<form action=”https://www.paypal.com/cgi-bin/webscr” method=”post” target=”_top”>
<input type=”hidden” name=”cmd” value=”_s-xclick”>
<input type=”hidden” name=”hosted_button_id” value=”5WFZ8HJSDR7TA”>
<table>
<tr><td><input type=”hidden” name=”on0″ value=”Options”>Options</td></tr><tr><td><select name=”os0″>
<option value=”Sample Box”>Sample Box : $39.00 USD – monthly</option>
<option value=”CBD Box”>CBD Box : $99.00 USD – monthly</option>
<option value=”Sample and CBD Box”>Sample and CBD Box : $99.00 USD – monthly</option>
</select> </td></tr>
</table>
<input type=”hidden” name=”currency_code” value=”USD”>
<input type=”image” src=”https://www.paypalobjects.com/en_US/i/btn/btn_subscribeCC_LG.gif” border=”0″ name=”submit” alt=”PayPal – The safer, easier way to pay online!”>
<img alt=”” border=”0″ src=”https://www.paypalobjects.com/en_US/i/scr/pixel.gif” width=”1″ height=”1″>
</form>