appsstuff.maxapex.net
Open in
urlscan Pro
195.201.4.87
Public Scan
Submitted URL: http://www.bankinfo.appsstuff.net/
Effective URL: https://appsstuff.maxapex.net/apex/f?p=153:1022::::::&tz=0:00
Submission: On July 11 via api from US — Scanned from US
Effective URL: https://appsstuff.maxapex.net/apex/f?p=153:1022::::::&tz=0:00
Submission: On July 11 via api from US — Scanned from US
Form analysis 1 forms found in the DOM
Name: wwv_flow — POST wwv_flow.accept
<form action="wwv_flow.accept" method="post" name="wwv_flow" id="wwvFlowForm" data-oj-binding-provider="none" novalidate="" autocomplete="off">
<input type="hidden" name="p_flow_id" value="153" id="pFlowId"><input type="hidden" name="p_flow_step_id" value="1022" id="pFlowStepId"><input type="hidden" name="p_instance" value="16180696437323" id="pInstance"><input type="hidden"
name="p_page_submission_id" value="186043628399154240256498466300271625025" id="pPageSubmissionId"><input type="hidden" name="p_request" value="" id="pRequest"><input type="hidden" name="p_reload_on_submit" value="S" id="pReloadOnSubmit"><input
type="hidden" value="186043628399154240256498466300271625025" id="pSalt">
<header class="t-Header" id="t_Header">
<div class="t-Header-branding">
<div class="t-Header-controls">
</div>
<div class="t-Header-logo">
<a href="#" class="t-Header-logo-link"><img src="" class="apex-logo-img"><span class="apex-logo-text">The Tipping Point Healthcare</span></a>
</div>
<div class="t-Header-navBar">
<ul class="t-NavigationBar js-menu-callout" id="149076038972743362"></ul>
</div>
</div>
</header>
<div class="t-Body">
<div class="t-Body-main" style="margin-top: 48px;">
<div class="t-Body-title" id="t_Body_title" style="top: 48px;">
<div class="t-HeroRegion " id="R34020291858382805">
<div class="t-HeroRegion-wrap">
<div class="t-HeroRegion-col t-HeroRegion-col--left"><span class="t-HeroRegion-icon t-Icon app-icon"></span></div>
<div class="t-HeroRegion-col t-HeroRegion-col--content">
<h1 class="t-HeroRegion-title">Bank Transfer (Payment) Form</h1>
<input type="hidden" id="P1022_EVENT_ID" name="P1022_EVENT_ID" value="267481157439682017005878816236248236033"><input type="hidden" data-for="P1022_EVENT_ID"
value="23WcD_gpHo_GYMpnWnJZ2CMtlqFT7dIxm7_-wFThCVwX1l0iv4KqQVo7klNjhkv_QpVQKnYBC6LcLGWU7GEeRg">
<ul class="t-Breadcrumb "></ul>
</div>
<div class="t-HeroRegion-col t-HeroRegion-col--right">
<div class="t-HeroRegion-form"></div>
<div class="t-HeroRegion-buttons"></div>
</div>
</div>
</div>
</div>
<div class="t-Body-content" id="t_Body_content">
<div id="t_Body_content_offset" style="height: 97px;"></div>
<span id="APEX_SUCCESS_MESSAGE" data-template-id="131344822209580209_S" class="apex-page-success u-hidden"></span><span id="APEX_ERROR_MESSAGE" data-template-id="131344822209580209_E" class="apex-page-error u-hidden"></span>
<div class="t-Body-contentInner">
<div class="container">
<div class="row">
<div class="col col-12 apex-col-auto">
<div class="t-Region t-Region--hideHeader t-Region--scrollBody" id="R34000657446357968">
<div class="t-Region-header">
<div class="t-Region-headerItems t-Region-headerItems--title">
<span class="t-Region-headerIcon"><span class="t-Icon " aria-hidden="true"></span></span>
<h2 class="t-Region-title" id="R34000657446357968_heading">Speaker_Bank_Info</h2>
</div>
<div class="t-Region-headerItems t-Region-headerItems--buttons"><span class="js-maximizeButtonContainer"></span></div>
</div>
<div class="t-Region-bodyWrap">
<div class="t-Region-buttons t-Region-buttons--top">
<div class="t-Region-buttons-left"></div>
<div class="t-Region-buttons-right"></div>
</div>
<div class="t-Region-body">
<h3 style="color:#e3264f;">Please fill the bank transfer confirmation form below!</h3><input type="hidden" id="P1022_ID" name="P1022_ID" value=""><input type="hidden" data-for="P1022_ID"
value="jn8BLm_mcosmpbCxvtu4Gr9b--EXRo80tfE20nNMDcy265RzviT1uK9gZLnFK6PQs0pfKgqqPiIa6zBDyyouLg">
<div class="container">
<div class="row">
<div class="col col-12 apex-col-auto">
<div class="t-Form-fieldContainer t-Form-fieldContainer--floatingLabel is-required apex-item-wrapper apex-item-wrapper--text-field" id="P1022_FULL_NAME_CONTAINER">
<div class="t-Form-labelContainer">
<label for="P1022_FULL_NAME" id="P1022_FULL_NAME_LABEL" class="t-Form-label">Full Name <span class="u-VisuallyHidden">(Value Required)</span></label>
</div>
<div class="t-Form-inputContainer">
<div class="t-Form-itemWrapper"><input type="text" id="P1022_FULL_NAME" name="P1022_FULL_NAME" class="text_field apex-item-text" value="" size="60" maxlength="250"></div><span id="P1022_FULL_NAME_error_placeholder"
class="a-Form-error" data-template-id="149054216755743353_ET"></span>
</div>
</div>
</div>
</div>
<div class="row">
<div class="col col-6 apex-col-auto">
<div class="t-Form-fieldContainer t-Form-fieldContainer--floatingLabel t-Form-fieldContainer--stretchInputs apex-item-wrapper apex-item-wrapper--text-field" id="P1022_BANK_NAME_CONTAINER">
<div class="t-Form-labelContainer">
<label for="P1022_BANK_NAME" id="P1022_BANK_NAME_LABEL" class="t-Form-label">Bank Name</label>
</div>
<div class="t-Form-inputContainer">
<div class="t-Form-itemWrapper"><input type="text" id="P1022_BANK_NAME" name="P1022_BANK_NAME" class="text_field apex-item-text" value="" size="60" maxlength="100"></div><span id="P1022_BANK_NAME_error_placeholder"
class="a-Form-error" data-template-id="149054005686743353_ET"></span>
</div>
</div>
</div>
<div class="col col-6 apex-col-auto">
<div class="t-Form-fieldContainer t-Form-fieldContainer--floatingLabel t-Form-fieldContainer--stretchInputs apex-item-wrapper apex-item-wrapper--text-field" id="P1022_BANK_ADDRESS_CONTAINER">
<div class="t-Form-labelContainer">
<label for="P1022_BANK_ADDRESS" id="P1022_BANK_ADDRESS_LABEL" class="t-Form-label">Bank Address</label>
</div>
<div class="t-Form-inputContainer">
<div class="t-Form-itemWrapper"><input type="text" id="P1022_BANK_ADDRESS" name="P1022_BANK_ADDRESS" class="text_field apex-item-text" value="" size="60" maxlength="250"></div><span
id="P1022_BANK_ADDRESS_error_placeholder" class="a-Form-error" data-template-id="149054005686743353_ET"></span>
</div>
</div>
</div>
</div>
<div class="row">
<div class="col col-6 apex-col-auto">
<div class="t-Form-fieldContainer t-Form-fieldContainer--floatingLabel u-textLeft t-Form-fieldContainer--stretchInputs apex-item-wrapper apex-item-wrapper--number-field" id="P1022_ACCOUNT_NO_CONTAINER">
<div class="t-Form-labelContainer">
<label for="P1022_ACCOUNT_NO" id="P1022_ACCOUNT_NO_LABEL" class="t-Form-label">Account Number</label>
</div>
<div class="t-Form-inputContainer">
<div class="t-Form-itemWrapper"><input type="text" id="P1022_ACCOUNT_NO" name="P1022_ACCOUNT_NO" class="number_field apex-item-text apex-item-number" value="" size="32" maxlength="255" style="text-align:right"></div>
<span id="P1022_ACCOUNT_NO_error_placeholder" class="a-Form-error" data-template-id="149054005686743353_ET"></span>
</div>
</div>
</div>
<div class="col col-6 apex-col-auto">
<div class="t-Form-fieldContainer t-Form-fieldContainer--floatingLabel apex-item-wrapper apex-item-wrapper--text-field" id="P1022_IBAN_CONTAINER">
<div class="t-Form-labelContainer">
<label for="P1022_IBAN" id="P1022_IBAN_LABEL" class="t-Form-label">IBAN</label>
</div>
<div class="t-Form-inputContainer">
<div class="t-Form-itemWrapper"><input type="text" id="P1022_IBAN" name="P1022_IBAN" class="text_field apex-item-text" value="" size="60" maxlength="200"></div><span id="P1022_IBAN_error_placeholder"
class="a-Form-error" data-template-id="149054005686743353_ET"></span>
</div>
</div>
</div>
</div>
<div class="row">
<div class="col col-6 apex-col-auto">
<div class="t-Form-fieldContainer t-Form-fieldContainer--floatingLabel apex-item-wrapper apex-item-wrapper--text-field" id="P1022_SWIFT_CODE_CONTAINER">
<div class="t-Form-labelContainer">
<label for="P1022_SWIFT_CODE" id="P1022_SWIFT_CODE_LABEL" class="t-Form-label">Swift Code</label>
</div>
<div class="t-Form-inputContainer">
<div class="t-Form-itemWrapper"><input type="text" id="P1022_SWIFT_CODE" name="P1022_SWIFT_CODE" class="text_field apex-item-text" value="" size="60" maxlength="200"></div><span id="P1022_SWIFT_CODE_error_placeholder"
class="a-Form-error" data-template-id="149054005686743353_ET"></span>
</div>
</div>
</div>
<div class="col col-6 apex-col-auto">
<div class="t-Form-fieldContainer t-Form-fieldContainer--floatingLabel apex-item-wrapper apex-item-wrapper--text-field" id="P1022_PAYPAL_ACCOUNT_CONTAINER">
<div class="t-Form-labelContainer">
<label for="P1022_PAYPAL_ACCOUNT" id="P1022_PAYPAL_ACCOUNT_LABEL" class="t-Form-label">Paypal Account</label>
</div>
<div class="t-Form-inputContainer">
<div class="t-Form-itemWrapper"><input type="text" id="P1022_PAYPAL_ACCOUNT" name="P1022_PAYPAL_ACCOUNT" class="text_field apex-item-text" value="" size="60" maxlength="100"></div><span
id="P1022_PAYPAL_ACCOUNT_error_placeholder" class="a-Form-error" data-template-id="149054005686743353_ET"></span>
</div>
</div>
</div>
</div>
<div class="row">
<div class="col col-12 apex-col-auto">
<div class="t-Form-fieldContainer t-Form-fieldContainer--floatingLabel apex-item-wrapper apex-item-wrapper--text-field" id="P1022_OTHER_BANK_INFO_CONTAINER">
<div class="t-Form-labelContainer">
<label for="P1022_OTHER_BANK_INFO" id="P1022_OTHER_BANK_INFO_LABEL" class="t-Form-label">Other Information</label>
</div>
<div class="t-Form-inputContainer">
<div class="t-Form-itemWrapper"><input type="text" id="P1022_OTHER_BANK_INFO" name="P1022_OTHER_BANK_INFO" class="text_field apex-item-text" value="" size="60" maxlength="200"></div><span
id="P1022_OTHER_BANK_INFO_error_placeholder" class="a-Form-error" data-template-id="149054005686743353_ET"></span>
</div>
</div>
</div>
</div>
</div>
<table role="presentation" cellspacing="0" cellpadding="0" border="0" width="100%">
<tbody>
<tr>
<td align="right"><button onclick="apex.submit({request:'CREATE',validate:true});" class="t-Button t-Button--hot t-Button--simple t-Button--stretch" type="button" id="B34012460013357991"><span
class="t-Button-label">SUBMIT</span></button></td>
</tr>
</tbody>
</table>
</div>
<div class="t-Region-buttons t-Region-buttons--bottom">
<div class="t-Region-buttons-left"></div>
<div class="t-Region-buttons-right"></div>
</div>
</div>
</div>
</div>
</div>
<div class="row">
<div class="col col-12 apex-col-auto">
<div id="R143994962456819332" class=""><input type="hidden" id="P0_PAGE_SESSION_TITLE" name="P0_PAGE_SESSION_TITLE" value=""><input type="hidden" data-for="P0_PAGE_SESSION_TITLE"
value="jzGvATDfb8ZWsJdaqxKkC08Kr7W8ZLSOCDBwustvI79CuFbNgqdn5f1YRCAW8CKN1sGih2-OkXrUZtjNJTkeaw"><input type="hidden" id="P0_SESSION_COLOR" name="P0_SESSION_COLOR" value=""><input type="hidden" data-for="P0_SESSION_COLOR"
value="pCsqsnDCK6DVpCNreX9CI_-XVmroYoJO-rP7x9cLzR8MRI1xGRoaTn3XCO4uky-iV0Ykysujcipz2xBcA45hiQ"><input type="hidden" id="P0_BUTTON_COLOR" name="P0_BUTTON_COLOR" value=""><input type="hidden" data-for="P0_BUTTON_COLOR"
value="nMcDK8Fz1lTtuYnVdHiY8nYU_cu-DbLJ_GemFGgYVgRn6yG-cCZ_zSRUOHAt2Pz4O5wcxgQVrbwCGRzEeHfKAQ"></div>
</div>
</div>
</div>
</div>
<!-- Footer Start -->
<footer id="footer" class="dark">
<div id="R50555381945125852" class="clearfix">
<div id="copyrights">
<div class="footer-container clearfix">
<div class="col_half u-textStart ">
</div>
</div>
</div>
</div>
</footer>
<!-- Footer End -->
</div>
</div>
</div>
<div class="t-Body-inlineDialogs">
</div><input type="hidden" id="pPageFormRegionChecksums" value="[]">
<input type="hidden" id="pPageItemsRowVersion" value=""><input type="hidden" id="pPageItemsProtected"
value="UDEwMjJfRVZFTlRfSUQ6UDEwMjJfSUQ6UDBfUEFHRV9TRVNTSU9OX1RJVExFOlAw.,X1NFU1NJT05fQ09MT1I6UDBfQlVUVE9OX0NPTE9S/LTQlmMC_c6-FSkBApL2yn-dtWJzTa5PyYiCnVOY4NR1OgyXbOKZVt9XH32N-y-V_3XUkbmJJpiyTfo9wz0y4lg">
</form>Text Content
The Tipping Point Healthcare BANK TRANSFER (PAYMENT) FORM SPEAKER_BANK_INFO PLEASE FILL THE BANK TRANSFER CONFIRMATION FORM BELOW! Full Name (Value Required) Bank Name Bank Address Account Number IBAN Swift Code Paypal Account Other Information SUBMIT