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<form action="/" method="post" onsubmit="return validateInput()">
  <div class="bannerHdr">
    <img src="/Content/Images/ebilling_banner.jpg">
  </div>
  <h1>Customer Billing Report</h1>
  <div id="intro-text" style="width: 440px; float: left;">
    <p></p>
  </div>
  <div id="divMain">
    <table>
      <tbody>
        <tr>
          <td style="width: 50%;">
            <div class="divtext">
              <table>
                <tbody>
                  <tr>
                    <td>
                      <div class="display-label">All fields are required</div>
                    </td>
                  </tr>
                </tbody>
              </table>
            </div>
            <div class="divtext">
              <div class="display-label">Account Number:</div>
              <div class="display-label">
                <table style="border-spacing: 0px; border-width: 0px;">
                  <tbody>
                    <tr>
                      <td>
                        <input data-val="true" data-val-regex="Account Number must be numeric." data-val-regex-pattern="([0-9][0-9]*)" data-val-required="*" id="CustomerNumber" maxlength="9" minlength="9" name="CustomerNumber" type="text" value="">
                      </td>
                    </tr>
                  </tbody>
                </table>
                <span class="field-validation-valid error" data-valmsg-for="CustomerNumber" data-valmsg-replace="true"></span>
              </div>
            </div>
            <div class="divtext">
              <div class="display-label">Invoice Number:</div>
              <div class="display-label">
                <table style="border-spacing: 0px; border-width: 0px;">
                  <tbody>
                    <tr>
                      <td>
                        <input data-val="true" data-val-regex="Invoice Number must be numeric." data-val-regex-pattern="([0-9][0-9]*)" data-val-required="*" id="Invoice" maxlength="8" name="Invoice" type="text" value="">
                      </td>
                    </tr>
                  </tbody>
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                <span class="field-validation-valid error" data-valmsg-for="Invoice" data-valmsg-replace="true"></span>
              </div>
            </div>
            <div class="divtext">
              <div class="display-label">Product Code:</div>
              <div class="display-label">
                <table style="border-spacing: 0px; border-width: 0px;">
                  <tbody>
                    <tr>
                      <td>
                        <input class="prodCode" data-val="true" data-val-regex="Product Code must be Alphanumeric and special character only '-' is allowed ." data-val-regex-pattern="^([\w\d-])*$" data-val-required="*" id="ProductCode" maxlength="10"
                          minlength="3" name="ProductCode" type="text" value="">
                      </td>
                    </tr>
                    <tr>
                      <td>
                        <div class="display-label"><a href="http://support.checkpoint.thomsonreuters.com/assets/ebilling/InvoiceHelp.pdf" target="_blank">Need help finding this information?</a> </div>
                      </td>
                    </tr>
                  </tbody>
                </table>
                <span class="field-validation-valid error" data-valmsg-for="ProductCode" data-valmsg-replace="true"></span>
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            <div class="divtext">
              <div class="display-label">I'm not a robot</div>
              <div class="display-label">
                <table style="border-spacing: 0px; border-width: 0px;">
                  <tbody>
                    <tr>
                      <td>
                        <img src="/Invoice/GetCaptchaImage">
                      </td>
                    </tr>
                    <tr>
                      <td>Please enter Captcha</td>
                    </tr>
                    <tr>
                      <td>
                        <input id="captchaText" name="captchaText" type="text" value="">
                      </td>
                    </tr>
                  </tbody>
                </table>
              </div>
            </div>
            <div class="display-label">
              <label for="error" style="margin: 5px auto 5px auto; color: Red; display: none">Please enter all requried input details</label>
              <input id="btnLogin" type="submit" name="command" value="Submit" class="btn" style="margin-bottom: 10px;">
            </div>
            <div class="validation-summary-errors error" style="color: red;">
            </div>
          </td>
        </tr>
      </tbody>
    </table>
  </div>
</form>

Text Content

 * Home


CUSTOMER BILLING REPORT



All fields are required

Account Number:



Invoice Number:



Product Code:
Need help finding this information?

I'm not a robot

Please enter Captcha

Please enter all requried input details


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