www.payment.bumdes-sukaharja.com Open in urlscan Pro
103.163.138.3  Public Scan

Form analysis
1 forms found in the DOM

POST https://www.payment.bumdes-sukaharja.com/payment/checking

<form id="payment-form" method="post" action="https://www.payment.bumdes-sukaharja.com/payment/checking">
  <input type="hidden" name="result_type" id="result-type" value="">
  <input type="hidden" name="result_data" id="result-data" value="">
  <div align="center">
    <img src="https://www.payment.bumdes-sukaharja.com/asset/images/header.png" style="max-width: 200px;">
  </div>
  <h3><b>Online Payment</b></h3>
  <hr>
  <input type="hidden" id="id_tagihan" class="form-control" name="id_tagihan">
  <div class="form-wrapper">
    <label for="">Nomor Tagihan</label>
    <input type="text" id="no_tagihan" class="form-control" name="no_tagihan" value="2022050057">
  </div>
  <div class="form-group">
    <div class="form-wrapper">
      <label for="">Nama Langkap</label>
      <input type="text" id="nama_lengkap" name="nama_lengkap" class="form-control read_data" readonly="">
    </div>
    <div class="form-wrapper">
      <label for="">No.Tlp</label>
      <input type="text" id="telp" name="telp" class="form-control read_data" readonly="">
    </div>
  </div>
  <div class="form-wrapper">
    <label for="">Nama Layanan</label>
    <input type="text" id="nama_layanan" class="form-control read_data" name="nama_layanan" readonly="">
  </div>
  <div class="form-wrapper">
    <label for="">Harga Paket</label>
    <input type="text" id="biaya_tagihan" name="biaya_tagihan" class="form-control read_data" readonly="">
  </div>
  <div class="form-wrapper">
    <label for="">Biaya Pajak</label>
    <input type="text" id="biaya_pajak" name="biaya_pajak" class="form-control read_data" readonly="">
  </div>
  <div class="form-wrapper">
    <label for="">Alamat</label>
    <input type="text" id="alamat" class="form-control read_data" name="alamat" readonly="">
  </div>
  <button id="pay-button">Pembayaran</button>
</form>

Text Content

ONLINE PAYMENT

--------------------------------------------------------------------------------

Nomor Tagihan
Nama Langkap
No.Tlp
Nama Layanan
Harga Paket
Biaya Pajak
Alamat
Pembayaran