Untitled

<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
    <meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
    <title>Test</title>
</head>
<body>
<?php

    $DaysTimestamp = strtotime('now');
    $Mo = date('m', $DaysTimestamp);
    $Day = date('d', $DaysTimestamp);
    $Year = date('Y', $DaysTimestamp);
    $StartDateGMT = $Year . '-' . $Mo . '-' . $Day . 'T00:00:00\Z';    ?>
<form action="./ipn/ipn-listener.php" method="post" data-ajax="false">
    <div style="max-width:700px; margin: 0 auto;">

            <input type="text" name="txn_type" value="RECURRING_PAYMENT">
            <input type="text" name="subscribername"  value="TEst subscriber">
            <input type="text" name="profilestartdate" value="<?php echo $StartDateGMT;?>">
            <input type="text" name="desc" value="Description of payment">
            <input type="text" name="maxfailedpayments" value="0">
            <input type="text" name="autobillamt" value="1">
            <input type="text" name="trialbillingperiod" value="">
            <input type="text" name="trialbillingfrequency" value="">
            <input type="text" name="trialtotalbillingcycles" value="">
            <input type="text" name="trialamt" value="">
            <input type="text" name="billingperiod" value="day">
            <input type="text" name="billingfrequency" value="1">
            <input type="text" name="totalbillingcycles" value="6">
            <input type="text" name="amt" value="133.54">
            <input type="text" name="currencycode" value="EUR">
            <input type="text" name="shippingamt" value="">
            <input type="text" name="taxamt" value="">
            <input type="text" name="creditcardtype" value="visa">
            <input type="text" name="acct" value="XXXXXXXX">
            <input type="text" name="cvv2" value="12">
            <input type="text" name="startdate" value="122017">
            <input type="text" name="issuenumber" value="">
            <input type="text" name="email" value="xxxxxxxx@gmail.com">
            <input type="text" name="payerid" value="">
            <input type="text" name="payerstatus" value="">
            <input type="text" name="countrycode" value="">
            <input type="text" name="business" value="testers, LLC">
            <input type="text" name="salutation" value="">
            <input type="text" name="firstname" value="XXYZ">
            <input type="text" name="middlename" value="">
            <input type="text" name="lastname" value="ZZZZZZZZZZZZZZZ">
            <input type="text" name="suffix" value="">

            <input type="hidden" name="caseid" value="1234556" />
        </fieldset>

        <button data-theme="e" type="submit" name="placajObrocno">Pay</button>
    </div>
</form>
</body>
</html>