<form action=”https://www.paypal.com/cgi-bin/webscr” method=”post” target=”_top”>
Ā <input type=”hidden” name=”cmd” value=”_s-xclick” />
Ā <input type=”hidden” name=”hosted_button_id” value=”TVYW75VJXEH8W” />
Ā <table>
Ā Ā Ā <tr>
Ā Ā Ā Ā Ā <td>
Ā Ā Ā Ā Ā Ā Ā <input type=”hidden” name=”on0″ value=”Choose an option for your trip deposit:”/>
Ā Ā Ā Ā Ā Ā Ā Choose an option for your trip deposit:
Ā Ā Ā Ā Ā </td>
Ā Ā Ā </tr>
Ā Ā Ā <tr>
Ā Ā Ā Ā Ā <td>
Ā Ā Ā Ā Ā Ā Ā <select name=”os0″>
Ā Ā Ā Ā Ā Ā Ā Ā Ā <option value=”Full Deposit”>
Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Full Deposit $1,500.00Ā USD
Ā Ā Ā Ā Ā Ā Ā Ā Ā </option>
Ā Ā Ā Ā Ā Ā Ā Ā Ā <option value=”Partial Deposit”>
Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Partial Deposit $200.00Ā USD
Ā Ā Ā Ā Ā Ā Ā Ā Ā </option>
Ā Ā Ā Ā Ā Ā Ā </select>
Ā Ā Ā Ā Ā </td>
Ā Ā Ā </tr>
Ā Ā Ā <tr>
Ā Ā Ā Ā Ā <td>
Ā Ā Ā Ā Ā Ā Ā <input type=”hidden” name=”on1″ value=”Name of traveler:”/>
Ā Ā Ā Ā Ā Ā Ā Name of traveler:
Ā Ā Ā Ā Ā </td>
Ā Ā Ā </tr>
Ā Ā Ā <tr>
Ā Ā Ā Ā Ā <td>
Ā Ā Ā Ā Ā Ā Ā <input type=”text” name=”os1″ maxLength=”200″ />
Ā Ā Ā Ā Ā </td>
Ā Ā Ā </tr>
Ā </table>
Ā <input type=”hidden” name=”currency_code” value=”USD” />
Ā <input type=”image” src=”https://www.paypalobjects.com/en_US/i/btn/btn_buynow_SM.gif” border=”0″ name=”submit” title=”PayPal – The safer, easier way to pay online!” alt=”Buy Now” />
</form>