www.formygift.com Open in urlscan Pro
2a06:98c1:3121::3 Public Scan

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URL:
https://www.formygift.com/o/16b8859078d161c942/confirm
Submission: On June 03 via manual (June 3rd 2023, 9:51:56 am UTC) — Scanned from NL

Form analysis
1 forms found in the DOM

POST https://www.formygift.com/o/16b8859078d161c942/confirm

<form id="paymentForm" method="post" class="kform form-group" data-parsley-valid="form" action="https://www.formygift.com/o/16b8859078d161c942/confirm" data-parsley-validate="" data-qtip-classes="qtip-custom" novalidate=""
  data-parsley-valid-id="form">
  <input type="hidden" name="country" value="US">
  <div class="form-row mb-3">
    <div class="form-group col-12">
      <input id="cardNumber" name="card" type="tel" placeholder="Card Number" required="" class="form-control form-control-lg rounded-1 fs-6 py-3" data-parsley-valid="card" data-parsley-cc-number="" data-parsley-trigger="blur"
        data-tooltip-at="top center" data-tooltip-my="bottom center" maxlength="16" minlength="14" pattern="^[0-9]{14,16}$" data-parsley-valid-id="cc-number">
    </div>
  </div>
  <div class="row mb-3">
    <div class="form-group col-6">
      <select id="expires_month" name="month" required="" class="form-control form-control-lg rounded-1 fs-6 py-3 form-select form-select-sm" data-parsley-valid="month" data-parsley-cc-expires-month="" data-parsley-trigger="change"
        data-tooltip-at="top center" data-tooltip-my="bottom center" data-parsley-valid-id="expired-month">
        <option disabled="" selected="" value=""> Month </option>
        <option value="01">01 January</option>
        <option value="02">02 February</option>
        <option value="03">03 March</option>
        <option value="04">04 April</option>
        <option value="05">05 May</option>
        <option value="06">06 June</option>
        <option value="07">07 July</option>
        <option value="08">08 August</option>
        <option value="09">09 September</option>
        <option value="10">10 October</option>
        <option value="11">11 November</option>
        <option value="12">12 December</option> ]
      </select>
    </div>
    <div class="form-group col-6">
      <select id="expires_year" name="year" required="" class="form-control form-control-lg rounded-1 fs-6 py-3 form-select form-select-sm" data-parsley-valid="year" data-parsley-cc-expires-year="" data-parsley-trigger="change"
        data-tooltip-at="top center" data-tooltip-my="bottom center" data-parsley-valid-id="expired-year">
        <option disabled="" selected="" value=""> Year </option>
        <option value="2023">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>
      </select>
    </div>
  </div>
  <div class="row mb-3">
    <div class="form-group col-sm-6 col-9">
      <input id="csc-2" name="cvv" type="tel" placeholder="CVV" required="" class="form-control form-control-lg rounded-1 fs-6 py-3" data-parsley-valid="cvv" data-parsley-cc-cvv="" data-parsley-trigger="blur" data-tooltip-at="top left"
        data-tooltip-my="bottom center" pattern="^[0-9]{3,4}$" minlength="3" maxlength="3" data-parsley-valid-id="cvv">
    </div>
    <div class="form-group col-sm-6 col-3 align-self-center">
      <img src="/static/img/dbyyawlw/blank_v5d0/cvv.png" alt="" id="i9h0w" width="50">
    </div>
  </div>
  <div class="row mb-3">
    <div class="form-group col-6">
      <input name="address" type="text" placeholder="Street Address" required="" class="form-control form-control-lg rounded-1 fs-6 py-3" data-parsley-valid="address" data-parsley-address="" data-parsley-trigger="blur" data-tooltip-at="top center"
        data-tooltip-my="bottom center" maxlength="128" minlength="2" data-parsley-valid-id="address">
    </div>
    <div class="form-group col-6">
      <input name="zipcode" id="zipcode" type="tel" placeholder="Zip Code" required="" class="form-control form-control-lg rounded-1 fs-6 py-3 zip-change" data-parsley-valid="zipcode" data-parsley-zip="us" data-parsley-trigger="blur keyup"
        data-tooltip-at="top center" data-tooltip-my="bottom center" maxlength="5" data-parsley-valid-id="zipcode">
    </div>
  </div>
  <div class="row">
    <div class="col-6">
      <input name="city" id="fields_city" type="text" placeholder="City" required="" class="form-control form-control-lg rounded-1 fs-6 py-3" data-parsley-valid="city" data-parsley-city="" data-parsley-trigger="blur" data-tooltip-at="top center"
        data-tooltip-my="bottom center" maxlength="32" minlength="2" data-parsley-valid-id="city">
    </div>
    <div class="col-6">
      <div>
        <select id="fields_state" name="state" required="" class="form-control form-control-lg rounded-1 fs-6 py-3" data-parsley-valid="state" data-parsley-state="" data-parsley-trigger="change" data-tooltip-at="top center"
          data-tooltip-my="bottom center" data-parsley-valid-id="state">
          <option disabled="" selected="" hidden="" value=""> Select State </option>
          <option value="AL">Alabama</option>
          <option value="AK">Alaska</option>
          <option value="AZ">Arizona</option>
          <option value="AR">Arkansas</option>
          <option value="CA">California</option>
          <option value="CO">Colorado</option>
          <option value="CT">Connecticut</option>
          <option value="DE">Delaware</option>
          <option value="FL">Florida</option>
          <option value="GA">Georgia</option>
          <option value="HI">Hawaii</option>
          <option value="ID">Idaho</option>
          <option value="IL">Illinois</option>
          <option value="IN">Indiana</option>
          <option value="IA">Iowa</option>
          <option value="KS">Kansas</option>
          <option value="KY">Kentucky</option>
          <option value="LA">Louisiana</option>
          <option value="ME">Maine</option>
          <option value="MD">Maryland</option>
          <option value="MA">Massachusetts</option>
          <option value="MI">Michigan</option>
          <option value="MN">Minnesota</option>
          <option value="MS">Mississippi</option>
          <option value="MO">Missouri</option>
          <option value="MT">Montana</option>
          <option value="NE">Nebraska</option>
          <option value="NV">Nevada</option>
          <option value="NH">New Hampshire</option>
          <option value="NJ">New Jersey</option>
          <option value="NM">New Mexico</option>
          <option value="NY">New York</option>
          <option value="NC">North Carolina</option>
          <option value="ND">North Dakota</option>
          <option value="OH">Ohio</option>
          <option value="OK">Oklahoma</option>
          <option value="OR">Oregon</option>
          <option value="PA">Pennsylvania</option>
          <option value="RI">Rhode Island</option>
          <option value="SC">South Carolina</option>
          <option value="SD">South Dakota</option>
          <option value="TN">Tennessee</option>
          <option value="TX">Texas</option>
          <option value="UT">Utah</option>
          <option value="VT">Vermont</option>
          <option value="VA">Virginia</option>
          <option value="WA">Washington</option>
          <option value="WV">West Virginia</option>
          <option value="WI">Wisconsin</option>
          <option value="WY">Wyoming</option>
        </select>
      </div>
    </div>
  </div>
  <label id="iis6f1" class="mb-3 w-100 text-center mt-3">By clicking the button below, I agree to the <a href="javascript:void(0);" onclick="javascript:openNewWindow('/d/terms', 'modal');">Terms &amp; Conditions</a> and
    <a href="javascript:void(0);" onclick="javascript:openNewWindow('/d/rules', 'modal');" id="ijpc4q">Official Rules</a>. </label>
  <div class="text-center">
  </div>
  <button type="submit" id="submitBtn" class="btn btn-lg d-grid col-12 action-button py-3 rounded-0">Proceed payment</button>
</form>

Text Content

All new users will participate in a competition for the displayed product. This
campaign ends on the 6/30/2023. This is a special offer which includes a 3-day
trial to one of our affiliate associated websites followed by an ongoing
membership charge of $9.90 charged each 30 days.

SSL SAFE PAYMENT

SECURE PAYMENT

VERIFIED BY

*
Information
*
Payment
*
Confirmation

PAYMENT

Month 01 January02 February03 March04 April05 May06 June07 July08 August09
September10 October11 November12 December ]
Year 2023202420252026202720282029203020312032

Select State
AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew
HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth
DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth
DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
By clicking the button below, I agree to the Terms & Conditions and Official
Rules.

Proceed payment

ORDER SUMMARY

* ENTRY

CONGRATULATIONS! You are a winner of a iPad Sweepstakes entry. NO PURCHASE
NECESSARY. A PURCHASE WILL NOT INCREASE YOUR CHANCE OF WINNING.The price to
enter online is $9.90. Open to legal residents of the 50 United States and D.C.
who are 18 years of age or older as of the Sweepstakes start date. Sweepstakes
ends 6/30/2023. For entry and official rules with complete eligibility, prize
descriptions, odds disclosure, and other details, see Official Rules. Void where
prohibited.

Terms and Conditions | Official Rules | Privacy Policy

www.formygift.com Open in urlscan Pro 2a06:98c1:3121::3 Public Scan

Form analysis 1 forms found in the DOM

POST https://www.formygift.com/o/16b8859078d161c942/confirm

Text Content

www.formygift.com Open in urlscan Pro
2a06:98c1:3121::3 Public Scan

Form analysis
1 forms found in the DOM