www.e-billexpress.com Open in urlscan Pro
103.41.70.82  Public Scan

Form analysis
4 forms found in the DOM

POST /ebpp/sedpayauto/Login

<form id="login-form" method="post" action="/ebpp/sedpayauto/Login" data-toggle="validator" autocomplete="off" novalidate="novalidate">
  <input name="__RequestVerificationToken" type="hidden" value="UzDT7DnwXs2prxNTxtMM5UrGl7lgY2Oe4gS9okgcmtps7qBgWorDLqtpS_R1rNwrFz6xfSnREn-7l4s76Xxb05gV6ZQZXaQVJS9WaXvaVP01">
  <input id="FastPaySelection" name="FastPaySelection" type="hidden" value="">
  <div class="form-group">
    <label class="required-asterisk" for="Login">Login ID</label>
    <input autocomplete="off" class="form-control" data-val="true" data-val-length="The field Login must be a string with a maximum length of 256." data-val-length-max="256" id="Login" name="Login" required="true" type="text" value=""
      aria-required="true">
    <span class="field-validation-valid" data-valmsg-for="Login" data-valmsg-replace="true"></span>
  </div>
  <div class="form-group fg-password">
    <label for="Password" class="required-asterisk"> Password </label>
    <div class="input-group">
      <input autocomplete="off" class="form-control" data-val="true" data-val-regex="Special characters are not allowed as input" data-val-regex-pattern="^[^\<]+$" id="Password" name="Password" required="true" type="password" aria-required="true">
      <span class="field-validation-valid" data-valmsg-for="Password" data-valmsg-replace="true"></span>
    </div>
  </div>
  <div class="row rl-desktop">
    <div class="col-md-6">
      <div class="actions form-inline">
        <button id="login-button" class="btn btn-success m-mobile">Login</button>
      </div>
    </div>
    <div class="col-md-6 m-mobile">
      <a href="/ebpp/sedpayauto/Login/RecoverUsername" class="forgot-username text-theme-link">Forgot your Login ID?</a>
      <br>
      <a href="/ebpp/sedpayauto/Login/SendPassword" class="reset-password text-theme-link">Password Help?</a>
    </div>
  </div>
</form>

POST /ebpp/sedpayauto/Login/PayAsGuest

<form id="guest-form" method="post" action="/ebpp/sedpayauto/Login/PayAsGuest" data-toggle="validator" autocomplete="off" novalidate="novalidate">
  <input name="__RequestVerificationToken" type="hidden" value="UrMF1s5W2IHVaYVHpQv6CHxg26KsphsRVfFRSqGPPVk8V8hPj5iAwese-QHZVdGsBQ2oW08yz47zdmpKz7zvT0N4T-pufkoUEg-hYjzfvEE1">
  <input name="BillerID" type="hidden" value="4016">
  <div class="popover-form-group">
    <label class="required-asterisk" for="AccountNumber">Reference Number/Claim Number</label>
    <input autocomplete="off" class="form-control" data-fieldlabel="Reference Number/Claim Number" data-val="true" data-val-regex="Special characters are not allowed as input" data-val-regex-pattern="^[^\<]+$" id="AccountNumber" maxlength="25"
      minlength="2" name="AccountNumber" required="true" type="text" value="" aria-required="true">
    <span class="field-validation-valid" data-valmsg-for="AccountNumber" data-valmsg-replace="true"></span>
  </div>
  <div class="popover-form-group">
    <label class="required-asterisk" for="PIN">Billing ZIP (5 Digit or Intl)</label>
    <div class="input-group">
      <input autocomplete="Off" class="form-control password-toggle" data-val="true" data-val-regex="Special characters are not allowed as input" data-val-regex-pattern="^[^\<]+$" id="PIN" name="PIN" required="true" type="password" value=""
        aria-required="true">
      <span class="input-group-btn">
        <button class="btn btn-default password-toggle" type="button" aria-label="Show entered Billing ZIP (5 Digit or Intl)" data-show-password-text="Show entered Billing ZIP (5 Digit or Intl)"
          data-hide-password-text="Hide entered Billing ZIP (5 Digit or Intl)">
          <i class="fa fa-eye fa-lg text-theme-link" aria-hidden="true"></i>
        </button>
      </span>
    </div>
    <span class="field-validation-valid" data-valmsg-for="PIN" data-valmsg-replace="true"></span>
  </div>
  <div class="row rl-desktop">
    <div class="col-md-12">
      <div class="actions form-inline">
        <button id="pay-now-button" class="btn btn-success m-mobile">Pay Now</button>
      </div>
    </div>
  </div>
</form>

POST #

<form id="form-paynow-search" novalidate="novalidate" method="post" action="#">
  <div class="row">
  </div>
  <p class="generic-error">Please provide some data to perform an account search</p>
  <div class="help-block">
    <p class="caption">
    </p>
  </div>
  <div class="actions">
    <button class="btn btn-link btn-cancel" type="button" data-dismiss="modal">Cancel</button>
    <button class="btn btn-success" type="submit">Search</button>
  </div>
</form>

POST /ebpp/sedpayauto/Login/PayAsGuestSearch

<form id="form-paynow-results" action="/ebpp/sedpayauto/Login/PayAsGuestSearch" novalidate="novalidate" method="post">
  <input name="__RequestVerificationToken" type="hidden" value="TO_MSCzOXH4WKsu-nElHo3ExB47c7fXz1_eHySd8qBt5f84cBZPKwxS3x4k5qYIjRagfP5t_9LOkclwlPItx-7pBhIKDn4DupTW1AmQQmvg1">
  <input type="hidden" id="PayNowResultName" name="Name">
  <input type="hidden" id="PayNowResultAddress" name="Address">
  <input type="hidden" id="PayNowResultAddress2" name="Address2">
  <input type="hidden" id="PayNowResultBillingAccountID" name="BillingAccountID">
</form>

Text Content

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Welcome to Sedgwick’s e-bill express auto payment portal for Consumer claims
powered by Wells Fargo. This portal allows parties to make payments towards
damages they are responsible for.
 * Login
 * Pay Now
 * Welcome to Sedgwick’s e-bill express auto payment portal for Consumer claims
   powered by Wells Fargo. This portal allows parties to make payments towards
   damages they are responsible for.

* Required Fields


LOGIN SCREEN

Login ID
Password

Login
Forgot your Login ID?
Password Help?


DON'T HAVE A LOGIN ID?

Enroll today to set up your secure user name and password, view and pay bills,
and see your account status and payment history.

Enroll


PAY NOW

Reference Number/Claim Number
Billing ZIP (5 Digit or Intl)

Pay Now


CONTINUE AS A GUEST OR ENROLL

Make a one-time payment or enroll today to set up your secure user name and
password, view and pay bills, and see your account status and payment history.

Enroll


PAYMENT OPTIONS

Choose one of the options below to make one-time or recurring payments using a
credit card, debit card or check. You will need your claim number and billing
ZIP code. Click Pay Now at the top of the page to make a one-time payment. Click
Enroll above to register for recurring payments.


ACCOUNT SETUP

To verify your identity, please enter your Claim Number and Billing ZIP (5-Digit
or International Code).


Enter your password.
× Close


SEARCH FOR ACCOUNT

Please provide some data to perform an account search



Cancel Search
Cancel Go Back

 * © 2004-2023 Wells Fargo Bank All Rights Reserved. |
 * Terms of Service
 * Privacy Policy
 * FAQs


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