app.staxpayments.com
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Submitted URL: https://paymnt.io/2g4Xnc
Effective URL: https://app.staxpayments.com/
Submission: On April 07 via manual from IN — Scanned from DE
Effective URL: https://app.staxpayments.com/
Submission: On April 07 via manual from IN — Scanned from DE
Form analysis 1 forms found in the DOM
<form id="external-payment-form">
<div class="ui-form">
<fieldset class="amount-field-component__AmountContainer-sc-19pwqt5-0 hwCqcJ amount-group-container ui-field">
<legend class="ui-heading">Pay Dan Kel Concrete Cutting</legend>
<div class="ui-field ui-field-full">
<div data-testid="text-field-wrapper" class="sc-HzFiz eGtcJy">
<div class="sc-iAvgwm gvUctq"><input type="text" id="external-payment-form-amount-input" data-has-prefix="false" data-has-suffix="false" placeholder="$0.00" data-testid="external-payment-form-amount-input"
class="sc-iTONeN ddMvuy ui-input ui-input-amount amount-large" value=""></div>
</div>
</div>
</fieldset>
</div>
<div id="external-payment-container">
<div id="external-payment-content" class="external-payment-content">
<div class="ui-field">
<h2 class="ui-heading">Additional Information</h2>
<div class="ui-field"><label class="ui-label " for="memo-field">Note to Dan Kel Concrete Cutting </label><textarea name="memo" type="text" class="ui-input" id="memo" data-testid="memo"></textarea></div>
</div>
<h2 class="ui-heading">Payment Method</h2>
<div class="payment-method-choices">
<div id="paypal-button-container" data-testid="paypal-button-container"></div>
<div class="ui-field payment-method-choice"><label for="methodcard" class="ui-radio-label -full">
<div class="method-fields-component__RadioContainer-sc-1qxvui3-1 fKSfXU"><label class="sc-ikjQzJ fFKhHd" style="border-color: rgb(185, 59, 228);"><input type="radio" id="methodcard" data-testid="method-card-radio-selection" class=""
name="method" value="card"><span class="sc-tsFYE gXHvQM check-mark"></span></label><span class="method-fields-component__RadioLabel-sc-1qxvui3-0 eQIcdL">Credit Card</span></div>
<div class="ui-image external-payment-form-payment-method-card-images"><img class="ui-image" src="src/svg/visa.svg"><img class="ui-image" src="src/svg/dinersclub.svg"><img class="ui-image" src="src/svg/amex.svg"><img class="ui-image"
src="src/svg/discover.svg"><img class="ui-image" src="src/svg/mastercard.svg"><img class="ui-image" src="src/svg/jcb.svg"></div>
</label></div>
<div class="payment-method-details">
<div class="ui-field"><label class="ui-label -required">Card Number</label><span class="ui-input-group">
<div id="card_number" data-testid="external-payment-form-card-number" class="ui-input" style="background-color: rgb(255, 255, 255);"><iframe sandbox="allow-scripts allow-same-origin" frameborder="0" width="100%" height="100%"
scrolling="no" id="spreedly-number-frame-2049" name="spreedly-number-frame-2049" src="https://core.spreedly.com/v1/embedded/number-frame-1.103.html"></iframe></div><span
style="width: 32px; background-color: rgb(242, 242, 242);"><span class="sc-bczRLJ cUjTnM"><svg aria-hidden="true" focusable="false" data-prefix="fas" data-icon="lock" class="svg-inline--fa fa-lock fa-w-14 " role="img"
xmlns="http://www.w3.org/2000/svg" viewBox="0 0 448 512" style="font-size: 14px; font-weight: 900; color: rgb(0, 155, 242);">
<path fill="currentColor"
d="M400 224h-24v-72C376 68.2 307.8 0 224 0S72 68.2 72 152v72H48c-26.5 0-48 21.5-48 48v192c0 26.5 21.5 48 48 48h352c26.5 0 48-21.5 48-48V272c0-26.5-21.5-48-48-48zm-104 0H152v-72c0-39.7 32.3-72 72-72s72 32.3 72 72v72z"></path>
</svg></span></span>
</span></div>
<div class="ui-field -half"><label class="ui-label -required" for="card_exp-field">Expiration (MM/YY) </label><input name="card_exp" type="text" id="external-payment-form-expiration" data-testid="external-payment-form-expiration"
class="ui-input" value=""></div>
<div class="ui-field -half"><label class="ui-label -required">CVV</label>
<div id="card_cvv" data-testid="external-payment-form-cvv" class="ui-input"><iframe sandbox="allow-scripts allow-same-origin" frameborder="0" width="100%" height="100%" scrolling="no" id="spreedly-cvv-frame-2049"
name="spreedly-cvv-frame-2049" src="https://core.spreedly.com/v1/embedded/cvv-frame-1.103.html"></iframe></div>
</div>
</div>
<div class="ui-field payment-method-choice"><label for="methodbank" class="ui-radio-label -full">
<div class="method-fields-component__RadioContainer-sc-1qxvui3-1 fKSfXU"><label class="sc-ikjQzJ fFKhHd" style="border-color: rgb(189, 201, 204);"><input type="radio" id="methodbank" data-testid="method-bank-radio-selection" class=""
name="method" value="bank"><span class="sc-tsFYE gXHvQM check-mark"></span></label><span class="method-fields-component__RadioLabel-sc-1qxvui3-0 eQIcdL">Bank Account</span></div>
<div style="margin-left: auto; padding-right: 1rem;"><span class="sc-bczRLJ cUjTnM"><svg aria-hidden="true" focusable="false" data-prefix="fas" data-icon="landmark" class="svg-inline--fa fa-landmark fa-w-16 " role="img"
xmlns="http://www.w3.org/2000/svg" viewBox="0 0 512 512" style="font-size: 14px;">
<path fill="currentColor"
d="M501.62 92.11L267.24 2.04a31.958 31.958 0 0 0-22.47 0L10.38 92.11A16.001 16.001 0 0 0 0 107.09V144c0 8.84 7.16 16 16 16h480c8.84 0 16-7.16 16-16v-36.91c0-6.67-4.14-12.64-10.38-14.98zM64 192v160H48c-8.84 0-16 7.16-16 16v48h448v-48c0-8.84-7.16-16-16-16h-16V192h-64v160h-96V192h-64v160h-96V192H64zm432 256H16c-8.84 0-16 7.16-16 16v32c0 8.84 7.16 16 16 16h480c8.84 0 16-7.16 16-16v-32c0-8.84-7.16-16-16-16z">
</path>
</svg></span></div>
</label></div>
</div>
<div class="ui-form">
<h2 class="ui-heading">Billing Details
<hr>
</h2>
<div class="ui-field -half"><label class="ui-label -required" for="firstname-field">First Name </label><input name="firstname" type="text" id="external-payment-form-first-name" data-testid="external-payment-form-first-name" class="ui-input"
value=""></div>
<div class="ui-field -half"><label class="ui-label -required" for="lastname-field">Last Name </label><input name="lastname" type="text" id="external-payment-form-last-name" data-testid="external-payment-form-last-name" class="ui-input"
value=""></div>
<div class="ui-field"><label class="ui-label " for="company-field">Company Name </label><input name="company" type="text" class="ui-input" value=""></div>
<div class="ui-field -half"><label class="ui-label -required" for="phone-field">Phone <i class="zmdi zmdi-info"></i></label><input name="phone" type="text" id="external-payment-form-phone" data-testid="external-payment-form-phone"
class="ui-input" value="">
<div class="billing-details-fields-component__OptInMessageContainer-sc-b8076i-1 dsSUzS">By entering your phone number, you are consenting to receiving SMS messages from this merchant.</div>
</div>
<div class="ui-field -half"><label class="ui-label " for="email-field">Email Address </label><input name="email" type="text" id="external-payment-form-email" data-testid="external-payment-form-email" class="ui-input" value=""></div>
<div class="ui-field -half"><label class="ui-label -required" data-testid="external-payment-form-address1-label">Billing Address</label><input name="address_1" type="text" id="external-payment-form-address1"
data-testid="external-payment-form-address1" class="ui-input" value=""></div>
<div class="ui-field -half"><label class="ui-label" data-testid="external-payment-form-address2-label">Address Line 2</label><input name="address_2" type="text" id="external-payment-form-address2" data-testid="external-payment-form-address2"
class="ui-input" value=""></div>
<div class="ui-field -half"><label class="ui-label -required" data-testid="external-payment-form-zip-label">Billing Postal/Zip Code</label><input name="address_zip" type="text" id="external-payment-form-zip"
data-testid="external-payment-form-zip" class="ui-input" value=""></div>
<div class="ui-field -half"><label class="ui-label -required" data-testid="external-payment-form-city-label">City</label><input name="address_city" type="text" id="external-payment-form-city" data-testid="external-payment-form-city"
class="ui-input" value=""></div>
<div class="ui-field -half"><label class="ui-label -required" data-testid="external-payment-form-country-label">Country</label>
<div class="ui-input truffle-select css-ywqs4m-container"><span aria-live="polite" aria-atomic="false" aria-relevant="additions text" class="css-7pg0cj-a11yText"></span>
<div class="truffle-select__control css-13lradr-control">
<div class="truffle-select__value-container truffle-select__value-container--has-value css-9evde0">
<div class="truffle-select__single-value css-ek5b1u-singleValue">United States</div>
<div class="css-160am7f">
<div class="truffle-select__input" style="display: inline-block;"><input autocapitalize="none" autocomplete="off" autocorrect="off" id="react-select-2-input" spellcheck="false" tabindex="0" type="text" aria-autocomplete="list"
value="" style="box-sizing: content-box; width: 2px; background: 0px center; border: 0px; font-size: inherit; opacity: 1; outline: 0px; padding: 0px; color: inherit;">
<div
style="position: absolute; top: 0px; left: 0px; visibility: hidden; height: 0px; overflow: scroll; white-space: pre; font-size: 14px; font-family: Roboto, AvenirNextLTW01-Regular, sans-serif; font-weight: 400; font-style: normal; letter-spacing: normal; text-transform: none;">
</div>
</div>
</div>
</div>
<div class="truffle-select__indicators css-16xrvgo">
<div class="truffle-select__indicator truffle-select__clear-indicator css-1bh6db4-indicatorContainer" aria-hidden="true"><span class="sc-bczRLJ cUjTnM"><svg aria-hidden="true" focusable="false" data-prefix="fas" data-icon="times"
class="svg-inline--fa fa-times fa-w-11 " role="img" xmlns="http://www.w3.org/2000/svg" viewBox="0 0 352 512">
<path fill="currentColor"
d="M242.72 256l100.07-100.07c12.28-12.28 12.28-32.19 0-44.48l-22.24-22.24c-12.28-12.28-32.19-12.28-44.48 0L176 189.28 75.93 89.21c-12.28-12.28-32.19-12.28-44.48 0L9.21 111.45c-12.28 12.28-12.28 32.19 0 44.48L109.28 256 9.21 356.07c-12.28 12.28-12.28 32.19 0 44.48l22.24 22.24c12.28 12.28 32.2 12.28 44.48 0L176 322.72l100.07 100.07c12.28 12.28 32.2 12.28 44.48 0l22.24-22.24c12.28-12.28 12.28-32.19 0-44.48L242.72 256z">
</path>
</svg></span></div><span class="truffle-select__indicator-separator css-43ykx9-indicatorSeparator"></span>
<div class="truffle-select__indicator truffle-select__dropdown-indicator css-1o0wxyi-indicatorContainer" aria-hidden="true"><span class="sc-bczRLJ cUjTnM"><svg aria-hidden="true" focusable="false" data-prefix="fas"
data-icon="caret-down" class="svg-inline--fa fa-caret-down fa-w-10 " role="img" xmlns="http://www.w3.org/2000/svg" viewBox="0 0 320 512">
<path fill="currentColor" d="M31.3 192h257.3c17.8 0 26.7 21.5 14.1 34.1L174.1 354.8c-7.8 7.8-20.5 7.8-28.3 0L17.2 226.1C4.6 213.5 13.5 192 31.3 192z"></path>
</svg></span></div>
</div>
</div><input name="address_country" type="hidden" value="USA">
</div>
</div>
<div class="ui-field -half"><label class="ui-label -required" data-testid="external-payment-form-state-label" id="external-payment-form-state">State</label>
<div class="ui-input truffle-select css-ywqs4m-container" id="external-payment-form-state"><span aria-live="polite" aria-atomic="false" aria-relevant="additions text" class="css-7pg0cj-a11yText"></span>
<div class="truffle-select__control css-13lradr-control">
<div class="truffle-select__value-container css-9evde0">
<div class="truffle-select__placeholder css-lh34pp-placeholder">Select...</div>
<div class="css-160am7f">
<div class="truffle-select__input" style="display: inline-block;"><input autocapitalize="none" autocomplete="off" autocorrect="off" id="react-select-3-input" spellcheck="false" tabindex="0" type="text" aria-autocomplete="list"
aria-labelledby="external-payment-form-state" value="" style="box-sizing: content-box; width: 2px; background: 0px center; border: 0px; font-size: inherit; opacity: 1; outline: 0px; padding: 0px; color: inherit;">
<div
style="position: absolute; top: 0px; left: 0px; visibility: hidden; height: 0px; overflow: scroll; white-space: pre; font-size: 14px; font-family: Roboto, AvenirNextLTW01-Regular, sans-serif; font-weight: 400; font-style: normal; letter-spacing: normal; text-transform: none;">
</div>
</div>
</div>
</div>
<div class="truffle-select__indicators css-16xrvgo"><span class="truffle-select__indicator-separator css-43ykx9-indicatorSeparator"></span>
<div class="truffle-select__indicator truffle-select__dropdown-indicator css-1o0wxyi-indicatorContainer" aria-hidden="true"><span class="sc-bczRLJ cUjTnM"><svg aria-hidden="true" focusable="false" data-prefix="fas"
data-icon="caret-down" class="svg-inline--fa fa-caret-down fa-w-10 " role="img" xmlns="http://www.w3.org/2000/svg" viewBox="0 0 320 512">
<path fill="currentColor" d="M31.3 192h257.3c17.8 0 26.7 21.5 14.1 34.1L174.1 354.8c-7.8 7.8-20.5 7.8-28.3 0L17.2 226.1C4.6 213.5 13.5 192 31.3 192z"></path>
</svg></span></div>
</div>
</div><input name="address_state" type="hidden" value="">
</div>
</div>
</div>
<div class="ui-form submit-button-group-container"><button data-trackingid="external-payment-form-submit-payment-button" id="external-payment-form-submit-payment-button" data-testid="external-payment-form-submit-payment-button" type="submit"
class="sc-gsnTZi ejVdGg sc-hKMtZM hGuStc" disabled=""><i class="zmdi zmdi-lock-outline" style="padding-right: 8px;"></i><span class="ui-text">Pay $0.00</span></button>
<div data-testid="submit-description" style="text-align: center;">
<p class="ui-subtext" style="text-align: center;">By clicking this button, you authorize Dan Kel Concrete Cutting to charge your card.</p>
<div id="reCAPTCHA-terms" data-testid="reCAPTCHA-terms" class="recaptcha-terms-component__Container-sc-1n61wmz-0 dhCrdB">This site is protected by reCAPTCHA and the Google
<a href="https://policies.google.com/privacy" target="_blank">Privacy Policy</a> and <a href="https://policies.google.com/terms" target="_blank">Terms of Service</a> apply.</div>
</div>
</div>
</div>
</div>
</form>Text Content
DAN KEL CONCRETE CUTTING 3550 Water Tower Road Longs, SC 29568 Melissa@dankelconcrete.com (843) 449-0199 Pay Dan Kel Concrete Cutting ADDITIONAL INFORMATION Note to Dan Kel Concrete Cutting PAYMENT METHOD Credit Card Card Number Expiration (MM/YY) CVV Bank Account BILLING DETAILS -------------------------------------------------------------------------------- First Name Last Name Company Name Phone By entering your phone number, you are consenting to receiving SMS messages from this merchant. Email Address Billing Address Address Line 2 Billing Postal/Zip Code City Country United States State Select... Pay $0.00 By clicking this button, you authorize Dan Kel Concrete Cutting to charge your card. This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.