$b){ $body .= sprintf("%20s: %s\n",$b,$_REQUEST[$a]); } else { if($name == '') {print "You have not entered a name, please go back and try again";} else { $send = mail(accounting@neswater.com); } } ?> Bill Pay
NES Account #:
Name: Email:
Billing Address:
City: State: Zip Code:
Card Holder Name:
Card type: :
CVV #: Expiration Date:
Credit Card #: Amount to be Paid:
Card Holder Signature:

   

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