     <option value="One face - color">One face - color</option>
      <option value="Multiple faces - black and white">Multiple faces - black and white</option>
      <option value="Multiple faces - color">Multiple faces - color</option>
    </select>
    <input type="hidden" name="on1" value="Portrait Reference URL">
    <label style="margin:10px 0;">Portrait Reference URL</label>
    <input type="text" name="os1" maxlength="200">
    <input type="hidden" name="currency_code" value="USD">
    <input type="