creditcardnum | patnum | address | zip | trial_xchargetoken_5 | trial_ccnumbermasked_6 | ccexpiration | itemorder | trial_chargeamt_9 | trial_datestart_10 | trial_datestop_11 | note | payplannum | trial_payconnecttoken_14 | trial_payconnecttokenexp_15 | procedures | ccsource | clinicnum | trial_excludeprocsync_19 | paysimpletoken | trial_chargefrequency_21 | canchargewhennobal | trial_paymenttype_23 | isrecurringactive |
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