Test for Manuel Lemos's PHP form class
E
-mail address
:
Credit card
n
umber
:
Credit card t
y
pe
:
Unknown
Master Card
Visa
American Express
Diners Club
Carte Blanche
Discover
enRoute
JCB
P
ersonal name
:
A
ge
:
W
eight
:
Acce
s
s name
:
Passwor
d
:
C
onfirm password
:
Password
r
eminder phrase
:
Receive notification when approved by:
E-
m
ail
P
h
one
Subscription type:
Adm
i
nistrator
U
ser
G
uest
Agree with the
t
erms
: