secure.tekcardpayments.net Open in urlscan Pro
3.22.60.38  Public Scan

URL: https://secure.tekcardpayments.net/
Submission: On May 24 via api from US — Scanned from DE

Form analysis 1 forms found in the DOM

POST https://secure.tekcardpayments.net/process.php

<form action="https://secure.tekcardpayments.net/process.php" method="post" class="validate form-horizontal " id="order_form" novalidate="novalidate">
  <input type="hidden" name="csrf" value="a986ece2c57e2df1b508aa917deed6d0">
  <input type="hidden" name="action" value="process_payment">
  <input type="hidden" class="enable-subscriptions" value="0">
  <div class="row">
    <div class="col-md-6">
      <h3 class="colorgray mb30">Payment Details</h3>
      <div class="form-group">
        <label class="col-md-3 control-label"><span class="colordanger">*</span>Amount</label>
        <div class="col-md-9">
          <div class="input-group">
            <span class="input-group-addon"><i class="fa fa-usd"></i></span>
            <input type="text" name="amount" class="form-control" placeholder="0.00" data-rule-required="true" data-rule-number="true" aria-required="true">
          </div>
        </div>
      </div>
      <div class="form-group">
        <label class="col-md-3 control-label"><span class="colordanger">*</span>Description</label>
        <div class="col-md-9">
          <textarea name="description" class="form-control h55 maxlength" maxlength="120" placeholder="Description" data-rule-required="true" aria-required="true"></textarea>
        </div>
      </div>
      <hr class="visible-xs visible-sm">
      <hr class="visible-xs visible-sm">
      <!--<div id="tAndC" class="module">-->
      <!--    <h4 class="header">Terms &amp; Conditions</h4>-->
      <!--    <div id="tAndC" class="tabox" style="font-size:11px;"><p>By checking the box below, I authorize, agree and acknowledge that Express Brooklyn Tile can use the credit card entered by me to make payment on this order.  I represent and warrant to Express Brooklyn Tile that (i) I have the full power and authority to provide the credit card information entered for payment, (ii) that such credit card is valid for payment for the orders in which it is used, and (iii) I will indemnify and hold Express Brooklyn Tile harmless on any and all claims alleging my unauthorized use of such credit card. I agree that all sales are final and any cancellations/returns, will be subject to a 20% restocking fee. Any orders for kitchen cabinets and any special orders are non refundable and no returns will be accepted.</p></div>-->
      <!--    <div style="color:black;">-->
      <!--        <input id="tAndCagreement" class="required" type="checkbox">-->
      <!--        <label class=" required" style="" for="tAndCagreement" style="color:black;"><span>I Agree</span></label>-->
      <!--    </div>-->
      <!--</div>-->
      <h3 class="colorgray mb10">Your Information</h3>
      <div class="form-group">
        <label class="control-label col-md-3"><span class="colordanger">*</span>Name</label>
        <div class="col-md-9">
          <input type="text" name="name" class="form-control" placeholder="Name" value="" data-rule-required="true" aria-required="true">
        </div>
      </div>
      <div class="form-group">
        <label class="control-label col-md-3"><span class="colordanger">*</span>Email</label>
        <div class="col-md-9">
          <input type="text" name="email" class="form-control" placeholder="Email" value="" data-rule-required="true" data-rule-email="true" aria-required="true">
        </div>
      </div>
      <hr class="visible-xs visible-sm">
      <h3 class="colorgray mb10">Billing Address</h3>
      <div class="form-group">
        <label class="control-label col-md-3"><span class="colordanger">*</span>Address</label>
        <div class="col-md-9">
          <input type="text" name="address" class="form-control" placeholder="Address" value="" data-rule-required="true" aria-required="true">
        </div>
      </div>
      <div class="form-group">
        <label class="control-label col-md-3"><span class="colordanger">*</span>City</label>
        <div class="col-md-9">
          <input type="text" name="city" class="form-control" placeholder="City" value="" data-rule-required="true" aria-required="true">
        </div>
      </div>
      <div class="form-group">
        <label class="control-label col-md-3"><span class="colordanger">*</span>State/Zip</label>
        <div class="col-md-9">
          <div class="row">
            <div class="col-md-8 col-xs-8 pr5">
              <select name="state" class="form-control" data-rule-required="true" aria-required="true">
                <option value="">-- Select State --</option>
                <optgroup label="US States">
                  <option value="AL">Alabama</option>
                  <option value="AK">Alaska</option>
                  <option value="AZ">Arizona</option>
                  <option value="AR">Arkansas</option>
                  <option value="BVI">British Virgin Islands</option>
                  <option value="CA">California</option>
                  <option value="CO">Colorado</option>
                  <option value="CT">Connecticut</option>
                  <option value="DE">Delaware</option>
                  <option value="FL">Florida</option>
                  <option value="GA">Georgia</option>
                  <option value="GU">Guam</option>
                  <option value="HI">Hawaii</option>
                  <option value="ID">Idaho</option>
                  <option value="IL">Illinois</option>
                  <option value="IN">Indiana</option>
                  <option value="IA">Iowa</option>
                  <option value="KS">Kansas</option>
                  <option value="KY">Kentucky</option>
                  <option value="LA">Louisiana</option>
                  <option value="ME">Maine</option>
                  <option value="MP">Mariana Islands</option>
                  <option value="MPI">Mariana Islands (Pacific)</option>
                  <option value="MD">Maryland</option>
                  <option value="MA">Massachusetts</option>
                  <option value="MI">Michigan</option>
                  <option value="MN">Minnesota</option>
                  <option value="MS">Mississippi</option>
                  <option value="MO">Missouri</option>
                  <option value="MT">Montana</option>
                  <option value="NE">Nebraska</option>
                  <option value="NV">Nevada</option>
                  <option value="NH">New Hampshire</option>
                  <option value="NJ">New Jersey</option>
                  <option value="NM">New Mexico</option>
                  <option value="NY">New York</option>
                  <option value="NC">North Carolina</option>
                  <option value="ND">North Dakota</option>
                  <option value="OH">Ohio</option>
                  <option value="OK">Oklahoma</option>
                  <option value="OR">Oregon</option>
                  <option value="PA">Pennsylvania</option>
                  <option value="PR">Puerto Rico</option>
                  <option value="RI">Rhode Island</option>
                  <option value="SC">South Carolina</option>
                  <option value="SD">South Dakota</option>
                  <option value="TN">Tennessee</option>
                  <option value="TX">Texas</option>
                  <option value="UT">Utah</option>
                  <option value="VT">Vermont</option>
                  <option value="USVI">VI U.S. Virgin Islands</option>
                  <option value="VA">Virginia</option>
                  <option value="WA">Washington</option>
                  <option value="DC">Washington, D.C.</option>
                  <option value="WV">West Virginia</option>
                  <option value="WI">Wisconsin</option>
                  <option value="WY">Wyoming</option>
                </optgroup>
                <optgroup label="Canadian Provinces">
                  <option value="AB">Alberta</option>
                  <option value="BC">British Columbia</option>
                  <option value="MB">Manitoba</option>
                  <option value="NB">New Brunswick</option>
                  <option value="NF">Newfoundland</option>
                  <option value="NT">Northwest Territories</option>
                  <option value="NS">Nova Scotia</option>
                  <option value="NVT">Nunavut</option>
                  <option value="ON">Ontario</option>
                  <option value="PE">Prince Edward Island</option>
                  <option value="QC">Quebec</option>
                  <option value="SK">Saskatchewan</option>
                  <option value="YK">Yukon</option>
                </optgroup>
                <optgroup label="Australian Provinces">
                  <option value="AU-NSW">New South Wales</option>
                  <option value="AU-QLD">Queensland</option>
                  <option value="AU-SA">South Australia</option>
                  <option value="AU-TAS">Tasmania</option>
                  <option value="AU-VIC">Victoria</option>
                  <option value="AU-WA">Western Australia</option>
                  <option value="AU-ACT">Australian Capital Territory</option>
                  <option value="AU-NT">Northern Territory</option>
                </optgroup>
                <option value="N/A">Other</option>
              </select>
            </div>
            <div class="col-md-4 col-xs-4 pl5">
              <input type="text" name="zip" class="form-control" placeholder="Zip" value="" data-rule-required="true" aria-required="true">
            </div>
          </div>
        </div>
      </div>
      <div class="form-group mb40">
        <label class="control-label col-md-3"><span class="colordanger">*</span>Country</label>
        <div class="col-md-9">
          <select name="country" class="form-control" data-rule-required="true" aria-required="true">
            <option value="">-- Select Country --</option>
            <option value="US" selected="">United States</option>
            <option value="CA">Canada</option>
            <option value="UK">United Kingdom</option>
            <option value="AU">Australia</option>
            <option value="AF">Afghanistan</option>
            <option value="AL">Albania</option>
            <option value="DZ">Algeria</option>
            <option value="AS">American Samoa</option>
            <option value="AD">Andorra</option>
            <option value="AO">Angola</option>
            <option value="AI">Anguilla</option>
            <option value="AQ">Antarctica</option>
            <option value="AG">Antigua and Barbuda</option>
            <option value="AR">Argentina</option>
            <option value="AM">Armenia</option>
            <option value="AW">Aruba</option>
            <option value="AT">Austria</option>
            <option value="AZ">Azerbaijan</option>
            <option value="BS">Bahamas</option>
            <option value="BH">Bahrain</option>
            <option value="BD">Bangladesh</option>
            <option value="BB">Barbados</option>
            <option value="BY">Belarus</option>
            <option value="BE">Belgium</option>
            <option value="BZ">Belize</option>
            <option value="BJ">Benin</option>
            <option value="BM">Bermuda</option>
            <option value="BT">Bhutan</option>
            <option value="BO">Bolivia</option>
            <option value="BA">Bosnia and Herzegovina</option>
            <option value="BW">Botswana</option>
            <option value="BR">Brazil</option>
            <option value="BN">Brunei Darussalam</option>
            <option value="BG">Bulgaria</option>
            <option value="BF">Burkina Faso</option>
            <option value="BI">Burundi</option>
            <option value="KH">Cambodia</option>
            <option value="CM">Cameroon</option>
            <option value="CV">Cape Verde</option>
            <option value="KY">Cayman Islands</option>
            <option value="CF">Central African Republic</option>
            <option value="TD">Chad</option>
            <option value="CL">Chile</option>
            <option value="CN">China</option>
            <option value="CX">Christmas Island</option>
            <option value="CC">Cocos (Keeling) Islands</option>
            <option value="CO">Colombia</option>
            <option value="KM">Comoros</option>
            <option value="CG">Congo</option>
            <option value="CD">Congo, The Democratic Republic of the</option>
            <option value="CK">Cook Islands</option>
            <option value="CR">Costa Rica</option>
            <option value="CI">Cote D`Ivoire</option>
            <option value="HR">Croatia</option>
            <option value="CY">Cyprus</option>
            <option value="CZ">Czech Republic</option>
            <option value="DK">Denmark</option>
            <option value="DJ">Djibouti</option>
            <option value="DM">Dominica</option>
            <option value="DO">Dominican Republic</option>
            <option value="EC">Ecuador</option>
            <option value="EG">Egypt</option>
            <option value="SV">El Salvador</option>
            <option value="GQ">Equatorial Guinea</option>
            <option value="ER">Eritrea</option>
            <option value="EE">Estonia</option>
            <option value="ET">Ethiopia</option>
            <option value="FK">Falkland Islands (Malvinas)</option>
            <option value="FO">Faroe Islands</option>
            <option value="FJ">Fiji</option>
            <option value="FI">Finland</option>
            <option value="FR">France</option>
            <option value="GF">French Guiana</option>
            <option value="PF">French Polynesia</option>
            <option value="GA">Gabon</option>
            <option value="GM">Gambia</option>
            <option value="GE">Georgia</option>
            <option value="DE">Germany</option>
            <option value="GH">Ghana</option>
            <option value="GI">Gibraltar</option>
            <option value="GR">Greece</option>
            <option value="GL">Greenland</option>
            <option value="GD">Grenada</option>
            <option value="GP">Guadeloupe</option>
            <option value="GU">Guam</option>
            <option value="GT">Guatemala</option>
            <option value="GN">Guinea</option>
            <option value="GW">Guinea-Bissau</option>
            <option value="GY">Guyana</option>
            <option value="HT">Haiti</option>
            <option value="HN">Honduras</option>
            <option value="HK">Hong Kong</option>
            <option value="HU">Hungary</option>
            <option value="IS">Iceland</option>
            <option value="IN">India</option>
            <option value="ID">Indonesia</option>
            <option value="IR">Iran (Islamic Republic Of)</option>
            <option value="IQ">Iraq</option>
            <option value="IE">Ireland</option>
            <option value="IL">Israel</option>
            <option value="IT">Italy</option>
            <option value="JM">Jamaica</option>
            <option value="JP">Japan</option>
            <option value="JO">Jordan</option>
            <option value="KZ">Kazakhstan</option>
            <option value="KE">Kenya</option>
            <option value="KI">Kiribati</option>
            <option value="KP">Korea North</option>
            <option value="KR">Korea South</option>
            <option value="KW">Kuwait</option>
            <option value="KG">Kyrgyzstan</option>
            <option value="LA">Laos</option>
            <option value="LV">Latvia</option>
            <option value="LB">Lebanon</option>
            <option value="LS">Lesotho</option>
            <option value="LR">Liberia</option>
            <option value="LI">Liechtenstein</option>
            <option value="LT">Lithuania</option>
            <option value="LU">Luxembourg</option>
            <option value="MO">Macau</option>
            <option value="MK">Macedonia</option>
            <option value="MG">Madagascar</option>
            <option value="MW">Malawi</option>
            <option value="MY">Malaysia</option>
            <option value="MV">Maldives</option>
            <option value="ML">Mali</option>
            <option value="MT">Malta</option>
            <option value="MH">Marshall Islands</option>
            <option value="MQ">Martinique</option>
            <option value="MR">Mauritania</option>
            <option value="MU">Mauritius</option>
            <option value="MX">Mexico</option>
            <option value="FM">Micronesia</option>
            <option value="MD">Moldova</option>
            <option value="MC">Monaco</option>
            <option value="MN">Mongolia</option>
            <option value="MS">Montserrat</option>
            <option value="MA">Morocco</option>
            <option value="MZ">Mozambique</option>
            <option value="NA">Namibia</option>
            <option value="NP">Nepal</option>
            <option value="NL">Netherlands</option>
            <option value="AN">Netherlands Antilles</option>
            <option value="NC">New Caledonia</option>
            <option value="NZ">New Zealand</option>
            <option value="NI">Nicaragua</option>
            <option value="NE">Niger</option>
            <option value="NG">Nigeria</option>
            <option value="NO">Norway</option>
            <option value="OM">Oman</option>
            <option value="PK">Pakistan</option>
            <option value="PW">Palau</option>
            <option value="PS">Palestine Autonomous</option>
            <option value="PA">Panama</option>
            <option value="PG">Papua New Guinea</option>
            <option value="PY">Paraguay</option>
            <option value="PE">Peru</option>
            <option value="PH">Philippines</option>
            <option value="PL">Poland</option>
            <option value="PT">Portugal</option>
            <option value="PR">Puerto Rico</option>
            <option value="QA">Qatar</option>
            <option value="RE">Reunion</option>
            <option value="RO">Romania</option>
            <option value="RU">Russian Federation</option>
            <option value="RW">Rwanda</option>
            <option value="VC">Saint Vincent and the Grenadines</option>
            <option value="MP">Saipan</option>
            <option value="SM">San Marino</option>
            <option value="SA">Saudi Arabia</option>
            <option value="SN">Senegal</option>
            <option value="SC">Seychelles</option>
            <option value="SL">Sierra Leone</option>
            <option value="SG">Singapore</option>
            <option value="SK">Slovak Republic</option>
            <option value="SI">Slovenia</option>
            <option value="SO">Somalia</option>
            <option value="ZA">South Africa</option>
            <option value="ES">Spain</option>
            <option value="LK">Sri Lanka</option>
            <option value="KN">St. Kitts/Nevis</option>
            <option value="LC">St. Lucia</option>
            <option value="SD">Sudan</option>
            <option value="SR">Suriname</option>
            <option value="SZ">Swaziland</option>
            <option value="SE">Sweden</option>
            <option value="CH">Switzerland</option>
            <option value="SY">Syria</option>
            <option value="TW">Taiwan</option>
            <option value="TI">Tajikistan</option>
            <option value="TZ">Tanzania</option>
            <option value="TH">Thailand</option>
            <option value="TG">Togo</option>
            <option value="TK">Tokelau</option>
            <option value="TO">Tonga</option>
            <option value="TT">Trinidad and Tobago</option>
            <option value="TN">Tunisia</option>
            <option value="TR">Turkey</option>
            <option value="TM">Turkmenistan</option>
            <option value="TC">Turks and Caicos Islands</option>
            <option value="TV">Tuvalu</option>
            <option value="UG">Uganda</option>
            <option value="UA">Ukraine</option>
            <option value="AE">United Arab Emirates</option>
            <option value="UY">Uruguay</option>
            <option value="UZ">Uzbekistan</option>
            <option value="VU">Vanuatu</option>
            <option value="VE">Venezuela</option>
            <option value="VN">Viet Nam</option>
            <option value="VG">Virgin Islands (British)</option>
            <option value="VI">Virgin Islands (U.S.)</option>
            <option value="WF">Wallis and Futuna Islands</option>
            <option value="YE">Yemen</option>
            <option value="YU">Yugoslavia</option>
            <option value="ZM">Zambia</option>
            <option value="ZW">Zimbabwe</option>
          </select>
        </div>
      </div>
    </div>
    <div class="col-md-6" style="border-left: 1px solid #ddddddaa;">
      <style>
        .ccard2 {
          width: 180px;
          margin-top: -5px;
          margin-right: -4px;
        }

        @media only screen and (min-width: 600px) and (max-width: 1280px) {
          .terminal-wrapper {
            margin-left: 2%;
            border-radius: 0px 0 0 0px;
          }

          .mainHeader {
            padding-bottom: 20px;
          }
        }

        @media only screen and (max-width: 600px) {
          .ccard2 {
            width: 134px;
            margin-top: 0;
            margin-right: -4px;
          }

          .mainHeader {
            text-align: center;
            padding-bottom: 20px;
          }
        }
      </style>
      <hr class="visible-xs visible-sm">
      <h3 class="colorgray mb10"> Payment Method <div class="floatright"> <img src="https://secure.tekcardpayments.net/assets/images/credit-cards-2.jpg" style="" class="ccard2">
        </div>
      </h3>
      <div class="creditcard-content">
        <div class="form-group">
          <label class="control-label col-md-3"><span class="colordanger">*</span>Name on Card</label>
          <div class="col-md-9">
            <div class="input-group">
              <input type="text" name="card_name" class="form-control" placeholder="Name on Card" value="" data-rule-required="true" aria-required="true">
              <span class="input-group-addon"><i class="fa fa-lock"></i></span>
            </div>
          </div>
        </div>
        <div class="form-group">
          <label class="control-label col-md-3"><span class="colordanger">*</span>Card Number</label>
          <div class="col-md-9">
            <div class="input-group">
              <!-- 4111111111111111 -->
              <input type="text" name="card_number" class="form-control card-number" placeholder="Card Number" value="" data-rule-required="true" data-rule-creditcard="true" aria-required="true">
              <span class="input-group-addon"><i class="fa fa-lock"></i></span>
            </div>
            <div class="card-type-image none"></div>
          </div>
        </div>
        <div class="form-group">
          <label class="control-label col-md-3"><span class="colordanger">*</span>Expiration/CVC</label>
          <div class="col-md-9">
            <div class="row">
              <div class="col-md-4 col-xs-4 pr5">
                <select name="card_exp_month" class="form-control" data-rule-required="true" aria-required="true">
                  <option value="1">01</option>
                  <option value="2">02</option>
                  <option value="3">03</option>
                  <option value="4">04</option>
                  <option value="5" selected="selected">05</option>
                  <option value="6">06</option>
                  <option value="7">07</option>
                  <option value="8">08</option>
                  <option value="9">09</option>
                  <option value="10">10</option>
                  <option value="11">11</option>
                  <option value="12">12</option>
                </select>
              </div>
              <div class="col-md-4 col-xs-4 pl5 pr5">
                <select name="card_exp_year" class="form-control" data-rule-required="true" aria-required="true">
                  <option value="2023">2023</option>
                  <option value="2024">2024</option>
                  <option value="2025">2025</option>
                  <option value="2026">2026</option>
                  <option value="2027">2027</option>
                  <option value="2028">2028</option>
                  <option value="2029">2029</option>
                  <option value="2030">2030</option>
                  <option value="2031">2031</option>
                  <option value="2032">2032</option>
                  <option value="2033">2033</option>
                </select>
              </div>
              <div class="col-md-4 col-xs-4 pl5">
                <div class="input-group">
                  <input type="text" name="card_cvv" class="form-control" placeholder="CVV" value="123" data-rule-required="true" aria-required="true">
                  <span class="input-group-addon"><i class="fa fa-lock"></i></span>
                </div>
              </div>
            </div>
          </div>
        </div>
      </div>
      <div class="row mt50">
        <div class="col-md-12">
          <div id="t_c" class="module">
            <h4 class="header">Terms &amp; Conditions</h4>
            <div id="t_c" class="" style="font-size:11px;">
              <p>By checking the box below, I authorize, agree and acknowledge that Express Brooklyn Tile can use the credit card entered by me to make payment on this order. I represent and warrant to Express Brooklyn Tile that (i) I have the full
                power and authority to provide the credit card information entered for payment, (ii) that such credit card is valid for payment for the orders in which it is used, and (iii) I will indemnify and hold Express Brooklyn Tile harmless on
                any and all claims alleging my unauthorized use of such credit card. I agree that all sales are final and any cancellations/returns, will be subject to a 20% restocking fee. Any orders for kitchen cabinets and any special orders are
                non refund able and no returns will be accepted. </p>
            </div>
            <style>
              #terms-error {
                color: red;
              }
            </style>
            <div class="input-group">
              <p><input id="field_terms" type="checkbox" required="" name="terms" aria-required="true"> I accept the <span>Terms and Conditions</span></p>
              <!--<label for="field_terms">I accept the <u>Terms and Conditions</u></label></p>-->
            </div>
          </div>
        </div>
      </div>
      <div class="row mt50">
        <div class="col-md-12 alignrightt">
          <div class="creditcard-content">
            <!--apachectl configtest-->
            <!--<script src='https://www.hCaptcha.com/1/api.js' async defer></script>-->
            <div class="h-captcha" data-sitekey="3c4dbe44-fd52-425f-9c6e-47242476a6c2" style="padding-bottom:15px;"><iframe
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PAYMENT METHOD


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TERMS & CONDITIONS

By checking the box below, I authorize, agree and acknowledge that Express
Brooklyn Tile can use the credit card entered by me to make payment on this
order. I represent and warrant to Express Brooklyn Tile that (i) I have the full
power and authority to provide the credit card information entered for payment,
(ii) that such credit card is valid for payment for the orders in which it is
used, and (iii) I will indemnify and hold Express Brooklyn Tile harmless on any
and all claims alleging my unauthorized use of such credit card. I agree that
all sales are final and any cancellations/returns, will be subject to a 20%
restocking fee. Any orders for kitchen cabinets and any special orders are non
refund able and no returns will be accepted.

I accept the Terms and Conditions


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