payment.assemblybuildings.com Open in urlscan Pro
2606:4700:3036::ac43:90f3  Public Scan

Form analysis
1 forms found in the DOM

POST checkout.php

<form id="paymentForm" action="checkout.php" method="post">
  <div class="mb-3">
    <label for="amount" class="form-label">Ödeme Miktarı:</label>
    <div class="input-group">
      <span class="input-group-text">₺</span>
      <input type="number" id="amount" name="amount" min="0" step="0.01" class="form-control" placeholder="Ödeme miktarını girin" required="">
    </div>
  </div>
  <div class="mb-3">
    <label for="name" class="form-label">İsim:</label>
    <input type="text" id="name" name="name" class="form-control" placeholder="İsim" required="">
  </div>
  <div class="mb-3">
    <label for="surname" class="form-label">Soyisim:</label>
    <input type="text" id="surname" name="surname" class="form-control" placeholder="Soyisim" required="">
  </div>
  <div class="mb-3">
    <label for="phone" class="form-label">Telefon Numarası:</label>
    <input type="tel" id="phone" name="phone" class="form-control" placeholder="05XXXXXXXXX" required="">
  </div>
  <div class="mb-3">
    <label for="email" class="form-label">E-posta Adresi:</label>
    <input type="email" id="email" name="email" class="form-control" placeholder="Email adresinizi girin" required="">
  </div>
  <button type="submit" class="btn btn-primary w-100">Ödemeyi Yap</button>
</form>

Text Content

ÖDEME FORMU

Ödeme Miktarı:
₺
İsim:
Soyisim:
Telefon Numarası:
E-posta Adresi:
Ödemeyi Yap



CARI BILGILERI

Ünvan:

Müşteri Ünvanı A.Ş.

İletişim Bilgileri:

0-544-695-XXXX

Borç Bakiyesi:

-₺12,345.67

E-posta Adresi:

ornek@domain.com

Kiralanan Yer Tipi:

Ofis