<form action="https://www.paypal.com/cgi-bin/webscr" method="post">
<input type="hidden" name="cmd" value="_xclick-subscriptions" />
<input type="hidden" name="business" value="paypal@blackoutgaming.org" />
<input type="hidden" name="no_shipping" value="1" />
<input type="hidden" name="item_name" value="BlackOut Gaming Donation" />
<input type="hidden" name="notify_url" value="http://blackoutgaming.org/ipn.php" />
<input type="hidden" name="currency_code" value="USD" />
<input type="hidden" name="tax" value="0" />
<input type="hidden" name="lc" value="GB" />
<input type="hidden" name="cn" value="Username" />
<input type="hidden" name="on0" value="SteamID:" />
<input type="hidden" name="on1" value="Nickname:" />
<table width="400" border="0" cellspacing="2" cellpadding="2">
<input type="hidden" name="p3" value="1" />
<input type="hidden" name="t3" value="M" />
<input type="hidden" name="src" value="1" />
<input type="hidden" name="sra" value="1" />
<input type="text" name="amount" value="" size="9" /></td>
<td>Steam ID:</td>
<input id="steam_id" type="text" name="os0" value="" maxlength="200" /></td>
<td>Nickname:</td>
<input type="text" name="os1" value="" maxlength="200" /></td>
Amount: <input type="text" name="a3" value="" size="6" />
Months: <input type="text" name="srt" value="" size="3" />
<input type="image" name="submit" src="https://www.paypalobjects.com/en_US/i/btn/btn_subscribe_LG.gif" alt="Make payments with PayPal - it's fast, free and secure!" />