DRC, if you'd like this form and the simple instructions on how to get your .htm/.html/.php galleries to carry a CCBill ID, let me know and I'll PM you the info.
http://www.maladaptedmedia.com/test/affiliate.php
I noticed that your current hosted gallery list is on a .nsf page, whatever that is.
The results from that sample form are produced by PHP, but I assume your server has PHP.