www.publicationmgr.com Open in urlscan Pro
35.212.123.151  Public Scan

Submitted URL: https://payss.publicationmgr.com/
Effective URL: https://www.publicationmgr.com/spscloud/app/payment2/?key=21010300082
Submission: On July 17 via api from US — Scanned from DE

Form analysis 8 forms found in the DOM

Name: form_ajax_redir_1POST

<form name="form_ajax_redir_1" method="post" style="display: none">
  <input type="hidden" name="nmgp_parms">
  <input type="hidden" name="nmgp_outra_jan">
  <input type="hidden" name="script_case_session" value="ff02727c49ae19bbf55bb93b817889b8">
</form>

Name: form_ajax_redir_2POST

<form name="form_ajax_redir_2" method="post" style="display: none">
  <input type="hidden" name="nmgp_parms">
  <input type="hidden" name="nmgp_url_saida">
  <input type="hidden" name="script_case_init">
  <input type="hidden" name="script_case_session" value="ff02727c49ae19bbf55bb93b817889b8">
</form>

Name: F2POST ./

<form name="F2" method="post" action="./" target="_self">
  <input type="hidden" name="nm_form_submit" value="1">
  <input type="hidden" name="nmgp_opcao" value="">
  <input type="hidden" name="master_nav" value="off">
  <input type="hidden" name="sc_ifr_height" value="">
  <input type="hidden" name="nmgp_parms" value="">
  <input type="hidden" name="nmgp_ordem" value="">
  <input type="hidden" name="nmgp_clone" value="">
  <input type="hidden" name="nmgp_arg_dyn_search" value="">
  <input type="hidden" name="script_case_init" value="3445">
</form>

Name: F4POST

<form name="F4" method="post" target="_self">
  <input type="hidden" name="nmgp_url_saida" value="">
  <input type="hidden" name="script_case_init" value="3445">
</form>

Name: F5POST ./

<form name="F5" method="post" action="./" target="_self">
  <input type="hidden" name="nmgp_opcao" value="igual">
  <input type="hidden" name="nmgp_parms" value="">
  <input type="hidden" name="script_case_init" value="3445">
</form>

Name: F6POST ./

<form name="F6" method="post" action="./" target="_self">
  <input type="hidden" name="script_case_init" value="3445">
</form>

Name: FCAPPOST

<form name="FCAP" action="" method="post" target="_blank">
  <input type="hidden" name="SC_lig_apl_orig" value="payment2">
  <input type="hidden" name="nmgp_parms" value="">
  <input type="hidden" name="nmgp_outra_jan" value="true">
  <input type="hidden" name="script_case_init" value="3445">
</form>

Name: F1POST ./

<form name="F1" method="post" action="./" target="_self">
  <input type="hidden" name="nm_form_submit" value="1">
  <input type="hidden" name="nmgp_idioma_novo" value="">
  <input type="hidden" name="nmgp_schema_f" value="">
  <input type="hidden" name="nmgp_url_saida" value="">
  <input type="hidden" name="bok" value="OK">
  <input type="hidden" name="nmgp_opcao" value="">
  <input type="hidden" name="nmgp_ancora" value="">
  <input type="hidden" name="nmgp_num_form" value="">
  <input type="hidden" name="nmgp_parms" value="">
  <input type="hidden" name="script_case_init" value="3445">
  <input type="hidden" name="NM_cancel_return_new" value="">
  <input type="hidden" name="csrf_token" value="2@521UC;1B.A8!8O3@:UG-q6;3Xby5P!HeJ9@$HVYd9LRNhDQ-{gn{Tl7N4[.3-3">
  <input type="hidden" name="_sc_force_mobile" id="sc-id-mobile-control" value="">
  <div style="display: none; position: absolute; z-index: 1000" id="id_error_display_table_frame">
    <table class="scFormErrorTable scFormToastTable">
      <tbody>
        <tr>
          <td style="padding: 0px" rowspan="2"><img src="/spscloud/app/_lib/img/scriptcase__NM__icnMensagemAlerta.png" style="border-width: 0px" align="top"></td>
          <td class="scFormErrorTitle scFormToastTitle">
            <table style="border-collapse: collapse; border-width: 0px; width: 100%">
              <tbody>
                <tr>
                  <td class="scFormErrorTitleFont" style="padding: 0px; vertical-align: top; width: 100%">Error</td>
                  <td style="padding: 0px; vertical-align: top">
                    <a onclick="scAjaxHideErrorDisplay('table'); return false;" class="scButton_default " title="Close" style="vertical-align: middle; display:inline-block;"><span class="btn-label">Close</span></a>
                  </td>
                </tr>
              </tbody>
            </table>
          </td>
        </tr>
        <tr>
          <td class="scFormErrorMessage scFormToastMessage"><span id="id_error_display_table_text"></span></td>
        </tr>
      </tbody>
    </table>
  </div>
  <div style="display: none; position: absolute; z-index: 1000" id="id_message_display_frame">
    <table class="scFormMessageTable" id="id_message_display_content" style="width: 100%">
      <tbody>
        <tr id="id_message_display_title_line">
          <td class="scFormMessageTitle" style="height: 20px">
            <a id="id_message_display_close_icon" onclick="_scAjaxMessageBtnClose(); return false;" class="scButton_default " title="Close" style="vertical-align: middle; display:inline-block;float: right"><span class="btn-label">Close</span></a>
            <span id="id_message_display_title" style="vertical-align: middle"></span>
          </td>
        </tr>
        <tr>
          <td class="scFormMessageMessage"><img id="id_message_display_body_icon" src="/spscloud/app/_lib/img/scriptcase__NM__exclamation.png" style="border-width: 0px; vertical-align: middle">&nbsp;<span id="id_message_display_text"></span>
            <div id="id_message_display_buttond" style="display: none; text-align: center"><br><input id="id_message_display_buttone" type="button" class="scButton_default" value="Ok" onclick="_scAjaxMessageBtnClick()"></div>
          </td>
        </tr>
      </tbody>
    </table>
  </div>
  <script type="text/javascript">
    var scMsgDefTitle = "";
    var scMsgDefButton = "Ok";
    var scMsgDefClose = "Close";
    var scMsgDefClick = "close";
    var scMsgDefScInit = "";
  </script>
  <table id="main_table_form" align="center" cellpadding="0" cellspacing="0">
    <tbody>
      <tr>
        <td>
          <div class="scFormBorder" style="">
            <table width="100%" cellspacing="0" cellpadding="0">
              <tbody>
                <tr>
                  <td class="sc-app-header">
                    <table width="100%" {nm_css_fun_cab}="" style="background-color:#ffffff;">
                      <tbody>
                        <tr>
                          <td style="padding: 8px 8px 4px 8px;">
                            <img src="../cust/files-10/img/mainlogo.png" style="width: 100%; max-width: 350px; float:left;">
                          </td>
                        </tr>
                      </tbody>
                    </table>
                  </td>
                </tr>
                <tr>
                  <td>
                    <div id="sc-ui-empty-form" class="scFormPageText" style="padding: 10px; font-weight: bold; display: none">No Records Found</div> <a name="bloco_0"></a>
                    <table width="100%" height="100%" cellpadding="0" cellspacing="0">
                      <tbody>
                        <tr valign="top">
                          <td width="100%" height="">
                            <div id="div_hidden_bloco_0"><!-- bloco_c -->
                              <table align="center" id="hidden_bloco_0" class="scFormTable" width="100%" style="height: 100%; border-style: none;">
                                <tbody>
                                  <tr>
                                    <td colspan="2" height="50" class="scFormBlock" style="background-color: #FFFFFF; vertical-align: bottom">
                                      <table style="padding: 0px; spacing: 0px; border-width: 0px;" width="100%" height="100%">
                                        <tbody>
                                          <tr>
                                            <td align="" valign="bottom" class="scFormBlockFont" style="font-size: 16px; color: #333333">Billing Information</td>
                                          </tr>
                                        </tbody>
                                      </table>
                                    </td>
                                  </tr>
                                  <tr>
                                    <td class="scFormLabelOdd scUiLabelWidthFix css_acctno_label" id="hidden_field_label_acctno" style="width: 120px;"><span id="id_label_acctno">Account #</span></td>
                                    <td class="scFormDataOdd css_acctno_line" id="hidden_field_data_acctno" style="">
                                      <span id="id_read_on_acctno" class="sc-ui-readonly-acctno css_acctno_line" style="display: none;"></span><span id="id_read_off_acctno" class="css_read_off_acctno" style="white-space: nowrap;">
                                        <input class="sc-js-input scFormObjectOdd css_acctno_obj" style="" id="id_sc_field_acctno" type="text" name="acctno" value="" size="7" maxlength="20"
                                          alt="{datatype: 'text', maxLength: 20, allowedChars: '', lettersCase: '', enterTab: false, enterSubmit: false, autoTab: false, selectOnFocus: true, watermark: '', watermarkClass: 'scFormObjectOddWm', maskChars: '(){}[].,;:-+/ '}"></span>
                                    </td>
                                  </tr>
                                  <tr>
                                    <td class="scFormLabelOdd scUiLabelWidthFix css_name_label" id="hidden_field_label_name" style="width: 120px;"><span id="id_label_name">Name <span style="color:red;">*</span></span></td>
                                    <td class="scFormDataOdd css_name_line" id="hidden_field_data_name" style="">
                                      <span id="id_read_on_name" class="sc-ui-readonly-name css_name_line" style="display: none;"></span><span id="id_read_off_name" class="css_read_off_name" style="white-space: nowrap;">
                                        <input class="sc-js-input scFormObjectOdd css_name_obj" style="" id="id_sc_field_name" type="text" name="name" value="" size="60" maxlength="60"
                                          alt="{datatype: 'text', maxLength: 60, allowedChars: '', lettersCase: '', enterTab: false, enterSubmit: false, autoTab: false, selectOnFocus: true, watermark: '', watermarkClass: 'scFormObjectOddWm', maskChars: '(){}[].,;:-+/ '}"></span>
                                    </td>
                                  </tr>
                                  <tr>
                                    <td class="scFormLabelOdd scUiLabelWidthFix css_addr1_label" id="hidden_field_label_addr1" style="width: 120px;"><span id="id_label_addr1">Address 1 <span style="color:red;">*</span></span></td>
                                    <td class="scFormDataOdd css_addr1_line" id="hidden_field_data_addr1" style="">
                                      <span id="id_read_on_addr1" class="sc-ui-readonly-addr1 css_addr1_line" style="display: none;"></span><span id="id_read_off_addr1" class="css_read_off_addr1" style="white-space: nowrap;">
                                        <input class="sc-js-input scFormObjectOdd css_addr1_obj" style="" id="id_sc_field_addr1" type="text" name="addr1" value="" size="60" maxlength="60"
                                          alt="{datatype: 'text', maxLength: 60, allowedChars: '', lettersCase: '', enterTab: false, enterSubmit: false, autoTab: false, selectOnFocus: true, watermark: '', watermarkClass: 'scFormObjectOddWm', maskChars: '(){}[].,;:-+/ '}"></span>
                                    </td>
                                  </tr>
                                  <tr>
                                    <td class="scFormLabelOdd scUiLabelWidthFix css_addr2_label" id="hidden_field_label_addr2" style="width: 120px;"><span id="id_label_addr2">Address 2</span></td>
                                    <td class="scFormDataOdd css_addr2_line" id="hidden_field_data_addr2" style="">
                                      <span id="id_read_on_addr2" class="sc-ui-readonly-addr2 css_addr2_line" style="display: none;"></span><span id="id_read_off_addr2" class="css_read_off_addr2" style="white-space: nowrap;">
                                        <input class="sc-js-input scFormObjectOdd css_addr2_obj" style="" id="id_sc_field_addr2" type="text" name="addr2" value="" size="60" maxlength="60"
                                          alt="{datatype: 'text', maxLength: 60, allowedChars: '', lettersCase: '', enterTab: false, enterSubmit: false, autoTab: false, selectOnFocus: true, watermark: '', watermarkClass: 'scFormObjectOddWm', maskChars: '(){}[].,;:-+/ '}"></span>
                                    </td>
                                  </tr>
                                  <tr>
                                    <td class="scFormLabelOdd scUiLabelWidthFix css_city_label" id="hidden_field_label_city" style="width: 120px;"><span id="id_label_city">City <span style="color:red;">*</span></span></td>
                                    <td class="scFormDataOdd css_city_line" id="hidden_field_data_city" style="">
                                      <span id="id_read_on_city" class="sc-ui-readonly-city css_city_line" style="display: none;"></span><span id="id_read_off_city" class="css_read_off_city" style="white-space: nowrap;">
                                        <input class="sc-js-input scFormObjectOdd css_city_obj" style="" id="id_sc_field_city" type="text" name="city" value="" size="60" maxlength="60"
                                          alt="{datatype: 'text', maxLength: 60, allowedChars: '', lettersCase: '', enterTab: false, enterSubmit: false, autoTab: false, selectOnFocus: true, watermark: '', watermarkClass: 'scFormObjectOddWm', maskChars: '(){}[].,;:-+/ '}"></span>
                                    </td>
                                  </tr>
                                  <tr>
                                    <td class="scFormLabelOdd scUiLabelWidthFix css_st_label" id="hidden_field_label_st" style="width: 120px;"><span id="id_label_st">State <span style="color:red;">*</span></span></td>
                                    <td class="scFormDataOdd css_st_line" id="hidden_field_data_st" style="">
                                      <span id="id_read_on_st" class="sc-ui-readonly-st css_st_line" style="display: none;"></span><span id="id_read_off_st" class="css_read_off_st" style="white-space: nowrap;">
                                        <input class="sc-js-input scFormObjectOdd css_st_obj" style="" id="id_sc_field_st" type="text" name="st" value="" size="2" maxlength="2"
                                          alt="{datatype: 'text', maxLength: 2, allowedChars: '', lettersCase: '', enterTab: false, enterSubmit: false, autoTab: false, selectOnFocus: true, watermark: '', watermarkClass: 'scFormObjectOddWm', maskChars: '(){}[].,;:-+/ '}"></span>
                                    </td>
                                  </tr>
                                  <tr>
                                    <td class="scFormLabelOdd scUiLabelWidthFix css_zip_label" id="hidden_field_label_zip" style="width: 120px;"><span id="id_label_zip">Zip <span style="color:red;">*</span></span></td>
                                    <td class="scFormDataOdd css_zip_line" id="hidden_field_data_zip" style="">
                                      <span id="id_read_on_zip" class="sc-ui-readonly-zip css_zip_line" style="display: none;"></span><span id="id_read_off_zip" class="css_read_off_zip" style="white-space: nowrap;">
                                        <input class="sc-js-input scFormObjectOdd css_zip_obj" style="" id="id_sc_field_zip" type="text" name="zip" value="" size="10" maxlength="10"
                                          alt="{datatype: 'text', maxLength: 10, allowedChars: '', lettersCase: '', enterTab: false, enterSubmit: false, autoTab: false, selectOnFocus: true, watermark: '', watermarkClass: 'scFormObjectOddWm', maskChars: '(){}[].,;:-+/ '}"></span>
                                    </td>
                                  </tr>
                                  <tr>
                                    <td class="scFormLabelOdd scUiLabelWidthFix css_ph1_label" id="hidden_field_label_ph1" style="width: 120px;"><span id="id_label_ph1">Phone</span></td>
                                    <td class="scFormDataOdd css_ph1_line" id="hidden_field_data_ph1" style="">
                                      <span id="id_read_on_ph1" class="sc-ui-readonly-ph1 css_ph1_line" style="display: none;"></span><span id="id_read_off_ph1" class="css_read_off_ph1" style="white-space: nowrap;">
                                        <input class="sc-js-input scFormObjectOdd css_ph1_obj" style="" id="id_sc_field_ph1" type="text" name="ph1" value="" size="25" maxlength="25"
                                          alt="{datatype: 'text', maxLength: 25, allowedChars: '', lettersCase: '', enterTab: false, enterSubmit: false, autoTab: false, selectOnFocus: true, watermark: '', watermarkClass: 'scFormObjectOddWm', maskChars: '(){}[].,;:-+/ '}"></span>
                                    </td>
                                  </tr>
                                  <tr>
                                    <td class="scFormLabelOdd scUiLabelWidthFix css_email_label" id="hidden_field_label_email" style="width: 120px;"><span id="id_label_email">Email <span style="color:red;">*</span></span></td>
                                    <td class="scFormDataOdd css_email_line" id="hidden_field_data_email" style="">
                                      <span id="id_read_on_email" class="sc-ui-readonly-email css_email_line" style="display: none;"></span><span id="id_read_off_email" class="css_read_off_email" style="white-space: nowrap;">
                                        <input class="sc-js-input scFormObjectOdd css_email_obj" style="" id="id_sc_field_email" type="text" name="email" value="" size="60" maxlength="60"
                                          alt="{enterTab: false, enterSubmit: false, autoTab: false, selectOnFocus: true, watermark: '', watermarkClass: 'scFormObjectOddWm', maskChars: '(){}[].,;:-+/ '}">&nbsp;<span
                                          style="display: none"><a id="email_mail" class="scButton_image " title="Send an email" style="vertical-align: middle; display:inline-block;" onclick="if (document.F1.email.value != '') {window.open('mailto:' + document.F1.email.value); }; return false;"><img id="id_img_email_mail" src="/spscloud/app/_lib/img/scriptcase__NM__nm_scriptcase9_Rhino_mail.png" style="border-width: 0; cursor: pointer"></a>
                                        </span>
                                      </span>
                                    </td>
                                  </tr>
                                </tbody>
                              </table>
                            </div><!-- bloco_f -->
                          </td>
                        </tr>
                      </tbody>
                    </table>
                    <a name="bloco_1"></a>
                    <table width="100%" height="100%" cellpadding="0" cellspacing="0">
                      <tbody>
                        <tr valign="top">
                          <td width="100%" height="">
                            <div id="div_hidden_bloco_1"><!-- bloco_c -->
                              <table align="center" id="hidden_bloco_1" class="scFormTable" width="100%" style="height: 100%; border-style: none;">
                                <tbody>
                                  <tr>
                                    <td colspan="2" height="50" class="scFormBlock" style="background-color: #FFFFFF; vertical-align: bottom">
                                      <table style="padding: 0px; spacing: 0px; border-width: 0px;" width="100%" height="100%">
                                        <tbody>
                                          <tr>
                                            <td align="" valign="bottom" class="scFormBlockFont" style="font-size: 16px; color: #333333">Payment Information</td>
                                          </tr>
                                        </tbody>
                                      </table>
                                    </td>
                                  </tr>
                                  <tr>
                                    <td class="scFormLabelOdd scUiLabelWidthFix css_payingfor_label" id="hidden_field_label_payingfor" style="width: 120px;"><span id="id_label_payingfor">I Am Paying For</span></td>
                                    <td class="scFormDataOdd css_payingfor_line" id="hidden_field_data_payingfor" style="">
                                      <span id="id_read_on_payingfor" class="sc-ui-readonly-payingfor css_payingfor_line" style="display: none;"></span><span id="id_read_off_payingfor" class="css_read_off_payingfor" style="white-space: nowrap;">
                                        <input class="sc-js-input scFormObjectOdd css_payingfor_obj" style="" id="id_sc_field_payingfor" type="text" name="payingfor" value="" size="60" maxlength="60"
                                          alt="{datatype: 'text', maxLength: 60, allowedChars: '', lettersCase: '', enterTab: false, enterSubmit: false, autoTab: false, selectOnFocus: true, watermark: 'Invoice # or Description', watermarkClass: 'scFormObjectOddWm', maskChars: '(){}[].,;:-+/ '}"
                                          placeholder="Invoice # or Description"></span>
                                    </td>
                                  </tr>
                                  <tr>
                                    <td class="scFormLabelOdd scUiLabelWidthFix css_total_label" id="hidden_field_label_total" style="width: 120px;"><span id="id_label_total">Amount <span style="color:red;">*</span></span></td>
                                    <td class="scFormDataOdd css_total_line" id="hidden_field_data_total" style="">
                                      <span id="id_read_on_total" class="sc-ui-readonly-total css_total_line" style="display: none;"></span><span id="id_read_off_total" class="css_read_off_total" style="white-space: nowrap;">
                                        <input class="sc-js-input scFormObjectOdd css_total_obj is-calculator" style="" id="id_sc_field_total" type="text" name="total" value="" size="10"
                                          alt="{datatype: 'decimal', maxLength: 20, precision: 2, decimalSep: '.', thousandsSep: '', thousandsFormat: 1, manualDecimals: true, allowNegative: true, onlyNegative: false, negativePos: 'prefix', enterTab: false, enterSubmit: false, autoTab: false, selectOnFocus: true, watermark: '', watermarkClass: 'scFormObjectOddWm', maskChars: '(){}[].,;:-+/ '}"
                                          maxlength="22"><img src="/spscloud/app/_lib/img/scriptcase__NM__nm_scriptcase9_Rhino_calc.png" alt="Open the calculator" title="Open the calculator" class="calculator-trigger"></span>
                                    </td>
                                  </tr>
                                  <tr>
                                    <td class="scFormLabelOdd scUiLabelWidthFix css_autorenew_label" id="hidden_field_label_autorenew" style="width: 120px;"><span id="id_label_autorenew">Auto Pay</span></td>
                                    <td class="scFormDataOdd css_autorenew_line" id="hidden_field_data_autorenew" style="">
                                      <span id="id_read_on_autorenew" class="css_autorenew_line" style="display: none;"></span><span id="id_read_off_autorenew" class="css_read_off_autorenew" style="white-space: nowrap; ">
                                        <span id="idAjaxSelect_autorenew" class=""><select class="sc-js-input scFormObjectOdd css_autorenew_obj" style="" id="id_sc_field_autorenew" name="autorenew" size="1" alt="{type: 'select', enterTab: false}"
                                            maxlength="1">
                                            <option value="N" selected="">Do not automatically pay future account balances</option>
                                            <option value="Y">Automatically pay account balances in the future</option>
                                          </select></span>
                                      </span>
                                    </td>
                                  </tr>
                                  <tr>
                                    <td class="scFormLabelOdd scUiLabelWidthFix css_payinfobtn_label" id="hidden_field_label_payinfobtn" style="width: 120px;"><span id="id_label_payinfobtn">Credit Card Data </span></td>
                                    <td class="scFormDataOdd css_payinfobtn_line" id="hidden_field_data_payinfobtn" style=""><span id="id_ajax_label_payinfobtn"><button id="payButton">Enter Your Credit Card Information and Pay</button></span>
                                      <input type="hidden" name="payinfobtn" value="<button id=&quot;payButton&quot;>Enter Your Credit Card Information and Pay</button>">
                                    </td>
                                  </tr>
                                </tbody>
                              </table>
                            </div><!-- bloco_f -->
                          </td>
                        </tr>
                      </tbody>
                    </table>
                    <a name="bloco_2"></a>
                    <table width="100%" height="100%" cellpadding="0" cellspacing="0">
                      <tbody>
                        <tr valign="top">
                          <td width="100%" height="">
                            <div id="div_hidden_bloco_2"><!-- bloco_c -->
                              <table align="center" id="hidden_bloco_2" class="scFormTable" width="100%" style="height: 100%; border-style: none;">
                                <tbody>
                                  <tr>
                                    <td class="scFormDataOdd css_authno_line" id="hidden_field_data_authno" style="display: none;">
                                      <span id="id_read_on_authno" class="sc-ui-readonly-authno css_authno_line" style="display: none;"></span><span id="id_read_off_authno" class="css_read_off_authno" style="white-space: nowrap;">
                                        <input class="sc-js-input scFormObjectOdd css_authno_obj" style="" id="id_sc_field_authno" type="text" name="authno" value="" size="10" maxlength="20"
                                          alt="{datatype: 'text', maxLength: 20, allowedChars: '', lettersCase: '', enterTab: false, enterSubmit: false, autoTab: false, selectOnFocus: true, watermark: '', watermarkClass: 'scFormObjectOddWm', maskChars: '(){}[].,;:-+/ '}"></span>
                                    </td>
                                  </tr>
                                  <tr>
                                    <td class="scFormDataOdd css_msg_line" id="hidden_field_data_msg" style=""> <span id="id_ajax_label_msg"></span>
                                      <input type="hidden" name="msg" value="">
                                    </td>
                                  </tr>
                                </tbody>
                              </table>
                            </div><!-- bloco_f -->
                          </td>
                        </tr>
                      </tbody>
                    </table>
                    <a name="bloco_3"></a>
                    <table width="100%" height="100%" cellpadding="0" cellspacing="0">
                      <tbody>
                        <tr valign="top">
                          <td width="100%" height="">
                            <div id="div_hidden_bloco_3"><!-- bloco_c -->
                              <table align="center" id="hidden_bloco_3" class="scFormTable" width="100%" style="height: 100%; border-style: none;">
                                <tbody>
                                  <tr>
                                    <td class="scFormDataOdd css_msg2_line" id="hidden_field_data_msg2" style=""> <span id="id_ajax_label_msg2"></span>
                                      <input type="hidden" name="msg2" value="">
                                    </td>
                                  </tr>
                                </tbody>
                              </table>
                            </div><!-- bloco_f -->
                          </td>
                        </tr>
                      </tbody>
                    </table>
                    <a name="bloco_4"></a>
                    <table width="100%" height="100%" cellpadding="0" cellspacing="0">
                      <tbody>
                        <tr valign="top">
                          <td width="100%" height="">
                            <div id="div_hidden_bloco_4"><!-- bloco_c -->
                              <table align="center" id="hidden_bloco_4" class="scFormTable" width="100%" style="height: 100%; border-style: none;">
                                <tbody>
                                  <tr>
                                    <td class="scFormDataOdd css_terms_line" id="hidden_field_data_terms" style=""> <span id="id_ajax_label_terms">
                                        <h3>By entering your payment information you authorize us<br>to process a payment for the amount displayed.</h3>
                                      </span>
                                      <input type="hidden" name="terms" value="<h3>By entering your payment information you authorize us<br />to process a payment for the amount displayed.</h3>">
                                    </td>
                                  </tr>
                                </tbody>
                              </table>
                            </div>
                          </td>
                        </tr>
                      </tbody>
                    </table><!-- bloco_f -->
                  </td>
                </tr>
              </tbody>
            </table>
          </div>
        </td>
      </tr>
    </tbody>
  </table>
  <div id="id_debug_window" style="display: none;" class="scDebugWindow">
    <table class="scFormMessageTable">
      <tbody>
        <tr>
          <td class="scFormMessageTitle"><a onclick="scAjaxHideDebug(); return false;" class="scButton_default " title="Close" style="vertical-align: middle; display:inline-block;"><span class="btn-label">Close</span></a> &nbsp;&nbsp;Output</td>
        </tr>
        <tr>
          <td class="scFormMessageMessage" style="padding: 0px; vertical-align: top">
            <div style="padding: 2px; height: 200px; width: 350px; overflow: auto" id="id_debug_text"></div>
          </td>
        </tr>
      </tbody>
    </table>
  </div>
</form>

Text Content

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Billing Information

Account # Name * Address 1 * Address 2 City * State * Zip * Phone Email *  

Payment Information

I Am Paying For Amount * Auto Pay Do not automatically pay future account
balances Automatically pay account balances in the future Credit Card Data Enter
Your Credit Card Information and Pay






BY ENTERING YOUR PAYMENT INFORMATION YOU AUTHORIZE US
TO PROCESS A PAYMENT FOR THE AMOUNT DISPLAYED.

Close   Output


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456-UseEnt
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