www.hcmm.cz Open in urlscan Pro
204.8.234.217  Public Scan

Form analysis
1 forms found in the DOM

Name: SupportForm — POST /index.php?a=email&PHPSESSID=csok29g88eh719vpgidqf6a3l3

<form name="SupportForm" action="/index.php?a=email&amp;PHPSESSID=csok29g88eh719vpgidqf6a3l3" method="post">
  <table cellpadding="1" cellspacing="1" class="table">
    <script type="text/javascript">
      var RecaptchaOptions = {
        theme: "white"
      };
    </script>
    <tbody>
      <tr>
        <td style="width: 240px;" class="bold">Name on the Account:</td>
        <td><input type="text" name="DATA[name]" value="" size="30" class="tableInput"></td>
      </tr>
      <tr>
        <td class="bold">Email Address:</td>
        <td><input type="text" name="DATA[email]" value="" size="30" class="tableInput"></td>
      </tr>
      <tr>
        <td class="bold">Phone Number:</td>
        <td>
          <div style="float: left;"><input type="text" name="DATA[phone]" size="30" class="tableInput"></div>
          <div style="float: left; margin-left: 5px; margin-top: -5px;">
            <i style="color: #FF0000; font-size: 14px; line-height: 100%;">(Optional but necessary<br> if you want a call-back)</i>
          </div>
          <div style="clear: both;"></div>
        </td>
      </tr>
      <tr>
        <td class="bold">Last 4-Digits of Credit Card Used:</td>
        <td><input name="DATA[last_four]" size="30" class="tableInput"> <i style="font-size: 14px;">(Optional)</i></td>
      </tr>
      <tr>
        <td class="bold">Date of Transaction:</td>
        <td><input name="DATA[date_transact]" size="30" class="tableInput"> <i style="font-size: 14px;">(Optional)</i></td>
      </tr>
      <tr>
        <td class="bold">Additional Information:</td>
        <td><textarea name="DATA[additional]" cols="30" rows="6" class="tableTextarea"></textarea> <i style="font-size: 14px;">(Optional)</i></td>
      </tr>
      <tr>
        <td class="bold">&nbsp;</td>
        <td>
          <br>
          <div class="form-elements">
            <div class="g-recaptcha" data-sitekey="6LdipE0UAAAAADRXXLIFByYvgZKqiy1epXWmzaAw">
              <div style="width: 304px; height: 78px;">
                <div><iframe title="reCAPTCHA"
                    src="https://www.google.com/recaptcha/api2/anchor?ar=1&amp;k=6LdipE0UAAAAADRXXLIFByYvgZKqiy1epXWmzaAw&amp;co=aHR0cHM6Ly93d3cuaGNtbS5jejo0NDM.&amp;hl=en&amp;v=Ai7lOI0zKMDPHxlv62g7oMoJ&amp;size=normal&amp;cb=jddk99wmwocf"
                    width="304" height="78" role="presentation" name="a-6kkfcikxpnu" frameborder="0" scrolling="no"
                    sandbox="allow-forms allow-popups allow-same-origin allow-scripts allow-top-navigation allow-modals allow-popups-to-escape-sandbox"></iframe></div><textarea id="g-recaptcha-response" name="g-recaptcha-response"
                  class="g-recaptcha-response" style="width: 250px; height: 40px; border: 1px solid rgb(193, 193, 193); margin: 10px 25px; padding: 0px; resize: none; display: none;"></textarea>
              </div><iframe style="display: none;"></iframe>
            </div>
          </div>
          <br>
          <input type="submit" class="tableSubmit" value="Submit Help Request">
        </td>
      </tr>
    </tbody>
  </table>
</form>

Text Content

Most likely, you are here because you are confused or unsure about a charge on
your credit card statement or bank account. We are here to help you resolve the
matter; please contact us before contacting your bank at the numbers listed
below and we will resolve your billing issue: Toll free 1-800-685-9236 or
+1-818-880-9021 (Outside United States).

If you would like us to contact you, please complete the form below and we will
get back to you as soon as possible.


SUBMIT HELP REQUEST

Name on the Account: Email Address: Phone Number:

(Optional but necessary
if you want a call-back)

Last 4-Digits of Credit Card Used: (Optional) Date of Transaction: (Optional)
Additional Information: (Optional)  






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