morstangeneralagency.epaypolicy.com
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urlscan Pro
2606:4700::6812:a20
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URL:
https://morstangeneralagency.epaypolicy.com/
Submission: On June 07 via api from US — Scanned from DE
Submission: On June 07 via api from US — Scanned from DE
Form analysis 1 forms found in the DOM
POST /
<form action="/" enctype="multipart/form-data" id="payment-form" method="post" sessionid="" novalidate="novalidate"><input data-val="true" data-val-required="The MakeFieldsReadonly field is required." id="MakeFieldsReadonly" name="MakeFieldsReadonly"
type="hidden" value="False">
<div class="row">
<div class="col-sm-12">
<div class="form-group">
<div class="col-lg-offset-1 col-md-offset-1 col-sm-offset-1 col-lg-2 col-md-2 col-sm-2 col-xs-12 left">
<label for="payer">Payer</label>
</div>
<div class="col-lg-9 col-md-9 col-sm-9 right">
<span class="field-validation-valid" data-valmsg-for="Payer" data-valmsg-replace="true"></span>
<input class="form-control" data-bind="value: payer" data-val="true" data-val-maxlength="The Payer has a maximum length of 150 characters." data-val-maxlength-max="150" data-val-required="The Payer field is required." id="Payer"
name="Payer" placeholder="Payer" required="" type="text" value="">
</div>
</div>
</div>
<div class="col-sm-12">
<div class="form-group email">
<div class="col-lg-offset-1 col-md-offset-1 col-sm-offset-1 col-lg-2 col-md-2 col-sm-2 col-xs-12 left">
<label for="email">Email Address</label>
</div>
<div class="col-lg-9 col-md-9 col-sm-9 right">
<span class="field-validation-valid" data-valmsg-for="EmailAddress" data-valmsg-replace="true"></span>
<input class="form-control" data-bind="value: emailAddress" data-val="true" data-val-email="The Email Address is not properly formatted"
data-val-maxlength="The field Email Address must be a string or array type with a maximum length of '150'." data-val-maxlength-max="150" data-val-required="The Email Address field is required." id="EmailAddress" name="EmailAddress"
placeholder="Email Address" required="" type="text" value="">
</div>
</div>
</div>
<div class="col-sm-12">
<div class="form-group">
<div class="col-lg-offset-1 col-md-offset-1 col-sm-offset-1 col-lg-2 col-md-2 col-sm-2 col-xs-12 left">
<label>Invoice / Policy #</label>
</div>
<div class="col-lg-9 col-md-9 col-sm-9 right">
<span class="field-validation-error transaction-attribute-regex-error-msg" style="display:none" data-valmsg-for="TransactionAttribute2636" data-valmsg-replace="true"></span>
<span class="field-validation-error" style="display:none" data-valmsg-for="TransactionAttribute2636" data-valmsg-replace="true">The Invoice / Policy # field is required.</span>
<input name="TransactionAttribute2636" class="form-control full " data-bind="textInput: TransactionAttribute2636" data-toggle="popover" data-trigger="manual focus" id="TransactionAttribute2636" onblur="validateCustomAttribute(event)"
pattern="(.*?)" placeholder="Invoice/Policy # (Required) If paying multiple, see Notes section below" required="" type="text" value="">
</div>
</div>
</div>
</div>
<div class="payment-amount row">
<div class="col-sm-12">
<div class="form-group">
<div class="col-lg-offset-1 col-md-offset-1 col-sm-offset-1 col-lg-2 col-md-2 col-sm-2 col-xs-12 left">
<label for="amount">Amount</label>
</div>
<div class="col-lg-9 col-md-9 col-sm-9 right">
<span class="field-validation-valid" data-valmsg-for="Amount" data-valmsg-replace="true"></span>
<input class="form-control" data-bind="numeric, value: amount" data-val="true" data-val-number="The field Amount must be a number." data-val-range="The Amount must be greater than 0." data-val-range-max="10000000" data-val-range-min="0.01"
data-val-required="The Amount field is required." id="Amount" name="Amount" placeholder="Amount (e.g. 123.45)" required="" type="text" value="">
</div>
</div>
</div>
</div>
<div class="row payment-type">
<div class="col-sm-12">
<div class="form-group clearfix">
<div class="col-lg-offset-1 col-md-offset-1 col-sm-offset-1 col-lg-2 col-md-2 col-sm-2 col-xs-12 left">
<label for="payment-type">Payment Type</label>
</div>
<div class="col-lg-9 col-md-9 col-sm-9 right clearfix">
<div class="large-device">
<label for="paymentType" class="payment-ui-card clearfix">
<input type="radio" class="form-control payment-radio" name="paymentType" data-bind="click: function() {setPaymentType('CreditCard'); return true;}, value: 'CreditCard', checked: paymentMethod" value="CreditCard">
<div class="payment-ui-card-wrapper">
<div class="ui-card-header ">
<img src="/images/credit-card-icon.png" class="img-responsive" alt="credit-card-icon">
<h3 class="text-center">Credit Card</h3>
</div>
<div class="ui-card-details">
<div class="ui-card-row">
<span class="row-label">Amount</span>
<span class="info" data-bind="text: formatAmount(amount(), 'USD')">$0.00</span>
</div>
<div class="ui-card-row fees">
<span class="row-label"> Fee </span>
<span class="info" data-bind="text: amount() > 0 ? formatAmount(payerCreditCardFee(), 'USD') : 'Enter Amount'">Enter Amount</span>
</div>
<div class="ui-card-row totals">
<span class="row-label" data-bind="text: enableScheduledPayments() ? 'Each Payment' : 'Total'">Total</span>
<span class="info" data-bind="text: formatAmount(creditCardTotal(), 'USD')">$0.00</span>
</div>
</div>
<div class="radio-button">
<span></span>
</div>
</div>
</label>
<label for="paymentType" class="payment-ui-card clearfix">
<input type="radio" class="form-control payment-radio" name="paymentType" data-bind="click: function() {setPaymentType('Ach'); return true;}, value: 'Ach', checked: paymentMethod" value="Ach">
<div class="payment-ui-card-wrapper">
<div class="ui-card-header ">
<img src="/images/echeck-icon.png" class="img-responsive" alt="credit-card-icon">
<h3 class="text-center">ACH</h3>
</div>
<div class="ui-card-details">
<div class="ui-card-row">
<span class="row-label">Amount</span>
<span class="info" data-bind="text: formatAmount(amount(), 'USD')">$0.00</span>
</div>
<div class="ui-card-row fees">
<span class="row-label">Fee</span>
<span class="info" data-bind="text: amount() > 0 ? formatAmount(payerAchFee(), 'USD') : 'Enter Amount'">Enter Amount</span>
</div>
<div class="ui-card-row totals">
<span class="row-label" data-bind="text: enableScheduledPayments() ? 'Each Payment' : 'Total'">Total</span>
<span class="info" data-bind="text: formatAmount(achTotal(), 'USD')">$0.00</span>
</div>
</div>
<div class="radio-button">
<span></span>
</div>
</div>
</label>
</div>
<div class="small-device">
<div class="options-row clearfix">
<label for="mobilePaymentType" class="payment-ui-card clearfix">
<input type="radio" class="form-control payment-radio" name="mobilePaymentType" data-bind="click: function() {setPaymentType('CreditCard'); return true;}, value: 'CreditCard', checked: paymentMethod" value="CreditCard">
<div class="radio-button">
<span></span>
</div>
<div class="ui-card-header">
<img src="/images/credit-card-icon.png" class="img-responsive" alt="credit-card-icon">
<h3 class="text-center">Credit Card</h3>
</div>
</label>
<label for="mobilePaymentType" class="payment-ui-card clearfix">
<input type="radio" class="form-control payment-radio" name="mobilePaymentType" data-bind="click: function() {setPaymentType('Ach'); return true;}, value: 'Ach', checked: paymentMethod" value="Ach">
<div class="radio-button">
<span></span>
</div>
<div class="ui-card-header">
<img src="/images/echeck-icon.png" class="img-responsive" alt="ach-icon">
<h3 class="text-center">ACH</h3>
</div>
</label>
</div>
<div class="payment-ui-card-wrapper left-tab" data-bind="visible: paymentMethod() == 'CreditCard'">
<div class="ui-card-details">
<div class="ui-card-row">
<span class="row-label">Amount</span>
<span class="info" data-bind="text: formatAmount(amount(), 'USD')">$0.00</span>
</div>
<div class="ui-card-row fees">
<span class="row-label">Fee</span>
<span class="info" data-bind="text: amount() > 0 ? formatAmount(payerCreditCardFee(), 'USD') : 'Enter Amount'">Enter Amount</span>
</div>
<div class="ui-card-row totals">
<span class="row-label" data-bind="text: enableScheduledPayments() ? 'Each Payment' : 'Total'">Total</span>
<span class="info" data-bind="text: formatAmount(creditCardTotal(), 'USD')">$0.00</span>
</div>
</div>
</div>
<div class="payment-ui-card-wrapper right-tab" data-bind="visible: paymentMethod() == 'Ach'" style="display: none;">
<div class="ui-card-details">
<div class="ui-card-row">
<span class="row-label">Amount</span>
<span class="info" data-bind="text: formatAmount(amount(), 'USD')">$0.00</span>
</div>
<div class="ui-card-row fees">
<span class="row-label"> Fee </span>
<span class="info" data-bind="text: amount() > 0 ? formatAmount(payerAchFee(), 'USD') : 'Enter Amount'">Enter Amount</span>
</div>
<div class="ui-card-row totals">
<span class="row-label" data-bind="text: enableScheduledPayments() ? 'Each Payment' : 'Total'">Total</span>
<span class="info" data-bind="text: formatAmount(achTotal(), 'USD')">$0.00</span>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="payment-info row">
<div class="col-sm-12">
<div class="form-group">
<div class="col-lg-offset-1 col-md-offset-1 col-sm-offset-1 col-lg-2 col-md-2 col-sm-2 col-xs-12 left">
<label for="payment-info">Payment Information</label>
</div>
<div class="col-lg-9 col-md-9 col-sm-9 right" data-bind="visible: paymentMethod() == 'CreditCard'">
<div class="form-group">
<div data-bind="visible: tokenPublicId() == 'newCreditCard' || creditCardTokenCount() == 0 || true" style="">
<div class="row">
<div class="col-lg-12">
<span class="field-validation-valid" data-valmsg-for="CardAccountHolder" data-valmsg-replace="true"></span>
<input autocomplete="off" class="form-control" data-val="true" data-val-maxlength="The Name on Card has a maximum length of 40 characters." data-val-maxlength-max="40" id="CardAccountHolder" name="CardAccountHolder"
placeholder="Name on Card" type="text" value="" required="required">
</div>
</div>
<div class="row">
<div class="col-lg-12">
<span class="field-validation-valid" data-valmsg-for="CardNumber" data-valmsg-replace="true"></span>
<span class="ccInput">
<input autocomplete="off" class="form-control" data-bind="textInput: cardNumber" data-val="true" data-val-maxlength="The Card Number has a maximum length of 16 characters." data-val-maxlength-max="16" id="CardNumber"
maxlength="16" name="CardNumber" placeholder="Credit Card Number" type="text" value="" required="required">
<!-- ko if: cardType() == 'DISCOVER' || cardType() == undefined --><i class="fab fa-2x fa-cc-discover"></i><!-- /ko -->
<!-- ko if: cardType() == 'AMEX' || cardType() == undefined --><i class="fab fa-2x fa-cc-amex"></i><!-- /ko -->
<!-- ko if: cardType() == 'MASTERCARD' || cardType() == undefined --><i class="fab fa-2x fa-cc-mastercard"></i><!-- /ko -->
<!-- ko if: cardType() == 'VISA' || cardType() == undefined --><i class="fab fa-2x fa-cc-visa"></i><!-- /ko -->
</span>
</div>
</div>
<div class="row">
<div class="col-lg-6 col-md-6 col-sm-6">
<input autocomplete="off" class="form-control" data-val="true" data-val-number="The field Month must be a number." id="Month" name="Month" placeholder="Month (MM)" type="text" value="" required="required">
</div>
<div class="col-lg-6 col-md-6 col-sm-6">
<input autocomplete="off" class="form-control" data-val="true" data-val-number="The field Year must be a number." id="Year" name="Year" placeholder="Year (YYYY)" type="text" value="" required="required">
</div>
</div>
<div class="row">
<div class="col-lg-6 col-md-6 col-sm-6">
<input autocomplete="off" class="form-control" data-val="true" data-val-maxlength="The CVC has a maximum length of 4 characters." data-val-maxlength-max="4" data-val-regex="The CVC can only contain numbers."
data-val-regex-pattern="^\d{3,4}$" id="CVC" name="CVC" placeholder="CVC" type="text" value="" required="required">
</div>
<div class="col-lg-6 col-md-6 col-sm-6">
<input autocomplete="off" class="form-control" id="PostalCode" maxlength="6" name="PostalCode" placeholder="Postal Code" type="text" value="" required="required">
</div>
</div>
<div class="row" data-bind="if: paymentMethod() != 'Ach'">
<div class="col-md-12">
<div class="checkbox" data-bind="click: ShowSignInPopup">
<input autocomplete="off" class="form-control" data-val="true" data-val-required="The SavePaymentOption field is required." id="SavePaymentOption" name="SavePaymentOption" type="checkbox" value="true"><input
name="SavePaymentOption" type="hidden" value="false">
<label for="SavePaymentOption">Save my card for future use</label>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="col-lg-9 col-md-9 col-sm-9 right" data-bind="visible: paymentMethod() == 'Ach'" style="display: none;">
<div>
<div class="tab-pane" id="2a">
<div class="form-group">
<div data-bind="visible: tokenPublicId() == 'newAch' || achTokenCount() == 0 || true" style="">
<div class="row">
<div class="col-lg-12">
<span class="field-validation-valid" data-valmsg-for="BankAccountHolder" data-valmsg-replace="true"></span>
<input autocomplete="off" class="form-control" data-val="true" data-val-maxlength="The Account Holder has a maximum length of 40 characters." data-val-maxlength-max="40" id="BankAccountHolder" name="BankAccountHolder"
placeholder="Bank Account Holder" type="text" value="">
</div>
</div>
<div class="row">
<div class="col-lg-12">
<span class="field-validation-valid" data-valmsg-for="RoutingNumber" data-valmsg-replace="true"></span>
<input autocomplete="off" class="form-control" data-original-title="Routing Number" data-toggle="popover" data-trigger="manual focus" data-val="true" data-val-maxlength="The Routing Number has a maximum length of 9 characters."
data-val-maxlength-max="9" id="RoutingNumber" name="RoutingNumber" placeholder="Routing Number" type="text" value="">
</div>
</div>
<div class="row">
<div class="col-lg-12">
<span class="field-validation-valid" data-valmsg-for="AccountNumber" data-valmsg-replace="true"></span>
<input autocomplete="off" class="form-control" data-original-title="Account Number" data-toggle="popover" data-trigger="manual focus" data-val="true" data-val-maxlength="The Account Number has a maximum length of 17 characters."
data-val-maxlength-max="17" data-val-minlength="The Account Number has a minimum length of 3 characters." data-val-minlength-min="3" data-val-regex="The account number can contain only digits." data-val-regex-pattern="\d+"
id="AccountNumber" name="AccountNumber" placeholder="Account Number" type="text" value="">
</div>
</div>
<div class="row">
<div class="col-lg-12">
<input autocomplete="off" class="form-control" data-original-title="Confirm Account Number" data-toggle="popover" data-trigger="manual focus" data-val="true" id="ConfirmAccountNumber" name="ConfirmAccountNumber"
placeholder="Confirm Account Number" type="text" value="">
</div>
</div>
<div class="row" data-bind="if: paymentMethod() == 'Ach'"></div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="row" id="attachments">
<div class="col-sm-12">
<div class="form-group">
<div class="col-lg-offset-1 col-md-offset-1 col-sm-offset-1 col-lg-2 col-md-2 col-sm-2 col-xs-12 left">
<label>Attachments</label>
</div>
<div class="col-lg-9 col-md-9 col-sm-9 right">
<table cellpadding="10" role="presentation" class="table">
<tbody class="files" data-bind="foreach: attachments"></tbody>
</table>
<div class="fileupload-buttonbar">
<div class="left">
<div class="btn add-btn fileinput-button">
<i class="fas fa-plus-circle" aria-hidden="true"></i>
<label id="files-label" for="files">Add files...</label>
<input id="files" type="file" name="files[]" data-url="/Attachments/Upload" accept=".pdf,.csv,.png,.jpg,.jpeg,.doc,.docx,.zip,.xlsx" multiple="">
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="row notes clearfix">
<div class="col-sm-12">
<div class="form-group">
<div class="col-lg-offset-1 col-md-offset-1 col-sm-offset-1 col-lg-2 col-md-2 col-sm-2 col-xs-12 left">
<label>Notes</label>
</div>
<div class="col-lg-9 col-md-9 col-sm-9 right">
<fieldset>
<span class="field-validation-valid" data-valmsg-for="Comments" data-valmsg-replace="true"></span>
<textarea class="notes-textarea" cols="20" id="Comments" name="Comments" placeholder="If paying multiple invoices/policies, please enter the policy numbers/invoice numbers here or attach the statement above." rows="5"></textarea>
</fieldset>
</div>
</div>
</div>
</div>
<!--ko if:model.enableAutopay-->
<div class="row autopay" style="display:none" data-bind="visible: autoPaySubscriptionId() == null && hasAccount()">
<div class="col-sm-12">
<div class="form-group">
<div class="col-lg-offset-1 col-md-offset-1 col-sm-offset-1 col-lg-2 col-md-2 col-sm-2 col-xs-12 left">
<label>AutoPay</label>
</div>
<div class="col-lg-9 col-md-9 col-sm-9 right">
<label class="switch">
<input class="form-control" data-bind="click: ShowSignInPopup" data-val="true" data-val-required="The EnableAutoPay field is required." id="autopay-enable" name="EnableAutoPay" tabindex="-1" type="checkbox" value="true"><input
name="EnableAutoPay" type="hidden" value="false">
<span class="slider round"> </span>
</label>
<label for="autopay-enable"> Enable AutoPay for future invoices. <span class="learn-more"><a href="#" data-bind="click: openAutopayModal">Learn more</a></span>
</label>
</div>
</div>
</div>
</div>
<!--/ko-->
<div class="row payment-confirmation">
<div class="col-sm-12">
<div class="form-group">
<div class="col-lg-offset-1 col-md-offset-1 col-sm-offset-1 col-lg-2 col-md-2 col-sm-2 col-xs-12 left"></div>
<div class="col-lg-9 col-md-9 col-sm-9 right">
<p class="agreement">
<label id="standard-disclaimer" class="" for="confirm-disclaimer">
<label id="confirm-disclaimer-label" for="confirm-disclaimer"> By clicking "Send", I authorize Hull & Company of New York, Inc. to debit my account. <span data-bind="visible: payerFee() > 0" style="display: none;"> I understand that
<span data-bind="visible: enableScheduledPayments() == false">this payment</span>
<span data-bind="visible: enableScheduledPayments" style="display: none;">each of the <span data-bind="text: numberOfPayments(), visible: numberOfPayments() > 0" style="display: none;"></span> payments</span> includes a <span
data-bind="text: formatAmount(payerFee(), 'USD')">$0.00</span> fee assessed by <a href="http://epaypolicy.com" target="_blank">ePayPolicy</a>. </span>
</label>
</label>
</p>
<p>
</p>
<div class="g-recaptcha" data-sitekey="6Ld0RzwUAAAAAOpZnxpJZrI-V-GMXXDHAmEpfEJV">
<div style="width: 304px; height: 78px;">
<div><iframe title="reCAPTCHA"
src="https://www.google.com/recaptcha/api2/anchor?ar=1&k=6Ld0RzwUAAAAAOpZnxpJZrI-V-GMXXDHAmEpfEJV&co=aHR0cHM6Ly9tb3JzdGFuZ2VuZXJhbGFnZW5jeS5lcGF5cG9saWN5LmNvbTo0NDM.&hl=de&v=M-QqaF9xk6BpjLH22uHZRhXt&size=normal&cb=luu4wgqk4su0"
width="304" height="78" role="presentation" name="a-jywuuovxbog" frameborder="0" scrolling="no"
sandbox="allow-forms allow-popups allow-same-origin allow-scripts allow-top-navigation allow-modals allow-popups-to-escape-sandbox"></iframe></div><textarea id="g-recaptcha-response" name="g-recaptcha-response"
class="g-recaptcha-response" style="width: 250px; height: 40px; border: 1px solid rgb(193, 193, 193); margin: 10px 25px; padding: 0px; resize: none; display: none;"></textarea>
</div><iframe style="display: none;"></iframe>
</div>
<input type="hidden" class="hiddenRecaptcha required" name="hiddenRecaptcha" id="hiddenRecaptcha">
<br>
<p></p>
<input type="submit" name="submitButton" class="btn btn-success" value="Send" id="Submit" data-bind="css: { 'inactive' : !confirmDisclaimer() }, click: submitForm">
<input type="hidden" id="PaymentMethod" name="PaymentMethod" data-bind="value: paymentMethod" value="CreditCard">
<input type="hidden" id="EnableScheduledPayments" name="EnableScheduledPayments" data-bind="value: enableScheduledPayments" value="false">
<input type="hidden" id="ScheduledPaymentsEndOption" name="ScheduledPaymentsEndOption" data-bind="value: scheduledPaymentsEndOption" value="Never">
<input type="hidden" id="TokenPublicId" name="TokenPublicId" data-bind="value: submitTokenPublicId">
<input id="PreAuthorizationCode" name="PreAuthorizationCode" type="hidden" value="">
<input data-val="true" data-val-date="The field PreAuthorizationDate must be a date." id="PreAuthorizationDate" name="PreAuthorizationDate" type="hidden" value="">
<input data-val="true" data-val-number="The field ClientNotificationId must be a number." id="ClientNotificationId" name="ClientNotificationId" type="hidden" value="">
<input name="__RequestVerificationToken" type="hidden" value="f0ErnDHKp0zOCjG7FluoKZC47O5doSa-KQKjI8Rx4lks9GosMyH3se2JK2Qstly-8GVxGPbdZQHcUcTCIXAlf8jDRtE1">
<input type="hidden" name="attachments" id="attachments" data-bind="value: fileModels" value="[]">
</div>
</div>
</div>
</div>
<div id="bankAccountNumberPopup" style="display: none">
<div><img src="/images/account-number.png"></div>
</div>
<div id="bankRoutingNumberPopup" style="display: none">
<div><img src="/images/routing-number.png"></div>
</div>
</form>Text Content
* Sign In * Sign Up * Sign In * Sign Up ×Close ×Close MAKE A PAYMENT Please enter your payment information below Payer Email Address Invoice / Policy # The Invoice / Policy # field is required. Amount Payment Type CREDIT CARD Amount $0.00 Fee Enter Amount Total $0.00 ACH Amount $0.00 Fee Enter Amount Total $0.00 CREDIT CARD ACH Amount $0.00 Fee Enter Amount Total $0.00 Amount $0.00 Fee Enter Amount Total $0.00 Payment Information Save my card for future use Attachments Add files... Notes AutoPay Enable AutoPay for future invoices. Learn more By clicking "Send", I authorize Hull & Company of New York, Inc. to debit my account. I understand that this payment each of the payments includes a $0.00 fee assessed by ePayPolicy. × Cancel Confirm × OK