Simple Script problem

My billing software problems are going nowhere. For the time being, I am looking for a simple form HTML with a script that would simply send ordering information such as login, password, domain, credit card info, etc. to me to bill them manually and set them up. If there's one that interfaces with Echo-Inc. great but for now I'd be content just doing it manually each time until I can get something better.

Anyone have such a simple script that will just give me their information from a form in a pretty secure way so that I can process their order from there?

Simple Script problem Any help would be GREATLY appreciated.

 

 

 

 

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