<form action="https://www.paypal.com/cgi-bin/webscr" method="post" target="_blank"> <input type="hidden" name="cmd" value="_s-xclick" /> <input type="hidden" name="hosted_button_id" value="ANT33A6RPBAJ4" /> <table> <tr> <td> <input type="hidden" name="on0" value="$100 Gift Card"/> $100 Gift Card </td> </tr> <tr> <td> <input type="text" name="os0" maxLength="200" /> </td> </tr> <tr> <td> <input type="hidden" name="on1" value="Name & Address to Mail to:"/> Name & Address to Mail to: </td> </tr> <tr> <td> <input type="text" name="os1" maxLength="200" /> </td> </tr> </table> <input type="hidden" name="currency_code" value="USD" /> <input type="image" src="https://www.paypalobjects.com/en_US/i/btn/btn_cart_LG.gif" border="0" name="submit" title="PayPal - The safer, easier way to pay online!" alt="Add to Cart" /> </form>
