sahimerdanmacun.com.tr Open in urlscan Pro
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<form action="" method="POST" id="myform">
  <div class="col-12 col-sm-12 col-lg-12" style="padding-left: 0; padding-right: 0;">
    <label>Ürün Seçiniz:</label><br>
    <input type="hidden" id="urun" name="urun" value="|" data-id="">
  </div>
  <div class="col-12 col-sm-12 col-lg-12" style="padding: 10px 0;" id="urun_secenek_alani"></div>
  <div class="col-12 col-sm-12 col-lg-12" style="padding: 10px 0;">
    <label>Ödeme Tipi Seçiniz:</label><br>
    <div style="background: #f1f1f1; margin-bottom: -11px; padding: 18px; border-radius: 5px;border: 1px solid #000;box-shadow: 1px 2px 9px 3px #888888;">
      <input type="radio" checked="" id="odeme1" name="odeme" value="Kapıda Nakit Öde-1">
      <label for="odeme1" style="margin-bottom: 0;">Kapıda Nakit Öde - Kapıda nakit olarak ödeyebilirsiniz.</label>
    </div>
    <br>
    <div style="background: #f1f1f1; margin-bottom: -11px; padding: 18px; border-radius: 5px;border: 1px solid #000;box-shadow: 1px 2px 9px 3px #888888;">
      <input type="radio" id="odeme2" name="odeme" value="Kapıda Kredi Kartı ile Öde-2">
      <label for="odeme2" style="margin-bottom: 0;">Kapıda Kredi Kartı ile Öde - Kapıda Kredi kartı ödeyebilirsiniz.</label>
    </div>
    <br>
  </div>
  <label>Sipariş Bilgileri:</label><br>
  <div class="col-12 col-sm-12 col-lg-12" style="background: #f1f1f1; margin-bottom: 11px; padding: 5px 18px 5px; border-radius: 5px;border: 1px solid #000;box-shadow: 1px 2px 9px 3px #888888;">
    <label>Ad Soyad:</label>
    <input type="text" class="form-control" name="siparis_ad" placeholder="Adınızı ve soyadınızı belirtiniz" required="">
  </div>
  <div class="col-12 col-sm-12 col-lg-12" style="background: #f1f1f1; margin-bottom: 11px; padding: 5px 18px 5px; border-radius: 5px;border: 1px solid #000;box-shadow: 1px 2px 9px 3px #888888;">
    <label>Telefon:</label>
    <input type="tel" onkeypress="return isNumberKey(event)" required="" class="form-control" name="siparis_tel" placeholder="Telefon numaranızı giriniz">
  </div>
  <div class="col-12 col-sm-12 col-lg-12" style="background: #f1f1f1; margin-bottom: 11px; padding: 5px 18px 5px; border-radius: 5px;border: 1px solid #000;box-shadow: 1px 2px 9px 3px #888888;">
    <label for="form_country">İl </label>
    <select class="form-control" required="" name="siparis_il" id="il" data-select-search="true">
      <option value="">İl seçiniz</option>
      <option data-id="34" value="İSTANBUL">İSTANBUL</option>
      <option data-id="6" value="ANKARA">ANKARA</option>
      <option data-id="35" value="İZMİR">İZMİR</option>
      <option data-id="16" value="BURSA">BURSA</option>
      <option data-id="1" value="ADANA">ADANA</option>
      <option data-id="2" value="ADIYAMAN">ADIYAMAN</option>
      <option data-id="3" value="AFYONKARAHİSAR">AFYONKARAHİSAR</option>
      <option data-id="4" value="AĞRI">AĞRI</option>
      <option data-id="68" value="AKSARAY">AKSARAY</option>
      <option data-id="5" value="AMASYA">AMASYA</option>
      <option data-id="7" value="ANTALYA">ANTALYA</option>
      <option data-id="75" value="ARDAHAN">ARDAHAN</option>
      <option data-id="8" value="ARTVİN">ARTVİN</option>
      <option data-id="9" value="AYDIN">AYDIN</option>
      <option data-id="10" value="BALIKESİR">BALIKESİR</option>
      <option data-id="74" value="BARTIN">BARTIN</option>
      <option data-id="72" value="BATMAN">BATMAN</option>
      <option data-id="69" value="BAYBURT">BAYBURT</option>
      <option data-id="11" value="BİLECİK">BİLECİK</option>
      <option data-id="12" value="BİNGÖL">BİNGÖL</option>
      <option data-id="13" value="BİTLİS">BİTLİS</option>
      <option data-id="14" value="BOLU">BOLU</option>
      <option data-id="15" value="BURDUR">BURDUR</option>
      <option data-id="17" value="ÇANAKKALE">ÇANAKKALE</option>
      <option data-id="18" value="ÇANKIRI">ÇANKIRI</option>
      <option data-id="19" value="ÇORUM">ÇORUM</option>
      <option data-id="20" value="DENİZLİ">DENİZLİ</option>
      <option data-id="21" value="DİYARBAKIR">DİYARBAKIR</option>
      <option data-id="41" value="KOCAELİ">KOCAELİ</option>
      <option data-id="42" value="KONYA">KONYA</option>
      <option data-id="43" value="KÜTAHYA">KÜTAHYA</option>
      <option data-id="44" value="MALATYA">MALATYA</option>
      <option data-id="45" value="MANİSA">MANİSA</option>
      <option data-id="47" value="MARDİN">MARDİN</option>
      <option data-id="33" value="MERSİN">MERSİN</option>
      <option data-id="48" value="MUĞLA">MUĞLA</option>
      <option data-id="49" value="MUŞ">MUŞ</option>
      <option data-id="50" value="NEVŞEHİR">NEVŞEHİR</option>
      <option data-id="51" value="NİĞDE">NİĞDE</option>
      <option data-id="52" value="ORDU">ORDU</option>
      <option data-id="80" value="OSMANİYE">OSMANİYE</option>
      <option data-id="53" value="RİZE">RİZE</option>
      <option data-id="54" value="SAKARYA">SAKARYA</option>
      <option data-id="55" value="SAMSUN">SAMSUN</option>
      <option data-id="56" value="SİİRT">SİİRT</option>
      <option data-id="57" value="SİNOP">SİNOP</option>
      <option data-id="73" value="ŞIRNAK">ŞIRNAK</option>
      <option data-id="58" value="SİVAS">SİVAS</option>
      <option data-id="59" value="TEKİRDAĞ">TEKİRDAĞ</option>
      <option data-id="60" value="TOKAT">TOKAT</option>
      <option data-id="61" value="TRABZON">TRABZON</option>
      <option data-id="62" value="TUNCELİ">TUNCELİ</option>
      <option data-id="63" value="ŞANLIURFA">ŞANLIURFA</option>
      <option data-id="64" value="UŞAK">UŞAK</option>
      <option data-id="65" value="VAN">VAN</option>
      <option data-id="77" value="YALOVA">YALOVA</option>
      <option data-id="66" value="YOZGAT">YOZGAT</option>
      <option data-id="67" value="ZONGULDAK">ZONGULDAK</option>
      <option data-id="81" value="DÜZCE">DÜZCE</option>
      <option data-id="22" value="EDİRNE">EDİRNE</option>
      <option data-id="23" value="ELAZIĞ">ELAZIĞ</option>
      <option data-id="24" value="ERZİNCAN">ERZİNCAN</option>
      <option data-id="25" value="ERZURUM">ERZURUM</option>
      <option data-id="26" value="ESKİŞEHİR">ESKİŞEHİR</option>
      <option data-id="27" value="GAZİANTEP">GAZİANTEP</option>
      <option data-id="28" value="GİRESUN">GİRESUN</option>
      <option data-id="29" value="GÜMÜŞHANE">GÜMÜŞHANE</option>
      <option data-id="30" value="HAKKARİ">HAKKARİ</option>
      <option data-id="31" value="HATAY">HATAY</option>
      <option data-id="76" value="IĞDIR">IĞDIR</option>
      <option data-id="32" value="ISPARTA">ISPARTA</option>
      <option data-id="46" value="KAHRAMANMARAŞ">KAHRAMANMARAŞ</option>
      <option data-id="78" value="KARABÜK">KARABÜK</option>
      <option data-id="70" value="KARAMAN">KARAMAN</option>
      <option data-id="36" value="KARS">KARS</option>
      <option data-id="37" value="KASTAMONU">KASTAMONU</option>
      <option data-id="38" value="KAYSERİ">KAYSERİ</option>
      <option data-id="79" value="KİLİS">KİLİS</option>
      <option data-id="71" value="KIRIKKALE">KIRIKKALE</option>
      <option data-id="39" value="KIRKLARELİ">KIRKLARELİ</option>
      <option data-id="40" value="KIRŞEHİR">KIRŞEHİR</option>
    </select>
  </div>
  <div class="col-12 col-sm-12 col-lg-12" style="background: #f1f1f1; margin-bottom: 11px; padding: 5px 18px 5px; border-radius: 5px;border: 1px solid #000;box-shadow: 1px 2px 9px 3px #888888;">
    <label>ilçe:</label>
    <select id="getIlceForIl" required="" name="siparis_ilce" class="getIlceForIl radio-dropdown">
      <option value="">Önce il seçiniz</option>
    </select>
  </div>
  <div class="col-12 col-sm-12 col-lg-12 " style="background: #f1f1f1; margin-bottom: 11px; padding: 5px 18px 5px; border-radius: 5px;border: 1px solid #000;box-shadow: 1px 2px 9px 3px #888888;">
    <label>Adres:</label>
    <textarea class="form-control" required="" name="siparis_adres" rows="3" placeholder="Açık adresinizi giriniz"></textarea>
  </div>
  <div class="col-12 col-sm-12 col-lg-12" style="padding-left: 0; padding-right: 0;">
    <div style="background: #f1f1f1; margin-bottom: 11px;padding: 4px 4px 4px 20px; border-radius: 5px;border: 1px solid #000;box-shadow: 1px 2px 9px 3px #888888;">
      <input type="radio" required="" checked="" readonly="" id="sozlesme" name="sozlesme" value="sozlesme">
      <label for="sozlesme" style="margin-bottom: 0;"><a target="_blank" href="sozlesme" style="color: #428e22;">Mesafeli Satış Sözleşmesi - İptal-İade Politikası - Teslimat Bilgileri</a> okudum ve onaylıyorum.</label>
    </div>
  </div>
  <br>
  <div style="word-wrap:break-word;">
    <button id="ButonGizle" type="submit" class="btn btn-gfort" name="siparisver" style="width: 100%;height: 50px;word-wrap:break-word; background: #428e22;border: none;">Sipariş Ver</button>
    <button id="ButonGoster" class="btn btn-gfort" style="display: none; width: 100%;height: 50px;word-wrap:break-word; background: #428e22;border: none;"> Lütfen Bekleyin.. </button>
  </div>
</form>

Text Content

Ürün Seçiniz:


Ödeme Tipi Seçiniz:

Kapıda Nakit Öde - Kapıda nakit olarak ödeyebilirsiniz.

Kapıda Kredi Kartı ile Öde - Kapıda Kredi kartı ödeyebilirsiniz.

Sipariş Bilgileri:

Ad Soyad:
Telefon:
İl İl seçiniz İSTANBUL ANKARA İZMİR BURSA ADANA ADIYAMAN AFYONKARAHİSAR AĞRI
AKSARAY AMASYA ANTALYA ARDAHAN ARTVİN AYDIN BALIKESİR BARTIN BATMAN BAYBURT
BİLECİK BİNGÖL BİTLİS BOLU BURDUR ÇANAKKALE ÇANKIRI ÇORUM DENİZLİ DİYARBAKIR
KOCAELİ KONYA KÜTAHYA MALATYA MANİSA MARDİN MERSİN MUĞLA MUŞ NEVŞEHİR NİĞDE ORDU
OSMANİYE RİZE SAKARYA SAMSUN SİİRT SİNOP ŞIRNAK SİVAS TEKİRDAĞ TOKAT TRABZON
TUNCELİ ŞANLIURFA UŞAK VAN YALOVA YOZGAT ZONGULDAK DÜZCE EDİRNE ELAZIĞ ERZİNCAN
ERZURUM ESKİŞEHİR GAZİANTEP GİRESUN GÜMÜŞHANE HAKKARİ HATAY IĞDIR ISPARTA
KAHRAMANMARAŞ KARABÜK KARAMAN KARS KASTAMONU KAYSERİ KİLİS KIRIKKALE KIRKLARELİ
KIRŞEHİR
ilçe: Önce il seçiniz
Adres:
Mesafeli Satış Sözleşmesi - İptal-İade Politikası - Teslimat Bilgileri okudum ve
onaylıyorum.

Sipariş Ver Lütfen Bekleyin..

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