securepayment.xyberix.co Open in urlscan Pro
191.101.230.165  Public Scan

Form analysis
1 forms found in the DOM

POST https://securepayment.xyberix.co/process/payment

<form action="https://securepayment.xyberix.co/process/payment" method="post">
  <input type="hidden" name="_token" value="UNZXdnrO3zgWRu2WZ9b2NVdlA4BTxWuE9NNQuKkn" autocomplete="off"> <input type="hidden" id="hiddenprice" name="price" value="2995.00">
  <div class="row">
    <div class="col-md-6 mb-3">
      <label for="firstName">First name <span class="text-danger">*</span></label>
      <input type="text" class="form-control " name="firstName" id="firstName" placeholder="First Name">
    </div>
    <div class="col-md-6 mb-3">
      <label for="lastName">Last name <span class="text-danger">*</span></label>
      <input type="text" class="form-control " id="lastName" name="lastName" placeholder="Last Name">
    </div>
  </div>
  <div class="mb-3">
    <label for="email">Email <span class="text-danger">*</span></label>
    <input type="email" class="form-control  " name="email" id="email" placeholder="you@example.com">
  </div>
  <div class="mb-3">
    <label for="address">Address <span class="text-danger">*</span></label>
    <input type="text" class="form-control " name="address" id="address" placeholder="1234 Main St">
  </div>
  <div class="mb-3">
    <label for="company">Company <span class="text-muted">(optional)</span></label>
    <input type="text" class="form-control " name="company" id="company" placeholder="Company Name">
  </div>
  <div class="mb-3">
    <label for="country">Country <span class="text-danger">*</span></label>
    <input type="text" class="form-control " name="country" id="country" placeholder="Country Name">
  </div>
  <div class="row">
    <div class="col-md-5 mb-3">
      <label for="city">City <span class="text-danger">*</span></label>
      <input class="form-control " name="city" placeholder="City Name" id="city">
    </div>
    <div class="col-md-4 mb-3">
      <label for="state">State <span class="text-danger">*</span></label>
      <input class="form-control  " name="state" placeholder="State Name" id="state">
    </div>
    <div class="col-md-3 mb-3">
      <label for="zip">Zip <span class="text-danger">*</span></label>
      <input type="number" name="zip" class="form-control " id="zip" placeholder="Zip Code">
    </div>
  </div>
  <hr class="mb-4">
  <h4 class="mb-3">Payment Information</h4>
  <div class="row mx-1">
    <img class="d-block mx-1 mb-4" src="https://secure.authorize.net/gateway/content/V.gif" alt="Visa">
    <img class="d-block mx-1  mb-4" src="https://secure.authorize.net/gateway/content/MC.gif" alt="Mastercard">
    <img class="d-block mx-1  mb-4" src="https://secure.authorize.net/gateway/content/Amex.gif" alt="Amex">
    <img class="d-block mx-1 mb-4" src="https://secure.authorize.net/gateway/content/Disc.gif" alt="Disc">
    <img class="d-block mx-1 mb-4" src="https://secure.authorize.net/gateway/content/JCB.gif" alt="JCB">
  </div>
  <div class="row">
    <div class="col-md-4 mb-3">
      <label for="ccname">Name on card</label>
      <input type="text" class="form-control " id="ccname" placeholder="Card Name">
      <small class="text-muted">Full name as displayed on card</small>
    </div>
    <div class="col-md-4 mb-3">
      <label for="ccnumber">Credit card number</label>
      <input type="number" class="form-control " id="ccnumber" name="cardNumber" placeholder="xxxxxxxxxxxxxxxx">
    </div>
    <div class="col-md-4 mb-3">
      <label for="amount">Amount</label>
      <input type="number" class="form-control" id="amount" name="amount" placeholder="Enter Amount">
    </div>
  </div>
  <div class="row">
    <div class="col-md-3 mb-3">
      <label for="cc-expiration">Expiration</label>
      <input type="text" class="form-control " id="cc-expiration" name="expirationDate" placeholder="YYYY-MM">
    </div>
    <div class="col-md-3 mb-3">
      <label for="cc-cvv">CVV</label>
      <input type="number" class="form-control  " name="cardCode" id="cc-cvv" placeholder="CVV">
    </div>
  </div>
  <hr class="mb-4">
  <button class="btn btn-primary btn-lg btn-block" type="submit">Proceed</button>
</form>

Text Content

CHECKOUT FORM

Please Enter Your Card Details Below

PRODUCT DETAIL

 * ITEM
   
   TBH1CondoWeeks
   $2995.00

 * DESCRIPTION
   
   LIFETIME (1 Condo Week) TBH (1 Condo Week)

 * QTY
   
   1

 * TAXABLE
   
   N
 * Total (USD) $2995.00
   Code
   Remove Coupon

BILLING INFORMATION

First name *
Last name *
Email *
Address *
Company (optional)
Country *
City *
State *
Zip *

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

PAYMENT INFORMATION


Name on card Full name as displayed on card
Credit card number
Amount
Expiration
CVV

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

Proceed

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