<form id="paymentDetailsForm" name="paymentDetailsForm" action="https://secure.net-a-porter.com/psp/payment" method="POST">
<input id="paymentSessionId" name="paymentSessionId" type="hidden" value="a530fe50d17324e5a822b3bc020ccd28">
<input id="redirectUrl" name="redirectUrl" type="hidden" value="https://www.net-a-porter.com/ca/en/purchasepath.nap?execution=e1s3&_eventId=processPayment&submittedToken=bc9d9248-dae1-44d7-be4e-f1ae5a493bfb&pspPaymentSessionId=a530fe50d17324e5a822b3bc020ccd28">
<input id="customerId" name="customerId" type="hidden" value="0">
<input id="site" name="site" type="hidden" value="nap_am">
<input id="adminId" name="adminId" type="hidden" value="0">
<div class="sectionheader" id="payment_header">
<h2 id="enter_payment_details_heading">
4. ENTER PAYMENT DETAILS
</h2>
</div>
<a id="cardform"></a>
<div class="section" id="cc_errors">
<div class="section" id="cc_errors_ul">
</div>
</div>
<div class="silver payment-info-note">
<p><strong>Please note</strong> that the value of your order will only be charged to your card at the time of delivery</p>
</div>
<div class="section card-form" id="ccard_form">
<div class="payment-form-container">
<input name="savedCard" value="false" type="hidden">
<div id="ccfield_large_icons" class="ccfield-choose">
<div class="cc-card-wrap">
<div class="cc-type type-visa">
<label for="visa"> <span title="Visa" class="card-icon card-icon-visa"></span> </label>
<input type="radio" value="VISA" id="visa" title="Visa" name="cardType" checked="checked">
</div>
<div class="cc-type type-mastercard">
<label for="mastercard"> <span title="Mastercard" class="card-icon card-icon-mastercard"></span> </label>
<input type="radio" value="MASTERCARD" id="mastercard" title="MasterCard" name="cardType">
</div>
<div class="cc-type type-amex">
<label for="amex"> <span title="American Express" class="card-icon card-icon-amex"></span> </label>
<input type="radio" value="AMEX" id="amex" title="American Express" name="cardType">
</div>
<div class="cc-type">
<h3 class="payment-or">or</h3>
</div>
</div>
<div class="cc-paypal-wrap">
<div class="cc-type type-paypal">
<label for="paypal">
<span title="PayPal" class="card-icon card-icon-paypal"></span>
</label>
<input type="radio" value="PAYPAL" id="paypal" title="PayPal" name="cardType">
</div>
</div>
<span id="selectCardError" class="paymentError error"></span>
</div>
<div id="card-detail-fields">
<table>
<tbody>
<tr class="error-line">
<td class="form-label"></td>
<td>
<span id="cardError" class="paymentError error"></span>
<span id="cardErrorMobile" class="paymentErrorMobile error"></span>
</td>
</tr>
<tr class="field_row">
<td class="form-label">
<label for="card_number">Card Number*</label>
</td>
<td>
<input type="tel" name="cardNumber" size="35" class="text form-field" id="card_number" value="" placeholder="">
</td>
</tr>
<tr class="error-line">
<td class="form-label"></td>
<td>
<span id="nameError" class="paymentError error"></span>
<span id="nameErrorMobile" class="paymentErrorMobile error"></span>
</td>
</tr>
<tr class="field_row">
<td class="form-label">
<label for="cardholders_name">Name on card*</label>
</td>
<td>
<input name="cardHoldersName" size="35" id="cardholders_name" class="text form-field" type="text" placeholder="">
</td>
</tr>
<tr class="error-line">
<td class="form-label"></td>
<td>
<span id="cvsError" class="paymentError error"></span>
<span id="cvsErrorMobile" class="paymentErrorMobile error"></span>
</td>
</tr>
<tr class="field_row">
<td class="form-label">
<label for="security_number">Security Number*</label>
</td>
<td>
<input type="tel" name="cVSNumber" maxlength="4" size="3" id="security_number" class="security_number" placeholder="">
<a id="cc-security-link" class="text-link" onclick="launchPopUp( this.href, 455, 350); return false;" href="http://www.net-a-porter.com/am/content.nap?page=Card-Security-Code&pgForward=popup" title="What is the security number?">
What is this?
</a>
</td>
</tr>
<tr class="error-line">
<td class="form-label"></td>
<td>
<span id="expiryError" class="paymentError error"></span>
<span id="expiryErrorMobile" class="paymentErrorMobile error"></span>
</td>
</tr>
<tr class="field_row">
<td class="form-label expiry-date">
<label for="expiry_month">Expiry Date*</label>
</td>
<td>
<select name="expiryMonth" class="date form-field" id="expiry_month">
<option value="">Month</option>
<option value="01">01</option>
<option value="02">02</option>
<option value="03">03</option>
<option value="04">04</option>
<option value="05">05</option>
<option value="06">06</option>
<option value="07">07</option>
<option value="08">08</option>
<option value="09">09</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
</select>
<select name="expiryYear" class="date form-field" id="expiryYear">
<option value="">Year</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
<option value="25">25</option>
<option value="26">26</option>
<option value="27">27</option>
</select>
</td>
</tr>
<tr class="empty-line"></tr>
<tr>
<td>
<input type="hidden" name="keepCard" value="false">
</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
<div class="section pp-box">
<div id="purchase_path_back_button">
<a href="//www.net-a-porter.com/ca/en/purchasepath.nap?execution=e1s3&_eventId=back" class="secondary-button">Back</a>
</div>
<input type="submit" name="_eventId_processPayment" id="processPayment" class="inlineright primary-button" value="Purchase Now">
</div>
</form>
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