Its been a while since ive had to enter info to buy something, but I see a lot of unnecessary spaces in there. If you're not sure try asking your parents or friends who recently bought an account.

(1) Use http://i.imgur.com/-snip-.jpg instead.
(2) Take it down, now. Clear out your credit card details before reposting. Internet security fail, rather. (Use Paint or something to like draw a white box over the numbers)

*EDIT* Snipped so that when OP takes down his link, nobody else can use my link to see his credit card info.