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You can accomplish that with Jotform. You may find the Authorize.net integration under "Payment Tools":
So if the form is built it can be set as a secure form. I now have three more questions.1 - Does the info on the form go to my email notification address in a secured fashion?
2 - Where do I put the Authorize.net widget?
a - at the end of the entire form?
b - just prior to the submit button?3 - How can I test the form after building it?