HTML: Authorize.net Basic Form

gistfile1.html

<?php 
if(isset($_POST['run'])) {
	include('payment_validation.php');
}
?>
<form action="" method="post" name="payment" onsubmit="document.getElementById('submit_button').disabled = 1;">
	<p><input name="page_id" type="hidden" value="4" /></p>
	<p><label>First Name</label><input name="first_name" type="text" /></p>
	<p><label>Last Name</label><input name="last_name" type="text" /></p>
	<p><label>Comments</label><textarea name="comments"></textarea></p>
	<p><label>Card Num</label><input name="cc_card_num" type="text" /></p>
	<p><label>Expiration Date</label><input name="cc_exp_date" type="text" /></p>
	<p><label>Amount</label><input name="cc_amount" type="text" /></p>
	<p><label>Description</label><input name="cc_description" type="text" /></p>
	<p><input id="submit_button" name="submit" type="submit" /></p>
	<p><input name="run" type="hidden" value="true" /></p>
</form>