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Y Chromosome Testing Application

From Dunham-Singletary Family Connections
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(Created page with "<emailform> {| | Full Name: || <emailform name=40 /> |- | Street Address: || <emailform street_address=40 /> |- | City: || <emailform city=40 /> |- | State/Province:...")
 
 
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<emailform>
 
<emailform>
 +
{| class="wikitable" align="{{{align|center}}}"
 +
|-
 +
! Description
 +
! Price
 +
|-
 +
|Y-DNA 37 marker Test
 +
|$158
 +
|-
 +
|Y-DNA 67 Marker Test
 +
|$247
 +
 +
|-
 +
|Y-DNA 111 Marker Test
 +
|$348
 +
 +
|-
 +
|Refine 37 to 67 Markers
 +
|$99
 +
|-
 +
|Refine 67 to 111 Markers
 +
|$138
 +
|}
 
  {|  
 
  {|  
 
  | Full Name: || <emailform name=40 />
 
  | Full Name: || <emailform name=40 />
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  |-   
 
  |-   
 
  | Email: || <emailform email=40 />  
 
  | Email: || <emailform email=40 />  
|-
 
| Website: || <emailform website=40 /> || (optional)
 
 
  |-
 
  |-
 
  | Comments:
 
  | Comments:
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  | colspan="3" align="center" | <emailform submit="Submit Application" />
 
  | colspan="3" align="center" | <emailform submit="Submit Application" />
 
  |}
 
  |}
 +
 +
 
  </emailform>
 
  </emailform>
 
  <emailform result>
 
  <emailform result>
Thanks for your registration.  
+
Thanks for your participation in the DNA Testing Program.  
  
  Your information has been transmitted; Please complete payment for membership  via PayPal by clicking on the add to cart button.
+
Your information has been transmitted; You can pay for the test by clicking on the desired option below.  Optionally, you can mail your payment to the DNA Testing coordinator.
  
# Create Table with payment options.
 
<html>
 
  
 +
{| class="wikitable" align="{{{align|center}}}"
 +
|-
 +
! Description
 +
! Price
 +
! Paypal
 +
|-
 +
|Y-DNA 37 marker Test
 +
|$158
 +
|<html> <form target="paypal" action="https://www.paypal.com/cgi-bin/webscr"
  
 +
method="post">
 +
<input type="hidden" name="cmd" value="_s-xclick">
 +
<input type="hidden" name="hosted_button_id" value="R6UJNQW4Z54H2">
 +
<input type="image"
  
 +
src="https://www.paypalobjects.com/en_US/i/btn/btn_cart_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>
 
</html>
 
</html>
 +
|-
 +
|Y-DNA 67 Marker Test
 +
|$247
 +
|<html>
 +
 +
<form target="paypal" action="https://www.paypal.com/cgi-bin/webscr"
 +
method="post">
 +
<input type="hidden" name="cmd" value="_s-xclick">
 +
<input type="hidden" name="hosted_button_id" value="XJL3KN9MYENY2">
 +
<input type="image"
 +
src="https://www.paypalobjects.com/en_US/i/btn/btn_cart_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>
 +
 +
 +
</html>
 +
|-
 +
|Y-DNA 111 Marker Test
 +
|$348
 +
|<html>
 +
<form target="paypal" action="https://www.paypal.com/cgi-bin/webscr"
 +
 +
method="post">
 +
<input type="hidden" name="cmd" value="_s-xclick">
 +
<input type="hidden" name="hosted_button_id" value="VUQ44JRKQ9CG8">
 +
<input type="image"
 +
 +
src="https://www.paypalobjects.com/en_US/i/btn/btn_cart_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>
 +
</html>
 +
|-
 +
|Refine 37 to 67 Markers
 +
|$99
 +
|<html>
 +
<form target="paypal" action="https://www.paypal.com/cgi-bin/webscr"
 +
 +
method="post">
 +
<input type="hidden" name="cmd" value="_s-xclick">
 +
<input type="hidden" name="hosted_button_id" value="VW8V52AWT666J">
 +
<input type="image"
 +
 +
src="https://www.paypalobjects.com/en_US/i/btn/btn_cart_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>
 +
</html>
 +
|-
 +
|Refine 67 to 111 Markers
 +
|$138
 +
|<html>
 +
<form target="paypal" action="https://www.paypal.com/cgi-bin/webscr"
 +
 +
method="post">
 +
<input type="hidden" name="cmd" value="_s-xclick">
 +
<input type="hidden" name="hosted_button_id" value="7FWAC2S86SDVS">
 +
<input type="image"
 +
 +
src="https://www.paypalobjects.com/en_US/i/btn/btn_cart_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>
 +
 +
</html>
 +
 +
|}
 +
 +
 
  </emailform>
 
  </emailform>

Latest revision as of 13:27, 15 March 2018

Description Price
Y-DNA 37 marker Test $158
Y-DNA 67 Marker Test $247
Y-DNA 111 Marker Test $348
Refine 37 to 67 Markers $99
Refine 67 to 111 Markers $138
Full Name:
Street Address:
City:
State/Province:
Zip/Postal Code:
Country:
Phone Number :
Email:
Comments:




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