Small Issue with a field

Hi I need urgent help with something.

The script below is for paypal payment what i would like to do is to hardcode a select box or input field beside my radio button so i could add the quantity value to my item so when i click subscribe/Checkout it will show whatever quantity i selected on the page.

Thanks very much!

<?php
global $wpdb, $paypali_membership_vars, $posted;
?>

<div id="paypali_membership_form">
  <?php 
	if (isset($errors) && sizeof($errors)>0 && $errors->get_error_code()) :
		echo '<ul class="errors">';
		foreach ($errors->errors as $error) {
			echo '<li>'.$error[0].'</li>';
		}
		echo '</ul>';
	endif; 
	?>
  <form id="paypali_membership_form" method="post" action="<?php
    	global $post;
    	if (is_single() || is_page()) :
    		echo get_permalink($post->ID);
    	else :
    		$pageURL = 'http';
    		if ($_SERVER["HTTPS"] == "on") $pageURL .= "s";
    		$pageURL .= "://";
    		if ($_SERVER["SERVER_PORT"] != "80") $pageURL .= $_SERVER["SERVER_NAME"].":".$_SERVER["SERVER_PORT"].$_SERVER["REQUEST_URI"];
    		else $pageURL .= $_SERVER["SERVER_NAME"].$_SERVER["REQUEST_URI"];
    		echo $pageURL;
    	endif;
    ?>" name="membershipform">
    <?php if (!is_user_logged_in()) : ?>
    <fieldset>
      <legend>
      <?php _e('Please fill in the following form to subscribe','paypali'); ?>
      </legend>
      <div>
        <label for="username"><span class="required">*</span>
          <?php _e('Username','paypali'); ?>
        </label>
        <input type="text" id="username" name="username" class="text" value="<?php if (isset($posted['username'])) echo $posted['username']; ?>" />
      </div>
      <div>
        <label for="firstname"><span class="required">*</span>
          <?php _e('Firstname','paypali'); ?>
        </label>
        <input type="text" id="firstname" name="firstname" class="text" value="<?php if (isset($posted['firstname'])) echo $posted['firstname']; ?>" />
      </div>
      <div>
        <label for="username"><span class="required">*</span>
          <?php _e('Lastname','paypali'); ?>
        </label>
        <input type="text" id="lastname" name="lastname" class="text" value="<?php if (isset($posted['lastname'])) echo $posted['lastname']; ?>" />
      </div>
      <div>
        <label for="email"><span class="required">*</span>
          <?php _e('Email','paypali'); ?>
        </label>
        <input type="text" id="email" name="email" class="text" value="<?php if (isset($posted['email'])) echo $posted['email']; ?>" />
      </div>
      <div>
        <label for="password"><span class="required">*</span>
          <?php _e('Password','paypali'); ?>
        </label>
        <input type="password" id="password" name="password" class="text input-short" value="<?php if (isset($posted['password'])) echo $posted['password']; ?>" placeholder="<?php _e('Enter password','paypali'); ?>" />
        <input type="password" id="password2" name="password2" class="text input-short" value="<?php if (isset($posted['password2'])) echo $posted['password2']; ?>" placeholder="<?php _e('Enter again','paypali'); ?>" />
      </div>
      <?php endif; ?>
      <fieldset>
        <legend>
        <?php _e('Choose a Membership Pack','paypali'); ?>
        </legend>
        <?php
					$free = false;
					$sql_packs = sprintf("SELECT * FROM %s ORDER BY id;",
						$wpdb->escape( $paypali_membership_vars['membership_database'] ));	
					$packs = $wpdb->get_results($sql_packs);
					if (!empty($packs)) :
						$alt = -1;
						foreach ( $packs as $pack ) : 
							?>
        <p class="radio <?php if ($alt==1) echo 'alt'; ?>">
          <input type="text" width="10" name="pack[]" class="radio" id="pack_<?php echo $pack->ID; ?>" value="<?php echo $pack->ID; ?>" <?php if (isset($posted['pack']) && $posted['pack']==$pack->ID) ?> />
      
          
       
   
          
          <label for="pack_<?php echo $pack->ID; ?>" class="radio">
            <?php 
								echo $pack->membership_name.' &ndash; <strong>';
								if ($pack->membership_price>0) :
									echo paypali_currency_wrap($pack->membership_price); 
								else :
									echo __('Free', 'paypali');
									$free = true;
								endif;
								echo '</strong>'; 
								if ($pack->membership_desc) :
									echo '<small>'.$pack->membership_desc.'</small>';
								endif;
							?>
          </label>
        </p>
        <?php
							$alt = $alt*-1;
						endforeach;
					endif;
				?>
        <p class="checkbox">
          <input type="checkbox" name="auto_renew" id="auto_renew" <?php if (isset($posted['auto_renew']) && $posted['auto_renew']) echo 'checked="checked"'; ?> />
          <label for="auto_renew">
            <?php _e('Automatically renew?', 'paypali'); ?>
          </label>
        </p>
      </fieldset>
      <div>
        <input type="submit" name="membershipform" class="submit" value="<?php _e('Subscribe &rarr;', 'paypali'); ?>" />
      </div>
      <?php if (!is_user_logged_in()) : ?>
    </fieldset>
    <?php endif; ?>
  </form>
</div>
Sponsor our Newsletter | Privacy Policy | Terms of Service