policypayments.takniki.com Open in urlscan Pro
64.64.25.213  Public Scan

Form analysis
1 forms found in the DOM

policy-payment.php

<form action="policy-payment.php">
  <!--row -->
  <div class="row " style="margin-top:10px;">
    <!-- col -->
    <div class="col-lg-3 col-md-6" style="background-color: #8080801f;padding:10px;">
      <div class="form-group">
        <label style="font-size: 13px;font-weight: normal;">Policy Payment ID <span style="color:red;">*</span> </label>
        <a id="policypaymentidinfo" class="screenshot" style="color:#2F6999;font-size: 13px;" title="What is this?" onclick="check_policyid()" rel="images/policypaymentid.png" href="#"><u>What is this?</u></a>
        <input type="text" style="font-size: 13px;max-width: 250px" class="form-control" placeholder="Policy Payment ID">
      </div>
    </div>
    <!-- /col -->
    <!-- col -->
    <div class="col-lg-9 col-md-6" style="background-color: #8080801f;padding:10px;">
      <div class="form-group">
        <label style="font-size: 13px;font-weight: normal;">Postal Code <span style="color:red;">*</span></label>
        <input type="text" style="font-size: 13px;max-width: 250px;" class="form-control" placeholder="Postal Code">
      </div>
    </div>
    <!-- /col -->
    <!-- col -->
  </div>
  <div class="row" style="margin-top:10px;">
    <div class="col-lg-11"></div>
    <div class="col-lg-1">
      <div class="banner-form-btn">
        <button type="submit" class="btn theme-btn-1 width-50" style="background: #065172 !important;"> Next </button>
      </div>
    </div>
    <!-- /col -->
  </div>
  <!-- /row -->
</form>

Text Content

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Français


Conveniently make a payment for your insurance policy.

Policy Payment ID * What is this?
Postal Code *
Next

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