mibew/site/login/register-hosting.php

<form id="loginForm" name="loginForm" method="post" action=".php">
  <table width="300" border="0" align="center" cellpadding="2" cellspacing="0">
    <tr>
      <th>First Name </th>
      <td><input name="fname" type="text" class="textfield" id="fname" /></td>
    </tr>
    <tr>
      <th>Last Name </th>
      <td><input name="lname" type="text" class="textfield" id="lname" /></td>
    </tr>
    <tr>
      <th>City </th>
      <td><input name="city" type="text" class="textfield" id="city" /></td>
    </tr>
      <tr>
      <th>State </th>
      <td><input name="state" type="text" class="textfield" id="state" /></td>
    </tr>
     <tr>
      <th>Country </th>
      <td><input name="country" type="text" class="textfield" id="country" /></td>
    </tr>
    <tr>
      <th>Phone </th>
      <td><input name="phone" type="text" class="textfield" id="phone" /></td>
    </tr>
    <tr>
      <th>Email </th>
      <td><input name="email" type="text" class="textfield" id="email" /></td>
    </tr>
    <tr>
      <th width="124">Login</th>
      <td width="168"><input name="login" type="text" class="textfield" id="login" /></td>
    </tr>

    <tr>
      <th>Password</th>
      <td><input name="password" type="text" class="textfield" id="password" /></td>
    </tr>
    <tr>
      <th>Confirm Password </th>
      <td><input name="cpassword" type="text" class="textfield" id="cpassword" /></td>
    </tr>
     <div align="center" ><font color="red">Please click the PayPal button before you click submit!</font></div>
    <tr>
      <td>&nbsp;</td>
      <td><input type="submit" name="Submit" value="Register" /></td>
    </tr>
  </table>
   <div align="center" >Your username will follow http://host.mibew.com/. </div>
   <div align="center" ><font color="red">If you have any questions, please don't fill this out. Post a ticket <a href="http://support.openwebim.org"> Click here </a></font> </div>
  
</form>
<form align="center" action="https://www.paypal.com/cgi-bin/webscr" method="post">
<input align="center" type="hidden" name="cmd" value="_s-xclick">
<input type="hidden" name="hosted_button_id" value="5951679">
<input type="image" src="https://www.paypal.com/en_US/i/btn/btn_buynowCC_LG.gif" border="0" name="submit" alt="PayPal - The safer, easier way to pay online!">
<img align="center" alt="" border="0" src="https://www.paypal.com/en_US/i/scr/pixel.gif" width="1" height="1">
</form>
<link href="default.css" rel="stylesheet" type="text/css" />
<div id="footer">
	<p id="legal"><a href="http://openwebim.org/" class="flink">Open Web Messenger</a> 1.6.1 | (c) 2009 openwebim.org</p>
</div>