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<!DOCTYPE html>
<html lang="en" dir="ltr"><head><meta charset="utf-8"><meta http-equiv="Content-Security-Policy" content="default-src 'none'; img-src data:; media-src data:; style-src data: 'unsafe-inline'; font-src data:; frame-src data:"><meta http-equiv="Memento-Datetime" content="Thu, 26 Sep 2024 11:26:55 GMT"><link rel="original" href="https://checkout.shopifycs.com/name?identifier=&location=&dir=ltr">
<meta http-equiv="X-UA-Compatible" content="IE=edge,chrome=1">
<meta name="viewport" content="width=device-width, initial-scale=1.0, height=device-height, minimum-scale=1.0, user-scalable=0">
<link rel="stylesheet" media="all" href="" data-original-href="https://checkout.shopifycs.com/build/inputs-98dafd5570.css">
</head>
<body>
<form>
<label for="number" class="visually-hidden" aria-hidden="true">Credit Card Number</label>
<input autocomplete="cc-number" id="number" name="number" type="text" inputmode="numeric" pattern="[0-9]*" class="visually-hidden" aria-hidden="true" data-honeypot-field="" tabindex="-1">
<div class="current-field">
<label for="name" class="visually-hidden">Name on card</label>
<input required="" autocomplete="cc-name" id="name" name="name" type="text" inputmode="text" pattern="" aria-describedby="error-for-name tooltip-for-name" data-current-field="name">
<span id="error-for-name" class="input-error-message visually-hidden"></span>
<span id="tooltip-for-name" class="input-tooltip-message visually-hidden"></span>
</div>
<label for="expiry_month" class="visually-hidden" aria-hidden="true">Expiry month</label>
<input autocomplete="cc-exp-month" id="expiry_month" name="expiry_month" type="text" inputmode="numeric" pattern="[0-9]*" class="visually-hidden" aria-hidden="true" data-honeypot-field="" tabindex="-1">
<label for="expiry_year" class="visually-hidden" aria-hidden="true">Expiry year</label>
<input autocomplete="cc-exp-year" id="expiry_year" name="expiry_year" type="text" inputmode="numeric" pattern="[0-9]*" class="visually-hidden" aria-hidden="true" data-honeypot-field="" tabindex="-1">
<label for="expiry" class="visually-hidden" aria-hidden="true">Expiry date (MM / YY)</label>
<input autocomplete="cc-exp" id="expiry" name="expiry" type="text" inputmode="numeric" pattern="[0-9]*" class="visually-hidden" aria-hidden="true" data-honeypot-field="" tabindex="-1">
<label for="verification_value" class="visually-hidden" aria-hidden="true">Security code</label>
<input autocomplete="cc-csc" id="verification_value" name="verification_value" type="text" inputmode="numeric" pattern="[0-9]*" class="visually-hidden" aria-hidden="true" data-honeypot-field="" tabindex="-1">
<label for="issue_date" class="visually-hidden" aria-hidden="true">Issue date (MM / YY)</label>
<input autocomplete="off" id="issue_date" name="issue_date" type="text" inputmode="numeric" pattern="[0-9]*" class="visually-hidden" aria-hidden="true" data-honeypot-field="" tabindex="-1">
<label for="issue_number" class="visually-hidden" aria-hidden="true">Issue number</label>
<input autocomplete="off" id="issue_number" name="issue_number" type="text" inputmode="numeric" pattern="[0-9]*" class="visually-hidden" aria-hidden="true" data-honeypot-field="" tabindex="-1">
<button type="submit" class="visually-hidden" aria-hidden="true" tabindex="-1"></button>
</form>
<div style="position: absolute !important; top: 0px !important; left: 0px !important; height: 0px !important; width: 0px !important;" data-lastpass-root=""></div></body></html>