chromium/components/test/data/autofill/heuristics/input/029_checkout_kohls.com.html

<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Strict//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-strict.dtd">
<html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en-US" lang="en-US">





	




	







<!-- esw1a202 -->
<!-- Template Name: shipping_billing_information.jsp -->
<!-- Look and Feel Assortment: Upgrade_Default_LookFeel-->
 
<head>
	
		<title>Billing and Shipping Information - Kohls.com</title>
		<meta http-equiv="Content-Type" content="text/html; charset=ISO-8859-1" />
		<meta http-equiv="Content-Language" content="en-us"/>
		<meta http-equiv="Content-Style-Type" content="text/css" />
		<meta name="currentTemplate" content="/upgrade/checkout/shipping_billing_information.jsp" />
</head>
<body>



		<form name="kohls_checkout_registered" method="post" id="checkout-sign-in-form" action="https://www.kohls.com/upgrade/checkout/shipping_billing_information.jsp">
<input type="hidden" name="bmForm" value="kohls_checkout_registered">
<input type="hidden" name="bmFormID" value="1307069334196">
<input type="hidden" name="bmUID" value="1307069334197">
<input type="hidden" name="bmIsForm" value="true">
<input type="hidden" name="bmPrevTemplate" value="/upgrade/checkout/shipping_billing_information.jsp">
			<fieldset>
				<legend><span class="hidden">Returning customers sign-in.</span></legend>
				<p id="sign-in-email">
					<label for="sign-in-emailaddress">E-mail Address:</label>
					<input type="hidden" name="bmText" value="LOGIN<>userid"><input type="hidden" name="bmRequired" value="LOGIN<>userid"><input name="LOGIN<>userid" type="text" id="sign-in-emailaddress"/>
				</p>
				<p id="sign-in-password">
					<label for="password">Password:</label>
					<input type="hidden" name="bmText" value="LOGIN<>passwordLogin"><input type="hidden" name="bmRequired" value="LOGIN<>passwordLogin"><input name="LOGIN<>passwordLogin" type="password" id="password"/>
				</p>
				<p>Passwords are case sensitive.</p>
				<p><a href="https://www.kohls.com/upgrade/myaccount/kohls_enter_name.jsp?PRODUCT%3C%3Eprd_id=845524892695748&FOLDER%3C%3Efolder_id=2534374757237898&bmUID=1307069334134">Forget your password?</a></p>
		
				<div class="button-container">
					<span class="do-not-display"><input type="hidden" name="bmImage" value="kohls_checkout_registered.x"><input type="hidden" name="bmImage" value="kohls_checkout_registered.y"><input type="hidden" name="bmImage" value="kohls_checkout_registered"><input type="image" name="kohls_checkout_registered" src="#" alt="Sign-in"/></span>	
					<button class="button-red" name="kohls_checkout_registered" type="submit" value="Sign-in"><span>Sign-in</span></button>
				</div>
				<input type="hidden" name="bmHidden" value="check_autologin"><input name="check_autologin" value="true" type="hidden"/>
			</fieldset>
		<input type="hidden" name="bmHidden" value="PRODUCT<>prd_id"><input type="hidden" name="PRODUCT<>prd_id" value="845524892695748">
<input type="hidden" name="bmHidden" value="FOLDER<>folder_id"><input type="hidden" name="FOLDER<>folder_id" value="2534374757237898">
<input type="hidden" name="bmFields" value="bmForm,bmFormID,bmUID,bmIsForm,bmPrevTemplate,bmText,bmRequired,bmImage,bmHidden">
<input type="hidden" name="bmHash" value="ff7629a5e0392169d1da733495887925425457ef">
</form>










				<form name="kohls_checkout_shipping_billing_unreg" method="post" id="bill_ship_form" action="https://www.kohls.com/upgrade/checkout/shipping_billing_information.jsp">
<input type="hidden" name="bmForm" value="kohls_checkout_shipping_billing_unreg">
<input type="hidden" name="bmFormID" value="1307069334197">
<input type="hidden" name="bmUID" value="1307069334198">
<input type="hidden" name="bmIsForm" value="true">
<input type="hidden" name="bmPrevTemplate" value="/upgrade/checkout/shipping_billing_information.jsp">	
					<div class="basic" id="list1a">
						<div class="individual-container" id="billing">
							<h2 class="accordion-title"><a>Billing Information</a></h2>		
							<fieldset>
							<legend><span class="hidden">Please provide your billing information.</span></legend>
		
								
	<input type="hidden" name="bmHidden" value="BILL_TO_ADDRESS<>indDefaultBillTo"><input type="hidden" name="BILL_TO_ADDRESS<>indDefaultBillTo" value="true"/>
	<div id="first-name-bill"
>
		<label for="bill_fname">First Name:</label>
		<input type="hidden" name="bmText" value="BILL_TO_ADDRESS<>firstName"><input type="hidden" name="bmRequired" value="BILL_TO_ADDRESS<>firstName"><input name="BILL_TO_ADDRESS<>firstName" type="text" id="bill_fname"/>
	</div>
	<div id="last-name-bill"
>
		<label for="bill_lname">Last Name:</label>
		<input type="hidden" name="bmText" value="BILL_TO_ADDRESS<>lastName"><input type="hidden" name="bmRequired" value="BILL_TO_ADDRESS<>lastName"><input name="BILL_TO_ADDRESS<>lastName" type="text" id="bill_lname"/>
	</div>
	<div id="mailing-address-bill"
>
		<label for="bill_addr1">Address:</label>
		<input type="hidden" name="bmText" value="BILL_TO_ADDRESS<>address1"><input type="hidden" name="bmRequired" value="BILL_TO_ADDRESS<>address1"><input name="BILL_TO_ADDRESS<>address1" type="text" id="bill_addr1"/>
	</div>
	<div id="apt-suite-bill"
>
		<label for="bill_addr2">Apt. or Suite #:</label>
		<input type="hidden" name="bmText" value="BILL_TO_ADDRESS<>address2"><input name="BILL_TO_ADDRESS<>address2" type="text" id="bill_addr2"/>
	</div>
	<div id="city-bill"
>
		<label for="bill_city">City:</label>
		<input type="hidden" name="bmText" value="BILL_TO_ADDRESS<>city"><input type="hidden" name="bmRequired" value="BILL_TO_ADDRESS<>city"><input name="BILL_TO_ADDRESS<>city" type="text" id="bill_city" onchange="clearCounty('bill_')"/>
	</div>
	
	<div id="state-bill"
>
		<label for="bill_state">State:</label>
		<input type="hidden" name="bmSingle" value="BILL_TO_ADDRESS<>state_cd"><input type="hidden" name="bmRequired" value="BILL_TO_ADDRESS<>state_cd"><select name="BILL_TO_ADDRESS<>state_cd" id="bill_state" onchange="clearCounty('bill_')">
<option value="">Choose a state</option>
<option value="AL">Alabama</option>
<option value="AK">Alaska</option>
<option value="AZ">Arizona</option>
<option value="AR">Arkansas</option>
<option value="CA">California</option>
<option value="CO">Colorado</option>
<option value="CT">Connecticut</option>
<option value="DE">Delaware</option>
<option value="DC">District of Columbia</option>
<option value="FL">Florida</option>
<option value="GA">Georgia</option>
<option value="HI">Hawaii</option>
<option value="ID">Idaho</option>
<option value="IL">Illinois</option>
<option value="IN">Indiana</option>
<option value="IA">Iowa</option>
<option value="KS">Kansas</option>
<option value="KY">Kentucky</option>
<option value="LA">Louisiana</option>
<option value="ME">Maine</option>
<option value="MD">Maryland</option>
<option value="MA">Massachusetts</option>
<option value="MI">Michigan</option>
<option value="MN">Minnesota</option>
<option value="MS">Mississippi</option>
<option value="MO">Missouri</option>
<option value="MT">Montana</option>
<option value="NE">Nebraska</option>
<option value="NV">Nevada</option>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NY">New York</option>
<option value="NC">North Carolina</option>
<option value="ND">North Dakota</option>
<option value="OH">Ohio</option>
<option value="OK">Oklahoma</option>
<option value="OR">Oregon</option>
<option value="PA">Pennsylvania</option>
<option value="RI">Rhode Island</option>
<option value="SC">South Carolina</option>
<option value="SD">South Dakota</option>
<option value="TN">Tennessee</option>
<option value="TX">Texas</option>
<option value="UT">Utah</option>
<option value="VT">Vermont</option>
<option value="VA">Virginia</option>
<option value="WA">Washington</option>
<option value="WV">West Virginia</option>
<option value="WI">Wisconsin</option>
<option value="WY">Wyoming</option>
<option value="AA">Armed Forces-America</option>
<option value="AE">Armed Forces-Europe</option>
<option value="AP">Armed Forces-Pacific</option>
</select><input type="hidden" name="bmDynamic" value="BILL_TO_ADDRESS<>state_cd:AL:AK:AZ:AR:CA:CO:CT:DE:DC:FL:GA:HI:ID:IL:IN:IA:KS:KY:LA:ME:MD:MA:MI:MN:MS:MO:MT:NE:NV:NH:NJ:NM:NY:NC:ND:OH:OK:OR:PA:RI:SC:SD:TN:TX:UT:VT:VA:WA:WV:WI:WY:AA:AE:AP:">
	</div>
  	<div id="zip-code-bill"
>
  		<label for="bill_postal">ZIP Code:</label>
  		<input type="hidden" name="bmText" value="BILL_TO_ADDRESS<>postal"><input type="hidden" name="bmRequired" value="BILL_TO_ADDRESS<>postal"><input name="BILL_TO_ADDRESS<>postal" type="text" id="bill_postal" onchange="clearCounty('bill_')"/>
  	</div>
	
	<div id="phone-number-bill"
>
		<label for="bill_area">Area Code</label>
		<input type="hidden" name="bmText" value="BILL_PHONE<>areacode"><input type="hidden" name="bmRequired" value="BILL_PHONE<>areacode"><input type="text" name="BILL_PHONE<>areacode" id="bill_area"/>
		<label for="bill_exch">Exchange</label>
		<input type="hidden" name="bmText" value="BILL_PHONE<>exchange"><input type="hidden" name="bmRequired" value="BILL_PHONE<>exchange"><input type="text" name="BILL_PHONE<>exchange" id="bill_exch"/>
		<label for="bill_ext">Extension</label>
		<input type="hidden" name="bmText" value="BILL_PHONE<>extension"><input type="hidden" name="bmRequired" value="BILL_PHONE<>extension"><input type="text" name="BILL_PHONE<>extension" id="bill_ext"/>
		<span class="do-not-display">
			<label for="bill_phone">Contact Phone:</label>
			<input type="hidden" name="bmText" value="bill_phone"><input type="text" id="bill_phone" name="bill_phone"/>
		</span>
	</div>
													
		
					<div id="email-address">	
						<label for="emailaddress">E-mail Address:</label>
						<input type="hidden" name="bmText" value="CURRENT_USER<>email"><input type="hidden" name="bmRequired" value="CURRENT_USER<>email"><input type="text" name="CURRENT_USER<>email" id="emailaddress"/>
						<span class="wrap-text">(E-mail address is required to place an order)</span>
						<div id="sale-alerts">
		<!-- 3rd Argument in getEmailCampaignOptStatusHTML is the email addr of the user, need to put in user's email if registered user -->
							<div class="checkbox_sufsa"><input type="hidden" name="bmHidden" value="EMAIL_OPT_STATUS_ARRAY<>email_cmpgn_cde"><input type="hidden" name="EMAIL_OPT_STATUS_ARRAY<>email_cmpgn_cde" value="WS"/><input type="hidden" name="bmArrayIndex" value="EMAIL_OPT_STATUS_ARRAY<>opt_status"><input type="hidden" name="bmCheckbox" value="EMAIL_OPT_STATUS_ARRAY<>opt_status"><input value="true" type="checkbox" id="WS" name="EMAIL_OPT_STATUS_ARRAY<>opt_status"/><label for="WS" >Yes, sign me up for Sale Alerts. (optional)</label></div>
					
						</div>
					</div>						
		
							</fieldset>
						</div>
		
						<div class="individual-container">
							<fieldset id="shipping-options">
							<h2>Is your shipping address the same as your billing address?</h2>
							<legend><span class="hidden">Please provide your shipping information.</span></legend>
							<div>
								<label for="yes">Yes</label>
								<input type="hidden" name="bmRadio" value="indShipIsBillTo"><input id="yes" type="radio" name="indShipIsBillTo" value="true" checked="checked"/>
							</div>
							<div>
								<label for="no">No</label>
								<input type="hidden" name="bmRadio" value="indShipIsBillTo"><input id="no" type="radio" name="indShipIsBillTo" value="false"/>
							</div>
							</fieldset>
						</div>
						<div class="individual-container" id="shipping">
							<h2 class="accordion-title"><a>Shipping Information</a></h2>
							<fieldset>
							<legend><span class="hidden"></span></legend>							
									
										
								
	<div id="first-name-ship"
>
		<label for="ship_fname">First Name:</label>
		<input type="hidden" name="bmText" value="SHIP_TO_ADDRESS<>firstName"><input type="hidden" name="bmRequired" value="SHIP_TO_ADDRESS<>firstName"><input name="SHIP_TO_ADDRESS<>firstName" type="text" id="ship_fname"/>
	</div>
	<div id="last-name-ship"
>
		<label for="ship_lname">Last Name:</label>
		<input type="hidden" name="bmText" value="SHIP_TO_ADDRESS<>lastName"><input type="hidden" name="bmRequired" value="SHIP_TO_ADDRESS<>lastName"><input name="SHIP_TO_ADDRESS<>lastName" type="text" id="ship_lname"/>
	</div>
	<div id="mailing-address-ship"
>
		<label for="ship_addr1">Address:</label>
		<input type="hidden" name="bmText" value="SHIP_TO_ADDRESS<>address1"><input type="hidden" name="bmRequired" value="SHIP_TO_ADDRESS<>address1"><input name="SHIP_TO_ADDRESS<>address1" type="text" id="ship_addr1"/>
	</div>
	<div id="apt-suite-ship"
>
		<label for="ship_addr2">Apt. or Suite #:</label>
		<input type="hidden" name="bmText" value="SHIP_TO_ADDRESS<>address2"><input name="SHIP_TO_ADDRESS<>address2" type="text" id="ship_addr2"/>
	</div>
	<div id="city-ship"
>
		<label for="ship_city">City:</label>
		<input type="hidden" name="bmText" value="SHIP_TO_ADDRESS<>city"><input type="hidden" name="bmRequired" value="SHIP_TO_ADDRESS<>city"><input name="SHIP_TO_ADDRESS<>city" type="text" id="ship_city" onchange="clearCounty('ship_')"/>
	</div>
	
	<div id="state-ship"
>
		<label for="ship_state">State:</label>
		<input type="hidden" name="bmSingle" value="SHIP_TO_ADDRESS<>state_cd"><input type="hidden" name="bmRequired" value="SHIP_TO_ADDRESS<>state_cd"><select name="SHIP_TO_ADDRESS<>state_cd" id="ship_state" onchange="clearCounty('ship_')">
<option value="">Choose a state</option>
<option value="AL">Alabama</option>
<option value="AK">Alaska</option>
<option value="AZ">Arizona</option>
<option value="AR">Arkansas</option>
<option value="CA">California</option>
<option value="CO">Colorado</option>
<option value="CT">Connecticut</option>
<option value="DE">Delaware</option>
<option value="DC">District of Columbia</option>
<option value="FL">Florida</option>
<option value="GA">Georgia</option>
<option value="HI">Hawaii</option>
<option value="ID">Idaho</option>
<option value="IL">Illinois</option>
<option value="IN">Indiana</option>
<option value="IA">Iowa</option>
<option value="KS">Kansas</option>
<option value="KY">Kentucky</option>
<option value="LA">Louisiana</option>
<option value="ME">Maine</option>
<option value="MD">Maryland</option>
<option value="MA">Massachusetts</option>
<option value="MI">Michigan</option>
<option value="MN">Minnesota</option>
<option value="MS">Mississippi</option>
<option value="MO">Missouri</option>
<option value="MT">Montana</option>
<option value="NE">Nebraska</option>
<option value="NV">Nevada</option>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NY">New York</option>
<option value="NC">North Carolina</option>
<option value="ND">North Dakota</option>
<option value="OH">Ohio</option>
<option value="OK">Oklahoma</option>
<option value="OR">Oregon</option>
<option value="PA">Pennsylvania</option>
<option value="RI">Rhode Island</option>
<option value="SC">South Carolina</option>
<option value="SD">South Dakota</option>
<option value="TN">Tennessee</option>
<option value="TX">Texas</option>
<option value="UT">Utah</option>
<option value="VT">Vermont</option>
<option value="VA">Virginia</option>
<option value="WA">Washington</option>
<option value="WV">West Virginia</option>
<option value="WI">Wisconsin</option>
<option value="WY">Wyoming</option>
<option value="AA">Armed Forces-America</option>
<option value="AE">Armed Forces-Europe</option>
<option value="AP">Armed Forces-Pacific</option>
</select><input type="hidden" name="bmDynamic" value="SHIP_TO_ADDRESS<>state_cd:AL:AK:AZ:AR:CA:CO:CT:DE:DC:FL:GA:HI:ID:IL:IN:IA:KS:KY:LA:ME:MD:MA:MI:MN:MS:MO:MT:NE:NV:NH:NJ:NM:NY:NC:ND:OH:OK:OR:PA:RI:SC:SD:TN:TX:UT:VT:VA:WA:WV:WI:WY:AA:AE:AP:">
	</div>
	<div id="zip-code-ship"
>
		<label for="ship_postal">ZIP Code:</label>
		<input type="hidden" name="bmText" value="SHIP_TO_ADDRESS<>postal"><input type="hidden" name="bmRequired" value="SHIP_TO_ADDRESS<>postal"><input name="SHIP_TO_ADDRESS<>postal" type="text" id="ship_postal" onchange="clearCounty('ship_')"/>
	</div>
	
       <input type="hidden" name="bmHidden" value="SHIP_TO_ADDRESS<>validateOption"><input type="hidden" name="SHIP_TO_ADDRESS<>validateOption" value="i">
   			  
	<div id="phone-number-ship"
>
		<label for="ship_area">Area Code</label>
		<input type="hidden" name="bmText" value="SHIP_PHONE<>areacode"><input type="hidden" name="bmRequired" value="SHIP_PHONE<>areacode"><input name="SHIP_PHONE<>areacode" type="text" id="ship_area"/>
		<label for="ship_exch">Exchange</label>
		<input type="hidden" name="bmText" value="SHIP_PHONE<>exchange"><input type="hidden" name="bmRequired" value="SHIP_PHONE<>exchange"><input type="text" name="SHIP_PHONE<>exchange" id="ship_exch"/>
		<label for="ship_ext">Extension</label>
		<input type="hidden" name="bmText" value="SHIP_PHONE<>extension"><input type="hidden" name="bmRequired" value="SHIP_PHONE<>extension"><input type="text" name="SHIP_PHONE<>extension" id="ship_ext"/>
		<span class="do-not-display">
			<label for="ship_phone">Contact Phone:</label>
			<input type="hidden" name="bmText" value="ship_phone"><input type="text" id="ship_phone" name="ship_phone"/>
		</span>
	</div>

		<input type="hidden" name="bmHidden" value="SHIP_TO_ADDRESS<>indDefaultShipTo"><input type="hidden" name="SHIP_TO_ADDRESS<>indDefaultShipTo" value="true"/>
							
		
							</fieldset>
						</div>
		
					</div>
		

				<!-- Begin Shipping rates arrival info -->


                    <h2 id="shipping-method-heading"><span></span>Shipping Method</h2>
                    <div class="individual-container">
                        <fieldset>
                            <legend><span class="hidden"></span></legend>
                            <label for="shippingmethod">Shipping Method:</label>
                            

		<!-- BP Shipmethod Change --> 	   
 	    <input type="hidden" name="bmSingle" value="validShippingMethodList"><input type="hidden" name="bmRequired" value="validShippingMethodList"><select name="validShippingMethodList" id="shippingmethod">
 	    <!-- END BP Shipmethod Change -->

			<option value="7037973929746583">Continental US - Priority Air    $15.95</option>

			<option value="7037973929746567">Alaska/Hawaii & APO/FPO - Standard Ground    $0.99</option>

			<option value="7037973929746575" selected >Continental US - Standard Ground    $0.99</option>
   
		</select>
                        </fieldset>
                        <p class="shipping disclaimer">Select your shipping method above. Please note: regular shipping rates shown are based on the subtotal before discounts are taken and may not reflect special shipping promotions.</p>
                    </div>
                    <p class="ground">Standard Ground should arrive between June 9 and June 15.</p>
                    <p class="priority">Priority Air should arrive between June 7 and June 8.</p>
                    <p class="ground">Alaska/Hawaii - Standard Ground should arrive between June 9 and June 15.</p>
                    <p class="priority">APO/FPO - Standard Ground should arrive between June 9 and June 15.</p>
                    <p class="slider"><!--<a href="#">This is the link that will show/hide</a>--></p>
                    <div class="slider">
                        <table summary="UPS Ground Shipping Cost">
                            <caption>
                                Standard Ground Shipping
                            </caption>
                            <tbody>
                                <tr>
                                    <th id="order-total">Order Total</th>
                                    <th id="shipping-rate">Shipping Rates</th>
                                </tr>
                                <tr><td headers="ups-ground order-total">$0.00 -  $25.00</td><td headers="ups-priority shipping-rate">$5.95</td></tr><tr><td headers="ups-ground order-total">$25.01 -  $50.00</td><td headers="ups-priority shipping-rate">$6.95</td></tr><tr><td headers="ups-ground order-total">$50.01 -  $75.00</td><td headers="ups-priority shipping-rate">$8.95</td></tr><tr><td headers="ups-ground order-total">$75.01 -  $100.00</td><td headers="ups-priority shipping-rate">$10.95</td></tr><tr><td headers="ups-ground order-total">$100.01 -  $150.00</td><td headers="ups-priority shipping-rate">$14.95</td></tr><tr><td headers="ups-ground order-total">$150.01 -  $200.00</td><td headers="ups-priority shipping-rate">$18.95</td></tr><tr><td headers="ups-ground order-total">$200.01 -  $300.00</td><td headers="ups-priority shipping-rate">$22.95</td></tr><tr><td headers="ups-ground order-total"> $300.01 - 400.00</td><td headers="ups-priority shipping-rate">$25.00</td></tr>
                                <tr>
                                    <td headers="additional" colspan="2">For every additional $100 spent, add an extra $5.00 to your shipping rate.</td>
                                </tr>
                            </tbody>
                        </table>
                        <table summary=" UPS Priority Shipping Cost" >
                            <caption>
                                Priority Air Shipping
                            </caption>
                            <tbody>
                                <tr>
                                    <th id="order-total">Order Total</th>
                                    <th id="shipping-rate">Shipping Rates</th>
                                </tr>
                                <tr><td headers="ups-ground order-total">$0.00 -  $25.00</td><td headers="ups-priority shipping-rate">$15.95</td></tr><tr><td headers="ups-ground order-total">$25.01 -  $50.00</td><td headers="ups-priority shipping-rate">$21.95</td></tr><tr><td headers="ups-ground order-total">$50.01 -  $75.00</td><td headers="ups-priority shipping-rate">$25.95</td></tr><tr><td headers="ups-ground order-total">$75.01 -  $100.00</td><td headers="ups-priority shipping-rate">$30.95</td></tr><tr><td headers="ups-ground order-total">$100.01 -  $150.00</td><td headers="ups-priority shipping-rate">$34.95</td></tr><tr><td headers="ups-ground order-total">$150.01 -  $200.00</td><td headers="ups-priority shipping-rate">$39.95</td></tr><tr><td headers="ups-ground order-total">$200.01 -  $300.00</td><td headers="ups-priority shipping-rate">$49.95</td></tr><tr><td headers="ups-ground order-total"> $300.01 - 400.00</td><td headers="ups-priority shipping-rate">$59.95</td></tr>
                                <tr>
                                    <td headers="additional" colspan="2">For every additional $100 spent, add an extra $10.00 to your shipping rate.</td>
                                </tr>
                            </tbody>
                        </table>
                    </div>

				<!-- End Shipping rates arrival info -->
					<div class="continuearea">
						<span class="do-not-display"><input type="hidden" name="bmImage" value="submit_shipping_billing.x"><input type="hidden" name="bmImage" value="submit_shipping_billing.y"><input type="hidden" name="bmImage" value="submit_shipping_billing"><input type="image" name="submit_shipping_billing" src="#" alt="Continue"/></span>
						<button class="button-red" type="submit" name="submit_shipping_billing"><span>Continue</span></button>
					</div>
		
				<input type="hidden" name="bmHidden" value="PRODUCT<>prd_id"><input type="hidden" name="PRODUCT<>prd_id" value="845524892695748">
<input type="hidden" name="bmHidden" value="FOLDER<>folder_id"><input type="hidden" name="FOLDER<>folder_id" value="2534374757237898">
<input type="hidden" name="bmFields" value="bmForm,bmFormID,bmUID,bmIsForm,bmPrevTemplate,bmHidden,bmText,bmRequired,bmSingle,bmDynamic,bmArrayIndex,bmCheckbox,bmRadio,bmImage">
<input type="hidden" name="bmHash" value="a9fe958a6158b56b860f4c1a57e988ca41831ff2">
</form>





</body>
</html>