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<form action="https://www.paypal.com/cgi-bin/webscr" method="post" target="_top">

<input type="hidden" name="cmd" value="_s-xclick">

<input type="hidden" name="hosted_button_id" value="RHXDEW4VYAX5E">

<table>

<tr><td><input type="hidden" name="on0" value="Choices:">Choices:</td></tr><tr><td><select name="os0">

<option value="Option 1">Option 1 $10.00 USD</option>

<option value="Option 2">Option 2 $25.00 USD</option>

<option value="Option 3">Option 3 $50.00 USD</option>

<option value="Option 4">Option 4 $75.00 USD</option>

<option value="Option 5">Option 5 $100.00 USD</option>

</select> </td></tr>

</table>

<input type="hidden" name="currency_code" value="USD">

<input type="image" src="https://www.paypalobjects.com/en_US/i/btn/btn_buynowCC_LG.gif" border="0" name="submit" alt="PayPal - The safer, easier way to pay online!">

<img alt="" border="0" src="https://www.paypalobjects.com/en_US/i/scr/pixel.gif" width="1" height="1">

</form>