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(Empty) | |
| 1 <form action="/ticket/addcard.do" method="post" id="payment_new"> |
| 2 <div class="dmethod"> |
| 3 <input type="hidden" name="newcard" value="1"> |
| 4 <input type="hidden" name="dest" value="/tmloggedin.do"> |
| 5 |
| 6 <div class="center"><img src="/styles/tmus/amex_parity_mini.gif" alt="credit
cards"> |
| 7 |
| 8 |
| 9 <img src="/styles/tmus/visa_parity_mini.gif" alt="creditcards"> |
| 10 <img src="/styles/tmus/mc_parity_mini.gif" alt="creditcards"> |
| 11 <img src="/styles/tmus/diners_parity_mini.gif" alt="creditcards"> |
| 12 <img src="/styles/tmus/discover_network_parity_mini.gif" alt="creditcards"
> |
| 13 </div> |
| 14 |
| 15 <label>Card Issuer</label> |
| 16 <select name="cardissuer"> |
| 17 <option value="">Select Card Type</option> |
| 18 <option value="AMEX">American Express</option> |
| 19 <option value="VISA">VISA</option> |
| 20 <option value="MC">MasterCard</option> |
| 21 <option value="DISCOVER">Discover Network</option> |
| 22 <option value="DINERS">Diners Club</option> |
| 23 </select><br> |
| 24 <label>Your cardnumber</label> |
| 25 <input name="cardnumber" type="text" pattern="[0-9]*" placeholder="Your 16 d
igit number"> |
| 26 <fieldset class="expiration"> |
| 27 <label><strong id="new_credit_card_expire_heading">Expiration Date</strong
> |
| 28 </label> |
| 29 <select id="expire_month" name="expire_month"> |
| 30 <option value="">Month</option> |
| 31 <option value="1">1</option> |
| 32 <option value="2">2</option> |
| 33 <option value="3">3</option> |
| 34 <option value="4">4</option> |
| 35 <option value="5">5</option> |
| 36 <option value="6">6</option> |
| 37 <option value="7">7</option> |
| 38 <option value="8">8</option> |
| 39 <option value="9">9</option> |
| 40 <option value="10">10</option> |
| 41 <option value="11">11</option> |
| 42 <option value="12">12</option> |
| 43 </select> |
| 44 |
| 45 <select id="expire_year" name="expire_year"> |
| 46 <option value="">Year</option> |
| 47 <option value="2015">2015</option> |
| 48 <option value="2016">2016</option> |
| 49 <option value="2017">2017</option> |
| 50 <option value="2018">2018</option> |
| 51 <option value="2019">2019</option> |
| 52 <option value="2020">2020</option> |
| 53 <option value="2021">2021</option> |
| 54 <option value="2022">2022</option> |
| 55 <option value="2023">2023</option> |
| 56 <option value="2024">2024</option> |
| 57 <option value="2025">2025</option> |
| 58 <option value="2026">2026</option> |
| 59 <option value="2027">2027</option> |
| 60 <option value="2028">2028</option> |
| 61 <option value="2029">2029</option> |
| 62 </select> |
| 63 |
| 64 </fieldset> |
| 65 </div> |
| 66 |
| 67 <div class="dmethod"> |
| 68 <span class="info" title="= Fields marked with an * are required">* = Requir
ed Text</span> |
| 69 |
| 70 <div class="smalltext">Enter the credit card billing address and name exactl
y as it appears on your credit card statement. |
| 71 </div> |
| 72 |
| 73 <div class="billInfo"> |
| 74 <fieldset> |
| 75 |
| 76 <div class="formline"> |
| 77 <label for="first_name" id="address_form_label_first_name">First Name
<span class="requiredText">*</span> </label> |
| 78 <input type="text" name="firstname" id="first_name" size="35" maxlengt
h="80"> |
| 79 |
| 80 </div> |
| 81 <div class="formline"> |
| 82 <label for="last_name" id="address_form_label_last_name">Last Name <sp
an class="requiredText">*</span> </label> |
| 83 <input type="text" name="lastname" id="last_name" size="35" maxlength=
"80"> |
| 84 </div> |
| 85 <div class="formline"> |
| 86 <label for="address1">Address |
| 87 <span class="requiredText">*</span> </label> |
| 88 <input type="text" size="35" maxlength="30" name="address1" id="addres
s1"></div> |
| 89 <div class="formline"> <span id="unit_title_span"><label for="unit">Unit
#</label></span> |
| 90 |
| 91 <span id="unit_input_span"><input type="text" size="10" name="unit" id
="unit"></span> <span id="unit_optional_span" class="txt11">(Optional)</span> |
| 92 </div> |
| 93 <div class="formline"> |
| 94 <label for="address2"><span id="address2_title_span">Address Line 2</s
pan></label> |
| 95 <input type="text" size="35" name="address2" id="address2"> |
| 96 </div> |
| 97 <div class="formline"> |
| 98 <label for="city"><span id="city_title_span">City <
/span> <span class="requiredText">*</span> </label> |
| 99 <input type="text" name="city" id="city" size="35"> |
| 100 <span class="info">Military Address? Enter APO or FPO.</span> |
| 101 </div> |
| 102 |
| 103 <div class="formline"> |
| 104 <label for="state_id"><span id="state_title_span">State
</span> <span class="requiredText">*</span> </label> |
| 105 <span id="state_input_span"> |
| 106 <select name="state" id="state_id"> |
| 107 <option value="">-- Select State |
| 108 -- |
| 109 </option> |
| 110 <option value="AL">Alabama</option> |
| 111 <option value="AK">Alaska</option> |
| 112 <option value="AS">American Samoa</option> |
| 113 <option value="AZ">Arizona</option> |
| 114 <option value="AR">Arkansas</option> |
| 115 <option value="AA">Armed Forces Americas</option> |
| 116 <option value="AE">Armed Forces Other</option> |
| 117 <option value="AP">Armed Forces Pacific</option> |
| 118 <option value="CA">California</option> |
| 119 <option value="CO">Colorado</option> |
| 120 <option value="CT">Connecticut</option> |
| 121 <option value="DE">Delaware</option> |
| 122 <option value="DC">District Of Columbia</option> |
| 123 <option value="FM">Federated States Of Micronesia</option> |
| 124 <option value="FL">Florida</option> |
| 125 <option value="GA">Georgia</option> |
| 126 <option value="GU">Guam</option> |
| 127 <option value="HI">Hawaii</option> |
| 128 <option value="ID">Idaho</option> |
| 129 <option value="IL">Illinois</option> |
| 130 <option value="IN">Indiana</option> |
| 131 <option value="IA">Iowa</option> |
| 132 <option value="KS">Kansas</option> |
| 133 <option value="KY">Kentucky</option> |
| 134 <option value="LA">Louisiana</option> |
| 135 <option value="ME">Maine</option> |
| 136 <option value="MH">Marshall Islands</option> |
| 137 <option value="MD">Maryland</option> |
| 138 <option value="MA">Massachusetts</option> |
| 139 <option value="MI">Michigan</option> |
| 140 <option value="MN">Minnesota</option> |
| 141 <option value="MS">Mississippi</option> |
| 142 <option value="MO">Missouri</option> |
| 143 <option value="MT">Montana</option> |
| 144 <option value="NE">Nebraska</option> |
| 145 <option value="NV">Nevada</option> |
| 146 <option value="NH">New Hampshire</option> |
| 147 <option value="NJ">New Jersey</option> |
| 148 <option value="NM">New Mexico</option> |
| 149 <option value="NY">New York</option> |
| 150 <option value="NC">North Carolina</option> |
| 151 <option value="ND">North Dakota</option> |
| 152 <option value="MP">Northern Mariana Islands</option> |
| 153 <option value="OH">Ohio</option> |
| 154 <option value="OK">Oklahoma</option> |
| 155 <option value="OR">Oregon</option> |
| 156 <option value="PW">Palau</option> |
| 157 <option value="PA">Pennsylvania</option> |
| 158 <option value="PR">Puerto Rico</option> |
| 159 <option value="RI">Rhode Island</option> |
| 160 <option value="SC">South Carolina</option> |
| 161 <option value="SD">South Dakota</option> |
| 162 <option value="TN">Tennessee</option> |
| 163 <option value="TX">Texas</option> |
| 164 <option value="UT">Utah</option> |
| 165 <option value="VT">Vermont</option> |
| 166 <option value="VI">Virgin Islands</option> |
| 167 <option value="VA">Virginia</option> |
| 168 <option value="WA">Washington</option> |
| 169 <option value="WV">West Virginia</option> |
| 170 <option value="WI">Wisconsin</option> |
| 171 <option value="WY">Wyoming</option> |
| 172 </div> |
| 173 <div class="formline"> |
| 174 <label for="postal_code"><span id="zip_title_span">ZIP Code</span><spa
n class="requiredText">*</span> |
| 175 </label> |
| 176 |
| 177 <input type="text" name="zip" id="postal_code" size="35" autocapitaliz
e="off" autocomplete="off"> |
| 178 </div> |
| 179 <div class="formline"> |
| 180 <label for="country">Country |
| 181 <span class="requiredText">*</span> |
| 182 </label> |
| 183 <select name="country" id="countrylist"> |
| 184 <option value="ad">Andorra</option> |
| 185 <option value="ae">United Arab Emirates</option> |
| 186 <option value="af">Afghanistan</option> |
| 187 <option value="ag">Antigua and Barbuda</option> |
| 188 <option value="ai">Anguilla</option> |
| 189 <option value="al">Albania</option> |
| 190 <option value="am">Armenia</option> |
| 191 <option value="an">Netherlands Antilles</option> |
| 192 <option value="ao">Angola</option> |
| 193 <option value="ap">Asia/Pacific Region</option> |
| 194 <option value="aq">Antarctica</option> |
| 195 <option value="ar">Argentina</option> |
| 196 <option value="as">American Samoa</option> |
| 197 <option value="at">Austria</option> |
| 198 <option value="au">Australia</option> |
| 199 |
| 200 <option value="aw">Aruba</option> |
| 201 <option value="ax">Aland Islands</option> |
| 202 <option value="az">Azerbaijan</option> |
| 203 <option value="ba">Bosnia and Herzegovina</option> |
| 204 <option value="bb">Barbados</option> |
| 205 <option value="bd">Bangladesh</option> |
| 206 <option value="be">Belgium</option> |
| 207 <option value="bf">Burkina Faso</option> |
| 208 <option value="bg">Bulgaria</option> |
| 209 <option value="bh">Bahrain</option> |
| 210 <option value="bi">Burundi</option> |
| 211 <option value="bj">Benin</option> |
| 212 <option value="bm">Bermuda</option> |
| 213 <option value="bn">Brunei Darussalam</option> |
| 214 <option value="bo">Bolivia</option> |
| 215 <option value="br">Brazil</option> |
| 216 <option value="bs">Bahamas</option> |
| 217 <option value="bt">Bhutan</option> |
| 218 <option value="bv">Bouvet Island</option> |
| 219 <option value="bw">Botswana</option> |
| 220 <option value="by">Belarus</option> |
| 221 <option value="bz">Belize</option> |
| 222 <option value="ca">Canada</option> |
| 223 <option value="cc">Cocos (Keeling) Islands</option> |
| 224 <option value="cd">Congo The Democratic Republic of the</option> |
| 225 <option value="cf">Central African Republic</option> |
| 226 <option value="cg">Congo</option> |
| 227 <option value="ch">Switzerland</option> |
| 228 <option value="ci">Cote d'Ivoire</option> |
| 229 <option value="ck">Cook Islands</option> |
| 230 <option value="cl">Chile</option> |
| 231 <option value="cm">Cameroon</option> |
| 232 <option value="cn">China</option> |
| 233 <option value="co">Colombia</option> |
| 234 <option value="cr">Costa Rica</option> |
| 235 <option value="cu">Cuba</option> |
| 236 <option value="cv">Cape Verde</option> |
| 237 <option value="cx">Christmas Island</option> |
| 238 <option value="cy">Cyprus</option> |
| 239 <option value="cz">Czech Republic</option> |
| 240 <option value="de">Germany</option> |
| 241 <option value="dj">Djibouti</option> |
| 242 <option value="dk">Denmark</option> |
| 243 <option value="dm">Dominica</option> |
| 244 <option value="do">Dominican Republic</option> |
| 245 <option value="dz">Algeria</option> |
| 246 <option value="ec">Ecuador</option> |
| 247 <option value="ee">Estonia</option> |
| 248 <option value="eg">Egypt</option> |
| 249 <option value="eh">Western Sahara</option> |
| 250 <option value="er">Eritrea</option> |
| 251 <option value="es">Spain</option> |
| 252 <option value="et">Ethiopia</option> |
| 253 <option value="eu">Europe</option> |
| 254 <option value="fi">Finland</option> |
| 255 <option value="fj">Fiji</option> |
| 256 <option value="fk">Falkland Islands (Malvinas)</option> |
| 257 <option value="fm">Micronesia Federated States of</option> |
| 258 <option value="fo">Faroe Islands</option> |
| 259 <option value="fr">France</option> |
| 260 <option value="ga">Gabon</option> |
| 261 <option value="gb">United Kingdom</option> |
| 262 <option value="gd">Grenada</option> |
| 263 <option value="ge">Georgia</option> |
| 264 <option value="gf">French Guiana</option> |
| 265 <option value="gg">Guernsey</option> |
| 266 <option value="gh">Ghana</option> |
| 267 <option value="gi">Gibraltar</option> |
| 268 <option value="gl">Greenland</option> |
| 269 <option value="gm">Gambia</option> |
| 270 <option value="gn">Guinea</option> |
| 271 <option value="gp">Guadeloupe</option> |
| 272 <option value="gq">Equatorial Guinea</option> |
| 273 <option value="gr">Greece</option> |
| 274 <option value="gs">South Georgia and the South Sandwich Islands</opt
ion> |
| 275 <option value="gt">Guatemala</option> |
| 276 <option value="gu">Guam</option> |
| 277 <option value="gw">Guinea-Bissau</option> |
| 278 <option value="gy">Guyana</option> |
| 279 <option value="hk">Hong Kong</option> |
| 280 <option value="hm">Heard Island and McDonald Islands</option> |
| 281 <option value="hn">Honduras</option> |
| 282 <option value="hr">Croatia</option> |
| 283 <option value="ht">Haiti</option> |
| 284 <option value="hu">Hungary</option> |
| 285 <option value="id">Indonesia</option> |
| 286 <option value="ie">Ireland</option> |
| 287 <option value="il">Israel</option> |
| 288 <option value="im">Isle of Man</option> |
| 289 <option value="in">India</option> |
| 290 <option value="io">British Indian Ocean Territory</option> |
| 291 <option value="iq">Iraq</option> |
| 292 <option value="ir">Iran Islamic Republic of</option> |
| 293 <option value="is">Iceland</option> |
| 294 <option value="it">Italy</option> |
| 295 <option value="je">Jersey</option> |
| 296 <option value="jm">Jamaica</option> |
| 297 <option value="jo">Jordan</option> |
| 298 <option value="jp">Japan</option> |
| 299 <option value="ke">Kenya</option> |
| 300 <option value="kg">Kyrgyzstan</option> |
| 301 <option value="kh">Cambodia</option> |
| 302 <option value="ki">Kiribati</option> |
| 303 <option value="km">Comoros</option> |
| 304 <option value="kn">Saint Kitts and Nevis</option> |
| 305 <option value="kp">Korea Democratic People's Republic of</option> |
| 306 <option value="kr">Korea Republic of</option> |
| 307 <option value="kw">Kuwait</option> |
| 308 <option value="ky">Cayman Islands</option> |
| 309 <option value="kz">Kazakhstan</option> |
| 310 <option value="la">Lao People's Democratic Republic</option> |
| 311 <option value="lb">Lebanon</option> |
| 312 <option value="lc">Saint Lucia</option> |
| 313 <option value="li">Liechtenstein</option> |
| 314 <option value="lk">Sri Lanka</option> |
| 315 <option value="lr">Liberia</option> |
| 316 <option value="ls">Lesotho</option> |
| 317 <option value="lt">Lithuania</option> |
| 318 <option value="lu">Luxembourg</option> |
| 319 <option value="lv">Latvia</option> |
| 320 <option value="ly">Libyan Arab Jamahiriya</option> |
| 321 <option value="ma">Morocco</option> |
| 322 <option value="mc">Monaco</option> |
| 323 <option value="md">Moldova Republic of</option> |
| 324 <option value="me">Montenegro</option> |
| 325 <option value="mg">Madagascar</option> |
| 326 <option value="mh">Marshall Islands</option> |
| 327 <option value="mk">Macedonia</option> |
| 328 <option value="ml">Mali</option> |
| 329 <option value="mm">Myanmar</option> |
| 330 <option value="mn">Mongolia</option> |
| 331 <option value="mo">Macao</option> |
| 332 <option value="mp">Northern Mariana Islands</option> |
| 333 <option value="mq">Martinique</option> |
| 334 <option value="mr">Mauritania</option> |
| 335 <option value="ms">Montserrat</option> |
| 336 <option value="mt">Malta</option> |
| 337 <option value="mu">Mauritius</option> |
| 338 <option value="mv">Maldives</option> |
| 339 <option value="mw">Malawi</option> |
| 340 <option value="mx">Mexico</option> |
| 341 <option value="my">Malaysia</option> |
| 342 <option value="mz">Mozambique</option> |
| 343 <option value="na">Namibia</option> |
| 344 <option value="nc">New Caledonia</option> |
| 345 <option value="ne">Niger</option> |
| 346 <option value="nf">Norfolk Island</option> |
| 347 <option value="ng">Nigeria</option> |
| 348 <option value="ni">Nicaragua</option> |
| 349 <option value="nl">Netherlands</option> |
| 350 <option value="no">Norway</option> |
| 351 <option value="np">Nepal</option> |
| 352 <option value="nr">Nauru</option> |
| 353 <option value="nu">Niue</option> |
| 354 <option value="nz">New Zealand</option> |
| 355 <option value="om">Oman</option> |
| 356 <option value="pa">Panama</option> |
| 357 <option value="pe">Peru</option> |
| 358 <option value="pf">French Polynesia</option> |
| 359 <option value="pg">Papua New Guinea</option> |
| 360 <option value="ph">Philippines</option> |
| 361 <option value="pk">Pakistan</option> |
| 362 <option value="pl">Poland</option> |
| 363 <option value="pm">Saint Pierre and Miquelon</option> |
| 364 <option value="pn">Pitcairn</option> |
| 365 <option value="pr">Puerto Rico</option> |
| 366 <option value="ps">Palestinian Territory</option> |
| 367 <option value="pt">Portugal</option> |
| 368 <option value="pw">Palau</option> |
| 369 <option value="py">Paraguay</option> |
| 370 <option value="qa">Qatar</option> |
| 371 <option value="re">Reunion</option> |
| 372 <option value="ro">Romania</option> |
| 373 <option value="rs">Serbia</option> |
| 374 <option value="ru">Russian Federation</option> |
| 375 <option value="rw">Rwanda</option> |
| 376 <option value="sa">Saudi Arabia</option> |
| 377 <option value="sb">Solomon Islands</option> |
| 378 <option value="sc">Seychelles</option> |
| 379 <option value="sd">Sudan</option> |
| 380 <option value="se">Sweden</option> |
| 381 <option value="sg">Singapore</option> |
| 382 <option value="sh">Saint Helena</option> |
| 383 <option value="si">Slovenia</option> |
| 384 <option value="sj">Svalbard and Jan Mayen</option> |
| 385 <option value="sk">Slovakia</option> |
| 386 <option value="sl">Sierra Leone</option> |
| 387 <option value="sm">San Marino</option> |
| 388 <option value="sn">Senegal</option> |
| 389 <option value="so">Somalia</option> |
| 390 <option value="sr">Suriname</option> |
| 391 <option value="st">Sao Tome and Principe</option> |
| 392 <option value="sv">El Salvador</option> |
| 393 <option value="sy">Syrian Arab Republic</option> |
| 394 <option value="sz">Swaziland</option> |
| 395 <option value="tc">Turks and Caicos Islands</option> |
| 396 <option value="td">Chad</option> |
| 397 <option value="tf">French Southern Territories</option> |
| 398 <option value="tg">Togo</option> |
| 399 <option value="th">Thailand</option> |
| 400 <option value="tj">Tajikistan</option> |
| 401 <option value="tk">Tokelau</option> |
| 402 <option value="tl">Timor-Leste</option> |
| 403 <option value="tm">Turkmenistan</option> |
| 404 <option value="tn">Tunisia</option> |
| 405 <option value="to">Tonga</option> |
| 406 <option value="tr">Turkey</option> |
| 407 <option value="tt">Trinidad and Tobago</option> |
| 408 <option value="tv">Tuvalu</option> |
| 409 <option value="tw">Taiwan</option> |
| 410 <option value="tz">Tanzania United Republic of</option> |
| 411 <option value="ua">Ukraine</option> |
| 412 <option value="ug">Uganda</option> |
| 413 <option selected="" value="us">United States</option> |
| 414 <option value="um">United States Minor Outlying Islands</option> |
| 415 <option value="uy">Uruguay</option> |
| 416 <option value="uz">Uzbekistan</option> |
| 417 <option value="va">Holy See (Vatican City State)</option> |
| 418 <option value="vc">Saint Vincent and the Grenadines</option> |
| 419 <option value="ve">Venezuela</option> |
| 420 <option value="vg">Virgin Islands British</option> |
| 421 <option value="vi">Virgin Islands U.S.</option> |
| 422 <option value="vn">Vietnam</option> |
| 423 <option value="vu">Vanuatu</option> |
| 424 <option value="wf">Wallis and Futuna</option> |
| 425 <option value="ws">Samoa</option> |
| 426 <option value="ye">Yemen</option> |
| 427 <option value="yt">Mayotte</option> |
| 428 <option value="za">South Africa</option> |
| 429 <option value="zm">Zambia</option> |
| 430 <option value="zw">Zimbabwe</option> |
| 431 </select> |
| 432 |
| 433 </div> |
| 434 <div class="formline"> |
| 435 <label for="phone3"><span id="phone3_mobile_phone">Mobile Phone</span>
<span class="requiredText">*</span></label> |
| 436 <input type="number" pattern="[0-9]*" name="phonenumber" id="phone3" s
ize="35" maxlength="140"> |
| 437 </div> |
| 438 </fieldset> |
| 439 |
| 440 </div> |
| 441 </div> |
| 442 <div class="pc"> |
| 443 <div class="smalltext">Your order may be canceled without notice if you do n
ot use the exact billing address of your credit card.<br> |
| 444 |
| 445 <strong>Age Restrictions</strong><br> |
| 446 If you are under 13 years old you cannot provide us with any information a
bout yourself. If you fill in this form, you represent that you are at least 13
years old. |
| 447 </div> |
| 448 </div> |
| 449 <div class="pc"> |
| 450 <input type="submit" class="btn btn-primarycta btn-large" value="Save Card"> |
| 451 <br><em>You will not be charged</em> |
| 452 </div> |
| 453 </form> |
OLD | NEW |