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<?
echo "<form method=post action=subscription_create.php>";
echo "<table width=35% border=0>";
echo "<tr>";
echo "<td><b><font size=2 face=arial>Create Subscription </b><br><br></td>";
echo "<td></td>";
echo "</tr>";
echo "<tr>";
echo "<td><font size=2 face=arial>Reference Id</td>";
echo "<td><input type=text name=refId value=''><font size=1 face=arial> MAX = 20 chars</td>";
echo "</tr>";
echo "<tr>";
echo "<td><font size=2 face=arial>Subscription Name</td>";
echo "<td><input type=text name=name value=''></td>";
echo "</tr>";
echo "<tr>";
echo "<td><font size=2 face=arial>Subscription Length</td>";
echo "<td><input type=text name=length value=''><font size=1 face=arial> 1 - 12 or 7 - 365</td>";
echo "</tr>";
echo "<tr>";
// и так далее...
Взято из примеров кода http://developer.authorize.net/samplecode/ для authorize.net