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<form name="one_time_payment" action="https://hosted.transactionexpress.com/Transaction/Transaction/Index" method ="POST">

<input type="hidden" name="HostedKey" id="HostedKey" value="1a5881b6-65c7-4aa9-b265-c6d56fb21e30" />

<input type="hidden" name="Gateway_ID" id="Gateway_ID" value="9060192387" />

<input type="hidden" name="IndustryCode" id="IndustryCode" value="2" />

<input type="hidden" name="Amount" id="Amount" value="" />

<input type="hidden" name="RecurringType" id="RecurringType" value="N" />

<input type="hidden" name="RecurringAmount" id="RecurringAmount" value="" />

<input type="hidden" name="RURL" id="RURL" value="https://www.premierpulmonaryandsleep.com/payment-success.php" />

<input type="hidden" name="CURL" id="CURL" value="https://www.premierpulmonaryandsleep.com/one-time-payment-cancellation.php" />

<input type="hidden" name="AVSRequired" id="AVSRequired" value="Y"/>

<input type="hidden" name="CVV2Required" id="CVV2Required"value="Y"/>

<input type="hidden" name="EmailRequired" id="EmailRequired" value="Y"/>

<input type="hidden" name="PostRspMsg" id="PostRspMsg" value="N"/>

<input type="hidden" name="SECCode" id="SECCode"  value="2" />

<input type="hidden" name="Descriptor" id="Descriptor" value="Doctor" />

<input type="hidden" required name="custrefid" id="custrefid" value="One Time Payment"/><br/>
</form>
<script>
	document.one_time_payment.submit();
</script>