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1 forms found in the DOM

POST https://www.viewinfeb.com/o/177010ea0268560160/confirm

<form method="POST" id="cart-form" style="margin-top: 10px;" data-parsley-valid="form" action="https://www.viewinfeb.com/o/177010ea0268560160/confirm" data-parsley-validate="" data-qtip-classes="qtip-custom" novalidate=""
  data-parsley-valid-id="form">
  <div class="bg-white">
    <div class="row m-0 p-2 w-100 row-input">
      <div class="col-6" style="padding: 0 5px">
        <input type="text" id="first_name" name="firstname" placeholder="First name" value="" required="" class="form-control unedited-field" data-parsley-valid="name" data-parsley-name="" data-parsley-trigger="blur" data-tooltip-at="top center"
          data-tooltip-my="bottom center" maxlength="32" minlength="2" data-parsley-valid-id="name">
      </div>
      <div class="col-6" style="padding: 0 5px">
        <input type="text" id="last_name" name="lastname" placeholder="Last name" value="" required="" class="form-control unedited-field" data-parsley-valid="name" data-parsley-name="" data-parsley-trigger="blur" data-tooltip-at="top center"
          data-tooltip-my="bottom center" maxlength="32" minlength="2" data-parsley-valid-id="name">
      </div>
    </div>
    <div class="w-100  px-2 row-input">
      <div class="col-12" style="padding: 10px 5px 0">
        <input id="line_1" name="address" type="text" placeholder="Address" value="" required="" class="form-control unedited-field" data-parsley-valid="address" data-parsley-address="" data-parsley-trigger="blur" data-tooltip-at="top center"
          data-tooltip-my="bottom center" maxlength="128" minlength="2" data-parsley-valid-id="address">
      </div>
    </div>
    <div class="row m-0 px-2 w-100 row-input">
      <div class="col-6" style="padding: 10px 5px 0">
        <input id="zip_or_postcode" name="zipcode" type="text" placeholder="Zip or Postcode" value="" required="" maxlength="10" class="form-control unedited-field" data-parsley-country="ca" data-parsley-valid="zipcode" data-parsley-zip="ca"
          data-parsley-trigger="blur keyup" data-tooltip-at="top center" data-tooltip-my="bottom center" data-parsley-valid-id="zipcode">
      </div>
      <div class="col-6" style="padding: 10px 5px 0">
        <input id="city" name="city" type="text" placeholder="City" value="" required="" class="form-control unedited-field" data-parsley-valid="city" data-parsley-city="" data-parsley-trigger="blur" data-tooltip-at="top center"
          data-tooltip-my="bottom center" maxlength="32" minlength="2" data-parsley-valid-id="city">
      </div>
    </div>
    <div class="w-100  px-2 row-input">
      <div class="col-12" style="padding: 10px 5px 0">
        <select id="country_code" name="state" required="" class="form-control unedited-field" data-parsley-valid="state" data-parsley-state="" data-parsley-trigger="change" data-tooltip-at="top center" data-tooltip-my="bottom center"
          data-parsley-valid-id="state">
          <option disabled="" selected="" hidden="" value=""> Select State </option>
          <option value="Nova Scotia">Nova Scotia</option>
          <option value="New Brunswick">New Brunswick</option>
          <option value="Quebec">Quebec</option>
          <option value="Ontario">Ontario</option>
          <option value="Manitoba">Manitoba</option>
          <option value="Saskatchewan">Saskatchewan</option>
          <option value="Alberta">Alberta</option>
          <option value="British Columbia">British Columbia</option>
          <option value="Yukon">Yukon</option>
          <option value="Northwest Territories">Northwest Territories</option>
          <option value="Nunavut">Nunavut</option>
          <option value="Prince Edward Island">Prince Edward Island</option>
          <option value="Newfoundland and Labrador">Newfoundland and Labrador</option>
        </select>
      </div>
    </div>
    <div class="w-100  px-2 row-input">
      <div class="col-12" style="padding: 10px 5px 0">
        <div class="iti iti--allow-dropdown iti--separate-dial-code">
          <div class="iti__flag-container">
            <div class="iti__selected-flag" role="combobox" aria-controls="iti-0__country-listbox" aria-owns="iti-0__country-listbox" aria-expanded="false" tabindex="0" title="Canada: +1" aria-activedescendant="iti-0__item-ca">
              <div class="iti__flag iti__ca"></div>
              <div class="iti__selected-dial-code">+1</div>
              <div class="iti__arrow"></div>
            </div>
          </div>
          <input type="tel" id="phone" name="phone" placeholder="Phone number" value="" required="" class="form-control unedited-field" autocomplete="off" style="padding-left: 78px;" data-parsley-country="ca" data-parsley-valid="phone"
            data-parsley-phone="ca" data-parsley-trigger="blur" data-tooltip-at="top center" data-tooltip-my="bottom center" maxlength="12" data-parsley-valid-id="phone">
        </div>
      </div>
    </div>
    <div class="w-100  px-2 row-input">
      <div class="col-12" style="padding: 0 5px 10px">
        <input type="email" id="email" name="email" placeholder="E-mail" value="" required="" class="form-control unedited-field" data-parsley-valid="email" data-parsley-type="email" data-parsley-trigger="blur" data-tooltip-at="top center"
          data-tooltip-my="bottom center" maxlength="128" data-parsley-valid-id="email">
      </div>
    </div>
    <div class="w-100  px-2 div-terms">
      <label for="terms" style="font-size: 10px; font-weight: normal;">
        <input type="checkbox" name="terms" id="terms" required="" onchange="document.getElementById('btn-submit').disabled = !this.checked;" checked="true" class="unedited-field" data-parsley-multiple="terms">
        <span>I certify I'm at least 18 years of age, and accept <a data-toggle="modal" data-target="#modalTerms" style="cursor: pointer;color: #0062cc">the terms and conditions and the flexible loyalty program</a>. </span>
      </label>
    </div>
    <div class="w-100 p-2 ">
      <input type="submit" value="Continue" class="btn-block w-75 btn my-3 font-weight-bold submit unedited-field" id="btn-submit" style="background: #008a2a; color: white;text-transform: uppercase; min-height:65px!important; width: 100%!important;">
    </div>
  </div>
  <input type="hidden" name="country" value="CA">
</form>

Text Content

This is a special offer for a limited period of 5 days which comes with a $15.00
welcome gift card to explore and buy products on one of our affiliates’
websites. By acquiring this membership you will be automatically enrolled in our
affiliate membership services. The membership fee amount is $29.00 which will be
automatically deducted every 30 days unless skipped or canceled. You can cancel
the service at any time with a 30 days cancellation period or pay $2.99 for
immediate opt-out. This campaign will expire on Apr 13.

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(1852 Reviews)

"Excellent" from +170.000 customers

ORDER SUMMARY:

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Delivery $2.99 Order total $2.99

1. INFORMATION

Select State Nova ScotiaNew
BrunswickQuebecOntarioManitobaSaskatchewanAlbertaBritish ColumbiaYukonNorthwest
TerritoriesNunavutPrince Edward IslandNewfoundland and Labrador
+1


I certify I'm at least 18 years of age, and accept the terms and conditions and
the flexible loyalty program.


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2. PAYMENT  



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➜➜
What our customers say

Fast and easy to use

○●○○○

"Excellent" from +170.000 customers

ORDER SUMMARY:

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Delivery $2.99 Order total $2.99

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30-day money-back guarantee



Secure Checkout


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1840 People viewed this site in the past 24 hours.

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