<?php
$selMarketingCode = $_POST['selMarketingCode'];
$intIssueStart = $_POST['intIssueStart'];
$chkReceiveSpecialIssues = $_POST['chkReceiveSpecialIssues'];
$chkBinders = $_POST['chkBinders'];
$chkStands = $_POST['chkStands'];
$chkMarketingCode = $_POST['chkMarketingCode'];

$selTitle = $_POST['selTitle'];
$txtForename = $_POST['txtForename'];
$txtSurname = $_POST['txtSurname'];
$txtAddressLine1 = $_POST['txtAddressLine1'];
$txtAddressLine2 = $_POST['txtAddressLine2'];
$txtTown = $_POST['txtTown'];
$txtCounty = $_POST['txtCounty'];
$txtPostcode1 = $_POST['txtPostcode1'];
$txtPostcode2 = $_POST['txtPostcode2'];
$selCountry = $_POST['selCountry'];
$txtTelephone = $_POST['txtTelephone'];
$txtEmail = $_POST['txtEmail'];
$txtConfirmEmail = $_POST['txtConfirmEmail'];
$selDifferentDeliveryDetails = $_POST['selDifferentDeliveryDetails'];
$selDate_Day = $_POST['selDate_Day'];
$selDate_Month = $_POST['selDate_Month'];
$selDateOfBirth_Year = $_POST['selDateOfBirth_Year'];
$selSex = $_POST['selSex'];
$chkOtherCompanyPromotions = $_POST['chkOtherCompanyPromotions'];
$chkThisCompanyPromotions = $_POST['chkThisCompanyPromotions'];
$chkEmailMe = $_POST['chkEmailMe'];

$txtTelephone_Delivery = $_POST['txtTelephone_Delivery'];
$txtForename_Delivery = $_POST['txtForename_Delivery'];
$txtTown_Delivery = $_POST['txtTown_Delivery'];
$txtCounty_Delivery = $_POST['txtCounty_Delivery'];
$txtPostcode_Delivery1 = $_POST['txtPostcode_Delivery1'];
$txtPostcode_Delivery2 = $_POST['txtPostcode_Delivery2'];
$selTitle_Delivery = $_POST['selTitle_Delivery'];
$txtAddressLine1_Delivery = $_POST['txtAddressLine1_Delivery'];
$txtAddressLine2_Delivery = $_POST['txtAddressLine2_Delivery']; 
$txtSurname_Delivery = $_POST['txtSurname_Delivery'];
$selCountry_Delivery = $_POST['selCountry_Delivery'];

?>
<?php
$today = date("d/m/y");
?>
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1" />
<title>Your Subscription: Step 2 of 2</title>
<link href="./css/main.css" rel="stylesheet" type="text/css" />
<link href="./css/default.css" rel="stylesheet" type="text/css" />
<script language="javascript" type="text/javascript" src="./javascript/generic.js"></script>
<script language="javascript" type="text/javascript" src="./javascript/date.js"></script>
<script language="javascript" type="text/javascript" src="./javascript/validations.js"></script>

<script src="SpryAssets/SpryMenuBar.js" type="text/javascript"></script>
<link href="SpryAssets/SpryMenuBarHorizontal.css" rel="stylesheet" type="text/css" />

<!-- this bit of code creates todays date in the following format mmm-yyyy -->
<script>
<!-- 
var pageDateForExpiryDate;
// Array of month Names
var monthNames = new Array(
"Jan","Feb","Mar","Apr","May","Jun","Jul",
"Aug","Sep","Oct","Nov","Dec");

var now = new Date();
pageDateForExpiryDate = (monthNames[now.getMonth()] + "-" + now.getFullYear());

// -->
</script>
</head>

<body onload="subscriptionsPage2_onload();">
<script type="text/javascript" src="./javascript/wz_tooltip.js"></script> <!-- this loads the tooltip plugin -->
	<div id="wrapper">
		<div id="banner"><img src="images/top_banner.gif" alt="My Zoo Animals" /></div>
    <!-- this is the FAQ bit -->
    <p align="center">
     <table width="300" border="0" align="center">
      <tr>
        <td>      
      <ul id="MenuBar1" class="MenuBarHorizontal">
        <li><a class="MenuBarItemSubmenu" href="#">FAQ</a>
            <ul>
                          <li><a class="MenuBarItemSubmenu" href="#">How much does it cost to subscribe?</a>
                  <ul>
                    <li><a href="#">UK Price: Issue 1 is £0.99 and issue 2 onwards is £4.99.<br/> If you would like to subscribe you can do so via our subscribe page, or call our customer services team on 0845 155 6396.
                        </a></li>
                  </ul>
              </li>
                            <li><a class="MenuBarItemSubmenu" href="#">What methods of payments do you accept?</a>
                  <ul>
                    <li><a href="#">You can pay by Credit Card (Visa, Master Card, Delta, Solo, Visa Electron) or by Direct Debit.<br /> You can subscribe online via our subscription page, or call our customer services team on 0845 155 6396.</a></li>
                  </ul>
              </li>
                            <li><a class="MenuBarItemSubmenu" href="#">Can I get the free gifts without subscribing?</a>
                  <ul>
                    <li><a href="#">The gifts are exclusive to subscribers. If you would like to subscribe, you can do so via our subscription page, or call our customer services team on 0845 155 6396.</a></li>
                  </ul>
              </li>
                            <li><a class="MenuBarItemSubmenu" href="#">I have received the wrong issue/s.</a>
                  <ul>
                    <li><a href="#">We will replace all your issues with the correct copies. Please post your incorrect copies to the below address with a note including your name, address, subscriber number and which issues you should have received to:<br /> OSPREY'S BATTLES OF WORLD WAR II,<br /> Database Factory,<br />Unit 4 Pullman Business Park,<br /> Pullman Way,<br /> Ringwood, <br />Hampshire BH24 1HD.<br /> Alternatively you can call or email our Customer Services Team on 0845 155 6396 or zooanimals@dbfactory.co.uk.<br /> If you email the team, please include your name and subscription reference in the subject line.</a></li>
                  </ul>
              </li>
                            <li><a class="MenuBarItemSubmenu" href="#">I have not received all my issues, can you help? </a>
                  <ul>
                    <li><a href="#">Our Customer Services Team can sort this out for you.<br /> Please call or email our Customer Services Team on 0845 155 6396 or zooanimals@dbfactory.co.uk.<br />  If you email the team, please include your name and subscription reference in the subject line.</a></li>
                  </ul>
              </li>
                            <li><a class="MenuBarItemSubmenu" href="#">How do I cancel my subscription?</a>
                  <ul>
                    <li><a href="#">You can cancel at any time giving 28 days notice - please write to us at:<br /> OSPREY'S BATTLES OF WORLD WAR II,<br /> Database Factory,<br />Unit 4 Pullman Business Park,<br /> Pullman Way,<br /> Ringwood,<br /> Hampshire BH24 1HD or email our Customer Services Team on: zooanimals@dbfactory.co.uk or alternatively you can call our Customer Services Team on 0845 155 6396. <br />We just ask that you use up any remaining credit on your account.<br />  If you email the team, please include your name and subscription reference in the subject line.</a></li>
                  </ul>
              </li>
            
              <li><a class="MenuBarItemSubmenu" href="#">Is this website secure?</a>
                  <ul>
                    <li><a href="#">We use a Thawte 128-bit encryption system.</a></li>
                  </ul>
              </li>
              <li><a class="MenuBarItemSubmenu" href="#">When will my payment be taken?</a>
                  <ul>
                    <li><a href="#">If you pay by credit card the payment will be taken within the next 5 working days. If you pay by Direct Debit the payment will be taken in 13 days.</a></li>
                  </ul>
              </li>
              <li><a class="MenuBarItemSubmenu" href="#">How will my payments be processed?</a>
                  <ul>
                    <li><a href="#">Credit card payments are processed using Commedia one of the UK’s largest payment services provider, all details are ICP security encrypted. Direct Debits are processed though BACS (Bank Automated Clearing System). Payments will appear on your bank statements as RBA Magazines.</a></li>
                  </ul>
              </li>
              <li><a class="MenuBarItemSubmenu" href="#">Where will my personal details be stored?</a>
                  <ul>
                    <li><a href="#">All your personal details are stored in a secure data centre behind state of the art firewalls. Your payment details cannot be seen in full by our call centre agents, only managers can access this information when required. A full audit trail is kept throughout your subscription.</a></li>
                  </ul>
              </li>
              <li><a class="MenuBarItemSubmenu" href="#">How will I know when my order has been processed?</a>
                  <ul>
                    <li><a href="#">We will send you an immediate confirmation that you subscription request has been received and within the next 5 working days you will receive an e-mail or letter confirming your subscription is set up.</a></li>
                  </ul>
              </li>
              <li><a class="MenuBarItemSubmenu" href="#">When I subscribe am I committed to an ongoing subscription?</a>
                  <ul>
                    <li><a href="#">No, you are free to cancel at any time after your first payment.</a></li>
                  </ul>
              </li>
            </ul>
        </li>
      </ul>
      </td></tr>
	</table>
            
            </p>


		<div id="content">
			<h2><img src="images/Cart_2.png" alt="Payment Options" width="423" height="81" /></h2>
			
			
<!-- START bmbPageContent -->

<div id="bmbPageContent">
<form action="page3.php" method="post" name="frmSubscription" id="frmSubscription" onsubmit="return subscriptionsValidatePage2();">

<!-- START: renderFormData -->
<!-- stores form data from previous page(s) -->
<input name="selMarketingCode" id="selMarketingCode" type="hidden" value="<?php echo($selMarketingCode);?>" />
<input name="intIssueStart" id="intIssueStart" type="hidden" value="<?php echo($intIssueStart);?>" />
<input name="chkReceiveSpecialIssues" id="chkReceiveSpecialIssues" type="hidden" value="<?php echo($chkReceiveSpecialIssues);?>" />
<input name="chkBinders" id="chkBinders" type="hidden" value="<?php echo($chkBinders);?>" />
<input name="chkStands" id="chkStands" type="hidden" value="<?php echo($chkStands);?>" />
<input name="chkMarketingCode" id="chkMarketingCode" type="hidden" value="<?php echo($chkMarketingCode);?>" />

<input name="selTitle" id="selTitle" type="hidden" value="<?php echo($selTitle);?>" />
<input name="txtForename" id="txtForename" type="hidden" value="<?php echo($txtForename);?>" />
<input name="txtSurname" id="txtSurname" type="hidden" value="<?php echo($txtSurname);?>" />
<input name="txtAddressLine1" id="txtAddressLine1" type="hidden" value="<?php echo($txtAddressLine1);?>" />
<input name="txtAddressLine2" id="txtAddressLine2" type="hidden" value="<?php echo($txtAddressLine2);?>" />
<input name="txtTown" id="txtTown" type="hidden" value="<?php echo($txtTown);?>" />
<input name="txtCounty" id="txtCounty" type="hidden" value="<?php echo($txtCounty);?>" />
<input name="txtPostcode1" id="txtPostcode1" type="hidden" value="<?php echo($txtPostcode1);?>" />
<input name="txtPostcode2" id="txtPostcode2" type="hidden" value="<?php echo($txtPostcode2);?>" />
<input name="selCountry" id="selCountry" type="hidden" value="<?php echo($selCountry);?>" />
<input name="txtTelephone" id="txtTelephone" type="hidden" value="<?php echo($txtTelephone);?>" />
<input name="txtEmail" id="txtEmail" type="hidden" value="<?php echo($txtEmail);?>" />
<input name="txtConfirmEmail" id="txtConfirmEmail" type="hidden" value="<?php echo($txtConfirmEmail);?>" />
<input name="selDifferentDeliveryDetails" id="selDifferentDeliveryDetails" type="hidden" value="<?php echo($selDifferentDeliveryDetails);?>" />
<input name="selDate_Day" id="selDate_Day" type="hidden" value="<?php echo($selDate_Day);?>" />
<input name="selDate_Month" id="selDate_Month" type="hidden" value="<?php echo($selDate_Month);?>" />
<input name="selDateOfBirth_Year" id="selDateOfBirth_Year" type="hidden" value="<?php echo($selDateOfBirth_Year);?>" />
<input name="selSex" id="selSex" type="hidden" value="<?php echo($selSex);?>" />
<input name="chkOtherCompanyPromotions" id="chkOtherCompanyPromotions" type="hidden" value="<?php echo($chkOtherCompanyPromotions);?>" />
<input name="chkThisCompanyPromotions" id="chkThisCompanyPromotions" type="hidden" value="<?php echo($chkThisCompanyPromotions);?>" />
<input name="chkEmailMe" id="chkEmailMe" type="hidden" value="<?php echo($chkEmailMe);?>" />

<input name="txtTelephone_Delivery" id="txtTelephone_Delivery" type="hidden" value="<?php echo($txtTelephone_Delivery);?>" />
<input name="txtForename_Delivery" id="txtForename_Delivery" type="hidden" value="<?php echo($txtForename_Delivery);?>" />
<input name="txtTown_Delivery" id="txtTown_Delivery" type="hidden" value="<?php echo($txtTown_Delivery);?>" />
<input name="txtCounty_Delivery" id="txtCounty_Delivery" type="hidden" value="<?php echo($txtCounty_Delivery);?>" />
<input name="txtPostcode_Delivery1" id="txtPostcode_Delivery1" type="hidden" value="<?php echo($txtPostcode_Delivery1);?>" />
<input name="txtPostcode_Delivery2" id="txtPostcode_Delivery2" type="hidden" value="<?php echo($txtPostcode_Delivery2);?>" />
<input name="selTitle_Delivery" id="selTitle_Delivery" type="hidden" value="<?php echo($selTitle_Delivery);?>" />
<input name="txtAddressLine1_Delivery" id="txtAddressLine1_Delivery" type="hidden" value="<?php echo($txtAddressLine1_Delivery);?>" />
<input name="txtAddressLine2_Delivery" id="txtAddressLine2_Delivery" type="hidden" value="<?php echo($txtAddressLine2_Delivery);?>" />
<input name="txtSurname_Delivery" id="txtSurname_Delivery" type="hidden" value="<?php echo($txtSurname_Delivery);?>" />
<input name="selCountry_Delivery" id="selCountry_Delivery" type="hidden" value="<?php echo($selCountry_Delivery);?>" />
<!-- END: renderFormData -->



<!-- START: renderDropDown() -->
<div class="bmbSelect">
  <label class="selPaymentMethodLabel" for="selPaymentMethod">How would you like to pay?</label>
    <select name="selPaymentMethod" id="selPaymentMethod" class="" onchange="selPaymentMethod_Changed(this.id, this.value);">

      <option value="--------">--------</option>
      <option value="Visa/Visa_Delta">Visa/Visa Delta/Visa Electron</option>
      <option value="Maestro">Solo</option>
	  <option value="MasterCard">MasterCard</option>
	  <option value="Direct_Debit">Direct Debit</option>
    </select>
</div>
<!-- END: renderDropDown() -->

<div id="creditCard">
<div class="logoImages"><img src="./images/visaLogo.gif"/><img src="./images/deltaLogo.gif" /><img src="./images/electronLogo.gif" /></div>
<!-- START: renderTextBox() -->
<div class="bmbTextBox">
  <label for="txtCardNumber"><span class="requiredField">*</span> Card Number</label>
    <input name="txtCardNumber" id="txtCardNumber" class="" type="text" value="" maxlength="" />
</div>
<!-- END: renderTextBox() -->


<div class="bmbDateSelect">

<!-- START: renderDropDown() -->
<div class="bmbSelect">
  <label class="selExpiry_MonthLabel" for="selExpiry_Month"><span class="requiredField">*</span> Expiry Date</label>
    <select name="selExpiry_Month" id="selExpiry_Month" class="" onchange="">
      <option value="Jan">Jan</option>
      <option value="Feb">Feb</option>
      <option value="Mar">Mar</option>

      <option value="Apr">Apr</option>
      <option value="May">May</option>
      <option value="Jun">Jun</option>
      <option value="Jul">Jul</option>
      <option value="Aug">Aug</option>
      <option value="Sep">Sep</option>

      <option value="Oct">Oct</option>
      <option value="Nov">Nov</option>
      <option value="Dec">Dec</option>
    </select>
</div>
<!-- END: renderDropDown() -->



<!-- START: renderDropDown() -->

<div class="bmbSelect">
  <label class="selExpiry_YearLabel" for="selExpiry_Year"></label>
    <select name="selExpiry_Year" id="selExpiry_Year" class="" onchange="">
      <option value="2015">2015</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>      
    </select>

</div>
<!-- END: renderDropDown() -->
</div>


<!-- START: renderTextBox() -->
<div class="bmbTextBox">
  <label for="txtCvsNumber"><span class="requiredField">*</span> 3 Digit Security Number </label>
    <input name="txtCvsNumber" id="txtCvsNumber" class="textBoxSmall" type="text" value="" maxlength="" /> 
	What's this? <img height="17px" width="26px" src="./images/security_digits.gif" onmousemove="Tip('<img src=\'./images/security_digits.gif\' width=\'262px\' height=\'170px\'>')"/>
</div>
<!-- END: renderTextBox() -->

</div>

<div id="visaElectron">
<div class="logoImages"><img src="./images/electronLogo.jpg" /></div>
<!-- START: renderTextBox() -->
<div class="bmbTextBox">
  <label for="txtVisaElectronCardNumber"><span class="requiredField">*</span> Card Number</label>
    <input name="txtVisaElectronCardNumber" id="txtVisaElectronCardNumber" class="" type="text" value="" maxlength="" />
</div>
<!-- END: renderTextBox() -->

<div class="bmbDateSelect">

<!-- START: renderDropDown() -->
<div class="bmbSelect">
  <label class="selVisaElectronExpiry_MonthLabel" for="selVisaElectronExpiry_Month"><span class="requiredField">*</span> Expiry Date</label>
    <select name="selVisaElectronExpiry_Month" id="selVisaElectronExpiry_Month" class="" onchange="">
      <option value="Jan">Jan</option>
      <option value="Feb">Feb</option>

      <option value="Mar">Mar</option>
      <option value="Apr">Apr</option>
      <option value="May">May</option>
      <option value="Jun">Jun</option>
      <option value="Jul">Jul</option>
      <option value="Aug">Aug</option>

      <option value="Sep">Sep</option>
      <option value="Oct">Oct</option>
      <option value="Nov">Nov</option>
      <option value="Dec">Dec</option>
    </select>
</div>
<!-- END: renderDropDown() -->


<!-- START: renderDropDown() -->
<div class="bmbSelect">
  <label class="selVisaElectronExpiry_YearLabel" for="selVisaElectronExpiry_Year"></label>
    <select name="selVisaElectronExpiry_Year" id="selVisaElectronExpiry_Year" class="" onchange="">
      <option value="2015">2015</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>

    </select>
</div>
<!-- END: renderDropDown() -->
</div>


<!-- START: renderTextBox() -->
<div class="bmbTextBox">
  <label for="txtVisaElectronCvsNumber"><span class="requiredField">*</span>  3 Digit  Security Number</label>
    <input name="txtVisaElectronCvsNumber" id="txtVisaElectronCvsNumber" class="textBoxSmall" type="text" value="" maxlength="" />
	What's this? <img height="17px" width="26px" src="./images/security_digits.gif" onmousemove="Tip('<img src=\'./images/security_digits.gif\' width=\'262px\' height=\'170px\'>')"/>
</div>

<!-- END: renderTextBox() -->


</div>

<div id="mastercard">
<div class="logoImages"><img src="./images/mastercardLogo.gif" /></div>
<!-- START: renderTextBox() -->
<div class="bmbTextBox">
  <label for="txtMasterCardCardNumber"><span class="requiredField">*</span> Card Number</label>
    <input name="txtMasterCardCardNumber" id="txtMasterCardCardNumber" class="" type="text" value="" maxlength="" />
</div>

<!-- END: renderTextBox() -->


<div class="bmbDateSelect">

<!-- START: renderDropDown() -->
<div class="bmbSelect">
  <label class="selMasterCardExpiry_MonthLabel" for="selMasterCardExpiry_Month"><span class="requiredField">*</span> Expiry Date</label>
    <select name="selMasterCardExpiry_Month" id="selMasterCardExpiry_Month" class="" onchange="">
      <option value="Jan">Jan</option>

      <option value="Feb">Feb</option>
      <option value="Mar">Mar</option>
      <option value="Apr">Apr</option>
      <option value="May">May</option>
      <option value="Jun">Jun</option>
      <option value="Jul">Jul</option>

      <option value="Aug">Aug</option>
      <option value="Sep">Sep</option>
      <option value="Oct">Oct</option>
      <option value="Nov">Nov</option>
      <option value="Dec">Dec</option>
    </select>

</div>
<!-- END: renderDropDown() -->



<!-- START: renderDropDown() -->
<div class="bmbSelect">
  <label class="selMasterCardExpiry_YearLabel" for="selMasterCardExpiry_Year"></label>
    <select name="selMasterCardExpiry_Year" id="selMasterCardExpiry_Year" class="" onchange="">
      <option value="2015">2015</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>
    </select>
</div>
<!-- END: renderDropDown() -->
</div>


<!-- START: renderTextBox() -->
<div class="bmbTextBox">
  <label for="txtMasterCardCvsNumber"><span class="requiredField">*</span>  3 Digit  Security Number</label>

    <input name="txtMasterCardCvsNumber" id="txtMasterCardCvsNumber" class="textBoxSmall" type="text" value="" maxlength="" /> 
	What's this? <img height="17px" width="26px" src="./images/security_digits.gif" onmousemove="Tip('<img src=\'./images/security_digits.gif\' width=\'262px\' height=\'170px\'>')"/>
</div> 
<!-- END: renderTextBox() -->


</div>

<div id="maestroCard">
<div class="logoImages"><img src="./images/soloLogo.gif" /></div>
<!-- START: renderTextBox() -->
<div class="bmbTextBox">
  <label for="txtMaestroCardNumber"><span class="requiredField">*</span> Card Number</label>

    <input name="txtMaestroCardNumber" id="txtMaestroCardNumber" class="" type="text" value="" maxlength="" />
</div>
<!-- END: renderTextBox() -->


<div class="bmbDateSelect">

<!-- START: renderDropDown() -->
<div class="bmbSelect">
  <label class="selMaestroValidFrom_MonthLabel" for="selMaestroValidFrom_Month"><span class="requiredField">*</span> Valid From Date</label>
    <select name="selMaestroValidFrom_Month" id="selMaestroValidFrom_Month" class="" onchange="">

      <option value="Jan">Jan</option>
      <option value="Feb">Feb</option>
      <option value="Mar">Mar</option>
      <option value="Apr">Apr</option>
      <option value="May">May</option>
      <option value="Jun">Jun</option>

      <option value="Jul">Jul</option>
      <option value="Aug">Aug</option>
      <option value="Sep">Sep</option>
      <option value="Oct">Oct</option>
      <option value="Nov">Nov</option>
      <option value="Dec">Dec</option>

    </select>
</div>
<!-- END: renderDropDown() -->




<!-- START: renderDropDown() -->
<div class="bmbSelect">
  <label class="selMaestroValidFrom_YearLabel" for="selMaestroValidFrom_Year"></label>
    <select name="selMaestroValidFrom_Year" id="selMaestroValidFrom_Year" class="" onchange="">
      <option value="2009">2009</option>
      <option value="2010">2010</option>
      <option value="2011">2011</option>
      <option value="2012">2012</option>
      <option value="2013">2013</option>
      <option value="2014">2014</option>
      <option value="2015">2015</option>
    </select>
</div>
<!-- END: renderDropDown() -->
</div>

<div class="bmbDateSelect">

<!-- START: renderDropDown() -->
<div class="bmbSelect">
  <label class="selMaestroExpiry_MonthLabel" for="selMaestroExpiry_Month"><span class="requiredField">*</span> Expiry Date</label>

    <select name="selMaestroExpiry_Month" id="selMaestroExpiry_Month" class="" onchange="">
      <option value="Jan">Jan</option>
      <option value="Feb">Feb</option>
      <option value="Mar">Mar</option>
      <option value="Apr">Apr</option>
      <option value="May">May</option>

      <option value="Jun">Jun</option>
      <option value="Jul">Jul</option>
      <option value="Aug">Aug</option>
      <option value="Sep">Sep</option>
      <option value="Oct">Oct</option>
      <option value="Nov">Nov</option>

      <option value="Dec">Dec</option>
    </select>
</div>
<!-- END: renderDropDown() -->



<!-- START: renderDropDown() -->
<div class="bmbSelect">
  <label class="selMaestroExpiry_YearLabel" for="selMaestroExpiry_Year"></label>
    <select name="selMaestroExpiry_Year" id="selMaestroExpiry_Year" class="" onchange="">
      <option value="2015">2015</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>
    </select>
</div>
<!-- END: renderDropDown() -->
</div>


<!-- START: renderTextBox() -->
<div class="bmbTextBox">
  <label for="txtMaestroCardIssueNumber"><span class="requiredField">*</span> Issue Number</label>

    <input name="txtMaestroCardIssueNumber" id="txtMaestroCardIssueNumber" class="textBoxSmall" type="text" value="" maxlength="" />
</div>
<!-- END: renderTextBox() -->



<!-- START: renderTextBox() -->
<div class="bmbTextBox">
  <label for="txtMaestroCvsNumber"><span class="requiredField">*</span>  3 Digit  Security Number</label>
    <input name="txtMaestroCvsNumber" id="txtMaestroCvsNumber" class="textBoxSmall" type="text" value="" maxlength="" />
	What's this? <img height="17px" width="26px" src="./images/security_digits.gif" onmousemove="Tip('<img src=\'./images/security_digits.gif\' width=\'262px\' height=\'170px\'>')"/>
</div>

<!-- END: renderTextBox() -->


</div>

<!-- Previous DD code

<div id="directDebit1">
<div class="ddImage">
<table width="405" border="0">
  <tr>
    <th width="40%" scope="col"><img src="./images/directDebitLogo.gif" /></th>
    <th scope="col"><img border="1" height="102px" width="250px" src="./images/EM guarantee_Neg.jpg" onmousemove="Tip('<img src=\'./images/EM guarantee_Neg.jpg\' width=\'779px\' height=\'317px\'>')"/><br /><div align="center"><a style="font-size:10px"> Direct Debit Guarantee<br />(mouse over to zoom...) </a></div></th>
  </tr>
</table>
</div>


<div class="bmbTextBox">
  <label for="txtBankName"><span class="requiredField">*</span> Bank Name</label>
    <input name="txtBankName" id="txtBankName" class="" type="text" value="" maxlength="" />
</div>


<div class="bmbTextBox">
  <label for="txtAccountNumber"><span class="requiredField">*</span> Account Number</label>
    <input name="txtAccountNumber" id="txtAccountNumber" class="" type="text" value="" maxlength="8" />
</div>




<div class="bmbTextBox">
  <label for="txtSortCode"><span class="requiredField">*</span> Sort Code</label>
    <input name="txtSortCode" id="txtSortCode" class="" type="text" value="" maxlength="6" />
</div>

<div class="bmbTextBox">

  <label for="txtAccountHolderName"><span class="requiredField">*</span> Account Holder's Name</label>
    <input name="txtAccountHolderName" id="txtAccountHolderName" class="" type="text" value="" maxlength="" />
</div>

</div> -->

<div id="directDebit">
<div class="ddImage">
<table width="412" border="0">
  <tr>
    <th width="40%" scope="col"><img src="./images/directDebitLogo.gif" /></th>
    <th scope="col"><img border="1" height="97px" width="250px" src="./images/RBA_guarantee.jpg" onmousemove="Tip('<img src=\'./images/RBA_guarantee.jpg\' width=\'767px\' height=\'296px\'>')"/><br /><div align="center"><a style="font-size:10px"> Direct Debit Guarantee<br />(mouse over to zoom...) </a></div></th>
  </tr>
</table>
</div>
<!-- this is the table for the input -->
<div> Please fill in the following information:
<br/><b>Confirm you are the account holder?</b>
<br/><b>Bank Name,</b>
<br/><b>Account Holders Name,</b>
<br/><b>Sort Code,</b>
<br/><b>Account number,</b>
<br/>in the boxes below.
</div>
        <div class="bmbCheckBox"> 
          <label>
          <input name="chkDD" id="chkDD" type="checkbox" value="N" onclick="value='Y'" />
			Are you the account holder and the only person required to authorise direct debits on this account?
			</label>
        </div>
  		<table align="center" width="412px" height="396px" border="0" background="./images/RBA_DDI_New_Neg.gif">
                <tr>
                  <th scope="col">
                  <td style="font-size:15px; font-family:Arial, Helvetica, sans-serif; color:#FFF" align="left" >Database Factory re RBA Colectionables SA -<span style="font-size:9px; font-family:Arial, Helvetica, sans-serif; color:#FFF">My Zoo Animals</span></td></th>
                </tr>
                <tr>
                  <td width="7">&nbsp;</td>
                  <!-- this is the indent -->
                  <td style="font-size:9px; font-family:Arial, Helvetica, sans-serif; color:#FFF;" align="left">FREEPOST Plus RRBR-UYAC-BJCK</td>
                </tr>

                <tr>
                  <td width="7">&nbsp;</td>
                  <!-- this is the indent -->
                  <td valign="top"><p>
                    <font size="1" style="font-family:Arial, Helvetica, sans-serif; color:#FFF"><strong>Name of Account Holder:</strong></font>
                    <label for="txtAccountHolderName"><span class="requiredInput">
                      <input name="txtAccountHolderName" id="txtAccountHolderName" class="requiredInput" type="text" value="Acc Holders Name" maxlength="" onfocus="value=''" />
                    </span></label></p>
                    <font size="1" style="font-family:Arial, Helvetica, sans-serif; color:#FFF"><strong>Account Number:</strong></font>
                    <label for="txtAccountNumber"><span class="requiredField">
                      <input name="txtAccountNumber" id="txtAccountNumber" class="requiredInput" type="text" value="Acc/No" maxlength="8" onfocus="value=''"/>
                    </span></label>
                    <p>
                    <font size="1" style="font-family:Arial, Helvetica, sans-serif; color:#FFF"><strong>Branch Sort Code:</strong></font>
                    <label for="txtSortCode" ><span class="requiredInput">
                      <input name="txtSortCode" id="txtSortCode" class="requiredInput" type="text" value="S/Code" maxlength="6" onfocus="value=''" />
                    </span></label></p></td>
                </tr>
           		 <tr>
                  <td width="7">&nbsp;</td>
                  <!-- this is the indent -->
                  <td></td>
                </tr>
           		 <tr>
                  <td width="7">&nbsp;</td>
                  <!-- this is the indent -->
                  <td><font size="1" style="font-family:Arial, Helvetica, sans-serif; color:#FFF"><strong>To The Manager</strong></font></td>
                </tr>                
                <tr>
                  <td></td>
                  <td valign="top"><font size="1" style="font-family:Arial, Helvetica, sans-serif; color:#FFF"><strong>Bank or Building Society:</strong></font>
                    <label for="txtBankName"><span class="">
                      <input name="txtBankName" id="txtBankName" class="requiredInput" type="text" value="Bank Name" maxlength="" onfocus="value=''" />
                    </span></label></td>
                  <td align="center"><input name="date" id="date" class="requiredInput" type="text" readonly="readonly" maxlength="10" value="<?php echo $today ?>"/></td>
                </tr>
            <tr>
              <td width="7">&nbsp;</td>
              <!-- this is the indent -->
              <td></td>
              <td width="220" align="center"></td>
            </tr>
            <tr>
              <td></td>
              <td></td>
              <td></td>
            </tr>
          </table>


</div>

<!-- START: renderRolloverSubmitButton() -->
<div id="submitImage">
  <input name="imgBtnSubmit" id="imgBtnSubmit" type="image" src="images/submit_info_up.gif" alt="Click button to Submit Information" title="Click button to Submit Information" onmouseout="MM_swapImgRestore()" onmouseover="MM_swapImage('imgBtnSubmit','','images/submit_info_over.gif',1)" />

</div>
<!-- END: renderRolloverSubmitButton() -->
  </form>
</div>
<div>
	<div id="footer">
	<a> This site is provided by </a><a href="http://www.dbfactory.co.uk">Data Base Factory Ltd</a><a> on behalf of </a>RBA Coleccionables S.A
	<br />
	<a> If you have any problems ordering please call 0344 472 5240 for assistance.</a>
	<br />
	<a> This site is protected by Thawte using 128bit encryption for your security.</a>
	<br />
	<br />
	<!-- this is the Thawte site seal -->
	<table width="10" border="0" cellspacing="0" align="center">
 <tr>
  <td>
   <script src="https://siteseal.thawte.com/cgi/server/thawte_seal_generator.exe"></script>
  </td>
 </tr>
 <tr>
  <td height="0" align="center">
   <a style="color:#AD0034" target="_new"
   href="http://www.thawte.com/digital-certificates/">
   <span style="font-family:arial; font-size:8px; color:#AD0034">
   ABOUT SSL CERTIFICATES</span>
   </a>
  </td>
 </tr>
</table>
<!-- this is the end of the Thawte site seal code -->
	<br />
	<table align="center" width="100" border="0">
  <tr>
    <th scope="col"><img src="./images/visaLogo.gif" /></th>
    <th scope="col"><img src="./images/mastercardLogo.gif" /></th>
    <th scope="col"><img src="./images/DeltaLogo.gif" /></th>
    <th scope="col"><img src="./images/electronLogo.gif" /></th>		
    <th scope="col"><img src="./images/directdebitLogo2.gif"/></th>
	<th scope="col">&nbsp;</th>
	<th scope="col">&nbsp;</th>
	<th scope="col">&nbsp;</th>
	<th scope="col">&nbsp;</th>
	<th scope="col">&nbsp;</th>

  </tr>
</table>
<!-- this is the end of the Thawte site seal code -->
	<br />
	<a> &copy; 2015</a>
</div>
</div>
<!-- END bmbPageContent -->

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</body>
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