jne-nama.shopify-plugin.devbdd.com Open in urlscan Pro
13.215.218.107  Public Scan

Form analysis
1 forms found in the DOM

POST https://jne-nama.shopify-plugin.devbdd.com/front/bukti_tf

<form class="form" method="post" action="https://jne-nama.shopify-plugin.devbdd.com/front/bukti_tf" enctype="multipart/form-data" id="submit_form_ac">
  <div class="form-group">
    <label class="control-label">No Order</label>
    <input type="text" name="no_order" class="form-control" placeholder="1001">
  </div>
  <div class="form-group">
    <label class="control-label">Email</label>
    <input type="text" name="email" class="form-control" placeholder="your email address">
  </div>
  <div class="form-group">
    <label class="control-label">Tanggal Transfer</label>
    <input type="text" name="tgl_tf" class="form-control dpicker hasDatepicker" id="dp1721695724663">
  </div>
  <div class="form-group">
    <label class="control-label">Bayar Ke</label>
    <select class="form-control" name="bayar_ke">
      <option value="bca">BCA</option>
      <option value="mandiri">Mandiri</option>
    </select>
  </div>
  <div class="form-group">
    <label class="control-label">Bukti Transfer</label>
    <input type="file" name="bukti_tf" class="form-control">
  </div>
  <div class="form-group">
    <label class="control-label">Catatan</label>
    <input type="text" name="catatan" class="form-control">
  </div>
  <div class="form-group">
    <button class="btn btn-primary" type="submit">Kirim</button>
  </div>
</form>

Text Content

JNE NAMA


PAYMENT CONFIRMATION

LOREM IPSUM DOLOR SIT AMET, CONSECTETUR ADIPISCING ELIT, SED DO EIUSMOD TEMPOR
INCIDIDUNT UT LABORE ET DOLORE MAGNA ALIQUA.

No Order
Email
Tanggal Transfer
Bayar Ke BCA Mandiri
Bukti Transfer
Catatan
Kirim