secure.telr.com Open in urlscan Pro
104.26.5.63  Public Scan

Submitted URL: https://fzmubct-zgpvh.maillist-manage.net/click/1d5e403cc278afd9/1d5e403cc2788edd
Effective URL: https://secure.telr.com/gateway/ql/ShamsMediaServicesLLC_968995.html
Submission Tags: falconsandbox
Submission: On July 24 via api from US — Scanned from DE

Form analysis 2 forms found in the DOM

Name: pf1POST /gateway/details.html

<form action="/gateway/details.html" method="post" name="pf1" id="pf1" role="form" onsubmit="return false;"><input type="hidden" name="pstore" id="pstore" value="26294"><input type="hidden" name="p_framed" id="p_framed" value="0"><input type="hidden"
    name="p_fbreak" id="p_fbreak" value="0"><input type="hidden" name="session" value="2750ff0769ed66a0b59cae30cfa522"><input type="hidden" name="jsref" id="jsref" value=""><input type="hidden" name="pptoken" id="pptoken" value=""><input
    type="hidden" name="mwidth" id="mwidth" value=""><input type="hidden" name="cancel" id="pcancel" value=""><input type="hidden" name="p_fb" id="p_fb" value=""></form>

Name: pf2POST /errors/noscript.html

<form action="/errors/noscript.html" method="post" name="pf2" id="pf2" role="form" onsubmit="return false;"><input type="hidden" name="ivp_pc" value="AED" dp="2"><input type="hidden" id="sessionID" name="session"
    value="2750ff0769ed66a0b59cae30cfa522">
  <input type="hidden" name="usrinf" value="0">
  <div class="panel-group" id="accordion">
    <div class="panel panel-default">
      <div class="panel-new-header">
        <div class="panel-subheader">
          <div class="card-block card-bar">
            <span class="text-right pull-right font-fix">
              <label class="we-accept" style="margin-right: 7px;">WE ACCEPT</label>
              <img src="https://secure.telrcdn.com/images/spacer.gif" class="logo_visa" id="logo_visa">
              <img src="https://secure.telrcdn.com/images/spacer.gif" class="logo_mastercard" id="logo_mastercard">
              <img src="https://secure.telrcdn.com/images/spacer.gif" class="logo_jcb" id="logo_jcb">
              <img src="https://secure.telrcdn.com/images/spacer.gif" class="logo_cup" id="logo_cup"></span>
          </div>
          <h4 class="panel-title mobile-only-panel-title"><input type="radio" name="payby" value="card" id="pm_cc">&nbsp;<label for="pm_cc">CREDIT/DEBIT CARDS</label></h4>
        </div> <!-- panel-subheader -->
        <div id="collapse_card" class="panel-collapse collapse in" aria-expanded="true" style="">
          <div id="panel_body_id" class="panel-body ">
            <div class="row">
              <div class="col-md-1 col-sm-1 col-xs-1"></div>
              <div class="col-md-9 col-sm-9 col-xs-12">
                <div class="form-group">
                  <div class="row" id="cardin_row" style="display:block">
                    <div class="col-md-10 col-sm-12 col-xs-12 slim-padding-right">
                      <label for="creditCardNumber" style="height: 15px;width: 200px;color: #9B9B9B;font-family: 'Arial';font-size: 12px;letter-spacing: 0;margin-top: 25px;">CARD NUMBER*</label>
                      <input type="search" pattern="[0-9 ]*" inputmode="numeric" x-inputmode="numeric" class="form-control" name="CCNo" id="creditCardNumber" autocomplete="cc-number" x-autocompletetype="cc-number" maxlength="21"
                        style=" border:1px solid #000;border-radius:0px;border-top-style: hidden; border-right-style: hidden; border-left-style: hidden;background-color: #ffffff;box-shadow: none; outline:none;" placeholder="xxxx xxxx xxxx xxxx">
                      <span class="error-block" style="display:none;" id="error_text_cc-number"></span>
                    </div>
                    <div class="col-md-4 col-sm-5 col-xs-5 slim-padding" id="up-skip1">
                      <label for="creditCardValidTill" style="height: 15px; width: 150px; color: #9B9B9B; font-family: 'Arial';font-size: 12px;letter-spacing: 0;line-height: 15px;margin-top: 25px;">VALID TILL*</label>
                      <input type="text" pattern="[0-9 ]*" inputmode="numeric" x-inputmode="numeric" class="form-control" name="CCExpiresValid" id="creditCardExp" autocomplete="cc-exp-year" x-autocompletetype="cc-exp-year"
                        oninput="return ppValidate.formatDate();" maxlength="5" style="box-shadow: none;border:0;border-bottom:1px solid #000;border-radius:0px;" placeholder="MM/YY">
                      <span class="error-block" id="new_error_text_cc-expiry"></span>
                      <p style="display:none"><span class="error-block" style="display:none;" id="error_text_cc-expiry"></span></p>
                    </div>
                    <div class="col-md-2 col-sm-4 hidden-xs"></div>
                    <div class="col-md-4 col-sm-5 col-xs-5 slim-padding-left skip-cvv" id="up-skip2">
                      <label for="cardCVV" style="height: 15px;width: 150px;color: #9B9B9B;font-family: 'Arial';font-size: 12px; letter-spacing: 0; line-height: 15px;margin-top: 25px;">ENTER CVV*</label>
                      <input type="password" pattern="[0-9 ]*" inputmode="numeric" x-inputmode="numeric" class="form-control" name="cc-csc" id="cardCVV" autocomplete="cc-csc" x-autocompletetype="cc-csc"
                        oninput="return ppValidate.validCvv(this.value);" maxlength="4" style="width: 80%;box-shadow: none;border:0;border-bottom:1px solid #000;border-radius:0px;display: inline-block;" placeholder="123">
                      <img id="cvv_info" src="https://secure.telr.com/cdn/images/info.svg">
                      <img id="cvv_tooltip" src="https://secure.telr.com/cdn/images/cvv_tooltip.png">
                      <span class="error-block" style="display:none;" id="error_text_cc-csc"></span>
                    </div>
                  </div> <!-- row -->
                  <div class="row" id="mcp_cd_row" style="display:none">
                    <src-card-list id="srcCardList" locale="en_US" card-brands="" display-cancel-option="false" display-add-card="true" display-preferred-card="true" display-sign-out="true" card-selection-type="radioButton" src-digital-card-id=""
                      display-header="false" background="default">
                    </src-card-list>
                  </div> <!-- row -->
                  <!--div class="row">
                        <div class="col-lg-8 col-md-8 col-sm-8 col-xs-8 slim-padding-right">
                            <span class="error-block" style="display:none;" id="error_text_cc-number">Some text here</span>
                        </div>
                        <div class="col-lg-4 col-md-4 col-sm-4 col-xs-4 slim-padding">
                            <span class="error-block" style="display:none;" id="error_text_cc-expiry"></span>
                        </div>
                        <div class="col-lg-4 col-md-4 col-sm-4 col-xs-4 slim-padding-left">
                            <span class="error-block" style="display:none;" id="error_text_cc-csc"></span>
                        </div>
                    </div> <-- row -->
                </div>
                <!--div class="form-group">
                    <div class="row">
                        <form>
                            <div class="col-md-4 col-sm-4 col-xs-4 slim-padding-right">
                                <label for="creditCardValidTill" style="height: 15px; width: 150px; color: #9B9B9B; font-family: 'Proxima Nova';font-size: 12px;letter-spacing: 0;line-height: 15px;">VALID TILL*</label> 
                                <input type="text" pattern="[0-9 ]*" inputmode="numeric" x-inputmode="numeric" class="form-control" name="cc-exp-valid" id="creditCardExp" autocomplete="cc-exp-year" x-autocompletetype="cc-exp-year" onkeyup="ppValidate.formatDate(this.value);" onblur="ppValidate.validDate(this.value);" maxlength="5" style="border:0" placeholder="MM/YY">
                            </div>
                        </form>
                        <div class="col-md-4 col-sm-4 col-xs-4 slim-padding-left">
                            <label for="cardCVV" style="height: 15px;width: 150px;color: #9B9B9B;font-family: 'Proxima Nova';font-size: 12px; letter-spacing: 0; line-height: 15px;">ENTER CVV*</label> 
                            <input type="password" pattern="[0-9 ]*" inputmode="numeric" x-inputmode="numeric" class="form-control" name="cc-csc" id="cardCVV" autocomplete="cc-csc" x-autocompletetype="cc-csc" onblur="ppValidate.validCvv(this.value);" maxlength="4" style="border:0" placeholder="123">
                        </div>
                    </div> <-- row ->
                    <div class="row">
                        <div class="col-lg-8 col-md-8 col-sm-8 col-xs-8 slim-padding-right">
                            <span class="error-block" style="display:none;" id="error_text_cc-expiry"></span>
                        </div>
                        <div class="col-lg-4 col-md-4 col-sm-4 col-xs-4 slim-padding-left">
                            <span class="error-block" style="display:none;" id="error_text_cc-csc"></span>
                        </div>
                    </div> <-- row ->
                    </div> <-- form-group -->
              </div> <!-- col-md-8 col-sm-10 col-xs-12 -->
              <div class="col-md-3 col-sm-1 hidden-xs"></div>
            </div> <!-- row -->
          </div> <!-- panel-body -->
          <div class="panel-body">
            <div class="row">
              <div class="col-md-1 col-sm-1 hidden-xs"></div>
              <div class="col-xl-10 col-lg-10 col-md-10 col-sm-12 col-xs-12">
                <div class="row" id="inline_userinfo">
                  <label for="billing" class="col-xs-12">Your details</label>
                  <div id="userinfo">
                    <div class="row row-spacer">
                      <label for="bill_name" class="col-lg-3 col-m3-3 col-sm-3 col-xs-3"><span class="hidden-xxxs">Full name</span><span class="visible-xxxs">Name</span></label>
                      <div class="col-lg-9 col-md-9 col-sm-9 col-xs-9" style="padding: 0.9em;padding-top: 0px;">
                        <!-- <div class="col-lg-9 col-md-9 col-sm-9 col-xs-9" style="padding: 0.8em;"> -->
                        <input type="text" class="form-control" name="bill_name" id="bill_name" maxlength="128" placeholder="Full name" value="" autocomplete="cc-name" x-autocompletetype="cc-name">
                        <span class="error-block" style="display:none;" id="error_text_bill_name"></span>
                      </div>
                    </div> <!-- row -->
                    <div class="row row-spacer">
                      <label for="bill_addr1" class="col-lg-3 col-md-3 col-sm-3 col-xs-3"><span class="hidden-xs">Address line 1</span><span class="visible-xs">Address</span></label>
                      <div class="col-lg-9 col-md-9 col-sm-9 col-xs-9" style="padding: 0.9em;padding-top: 0px;">
                        <!-- <div class="col-lg-9 col-md-9 col-sm-9 col-xs-9" style="padding: 0.8em;"> -->
                        <input type="text" class="form-control" name="bill_addr1" id="bill_addr1" maxlength="128" placeholder="" value="" autocomplete="billing address-line1" x-autocompletetype="billing address-line1">
                        <span class="error-block" style="display:none;" id="error_text_bill_addr1"></span>
                      </div>
                    </div> <!-- row -->
                    <div class="row row-spacer">
                      <label for="bill_addr2" class="col-lg-3 col-md-3 col-sm-3 col-xs-3"><span class="hidden-xs" style="font-weight: 1">Address line 2</span><span class="visible-xs" style="font-weight: 1">Line 2</span></label>
                      <div class="col-lg-9 col-md-9 col-sm-9 col-xs-9" style="padding: 0.9em;padding-top: 0px;">
                        <!-- <div class="col-lg-9 col-md-9 col-sm-9 col-xs-9" style="padding: 0.8em;"> -->
                        <input type="text" class="form-control" name="bill_addr2" id="bill_addr2" maxlength="128" placeholder="" value="" autocomplete="billing address-line2" x-autocompletetype="billing address-line2">
                        <span class="error-block" style="display:none;" id="error_text_bill_addr2"></span>
                      </div>
                    </div> <!-- row -->
                    <div class="row row-spacer">
                      <label for="bill_city" class="col-lg-3 col-md-3 col-sm-3 col-xs-3"><span class="hidden-xs">City</span><span class="visible-xs">City</span></label>
                      <div class="col-lg-9 col-md-9 col-sm-9 col-xs-9" style="padding: 0.9em;padding-top: 0px;">
                        <!-- <div class="col-lg-9 col-md-9 col-sm-9 col-xs-9" style="padding: 0.8em;"> -->
                        <input type="text" class="form-control" name="bill_city" id="bill_city" maxlength="48" placeholder="" value="">
                        <span class="error-block" style="display:none;" id="error_text_bill_city"></span>
                      </div>
                    </div> <!-- row -->
                    <div class="row row-spacer">
                      <label for="bill_region" class="col-lg-3 col-md-3 col-sm-3 col-xs-3"><span class="hidden-xs" style="font-weight: 1">Region/State</span><span class="visible-xs" style="font-weight: 1">Region</span></label>
                      <div class="col-lg-9 col-md-9 col-sm-9 col-xs-9" style="padding: 0.9em;padding-top: 0px;">
                        <!-- <div class="col-lg-9 col-md-9 col-sm-9 col-xs-9" style="padding: 0.8em;"> -->
                        <input type="text" class="form-control" name="bill_region" id="bill_region" maxlength="48" placeholder="" value="">
                        <span class="error-block" style="display:none;" id="error_text_bill_region"></span>
                      </div>
                    </div> <!-- row -->
                    <div class="row row-spacer">
                      <label for="bill_country" class="col-lg-3 col-md-3 col-sm-3 col-xs-3"><span class="hidden-xs">Country</span><span class="visible-xs">Country</span></label>
                      <div class="col-lg-9 col-md-9 col-sm-9 col-xs-9" style="padding: 0.9em;padding-top: 0px;">
                        <!-- <div class="col-lg-9 col-md-9 col-sm-9 col-xs-9" style="padding: 0.8em;"> -->
                        <select class="form-control" name="bill_country" id="bill_country" autocomplete="billing country" x-autocompletetype="billing country">
                          <option value="">--Select--</option>
                          <option value="af">Afghanistan</option>
                          <option value="al">Albania</option>
                          <option value="dz">Algeria</option>
                          <option value="as">American Samoa</option>
                          <option value="ad">Andorra</option>
                          <option value="ao">Angola</option>
                          <option value="ai">Anguilla</option>
                          <option value="ag">Antigua and Barbuda</option>
                          <option value="ar">Argentina</option>
                          <option value="am">Armenia</option>
                          <option value="aw">Aruba</option>
                          <option value="au">Australia</option>
                          <option value="at">Austria</option>
                          <option value="az">Azerbaijan</option>
                          <option value="bs">Bahamas</option>
                          <option value="bh">Bahrain</option>
                          <option value="bd">Bangladesh</option>
                          <option value="bb">Barbados</option>
                          <option value="by">Belarus</option>
                          <option value="be">Belgium</option>
                          <option value="bz">Belize</option>
                          <option value="bj">Benin</option>
                          <option value="bm">Bermuda</option>
                          <option value="bt">Bhutan</option>
                          <option value="bo">Bolivia</option>
                          <option value="ba">Bosnia and Herzegovina</option>
                          <option value="bw">Botswana</option>
                          <option value="br">Brazil</option>
                          <option value="io">British Indian Ocean Territory</option>
                          <option value="vg">British Virgin Islands</option>
                          <option value="bn">Brunei Darussalam</option>
                          <option value="bg">Bulgaria</option>
                          <option value="bf">Burkina Faso</option>
                          <option value="bi">Burundi</option>
                          <option value="kh">Cambodia</option>
                          <option value="cm">Cameroon</option>
                          <option value="ca">Canada</option>
                          <option value="cv">Cape Verde</option>
                          <option value="ky">Cayman Islands</option>
                          <option value="cf">Central African Rep</option>
                          <option value="td">Chad</option>
                          <option value="cl">Chile</option>
                          <option value="cn">China</option>
                          <option value="cx">Christmas Island</option>
                          <option value="cc">Cocos (Keeling) Islands</option>
                          <option value="co">Colombia</option>
                          <option value="km">Comoros</option>
                          <option value="cd">Congo, Democratic Rep of</option>
                          <option value="cg">Congo, Republic of</option>
                          <option value="ck">Cook Islands</option>
                          <option value="cr">Costa Rica</option>
                          <option value="ci">Cote d'Ivoire</option>
                          <option value="hr">Croatia</option>
                          <option value="cy">Cyprus</option>
                          <option value="cz">Czech Rep</option>
                          <option value="dk">Denmark</option>
                          <option value="dj">Djibouti</option>
                          <option value="dm">Dominica</option>
                          <option value="do">Dominican Rep</option>
                          <option value="ec">Ecuador</option>
                          <option value="eg">Egypt</option>
                          <option value="sv">El Salvador</option>
                          <option value="gq">Equatorial Guinea</option>
                          <option value="er">Eritrea</option>
                          <option value="ee">Estonia</option>
                          <option value="et">Ethiopia</option>
                          <option value="fk">Falkland Islands</option>
                          <option value="fo">Faroe Islands</option>
                          <option value="fj">Fiji</option>
                          <option value="fi">Finland</option>
                          <option value="fr">France</option>
                          <option value="gf">French Guyana</option>
                          <option value="pf">French Polynesia</option>
                          <option value="ga">Gabon</option>
                          <option value="gm">Gambia</option>
                          <option value="ge">Georgia</option>
                          <option value="de">Germany</option>
                          <option value="gh">Ghana</option>
                          <option value="gi">Gibraltar</option>
                          <option value="gr">Greece</option>
                          <option value="gl">Greenland</option>
                          <option value="gd">Grenada</option>
                          <option value="gp">Guadeloupe</option>
                          <option value="gu">Guam</option>
                          <option value="gt">Guatemala</option>
                          <option value="gn">Guinea</option>
                          <option value="gw">Guinea-Bissau</option>
                          <option value="gy">Guyana</option>
                          <option value="ht">Haiti</option>
                          <option value="hn">Honduras</option>
                          <option value="hk">Hong Kong</option>
                          <option value="hu">Hungary</option>
                          <option value="is">Iceland</option>
                          <option value="in">India</option>
                          <option value="id">Indonesia</option>
                          <option value="iq">Iraq</option>
                          <option value="ie">Ireland</option>
                          <option value="il">Israel</option>
                          <option value="it">Italy</option>
                          <option value="jm">Jamaica</option>
                          <option value="jp">Japan</option>
                          <option value="jo">Jordan</option>
                          <option value="kz">Kazakhstan</option>
                          <option value="ke">Kenya</option>
                          <option value="ki">Kiribati</option>
                          <option value="kr">Korea, South</option>
                          <option value="kw">Kuwait</option>
                          <option value="kg">Kyrgyzstan</option>
                          <option value="la">Laos</option>
                          <option value="lv">Latvia</option>
                          <option value="lb">Lebanon</option>
                          <option value="ls">Lesotho</option>
                          <option value="lr">Liberia</option>
                          <option value="ly">Libya</option>
                          <option value="li">Liechtenstein</option>
                          <option value="lt">Lithuania</option>
                          <option value="lu">Luxembourg</option>
                          <option value="mo">Macau</option>
                          <option value="mk">Macedonia</option>
                          <option value="mg">Madagascar</option>
                          <option value="mw">Malawi</option>
                          <option value="my">Malaysia</option>
                          <option value="mv">Maldives</option>
                          <option value="ml">Mali</option>
                          <option value="mt">Malta</option>
                          <option value="mh">Marshall Islands</option>
                          <option value="mq">Martinique</option>
                          <option value="mr">Mauritania</option>
                          <option value="mu">Mauritius</option>
                          <option value="yt">Mayotte</option>
                          <option value="mx">Mexico</option>
                          <option value="fm">Micronesia</option>
                          <option value="md">Moldova, Rep of</option>
                          <option value="mc">Monaco</option>
                          <option value="mn">Mongolia</option>
                          <option value="me">Montenegro</option>
                          <option value="ms">Montserrat</option>
                          <option value="ma">Morocco</option>
                          <option value="mz">Mozambique</option>
                          <option value="mm">Myanmar</option>
                          <option value="na">Namibia</option>
                          <option value="nr">Nauru</option>
                          <option value="np">Nepal</option>
                          <option value="nl">Netherlands</option>
                          <option value="an">Netherlands Antilles</option>
                          <option value="nc">New Caledonia</option>
                          <option value="nz">New Zealand</option>
                          <option value="ni">Nicaragua</option>
                          <option value="ne">Niger</option>
                          <option value="ng">Nigeria</option>
                          <option value="nu">Niue</option>
                          <option value="nf">Norfolk Island</option>
                          <option value="mp">Northern Mariana Islands</option>
                          <option value="no">Norway</option>
                          <option value="om">Oman</option>
                          <option value="pk">Pakistan</option>
                          <option value="pw">Palau</option>
                          <option value="ps">Palestinian Territory, Occupied</option>
                          <option value="pa">Panama</option>
                          <option value="pg">Papua New Guinea</option>
                          <option value="py">Paraguay</option>
                          <option value="pe">Peru</option>
                          <option value="ph">Philippines</option>
                          <option value="pn">Pitcairn Islands</option>
                          <option value="pl">Poland</option>
                          <option value="pt">Portugal</option>
                          <option value="pr">Puerto Rico</option>
                          <option value="qa">Qatar</option>
                          <option value="re">Reunion</option>
                          <option value="ro">Romania</option>
                          <option value="rw">Rwanda</option>
                          <option value="ws">Samoa</option>
                          <option value="sm">San Marino</option>
                          <option value="st">Sao Tome and Principe</option>
                          <option value="sa">Saudi Arabia</option>
                          <option value="sn">Senegal</option>
                          <option value="rs">Serbia</option>
                          <option value="sc">Seychelles</option>
                          <option value="sl">Sierra Leone</option>
                          <option value="sg">Singapore</option>
                          <option value="sk">Slovakia</option>
                          <option value="si">Slovenia</option>
                          <option value="sb">Solomon Islands</option>
                          <option value="so">Somalia</option>
                          <option value="za">South Africa</option>
                          <option value="es">Spain</option>
                          <option value="lk">Sri Lanka</option>
                          <option value="sh">St Helena</option>
                          <option value="kn">St Kitts and Nevis</option>
                          <option value="lc">St Lucia</option>
                          <option value="pm">St Pierre and Miquelon</option>
                          <option value="vc">St Vincent and Grenadines</option>
                          <option value="sr">Suriname</option>
                          <option value="sz">Swaziland</option>
                          <option value="se">Sweden</option>
                          <option value="ch">Switzerland</option>
                          <option value="tw">Taiwan, Rep of China</option>
                          <option value="tj">Tajikistan</option>
                          <option value="tz">Tanzania</option>
                          <option value="th">Thailand</option>
                          <option value="tl">Timor-Leste</option>
                          <option value="tg">Togo</option>
                          <option value="tk">Tokelau</option>
                          <option value="to">Tonga</option>
                          <option value="tt">Trinidad and Tobago</option>
                          <option value="tn">Tunisia</option>
                          <option value="tr">Turkey</option>
                          <option value="tm">Turkmenistan</option>
                          <option value="tc">Turks and Caicos Islands</option>
                          <option value="tv">Tuvalu</option>
                          <option value="ug">Uganda</option>
                          <option value="ae">United Arab Emirates</option>
                          <option value="gb">United Kingdom</option>
                          <option value="vi">United States Virgin Islands</option>
                          <option value="us">United States of America</option>
                          <option value="uy">Uruguay</option>
                          <option value="uz">Uzbekistan</option>
                          <option value="vu">Vanuatu</option>
                          <option value="va">Vatican City</option>
                          <option value="ve">Venezuela</option>
                          <option value="vn">Viet Nam</option>
                          <option value="wf">Wallis and Futuna Islands</option>
                          <option value="eh">Western Sahara</option>
                          <option value="zm">Zambia</option>
                          <option value="zw">Zimbabwe</option>
                          <option value="ss">South Sudan</option>
                        </select>
                        <span class="error-block" style="display:none;" id="error_text_bill_country"></span>
                      </div>
                    </div> <!-- row -->
                    <div class="row row-spacer">
                      <label for="bill_zip" class="col-lg-3 col-md-3 col-sm-3 col-xs-3"><span class="hidden-xs" style="font-weight: 1">Post/Zip code</span><span class="visible-xs" style="font-weight: 1">Post/Zip code</span></label>
                      <div class="col-lg-9 col-md-9 col-sm-9 col-xs-9" style="padding: 0.9em;padding-top: 0px;">
                        <!-- <div class="col-lg-9 col-md-9 col-sm-9 col-xs-9" style="padding: 0.8em;"> -->
                        <input type="text" class="form-control" name="bill_zip" id="bill_zip" maxlength="32" placeholder="" value="" autocomplete="billing postal-code" x-autocompletetype="billing postal-code">
                        <span class="error-block" style="display:none;" id="error_text_bill_zip"></span>
                      </div>
                    </div> <!-- row -->
                    <div class="row row-spacer">
                      <label for="bill_email" class="col-lg-3 col-md-3 col-sm-3 col-xs-3"><span class="hidden-xs">Email</span><span class="visible-xs">Email</span></label>
                      <div class="col-lg-9 col-md-9 col-sm-9 col-xs-9" style="padding: 0.9em;padding-top: 0px;">
                        <!-- <div class="col-lg-9 col-md-9 col-sm-9 col-xs-9" style="padding: 0.8em;"> -->
                        <input type="email" class="form-control" name="bill_email" id="bill_email" maxlength="128" placeholder="" value="" autocomplete="email" x-autocompletetype="email">
                        <span class="error-block" style="display:none;" id="error_text_bill_email"></span>
                      </div>
                    </div> <!-- row -->
                    <div class="row row-spacer">
                      <label for="bill_phone" class="col-lg-3 col-md-3 col-sm-3 col-xs-3"><span class="hidden-xs">Phone number</span><span class="visible-xs">Phone</span></label>
                      <div class="col-lg-9 col-md-9 col-sm-9 col-xs-9" style="padding: 0.9em;padding-top: 0px;">
                        <!-- <div class="col-lg-9 col-md-9 col-sm-9 col-xs-9" style="padding: 0.8em;"> -->
                        <input type="text" class="form-control" name="bill_phone" id="bill_phone" maxlength="25" placeholder="" value="" data-opt="2" autocomplete="tel-national" x-autocompletetype="tel-national">
                        <span class="error-block" style="display:none;" id="error_text_bill_phone"></span>
                      </div>
                    </div> <!-- row -->
                  </div>
                </div> <!-- row -->
                <div class="row row-spacer">
                  <!-- <div class="col-lg-3 col-md-3 col-sm-3 col-xs-3"></div> -->
                  <div class="col-lg-3 col-md-3 col-sm-12 col-xs-12" style="position: absolute;"></div>
                  <div class="col-lg-9 col-md-9 col-sm-9 col-xs-9 btn-elements">
                    <button type="submit" id="cardpaybutton" class="btn btn-success" onclick="ppValidate.PayWith_Card(this); return false; " style="font-weight: bold;">ENTER VALID CARD DETAILS</button>
                    <input type="hidden" id="paybutton" value="ENTER VALID CARD DETAILS">
                    <input type="hidden" id="makebutton" value="Make payment">
                    <button type="submit" class="btn btn-danger" style="font-weight: bold;" onclick="ppValidate.Cancel(this); return false;">Cancel</button>
                    <!--<button type="submit" class="btn btn-danger" onclick="ppValidate.Cancel(this); return false;"></button> -->
                  </div>
                </div> <!-- row -->
              </div> <!-- col-md-8 col-sm-10 col-xs-12 -->
              <div class="col-md-3 col-sm-1 hidden-xs"></div>
            </div> <!-- row -->
          </div> <!-- panel-body -->
        </div> <!-- collapse_card -->
      </div>
    </div> <!-- panel-default -->
  </div> <!-- panel-group -->
  <div class="row"> <!-- inner row, same level as expiry, cvv etc -->
    <div class="col-lg-12 col-md-12 col-sm-12 col-xs-12" style="margin-bottom: 15px;margin-bottom: 10px;">
      <div class="tc_block">
        <div class="tc_text">
          <input id="tc_box" type="checkbox" name="term_agree" value="agree"> By clicking on this checkbox you agree to the <a href="http://shams.ae/" target="_blank" onclick="display_terms(); return false;"> terms and conditions</a> of the website
        </div>
        <div class="tc_check"></div>
      </div>
    </div>
  </div> <!-- row -->
  <script langauge="javascript">
    function enable_tcbox() {
      document.getElementById("tc_box").disabled = false;
    }

    function display_terms() {
      setTimeout(enable_tcbox, 5000);
      window.open('http://shams.ae/', 'PaymentTerms', 'height=650,width=850,left=80,top=80,resizable=yes,scrollbars=yes,toolbar=no,menubar=no,location=no,directories=no,status=no,titlebar=yes');
    }
  </script>
</form>

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