campaign.flickssupply.com Open in urlscan Pro
208.99.78.210  Public Scan

Form analysis
1 forms found in the DOM

POST /payment.php

<form class="needs-validation" method="post" id="form" novalidate="" action="/payment.php">
  <h3 class="text-center formtitle mb-3">Create Your Account</h3>
  <!-- Text input-->
  <div class="form-group">
    <input name="firstname" id="firstname" type="text" placeholder="First Name" class="form-control radius form-control-lg" value="" required="">
    <div class="invalid-tooltip"> Please enter your first name </div>
  </div>
  <!-- Text input-->
  <div class="form-group">
    <input name="lastname" id="lastname" type="text" placeholder="Last Name" class="form-control radius  form-control-lg" value="" required="">
    <div class="invalid-tooltip"> Please enter your last name </div>
  </div>
  <!-- Text input-->
  <div class="form-group">
    <input name="email" id="email" type="email" placeholder="Email Address" class="form-control radius  form-control-lg" value="" required="">
    <div class="invalid-tooltip"> Please provide a valid email </div>
  </div>
  <input type="hidden" name="lang" id="lang" value="en">
  <input type="hidden" name="c" id="c" value="eyJhIjoyMDc4OCwibyI6Njg2LCJzbyI6OTUwLCJwIjoyNiwibHAiOjI1MCwiYyI6e319">
  <input type="hidden" name="tracker" id="tracker" value="4_236">
  <input type="hidden" name="clickid" id="clickid" value="f0d378085d004fa58da1515b624d3115">
  <div class="custom-control custom-checkbox my-4">
    <input type="checkbox" class="custom-control-input" id="customCheck1" checked="" required="">
    <label class="custom-control-label" for="customCheck1"> By clicking Continue you agree to the <a href="http://flickssupply.com/terms.php" target="_blank">Terms of Use</a> and <a href="http://flickssupply.com/privacy.php">Privacy Policy</a> and
      that my subscription will automatically recur until I cancel.</label>
    <div class="invalid-tooltip"> You must agree to the terms </div>
  </div>
  <!-- Button -->
  <div class="form-group text-center">
    <button id="submit-button" name="reg" class="btn radius btn-lg btn-success text-uppercase btnsubmit mt-3 ">Continue →</button>
  </div>
  <input type="hidden" id="phonedata" name="phonedata">
</form>

Text Content

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