PayJunction Test

T-shirt Order Form

Choose your T-shirt

product

Jazz Red $ 5.00

Quantity Size

product

Sax $ 4.00

Size Quantity

product

Jazz Purple $ 3.00

Size Quantity

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Should be Empty:

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