BUDGET: $20
MAGENTO 1.6
Please see attached for the xml/php/phtml files. I think the issue is with the [login to view URL] in /Pay/Model/ folder. See my commented lines.
REQUIREMENTS
1. All 3 fields should accept data as shown.
2. Input should show on right column after submit.
3. Data should be added to database once order completes.
You'll re-zip the files to me and I'll deploy it and it should work as needed.
This should take no more than 2 hours for an experienced magento programmer