secure.cardknox.com
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Submitted URL: https://payments.teliphone.us/
Effective URL: https://secure.cardknox.com/teliphoneusa
Submission: On July 19 via api from US — Scanned from US
Effective URL: https://secure.cardknox.com/teliphoneusa
Submission: On July 19 via api from US — Scanned from US
Form analysis
1 forms found in the DOMPOST /teliphoneusa
<form action="/teliphoneusa" id="process_cc_form" method="post">
<div class="form-content">
<div class="wrapleft tab_NewTransaction tabsDiv">
<div class="module">
<span class="header"> Billing Information </span>
<div class="grid">
<div class="grid_item"> <label id="lbl_xCustom02" for="xCustom02" class="label required">Teliphone Account Number (ex: Y123456789)</label>
<input type="text" id="xCustom02" name="xCustom02" class="input required" value="">
</div>
<div class="grid_item"> <label id="lbl_xBillLastName" for="xBillLastName" class="label required">Customer Name</label>
<input type="text" id="xBillLastName" name="xBillLastName" class="input required" value="">
</div>
<div class="grid_item"> <label id="lbl_xBillStreet" for="xBillStreet" class="label required">Customer Address</label>
<input type="text" id="xBillStreet" name="xBillStreet" class="input required" value="">
</div>
<div class="grid_item no_margin">
<div class="group">
<div class="grid_item">
<div class="inputmulti xBillCity">
<label for="xBillCity" class="label ">City</label>
<input type="text" id="xBillCity" name="xBillCity" class="input" value="">
</div>
</div>
<div class="grid_item">
<div class="inputmulti xBillState">
<label for="xBillState" class="label ">State</label>
<select name="xBillState" id="xBillState" class="input ">
<option value="" selected="selected"></option>
<option value="AL">AL</option>
<option value="AK">AK</option>
<option value="AZ">AZ</option>
<option value="AR">AR</option>
<option value="CA">CA</option>
<option value="CO">CO</option>
<option value="CT">CT</option>
<option value="DC">DC</option>
<option value="DE">DE</option>
<option value="FL">FL</option>
<option value="GA">GA</option>
<option value="HI">HI</option>
<option value="ID">ID</option>
<option value="IL">IL</option>
<option value="IN">IN</option>
<option value="IA">IA</option>
<option value="KS">KS</option>
<option value="KY">KY</option>
<option value="LA">LA</option>
<option value="ME">ME</option>
<option value="MD">MD</option>
<option value="MA">MA</option>
<option value="MI">MI</option>
<option value="MN">MN</option>
<option value="MS">MS</option>
<option value="MO">MO</option>
<option value="MT">MT</option>
<option value="NE">NE</option>
<option value="NV">NV</option>
<option value="NH">NH</option>
<option value="NJ">NJ</option>
<option value="NM">NM</option>
<option value="NY">NY</option>
<option value="NC">NC</option>
<option value="ND">ND</option>
<option value="OH">OH</option>
<option value="OK">OK</option>
<option value="OR">OR</option>
<option value="PA">PA</option>
<option value="PR">PR</option>
<option value="RI">RI</option>
<option value="SC">SC</option>
<option value="SD">SD</option>
<option value="TN">TN</option>
<option value="TX">TX</option>
<option value="UT">UT</option>
<option value="VT">VT</option>
<option value="VA">VA</option>
<option value="WA">WA</option>
<option value="WV">WV</option>
<option value="WI">WI</option>
<option value="WY">WY</option>
</select>
</div>
</div>
<div class="grid_item">
<div class="inputmulti xBillZip">
<label for="xBillZip" class="label required">Zip</label>
<input type="text" id="xBillZip" name="xBillZip" class="input required" value="">
</div>
</div>
</div>
</div>
<div class="grid_item"> <label id="lbl_xBillPhone" for="xBillPhone" class="label ">Customer Phone Number</label>
<input type="text" id="xBillPhone" name="xBillPhone" class="input" value="">
</div>
<div class="grid_item"> <label id="lbl_xEmail" for="xEmail" class="label ">Customer Email</label>
<input type="text" id="xEmail" name="xEmail" class="input" value="">
</div>
</div>
</div>
<div class="module">
<span class="header"> Transaction Details </span>
<div class="grid">
<div class="grid_item"> <label id="lbl_xDescription" for="xDescription" class="label ">Note</label>
<input type="text" id="xDescription" name="xDescription" class="input" value="">
</div>
<div class="grid_item"> <label id="lbl_xAmount" for="xAmount" class="label required">Amount</label>
<div class="amount-input"><span class="currency">$</span><input type="number" step=".01" min="0" id="xAmount" autocomplete="off" name="xAmount" class="input required" value="" style="padding-left: 15.9062px;"></div>
</div>
</div>
</div>
<div>
</div>
<div>
<div name="h-captcha" class="h-captcha" data-sitekey="921ca4c2-5606-4dcf-8248-ec26f78f062b"><iframe
src="https://newassets.hcaptcha.com/captcha/v1/12d4359/static/hcaptcha.html#frame=checkbox&id=0qp62lgqa2yd&host=secure.cardknox.com&sentry=true&reportapi=https%3A%2F%2Faccounts.hcaptcha.com&recaptchacompat=true&custom=false&hl=en&tplinks=on&pstissuer=https%3A%2F%2Fpst-issuer.hcaptcha.com&sitekey=921ca4c2-5606-4dcf-8248-ec26f78f062b&theme=light&origin=https%3A%2F%2Fsecure.cardknox.com"
tabindex="0" frameborder="0" scrolling="no" allow="private-state-token-issuance 'src'; private-state-token-redemption 'src'" title="Widget containing checkbox for hCaptcha security challenge" data-hcaptcha-widget-id="0qp62lgqa2yd"
data-hcaptcha-response="" style="pointer-events: auto; width: 303px; height: 78px; overflow: hidden;"></iframe><textarea id="g-recaptcha-response-0qp62lgqa2yd" name="g-recaptcha-response" style="display: none;"></textarea><textarea
id="h-captcha-response-0qp62lgqa2yd" name="h-captcha-response" style="display: none;"></textarea></div>
</div>
</div>
<div class="wrapright tab_NewTransaction tabsDiv">
<div class="wraprightabsolute absolute" style="top: 0px;">
<div class="module border">
<div class="header">Payment Information</div>
<div class="grid">
<div id="div_cc_num" class="">
<div class="group">
<div class="grid">
<div class="grid_item">
<div class="label left">Payment Type</div>
<span class="right">
<input type="radio" name="pt" id="ptCc" value="CC"> <label for="ptCc" class="">Credit Card</label> <input type="radio" name="pt" id="ptAch" value="ACH"> <label for="ptAch" class="">Check</label>
</span>
</div>
</div>
</div>
<div class="group">
<div class="grid_item">
<span class="right cards ccField hidden">
<img class="" src="https://secure-cdn.cardknox.com/content/themes/grey/Icons/4_card.png" width="34" id="visa" alt="Visa">
<img class="" src="https://secure-cdn.cardknox.com/content/themes/grey/Icons/5_card.png" width="34" id="mc" alt="MasterCard">
<img class="" src="https://secure-cdn.cardknox.com/content/themes/grey/Icons/6_card.png" width="34" id="disc" alt="Discover">
<img class="" src="https://secure-cdn.cardknox.com/content/themes/grey/Icons/3_card.png" width="34" id="amex" alt="American Express">
</span>
</div>
<div class="grid_item">
<label id="lbl_xCardNum" for="xCardNum" class="label ccField left required hidden">Card Number</label>
<input type="text" autocomplete="off" inputmode="numeric" id="xCardNum" name="xCardNum" class="input required ccField integer fs-exclude hidden">
<input type="hidden" name="xMagstripe" id="xMagstripe" disabled="disabled">
<a href="#0" class="edit-card-num hidden">Change Card Number</a>
<input type="hidden" class="hidden" id="xCCToken" name="xToken" disabled="disabled">
</div>
</div>
<div class="grid ccField ccInfo group hidden">
<div class="grid_item">
<!-- Begin Expiration -->
<div class="expiration left">
<label class="label ccField required hidden" id="lbl_exp" for="exp">Expiration</label>
<select class="input required exp" id="exp" name="ccExpMonth">
<option selected="" hidden="" value=""></option>
<option>01</option>
<option>02</option>
<option>03</option>
<option>04</option>
<option>05</option>
<option>06</option>
<option>07</option>
<option>08</option>
<option>09</option>
<option>10</option>
<option>11</option>
<option>12</option>
</select>
<select class="input required exp" id="ccExpYear" name="ccExpYear">
<option selected="" hidden="" value=""></option>
<option>24</option>
<option>25</option>
<option>26</option>
<option>27</option>
<option>28</option>
<option>29</option>
<option>30</option>
<option>31</option>
<option>32</option>
<option>33</option>
<option>34</option>
<option>35</option>
<option>36</option>
<option>37</option>
<option>38</option>
<option>39</option>
<option>40</option>
<option>41</option>
<option>42</option>
<option>43</option>
<option>44</option>
<option>45</option>
<option>46</option>
<option>47</option>
<option>48</option>
<option>49</option>
<option>50</option>
<option>51</option>
<option>52</option>
<option>53</option>
<option>54</option>
<option>55</option>
<option>56</option>
<option>57</option>
<option>58</option>
<option>59</option>
<option>60</option>
<option>61</option>
<option>62</option>
<option>63</option>
<option>64</option>
<option>65</option>
<option>66</option>
<option>67</option>
<option>68</option>
<option>69</option>
<option>70</option>
<option>71</option>
<option>72</option>
<option>73</option>
<option>74</option>
</select>
</div>
<!-- End Expiration -->
<!-- Begin CVV -->
<div class="right cvvD" id="div_cvv">
<label class="label ccField hidden" id="lbl_xCVV" for="xCVV"> CVV </label>
<input type="text" inputmode="numeric" autocomplete="off" id="xCVV" name="xCVV" maxlength="4" class="input wInfo fs-exclude">
<span class="infoI" style="margin: 0" id="cvvB">i</span>
</div>
<!-- End CVV -->
</div>
</div>
</div>
<div id="command_type" class="ccField hidden">
<div class="grid_item">
<input type="hidden" id="xCommand" name="xCommand" value="cc:sale">
</div>
</div>
<div class="achDiv">
<div class="grid">
<div class="grid_item hidden">
<label class="label required achField" for="xAccountType">Account Type</label>
<select id="xAccountType" name="xAccountType" class="select required achField">
<option value="">Select One</option>
<option value="Checking">Checking</option>
<option value="Savings">Savings</option>
</select>
</div>
<div class="grid_item hidden">
<label class="label required achField" for="xName">Name on Account</label>
<input type="text" id="xName" name="xName" class="input required achField">
</div>
<div class="grid_item hidden">
<label class="label required achField" for="xRouting"> Routing Number </label>
<input type="text" id="xRouting" name="xRouting" class="input required achField wInfo integer" maxlength="9" minlength="9" pattern="[0-9]*" title="Please enter numbers only">
<span id="routNum" style="margin: 0" class="infoI achField">i</span>
</div>
<div class="grid_item hidden">
<label class="label required achField" for="xRouting2">Re-enter Routing Number</label>
<input id="xRouting2" class="input required achField integer" type="text" autocomplete="off" maxlength="9" minlength="9" pattern="[0-9]*" title="Please enter numbers only">
</div>
<div class="grid_item hidden">
<label class="label required achField" for="xAccount"> Account Number </label>
<input type="text" autocomplete="off" id="xAccount" name="xAccount" class="input required achField wInfo integer fs-exclude">
<span id="accNum" style="margin: 0" class="infoI achField">i</span>
</div>
<div class="grid_item hidden">
<label class="label required achField" for="xAccount2">Re-enter Account Number</label>
<input id="xAccount2" class="input required achField integer fs-exclude" type="text" autocomplete="off">
</div>
<div class="grid_item">
<a href="#0" class="edit-account-info hidden">Change Acount Info</a>
<input type="hidden" class="hidden" id="xACHToken" name="xToken" disabled="disabled">
</div>
</div>
<div class="achagree achField">
<p id="pactsafe-authorization" data-all-agreed="false"></p>
<div id="ps-group-ps-ach-auth" class="ps-group ps-style-full" data-gid="35267" data-key="ps-ach-auth">
<style scoped="">
#ps-group-ps-ach-auth *,
#ps-group-ps-ach-auth div {
border: 0;
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}
#ps-group-ps-ach-auth a {
font-size: 1em;
}
#ps-group-ps-ach-auth a:hover {
text-decoration: underline;
}
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#ps-group-ps-ach-auth span {
color: #444;
}
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display: block;
padding: 0 0 25px;
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color: #444;
font-size: 13px;
line-height: 1.5;
}
#ps-group-ps-ach-auth div.ps-contract-title {
display: block;
margin: 0 0 10px;
font-size: 1.15em;
}
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display: block;
font-size: 0.9em;
height: auto;
background-color: #f6f6f6;
border: 1px solid #ddd;
border-bottom-width: 0;
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#ps-group-ps-ach-auth table.ps-contract-options-links {
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text-align: left;
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}
#ps-group-ps-ach-auth td.ps-contract-options-right {
text-align: right;
width: 50%;
}
#ps-group-ps-ach-auth div.ps-expand-button {
display: block;
width: auto;
cursor: pointer;
}
#ps-group-ps-ach-auth a.ps-download-link {
display: inline-block;
}
#ps-group-ps-ach-auth div.ps-contract-body {
display: block;
border: 1px solid #ddd;
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font-size: 1em;
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#ps-group-ps-ach-auth div.ps-contract-scroll {
max-height: 400px;
min-height: auto;
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#ps-group-ps-ach-auth div.ps-contract-body span {
display: inline;
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#ps-group-ps-ach-auth label.ps-checkbox-container {
display: block;
background-color: #f6f6f6;
border: 1px solid #ddd;
padding: 15px 15px 15px 36px;
text-transform: none;
font-size: 1em;
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}
#ps-group-ps-ach-auth input[type="checkbox"].ps-contract-target {
display: inline;
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width: auto;
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#ps-group-ps-ach-auth div.ps-contract-label {
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</style>
<div id="ps-contract-189201" class="ps-contract" data-cid="189201" data-vid="62cc78f520372145153b0627" data-mjvid="62cc78f520372145153b0627" style="display: block;" data-agreed="false">
<div class="ps-contract-title">ACH Authorization</div>
<div class="ps-contract-options">
<table class="ps-contract-options-links">
<tbody>
<tr>
<td class="ps-contract-options-left">
<div class="ps-expand-button" style="display: none;">Expand Contract</div>
</td>
<td class="ps-contract-options-right">
<a href="https://vault.pactsafe.io/s/ce60a635-12e1-480c-b5b9-d2678cd6b018/contracts/189201.pdf" target="_blank" rel="noopener" class="ps-download-link" onclick="window.open('https://vault.pactsafe.io/s/ce60a635-12e1-480c-b5b9-d2678cd6b018/contracts/189201.pdf')">Download</a>
</td>
</tr>
</tbody>
</table>
</div>
<div class="ps-contract-body ps-contract-full">
<div data-section-type="1" class="ps-section" data-id="ryOuyRGi9" data-time="1657098096496"><span style="background-color: initial;" cursorposition="890">I hereby authorize this company to debit my bank account through the
electronic Automated Clearing House (ACH) network within one to three business days from the payment date for the amount or payment plan amount listed above. I am aware that in the event this company is unable to secure
funds from my bank account for this transaction for any reason, including but not limited to insufficient funds in my account or insufficient or inaccurate information I provided when I submitted the electronic payment,
further collection action may be undertaken by this company, including the application of returned check fees to the extent permitted by law. If my bank returns the payment, I am still responsible for making a payment to
this company. If this is a recurring schedule, I understand this will remain in effect until a written request is submitted to this company requesting a change.</span></div>
</div>
<label for="ps-contract-checkbox-189201" class="ps-checkbox-container ps-checkbox-clickable required">
<input type="checkbox" class="ps-contract-target ps-checkbox required" id="ps-contract-checkbox-189201" name="ps-contract-checkbox-189201" value="189201:62cc78f520372145153b0627">
<div class="ps-contract-label">I acknowledge that I have read, understand and agree to the full terms and conditions set forth above.</div>
</label>
</div>
</div>
<p></p>
<input class="hidden" id="xPactsafeAuthIp" name="xPactsafeAuthIp" value="">
<input class="hidden" id="xPactsafeAuthTimestamp" name="xPactsafeAuthTimestamp" value="">
<input class="hidden" id="xPactsafeUserId" name="xPactsafeUserId" value="ps00015465">
<br>
</div>
</div>
<div id="amountMain" class="amountMain">
<span class="totalLbl" id="totalLbl">Total:</span> <span id="totalCur">$</span><span id="totalAmount">0.00</span>
</div>
<input id="formS" type="submit" class="formSub" value="Process Payment">
</div>
</div>
<div class="module border module-meter">
<div class="header"> Required Field Meter™ <span class="highlight_req floatright" data-org-text="»Highlight fields" data-sec-text="»Undo highlight fields">»Highlight fields</span>
</div>
<div class="required_empty hidden"></div>
<div class="required_meter group">
<div class="meter">
<div class="bar">
<span class="color"></span>
<span class="line"></span>
</div>
<span class="part per100"></span>
<span class="part per90"></span>
<span class="part per80"></span>
<span class="part per70"></span>
<span class="part per60"></span>
<span class="part per50"></span>
<span class="part per40"></span>
<span class="part per30"></span>
<span class="part per20"></span>
<span class="part per10"></span>
<div class="top">
<span class="raised" id="perc_done">0</span>%
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<input type="hidden" name="node" value="1202">
<input type="hidden" name="path" value="/teliphoneusa">
</form>
Text Content
Secure Payment Form Billing Information Teliphone Account Number (ex: Y123456789) Customer Name Customer Address City State ALAKAZARCACOCTDCDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPAPRRISCSDTNTXUTVTVAWAWVWIWY Zip Customer Phone Number Customer Email Transaction Details Note Amount $ Payment Information Payment Type Credit Card Check Card Number Change Card Number Expiration 01 02 03 04 05 06 07 08 09 10 11 12 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 CVV i Account Type Select One Checking Savings Name on Account Routing Number i Re-enter Routing Number Account Number i Re-enter Account Number Change Acount Info ACH Authorization Expand Contract Download I hereby authorize this company to debit my bank account through the electronic Automated Clearing House (ACH) network within one to three business days from the payment date for the amount or payment plan amount listed above. I am aware that in the event this company is unable to secure funds from my bank account for this transaction for any reason, including but not limited to insufficient funds in my account or insufficient or inaccurate information I provided when I submitted the electronic payment, further collection action may be undertaken by this company, including the application of returned check fees to the extent permitted by law. If my bank returns the payment, I am still responsible for making a payment to this company. If this is a recurring schedule, I understand this will remain in effect until a written request is submitted to this company requesting a change. I acknowledge that I have read, understand and agree to the full terms and conditions set forth above. Total: $0.00 Required Field Meter™ »Highlight fields 0% X © Copyright 2024 Cardknox (1.04.2405.30180)