[MM_Form_Message type=’error’]
[MM_Form_Section type=’accountInfo’]
Account Information
[MM_Form_Field type=’input’ name=’firstName’ customAttributes=’placeholder=”First Name”‘]
[MM_Form_Field type=’input’ name=’lastName’ customAttributes=’placeholder=”Last Name”‘]
[MM_Form_Field type=’input’ name=’email’ customAttributes=’placeholder=”Email Address”‘]
[MM_Form_Field type=’input’ name=’password’ customAttributes=’placeholder=”Password”‘]
[MM_Form_Field type=’input’ name=’phone’ isRequired=’false’ customAttributes=’placeholder=”Phone Number”‘]
Are you a new FLENJ member?
[MM_Form_Field type=’custom’ id=’27’ isRequired=’false’ class=”]
[MM_Member_Decision isMember=’false’]
[/MM_Form_Section] [MM_Form_Section type=’billingInfo’]
Billing Details
[MM_Form_Field name=’ccNumber’ customAttributes=’placeholder=”Credit Card Number”‘]
[MM_Form_Field name=’ccSecurityCode’ customAttributes=’placeholder=”Security Code”‘]
[MM_Form_Field name=’ccExpirationDate’]
Billing Address
[MM_Form_Field name=’billingAddress’ customAttributes=’placeholder=”Billing Address”‘]
[MM_Form_Field name=’billingCity’ customAttributes=’placeholder=”Billing City”‘]
[MM_Form_Field name=’billingState’ customAttributes=’placeholder=”Billing State”‘]
[MM_Form_Field name=’billingZipCode’ customAttributes=’placeholder=”Billing Zip Code”‘]
[MM_Form_Field name=’billingCountry’]
Additional Info (For New Customers Only)
[MM_Form_Field type=’custom’ id=’1′ isRequired=’false’ class=”]
[MM_Form_Field type=’custom’ id=’2′ isRequired=’false’ class=”]
[MM_Form_Field type=’custom’ id=’3′ isRequired=’false’ class=”]
[MM_Form_Field type=’custom’ id=’6′ isRequired=’false’ class=”]
What is your technology level?
[MM_Form_Field type=’custom’ id=’25’ isRequired=’false’ class=”]
[MM_Form_Field type=’custom’ id=’4′ isRequired=’false’ class=”]
[MM_Form_Field type=’custom’ id=’8′ isRequired=’false’ class=”]
[MM_Form_Data name=’productName’ useAccessName=’false’]
[MM_Form_Data name=’productDescription’]
- Product Price: [MM_Form_Data name=’productPriceDescription’]
[MM_Order_Decision isShippable=’true’]
- Shipping Price: [MM_Form_Data name=’shippingPrice’]
[/MM_Order_Decision]
[MM_Order_Decision isDiscounted=’true’]
- Discount: [MM_Form_Data name=’discount’]
[/MM_Order_Decision]
- Total Price: [MM_Form_Data name=’totalPrice’]
[MM_Member_Decision isMember=’true’][MM_Form_Field type=’input’ name=’gift’] Is this a gift?
[/MM_Member_Decision]
[/MM_Form]
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