<script>
        function disableButton()
        {
            document.getElementById('SubmitButton').disabled=true;
            return true;
        }
    </script>

    <form action="https://gw.freepay.dk/secure/authorize.aspx" onsubmit="return disableButton();"
        method="POST" name="form1" id="Payform" autocomplete="false">
        <table>
            <tr>
                <td>
                    Merchantnummer</td>
                <td>
                    <input type="text" name="Merchant" value="" size="20"></td>
            </tr>
            <tr>
                <td>
                    Valuta</td>
                <td>
                    <input type="text" name="Currency" value="208" size="3"></td>
            </tr>
            <tr>
                <td>
                    Beløb i ører.</td>
                <td>
                    <input type="text" name="Amount" value="" size="20"></td>
            </tr>
            <tr>
                <td>
                    Kortnummer</td>
                <td>
                    <input type="text" name="CardNumber" size="20"></td>
            </tr>
            <tr>
                <td>
                    Udløbsdato (MM/ÅÅ)</td>
                <td>
                    <input type="text" name="ExpireMonth" size="2" maxlength="2" value="">
                    /
                    <input type="text" name="ExpireYear" size="2" maxlength="2" value=""></td>
            </tr>
            <tr>
                <td>
                    CardCVC</td>
                <td>
                    <input type="text" name="cvc" size="3"></td>
            </tr>
            <tr>
                <td>
                    Ordrenummer</td>
                <td>
                    <input type="text" name="OrderNumber" value="" size="4">
                </td>
            </tr>
            <tr>
                <td>
                </td>
                <td>
                    <input type="submit" id="SubmitButton" value="send" /></td>
            </tr>
        </table>
        <input type="hidden" name="AcceptURL" value="http://shop.freeway.dk/accept.asp">
        <input type="hidden" name="DeclineURL" value="http://shop.freeway.dk/decline.asp">