Pay by Online Transfer

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=90 BGCOLOR="#A6CAF0" TEXT="#080000" bgproperties="fixed" background="0095e3c3.jpg"> <div> <B>DerivativeMaster.com</B></div> <div> <B> </B><FONT SIZE="2" COLOR="#FFFFFF" FACE="Tahoma" ><B>Where Fundamentals end Derivatives begin.</B></FONT></div> <div> </div> </td> </tr><tr> <td valign="top" width=210 BGCOLOR="#0000CC" TEXT="#080000"> <div> <B>PRODUCTS</B></div> <div> <TABLE BORDER="1" CELLPADDING="8" CELLSPACING="1" WIDTH="176" BORDERCOLORLIGHT="#000099" BORDERCOLORDARK="#000099" FRAME="HSIDES" RULES="ALL" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 20 ><NOBR><div> <A HREF="id3.htm" TARGET="_top" TITLE="Futures Master"><U><B>Futures Master</B></U></A></div> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 20 ><NOBR><div> <A HREF="id4.htm" TARGET="_top" TITLE="Options Master"><U><B>Options Master</B></U></A></div> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 20 ><NOBR><div> <A HREF="id5.htm" TARGET="_top" TITLE="Weekly Master"><U><B>Weekly Master</B></U></A></div> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 20 ><NOBR><div> <A HREF="id6.htm" TARGET="_top" TITLE="Combination Packages"><U><B>Combination Plans</B></U></A></div> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP ROWSPAN=2 HEIGHT= 1 ><NOBR><bR> <bR> <div> <B>PREMIUM PLANS</B></div> </NOBR></tD> </tR> <tR> </tR> <tR> <tD VALIGN=TOP HEIGHT= 20 WIDTH="158"><div> <A HREF="id2.htm" TARGET="_top" TITLE="Nifty Master"><U><B>Nifty Master</B></U></A></div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 55 WIDTH="158"><div> <A HREF="id8.htm" TARGET="_top" TITLE="Monthly Derivative Portfolio."><U><B>Monthly Derivative Portfolio.</B></U></A></div> </tD> </tR> </TABLE></div> <bR> </td> <td valign="top" height=390 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <IMG SRC="05602170.png" border=0 width="258" height="23" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> <TABLE BORDER="2" CELLPADDING="2" CELLSPACING="1" WIDTH="694" BORDERCOLORLIGHT="#EEEEEE" BORDERCOLORDARK="#EEEEEE" FRAME="BOX" RULES="ALL" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP COLSPAN=2 HEIGHT= 17 ><NOBR><div> <B>Transfer Online towards Subscription Charges in Follow Bank Account :</B></div> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 17 WIDTH="198"><div> <B>Payee</B></div> </tD> <tD VALIGN=TOP WIDTH="477"><div> <B>EPAY ENTERPRISE</B></div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 17 WIDTH="198"><div> <B>Account Number</B></div> </tD> <tD VALIGN=TOP WIDTH="477"><div> <B>001105014756</B></div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 17 WIDTH="198"><div> <B>Banker</B></div> </tD> <tD VALIGN=TOP WIDTH="477"><div> <B>ICICI Bank</B></div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 17 WIDTH="198"><div> <B>Account Type</B></div> </tD> <tD VALIGN=TOP WIDTH="477"><div> <B>Current Account</B></div> </tD> </tR> <tR> <tD VALIGN=TOP COLSPAN=2 HEIGHT= 17 WIDTH="678"><div> <B>Once Transferd kindly fill in the Registration Form below:</B></div> </tD> </tR> </TABLE></div> <bR> <DIV ALIGN="LEFT"></DIV> <div> <B>PAYMENT REGISTRATION FORM</B></div> <div> <I> <I>   <FORM METHOD="POST" <form action="http://formmail.liscripts.net/promailer.php?formid=782b83df33c554b9af32b33bca730fbb" method="post"> <table cellspacing="10" cellpadding="10" border="0"> <tr> <td valign="top"> <FONT SIZE="3" FACE="Bookman Old Style" >Full Name:</b> </td> <td valign="top"> <input type="text" name="name" size="40" value=""> </td> </tr> <tr> <td valign="top"> <FONT SIZE="3" FACE="Bookman Old Style" >Postal Address:</b> </td> <td valign="top"> <input type="text" name="address" size="40" value=""> </td> </tr> <tr> <td valign="top"> <FONT SIZE="3" FACE="Bookman Old Style" >Email Address :</b> </td> <td valign="top"> <input type="text" name="email" size="40" value=""> </td> </tr> <tr> <td valign="top"> <FONT SIZE="3" FACE="Bookman Old Style" >Mobile Number :</b> </td> <td valign="top"> <input type="text" name="mobile" size="40" value=""> </td> </tr> <tr> <td valign="top"> <FONT SIZE="3" FACE="Bookman Old Style" >Click on all Subscription Plan/s Subscribed :</b> </td> <td valign="top"> <input type="checkbox" name="SubscriptionPlan1" value="Futures Master"> Futures Master<br/> <input type="checkbox" name="SubscriptionPlan2" value="Options Master"> Options Master<br/> <input type="checkbox" name="SubscriptionPlan3" value="Weekly Stratergy"> Weekly Stratergy<br/> <input type="checkbox" name="SubscriptionPlan4" value="Nifty Master"> Nifty Master<br/> <input type="checkbox" name="SubscriptionPlan5" value="Monthly Derivative Portfolio"> Monthly Derivative Portfolio<br/> </td> </tr> <tr> <td valign="top"> <FONT SIZE="3" FACE="Bookman Old Style" >Subscription Period :</b> </td> <td valign="top"> <select name="Period"> <option value="Click & Select...">Click & Select...</option> <option value="Monthly">Monthly</option> <option value="Quarterly">Quarterly</option> <option value="Half-Yearly">Half-Yearly</option> <option value="Yearly">Yearly</option> </select> </td> </tr> <tr> <td valign="top"> <FONT SIZE="3" FACE="Bookman Old Style" >Mode/s Selected :</b> </td> <td valign="top"> <input type="checkbox" name="mode1" value="SMS (Mobile)"> SMS (Mobile)<br/> <input type="checkbox" name="mode2" value="Messenger"> Messenger<br/> <input type="checkbox" name="mode3" value="Email"> Email<br/> </td> </tr> <tr> <td valign="top"> <FONT SIZE="3" FACE="Bookman Old Style" >Mode Of Payment :</b> </td> <td valign="top"> <select name="PaymentBy"> <option value="Click & Select...">Click & Select...</option> <option value="Online Internet Transfer">Online Internet Transfer</option> <option value="Cheque/DD Deposit at Branch/ATM">Cheque/DD Deposit at Branch/ATM</option> <option value="Cash Deposit at Branch/ATM">Cash Deposit at Branch/ATM</option> </select> </td> </tr> <tr> <td valign="top"> <FONT SIZE="3" FACE="Bookman Old Style" >Total Amount Paid :</b> </td> <td valign="top"> <input type="text" name="Amount" size="40" value=""> </td> </tr> <tr> <td valign="top"> <FONT SIZE="3" FACE="Bookman Old Style" >Online Transfer Number :</b> </td> <td valign="top"> <input type="text" name="Number_Branch Name" size="40" value=""> </td> </tr> <tr> <td valign="top"> <FONT SIZE="3" FACE="Bookman Old Style" >Date of Payment :</b> </td> <td valign="top"> <input type="text" name="DateofPayment" size="40" value=""> </td> </tr> <tr> <td valign="top"> <FONT SIZE="3" FACE="Bookman Old Style" >Subscribers Profile :</b> </td> <td valign="top"> <select name="Profile"> <option value="Click & Select...">Click & Select...</option> <option value="New Subscription">New Subscription</option> <option value="Renued Subscription">Renued Subscription</option> </select> </td> </tr> <tr> <td colspan="2" align="center"> <input type="submit" value=" Confirm Subscription Details "> </td> </tr> </table> </form>    </I></div> </td> </tr></table></body>