www.confirm.ronells.com Open in urlscan Pro
151.106.34.50  Public Scan

Form analysis
1 forms found in the DOM

Name: M1 — POST /cgi-bin/confirm.cgi

<form name="M1" method="POST" action="/cgi-bin/confirm.cgi">
  <p>&nbsp;</p>
  <div align="left">
    <table border="0" width="100%">
      <tbody>
        <tr>
          <td width="50%" style="text-align: left; vertical-align: top; font-family: Tahoma; font-size: 11px; color: #000000">Company Name:</td>
          <td width="50%" style="text-align: left; vertical-align: top; font-family: Tahoma; font-size: 11px; color: #000000"><input type="text" name="Company" size="40"></td>
        </tr>
        <tr>
          <td width="50%" style="text-align: left; vertical-align: top; font-family: Tahoma; font-size: 11px; color: #000000">Contact Person:</td>
          <td width="50%" style="text-align: left; vertical-align: top; font-family: Tahoma; font-size: 11px; color: #000000"><input type="text" name="Person" size="40"></td>
        </tr>
        <tr>
          <td width="50%" style="text-align: left; vertical-align: top; font-family: Tahoma; font-size: 11px; color: #000000">Customer Account Number:</td>
          <td width="50%" style="text-align: left; vertical-align: top; font-family: Tahoma; font-size: 11px; color: #000000"><input type="text" name="Account" size="5"></td>
        </tr>
      </tbody>
    </table>
  </div>
  <p>I hereby confirm Proforma Invoice Number <input type="text" name="PI" size="6"> to be complete and accurate, and instruct Rnls Ltd. to dispatch the goods with a courier to my shipping address, as stated on the Proforma Invoice. I authorise
    anybody at that address to sign for receipt of goods.&nbsp;</p>
  <p>Payment for the invoice will be done by <select size="1" name="PaymentMethod">
      <option selected="" value="Card">Credit/Debit Card</option>
      <option value="BankTransfer">Bank Transfer</option>
      <option value="Cash">Cash</option>
      <option value="Other">Other - will advise</option>
    </select></p>
  <table border="0" width="100%">
    <tbody>
      <tr>
        <td width="100%" bgcolor="#FFFFCC">If paying by card, please complete the below: <p>I hereby authorise Rnls Ltd. to charge my <select size="1" name="CardType">
              <option selected="" value="0">-</option>
              <option value="PERSONAL_DEBIT_CARD">Personal Debit Card</option>
              <option value="PERSONAL_CREDIT_CARD">Personal Credit Card</option>
              <option value="COMPANY_DEBIT_CARD">Company Debit Card</option>
              <option value="COMPANY_CREDIT_CARD">Company Credit Card</option>
            </select><br> to the amount of £<input type="text" name="Pounds" size="4"> and <input type="text" name="Pence" size="2"> pence.&nbsp;</p>
          <p>Card number: <input type="text" name="CardNumber" size="20"> &nbsp;<br> Cardholder's Name (exactly as it appears on the card): <input type="text" name="CardName" size="30"><br> Expiry date and security code <select size="1"
              name="CardDetails">
              <option selected="" value="OnFile">are with RNLS on file</option>
              <option value="OverPhone">I would like to give you over the phone</option>
            </select><br> Card registered address: House Name/Number: <input type="text" name="HouseNumber" size="6"> Post Code: <input type="text" name="PostCode" size="6">
          </p>
        </td>
      </tr>
    </tbody>
  </table>
  <p><br> I confirm to be the owner or signatory of the above card.<br> I confirm to have read and accept the Terms and Conditions of sale as published on rnls.co.uk/terms.html.&nbsp; </p>
  <p>First Name,&nbsp; Surname<input type="text" name="Signature" size="50"></p>
  <p>Information submitted through this web-page is secured by COMODO 128 bit encryption. &nbsp;</p>
  <p>&nbsp;</p>
  <p><input type="submit" value="Submit" name="B1" onclick="return confirmSubmit()"><input type="reset" value="Reset" name="B2"></p>
</form>

Text Content

Secure Server
SSL

Secured with 128 bit encryption SSL Certificate provided by COMODO.

For additional security, we don't ask you to submit your card's expiry date and
security code on this website. 

 

 
ORDER CONFIRMATION
Secured by COMODO SSL with 128 bit encryption

 

Company Name: Contact Person: Customer Account Number:

I hereby confirm Proforma Invoice Number to be complete and accurate, and
instruct Rnls Ltd. to dispatch the goods with a courier to my shipping address,
as stated on the Proforma Invoice. I authorise anybody at that address to sign
for receipt of goods. 

Payment for the invoice will be done by Credit/Debit Card Bank Transfer Cash
Other - will advise

If paying by card, please complete the below:

I hereby authorise Rnls Ltd. to charge my - Personal Debit Card Personal Credit
Card Company Debit Card Company Credit Card
to the amount of £ and pence. 

Card number:  
Cardholder's Name (exactly as it appears on the card):
Expiry date and security code are with RNLS on file I would like to give you
over the phone
Card registered address: House Name/Number: Post Code:


I confirm to be the owner or signatory of the above card.
I confirm to have read and accept the Terms and Conditions of sale as published
on rnls.co.uk/terms.html. 

First Name,  Surname

Information submitted through this web-page is secured by COMODO 128 bit
encryption.