WELCOME TO THE DEMO STORE!
THIS IS FOR DEMONSTRATION PURPOSES ONLY.        This is a demonstration of NationWide Real-Time eCommerce STANDARD FORM  technology.   The customer's name, address, email address, and account information are all requested on the merchant's site.

	PRODUCT DESCRIPTION		PRICE

	Octane Laptop XL34			$2,275.95
	Intel 233 MHz Pentium 4.1GB Hard Drive 4MB Video RAM Internal 20X CD-ROM		64MB EDO RAM TV-Out Port 13.3" TFT/DSTN 16-bit Stereo Sound
	Select to Order  | Quantity: 12345678910

	PRODUCT DESCRIPTION		PRICE

	THX Workstation			$2,385.95
	Intel Pentium 32MB Sychronous DRAM 3.2GB Hard Drive QWE 3D Grahics Card 2MB SDRAM		17" CRT .28dp Monitor 33.6 Fax Modem 16-bit PCI Sound Card Enhanced Software Collection titles
	Select to Order  | CPU Speed: 166 MHz200 MHz233 MHz Increase Monitor to 19 inch (Add $300.00) Add 32 MB RAM (64 MB total) (Add $40.00)

	PRODUCT DESCRIPTION		PRICE

	Stellar EXC+ Server			$4,102.00
	Intel 333 MHz Pentium II Intel Triton 440FX Chipset 9.4GB SCSI Hard Disk 30X IDE CD-ROM 128MB EDO RAM		17" Flat Screen .28NI Monitor 240W Stereo Speakers MS Windows NT/Office 56K Fax/Modem w/Voice 3-Year On-Site Warranty
	Select to Order  | Case Color: WhiteTanDark GreenBlack 56k Sportster Modem (Add $65.00) 400 MHz Processor (Add $249.95)

GENERAL INFORMATION

First Name:	Last Name:
Address:
City:	State: Zip:
Country:
Phone Number:
E-Mail Address:

CREDIT CARD PAYMENT OPTION Card Number: Exp. Date: 010203040506070809101112 19981999200020012002200320042005 Demo Number: 5454545454545454 Demo Exp. Date: 02/2002

CHECKING ACCOUNT PAYMENT OPTION At the bottom of your check is a series of numbers, separated by symbols. It is not necessary to enter symbols or spaces in the fields provided below. Enter the series of nine numbers between symbol   (Demo ABA: 124000054) Enter the series of numbers found before this symbol   (Demo ACCT: 12345) Check number to use:     (Not required.) Note: Some banks use a non-standard format in this series of numbers. If your account number includes this symbol , simply disregard the symbols and enter this section of numbers.

SUBMIT THIS FORM ONCE ONLY! THIS TRANSACTION WILL BE PROCESSED IN REAL-TIME. Pressing submit multiple times will cause duplicate orders and charges to your account. Your transaction should be completed in 10-25 seconds, depending on Internet traffic. In some cases, it may take longer.  If your browser supports JavaScript, a timer will count up from zero.  Please be patient.

FORM EXAMPLE B

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FORM EXAMPLE E

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