payment.thedatacouncil.com Open in urlscan Pro
34.120.168.40  Public Scan

Form analysis
1 forms found in the DOM

#

<form class="form-container" id="payment-form" action="#" onsubmit="return submitPaymentForm();">
  <div class="mb-3">
    <span class="text-20 main-color" style="font-weight:600">Enter Payment Information</span>
  </div>
  <div class="row">
    <div class="col-md-12 col-lg-4">
      <div class="form-group">
        <input type="text" class="form-control" placeholder="Customer ID*" id="txtIxoneAccountNumber" name="IxoneAccountNumber" required="" maxlength="30">
        <span class="red-text error-message"></span>
      </div>
    </div>
    <div class="col-md-12 col-lg-4">
      <div class="form-group">
        <input type="text" class="form-control" id="txtCompanyName" placeholder="Company Name*" name="CompanyName" required="" maxlength="100">
        <span class="red-text error-message"></span>
      </div>
    </div>
    <div class="col-md-12 col-lg-4">
      <div class="form-group">
        <input type="text" class="form-control" id="txtInvoiceNumber" placeholder="IX-ONE Invoice Number(s)*" name="InvoiceNumber" required="" maxlength="100">
      </div>
    </div>
  </div>
  <div class="row">
    <div class="col-lg-4 col-md-12">
      <div class="form-group">
        <input type="text" class="form-control" id="txtCreditCardNumber" placeholder="Credit Card Number*" name="CreditCardNumber" required="" maxlength="30">
      </div>
    </div>
    <div class="col-lg-3 col-md-12">
      <div class="form-group">
        <select class="form-control" name="ExpirationMonth" id="txtExpirationMonth" required="">
          <option value="" disabled="" selected="" style="color: #CBC2B2">Expiration Month*</option>
          <option value="01">01</option>
          <option value="02">02</option>
          <option value="03">03</option>
          <option value="04">04</option>
          <option value="05">05</option>
          <option value="06">06</option>
          <option value="07">07</option>
          <option value="08">08</option>
          <option value="09">09</option>
          <option value="10">10</option>
          <option value="11">11</option>
          <option value="12">12</option>
        </select>
      </div>
    </div>
    <div class="col-lg-3 col-md-12">
      <div class="form-group">
        <div class="form-group">
          <select class="form-control" name="ExpirationYear" id="txtExpirationYear" required="">
            <option value="" disabled="" selected="" style="color: #CBC2B2">Expiration Year*</option>
            <option value="24">2024</option>
            <option value="25">2025</option>
            <option value="26">2026</option>
            <option value="27">2027</option>
            <option value="28">2028</option>
            <option value="29">2029</option>
            <option value="30">2030</option>
            <option value="31">2031</option>
            <option value="32">2032</option>
            <option value="33">2033</option>
            <option value="34">2034</option>
          </select>
        </div>
      </div>
    </div>
    <div class="col-lg-2 col-md-12">
      <div class="form-group">
        <input type="text" maxlength="4" pattern="\d{3,4}" placeholder="CVV*" class="form-control" id="txtCardCVV" name="CardCVV" required="">
      </div>
    </div>
  </div>
  <div class="row">
    <div class="col-lg-4 col-md-12">
      <div class="form-group">
        <input type="text" class="form-control" id="txtFirstName" placeholder="First Name*" name="FirstName" required="" maxlength="20">
      </div>
    </div>
    <div class="col-lg-4 col-md-12">
      <div class="form-group">
        <input type="text" class="form-control" id="txtLastName" placeholder="Last Name*" name="LastName" required="" maxlength="20">
      </div>
    </div>
    <div class="col-lg-4 col-md-12">
      <div class="form-group">
        <input type="number" class="form-control" id="txtPaymentAmount" placeholder="Payment Amount (USD)*" name="PaymentAmount" onchange="caculateTotal()" required="" min="1" maxlength="100">
      </div>
    </div>
  </div>
  <div class="row">
    <div class="col-lg-4 col-md-12">
      <div class="form-group">
        <input type="text" class="form-control" id="txtBillingAddress" placeholder="Credit Card Billing Street Address*" name="BillingAddress" required="" maxlength="30">
      </div>
    </div>
    <div class="col-lg-4 col-md-12">
      <div class="form-group">
        <input type="text" class="form-control" id="txtBillingState" placeholder="Credit Card Billing State*" name="BillingState" required="" maxlength="30">
      </div>
    </div>
    <div class="col-lg-4 col-md-12">
      <div class="form-group">
        <input type="text" class="form-control" id="txtBillingZip" placeholder="Credit Card Billing ZIP/Postal Code*" name="BillingZip" required="" maxlength="30">
      </div>
    </div>
  </div>
  <div class="row">
    <div class="col-lg-6 col-md-12">
      <div class="form-group">
        <input type="text" class="form-control" id="txtBillingContactName" placeholder="Billing Contact Name*" name="BillingContactName" required="" maxlength="100">
      </div>
    </div>
    <div class="col-lg-6 col-md-12">
      <div class="form-group">
        <input type="text" class="form-control" id="txtBillingContactPhone" placeholder="Billing Contact Phone*" name="Phone" required="" maxlength="100">
      </div>
    </div>
  </div>
  <div class="row">
    <div class="col-lg-6 col-md-12">
      <div class="form-group">
        <input type="email" class="form-control" id="txtBillingContactEmail" placeholder="Billing Contact Email*" name="BillingContactEmail" required="" maxlength="100">
      </div>
    </div>
    <div class="col-lg-6 col-md-12">
      <div class="form-group">
        <input type="email" class="form-control" id="txtBillingContactEmail2" placeholder="Billing Contact Email (verify)*" name="BillingContactEmail2" required="" maxlength="100">
      </div>
    </div>
  </div>
  <div class="row">
    <div class="col-md-12">
      <p id="generalErrorMessage" class="red-text"></p>
    </div>
  </div>
  <div class="row">
    <div class="col-md-12 mb-3">
      <span class="text-16">Your transaction total will be: <strong>$<span id="txtTotal">0.00</span></strong></span>
    </div>
  </div>
  <div class="row">
    <div class="col-lg-7 col-md-12 mb-4">
      <span class="text-16">By submitting this form you approve the transaction total to be charged to your credit card.</span>
    </div>
    <div class="col-lg-2 col-md-12"></div>
    <div class="col-lg-3 col-md-12 mb-4">
      <button type="submit" class="btn col-md-12 btn-success btn-lg btn-submit float-right">SUBMIT</button>
    </div>
  </div>
</form>

Text Content

Credit Card Payment Processing
Welcome to The Data Council credit card payment processing site. This site is
reserved for the use of Data Council members. For more information, please visit
www.thedatacouncil.com or www.gorivir.com
If you would like to make a payment, please complete the form.
Please note:
 * All transactions are U.S. Dollars
 * Incoming payments are applied to the oldest invoices
 * The Billing Contact Email Address (below) will be used to send the
   transaction confirmation

Enter Payment Information

Expiration Month* 01 02 03 04 05 06 07 08 09 10 11 12
Expiration Year* 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034








Your transaction total will be: $0.00
By submitting this form you approve the transaction total to be charged to your
credit card.

SUBMIT

COMPLETED!

Transaction completed.

Your transaction ID is

OK
Contact us at (904) 512-3200 or info@thedatacouncil.com