SECURE ORDER FORM
intro | demo | place your order | faq | tech support		 Capitola Works 
 THIS IS AN EXAMPLE OF THE STANDARD ORDER FORM
IT IS FULLY FUNCTIONAL!   TRY IT OUT:  REMEMBER, INFO YOU SUBMIT ON THIS
DEMO IS NOT SECURE.  AFTER YOU COMPLETE  THIS SAMPLE FORM YOU WILL
HAVE THE OPTION TO SEE THE "ORDERS RECEIVED" PAGE WHERE THE INFO
THAT YOU SUBMITTED WILL BE DISPLAYED, ALONG WITH ALL THE OTHER DEMO
ORDERS THAT HAVE BEEN PLACED HERE DURING THE PAST FEW DAYS.
 
Confirm the product you want to purchase at right and fill in the information below.  

All fields are required! They must all be filled in before your order will be transmitted!

 The products below can also be set up with check boxes so that more than one item can be purchased at the same time 
  product 1..............$1200 
  product 2..............$ 300.95 
  product 3..............FREE  
  product 4..............we owe you $0.02 
 
 
 

To receive confirmation e-mail (like your customers would) be sure to enter your real e-mail address below.

CREDIT CARD VERIFICATION IS ENABLED: you must use a real credit card number or the one already entered below. For purposes of this DEMO select "Visa" for Credit Card type!



BILLING INFORMATION
Billing Address: Name on
Credit Card:
City: Your eMail:
State: Card Number:
Zip Code:    
Phone:   Expiration: / 
Country:


SHIPPING INFORMATION
Check here if Shipping Address is same as the Billing Address or fill out below:
Shipping Address:
Shipping City:
Shipping State:     Shipping Zip Code:  
Shipping Country:


Any comments, questions? 
 

 


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intro | demo | place your order | faq | tech support