<form id="silentOrderPostForm" name="silentOrderPostForm" class="payment-container checkoutProcess clearfix" action="/checkout/multi/sop-response" method="POST" onsubmit="usb2cCmCreateConversionEventTagPaypal()">
<div class="fields" id="cardForm" style="display:block">
<p class="italic smallCopy reqFields">
Required Fields<sup>*</sup>
</p>
<div class="field">
<div class="control-group">
<label class="control-label " for="card_firstNameOnCard">
First Name<sup>*</sup>
<span class="errorMsg"></span>
</label>
<div class="controls field">
<input id="card_firstNameOnCard" name="card_firstNameOnCard" type="text" value="">
</div>
</div>
</div>
<div class="field">
<div class="control-group">
<label class="control-label " for="card_lastNameOnCard">
Last Name<sup>*</sup>
<span class="errorMsg"></span>
</label>
<div class="controls field">
<input id="card_lastNameOnCard" name="card_lastNameOnCard" type="text" value="">
</div>
</div>
</div>
<input id="card_nameOnCard" name="card_nameOnCard" type="hidden" value=""><div class="field">
<div class="control-group">
<label class="control-label " for="card_accountNumber">
Card Number<sup>*</sup>
<span class="errorMsg"></span>
</label>
<div class="controls field">
<input id="card_accountNumber" name="card_accountNumber" type="text" value="">
</div>
</div>
</div>
<div class="field with-cc-icons">
<div class="hidden" id="card_cardType_injected_error">
Please select a Card Type
</div>
<div class="control-group">
<label class="control-label " for="card_cardType">
Card Type<span class="errorMsg"></span>
</label>
<div class="controls field">
<select id="card_cardType" name="card_cardType" class="selectTagClass dd " style="display: none;">
<option value="" disabled="disabled" selected="selected">Please select a card type</option>
<option value="003">American Express</option>
<option value="004">Discover</option>
<option value="001">Visa</option>
<option value="002">Mastercard</option>
</select><div class="chosen-container chosen-container-single chosen-container-single-nosearch" style="width: 247px;" title="" id="card_cardType_chosen"><a class="chosen-single" tabindex="-1"><span>Please select a card type</span><div><b></b></div></a><div class="chosen-drop"><div class="chosen-search"><input type="text"></div><ul class="chosen-results"></ul></div></div>
</div>
</div>
<div id="cardTypeImage" class="icons-co-credit-cards-container">
<a class="cc icons-co-visa" data-select-cc="">Visa</a>
<a class="cc icons-co-mc" data-select-cc="">Mastercard</a>
<a class="cc icons-co-amex" data-select-cc="">American Express</a>
<a class="cc icons-co-disc" data-select-cc="">Discover</a>
</div>
</div>
<div class="field expDate clearfix">
<label>Expiration Date<sup>*</sup></label><br>
<div id="" class="expMp clearfix">
<div class="control-group">
<select id="ExpiryMonth" name="card_expirationMonth" class="dd" style="display: none;">
<option value="" disabled="disabled" selected="selected">Month</option>
<option value="1">01</option>
<option value="2">02</option>
<option value="3">03</option>
<option value="4">04</option>
<option value="5">05</option>
<option value="6">06</option>
<option value="7">07</option>
<option value="8">08</option>
<option value="9">09</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
</select><div class="chosen-container chosen-container-single" style="width: 150px;" title="" id="ExpiryMonth_chosen"><a class="chosen-single" tabindex="-1"><span>Month</span><div><b></b></div></a><div class="chosen-drop"><div class="chosen-search"><input type="text"></div><ul class="chosen-results"></ul></div></div>
</div>
</div>
<div id="" class="expYear clearfix">
<div class="control-group">
<select id="ExpiryYear" name="card_expirationYear" class="dd" style="display: none;">
<option value="" disabled="disabled" selected="selected">Year</option>
<option value="2016">2016</option>
<option value="2017">2017</option>
<option value="2018">2018</option>
<option value="2019">2019</option>
<option value="2020">2020</option>
<option value="2021">2021</option>
<option value="2022">2022</option>
<option value="2023">2023</option>
<option value="2024">2024</option>
<option value="2025">2025</option>
<option value="2026">2026</option>
</select><div class="chosen-container chosen-container-single" style="width: 150px;" title="" id="ExpiryYear_chosen"><a class="chosen-single" tabindex="-1"><span>Year</span><div><b></b></div></a><div class="chosen-drop"><div class="chosen-search"><input type="text"></div><ul class="chosen-results"></ul></div></div>
</div>
</div>
</div>
<div class="field secCode clearfix">
<div class="control-group">
<label class="control-label " for="card_cvNumber">
Security Code<sup>*</sup>
<span class="errorMsg"></span>
</label>
<div class="controls field">
<input id="card_cvNumber" name="card_cvNumber" type="text" value="">
</div>
</div>
<div class="circle-link-image info">
<span class="hover icons-info">
<span class="icons-info-over"></span>
</span>
<div class="msg">
The card security code is located on the back of MasterCard, Visa and Discover credit or debit cards and is typically a separate group of 3 digits to the right of the signature strip. On American Express cards, the card security code is a printed, not embossed, group of four digits on the front towards the right.
</div>
</div>
</div>
<span id="submit_silentOrderPostForm_Checkout" class="btn-box btn-orange continue">CONTINUE TO REVIEW ORDER</span>
</form>
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