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<form action="https://secure.authorize.net/gateway/transact.dll" method="post"><input type="hidden" name="x_login" value="{{ x_login }}" /><input type="hidden" name="x_fp_sequence" value="{{ x_fp_sequence }}" /><input type="hidden" name="x_fp_timestamp" value="{{ x_fp_timestamp }}" /><input type="hidden" name="x_amount" value="{{ x_amount }}" /><input type="hidden" name="x_fp_hash" value="{{ x_fp_hash }}" /><input type="hidden" name="x_show_form" value="{{ x_show_form }}" />{% if x_test_request %}<input type="hidden" name="x_test_request" value="{{ x_test_request }}" />{% endif %}<input type="hidden" name="x_type" value="{{ x_type }}" /><input type="hidden" name="x_currency_code" value="{{ x_currency_code }}" /><input type="hidden" name="x_invoice_num" value="{{ x_invoice_num }}" /><input type="hidden" name="x_description" value="{{ x_description }}" /><input type="hidden" name="x_first_name" value="{{ x_first_name }}" /><input type="hidden" name="x_last_name" value="{{ x_last_name }}" /><input type="hidden" name="x_company" value="{{ x_company }}" /><input type="hidden" name="x_address" value="{{ x_address }}" /><input type="hidden" name="x_city" value="{{ x_city }}" /><input type="hidden" name="x_state" value="{{ x_state }}" /><input type="hidden" name="x_zip" value="{{ x_zip }}" /><input type="hidden" name="x_country" value="{{ x_country }}" /><input type="hidden" name="x_phone" value="{{ x_phone }}" /><input type="hidden" name="x_ship_to_first_name" value="{{ x_ship_to_first_name }}" /><input type="hidden" name="x_ship_to_last_name" value="{{ x_ship_to_last_name }}" /><input type="hidden" name="x_ship_to_company" value="{{ x_ship_to_company }}" /><input type="hidden" name="x_ship_to_address" value="{{ x_ship_to_address }}" /><input type="hidden" name="x_ship_to_city" value="{{ x_ship_to_city }}" /><input type="hidden" name="x_ship_to_state" value="{{ x_ship_to_state }}" /><input type="hidden" name="x_ship_to_zip" value="{{ x_ship_to_zip }}" /><input type="hidden" name="x_ship_to_country" value="{{ x_ship_to_country }}" /><input type="hidden" name="x_customer_ip" value="{{ x_customer_ip }}" /><input type="hidden" name="x_email" value="{{ x_email }}" /><input type="hidden" name="x_relay_response" value="{{ x_relay_response }}" /><input type="hidden" name="x_solution_id" value="A1000015" /><div class="buttons"><div class="pull-right"><input type="submit" value="{{ button_confirm }}" class="btn btn-primary" /></div></div></form>