www.secure.sanantoniosecurityalarms.com Open in urlscan Pro
206.80.96.178  Public Scan

Form analysis
1 forms found in the DOM

Name: os_form — POST https://www.secure.sanantoniosecurityalarms.com/?view=form&layout=2cols2lines&form_id=1

<form method="post" name="os_form" id="os_form" action="https://www.secure.sanantoniosecurityalarms.com/?view=form&amp;layout=2cols2lines&amp;form_id=1" autocomplete="off" class="form" enctype="multipart/form-data">
  <div class="form-fields-container clearfix">
    <div class="row clearfix">
      <div class="col-md-6">
        <h3 id="field_contact" class="section-label pf-heading">Contact Information</h3>
      </div>
      <div class="col-md-6">
        <div class="row form-group form-row" id="field_first_name">
          <div class="col-md-3 form-control-label">
            <label id="first_name-lbl" for="first_name"> First Name <span class="required">*</span>
            </label>
          </div>
          <div class="col-md-9">
            <input type="text" name="first_name" id="first_name" value="" class="validate[required] form-control" size="25">
          </div>
        </div>
      </div>
    </div>
    <div class="row clearfix">
      <div class="col-md-6">
        <div class="row form-group form-row" id="field_last_name">
          <div class="col-md-3 form-control-label">
            <label id="last_name-lbl" for="last_name"> Last Name <span class="required">*</span>
            </label>
          </div>
          <div class="col-md-9">
            <input type="text" name="last_name" id="last_name" value="" class="validate[required] form-control" size="25">
          </div>
        </div>
      </div>
      <div class="col-md-6">
        <div class="row form-group form-row" id="field_organization">
          <div class="col-md-3 form-control-label">
            <label id="organization-lbl" for="organization"> Business or Organization name</label>
          </div>
          <div class="col-md-9">
            <input type="text" name="organization" id="organization" value="" size="50" class="form-control">
          </div>
        </div>
      </div>
    </div>
    <div class="row clearfix">
      <div class="col-md-6">
        <div class="row form-group form-row" id="field_email">
          <div class="col-md-3 form-control-label">
            <label id="email-lbl" for="email"> Email <span class="required">*</span>
            </label>
          </div>
          <div class="col-md-9">
            <input type="text" name="email" id="email" value="" class="validate[required,custom[email]] form-control" size="35">
          </div>
        </div>
      </div>
      <div class="col-md-6">
        <div class="row form-group form-row" id="field_phone">
          <div class="col-md-3 form-control-label">
            <label id="phone-lbl" for="phone"> Phone <span class="required">*</span>
            </label>
          </div>
          <div class="col-md-9">
            <input type="text" name="phone" id="phone" value="" class="validate[required] form-control" size="20">
          </div>
        </div>
      </div>
    </div>
    <div class="row clearfix">
      <div class="col-md-6">
        <h3 id="field_billing" class="section-label pf-heading">Billing Address</h3>
      </div>
      <div class="col-md-6">
        <div class="row form-group form-row" id="field_address">
          <div class="col-md-3 form-control-label">
            <label id="address-lbl" for="address"> Address <span class="required">*</span>
            </label>
          </div>
          <div class="col-md-9">
            <input type="text" name="address" id="address" value="" class="validate[required] form-control" size="50">
          </div>
        </div>
      </div>
    </div>
    <div class="row clearfix">
      <div class="col-md-6">
        <div class="row form-group form-row" id="field_city">
          <div class="col-md-3 form-control-label">
            <label id="city-lbl" for="city"> City <span class="required">*</span>
            </label>
          </div>
          <div class="col-md-9">
            <input type="text" name="city" id="city" value="" class="validate[required] form-control" size="20">
          </div>
        </div>
      </div>
      <div class="col-md-6">
        <div class="row form-group form-row" id="field_state">
          <div class="col-md-3 form-control-label">
            <label id="state-lbl" for="state"> State <span class="required">*</span>
            </label>
          </div>
          <div class="col-md-9">
            <input type="text" name="state" id="state" value="" class="validate[required] form-control" size="20">
          </div>
        </div>
      </div>
    </div>
    <div class="row clearfix">
      <div class="col-md-6">
        <div class="row form-group form-row" id="field_zip">
          <div class="col-md-3 form-control-label">
            <label id="zip-lbl" for="zip"> Zip <span class="required">*</span>
            </label>
          </div>
          <div class="col-md-9">
            <input type="text" name="zip" id="zip" value="" class="validate[required] form-control" size="10">
          </div>
        </div>
      </div>
      <div class="col-md-6">
        <div class="row form-group form-row" id="field_comment">
          <div class="col-md-3 form-control-label">
            <label id="comment-lbl" for="comment"> Comment</label>
          </div>
          <div class="col-md-9">
            <textarea name="comment" id="comment" rows="5" cols="40" class="form-control"></textarea>
          </div>
        </div>
      </div>
    </div>
    <div class="row clearfix">
      <div class="col-md-6">
        <div class="row form-group form-row payment-calculation" id="field_charge">
          <div class="col-md-3 form-control-label">
            <label id="charge-lbl" for="charge" class="hasTooltip hasTip" title="" data-bs-original-title="<strong>Amount to Charge</strong><br>Please enter the amount to charge from your invoice."> Amount to Charge <span class="required">*</span>
            </label>
          </div>
          <div class="col-md-9">
            <input type="text" name="charge" id="charge" value="" class="validate[required,custom[number]] form-control" size="10" onchange="calculateFormFee();">
          </div>
        </div>
      </div>
    </div>
  </div>
  <div class="payment-information-container form form-horizontal clearfix">
    <div class="row form-group form-row">
      <div class="col-md-3 form-control-label"> Total Amount </div>
      <div class="col-md-9">
        <div class="input-group">
          <span class="input-group-text">$</span>
          <input id="total_amount" type="text" readonly="readonly" class="input-small form-control" value="0.00">
        </div>
      </div>
    </div>
    <div class="row form-group form-row payment_information" style="display: none;">
      <div class="col-md-3 form-control-label"> Payment method </div>
      <div class="col-md-9"> Offline Creditcard processing </div>
    </div>
    <div class="row form-group form-row payment_information" id="sq_field_zipcode" style="display:none">
      <div class="col-md-3 form-control-label" for="sq_billing_zipcode"> Billing Zipcode<span class="required">*</span>
      </div>
      <div class="col-md-9" id="field_zip_input">
        <input type="text" id="sq_billing_zipcode" name="sq_billing_zipcode" class="input-large form-control" value="">
      </div>
    </div>
    <div class="row form-group form-row payment_information" id="tr_card_number" style="display: none;">
      <div class="col-md-3 form-control-label">Credit Card Number<span class="required">*</span></div>
      <div class="col-md-9" id="sq-card-number">
        <input type="text" name="x_card_num" class="input-large form-control validate[required,creditCard]" onkeyup="checkNumber(this)" value="" size="20">
      </div>
    </div>
    <div class="row form-group form-row payment_information" id="tr_exp_date" style="display: none;">
      <div class="col-md-3 form-control-label"> Expiration Date<span class="required">*</span>
      </div>
      <div class="col-md-9" id="sq-expiration-date">
        <select id="exp_month" name="exp_month" class="input-small form-select d-inline-block w-auto">
          <option value="1">01</option>
          <option value="2">02</option>
          <option value="3">03</option>
          <option value="4">04</option>
          <option value="5">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> / <select id="exp_year" name="exp_year" class="input-small form-select d-inline-block w-auto">
          <option value="2023" selected="selected">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>
    <div class="row form-group form-row payment_information" id="tr_cvv_code" style="display: none;">
      <div class="col-md-3 form-control-label"> Card (CVV) Code<span class="required">*</span>
      </div>
      <div class="col-md-9" id="sq-cvv">
        <input type="text" name="x_card_code" class="input-large form-control validate[required,custom[number]]" value="" size="20">
      </div>
    </div>
    <div class="row form-group form-row payment_information" id="tr_card_type" style="display:none;">
      <div class="col-md-3 form-control-label"> Card Type<span class="required">*</span>
      </div>
      <div class="col-md-9">
        <select id="card_type" name="card_type" class="form-select">
          <option value="Visa">Visa</option>
          <option value="MasterCard">MasterCard</option>
          <option value="Discover">Discover</option>
          <option value="Amex">American Express</option>
        </select>
      </div>
    </div>
    <div class="row form-group form-row payment_information" id="tr_card_holder_name" style="display: none;">
      <div class="col-md-3 form-control-label"> Card Holder Name<span class="required">*</span>
      </div>
      <div class="col-md-9">
        <input type="text" name="card_holder_name" class="input-large form-control validate[required]" value="" size="40">
      </div>
    </div>
    <div class="row form-group form-row">
      <div class="col-md-3 form-control-label" style="display:none;"> Captcha<span class="required">*</span>
      </div>
      <div class="col-md-9">
        <div id="captcha" class="required g-recaptcha" data-sitekey="6LdNiuYgAAAAAEcfpzzxkVa9tItAJdeBwhln_Gup" data-badge="bottomright" data-size="invisible" data-tabindex="0" data-callback="" data-expired-callback="" data-error-callback=""
          data-recaptcha-widget-id="0">
          <div class="grecaptcha-badge" data-style="bottomright"
            style="width: 256px; height: 60px; display: block; transition: right 0.3s ease 0s; position: fixed; bottom: 14px; right: -186px; box-shadow: gray 0px 0px 5px; border-radius: 2px; overflow: hidden;">
            <div class="grecaptcha-logo"><iframe title="reCAPTCHA"
                src="https://www.google.com/recaptcha/api2/anchor?ar=1&amp;k=6LdNiuYgAAAAAEcfpzzxkVa9tItAJdeBwhln_Gup&amp;co=aHR0cHM6Ly93d3cuc2VjdXJlLnNhbmFudG9uaW9zZWN1cml0eWFsYXJtcy5jb206NDQz&amp;hl=en-GB&amp;v=tNAc29ZZrpcOCErva2nr4BS9&amp;size=invisible&amp;badge=bottomright&amp;cb=jliomi4clcgb"
                width="256" height="60" role="presentation" name="a-b4o7cbfb0sfr" frameborder="0" scrolling="no"
                sandbox="allow-forms allow-popups allow-same-origin allow-scripts allow-top-navigation allow-modals allow-popups-to-escape-sandbox"></iframe></div>
            <div class="grecaptcha-error"></div><textarea id="g-recaptcha-response" name="g-recaptcha-response" class="g-recaptcha-response"
              style="width: 250px; height: 40px; border: 1px solid rgb(193, 193, 193); margin: 10px 25px; padding: 0px; resize: none; display: none;"></textarea>
          </div><iframe style="display: none;"></iframe>
        </div>
      </div>
    </div>
    <div class="form-actions">
      <input type="submit" id="btn-submit" class="btn btn-primary" name="btnSubmit" value="Process payment">
      <img id="ajax-loading-animation" src="/media/com_pmform/assets/icons/ajax-loadding-animation.gif" style="display: none;">
    </div>
    <input type="hidden" name="payment_method" value="os_offline_creditcard">
    <input type="hidden" name="count_method" value="1">
    <input type="hidden" name="form_page_url" value="aHR0cHM6Ly93d3cuc2VjdXJlLnNhbmFudG9uaW9zZWN1cml0eWFsYXJtcy5jb20v">
    <input type="hidden" name="form_id" value="1">
    <input type="hidden" name="task" value="controller.process_payment">
    <input type="hidden" name="show_payment_fee" value="0">
    <input type="hidden" id="card-nonce" name="nonce">
    <input type="text" name="pf_sa_security" value="" autocomplete="off" class="pf_invisible_to_visitors">
    <input type="hidden" name="0aaad2693dfd348888e0e4d86b92739e" value="1676326481">
    <input type="hidden" name="2b47042c23a5540ceeea81e7c7d86cc5" value="1">
  </div>
</form>

Text Content

San Antonio Security


PAYMENT FOR ONLINE SUBMISSION

Please enter the requested information on this form to submit. We will process
your payment in the next couple of business days.


CONTACT INFORMATION

First Name *

Last Name *

Business or Organization name

Email *

Phone *



BILLING ADDRESS

Address *

City *

State *

Zip *

Comment

Amount to Charge *

Total Amount
$
Payment method
Offline Creditcard processing
Billing Zipcode*

Credit Card Number*

Expiration Date*
01 02 03 04 05 06 07 08 09 10 11 12 / 2023 2024 2025 2026 2027 2028 2029 2030
2031 2032 2033
Card (CVV) Code*

Card Type*
Visa MasterCard Discover American Express
Card Holder Name*

Captcha*