Card number

Exp.

<%= for ( ( map "0$_", 1 .. 9 ), 10 .. 12 ) { $OUT .= '$_\n"; } %>

/

<%= my @a = localtime; for ( $a[5]+1900 .. $a[5]+1915 ) { $OUT .= '$_\n"; } %>

<%= if ( $withcvv ) { $OUT .= qq!!; $OUT .= qq!CVV2 (help)!; $OUT .= qq!!; $OUT .= qq!!; } ''; %> Exact name on card Card billing address Address line 2 City

State

<%= for ( @states ) { $OUT .= '$_\n"; } %>

Zip