["ccnumber","ccexp"]
"hide"

"https:\/\/quickclick.com\/cart\/security.php"
Secure Transaction
Billing Information
First Name:
Last Name:
Country:
Address:
City:
State/Province:
Zip/Postal Code:
Phone Number:
Fax Number:
Email Address:

Additional Information
Name:
Account:
Master/Reference:
Original Creditor:
If Other, enter Original Creditor here: