<!DOCTYPE html PUBLIC "-//W3C//DTD HTML 4.01//EN">
<!-- https://secure.kneedraggers.com/cart/ -->
<html>
<head>
<title></title>
</head>
<body>
<form method="post" name="cart" id="cart_form" action="https://secure.kneedraggers.com/cart/">
<div>
<table border="0">
<tbody>
<tr>
<td>
<div>
Your Billing Address:
</div><!--*******************************-->
<div>
<div>
<span>First Name</span>
</div>
<div>
<input maxlength="30" name="user[billing][firstname]" value="" id="BILL_FIRSTNAME">
</div>
<div></div>
</div><!--*******************************-->
<div>
<div>
<span>Last Name</span>
</div>
<div>
<input maxlength="30" name="user[billing][lastname]" value="" id="BILL_LASTNAME">
</div>
<div></div>
</div><!--*******************************-->
<div>
<div>
<span>Billing Address</span>
</div>
<div>
<input maxlength="35" name="user[billing][address_first]" value="" id="BILL_ADDRESS1">
</div>
<div></div>
</div><!--*******************************-->
<div>
<div>
<span>Billing Suite/Apt #</span>
</div>
<div>
<input maxlength="35" name="user[billing][address_second]" value="" id="BILL_ADDRESS2">
</div>
<div></div>
</div><!--*******************************-->
<div>
<div>
<span>Billing City</span>
</div>
<div>
<input maxlength="30" name="user[billing][city]" value="" id="BILL_CITY">
</div>
<div></div>
</div><!--*******************************-->
<div>
<div>
<span>State/Province</span>
</div>
<div>
<select name="user[billing][state]" disabled="disabled" id="SHIP_STATE">
<option value="">
Select State
</option>
<option>
--- Armed Forces ---
</option>
<option value="APO AA">
AA - Military
</option>
<option value="APO AE">
AE - Military
</option>
<option value="APO AP">
AP - Military
</option>
<option>
--- United States ---
</option>
<option value="AK">
Alaska
</option>
<option value="AL">
Alabama
</option>
<option value="AR">
Arkansas
</option>
<option value="AZ">
Arizona
</option>
<option value="CA" selected>
California
</option>
<option value="CO">
Colorado
</option>
<option value="CT">
Connecticut
</option>
<option value="DC">
District of Columbia
</option>
<option value="DE">
Delaware
</option>
<option value="FL">
Florida
</option>
<option value="GA">
Georgia
</option>
<option value="HI">
Hawaii
</option>
<option value="IA">
Iowa
</option>
<option value="ID">
Idaho
</option>
<option value="IL">
Illinois
</option>
<option value="IN">
Indiana
</option>
<option value="KS">
Kansas
</option>
<option value="KY">
Kentucky
</option>
<option value="LA">
Louisiana
</option>
<option value="MA">
Massachusetts
</option>
<option value="MD">
Maryland
</option>
<option value="ME">
Maine
</option>
<option value="MI">
Michigan
</option>
<option value="MN">
Minnesota
</option>
<option value="MO">
Missouri
</option>
<option value="MS">
Mississippi
</option>
<option value="MT">
Montana
</option>
<option value="NC">
North Carolina
</option>
<option value="ND">
North Dakota
</option>
<option value="NE">
Nebraska
</option>
<option value="NH">
New Hampshire
</option>
<option value="NJ">
New Jersey
</option>
<option value="NM">
New Mexico
</option>
<option value="NV">
Nevada
</option>
<option value="NY">
New York
</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="VA">
Virginia
</option>
<option value="VT">
Vermont
</option>
<option value="WA">
Washington
</option>
<option value="WI">
Wisconsin
</option>
<option value="WV">
West Virginia
</option>
<option value="WY">
Wyoming
</option>
</select>
</div>
<div></div>
</div><!--*******************************-->
<div>
<div>
<span>Billing Postal Code</span>
</div>
<div>
<input disabled="disabled" maxlength="30" name="user[billing][zip]" value="94043" id="BILL_POSTAL">
</div>
<div></div>
</div><!--*******************************-->
<div>
<div>
<span>Billing Country</span>
</div>
<div>
<select disabled="disabled" name="user[billing][country]" id="BILL_COUNTRY">
<option value="US" selected>
United States
</option>
<option value="CA">
Canada
</option>
<option value="AL">
Albania
</option>
<option value="AI">
Anguilla
</option>
<option value="AG">
Antigua
</option>
<option value="AR">
Argentina
</option>
<option value="AW">
Aruba
</option>
<option value="AU">
Australia
</option>
<option value="AT">
Austria
</option>
<option value="BH">
Bahrain
</option>
<option value="BE">
Belgium
</option>
<option value="BM">
Bermuda
</option>
<option value="BA">
Bosnia and Herzegovina
</option>
<option value="BR">
Brazil
</option>
<option value="BN">
Brunei Darussalam
</option>
<option value="BG">
Bulgaria
</option>
<option value="CL">
Chile
</option>
<option value="CN">
China
</option>
<option value="CO">
Colombia
</option>
<option value="CR">
Costa Rica
</option>
<option value="HR">
Croatia
</option>
<option value="CY">
Cyprus
</option>
<option value="DK">
Denmark
</option>
<option value="EC">
Ecuador
</option>
<option value="EG">
Egypt
</option>
<option value="FI">
Finland
</option>
<option value="FR">
France
</option>
<option value="GB">
Great Britain / UK
</option>
<option value="GF">
French Guiana
</option>
<option value="PF">
French Polynesia
</option>
<option value="DE">
Germany
</option>
<option value="GR">
Greece
</option>
<option value="GU">
Guam
</option>
<option value="GT">
Guatemala
</option>
<option value="HN">
Honduras
</option>
<option value="HK">
Hong Kong
</option>
<option value="IS">
Iceland
</option>
<option value="IN">
India
</option>
<option value="IE">
Ireland
</option>
<option value="IT">
Italy
</option>
<option value="JM">
Jamaica
</option>
<option value="JP">
Japan
</option>
<option value="JO">
Jordan
</option>
<option value="KW">
Kuwait
</option>
<option value="MT">
Malta
</option>
<option value="MX">
Mexico
</option>
<option value="MA">
Morocco
</option>
<option value="NL">
Netherlands
</option>
<option value="NZ">
New Zealand
</option>
<option value="NI">
Nicaragua
</option>
<option value="NO">
Norway
</option>
<option value="OM">
Oman
</option>
<option value="PA">
Panama
</option>
<option value="PG">
Papua New Guinea
</option>
<option value="PY">
Paraguay
</option>
<option value="PE">
Peru
</option>
<option value="PL">
Poland
</option>
<option value="PT">
Portugal
</option>
<option value="PR">
Puerto Rico
</option>
<option value="QA">
Qatar
</option>
<option value="RE">
Reunion
</option>
<option value="SA">
Saudi Arabia
</option>
<option value="SN">
Senegal
</option>
<option value="SI">
Slovenia
</option>
<option value="ZA">
South Africa
</option>
<option value="KR">
South Korea
</option>
<option value="ES">
Spain
</option>
<option value="SE">
Sweden
</option>
<option value="CH">
Switzerland
</option>
<option value="TW">
Taiwan
</option>
<option value="TT">
Trinidad and Tobago
</option>
<option value="TR">
Turkey
</option>
<option value="AE">
United Arab Emirates
</option>
<option value="VE">
Venezuela
</option>
</select>
</div>
<div></div>
</div><!--*******************************-->
<div>
<div>
<span>Phone Number</span>
</div>
<div>
<input maxlength="30" name="user[phone_first]" value="" id="PHONE1">
</div>
<div></div>
</div><!--*******************************-->
<div>
<div>
<span>Email Address</span>
</div>
<div>
<input maxlength="165" name="user[email]" value="" id="EMAIL">
</div>
<div></div>
</div><!--*******************************-->
<div>
<div>
<span>Confirm Email Address</span>
</div>
<div>
<input maxlength="165" name="user[email_confirm]" value="" id="EMAIL_CONFIRM">
</div>
<div></div>
</div><!--*******************************-->
</td>
</tr>
</tbody>
</table>
</div>
<div>
<table border="0">
<tbody>
<tr>
<td>
<div>
Your Payment Information:
</div><input name="payment[method]" type="hidden" id="PAY_METHOD_CC" value="creditcard">
<div>
<div>
<span>Credit Card Number</span>
</div>
<div>
<input type="text" name="payment[cc_number]" id="CC_NUMBER" value="" size="20" maxlength="19">
</div>
<div></div>
</div><!--*******************************-->
<div>
<div>
<span>Expiration Month</span>
</div>
<div>
<input type="text" name="payment[cc_expmo]" id="CC_EXPMO" size="3" maxlength="2" value=""> <font>MM (TWO DIGIT MONTH)</font>
</div>
<div></div>
</div><!--*******************************-->
<div>
<div>
<span>Expiration Year</span>
</div>
<div>
<input type="text" name="payment[cc_expyr]" id="CC_EXPYR" size="4" maxlength="4" value=""> <font>YYYY (FOUR DIGIT YEAR)</font>
</div>
<div></div>
</div><!--*******************************-->
<div>
<div>
<span>CVV2/Panel Code</span>
</div>
<div>
<input name="payment[sigpanel]" id="CC_SIGPANEL" value="" size="4" maxlength="4"> <font><a href="#">What's this?</a></font>
</div>
<div></div>
</div><!--*******************************-->
</td>
</tr>
</tbody>
</table>
</div>
</form>
</body>
</html>
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