<form method="POST" action="http://www.asecurecart.net/server/cart.aspx/alaskamedallions">

<input type="hidden" name="ID" value="State Quart Rep">
<input type="hidden" name="Describe" value="Alaska State Quarter Replica 1oz Silver">
<input type="hidden" name="Price" value="54.95">
<input type="hidden" name="Multi" value="N">
<input type="hidden" name="ReturnLink" value="http://www.alaskamedallions.com/2010BlackBear">
<br>
<input type="submit" name="Submit" value="Add to Cart">
</form>