[MM_Form_Data name=’productDescription’]
[MM_Form_Section type=’accountInfo’]
[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=’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’]
We accept all major credit cards
[MM_Form_Field name=’ccNumber’ customAttributes=’placeholder=”Credit Card Number”‘]
[MM_Form_Field name=’ccSecurityCode’ customAttributes=’placeholder=”Security Code”‘]
[MM_Form_Field name=’ccExpirationDate’]
[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 County/State”‘]
[MM_Form_Field name=’billingZipCode’ customAttributes=’placeholder=”Billing Postcode or Zip Code”‘]
[MM_Form_Field name=’billingCountry’]
[MM_Form_Section type=”coupon”]
Coupon Code: [MM_Form_Field name=”couponCode”]
[MM_Form_Message type=”couponSuccess”]
[MM_Form_Message type=”couponError”]
Apply Coupon
[/MM_Form_Section]
[MM_Form_Button type=’all’ label=’Order Now’ color=’customsubmitbutton’]
[/MM_Form]