[MM_Form type=’checkout’] [MM_Form_Message type=’error’]
[MM_Form_Section type=’accountInfo’]

Step 1: Account Info

[MM_Form_Field type=’input’ name=’firstName’ customAttributes=’placeholder=”First Name”‘]

[MM_Form_Field type=’input’ name=’lastName’ customAttributes=’placeholder=”Last Name”‘]

[MM_Form_Field type=’custom’ id=’1′ customAttributes=’placeholder=”COSA.123456″‘]

[MM_Form_Field type=’input’ name=’email’ customAttributes=’placeholder=”Email Address”‘]

[MM_Form_Field type=’input’ name=’password’ customAttributes=’placeholder=”Password”‘]

[MM_Form_Field type=’input’ name=’phone’ isRequired=’false’ customAttributes=’placeholder=”Phone Number”‘]

[/MM_Form_Section] [MM_Form_Section type=’billingInfo’]

Step 2: Billing Address

[MM_Form_Field name=’billingAddress’ customAttributes=’placeholder=”Billing Address”‘]

[MM_Form_Field name=’billingCity’ customAttributes=’placeholder=”Billing City”‘]

[MM_Form_Field name=’billingState’ customAttributes=’placeholder=”Billing State”‘]

[MM_Form_Field name=’billingZipCode’ customAttributes=’placeholder=”Billing Zip/Postal Code”‘]

[MM_Form_Field name=’billingCountry’]

Step 3: Billing Details

Visa, Master Card, American Express, Discover

[MM_Form_Field name=’ccNumber’ customAttributes=’placeholder=”Credit Card Number”‘]

[MM_Form_Field name=’ccSecurityCode’ customAttributes=’placeholder=”Security Code”‘]

[MM_Form_Field name=’ccExpirationDate’]

PLEASE REVIEW YOUR SHOPPING CART

PRODUCT QUANTITY UNIT PRICE
[MM_Form_Data name=’productName’] 1 [MM_Form_Data name=’productPriceDescription’]
Total Today: [MM_Form_Data name=’totalPrice’]
[MM_Form_Button type=’all’ label=’Submit Order’ color=’green’]

By completing your purchase, you agree to the Terms & Conditions

[/MM_Form_Section]

[MM_Form_Section type=’coupon’]

Coupons

[MM_Form_Field name=’couponCode’] Apply Coupon

[MM_Form_Message type=’couponSuccess’] [MM_Form_Message type=’couponError’]

[/MM_Form_Section]

[MM_Form_Data name=’productName’ useAccessName=’false’]

[MM_Form_Data name=’productDescription’]

[MM_Form_Field type=’custom’ id=’9′ name=’#’ placeholder=’#’] [MM_Form_Field type=’custom’ id=’8′ name=’— Pending Activation —‘ placeholder=’— Pending Activation —‘] [MM_Form_Field type=’custom’ id=’7′ placeholder=’— Pending Activation —”] [MM_Form_Field type=’custom’ id=’5′ placeholder=’— Pending Activation —‘]
[/MM_Form]