<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="JC3V42USQ74AQ" /> <table> <tr> <td> <input type="hidden" name="on0" value="GALACAR Payment Center"/> GALACAR Payment Center </td> </tr> <tr> <td> <select name="os0"> <option value="Price 1 "> Price 1 $25.00 USD </option> <option value="Price 2"> Price 2 $30.00 USD </option> <option value="Price 3"> Price 3 $35.00 USD </option> <option value="Price 4"> Price 4 $40.00 USD </option> <option value="Price 5"> Price 5 $45.00 USD </option> <option value="Price 6"> Price 6 $50.00 USD </option> </select> </td> </tr> <tr> <td> <input type="hidden" name="on1" value="GA LA CAR Services"/> GA LA CAR Services </td> </tr> <tr> <td> <select name="os1"> <option value="Hair Services"> Hair Services </option> <option value="Nail Service(s) "> Nail Service(s) </option> <option value="Beauty Service(s)"> Beauty Service(s) </option> <option value="Product(s)"> Product(s) </option> </select> </td> </tr> <tr> <td> <input type="hidden" name="on2" value="Thank you for your business"/> Thank you for your business </td> </tr> <tr> <td> <input type="text" name="os2" maxLength="200" /> </td> </tr> <tr> <td> <input type="hidden" name="on3" value="Operator&"/> Operator&#39;s name </td> </tr> <tr> <td> <input type="text" name="os3" 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_SM.gif" border="0" name="submit" title="PayPal - The safer, easier way to pay online!" alt="Add to Cart" /> </form>