diff --git a/server-ca/index.html b/server-ca/index.html
index 4389d4477..69d58bd99 100644
--- a/server-ca/index.html
+++ b/server-ca/index.html
@@ -39,6 +39,7 @@
                     <section>
                         <h2>Payment Form</h2>
                           <form method="get" accept-charset="UTF-8" action="/payment.py/submit=%s">
+                            <p><label for="name">Name:</label> <input name="" type="text" autocomplete="off" value="John Doe" id="name" size="20" maxlength="30" /></p>
                             <p><label for="card-type">Credit card type:</label> <select name=""><option>Vista</option><option>MisterCard</option><option>Discovery</option></select></p>
                             <p><label for="credit-card">Credit card number:</label> <input name="" type="text" autocomplete="off" id="credit-card" size="20" style="font-family:monospace" maxlength="16" /></p>
                             <p><input type="submit" value="Submit" /></p>