<form action="https://www.paypal.com/cgi-bin/webscr" method="post">
<input type="hidden" name="cmd" value="_xclick-subscriptions">
<input type="hidden" name="business" value="Xpaypal_userX">
<input type="hidden" name="item_name" value="ONLINE ORDER">
<input type="hidden" name="no_note" value="1">
<input type="hidden" name="currency_code" value="Xcurrency_codeX">
<input type="hidden" name="a1" value="Xwith_taxX">
<input type="hidden" name="p1" value="3">
<input type="hidden" name="t1" value="M">
<input type="hidden" name="a3" value="XqtX">
<input type="hidden" name="p3" value="3">
<input type="hidden" name="t3" value="M">
<input type="hidden" name="src" value="1">
<input type="hidden" name="sra" value="1">
<input type="hidden" name="first_name" value="XfirstnameX"> 
<input type="hidden" name="last_name" value="XsurnameX"> 
<input type="hidden" name="address1" value="Xbilling_address1X"> 
<input type="hidden" name="address2" value="Xbilling_address2X"> 
<input type="hidden" name="city" value="Xbilling_townX"> 
<input type="hidden" name="state" value="Xbilling_countyX"> 
<input type="hidden" name="zip" value="Xbilling_postcodeX"> 
<input type="hidden" name="rm" value="1">
<input type="hidden" name="return" value="Xsuccess_urlX">
<input type="hidden" name="cancel_return" value="Xfail_urlX">
<input type="hidden" name="notify_url" value="Xpaypal_notifyX">
<input type="hidden" name="custom" value="XsessionX">
<input type="image" value="pay" name="buy" src="../program_images/payment-paypal.gif">
</form>