restlesslegs-site.e-captain.nl
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2001:4018:1000:52::ec:10
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URL:
https://restlesslegs-site.e-captain.nl/onlinebetalen/a881a9a938bddb0f0f6cbacc5e8c5c51
Submission: On August 25 via api from BE — Scanned from NL
Submission: On August 25 via api from BE — Scanned from NL
Form analysis
1 forms found in the DOMPOST
<form action="" method="post">
<div class="table-responsive">
<table class="table table-striped table-hover">
<thead>
<tr>
<th>Factuurnr.</th>
<th>Fact. datum</th>
<th style="text-align: right;">Totaal</th>
<th style="text-align: right;">Openstaand</th>
</tr>
</thead>
<tbody>
<tr>
<td style="text-align: left; ">202200541</td>
<td style="text-align: left; ">25-08-2022</td>
<td style="text-align: right; ">€ 25,00</td>
<td style="text-align: right; "><span style="font-weight: bold;">€ 25,00</span></td>
<td>
<input type="checkbox" name="cb_3013" checked="">
</td>
</tr>
</tbody>
</table>
</div>
<div style="font-weight: bold;"> Totaal openstaand: € 25,00 </div>
<br>
<div style="float: left;"> Betaalwijze: </div>
<div style="float: left;">
<select name="psp_code" class="form-control" style="max-width: 300px;">
<option value="0" selected="selected">iDeal</option>
</select>
</div> <button type="submit" id="btnafrekenen" name="btnafrekenen" class="btn btn-default " style="width: 100px">Betalen</button>
<br><br>
<img src="/inc/images/logo ideal25px.jpg" border="0" title="Via uw eigen bank met iDEAL">
</form>
Text Content
Toggle navigation * Home * Over ons * Contact Factuurnr. Fact. datum Totaal Openstaand 202200541 25-08-2022 € 25,00 € 25,00 Totaal openstaand: € 25,00 Betaalwijze: iDeal Betalen