WooCommerce Checkout Form

<form name="checkout" method="post" class="checkout woocommerce-checkout" action="http://www.viraone.com/checkout/" enctype="multipart/form-data">
		
		<div class="col2-set" id="customer_details">
			<div class="col-1">
				<div class="woocommerce-billing-fields">
	
		<h3>Billing Details</h3>

	<span class="international">Outside Canada or the U.S.? <a href="mailto:info@viraone.com">Email us</a> to order.</span>
	
		<p class="form-row form-row form-row-first validate-required" id="billing_first_name_field"><label for="billing_first_name" class="">First Name <abbr class="required" title="required">*</abbr></label><input type="text" class="input-text " name="billing_first_name" id="billing_first_name" placeholder=""  autocomplete="given-name" value=""  /></p>
	
		<p class="form-row form-row form-row-last validate-required" id="billing_last_name_field"><label for="billing_last_name" class="">Last Name <abbr class="required" title="required">*</abbr></label><input type="text" class="input-text " name="billing_last_name" id="billing_last_name" placeholder=""  autocomplete="family-name" value=""  /></p><div class="clear"></div>
	
		<p class="form-row form-row form-row-wide" id="billing_company_field"><label for="billing_company" class="">Company Name</label><input type="text" class="input-text " name="billing_company" id="billing_company" placeholder=""  autocomplete="organization" value=""  /></p>
	
		<p class="form-row form-row form-row-first validate-required validate-email" id="billing_email_field"><label for="billing_email" class="">Email Address <abbr class="required" title="required">*</abbr></label><input type="email" class="input-text " name="billing_email" id="billing_email" placeholder=""  autocomplete="email" value=""  /></p>
	
		<p class="form-row form-row form-row-last validate-required validate-phone" id="billing_phone_field"><label for="billing_phone" class="">Phone <abbr class="required" title="required">*</abbr></label><input type="tel" class="input-text " name="billing_phone" id="billing_phone" placeholder=""  autocomplete="tel" value=""  /></p><div class="clear"></div>
	
		<p class="form-row form-row form-row-wide address-field update_totals_on_change validate-required" id="billing_country_field"><label for="billing_country" class="">Country <abbr class="required" title="required">*</abbr></label><select name="billing_country" id="billing_country" autocomplete="country" class="country_to_state country_select " ><option value="">Select a country&hellip;</option><option value="CA" >Canada</option><option value="US"  selected='selected'>United States (US)</option></select><noscript><input type="submit" name="woocommerce_checkout_update_totals" value="Update country" /></noscript></p>
	
		<p class="form-row form-row form-row-wide address-field validate-required" id="billing_address_1_field"><label for="billing_address_1" class="">Address <abbr class="required" title="required">*</abbr></label><input type="text" class="input-text " name="billing_address_1" id="billing_address_1" placeholder="Street address"  autocomplete="address-line1" value=""  /></p>
	
		<p class="form-row form-row form-row-wide address-field" id="billing_address_2_field"><input type="text" class="input-text " name="billing_address_2" id="billing_address_2" placeholder="Apartment, suite, unit etc. (optional)"  autocomplete="address-line2" value=""  /></p>
	
		<p class="form-row form-row form-row-wide address-field validate-required" id="billing_city_field"><label for="billing_city" class="">Town / City <abbr class="required" title="required">*</abbr></label><input type="text" class="input-text " name="billing_city" id="billing_city" placeholder=""  autocomplete="address-level2" value=""  /></p>
	
		<p class="form-row form-row form-row-first address-field validate-required validate-state" id="billing_state_field"><label for="billing_state" class="">State <abbr class="required" title="required">*</abbr></label><select name="billing_state" id="billing_state" class="state_select "  data-placeholder="" autocomplete="address-level1">
						<option value="">Select a state&hellip;</option><option value="AL" >Alabama</option><option value="AK" >Alaska</option><option value="AZ" >Arizona</option><option value="AR" >Arkansas</option><option value="CA" >California</option><option value="CO" >Colorado</option><option value="CT" >Connecticut</option><option value="DE" >Delaware</option><option value="DC" >District Of Columbia</option><option value="FL" >Florida</option><option value="GA" >Georgia</option><option value="HI" >Hawaii</option><option value="ID" >Idaho</option><option value="IL" >Illinois</option><option value="IN" >Indiana</option><option value="IA" >Iowa</option><option value="KS" >Kansas</option><option value="KY" >Kentucky</option><option value="LA" >Louisiana</option><option value="ME" >Maine</option><option value="MD" >Maryland</option><option value="MA" >Massachusetts</option><option value="MI" >Michigan</option><option value="MN" >Minnesota</option><option value="MS" >Mississippi</option><option value="MO" >Missouri</option><option value="MT" >Montana</option><option value="NE" >Nebraska</option><option value="NV" >Nevada</option><option value="NH" >New Hampshire</option><option value="NJ" >New Jersey</option><option value="NM" >New Mexico</option><option value="NY" >New York</option><option value="NC" >North Carolina</option><option value="ND" >North Dakota</option><option value="OH" >Ohio</option><option value="OK" >Oklahoma</option><option value="OR" >Oregon</option><option value="PA" >Pennsylvania</option><option value="RI" >Rhode Island</option><option value="SC" >South Carolina</option><option value="SD" >South Dakota</option><option value="TN" >Tennessee</option><option value="TX" >Texas</option><option value="UT" >Utah</option><option value="VT" >Vermont</option><option value="VA" >Virginia</option><option value="WA" >Washington</option><option value="WV" >West Virginia</option><option value="WI" >Wisconsin</option><option value="WY" >Wyoming</option><option value="AA" >Armed Forces (AA)</option><option value="AE" >Armed Forces (AE)</option><option value="AP" >Armed Forces (AP)</option></select></p>
	
		<p class="form-row form-row form-row-last address-field validate-required validate-postcode" id="billing_postcode_field"><label for="billing_postcode" class="">ZIP <abbr class="required" title="required">*</abbr></label><input type="text" class="input-text " name="billing_postcode" id="billing_postcode" placeholder=""  autocomplete="postal-code" value=""  /></p><div class="clear"></div>
	
	
	
		
			<p class="form-row form-row-wide create-account">
				<input class="input-checkbox" id="createaccount"  type="checkbox" name="createaccount" value="1" /> <label for="createaccount" class="checkbox">Create an account?</label>
			</p>

		
		
		
			<div class="create-account">

				<p>Create an account by entering the information below. If you are a returning customer please login at the top of the page.</p>

				
					<p class="form-row form-row validate-required" id="account_password_field"><label for="account_password" class="">Account password <abbr class="required" title="required">*</abbr></label><input type="password" class="input-text " name="account_password" id="account_password" placeholder="Password"   value=""  /></p>
				
				<div class="clear"></div>

			</div>

		
		
	</div>
			</div>

			<div class="col-2">
				<div class="woocommerce-shipping-fields">
	
		<h3 id="ship-to-different-address">
			<label for="ship-to-different-address-checkbox" class="checkbox">Ship to a different address?</label>
			<input id="ship-to-different-address-checkbox" class="input-checkbox"  type="checkbox" name="ship_to_different_address" value="1" />
		</h3>

		<div class="shipping_address">

			
			
				<p class="form-row form-row form-row-first validate-required" id="shipping_first_name_field"><label for="shipping_first_name" class="">First Name <abbr class="required" title="required">*</abbr></label><input type="text" class="input-text " name="shipping_first_name" id="shipping_first_name" placeholder=""  autocomplete="given-name" value=""  /></p>
			
				<p class="form-row form-row form-row-last validate-required" id="shipping_last_name_field"><label for="shipping_last_name" class="">Last Name <abbr class="required" title="required">*</abbr></label><input type="text" class="input-text " name="shipping_last_name" id="shipping_last_name" placeholder=""  autocomplete="family-name" value=""  /></p><div class="clear"></div>
			
				<p class="form-row form-row form-row-wide" id="shipping_company_field"><label for="shipping_company" class="">Company Name</label><input type="text" class="input-text " name="shipping_company" id="shipping_company" placeholder=""  autocomplete="organization" value=""  /></p>
			
				<p class="form-row form-row form-row-wide address-field update_totals_on_change validate-required" id="shipping_country_field"><label for="shipping_country" class="">Country <abbr class="required" title="required">*</abbr></label><select name="shipping_country" id="shipping_country" autocomplete="country" class="country_to_state country_select " ><option value="">Select a country&hellip;</option><option value="CA" >Canada</option><option value="US"  selected='selected'>United States (US)</option></select><noscript><input type="submit" name="woocommerce_checkout_update_totals" value="Update country" /></noscript></p>
			
				<p class="form-row form-row form-row-wide address-field validate-required" id="shipping_address_1_field"><label for="shipping_address_1" class="">Address <abbr class="required" title="required">*</abbr></label><input type="text" class="input-text " name="shipping_address_1" id="shipping_address_1" placeholder="Street address"  autocomplete="address-line1" value=""  /></p>
			
				<p class="form-row form-row form-row-wide address-field" id="shipping_address_2_field"><input type="text" class="input-text " name="shipping_address_2" id="shipping_address_2" placeholder="Apartment, suite, unit etc. (optional)"  autocomplete="address-line2" value=""  /></p>
			
				<p class="form-row form-row form-row-wide address-field validate-required" id="shipping_city_field"><label for="shipping_city" class="">Town / City <abbr class="required" title="required">*</abbr></label><input type="text" class="input-text " name="shipping_city" id="shipping_city" placeholder=""  autocomplete="address-level2" value=""  /></p>
			
				<p class="form-row form-row form-row-first address-field validate-required validate-state" id="shipping_state_field"><label for="shipping_state" class="">State <abbr class="required" title="required">*</abbr></label><select name="shipping_state" id="shipping_state" class="state_select "  data-placeholder="" autocomplete="address-level1">
						<option value="">Select a state&hellip;</option><option value="AL" >Alabama</option><option value="AK" >Alaska</option><option value="AZ" >Arizona</option><option value="AR" >Arkansas</option><option value="CA" >California</option><option value="CO" >Colorado</option><option value="CT" >Connecticut</option><option value="DE" >Delaware</option><option value="DC" >District Of Columbia</option><option value="FL" >Florida</option><option value="GA" >Georgia</option><option value="HI" >Hawaii</option><option value="ID" >Idaho</option><option value="IL" >Illinois</option><option value="IN" >Indiana</option><option value="IA" >Iowa</option><option value="KS" >Kansas</option><option value="KY" >Kentucky</option><option value="LA" >Louisiana</option><option value="ME" >Maine</option><option value="MD" >Maryland</option><option value="MA" >Massachusetts</option><option value="MI" >Michigan</option><option value="MN" >Minnesota</option><option value="MS" >Mississippi</option><option value="MO" >Missouri</option><option value="MT" >Montana</option><option value="NE" >Nebraska</option><option value="NV" >Nevada</option><option value="NH" >New Hampshire</option><option value="NJ" >New Jersey</option><option value="NM" >New Mexico</option><option value="NY" >New York</option><option value="NC" >North Carolina</option><option value="ND" >North Dakota</option><option value="OH" >Ohio</option><option value="OK" >Oklahoma</option><option value="OR" >Oregon</option><option value="PA" >Pennsylvania</option><option value="RI" >Rhode Island</option><option value="SC" >South Carolina</option><option value="SD" >South Dakota</option><option value="TN" >Tennessee</option><option value="TX" >Texas</option><option value="UT" >Utah</option><option value="VT" >Vermont</option><option value="VA" >Virginia</option><option value="WA" >Washington</option><option value="WV" >West Virginia</option><option value="WI" >Wisconsin</option><option value="WY" >Wyoming</option><option value="AA" >Armed Forces (AA)</option><option value="AE" >Armed Forces (AE)</option><option value="AP" >Armed Forces (AP)</option></select></p>
			
				<p class="form-row form-row form-row-last address-field validate-required validate-postcode" id="shipping_postcode_field"><label for="shipping_postcode" class="">ZIP <abbr class="required" title="required">*</abbr></label><input type="text" class="input-text " name="shipping_postcode" id="shipping_postcode" placeholder=""  autocomplete="postal-code" value=""  /></p><div class="clear"></div>
			
			
		</div>

	
	
	
		
		
			<p class="form-row form-row notes" id="order_comments_field"><label for="order_comments" class="">Order Notes</label><textarea name="order_comments" class="input-text " id="order_comments" placeholder="Notes about your order, e.g. special notes for delivery."    rows="2" cols="5"></textarea></p>
		
	
	</div>
			</div>
		</div>

		
	
	<h3 id="order_review_heading">Your order</h3>

	
	<div id="order_review" class="woocommerce-checkout-review-order">
		<table class="shop_table woocommerce-checkout-review-order-table">
	<thead>
		<tr>
			<th class="product-name">Product</th>
			<th class="product-total">Total</th>
		</tr>
	</thead>
	<tbody>
							<tr class="cart_item">
						<td class="product-name">
							Chocolate Chaga GoodStuff Smoothie Mix&nbsp;							 <strong class="product-quantity">&times; 1</strong>							<dl class="variation">
			<dt class="variation-Size">Size:</dt>
		<dd class="variation-Size"><p>150g (18 servings)</p>
</dd>
	</dl>
						</td>
						<td class="product-total">
							<span class="woocommerce-Price-amount amount"><span class="woocommerce-Price-currencySymbol">&#36;</span>&nbsp;22.00</span>						</td>
					</tr>
						</tbody>
	<tfoot>

		<tr class="cart-subtotal">
			<th>Subtotal</th>
			<td><span class="woocommerce-Price-amount amount"><span class="woocommerce-Price-currencySymbol">&#36;</span>&nbsp;22.00</span></td>
		</tr>

		
		
			
			<tr class="shipping">
	<th>Shipping</th>
	<td data-title="Shipping">
					International Delivery: <span class="woocommerce-Price-amount amount"><span class="woocommerce-Price-currencySymbol">&#36;</span>&nbsp;7.50</span> <input type="hidden" name="shipping_method[0]" data-index="0" id="shipping_method_0" value="legacy_international_delivery" class="shipping_method" />		
		
			</td>
</tr>

			
		
		
		
		
		<tr class="order-total">
			<th>Total</th>
			<td><strong><span class="woocommerce-Price-amount amount"><span class="woocommerce-Price-currencySymbol">&#36;</span>&nbsp;29.50</span></strong> </td>
		</tr>

		
	</tfoot>
</table>
<div id="payment" class="woocommerce-checkout-payment">
			<ul class="wc_payment_methods payment_methods methods">
			<li class="wc_payment_method payment_method_paypal">
	<input id="payment_method_paypal" type="radio" class="input-radio" name="payment_method" value="paypal"  checked='checked' data-order_button_text="Proceed to PayPal" />

	<label for="payment_method_paypal">
		PayPal <img src="https://www.paypalobjects.com/webstatic/en_CA/mktg/logo-image/AM_mc_vs_dc_ae.jpg" alt="PayPal Acceptance Mark" /><a href="https://www.paypal.com/ca/webapps/mpp/paypal-popup" class="about_paypal" onclick="javascript:window.open('https://www.paypal.com/ca/webapps/mpp/paypal-popup','WIPaypal','toolbar=no, location=no, directories=no, status=no, menubar=no, scrollbars=yes, resizable=yes, width=1060, height=700'); return false;" title="What is PayPal?">What is PayPal?</a>	</label>
			<div class="payment_box payment_method_paypal" >
			<p>Pay via PayPal; you can pay with your credit card if you don&#8217;t have a PayPal account.</p>
		</div>
	</li>
		</ul>
		<div class="form-row place-order">
		<noscript>
			Since your browser does not support JavaScript, or it is disabled, please ensure you click the <em>Update Totals</em> button before placing your order. You may be charged more than the amount stated above if you fail to do so.			<br/><input type="submit" class="button alt" name="woocommerce_checkout_update_totals" value="Update totals" />
		</noscript>

		
		
		<input type="submit" class="button alt" name="woocommerce_checkout_place_order" id="place_order" value="Place order" data-value="Place order" />
		
		<input type="hidden" id="_wpnonce" name="_wpnonce" value="6e17960181" /><input type="hidden" name="_wp_http_referer" value="/checkout/" />	</div>
</div>
	</div>

	
</form>