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[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="4XHCNJQP77QYA">
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<tr><td><input type="hidden" name="on0" value="Sizes">Sizes</td></tr><tr><td><select name="os0">
<option value="Small">Small $29.50</option>
<option value="Medium">Medium $29.50</option>
<option value="Large">Large $29.50</option>
<option value="X-Large">X-Large $29.50</option>
<option value="XX-Large">XX-Large $31.50</option>
<option value="XXX-Large">XXX-Large $31.50</option>
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<tr><td><input type="hidden" name="on1" value="Name And Number">Name And Number</td></tr><tr><td><input type="text" name="os1" maxlength="60"></td></tr>
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</form>
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