Payment Page Needed

Avg Bid (USD)
Project Budget (USD)
$30 - $250

Project Description:
we need a simple payment screen that mirrors the exact payment page:

Please fill out the above form to see how it works.

The initial form will carry all of the 4 fields to the second page and the client will then fill out their credit card information and billing information. If the payment is approved the purchaser will be send to a confirmation page, if the payment is denied they will be notified as well.

All of the data will be sent to an email address with the purchase details.

Our gateway is Authorize.NET and the Merchant is ready to go. We need this done in PHP, as asp is not part of the hosting package.

Skills required:
About the employer:
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