payments.bearfoxmarketing.com Open in urlscan Pro
89.117.22.227  Public Scan

Form analysis
1 forms found in the DOM

POST https://payment.bearfoxmarketing.com/index2.php

<form id="payment-gateway-form" method="post" action="https://payment.bearfoxmarketing.com/index2.php" class="form-horizontal" role="form">
  <input type="hidden" name="page" value="Submit Info">
  <div id="bear_fox_logo_container"><img src="logo.png"></div>
  <div id="payment_form_instructions_title">Bear Fox Marketing Payment Gateway</div>
  <div id="payment_form_instructions">
    <p>Thanks for using our secure payment gateway. Please fill out the fields below.</p>
  </div>
  <div id="error_message" class="status_message required" style="display:none;">Please fill in the required fields below prior to submission.</div>
  <div id="success_message" class="status_message" style="display:none;">Your payment information has successfully been sent.</div>
  <div id="options_container">
    <div class="container">
      <fieldset>
        <legend>
          <h1 class="form-top">ACH Payment (recommended)</h1>
        </legend>
        <div class="payment_method_verbage">Bear Fox offers direct ACH billing with your bank. Invoices are sent to you and then processed automatically via bank ACH.</div>
        <div class="form-group who_am_i">
          <label class="col-sm-3 control-label" for="company-name">Username</label>
          <div class="col-sm-9">
            <input type="text" class="form-control" name="username" id="username" placeholder="Username">
          </div>
        </div>
        <div class="form-group">
          <label class="col-sm-3 control-label" for="company-name">Name</label>
          <div class="col-sm-9">
            <input type="text" class="form-control" name="company-name" id="company-name" placeholder="Company Name">
          </div>
        </div>
        <div class="form-group">
          <label class="col-sm-3 control-label" for="address1-ach">Address</label>
          <div class="col-sm-9">
            <input type="text" class="form-control" name="address1-ach" id="address1-ach" placeholder="Street Address">
          </div>
        </div>
        <div class="form-group">
          <label class="col-sm-3 control-label" for="address2-ach"></label>
          <div class="col-sm-9">
            <input type="text" class="form-control" name="address2-ach" id="address2-ach">
          </div>
        </div>
        <div class="form-group">
          <label class="col-sm-3 control-label" for="city-state-ach"></label>
          <div class="col-sm-9">
            <div class="row">
              <div class="col-xs-8">
                <input type="text" class="form-control" name="city-ach" id="city-ach" placeholder="City">
              </div>
              <div class="col-xs-4">
                <input type="text" class="form-control" name="state-ach" id="state-ach" placeholder="State">
              </div>
            </div>
          </div>
        </div>
        <div class="form-group">
          <label class="col-sm-3 control-label" for="zip-ach"></label>
          <div class="col-sm-4">
            <input type="text" class="form-control" name="zip_code-ach" id="zip_code-ach" placeholder="Zip Code">
          </div>
        </div>
        <div class="form-group">
          <label class="col-sm-3 control-label" for="bank-name">Bank</label>
          <div class="col-sm-9">
            <input type="text" class="form-control" name="bank-name" id="bank-name" placeholder="Bank Name">
          </div>
        </div>
        <div class="form-group">
          <label class="col-sm-3 control-label" for="card-number">Routing #</label>
          <div class="col-sm-9">
            <input type="text" class="form-control" name="routing-number" id="routing-number" placeholder="Routing Number">
          </div>
        </div>
        <div class="form-group">
          <label class="col-sm-3 control-label" for="card-number">Account #</label>
          <div class="col-sm-9">
            <input type="text" class="form-control" name="account-number" id="account-number" placeholder="Account Number">
          </div>
        </div>
      </fieldset>
    </div>
    <div class="container">
      <fieldset>
        <legend>
          <h1 class="form-top">Credit Card</h1>
        </legend>
        <div class="payment_method_verbage">If you will be doing online advertising, please include your credit card information here so that we can set this up for automatic direct billing.<br>&nbsp;</div>
        <div class="form-group">
          <label class="col-sm-3 control-label" for="card-holder-name">Name</label>
          <div class="col-sm-9">
            <input type="text" class="form-control" name="card-holder-name" id="card-holder-name" placeholder="Card Holder's Name">
          </div>
        </div>
        <div class="form-group">
          <label class="col-sm-3 control-label" for="address1">Address</label>
          <div class="col-sm-9">
            <input type="text" class="form-control" name="address1" id="address1" placeholder="Street Address">
          </div>
        </div>
        <div class="form-group">
          <label class="col-sm-3 control-label" for="address2"></label>
          <div class="col-sm-9">
            <input type="text" class="form-control" name="address2" id="address2">
          </div>
        </div>
        <div class="form-group">
          <label class="col-sm-3 control-label" for="city-state"></label>
          <div class="col-sm-9">
            <div class="row">
              <div class="col-xs-8">
                <input type="text" class="form-control" name="city" id="city" placeholder="City">
              </div>
              <div class="col-xs-4">
                <input type="text" class="form-control" name="state" id="state" placeholder="State">
              </div>
            </div>
          </div>
        </div>
        <div class="form-group">
          <label class="col-sm-3 control-label" for="zip"></label>
          <div class="col-sm-4">
            <input type="text" class="form-control" name="zip_code" id="zip_code" placeholder="Zip Code">
          </div>
        </div>
        <div class="form-group">
          <label class="col-sm-3 control-label" for="card-number">Number</label>
          <div class="col-sm-9">
            <input type="text" class="form-control" name="card-number" id="card-number" placeholder="Debit/Credit Card Number">
          </div>
        </div>
        <div class="form-group">
          <label class="col-sm-3 control-label" for="expiry-month">Expiration</label>
          <div class="col-sm-9">
            <div class="row">
              <div class="col-xs-6">
                <select class="form-control col-sm-2" name="expiry-month" id="expiry-month">
                  <option value="">Month</option>
                  <option value="01">Jan (01)</option>
                  <option value="02">Feb (02)</option>
                  <option value="03">Mar (03)</option>
                  <option value="04">Apr (04)</option>
                  <option value="05">May (05)</option>
                  <option value="06">June (06)</option>
                  <option value="07">July (07)</option>
                  <option value="08">Aug (08)</option>
                  <option value="09">Sep (09)</option>
                  <option value="10">Oct (10)</option>
                  <option value="11">Nov (11)</option>
                  <option value="12">Dec (12)</option>
                </select>
              </div>
              <div class="col-xs-6">
                <select class="form-control col-sm-2" name="expiry-year" id="expiry-year">
                  <option value="">Year</option>
                  <option value="24">2024</option>
                  <option value="25">2025</option>
                  <option value="26">2026</option>
                  <option value="27">2027</option>
                  <option value="28">2028</option>
                  <option value="29">2029</option>
                  <option value="30">2030</option>
                  <option value="31">2031</option>
                </select>
              </div>
            </div>
          </div>
        </div>
        <div class="form-group">
          <label class="col-sm-3 control-label" for="cvv">Card CVV</label>
          <div class="col-sm-6">
            <input type="text" class="form-control" name="cvv" id="cvv" placeholder="Security Code">
          </div>
        </div>
      </fieldset>
    </div>
    <!-- <div class="or_container"><div class="inner_or_container">OR</div></div> -->
    <div class="container2">
      <fieldset>
        <legend>
          <h1 class="form-top">Preferences</h1>
        </legend>
        <div class="payment_method_verbage2">To what email should invoices be sent?</div>
        <div class="form-group">
          <textarea id="email-preference" class="form-control" name="email-preference" rows="3"></textarea>
        </div>
        <div style="height:10px;"></div>
        <div class="payment_method_verbage2">For agency fees, what is your preferred method of payment, <u><b>Bank ACH or Credit Card</b></u>? Note that if agency fees are billed by credit card (Stripe, Square, etc.) a 3.5% processing fee will be
          added to the invoice.</div>
        <div class="form-group">
          <textarea id="set-up-fee-preference" class="form-control" name="set-up-fee-preference" rows="3"></textarea>
        </div>
      </fieldset>
    </div>
  </div>
</form>

Text Content

Bear Fox Marketing Payment Gateway

Thanks for using our secure payment gateway. Please fill out the fields below.

Please fill in the required fields below prior to submission.
Your payment information has successfully been sent.


ACH PAYMENT (RECOMMENDED)

Bear Fox offers direct ACH billing with your bank. Invoices are sent to you and
then processed automatically via bank ACH.
Username

Name

Address




Bank

Routing #

Account #



CREDIT CARD

If you will be doing online advertising, please include your credit card
information here so that we can set this up for automatic direct billing.
 
Name

Address




Number

Expiration
Month Jan (01) Feb (02) Mar (03) Apr (04) May (05) June (06) July (07) Aug (08)
Sep (09) Oct (10) Nov (11) Dec (12)
Year 20242025202620272028202920302031
Card CVV



PREFERENCES

To what email should invoices be sent?


For agency fees, what is your preferred method of payment, Bank ACH or Credit
Card? Note that if agency fees are billed by credit card (Stripe, Square, etc.)
a 3.5% processing fee will be added to the invoice.

Send Payment Info