www.budget.com Open in urlscan Pro
2a02:26f0:dc:187::1b66  Public Scan

Submitted URL: https://www.budget.com/budgetWeb/profile/retrieveEreceipt.ex?KEY=95877710cad42aa26b9a15c4da2ed185bce5bfef8a35bcea5ef47b...
Effective URL: https://www.budget.com/en/reservation/get-e-receipt?COUNTRY=US&LANGUAGE=EN&&KEY=95877710cad42aa26b9a15c4da2ed185bce5bfe...
Submission: On December 22 via manual from IN — Scanned from DE

Form analysis 3 forms found in the DOM

Name: loginFormPOST

<form name="loginForm" novalidate="" class="ng-pristine ng-pending" method="post">
  <!---->
  <!---->
  <!---->
  <!---->
  <!-- ABGPR-580 Timeout message changes -->
  <!---->
  <div class="">
    <!---->
  </div>
  <!---->
  <div class="form-group form-bg-color" ng-if="!isRecognized">
    <input type="text" class="form-control radius-non ng-pristine ng-untouched ng-pending ng-empty" id="username" name="username" placeholder="Username or Customer ID " ng-model="vm.loginModel.uName" validator="required" valid-method="blur"
      required-error-message="Username or Customer ID is a required field."><span class="platform-error-message error"></span>
  </div><!---->
  <!---->
  <div class="form-group ng-hide" ng-show="vm.loginWarningMsg">
    <span class="error">For full Budget and Amazon benefits, after logging in with Amazon you'll need to log in to Budget and link your accounts.</span>
  </div>
  <div class="form-group form-bg-color">
    <input type="password" autocomplete="new-password" class="form-control radius-non ng-pristine ng-untouched ng-pending ng-empty" id="password" name="password" ng-model="vm.loginModel.password" placeholder="Password (Case Sensitive)"
      validator="required" ng-blur="vm.checkEmpty();" valid-method="blur" required-error-message="Password is a required field."><span class="platform-error-message error"></span>
  </div>
  <!---->
  <div class="rememberMe-btn">
    <!----><label class="checkbox rem pull-left" aria-label="Remember Me" for="rememberme" ng-if="vm.loginModel.displayControl.variation == carRentalConstant.displayControlBig"> Remember Me </label><!---->
    <div class="toggle-check pull-right" ng-show="vm.loginModel.displayControl.variation == carRentalConstant.displayControlBig">
      <input type="checkbox" class="checkbox ng-pristine ng-untouched ng-valid ng-empty" name="rememberme" id="rememberme" ng-model="vm.loginModel.rememberMe">
      <div class="toggle-slide">
        <div class="indicator"></div>
        <div class="toggle-on">YES</div>
        <div class="toggle-off">NO</div>
      </div>
    </div>
  </div>
  <!--<div class="clearfix top30 mar-bottom-20 pull-right w-100 cus-d-flex cus-justify-content-center" ng-if="vm.enableCaptcha == 'true' && vm.isLoginModelOpen">
							<re-captcha></re-captcha>
					</div>  --><br><br><br>
  <!-- Enterprise captcha changes for Avis and Budget starts -->
  <!---->
  <div ng-if="vm.enableEnterpriseCaptcha == 'true' " class="form-group form-bg-color"> This site is protected by reCAPTCHA Enterprise and the Google <a href="https://policies.google.com/privacy">Privacy Policy</a> and
    <a href="https://policies.google.com/terms">Terms of Service</a> apply. </div><!---->
  <!---->
  <!-- Enterprise captcha changes for Avis and Budget ends -->
  <!----><button class="btn btn-lg btn-primary btn-block radius-non btn-submit btn-continue" id="res-login-profile" aria-label="Continue" ng-click="vm.getLogin.submit(loginForm, vm)" name="button"
    ng-if="vm.loginModel.displayControl.variation == carRentalConstant.displayControlBig">Sign In</button><!---->
  <!---->
</form>

Name: receipt_form_hiddenPOST /bin/pdf

<form name="receipt_form_hidden" action="/bin/pdf" method="post" novalidate="" class="ng-pristine ng-pending ng-valid-maxlength ng-invalid-required ng-valid-pattern">
  <!-- <div ng-if="vm.errorDisplayList" class="col-xs-12">
						<div ng-repeat="error in vm.errorDisplayList" >
							<div  class="col-lg-12 mainErrorMsg login error res-PageError">
						        <span class="mainErrorImage info-error-war-msg-image"><span></span></span>
								<span class="mainErrorText ng-binding" ng-bind-html="error.message | htmlFilter"></span>
							</div>
						</div>
					</div> -->
  <abg-error-message-list hide-then="vm.errorDisplayList.length>0" message-list="vm.errorDisplayList"><!----></abg-error-message-list>
  <!-- <div ng-if="vm.prod.errorList">
						<div ng-repeat="error in vm.prod.errorList">
							<div  class="col-lg-12 mainErrorMsg login error res-PageError">
						        <span class="mainErrorImage info-error-war-msg-image"><span></span> </span>
								<span class="mainErrorText ng-binding" ng-bind-html="error.message| htmlFilter"></span>
							</div>
						</div>
					</div> -->
  <abg-error-message-list hide-then="vm.prod.errorList.length>0" message-list="vm.prod.errorList"><!---->
    <div ng-repeat="error in messageList" ng-show="hideThen" class="col-lg-12 res-PageError"><span class="mainErrorImage info-error-war-msg-image"><span></span></span><span class="mainErrorText info-error-msg-text"
        ng-bind-html="error.message | htmlFilter">We are unable to process your request at this time. Please return to the Homepage and start your process again or use the
        <a href="https://www.avis.com/en/customer-service/worldwide-telephone-numbers">Worldwide Phone Number</a><a> List to find your Budget Customer Service telephone number.</a></span></div><!---->
  </abg-error-message-list>
  <div class="">
    <!---->
  </div>
  <div class="col-xs-12 vmc-margtoppad">
    <!---->
    <p class="clInfo" ng-if="isAnonymous"> To request a receipt, please complete the fields below, or <a href="javascript:void(0)" ng-click="vm.getLoginModalWindow();">log in</a> to your Budget profile and access your Past Rentals page. </p><!---->
    <!---->
    <!---->
    <p>
      <strong>Note:</strong> Miles/Points can be added when viewing receipt.
    </p>
  </div>
  <div class="row">
    <div class="col-xs-12 vmctxtfld">
      <div class="col-xs-12 col-sm-4 col-md-3 col-lg-3 form-bg-color">
        <label aria-label="Last Name">Country</label>
        <div class="customDD resident">
          <select id="countrylookup" class="form-control form-bg-color ng-pristine ng-untouched ng-pending ng-not-empty" name="vm.receiptRequest.countryCode" required-error-message="country is required" ng-model="vm.country"
            ng-options=" residence.code as residence.name for residence in vm.pageContent.countryList " aria-label="Select Residency" validator="required" valid-method="blur">
            <option label="ALBANIA" value="string:E-ALBANIA">ALBANIA</option>
            <option label="ANDORRA" value="string:E-ANDORRA">ANDORRA</option>
            <option label="ANGOLA" value="string:E-ANGOLA">ANGOLA</option>
            <option label="ANTIGUA" value="string:B-ANTIGUA">ANTIGUA</option>
            <option label="ARGENTINA" value="string:L-ARGENTINA">ARGENTINA</option>
            <option label="ARMENIA" value="string:E-ARMENIA">ARMENIA</option>
            <option label="ARUBA" value="string:B-ARUBA">ARUBA</option>
            <option label="ARUBA" value="string:L-ARUBA">ARUBA</option>
            <option label="AUSTRALIA" value="string:P-AUSTRALIA">AUSTRALIA</option>
            <option label="AUSTRALIA" value="string:U-AUSTRALIA">AUSTRALIA</option>
            <option label="AUSTRIA" value="string:E-AUSTRIA">AUSTRIA</option>
            <option label="BAHAMAS" value="string:L-BAHAMAS">BAHAMAS</option>
            <option label="BAHAMAS" value="string:B-BAHAMAS">BAHAMAS</option>
            <option label="BAHRAIN" value="string:E-BAHRAIN">BAHRAIN</option>
            <option label="BELARUS" value="string:E-BELARUS">BELARUS</option>
            <option label="BELGIUM" value="string:E-BELGIUM">BELGIUM</option>
            <option label="BELIZE" value="string:L-BELIZE">BELIZE</option>
            <option label="BOLIVIA" value="string:L-BOLIVIA">BOLIVIA</option>
            <option label="BONAIRE" value="string:L-BONAIRE">BONAIRE</option>
            <option label="BONAIRE" value="string:B-BONAIRE">BONAIRE</option>
            <option label="BOSNIA" value="string:E-BOSNIA">BOSNIA</option>
            <option label="BOSNIA &amp; HERZEGOVINA" value="string:E-BOSNIA &amp; HERZEGOVINA">BOSNIA &amp; HERZEGOVINA</option>
            <option label="BOTSWANA" value="string:E-BOTSWANA">BOTSWANA</option>
            <option label="BRAZIL" value="string:L-BRAZIL">BRAZIL</option>
            <option label="BRUNEI" value="string:P-BRUNEI">BRUNEI</option>
            <option label="BULGARIA" value="string:E-BULGARIA">BULGARIA</option>
            <option label="CAMBODIA" value="string:P-CAMBODIA">CAMBODIA</option>
            <option label="CAMBODIA" value="string:A-CAMBODIA">CAMBODIA</option>
            <option label="CANADA" value="string:C-CANADA">CANADA</option>
            <option label="CANADA" value="string:U-CANADA">CANADA</option>
            <option label="CAYMAN ISLANDS (GRAND CAYMAN)" value="string:B-CAYMAN ISLANDS (GRAND CAYMAN)">CAYMAN ISLANDS (GRAND CAYMAN)</option>
            <option label="CHILE" value="string:L-CHILE">CHILE</option>
            <option label="COLOMBIA" value="string:L-COLOMBIA">COLOMBIA</option>
            <option label="CONGO" value="string:E-CONGO">CONGO</option>
            <option label="COOK ISLANDS" value="string:P-COOK ISLANDS">COOK ISLANDS</option>
            <option label="COSTA RICA" value="string:L-COSTA RICA">COSTA RICA</option>
            <option label="COSTA RICA" value="string:B-COSTA RICA">COSTA RICA</option>
            <option label="CROATIA" value="string:E-CROATIA">CROATIA</option>
            <option label="CURACAO (NETHERLAND ANTILLES)" value="string:B-CURACAO (NETHERLAND ANTILLES)">CURACAO (NETHERLAND ANTILLES)</option>
            <option label="CURACAO (NETHERLAND ANTILLES)" value="string:L-CURACAO (NETHERLAND ANTILLES)">CURACAO (NETHERLAND ANTILLES)</option>
            <option label="CYPRUS" value="string:E-CYPRUS">CYPRUS</option>
            <option label="CZECH REPUBLIC" value="string:E-CZECH REPUBLIC">CZECH REPUBLIC</option>
            <option label="DENMARK" value="string:E-DENMARK">DENMARK</option>
            <option label="DOMINICAN REPUBLIC" value="string:B-DOMINICAN REPUBLIC">DOMINICAN REPUBLIC</option>
            <option label="ECUADOR" value="string:L-ECUADOR">ECUADOR</option>
            <option label="EGYPT" value="string:E-EGYPT">EGYPT</option>
            <option label="EL SALVADOR" value="string:L-EL SALVADOR">EL SALVADOR</option>
            <option label="ESTONIA" value="string:E-ESTONIA">ESTONIA</option>
            <option label="FAROE ISLANDS" value="string:E-FAROE ISLANDS">FAROE ISLANDS</option>
            <option label="FEDERATED STATES OF MICRONESIA" value="string:P-FEDERATED STATES OF MICRONESIA">FEDERATED STATES OF MICRONESIA</option>
            <option label="FIJI" value="string:P-FIJI">FIJI</option>
            <option label="FINLAND" value="string:E-FINLAND">FINLAND</option>
            <option label="FRANCE" value="string:E-FRANCE">FRANCE</option>
            <option label="FRENCH GUIANA" value="string:L-FRENCH GUIANA">FRENCH GUIANA</option>
            <option label="GEORGIA" value="string:E-GEORGIA">GEORGIA</option>
            <option label="GERMANY" value="string:E-GERMANY">GERMANY</option>
            <option label="GERMANY" value="string:U-GERMANY">GERMANY</option>
            <option label="GHANA" value="string:E-GHANA">GHANA</option>
            <option label="GRAND CAYMAN (CAYMAN ISLANDS)" value="string:B-GRAND CAYMAN (CAYMAN ISLANDS)">GRAND CAYMAN (CAYMAN ISLANDS)</option>
            <option label="GREAT BRITAIN" value="string:E-GREAT BRITAIN">GREAT BRITAIN</option>
            <option label="GREECE" value="string:E-GREECE">GREECE</option>
            <option label="GUADELOUPE" value="string:B-GUADELOUPE">GUADELOUPE</option>
            <option label="GUADELOUPE" value="string:L-GUADELOUPE">GUADELOUPE</option>
            <option label="GUAM" value="string:P-GUAM">GUAM</option>
            <option label="GUATEMALA" value="string:L-GUATEMALA">GUATEMALA</option>
            <option label="HAITI" value="string:B-HAITI">HAITI</option>
            <option label="HERZEGOVINA" value="string:E-HERZEGOVINA">HERZEGOVINA</option>
            <option label="HOLLAND" value="string:E-HOLLAND">HOLLAND</option>
            <option label="HONDURAS" value="string:L-HONDURAS">HONDURAS</option>
            <option label="HUNGARY" value="string:E-HUNGARY">HUNGARY</option>
            <option label="ICELAND" value="string:E-ICELAND">ICELAND</option>
            <option label="IRELAND" value="string:E-IRELAND">IRELAND</option>
            <option label="ISRAEL" value="string:E-ISRAEL">ISRAEL</option>
            <option label="ITALY" value="string:E-ITALY">ITALY</option>
            <option label="IVORY COAST" value="string:E-IVORY COAST">IVORY COAST</option>
            <option label="JAMAICA" value="string:P-JAMAICA">JAMAICA</option>
            <option label="JAMAICA" value="string:B-JAMAICA">JAMAICA</option>
            <option label="JAPAN" value="string:A-JAPAN">JAPAN</option>
            <option label="JAPAN" value="string:P-JAPAN">JAPAN</option>
            <option label="JORDAN" value="string:E-JORDAN">JORDAN</option>
            <option label="KENYA" value="string:E-KENYA">KENYA</option>
            <option label="KOSOVO" value="string:E-KOSOVO">KOSOVO</option>
            <option label="KUWAIT" value="string:E-KUWAIT">KUWAIT</option>
            <option label="LAOS" value="string:P-LAOS">LAOS</option>
            <option label="LA REUNION" value="string:E-LA REUNION">LA REUNION</option>
            <option label="LATVIA" value="string:E-LATVIA">LATVIA</option>
            <option label="LEBANON" value="string:E-LEBANON">LEBANON</option>
            <option label="LESOTHO" value="string:E-LESOTHO">LESOTHO</option>
            <option label="LIBYA" value="string:E-LIBYA">LIBYA</option>
            <option label="LITHUANIA" value="string:E-LITHUANIA">LITHUANIA</option>
            <option label="LUXEMBOURG" value="string:E-LUXEMBOURG">LUXEMBOURG</option>
            <option label="MACEDONIA" value="string:E-MACEDONIA">MACEDONIA</option>
            <option label="MADAGASCAR" value="string:E-MADAGASCAR">MADAGASCAR</option>
            <option label="MALTA" value="string:E-MALTA">MALTA</option>
            <option label="MARIANA ISLANDS" value="string:P-MARIANA ISLANDS">MARIANA ISLANDS</option>
            <option label="MARTINIQUE" value="string:B-MARTINIQUE">MARTINIQUE</option>
            <option label="MAURITIUS" value="string:E-MAURITIUS">MAURITIUS</option>
            <option label="MAYOTTE" value="string:E-MAYOTTE">MAYOTTE</option>
            <option label="MEXICO" value="string:L-MEXICO">MEXICO</option>
            <option label="MICRONESIA" value="string:P-MICRONESIA">MICRONESIA</option>
            <option label="MONTENEGRO" value="string:E-MONTENEGRO">MONTENEGRO</option>
            <option label="MOROCCO" value="string:E-MOROCCO">MOROCCO</option>
            <option label="MOZAMBIQUE" value="string:E-MOZAMBIQUE">MOZAMBIQUE</option>
            <option label="NAMIBIA" value="string:E-NAMIBIA">NAMIBIA</option>
            <option label="NETHERLAND ANTILLES (CURACAO)" value="string:B-NETHERLAND ANTILLES (CURACAO)">NETHERLAND ANTILLES (CURACAO)</option>
            <option label="NETHERLAND ANTILLES (CURACAO)" value="string:L-NETHERLAND ANTILLES (CURACAO)">NETHERLAND ANTILLES (CURACAO)</option>
            <option label="NETHERLANDS" value="string:E-NETHERLANDS">NETHERLANDS</option>
            <option label="NEW CALEDONIA" value="string:P-NEW CALEDONIA">NEW CALEDONIA</option>
            <option label="NEW GUINEA (PAPAU)" value="string:P-NEW GUINEA (PAPAU)">NEW GUINEA (PAPAU)</option>
            <option label="NEW ZEALAND" value="string:P-NEW ZEALAND">NEW ZEALAND</option>
            <option label="NICARAGUA" value="string:L-NICARAGUA">NICARAGUA</option>
            <option label="NORTHERN MARIANA ISLANDS" value="string:P-NORTHERN MARIANA ISLANDS">NORTHERN MARIANA ISLANDS</option>
            <option label="NORWAY" value="string:E-NORWAY">NORWAY</option>
            <option label="OMAN (SULTANATE OF)" value="string:E-OMAN (SULTANATE OF)">OMAN (SULTANATE OF)</option>
            <option label="PALAU" value="string:P-PALAU">PALAU</option>
            <option label="PANAMA" value="string:L-PANAMA">PANAMA</option>
            <option label="PAPUA  (NEW GUINEA)" value="string:P-PAPUA  (NEW GUINEA)">PAPUA (NEW GUINEA)</option>
            <option label="PARAGUAY" value="string:L-PARAGUAY">PARAGUAY</option>
            <option label="PERU" value="string:L-PERU">PERU</option>
            <option label="PHILIPPINES" value="string:P-PHILIPPINES">PHILIPPINES</option>
            <option label="POHNPEI" value="string:P-POHNPEI">POHNPEI</option>
            <option label="POLAND" value="string:E-POLAND">POLAND</option>
            <option label="PORTUGAL" value="string:E-PORTUGAL">PORTUGAL</option>
            <option label="PUERTO RICO" value="string:U-PUERTO RICO">PUERTO RICO</option>
            <option label="QATAR" value="string:E-QATAR">QATAR</option>
            <option label="REPUBLIC OF IRELAND" value="string:E-REPUBLIC OF IRELAND">REPUBLIC OF IRELAND</option>
            <option label="REUNION ISLANDS" value="string:E-REUNION ISLANDS">REUNION ISLANDS</option>
            <option label="ROMANIA" value="string:E-ROMANIA">ROMANIA</option>
            <option label="ROTA, MARIANA ISLAND" value="string:P-ROTA, MARIANA ISLAND">ROTA, MARIANA ISLAND</option>
            <option label="RUSSIA" value="string:E-RUSSIA">RUSSIA</option>
            <option label="SAIPAIN, MARIANA ISLAND" value="string:P-SAIPAIN, MARIANA ISLAND">SAIPAIN, MARIANA ISLAND</option>
            <option label="SAMOA (WESTERN)" value="string:P-SAMOA (WESTERN)">SAMOA (WESTERN)</option>
            <option label="SAUDI ARABIA" value="string:E-SAUDI ARABIA">SAUDI ARABIA</option>
            <option label="SENEGAL" value="string:P-SENEGAL">SENEGAL</option>
            <option label="SENEGAL" value="string:E-SENEGAL">SENEGAL</option>
            <option label="SERBIA" value="string:E-SERBIA">SERBIA</option>
            <option label="SINGAPORE" value="string:P-SINGAPORE">SINGAPORE</option>
            <option label="SLOVAKIA" value="string:E-SLOVAKIA">SLOVAKIA</option>
            <option label="SLOVENIA" value="string:E-SLOVENIA">SLOVENIA</option>
            <option label="SOUTH AFRICA" value="string:E-SOUTH AFRICA">SOUTH AFRICA</option>
            <option label="SOUTH KOREA" value="string:P-SOUTH KOREA">SOUTH KOREA</option>
            <option label="SPAIN" value="string:E-SPAIN">SPAIN</option>
            <option label="SRI LANKA" value="string:A-SRI LANKA">SRI LANKA</option>
            <option label="SRI LANKA" value="string:P-SRI LANKA">SRI LANKA</option>
            <option label="ST BARTHELEMY" value="string:B-ST BARTHELEMY">ST BARTHELEMY</option>
            <option label="ST BARTHELEMY" value="string:L-ST BARTHELEMY">ST BARTHELEMY</option>
            <option label="ST CROIX (US VIRGIN ISLANDS)" value="string:P-ST CROIX (US VIRGIN ISLANDS)">ST CROIX (US VIRGIN ISLANDS)</option>
            <option label="ST CROIX (US VIRGIN ISLANDS)" value="string:B-ST CROIX (US VIRGIN ISLANDS)">ST CROIX (US VIRGIN ISLANDS)</option>
            <option label="ST LUCIA" value="string:B-ST LUCIA">ST LUCIA</option>
            <option label="ST MAARTEN (DUTCH)" value="string:B-ST MAARTEN (DUTCH)">ST MAARTEN (DUTCH)</option>
            <option label="ST MARTIN (FRENCH)" value="string:L-ST MARTIN (FRENCH)">ST MARTIN (FRENCH)</option>
            <option label="ST MARTIN (FRENCH)" value="string:B-ST MARTIN (FRENCH)">ST MARTIN (FRENCH)</option>
            <option label="ST THOMAS (US VIRGIN ISLANDS)" value="string:B-ST THOMAS (US VIRGIN ISLANDS)">ST THOMAS (US VIRGIN ISLANDS)</option>
            <option label="SURINAME" value="string:L-SURINAME">SURINAME</option>
            <option label="SWAZILAND" value="string:E-SWAZILAND">SWAZILAND</option>
            <option label="SWEDEN" value="string:E-SWEDEN">SWEDEN</option>
            <option label="SWITZERLAND" value="string:E-SWITZERLAND">SWITZERLAND</option>
            <option label="TAIWAN" value="string:A-TAIWAN">TAIWAN</option>
            <option label="THAILAND" value="string:P-THAILAND">THAILAND</option>
            <option label="TOBAGO" value="string:B-TOBAGO">TOBAGO</option>
            <option label="TOGO" value="string:E-TOGO">TOGO</option>
            <option label="TRINIDAD" value="string:B-TRINIDAD">TRINIDAD</option>
            <option label="TUNISIA" value="string:E-TUNISIA">TUNISIA</option>
            <option label="TURKEY" value="string:E-TURKEY">TURKEY</option>
            <option label="TURKS &amp; CAICOS" value="string:B-TURKS &amp; CAICOS">TURKS &amp; CAICOS</option>
            <option label="UKRAINE" value="string:E-UKRAINE">UKRAINE</option>
            <option label="UNITED ARAB EMIRATES" value="string:E-UNITED ARAB EMIRATES">UNITED ARAB EMIRATES</option>
            <option label="UNITED KINGDOM" value="string:E-UNITED KINGDOM">UNITED KINGDOM</option>
            <option label="UNITED STATES" value="string:U-UNITED STATES" selected="selected">UNITED STATES</option>
            <option label="URUGUAY" value="string:L-URUGUAY">URUGUAY</option>
            <option label="US VIRGIN ISLANDS (ST CROIX)" value="string:P-US VIRGIN ISLANDS (ST CROIX)">US VIRGIN ISLANDS (ST CROIX)</option>
            <option label="US VIRGIN ISLANDS (ST CROIX)" value="string:B-US VIRGIN ISLANDS (ST CROIX)">US VIRGIN ISLANDS (ST CROIX)</option>
            <option label="US VIRGIN ISLANDS (ST THOMAS)" value="string:B-US VIRGIN ISLANDS (ST THOMAS)">US VIRGIN ISLANDS (ST THOMAS)</option>
            <option label="VANUATU" value="string:P-VANUATU">VANUATU</option>
            <option label="VENEZUELA" value="string:L-VENEZUELA">VENEZUELA</option>
            <option label="WESTERN SAMOA" value="string:P-WESTERN SAMOA">WESTERN SAMOA</option>
            <option label="YAP" value="string:P-YAP">YAP</option>
            <option label="YEMEN" value="string:E-YEMEN">YEMEN</option>
            <option label="ZIMBABWE" value="string:E-ZIMBABWE">ZIMBABWE</option>
          </select><span class="platform-error-message error"></span>
        </div>
      </div>
      <div class="col-xs-12 col-sm-3 col-md-4 col-lg-5 form-bg-color" ng-show="isAnonymous">
        <label aria-label="Last Name" for="lastName">Last Name</label> <input type="text" class="form-control ng-pristine ng-untouched ng-pending ng-empty ng-valid-maxlength" id="lastName" name="vm.receiptRequest.lastName"
          ng-model="vm.receiptRequest.lastName" validator="required,minlength=1" maxlength="20" valid-method="blur" required-error-message="<strong>Last Name</strong> is a required field."
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ALBANIAANDORRAANGOLAANTIGUAARGENTINAARMENIAARUBAARUBAAUSTRALIAAUSTRALIAAUSTRIABAHAMASBAHAMASBAHRAINBELARUSBELGIUMBELIZEBOLIVIABONAIREBONAIREBOSNIABOSNIA
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REPUBLICDENMARKDOMINICAN REPUBLICECUADOREGYPTEL SALVADORESTONIAFAROE
ISLANDSFEDERATED STATES OF MICRONESIAFIJIFINLANDFRANCEFRENCH
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& CAICOSUKRAINEUNITED ARAB EMIRATESUNITED KINGDOMUNITED STATESURUGUAYUS VIRGIN
ISLANDS (ST CROIX)US VIRGIN ISLANDS (ST CROIX)US VIRGIN ISLANDS (ST
THOMAS)VANUATUVENEZUELAWESTERN SAMOAYAPYEMENZIMBABWE
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