<form action="https://www.paypal.com/cgi-bin/webscr" method="post" target="_top"><!-- [et_pb_line_break_holder] --><input type="hidden" name="cmd" value="_xclick"><!-- [et_pb_line_break_holder] --><input type="hidden" name="business" value="FWQ86Y3GNLBPW"><!-- [et_pb_line_break_holder] --><input type="hidden" name="lc" value="CA"><!-- [et_pb_line_break_holder] --><input type="hidden" name="item_name" value="Loyalty Reading Pre-Payment"><!-- [et_pb_line_break_holder] --><input type="hidden" name="item_number" value="10"><!-- [et_pb_line_break_holder] --><input type="hidden" name="amount" value="150.00"><!-- [et_pb_line_break_holder] --><input type="hidden" name="currency_code" value="USD"><!-- [et_pb_line_break_holder] --><input type="hidden" name="button_subtype" value="services"><!-- [et_pb_line_break_holder] --><input type="hidden" name="no_note" value="0"><!-- [et_pb_line_break_holder] --><input type="hidden" name="cn" value="Add special message to Angie:"><!-- [et_pb_line_break_holder] --><input type="hidden" name="no_shipping" value="1"><!-- [et_pb_line_break_holder] --><input type="hidden" name="undefined_quantity" value="1"><!-- [et_pb_line_break_holder] --><input type="hidden" name="bn" value="PP-BuyNowBF:btn_paynow_LG.gif:NonHosted"><!-- [et_pb_line_break_holder] --><input type="hidden" name="discount_rate" value="0"><!-- [et_pb_line_break_holder] --><input type="image" src="https://www.paypalobjects.com/en_US/i/btn/btn_paynow_LG.gif" border="0" name="submit" alt="PayPal - The safer, easier way to pay online!"><!-- [et_pb_line_break_holder] --><img alt="" border="0" src="https://www.paypalobjects.com/en_US/i/scr/pixel.gif" width="1" height="1"><!-- [et_pb_line_break_holder] --></form><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <!-- the discount input --><!-- [et_pb_line_break_holder] --> <label>Enter Coupon Code</label><!-- [et_pb_line_break_holder] --> <input type="text" id="coup" name="code" value=""><!-- [et_pb_line_break_holder] --><input id="Coupon" type="button" value="Submit" onclick="checkCode(document.getElementById('coup').value)" /><!-- [et_pb_line_break_holder] -->