<form>
<div id="fieldsCC" class="">
<div id="fieldrowCCNumber" class="opened">
<p class="group">
<label for="cc_number"><span class="labelText"><span class="label" id="labelChange">Debit or Prepaid gift card number</span></span></label>
<span class="field restricted"><input type="text" id="cc_number" maxlength="19" class="restricted large" name="cc_number" value=""></span>
</p>
<p id="prepaidgiftMsgGroup" class="group hide">
<span class="prepaidAlertContainer">
<span>To use a prepaid gift card from Visa, MasterCard, or American Express, you must add your billing address to the card.</span>
<span class="accessAid">Prepaid Gift Card Info</span>
<span class="fieldPrepaid">On the back of the card you can find either a website address where you can register your billing address directly, or contact information for the card issuer.</span>
</span>
</p>
</div>
<fieldset id="pm-type" class="group US"><legend><span class="label">Payment types<span class="accessAid" id="hlpHilite">Shows credit card type you entered</span></span></legend>
<div id="cctype" class="ccIcon cctype icon selected">
<label class="radio visa hilite" id="pm-visa" for="visa">
<input id="visa" type="radio" name="credit_card_type" value="V">
<span class="cclogo visa"> </span>
<span>Visa</span>
</label>
<label class="radio mc hilite" id="pm-mastercard" for="mastercard">
<input class="mc_subtype" id="mastercard" type="radio" name="credit_card_type" value="M">
<span class="cclogo mc"> </span>
<span>MasterCard</span>
</label>
<label class="radio disc hilite" id="pm-discover" for="discover">
<input id="discover" type="radio" name="credit_card_type" value="D">
<span class="cclogo disc"> </span>
<span>Discover</span>
</label>
<label class="radio amex hilite" id="pm-amex" for="amex">
<input id="amex" type="radio" name="credit_card_type" value="A">
<span class="cclogo amex"> </span>
<span>American Express</span>
</label>
</div>
</fieldset>
<div id="fieldrowCCExpDate" class="opened">
<fieldset class="multi">
<legend class="accessAid">Expiration date</legend>
<span class="labels"><span class="label">Expiration date</span></span>
<div class="fields">
<span>
<p class="group first help">
<label for="expdate_month"><span class="accessAid">Month</span></label>
<span class="help">mm</span>
<span class="field restricted">
<input type="text" id="expdate_month" maxlength="2" class="restricted small" style="" name="expdate_month" value=""> /<br>
</span>
</p>
<p class="group help">
<label for="expdate_year"><span class="accessAid">Year</span></label>
<span class="help">yy</span>
<span class="field restricted">
<input type="text" id="expdate_year" maxlength="2" class="restricted small" style="" name="expdate_year" value="">
</span>
</p>
</span>
</div>
</fieldset>
</div>
<div id="fieldrowCSC" class="opened">
<p class="group">
<label for="cvv2_number">
<span class="labelText">CSC</span>
<a class="balloonControl" href="https://www.paypal.com/us/cgi-bin/merchantpaymentweb?cmd=#cvv2_number_panel">
<span>What is this?</span>
<span class="accessAid">For American Express, it's the four digits on the front of the card.For MasterCard, Visa or Discover, it's the last three digits in the signature area on the back of your card.</span>
</a>
</label>
<span class="field restricted"><input type="text" id="cvv2_number" maxlength="4" class="restricted small" name="cvv2_number" value=""></span>
</p>
<div class="balloonCallout jsHide accessAid" id="cvv2_number_panel">
<p class="amexCSCHelpTxt show">
<span class="cardIcon"></span>For American Express, it's the four digits on the front of the card.</p>
<p class="cscHelpTxt show"><span class="cardIcon"></span>For MasterCard, Visa or Discover, it's the last three digits in the signature area on the back of your card.</p>
</div>
</div>
<input type="hidden" id="cc_country_code" name="cc_country_code" value="US">
<input type="hidden" id="cc_brand" name="cc_brand" value="">
</div>
</form>
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