<center>
<!-- Begin PayPal Logo -->
<form action="https://www.paypal.com/cgi-bin/webscr" method="post">
<input type="hidden" name="cmd" value="_xclick">
<input type="hidden" name="business" value="YourEmail@YourDomain.com">
<input type="hidden" name="item_name" value="The Name Of Your List Safelist Lifetime Membership Fee">
<input type="hidden" name="item_number" value="1">
<input type="hidden" name="amount" value="10.00">
<input type="hidden" name="return" value="http://www.YourDomain.com/safelist/form.html">
<input type="hidden" name="cancel_return" value="http://www.YourDomain.com/safelist/index.htm">
<input type="image" src="http://images.paypal.com/images/x-click-but5.gif" border="0" name="submit" alt="Make payments with PayPal - it's fast, free and secure!">
</form>
<!-- End PayPal Logo -->
</center>
