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staging.conqueridigital.com Open in urlscan Pro
2a02:4780:2b:1554:0:3568:de55:3  Public Scan

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URL: https://staging.conqueridigital.com/
Submission: On July 01 via api from US — Scanned from DE

Form analysis 1 forms found in the DOM

Name: invoiceFrm — POST invoicesuccess.php

<form method="POST" action="invoicesuccess.php" name="invoiceFrm" novalidate="novalidate">
  <div class="container">
    <div class="row">
      <table class="table invoiceID_table">
        <tbody>
          <tr>
            <td>Invoice#</td>
            <td><input type="text" name="invoice_Id" class="form-control"></td>
          </tr>
        </tbody>
      </table>
    </div>
  </div>
  <div class="container">
    <div class="row">
      <table class="table invoice_table">
        <tbody>
          <tr>
            <th>Bill To :</th>
            <th> </th>
            <th>Invoice :</th>
            <th> </th>
          </tr>
          <tr>
            <td>Cust Name :</td>
            <td><input type="text" name="customer_name" class="form-control"></td>
            <td>Invoice Date :</td>
            <td><input type="date" name="invoice_date" class="form-control"></td>
          </tr>
          <tr>
            <td>Address :</td>
            <td><input type="text" name="address" class="form-control"></td>
            <td>Due Date :</td>
            <td><input type="date" name="due_date" class="form-control"></td>
          </tr>
          <tr>
            <td>Phone Number :</td>
            <td><input type="text" name="phone_number" class="form-control"></td>
            <td>Cust Id :</td>
            <td><input type="text" name="customer_id" class="form-control"></td>
          </tr>
          <tr>
            <td>Email Id :</td>
            <td><input type="text" name="emailid" class="form-control"></td>
            <td>State :</td>
            <td>
              <select class="form-control" name="state">
                <optgroup label="United States">
                  <option value="AL"> Alabama (AL)</option>
                  <option value="AK"> Alaska (AK)</option>
                  <option value="AZ"> Arizona (AZ)</option>
                  <option value="AR"> Arkansas (AR)</option>
                  <option value="CA"> California (CA)</option>
                  <option value="CO"> Colorado (CO)</option>
                  <option value="CT"> Connecticut (CT)</option>
                  <option value="DE"> Delaware (DE)</option>
                  <option value="DC"> District of Columbia (DC)</option>
                  <option value="FL"> Florida (FL)</option>
                  <option value="GA"> Georgia (GA)</option>
                  <option value="HI"> Hawaii (HI)</option>
                  <option value="ID"> Idaho (ID)</option>
                  <option value="IL"> Illinois (IL)</option>
                  <option value="IN"> Indiana (IN)</option>
                  <option value="IA"> Iowa (IA)</option>
                  <option value="KS"> Kansas (KS)</option>
                  <option value="KY"> Kentucky (KY)</option>
                  <option value="LA"> Louisiana (LA)</option>
                  <option value="ME"> Maine (ME)</option>
                  <option value="MD"> Maryland (MD)</option>
                  <option value="MA"> Massachusetts (MA)</option>
                  <option value="MI"> Michigan (MI)</option>
                  <option value="MN"> Minnesota (MN)</option>
                  <option value="MS"> Mississippi (MS)</option>
                  <option value="MO"> Missouri (MO)</option>
                  <option value="MT"> Montana (MT)</option>
                  <option value="NE"> Nebraska (NE)</option>
                  <option value="NV"> Nevada (NV)</option>
                  <option value="NH"> New Hampshire (NH)</option>
                  <option value="NJ"> New Jersey (NJ)</option>
                  <option value="NM"> New Mexico (NM)</option>
                  <option value="NY"> New York (NY)</option>
                  <option value="NC"> North Carolina (NC)</option>
                  <option value="ND"> North Dakota (ND)</option>
                  <option value="OH"> Ohio (OH)</option>
                  <option value="OK"> Oklahoma (OK)</option>
                  <option value="OR"> Oregon (OR)</option>
                  <option value="PA"> Pennsylvania (PA)</option>
                  <option value="PR"> Puerto Rico (PR)</option>
                  <option value="RI"> Rhode Island (RI)</option>
                  <option value="SC"> South Carolina (SC)</option>
                  <option value="SD"> South Dakota (SD)</option>
                  <option value="TN"> Tennessee (TN)</option>
                  <option value="TX"> Texas (TX)</option>
                  <option value="UT"> Utah (UT)</option>
                  <option value="VT"> Vermont (VT)</option>
                  <option value="VA"> Virginia (VA)</option>
                  <option value="WA"> Washington (WA)</option>
                  <option value="WV"> West Virginia (WV)</option>
                  <option value="WI"> Wisconsin (WI)</option>
                  <option value="WY"> Wyoming (WY)</option>
                </optgroup>
                <optgroup label="Canadian States">
                  <option value="AB">Alberta</option>
                  <option value="BC">British Columbia</option>
                  <option value="MB">Manitoba</option>
                  <option value="NB">New Brunswick</option>
                  <option value="NL">Newfoundland and Labrador</option>
                  <option value="NS">Nova Scotia</option>
                  <option value="ON">Ontario</option>
                  <option value="PE">Prince Edward Island</option>
                  <option value="QC">Quebec</option>
                  <option value="SK">Saskatchewan</option>
                  <option value="NT">Northwest Territories</option>
                  <option value="NU">Nunavut</option>
                  <option value="YT">Yukon</option>
                </optgroup>
              </select>
            </td>
          </tr>
        </tbody>
      </table>
    </div>
  </div>
  <div class="container">
    <div class="row">
      <div class="addmore_button">
        <br><br>
        <input type="hidden" name="addmore_plan" id="addmore_plan" value="1">
        <button type="button" id="addmoreplan" class="btn btn-secondary btn-sm float-right">Add more plan</button>
      </div>
      <div class="">
        <div class="allplan">
          <table class="table invoice_table invoice_table1">
            <tbody>
              <tr id="theadtbl">
                <th style="min-width: 350px;">Plan/Product :</th>
                <th>Price</th>
                <th>Discount</th>
                <th>Tax(Y/N)</th>
                <th>Tax Amt</th>
                <th>Shipping</th>
                <th>Net Amount</th>
              </tr>
            </tbody>
          </table>
          <table class="table invoice_table invoice_input1" id="invoice_table-1">
            <tbody>
              <tr id="allplans">
                <td style="min-width: 350px;"><input type="text" name="planname1" id="planname1" class="form-control" placeholder="Description of service or product..."></td>
                <td><input type="text" name="amount1" id="amount1" class="form-control amount" value=""></td>
                <td><input type="text" name="discount1" id="discount1" class="form-control discount" value=""></td>
                <td>
                  <select class="form-control apply-tax" id="apply-tax1">
                    <option value="0">No</option>
                    <option value="1">Yes</option>
                  </select>
                </td>
                <td><input type="text" name="tax1" id="tax1" class="form-control tax" value=""></td>
                <td><input type="text" name="shipping1" id="shipping1" class="form-control shipping" value=""></td>
                <td><input type="text" name="netamount1" id="netamount1" class="form-control netamount" value="" readonly="readonly"></td>
              </tr>
            </tbody>
          </table>
          <table class="table invoice_table invoice_input1" style="border-top: 1px solid #8c8a8a; border-bottom: 1px solid #8c8a8a; margin-top: 25px;">
            <tbody>
              <tr id="allplans">
                <td style="min-width: 350px; font-weight: 600; padding: 8px 15px;">Sub Total</td>
                <td><input type="text" name="sub_total" id="sub_total" class="form-control amount" readonly="" style="padding-left: 4px; padding-right: 4px;"></td>
                <td><input type="text" name="total_discount" id="total_discount" class="form-control discount" readonly=""></td>
                <td> &nbsp; </td>
                <td><input type="text" name="total_tax" id="total_tax" class="form-control" value="0.00" readonly=""></td>
                <td><input type="text" name="total_shipping" id="total_shipping" class="form-control" readonly=""></td>
                <td><input type="text" name="total_net_amount" id="total_net_amount" class="form-control netamount" value="" readonly="readonly"></td>
              </tr>
            </tbody>
          </table>
        </div>
      </div>
      <table class="table float-right" style="border:none;">
        <tbody>
          <tr>
            <td class="border_bottomNone" style="border:none;">
              <p id="calculateprice" class="btn btn-sm btn-info float-right">Calculate Price</p>
            </td>
          </tr>
        </tbody>
      </table>
      <table class="table subtotal_table">
        <tbody>
          <tr>
            <td rowspan="5">
              <textarea name="plan_description" cols="8" placeholder="Decription" class="form-control"></textarea>
            </td>
          </tr>
          <!-- <tr>
                            <td style="padding-right: 15px;">Subtotal: </td>
                            <td><input type="text" name="sub_total" class="form-control" id="subtotal" readonly="readonly" value=""></td>
                        </tr>
                        <tr>
                            <td style="padding-right: 15px;">Total Discount: </td>
                            <td><input type="text" name="total_discount" class="form-control" id="total_discount" readonly="readonly" value=""></td>
                        </tr> -->
        </tbody>
      </table>
      <table class="table invoice_total">
        <tbody>
          <tr>
            <td>
              <table class="table">
                <tbody>
                  <tr>
                    <td width="80%" style="padding-right: 15px;">Invoice Total: </td>
                    <td width="20%"><input name="invoice_total" id="invoice_total" type="text" required="true" class="form-control" readonly="readonly" aria-required="true"></td>
                  </tr>
                </tbody>
              </table>
            </td>
          </tr>
        </tbody>
      </table>
    </div>
  </div>
  <footer>
    <div class="container">
      <div class="row">
        <div class="" style="width:100%;">
          <button type="button" name="generateBtn" class="btn btn-success btn-lg float-right" id="generateBtn">Generate Invoice</button>
          <br><br><br><br><br><br>
        </div>
      </div>
    </div>
  </footer>
</form>

Text Content

Support Nerds Inc
72 Pottstown Pike
Unit 102
Chester Springs, PA-19425

Invoice#

Bill To : Invoice : Cust Name : Invoice Date : Address : Due Date : Phone Number
: Cust Id : Email Id : State : Alabama (AL) Alaska (AK) Arizona (AZ) Arkansas
(AR) California (CA) Colorado (CO) Connecticut (CT) Delaware (DE) District of
Columbia (DC) Florida (FL) Georgia (GA) Hawaii (HI) Idaho (ID) Illinois (IL)
Indiana (IN) Iowa (IA) Kansas (KS) Kentucky (KY) Louisiana (LA) Maine (ME)
Maryland (MD) Massachusetts (MA) Michigan (MI) Minnesota (MN) Mississippi (MS)
Missouri (MO) Montana (MT) Nebraska (NE) Nevada (NV) New Hampshire (NH) New
Jersey (NJ) New Mexico (NM) New York (NY) North Carolina (NC) North Dakota (ND)
Ohio (OH) Oklahoma (OK) Oregon (OR) Pennsylvania (PA) Puerto Rico (PR) Rhode
Island (RI) South Carolina (SC) South Dakota (SD) Tennessee (TN) Texas (TX) Utah
(UT) Vermont (VT) Virginia (VA) Washington (WA) West Virginia (WV) Wisconsin
(WI) Wyoming (WY) Alberta British Columbia Manitoba New Brunswick Newfoundland
and Labrador Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan
Northwest Territories Nunavut Yukon



Add more plan

Plan/Product : Price Discount Tax(Y/N) Tax Amt Shipping Net Amount

No Yes

Sub Total  

Calculate Price



Invoice Total:

Generate Invoice