www.payments.dementia-india.org Open in urlscan Pro
103.133.214.160  Public Scan

Form analysis
1 forms found in the DOM

POST

<form method="post" id="form">
  <table class="table table-bordered table-hover">
    <tbody>
      <tr class="info">
        <th width="40%">Field Name</th>
        <th width="60%">Field Value</th>
      </tr>
      <tr>
        <td><label>Merchant ID</label></td>
        <td><input type="text" name="mrctCode" value="L959684"></td>
      </tr>
      <tr>
        <td><label>Transaction ID</label></td>
        <td><input type="text" name="txn_id" value="920913519"></td>
      </tr>
      <tr>
        <td><label>Total Amount</label></td>
        <td><input type="text" id="myamount" name="amount" value=""></td>
      </tr>
      <tr>
        <td><label>Scheme Code</label></td>
        <td><input type="text" name="scheme" value="FIRST"></td>
      </tr>
      <tr>
        <td><label>Consumer ID</label></td>
        <td><input type="text" name="custID" value="c497399"></td>
      </tr>
      <tr>
        <td><label>Mobile Number</label></td>
        <td><input type="number" name="mobNo" value=""></td>
      </tr>
      <tr>
        <td><label>Email</label></td>
        <td><input type="text" name="email" value=""></td>
      </tr>
      <tr>
        <td><label>Customer Name</label></td>
        <td><input type="text" name="name" value=""></td>
      </tr>
      <tr>
        <td><label>Currency</label></td>
        <td><input type="text" name="currency" value="INR"></td>
      </tr>
      <tr>
        <td><label>SALT</label></td>
        <td><input type="text" name="SALT" value="9790170155CNBPGW"></td>
      </tr>
      <tr>
        <td><label>Return url</label></td>
        <td><input type="text" name="returnUrl" value="https://www.payments.dementia-india.org/index.php"></td>
      </tr>
      <tr class="hid">
        <td><label>Account Number</label></td>
        <td><input type="number" name="accNo" value=""></td>
      </tr>
      <tr class="hid">
        <td><label>Account Type</label></td>
        <td>
          <select class="form-control" name="accountType">
            <option value="">-- SELECT -- </option>
            <option value="Saving">Saving</option>
            <option value="Current">Current</option>
          </select>
        </td>
      </tr>
      <tr class="hid">
        <td><label>Account Name</label></td>
        <td><input type="text" name="accountName" value=""></td>
      </tr>
      <tr class="hid">
        <td><label>Aadhar Number</label></td>
        <td><input type="text" name="aadharNumber" value=""></td>
      </tr>
      <tr class="hid">
        <td><label>IFSC Code</label></td>
        <td><input type="text" name="ifscCode" value=""></td>
      </tr>
      <tr class="hid">
        <td><label>Debit Start Date</label></td>
        <td><input type="date" name="debitStartDate" value=""></td>
      </tr>
      <tr class="hid">
        <td><label>Debit End Date</label></td>
        <td><input type="date" name="debitEndDate" value=""></td>
      </tr>
      <tr class="hid">
        <td><label>maxAmount</label></td>
        <td><input type="number" id="mymaxAmount" name="maxAmount" value=""></td>
      </tr>
      <tr class="hid">
        <td><label>Amount Type</label></td>
        <td>
          <select class="form-control" name="amountType">
            <option value="" selected="selected">SELECT OPTION</option>
            <option value="M">Variable</option>
            <option value="F">Fixed</option>
          </select>
        </td>
      </tr>
      <tr class="hid">
        <td><label>Frequency</label></td>
        <td>
          <select class="form-control" name="frequency">
            <option value="" selected="selected">SELECT OPTION</option>
            <option value="ADHO"> As and when presented </option>
            <option value="DAIL"> Daily </option>
            <option value="WEEK"> Weekly </option>
            <option value="MNTH"> Monthly </option>
            <option value="BIMN"> Bi- monthly </option>
            <option value="QURT"> Quarterly </option>
            <option value="MIAN"> Semi annually </option>
            <option value="YEAR"> Yearly </option>
          </select>
        </td>
      </tr>
      <tr class="hidden">
        <td><label>Card Number</label></td>
        <td><input type="text" name="cardNumber" value=""></td>
      </tr>
      <tr class="hidden">
        <td><label>Exp Month</label></td>
        <td><input type="text" name="expMonth" value=""></td>
      </tr>
      <tr class="hidden">
        <td><label>Exp Year</label></td>
        <td><input type="text" name="expYear" value=""></td>
      </tr>
      <tr class="hidden">
        <td><label>Cvv Code</label></td>
        <td><input type="text" name="cvvCode" value=""></td>
      </tr>
      <tr>
        <td colspan="2">
          <input class="btn btn-danger" id="btnSubmit" type="submit" name="submit" value="Make Payment">
        </td>
      </tr>
    </tbody>
  </table>
</form>

Text Content

PAYMENT DETAILS

Field Name Field Value Merchant ID Transaction ID Total Amount Scheme Code
Consumer ID Mobile Number Email Customer Name Currency SALT Return url Account
Number Account Type -- SELECT -- Saving Current Account Name Aadhar Number IFSC
Code Debit Start Date Debit End Date maxAmount Amount Type SELECT OPTION
Variable Fixed Frequency SELECT OPTION As and when presented Daily Weekly
Monthly Bi- monthly Quarterly Semi annually Yearly Card Number Exp Month Exp
Year Cvv Code