payments.samulco.coop Open in urlscan Pro
202.137.120.74  Public Scan

Form analysis
1 forms found in the DOM

POST https://payments.samulco.coop/client/accounts

<form id="login-form" class="login100-form validate-form" method="POST" action="https://payments.samulco.coop/client/accounts">
  <input type="hidden" name="_token" value="Jx6yYxkHnwEieJwEroT1VxXmzHxoPBqpZpxRptC1">
  <div class="form-fields">
    <div class="form-group validate-input" data-validate="Lastname username is required">
      <div class="lastname">
        <input id="lastname" class="form-input" type="text" name="lastname" value="" autocomplete="off" placeholder="Lastname">
      </div>
    </div>
    <div class="form-group validate-input" data-validate="Firstname username is required">
      <div class="firstname">
        <input id="firstname" class="form-input" type="text" name="firstname" value="" autocomplete="off" placeholder="Firstname">
      </div>
    </div>
    <div class="form-group validate-input" data-validate="Valid Birthdate is required">
      <div class="birthdate">
        <input id="birthdate" class="input--style-2 js-datepicker form-input" type="text" value="" autocomplete="off" placeholder="Birthdate" name="birthdate">
      </div>
    </div>
    <!-- <div class="form-group validate-input" data-validate = "Valid mobile number is required">
                                        <div class="mobile">
                                            <input id="mobilenumber" class="form-input" type="hidden" name="mobilenumber" value="">
                                            <input id="mobilenumber-intltelinput" class="form-input" type="text" name="mobilenumber-intltelinput" value="" autocomplete="off" placeholder="">
                                        </div>
                                    </div> -->
    <div class="form-group centered login">
      <p>For Registered Members only</p>
      <button id="submit-form" class="btn-lg btn-primary login100-form-btn btn-block show-loader-trigger"> Submit </button>
    </div>
    <!-- <div class="form-group centered login">
                                        <a href="https://payments.samulco.coop/login" class="btn-lg btn-warning loader-trigger">
                                            Back to Login
                                        </a>
                                    </div> -->
  </div>
</form>

Text Content

ONLINE PAYMENT GATEWAY

Know your outstanding balance, and pay online at your own convenience.

For Registered Members only

Submit
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