[Your_Business_Name] Secure Payment Form     Example of how to include Membership options on the form Check box to Accept Membership Terms Item Code Description Price Select 1 Membership A US$ 40.00 2 Membership B US$ 60.00 3 Membership C US$ 80.00 Example of Rebilling option ATTENTION Your credit card will be rebilled automatically at the end of the selected period. This is to guarantee you continuity of service. Please input a password below and complete the card details. Do not rebill my card automatically US$ 40.00 US$ 60.00 US$ 80.00 Yes, please bill my card monthly US$ 120.00 US$ 180.00 US$ 240.00 Yes, please bill my card quarterly Password to change details (4-10 characters) Customer may stop, change frequency, change expiry date etc. using password and order number. Login Next please complete your card details on a secure server