payments.karpahasands.com Open in urlscan Pro
89.233.104.146  Public Scan

Form analysis
1 forms found in the DOM

POST /

<form method="post" accept-charset="utf-8" id="pay-form" onsubmit="validate(event)" action="/">
  <div style="display:none;"><input type="hidden" name="_method" value="POST"></div>
  <div class="form-group float-l clearfix name-sec">
    <label>Name <span class="red">*</span></label>
    <div class="input text required"><input type="text" name="first_name" class="form-control" required="required" id="first-name"></div>
  </div>
  <div class="form-group float-l clearfix email-sec">
    <label>Email <span class="red">*</span></label>
    <div class="input email required"><input type="email" name="email" class="form-control" required="required" id="email"></div>
  </div>
  <div class="form-group float-l clearfix checkin">
    <label>Check in <span class="red">*</span></label>
    <div id="checkin-datepicker" class="input-group date" data-date-format="yyyy-mm-dd">
      <div class="input text required"><input type="text" name="checkin" class="form-control" required="required" readonly="readonly" id="checkin"></div> <span class="input-group-addon"><i class="glyphicon glyphicon-calendar"></i></span>
    </div>
  </div>
  <div class="form-group float-l clearfix checkout">
    <label>Check out <span class="red">*</span></label>
    <div id="checkout-datepicker" class="input-group date" data-date-format="yyyy-mm-dd">
      <div class="input text required"><input type="text" name="checkout" class="form-control" required="required" readonly="readonly" id="checkout"></div> <span class="input-group-addon"><i class="glyphicon glyphicon-calendar"></i></span>
    </div>
  </div>
  <div class="form-group">
    <label>Deposit Amount (USD) <span class="red">*</span></label>
    <div class="input number required"><input type="number" name="booking_amount" class="form-control" required="required" placeholder="USD" id="booking-amount"></div>
  </div>
  <div class="form-group">
    <div class="input checkbox required"><input type="hidden" name="terms_conditions" value="0"><input type="checkbox" name="terms_conditions" value="1" required="required" id="terms-conditions"></div> I have read and agree to the
    <a href="https://www.karpahasands.com/t-c/" target="_blank">Terms and Conditions</a>.<span class="red">*</span>
  </div>
  <input type="hidden" id="grc" name="grc">
  <button type="submit" class="submit btn btn-primary">Submit</button>
</form>

Text Content

Go to the Home Page

+94 70 366 2018

lovekarpaha@karpahasands.com

Home > Payment Center


PAYMENT CENTRE

Name *

Email *

Check in *

Check out *

Deposit Amount (USD) *


I have read and agree to the Terms and Conditions.*
Submit
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