bigbondgh.com Open in urlscan Pro
198.251.88.162  Public Scan

Form analysis
1 forms found in the DOM

POST https://bigbondgh.com/payprocessing.php

<form class="contact-form" method="post" id="paymentForm" action="https://bigbondgh.com/payprocessing.php">
  <div class="messages"></div>
  <div class="controls">
    <div class="row gx-4">
      <div class="col-12">
        <h2 class="mb-3 text-center">Please fill out the form below with the details found on your PFI Invoice.</h2>
        <div class="col-md-6">
          <p><strong>Personal Details</strong></p>
          <div class="form-label-group mb-4">
            <input id="form_name" type="text" name="name" class="form-control" placeholder="Jane" required="required" data-error="First Name is required.">
            <label for="form_name">Your First Name *</label>
            <div class="help-block with-errors"></div>
          </div>
        </div>
        <!-- /column -->
        <div class="col-md-6">
          <div class="form-label-group mb-4">
            <input id="form_lastname" type="text" name="surname" class="form-control" placeholder="Doe" required="required" data-error="Last Name is required.">
            <label for="form_lastname">Your Last Name *</label>
            <div class="help-block with-errors"></div>
          </div>
        </div>
        <!-- /column -->
        <div class="col-md-6">
          <div class="form-label-group mb-4">
            <input id="form_email" type="email" name="email" class="form-control" placeholder="jane.doe@example.com" required="required" data-error="Valid email is required.">
            <label for="form_email">Your Email *</label>
            <div class="help-block with-errors"></div>
          </div>
        </div>
        <!-- /column -->
        <div class="col-md-6">
          <div class="form-label-group mb-4">
            <input id="form_phone" type="tel" name="phone" class="form-control" placeholder="Your phone number">
            <label for="form_phone">Your Phone</label>
            <div class="help-block with-errors"></div>
          </div>
        </div>
        <!-- /column -->
        <p><strong>PFI Details</strong></p>
        <div class="form-label-group mb-4">
          <input id="customer_name" type="text" name="customername" class="form-control" placeholder="Customer Name" required="required" data-error="Customer Name">
          <label for="customer_name">Customer Name *</label>
          <div class="help-block with-errors"></div>
        </div>
      </div>
      <!-- /column -->
      <div class="col-md-6">
        <div class="form-label-group mb-4">
          <input id="invoice_number" type="text" name="clientref" class="form-control" placeholder="Bxxxxxxx" required="required" data-error="Invoice Number required">
          <label for="form_invoice">PFI Number *</label>
          <div class="help-block with-errors"></div>
        </div>
      </div>
      <!-- /column -->
      <div class="col-md-6">
        <div class="form-label-group mb-4">
          <input id="form_amount" type="number" name="amount" step=".01" class="form-control" placeholder="GHS" required="required" data-error="Amount is required.">
          <label for="form_amount">Amount Due GHS*</label>
          <div class="help-block with-errors"></div>
        </div>
      </div>
      <!-- /column -->
      <div class="col-12">
        <input type="submit" class="btn btn-primary rounded-pill mb-3" value="submit">
        <p class="text-muted"><strong>*</strong> These fields are required.</p>
      </div>
      <!-- /column -->
    </div>
    <!-- /.row -->
  </div>
  <!-- /.controls -->
</form>

Text Content

 * Home
 * Main Website

 * Request a Quote
 * 


INVOICE PAYMENT


PLEASE FILL OUT THE FORM BELOW WITH THE DETAILS FOUND ON YOUR PFI INVOICE.

Personal Details

Your First Name *

Your Last Name *

Your Email *

Your Phone


PFI Details

Customer Name *

PFI Number *

Amount Due GHS*


* These fields are required.

PROFORMA INVOICE DETAILS


PROFORMA INVOICE DETAILS

1

CUSTOMER NAME

Enter the name of the Customer here

2

PFI NUMBER

Enter the Invoice Number

3

TOTAL AMOUNT

Enter the amount you are paying for your invoice

ADDRESS

34 Mausoleum Lane, North Industrial Area, Accra

PHONE

+233-(0)-501-290-390
+233-(0)-501-290-391

E-MAIL

info@bigbondgh.com

quote@bigbondgh.com


WANT TO KNOW HOW MUCH IT COSTS?

Get a Free Quote

© 2021 Bigbond Roofing.
All rights reserved.



GET IN TOUCH

34 Mausoleum Lane, North Industrial Area, Accra info@bigbondgh.com
+233-(0)-501-290-390 /
+233-(0)-501-290-391

INFORMATION

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 * Careers
 * Products
 * Contact us