hidden” name=”UMschedule” value=”[UMschedule]”>
<input type=”hidden” name=”UMnumleft” value=”[UMnumleft]”>
<input type=”hidden” name=”UMstart” value=”[UMstart]”>
<input type=”hidden” name=”UMexpire” value=”[UMexpire]”>
<input type=”hidden” name=”UMdescription” value=”[UMdescription]”>
<input type=”hidden” name=”UMechofields” value=”[UMechofields]”>
<input type=”hidden” name=”UMformString” value=”[UMformString]”>
[UMlineitems]
[UMcustomfields]
<div>
<table style=”width:700px; margin: 0 auto; font-size:12px;” cellpadding=”4″>
<tr>
<td style=”background-color:#9999FF;” colspan=”2″>
<b>
<span style=”color: #FFFFFF; font-size: 2rem;”>Island Seas Investments</span>
<span style=”color: #FFFFFF; font-size: 1.15rem”><br>
Secure Payment Form</span></b></td>
</tr>
<tr>
<td style=”background-color:#C4C7D4;” colspan=”2″>
<p style=”text-align:center;”>
<img alt=”visa card” src=”/images/visa.gif” width=”44″ height=”28″ style=”margin:0 3px”> <img alt=”master card” src=”/images/mastercard.gif” width=”44″ height=”28″ style=”margin:0 3px”> <img alt=”american express” src=”/images/amex.gif” width=”44″ height=”28″ style=”margin:0 3px”> <img alt=”discover card” src=”/images/discover.gif” width=”44″ height=”28″ style=”margin:0 3px”> </td>
</tr>
<tr>
<td style=”background-color:#F0F0F0;” colspan=”2″> </td>
</tr>
<tr>
<td style=”background-color:#C4C7D4;” colspan=”2″>
<b><span>Payment Summary:</span></b></td>
</tr>
<tr>
<td bgcolor=”#F0F0F0″ width=”234″ align=”right”><font face=”Verdana” size=”2″>Payment Amount:
</font></td>
<td bgcolor=”#F0F0F0″ width=”450″>
<input type=”text” name=”UMamount” size=”25″ value=”[UMamount]”></td>
</tr>
<tr>
<td bgcolor=”#F0F0F0″ width=”234″ align=”right”><font size=”2″ face=”Verdana”>Description: </font></td>
<td bgcolor=”#F0F0F0″ width=”450″>Membership Fee Payment </td>
</tr>
<tr>
<td style=”background-color:#F0F0F0; width: 234px; text-align: right;”>
</td>
<td style=”background-color:#F0F0F0; width:450px;”> </td>
</tr>
[svp]
<tr>
<td
style="background-color:#C4C7D4;" colspan="2"><b><span>Secure
Vault Payment
Information:</span>
[hascreditcards] <input
type="submit" name="action" value="Pay By Credit
Card">[/hascreditcards]
[haschecks] <input
type="submit" name="action" value="Pay By
Check">[/haschecks]
</b></td>
</tr>
<tr>
<td
colspan="2">
<input
type="hidden" name="paybysvp" value="1">
</td>
</tr>
<tr><td
colspan=2>
Secure
Vault Payment allows you to pay directly using your online banking. Select your bank from the list below.
<a
href="http://securevaultpayments.org/">Learn More</a>
</td></tr>
<tr>
<td
style="background-color:#F0F0F0; width: 234px; text-align:
right;"><span style="font-size: .8rem;">Select your
bank:
</span></td>
<td
style="background-color:#F0F0F0; width:450px;"><select
name="UMsvpbank">[SVPbanklist]</select></td>
</tr>
[/svp]
[echeck]
<tr>
<td
style="background-color:#C4C7D4;"
colspan="2"><b><span>Checking Account
Information:</span>
[hascreditcards] <input
type="submit" name="action" value="Pay By Credit
Card">[/hascreditcards]
[hassvp] <input
type="submit" name="action" value="Pay By Secure Vault
Payment">[/hassvp]
</b></td>
</tr>
<tr>
<td
colspan="2">
<input
type="hidden" name="paybycheck" value="1">
</td>
</tr>
<tr><td
align=center colspan=2 style="background-color:#F0F0F0;"><img
src="/images/samplecheck.gif"
alt=""></td></tr>
<tr>
<td
style="background-color:#F0F0F0; width: 234px; text-align:
right;"><span style="font-size: .8rem;">Account Holder
Name:
</span></td>
<td
style="background-color:#F0F0F0; width:450px;">
<input
type="text" name="UMname" size="25"
value="[UMname]"></td>
</tr>
<tr>
<td
style="background-color:#F0F0F0; width: 234px; text-align:
right;"><span style="font-size: .8rem;">Bank Routing
Number:
</span></td>
<td
style="background-color:#F0F0F0; width:450px;">
<input
type="text" name="UMrouting" size="25"></td>
</tr>
<tr>
<td
style="background-color:#F0F0F0; width: 234px; text-align:
right;"><span style="font-size: .8rem;">Bank Account
Number:
</span></td>
<td
style="background-color:#F0F0F0; width:450px;">
<input
type="text" name="UMaccount"
size="25"></td>
</tr>
<tr>
<td
style="background-color:#F0F0F0; width: 234px; text-align:
right;"><span style="font-size: .8rem;">Social Security
Number:
</span></td>
<td
style="background-color:#F0F0F0; width:450px;">
<input
type="text" name="UMssn" size="11"></td>
</tr>
<tr>
<td
style="background-color:#F0F0F0; width: 234px; text-align:
right;"><span style="font-size: .8rem;">Drivers License
Number:
</span></td>
<td
style="background-color:#F0F0F0; width:450px;">
<input
type="text" name="UMdlnum"
size="15"></td>
</tr>
<tr>
<td
style="background-color:#F0F0F0; width: 234px; text-align:
right;"><span style="font-size: .8rem;">Drivers License
State:
</span></td>
<td
style="background-color:#F0F0F0; width:450px;">
<input
type="text" name="UMdlstate" style="font-size:
.8rem;"></td>
</tr>
[/echeck]
[creditcard]
<tr>
<td
style="background-color:#C4C7D4;"
colspan="2"><b><span>Credit Card
Information:</span>
[haschecks] <input
type="submit" name="action" value="Pay By
Check">[/haschecks]
[hassvp] <input
type="submit" name="action" value="Pay By Secure Vault
Payment">[/hassvp]
</b></td>
</tr>
<tr>
<td
colspan="2">
<input
type="hidden" name="paybycredit" value="1">
</td>
</tr>
<tr>
<td
style="background-color:#F0F0F0; width: 234px; text-align:
right;"><span style="font-size: .8rem;">Card
Type:</span></td>
<td
style="background-color:#F0F0F0; width:450px;">
<p><select
size="1" name="payment_type">
<option
value="Visa">Visa</option> <option
value="MasterCard">MasterCard</option> <option
value="American Express">American Express</option> <option
value="Discover">Discover</option> </select></p>
</td>
</tr>
<tr>
<td
style="background-color:#F0F0F0; width: 234px; text-align:
right;"><span style="font-size: .8rem;">Name as on
Card:
</span></td>
<td
style="background-color:#F0F0F0; width:450px;">
<input
type="text" name="UMname" size="25"
value="[UMname]"></td>
</tr>
<tr>
<td
style="background-color:#F0F0F0; width: 234px; text-align:
right;"><span style="font-size: .8rem;">Card Billing
Address:
</span></td>
<td
style="background-color:#F0F0F0; width:450px;">
<input
type="text" name="UMstreet" size="25"
value="[UMstreet]"></td>
</tr>
<tr>
<td
style="background-color:#F0F0F0; width: 234px; text-align:
right;"><span style="font-size: .8rem;">Card Billing
Zipcode:
</span></td>
<td
style="background-color:#F0F0F0; width:450px;">
<input
type="text" name="UMzip" size="10"
value="[UMzip]"></td>
</tr>
<tr>
<td
style="background-color:#F0F0F0; width: 234px; text-align:
right;"><span style="font-size: .8rem;">Card
Number:</span></td>
<td
style="background-color:#F0F0F0; width:450px;">
<input
type="text" name="UMcard"
size="17"></td>
</tr>
<tr>
<td
style="background-color:#F0F0F0; width: 234px; text-align:
right;"><span style="font-size: .8rem;">Card Expiration
Date:
</span></td>
<td
style="background-color:#F0F0F0; width:450px;">
<input
type="text" name="UMexpir" size="4">
MMYY</td>
</tr>
<tr>
<td
style="background-color:#F0F0F0; width: 234px; text-align:
right;"><span><span style="font-size: .8rem;">
Card
ID (CVV2/CID) Number:<br>
</span><span>[<a
target="_blank" href="/cvv.htm">What is the Card
ID?</a>]</span></span></td>
<td
style="background-color:#F0F0F0; width:450px;">
<input
type="text" name="UMcvv2" size="5"></td>
</tr>
<tr>
<td
style="background-color:#F0F0F0;"
colspan="2"> </td>
</tr>
[/creditcard]
<tr>
<td style=”background-color:#C4C7D4;” colspan=”2″><span><b>Billing Information:</b></span></td>
</tr>
<tr>
<td bgcolor=”#F0F0F0″ width=”234″ align=”right”><font face=”Verdana” size=”2″>Account Number:</font></td>
<td bgcolor=”#F0F0F0″ width=”450″>
<input type=”text” name=”UMcustid” size=”28″ value=”[UMcustid]”></td>
</tr>
<tr>
<td style=”background-color:#F0F0F0; width: 234px; text-align: right;”><span style=”font-size: .8rem;”>First Name:</span></td>
<td style=”background-color:#F0F0F0; width:450px;”>
<input type=”text” name=”UMbillfname” size=”20″ value=”[UMbillfname]”></td>
</tr>
<tr>
<td style=”background-color:#F0F0F0; width: 234px; text-align: right;”><span style=”font-size: .8rem;”>Last Name:</span></td>
<td style=”background-color:#F0F0F0; width:450px;”>
<input type=”text” name=”UMbilllname” size=”27″ value=”[UMbilllname]”></td>
</tr>
<tr>
<td style=”background-color:#F0F0F0; width: 234px; text-align: right;”><span style=”font-size: .8rem;”>Address:</span></td>
<td style=”background-color:#F0F0F0; width:450px;”>
<input type=”text” name=”UMbillstreet” size=”25″ value=”[UMbillstreet]”></td>
</tr>
<tr>
<td style=”background-color:#F0F0F0; width: 234px; text-align: right;”><span style=”font-size: .8rem;”>Address Line 2:</span></td>
<td style=”background-color:#F0F0F0; width:450px;”>
<input type=”text” name=”UMbillstreet2″ size=”20″ value=”[UMbillstreet2]”></td>
</tr>
<tr>
<td style=”background-color:#F0F0F0; width: 234px; text-align: right;”><span style=”font-size: .8rem;”>City:</span></td>
<td style=”background-color:#F0F0F0; width:450px;”>
<input type=”text” name=”UMbillcity” size=”29″ value=”[UMbillcity]”></td>
</tr>
<tr>
<td style=”background-color:#F0F0F0; width: 234px; text-align: right;”><span style=”font-size: .8rem;”>State:</span></td>
<td style=”background-color:#F0F0F0; width:450px;”>
<input type=”text” name=”UMbillstate” size=”20″ value=”[UMbillstate]”></td>
</tr>
<tr>
<td style=”background-color:#F0F0F0; width: 234px; text-align: right;”><span style=”font-size: .8rem;”>Zip:</span></td>
<td style=”background-color:#F0F0F0; width:450px;”>
<input type=”text” name=”UMbillzip” size=”11″ value=”[UMbillzip]”></td>
</tr>
<tr>
<td style=”background-color:#F0F0F0; width: 234px; text-align: right;”><span style=”font-size: .8rem;”>Country:</span></td>
<td style=”background-color:#F0F0F0; width:450px;”>
<input type=”text” name=”UMbillcountry” size=”26″ value=”[UMbillcountry]”></td>
</tr>
<tr>
<td style=”background-color:#F0F0F0; width: 234px; text-align: right;”><span style=”font-size: .8rem;”>Phone Number:</span></td>
<td style=”background-color:#F0F0F0; width:450px;”>
<input type=”text” name=”UMbillphone” size=”20″ value=”[UMbillphone]”></td>
</tr>
<tr>
<td style=”background-color:#F0F0F0; width: 234px; text-align: right;”><span style=”font-size: .8rem;”>Email Address:</span></td>
<td style=”background-color:#F0F0F0; width:450px;”>
<input type=”text” name=”UMemail” size=”20″ value=”[UMemail]”></td>
</tr>
<tr>
<td style=”background-color:#F0F0F0;” colspan=”2″><span style=”font-size: .8rem;”>
</span></td>
</tr>
<tr>
<td style=”background-color:#F0F0F0; width: 234px; text-align: right;”> </td>
<td style=”background-color:#F0F0F0; width:450px;”> </td>
</tr>
<tr>
<td style=”background-color:#F0F0F0;” colspan=”2″>
<p style=”text-align: center;”>
<input type=”submit” name=”submitbutton” value=”Process Payment >>”></p>
<hr>
</td>
</tr>
<tr>
<td style=”background-color:#FFFFFF;” colspan=”2″>
<div>
<table style=”width:100%;”>
<tr>
<td>
</td>
<td style=”width:84px;”></td>
</tr>
</table>
</div>
</td>
</tr>
</table>
</div>
</form>
</body>
</html>