payment.bhs.edu.lb Open in urlscan Pro
160.153.53.97  Public Scan

Form analysis
1 forms found in the DOM

Name: firststep — POST index.php?loc=checkinfo

<form action="index.php?loc=checkinfo" autocomplete="off" name="firststep" onsubmit="keypress_merge(); return formCheck(this) &amp;&amp; ValidateForm();" method="post" class="mb-5">
  <fieldset class="form-group">
    <legend>Payment</legend>
    <div class="row">
      <div class="col-md-6 mb-3">
        <label for="reason">Reason for payment <span style="color:red;"><b>*</b></span></label>
        <select class="form-control" id="ddlReason" name="reason">
          <option value="Bursary Fund">Bursary Fund</option>
          <option value="Teachers_Support_Staff_Fund">Teachers and Support Staff Fund</option>
          <option value="Capital Fund">Capital Fund</option>
          <option value="Unrestricted Donation">Unrestricted Donation</option>
          <option value="Transcript fees">Transcript fees</option>
          <option value="Application fees">Application Fees</option>
          <option value="Other">Other, please specify</option>
        </select>
        <input style="display:none" type="text" class="form-control" name="reasontext" id="reasontext" size="30" value=" ">
      </div>
      <div class="col-md-6 mb-3">
        <label for="city">Please specify the amount of money you wish to pay (USD)<span style="color:red;"><b> *</b></span> </label>
        <input type="text" onkeypress="return isNumberKey(event); " class="form-control" name="amounttopay" id="ts" size="40" value="">
      </div>
    </div>
  </fieldset>
  <fieldset class="form-group">
    <legend>Personal details</legend>
    <div class="row">
      <div class="col-md-6 mb-3">
        <label for="firstname">First name<span style="color:red;"><b> *</b></span></label>
        <input type="text" name="firstname" class="form-control" id="firstname" placeholder="First name" value="" onkeypress="firstname_count()" ;="">
      </div>
      <div class="col-md-6 mb-3">
        <label for="lastname">Last name<span style="color:red;"><b> *</b></span></label>
        <input type="text" name="lastname" class="form-control" id="lastname" placeholder="Last name" value="" onkeypress="lastname_count()" ;="">
      </div>
    </div>
    <div class="row">
      <div class="col-md-6 mb-3">
        <label for="company">Institution</label>
        <input type="text" name="company" class="form-control" id="company" placeholder="Institution" value="" onkeypress="companyname_count()" ;="">
        <small class="form-text text-muted">If paying on behalf of an institution, please put the name here.</small>
      </div>
      <div class="col-md-6 mb-3">
        <label for="phonenumber">Phone Number<span style="color:red;"><b> *</b></span></label>
        <input type="text" name="phonenumber" class="form-control" id="phonenumber" placeholder="Phone Number" value="" onkeypress="phone_count()" ;="">
        <small class="form-text text-muted">Please provide a phone number where you may be reached.<br>For security reasons, we may call to confirm information provided.</small>
      </div>
    </div>
    <div class="row">
      <div class="col-md-6 mb-3">
        <label for="email">Email Address<span style="color:red;"><b> *</b></span></label>
        <input type="text" name="email" class="form-control" id="email" placeholder="Email Address" value="" onkeypress="email_count()" ;="">
        <small class="form-text text-muted">If possible, please use a private service provider email address in preference to a webmail address such as Yahoo, Hotmail, or Gmail. This will allow us to process your payment more easily.</small>
      </div>
      <div class="col-md-6 mb-3">
        <label for="address">Full Address<span style="color:red;"><b> *</b></span></label>
        <textarea onkeypress="fulladdr_count()" class="form-control" placeholder="Full Address" name="address" id="address" style="height: 100px" rows="1" cols="20"></textarea>
      </div>
    </div>
    <div class="row">
      <div class="col-md-6 mb-3">
        <label for="address">Relationship to the School<span style="color:red;"><b> *</b></span></label>
        <select id="ddlRelation" name="relation" class="form-control">
          <option></option>
          <option value="Old Scholar">Old Scholar</option>
          <option value="Parent">Parent</option>
          <option value="Quaker">Quaker</option>
          <option value="Staff">Staff</option>
          <option value="Governor_Trustee">Governor/Trustee</option>
          <option value="Other">Other</option>
        </select>
        <label id="relationlabel" style="display: none"></label>
        <input style="display:none" class="form-control" type="text" name="relationtext" id="relationtext" size="30" value=" " <="" a="">
      </div>
    </div>
  </fieldset>
  <fieldset class="form-group">
    <legend>Credit Card Billing Information</legend>
    <div class="row">
      <div class="col-md-6 mb-3">
        <label for="issuer">Issuing Bank<span style="color:red;"><b> *</b></span></label>
        <input type="text" name="issuer" size="30" class="form-control" value="" onkeypress="issuer_count()">
        <small class="form-text text-muted">For security purposes, please enter the <u>name of the bank / institution</u> which issued your credit card. This information is usually found on the back of the credit card.</small>
      </div>
      <div class="col-md-6 mb-3">
        <label for="issuer">Country of issue<span style="color:red;"><b> *</b></span></label>
        <select name="country" class="form-control">
          <option value="1"></option>
          <option value="Algeria">Algeria</option>
          <option value="American Samoa">American Samoa</option>
          <option value="Andorra">Andorra</option>
          <option value="Angola">Angola</option>
          <option value="Anguilla">Anguilla</option>
          <option value="Antigua">Antigua</option>
          <option value="Argentina">Argentina</option>
          <option value="Armenia">Armenia</option>
          <option value="Aruba">Aruba</option>
          <option value="Australia">Australia</option>
          <option value="Austria">Austria</option>
          <option value="Azerbaijan">Azerbaijan</option>
          <option value="Babuda">Babuda</option>
          <option value="Bahamas">Bahamas</option>
          <option value="Bahrain">Bahrain</option>
          <option value="Bangladesh">Bangladesh</option>
          <option value="Barbados">Barbados</option>
          <option value="Belarus">Belarus</option>
          <option value="Belgium">Belgium</option>
          <option value="Belize">Belize</option>
          <option value="Benin">Benin</option>
          <option value="Bermuda">Bermuda</option>
          <option value="Bhutan">Bhutan</option>
          <option value="Bolivia">Bolivia</option>
          <option value="Bonaire">Bonaire</option>
          <option value="Bosnia">Bosnia</option>
          <option value="Botswana">Botswana</option>
          <option value="Brazil">Brazil</option>
          <option value="British Virgin Islands">British Virgin Islands</option>
          <option value="Brunei">Brunei</option>
          <option value="Bulgaria">Bulgaria</option>
          <option value="Burkina Faso">Burkina Faso</option>
          <option value="Burundi">Burundi</option>
          <option value="Cambodia">Cambodia</option>
          <option value="Cameroon">Cameroon</option>
          <option value="Canada">Canada</option>
          <option value="Cape Verde">Cape Verde</option>
          <option value="Cayman Islands">Cayman Islands</option>
          <option value="Central African Republic">Central African Republic</option>
          <option value="Chad">Chad</option>
          <option value="Channel Islands">Channel Islands</option>
          <option value="Chile">Chile</option>
          <option value="China">China</option>
          <option value="Colombia">Colombia</option>
          <option value="Congo">Congo</option>
          <option value="Cook Islands">Cook Islands</option>
          <option value="Costa Rica">Costa Rica</option>
          <option value="Croatia">Croatia</option>
          <option value="Curacao">Curacao</option>
          <option value="Cyprus">Cyprus</option>
          <option value="Czech Republic">Czech Republic</option>
          <option value="Denmark">Denmark</option>
          <option value="Djibouti">Djibouti</option>
          <option value="Dominica">Dominica</option>
          <option value="Dominican Republic">Dominican Republic</option>
          <option value="Ecuador">Ecuador</option>
          <option value="Egypt">Egypt</option>
          <option value="El Salvador">El Salvador</option>
          <option value="Equatorial Guinea">Equatorial Guinea</option>
          <option value="Eritrea">Eritrea</option>
          <option value="Estonia">Estonia</option>
          <option value="Ethiopia">Ethiopia</option>
          <option value="Faeroe Islands">Faeroe Islands</option>
          <option value="Fiji">Fiji</option>
          <option value="Finland">Finland</option>
          <option value="France">France</option>
          <option value="French Guiana">French Guiana</option>
          <option value="French Polynesia">French Polynesia</option>
          <option value="Gabon">Gabon</option>
          <option value="Gambia">Gambia</option>
          <option value="Georgia">Georgia</option>
          <option value="Germany">Germany</option>
          <option value="Ghana">Ghana</option>
          <option value="Gibraltar">Gibraltar</option>
          <option value="Greece">Greece</option>
          <option value="Greenland">Greenland</option>
          <option value="Grenada">Grenada</option>
          <option value="Guadeloupe">Guadeloupe</option>
          <option value="Guam">Guam</option>
          <option value="Guatemala">Guatemala</option>
          <option value="Guinea Bissau">Guinea Bissau</option>
          <option value="Guinea">Guinea</option>
          <option value="Guyana">Guyana</option>
          <option value="Haiti">Haiti</option>
          <option value="Herzegowina">Herzegowina</option>
          <option value="Honduras">Honduras</option>
          <option value="Hong Kong">Hong Kong</option>
          <option value="Hungary">Hungary</option>
          <option value="Iceland">Iceland</option>
          <option value="India">India</option>
          <option value="Indonesia">Indonesia</option>
          <option value="Iran">Iran</option>
          <option value="Iraq">Iraq</option>
          <option value="Ireland">Ireland</option>
          <option value="Italy">Italy</option>
          <option value="Ivory Coast">Ivory Coast</option>
          <option value="Jamaica">Jamaica</option>
          <option value="Japan">Japan</option>
          <option value="Jordan">Jordan</option>
          <option value="Kazakhstan">Kazakhstan</option>
          <option value="Kenya">Kenya</option>
          <option value="Kuwait">Kuwait</option>
          <option value="Laos">Laos</option>
          <option value="Latvia">Latvia</option>
          <option value="Lebanon">Lebanon</option>
          <option value="Lesotho">Lesotho</option>
          <option value="Liberia">Liberia</option>
          <option value="Liechtenstein">Liechtenstein</option>
          <option value="Lithuania">Lithuania</option>
          <option value="Luxembourg">Luxembourg</option>
          <option value="Lybia">Lybia</option>
          <option value="Macau">Macau</option>
          <option value="Macedonia">Macedonia</option>
          <option value="Madagascar">Madagascar</option>
          <option value="Malawi">Malawi</option>
          <option value="Malaysia">Malaysia</option>
          <option value="Maldives">Maldives</option>
          <option value="Mali">Mali</option>
          <option value="Malta">Malta</option>
          <option value="Marshall Islands">Marshall Islands</option>
          <option value="Martinique">Martinique</option>
          <option value="Mauritania">Mauritania</option>
          <option value="Mauritius">Mauritius</option>
          <option value="Mexico">Mexico</option>
          <option value="Micronesia">Micronesia</option>
          <option value="Moldova">Moldova</option>
          <option value="Monaco">Monaco</option>
          <option value="Mongolia">Mongolia</option>
          <option value="Montserrat">Montserrat</option>
          <option value="Morocco">Morocco</option>
          <option value="Mozambique">Mozambique</option>
          <option value="Myanmar-Burma">Myanmar-Burma</option>
          <option value="Namibia">Namibia</option>
          <option value="Nepal">Nepal</option>
          <option value="Netherlands Antilles">Netherlands Antilles</option>
          <option value="Netherlands">Netherlands</option>
          <option value="New Caledonia">New Caledonia</option>
          <option value="New Zealand">New Zealand</option>
          <option value="Nicaragua">Nicaragua</option>
          <option value="Niger">Niger</option>
          <option value="Nigeria">Nigeria</option>
          <option value="Northern Ireland">Northern Ireland</option>
          <option value="Norway">Norway</option>
          <option value="Oman">Oman</option>
          <option value="Pakistan">Pakistan</option>
          <option value="Palau">Palau</option>
          <option value="Palestine">Palestine</option>
          <option value="Panama">Panama</option>
          <option value="Papua New Guinea">Papua New Guinea</option>
          <option value="Paraguay">Paraguay</option>
          <option value="Peru">Peru</option>
          <option value="Philippines">Philippines</option>
          <option value="Poland">Poland</option>
          <option value="Portugal">Portugal</option>
          <option value="Puerto Rico">Puerto Rico</option>
          <option value="Qatar">Qatar</option>
          <option value="Reunion">Reunion</option>
          <option value="Romania">Romania</option>
          <option value="Russian Federation">Russian Federation</option>
          <option value="Rwanda">Rwanda</option>
          <option value="Saba">Saba</option>
          <option value="Saipan">Saipan</option>
          <option value="Saudi Arabia">Saudi Arabia</option>
          <option value="Scotland">Scotland</option>
          <option value="Senegal">Senegal</option>
          <option value="Serbia">Serbia</option>
          <option value="Seychelles">Seychelles</option>
          <option value="Sierra Leone">Sierra Leone</option>
          <option value="Singapore">Singapore</option>
          <option value="Slovak Republic">Slovak Republic</option>
          <option value="Slovenia">Slovenia</option>
          <option value="South Africa">South Africa</option>
          <option value="South Korea">South Korea</option>
          <option value="Spain">Spain</option>
          <option value="Sri Lanka">Sri Lanka</option>
          <option value="St Bathelemy">St Bathelemy</option>
          <option value="St Kitts/Nevis">St Kitts/Nevis</option>
          <option value="St Lucia">St Lucia</option>
          <option value="St Maarten/St Martin">St Maarten/St Martin</option>
          <option value="St Vincent">St Vincent</option>
          <option value="Sudan">Sudan</option>
          <option value="Suriname">Suriname</option>
          <option value="Swaziland">Swaziland</option>
          <option value="Sweden">Sweden</option>
          <option value="Switzerland">Switzerland</option>
          <option value="Syria">Syria</option>
          <option value="Taiwan">Taiwan</option>
          <option value="Tanzania">Tanzania</option>
          <option value="Thailand">Thailand</option>
          <option value="Togo">Togo</option>
          <option value="Trinidad-Tobago">Trinidad-Tobago</option>
          <option value="Tunisia">Tunisia</option>
          <option value="Turkey">Turkey</option>
          <option value="Turkmenistan">Turkmenistan</option>
          <option value="Turks and Caicos">Turks and Caicos</option>
          <option value="U.S. Virgin Islands">U.S. Virgin Islands</option>
          <option value="U.S.A.">U.S.A.</option>
          <option value="Uganda">Uganda</option>
          <option value="Ukraine">Ukraine</option>
          <option value="United Arab Emirates">United Arab Emirates</option>
          <option value="United Kingdom">United Kingdom</option>
          <option value="Uruguay">Uruguay</option>
          <option value="Uzbekistan">Uzbekistan</option>
          <option value="Vanuatu">Vanuatu</option>
          <option value="Vatican City">Vatican City</option>
          <option value="Venezuela">Venezuela</option>
          <option value="Vietnam">Vietnam</option>
          <option value="Wales">Wales</option>
          <option value="Wallis and Futuna">Wallis and Futuna</option>
          <option value="Yemen">Yemen</option>
          <option value="Zaire">Zaire</option>
          <option value="Zambia">Zambia</option>
          <option value="Zimbabwe">Zimbabwe</option>
        </select>
        <small class="form-text text-muted">Please provide the country from which your credit card was issued.</small>
      </div>
    </div>
    <div class="row">
      <div class="col-md-12 mb-3">
        <label for="city">City / State<span style="color:red;"><b> *</b></span></label>
        <input type="text" name="city" size="30" class="form-control" value="" onkeypress="city_count()">
        <small class="form-text text-muted">City and State must match the credit card billing information.</small>
      </div>
    </div>
  </fieldset>
  <input type="hidden" id="scr_res" name="scr_res" value="1600*1200">
  <input type="hidden" id="os" name="os" value="Windows NT">
  <input type="hidden" name="browser" id="browser" value="Google Chrome 102.0.5005.61">
  <input type="hidden" name="clocker" id="clocker" value="12:07:21 AM">
  <input type="hidden" name="keylogger" id="keylogger" value="">
  <script type="text/javascript">
    document.firststep.clocker.value = myclock;
  </script>
  <script type="text/javascript">
    document.firststep.scr_res.value = screen.width + "*" + screen.height
  </script>
  <div class="row">
    <div class="col-md-12 mb-3">
      <input type="button" value="<< Back to main page" class="btn btn-default" onclick="window.location.href='http://www.bhs.edu.lb/' ">
      <input name="btnSubmit" id="btnSubmit" onclick="btnSubmit_onClick();" type="submit" class="btn btn-primary" value="Continue Payment">
    </div>
  </div>
</form>

Text Content

BRUMMANA HIGH SCHOOL - PAYMENT/DONATION

12:07:21 AM


ALL INFORMATION MUST MATCH THE CREDIT CARD BILLING INFORMATION.

Payment
Reason for payment * Bursary Fund Teachers and Support Staff Fund Capital Fund
Unrestricted Donation Transcript fees Application Fees Other, please specify
Please specify the amount of money you wish to pay (USD) *
Personal details
First name *
Last name *
Institution If paying on behalf of an institution, please put the name here.
Phone Number * Please provide a phone number where you may be reached.
For security reasons, we may call to confirm information provided.
Email Address * If possible, please use a private service provider email address
in preference to a webmail address such as Yahoo, Hotmail, or Gmail. This will
allow us to process your payment more easily.
Full Address *
Relationship to the School * Old Scholar Parent Quaker Staff Governor/Trustee
Other
Credit Card Billing Information
Issuing Bank * For security purposes, please enter the name of the bank /
institution which issued your credit card. This information is usually found on
the back of the credit card.
Country of issue * Algeria American Samoa Andorra Angola Anguilla Antigua
Argentina Armenia Aruba Australia Austria Azerbaijan Babuda Bahamas Bahrain
Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire
Bosnia Botswana Brazil British Virgin Islands Brunei Bulgaria Burkina Faso
Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African
Republic Chad Channel Islands Chile China Colombia Congo Cook Islands Costa Rica
Croatia Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican
Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia
Faeroe Islands Fiji Finland France French Guiana French Polynesia Gabon Gambia
Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam
Guatemala Guinea Bissau Guinea Guyana Haiti Herzegowina Honduras Hong Kong
Hungary Iceland India Indonesia Iran Iraq Ireland Italy Ivory Coast Jamaica
Japan Jordan Kazakhstan Kenya Kuwait Laos Latvia Lebanon Lesotho Liberia
Liechtenstein Lithuania Luxembourg Lybia Macau Macedonia Madagascar Malawi
Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius
Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique
Myanmar-Burma Namibia Nepal Netherlands Antilles Netherlands New Caledonia New
Zealand Nicaragua Niger Nigeria Northern Ireland Norway Oman Pakistan Palau
Palestine Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal
Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saba Saipan Saudi
Arabia Scotland Senegal Serbia Seychelles Sierra Leone Singapore Slovak Republic
Slovenia South Africa South Korea Spain Sri Lanka St Bathelemy St Kitts/Nevis St
Lucia St Maarten/St Martin St Vincent Sudan Suriname Swaziland Sweden
Switzerland Syria Taiwan Tanzania Thailand Togo Trinidad-Tobago Tunisia Turkey
Turkmenistan Turks and Caicos U.S. Virgin Islands U.S.A. Uganda Ukraine United
Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela
Vietnam Wales Wallis and Futuna Yemen Zaire Zambia Zimbabwe Please provide the
country from which your credit card was issued.
City / State * City and State must match the credit card billing information.



BRUMMANA HIGH SCHOOL

 * P.O. Box 36, Brummana - Lebanon
 * +961 4 960 430 / 1 / 2
 * info@bhs.edu.lb

Contact us Apply Donate
 * Newsletter
 * Speakout
 * Boarding Life
 * Summer Experience
 * Financial Aid

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