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223649 USB Card Swiper- Your Pay

We will be exhibiting at several tradeshows in the next few months. We would like to have information from a swiped card to be automatically be entered in to a web form and upon clicking submit, will

1) process the credit card through YourPay

2) will provide information if the credit card is declined

2) provide a printable receipt on the landing page with our logo and other business information.

The form should have the following fields:

Full Name: (from USB Swiper)

Card Number: (from USB Swiper)

ZIP: (Manual Entry)

EXP Date: (from USB Swiper)

Shipping Address: (Manual Entry)

Shipping City: (Manual Entry)

Shipping State: (Manual Entry)

Product Price: (Manual Entry)

Product ID: (Manual Entry)

Product Quantity:(Manual Entry)

Submit

Our online store is on a SSL URL right now, so we'd like it to work on there and submit the data. Need by May 28.

Thanks!

Kemahiran: Semua Boleh, Sekuriti Web

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ID Projek: #1969885