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one page credit card processing using [url removed, login to view]

I am looking to have a single page "secure payment form" that can process a payment ($99.90) via [url removed, login to view] on my webpage. I would like it to be a secure (SSL) connection and auth/decline codes displayed (approved, declined,address mismatch street/zip, cvv mismatch). I need this form to be in a webpage.

I would like the form to include:

First Name

Last Name

Billing:

Street Address

City

State

Zip

Shipping:

Street Address

City

State

Zip

Phone Number

Email

Credit Card Type (Master Card/Visa/Discover/American Express)

Credit Card #

Credit Card Expiration

Credit Card CVV Code

Submit/Reset buttons

once order is submitted email should go out to admin and a thank you email to user

here is the design for the form. something like this.

[url removed, login to view]

Skills: PHP

See more: webpage design codes, visa php payment, thank you card design, pending credit, order express, design for name card, credit one, i decline, a credit card number, visa card, thank you card, street 3, php credit, phone card, Payment processing, payment card, order processing, discover , credit, credit card#, credit card processing, code name one, charge charge card, authorize credit card, auth

About the Employer:
( 25 reviews ) Shippensburg, United States

Project ID: #548728

8 freelancers are bidding on average $66 for this job

NetzPro

We are ready to start working on this project. Kindly refer the PMB for details. Thanks.

$50 USD in 1 day
(352 Reviews)
8.6
agstech123

Hi, please check PMB to know more about our technical expertise and capabilities. Regards

$100 USD in 2 days
(12 Reviews)
6.0
hindusthanJOBS

we are expert in payment gateway [url removed, login to view]::---------------------Hindusthan Development

$31 USD in 1 day
(1 Review)
3.4
nitinjjn

Please see PM.

$50 USD in 1 day
(0 Reviews)
0.0
mediavince

PHP/MySQL developer highly experienced with CMS, E-commerce and custom projects implementation. Communication is key. Please check PMB, cheers!

$200 USD in 2 days
(0 Reviews)
0.0
orchidtree

I have worked with [url removed, login to view] API's and can have your page up and working quickly! Please don't hesitate to contact me! Best regards, Bret Hash

$40 USD in 1 day
(0 Reviews)
0.0
dreamwings

Hello sir We are a web developing team named "Dreamwings", studied your notes. We are interested to do this project. If you are interested to work with us we will make a plan of work and send to you. If you More

$30 USD in 1 day
(0 Reviews)
0.0
sailu27cw

Hi! I have gone through your requirement and i am glad that i can accomplish this task, i would be more interested to speak to you on IM. Pls give us an opportunity to work with you.

$30 USD in 2 days
(0 Reviews)
0.0