[MM_Form type=”checkout”]

[MM_Form_Message type=”error”]

[MM_Form_Data name=”productName”]

[MM_Form_Data name=”productDescription”]

Membership Price: [MM_Form_Data name=”productPrice”]

Discount: [MM_Form_Data name=”discount”]

Total Price: [MM_Form_Data name=”totalPrice”] [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]

Enter your payment details: [fusion_popover title=”Secured Site” title_bg_color=”#2B99FF” content=”We take your security seriously.We safeguard your payment information with SSL (Secure Sockets Layer) when sent over the Internet. SSL encrypts personal information, including your name and payment information, so that it cannot be read in transit by a third party. We also store your payment information in an encrypted format.” content_bg_color=”#ffffff” bordercolor=”#ffffff” textcolor=”black” trigger=”hover” placement=”right” class=”secure” id=””]

(Secured)

[/fusion_popover]

Visa, Master Card, American Express, Discover

 

 

[MM_Form_Section type=”accountInfo”] Account Information:
 

First Name: [MM_Form_Field type=”input” name=”firstName”] Last Name: [MM_Form_Field type=”input” name=”lastName”] Email: [MM_Form_Field type=”input” name=”email”] Password:
[MM_Form_Field type=”input” name=”password”] [MM_Form_Field type=”hidden” name=”phone”] [/MM_Form_Section] [MM_Form_Section type=”billingInfo”] [MM_Form_Field type=’hidden’ name=”billingAddress”] [MM_Form_Field type=’hidden’ name=”billingCity”] [MM_Form_Field type=’hidden’ name=”billingState”] [MM_Form_Field type=’hidden’ name=”billingZipCode”] [MM_Form_Field type=’hidden’ name=”billingCountry”]

Credit Card Number:[MM_Form_Field name=”ccNumber”]  

Exp. Date: [MM_Form_Field name=”ccExpirationDate”]  

Security Code: [MM_Form_Field name=”ccSecurityCode”] [/MM_Form_Section]

[MM_Form_Button type=’all’ label=’Submit Order’ color=’orange’]

[/MM_Form]