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purchase.drrajivspharma.in Open in urlscan Pro
103.21.58.169  Public Scan

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URL: https://purchase.drrajivspharma.in/
Submission: On July 14 via automatic, source certstream-suspicious — Scanned from US

Form analysis 1 forms found in the DOM

POST ./

<form method="post" action="./" id="form1">
  <div class="aspNetHidden">
    <input type="hidden" name="__VIEWSTATE" id="__VIEWSTATE"
      value="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">
  </div>
  <div class="aspNetHidden">
    <input type="hidden" name="__VIEWSTATEGENERATOR" id="__VIEWSTATEGENERATOR" value="D8ECDCB4">
    <input type="hidden" name="__EVENTTARGET" id="__EVENTTARGET" value="">
    <input type="hidden" name="__EVENTARGUMENT" id="__EVENTARGUMENT" value="">
    <input type="hidden" name="__EVENTVALIDATION" id="__EVENTVALIDATION"
      value="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">
  </div>
  <div class="container">
    <div class="row">
      <div class="col-lg-12 col-xs-12 col-md-12 col-sm-12 bgimage" style="min-height: 300px!important;">
        <div class="col-lg-12 col-xs-12 col-md-12 col-sm-12 " style="min-height: 300px!important;">
          <div class="container">
            <div class="row">
              <div class="col-lg-12 col-xs-12 col-md-12 col-sm-12">
                <table style="width: 100%;">
                  <tbody>
                    <tr>
                      <td style="width: 35%;"></td>
                      <td>
                        <img src="../Images/logo.png" class="loginimage textcenter">
                      </td>
                      <td style="width: 35%;"></td>
                    </tr>
                  </tbody>
                </table>
              </div>
              <div class="col-lg-12 col-xs-12 col-md-12 col-sm-12 mainheading">
                <div id="ContentPlaceHolder1_divHeading">New Order for Migrainoil 100 ml</div>
              </div>
            </div>
          </div>
          <div class="container">
            <div class="row form-inline">
              <div class="col-lg-2 col-xs-0 col-md-0 col-sm-0"></div>
              <div class="col-lg-3 col-xs-6 col-md-6 col-sm-6 formentry">
                <div id="divOrderPersonName">Full Name *</div>
                <input name="ctl00$ContentPlaceHolder1$txtOrderPersonName" type="text" id="ContentPlaceHolder1_txtOrderPersonName" class="form-control textbox" autocomplete="off">
              </div>
              <div class="col-lg-2 col-xs-0 col-md-0 col-sm-0"></div>
              <div class="col-lg-3 col-xs-6 col-md-6 col-sm-6 formentry">
                <div id="divContactNo">Phone Number *</div>
                <input name="ctl00$ContentPlaceHolder1$txtContactNo" type="text" id="ContentPlaceHolder1_txtContactNo" class="form-control textbox" autocomplete="off">
              </div>
              <div class="col-lg-2 col-xs-0 col-md-0 col-sm-0"></div>
            </div>
            <div class="row form-inline">
              <div class="col-lg-2 col-xs-0 col-md-0 col-sm-0"></div>
              <div class="col-lg-3 col-xs-6 col-md-6 col-sm-6 formentry">
                <div id="divDeliveryAddress1">House / Office Name *</div>
                <input name="ctl00$ContentPlaceHolder1$txtDeliveryAddress1" type="text" id="ContentPlaceHolder1_txtDeliveryAddress1" class="form-control textbox" autocomplete="off">
              </div>
              <div class="col-lg-2 col-xs-0 col-md-0 col-sm-0"></div>
              <div class="col-lg-3 col-xs-6 col-md-6 col-sm-6 formentry">
                <div id="divDeliveryAddress2">Road Name / Area / Colony</div>
                <input name="ctl00$ContentPlaceHolder1$txtDeliveryAddress2" type="text" id="ContentPlaceHolder1_txtDeliveryAddress2" class="form-control textbox" autocomplete="off">
              </div>
              <div class="col-lg-2 col-xs-0 col-md-0 col-sm-0"></div>
            </div>
            <div class="row form-inline">
              <div class="col-lg-2 col-xs-0 col-md-0 col-sm-0"></div>
              <div class="col-lg-3 col-xs-6 col-md-6 col-sm-6 formentry">
                <div id="divDeliveryAddress3">Landmark / Place / City</div>
                <input name="ctl00$ContentPlaceHolder1$txtDeliveryAddress3" type="text" id="ContentPlaceHolder1_txtDeliveryAddress3" class="form-control textbox" autocomplete="off">
              </div>
              <div class="col-lg-2 col-xs-0 col-md-0 col-sm-0"></div>
              <div class="col-lg-3 col-xs-6 col-md-6 col-sm-6 formentry">
                <div id="divState">State *</div>
                <select name="ctl00$ContentPlaceHolder1$ddlState" id="ContentPlaceHolder1_ddlState" class="form-control dropdown select2-hidden-accessible" data-select2-id="select2-data-ContentPlaceHolder1_ddlState" tabindex="-1" aria-hidden="true">
                  <option value="0">Select</option>
                  <option selected="selected" value="1" data-select2-id="select2-data-2-7jhv">Kerala</option>
                  <option value="4">Puducherry</option>
                  <option value="2">Tamilnadu</option>
                  <option value="3">Karnataka</option>
                  <option value="6">Jammu and Kashmir</option>
                  <option value="7">Himachal Pradesh</option>
                  <option value="8">Punjab</option>
                  <option value="9">Chandigarh</option>
                  <option value="10">Uttarakhand</option>
                  <option value="11">Haryana</option>
                  <option value="12">Delhi</option>
                  <option value="13">Rajasthan</option>
                  <option value="14">Uttar Pradesh</option>
                  <option value="15">Bihar</option>
                  <option value="16">Sikkim</option>
                  <option value="17">Arunachal Pradesh</option>
                  <option value="18">Nagaland</option>
                  <option value="19">Manipur</option>
                  <option value="20">Mizoram</option>
                  <option value="21">Tripura</option>
                  <option value="22">Meghalaya</option>
                  <option value="23">Assam</option>
                  <option value="24">West Bengal</option>
                  <option value="25">Jharkhand</option>
                  <option value="26">Odisha</option>
                  <option value="27">Chhattisgarh</option>
                  <option value="28">Madhya Pradesh</option>
                  <option value="29">Gujarat</option>
                  <option value="30">Daman and Diu</option>
                  <option value="31">Dadra and Nagar Haveli</option>
                  <option value="32">Maharashtra</option>
                  <option value="33">Goa</option>
                  <option value="34">Lakshadweep</option>
                  <option value="35">Andaman and Nicobar Islands</option>
                  <option value="36">Telangana</option>
                  <option value="37">Ladakh</option>
                  <option value="38">Foreign Country</option>
                  <option value="39">Other Territory</option>
                  <option value="5">Andhra Pradesh</option>
                </select><span class="select2 select2-container select2-container--default" dir="ltr" data-select2-id="select2-data-1-fp5g" style="width: 250px;"><span class="selection"><span class="select2-selection select2-selection--single"
                      role="combobox" aria-haspopup="true" aria-expanded="false" tabindex="0" aria-disabled="false" aria-labelledby="select2-ContentPlaceHolder1_ddlState-container"><span class="select2-selection__rendered"
                        id="select2-ContentPlaceHolder1_ddlState-container" role="textbox" aria-readonly="true" title="Kerala">Kerala</span><span class="select2-selection__arrow"
                        role="presentation"><b role="presentation"></b></span></span></span><span class="dropdown-wrapper" aria-hidden="true"></span></span>
              </div>
              <div class="col-lg-2 col-xs-0 col-md-0 col-sm-0"></div>
            </div>
            <div class="row form-inline">
              <div class="col-lg-2 col-xs-0 col-md-0 col-sm-0"></div>
              <div class="col-lg-3 col-xs-6 col-md-6 col-sm-6 formentry">
                <div id="divPostOffice">Post Office *</div>
                <input name="ctl00$ContentPlaceHolder1$txtPostOffice" type="text" id="ContentPlaceHolder1_txtPostOffice" class="form-control textbox" autocomplete="off">
              </div>
              <div class="col-lg-2 col-xs-0 col-md-0 col-sm-0"></div>
              <div class="col-lg-3 col-xs-6 col-md-6 col-sm-6 formentry">
                <div id="divPinCode">Pin Code *</div>
                <input name="ctl00$ContentPlaceHolder1$txtPinCode" type="text" id="ContentPlaceHolder1_txtPinCode" class="form-control textbox" autocomplete="off">
              </div>
              <div class="col-lg-2 col-xs-0 col-md-0 col-sm-0"></div>
            </div>
            <div class="row form-inline">
              <div class="col-lg-2 col-xs-0 col-md-0 col-sm-0"></div>
              <div class="col-lg-3 col-xs-6 col-md-6 col-sm-6 formentry">
                <div id="divProduct">Product *</div>
                <select name="ctl00$ContentPlaceHolder1$ddlProduct" onchange="javascript:setTimeout('__doPostBack(\'ctl00$ContentPlaceHolder1$ddlProduct\',\'\')', 0)" id="ContentPlaceHolder1_ddlProduct" disabled="disabled"
                  class="aspNetDisabled form-control dropdown">
                  <option value="0">Select</option>
                  <option value="1">Tonnoil 120 ml (120.00ml.)</option>
                  <option value="3">Tonnoil 200 ml (200.00ml.)</option>
                  <option selected="selected" value="4">Migrainoil 100 ml (100.00ml.)</option>
                  <option value="5">Dermol 200 ml (200.00ml.)</option>
                  <option value="6">MG Oil 100 ml (100.00ml.)</option>
                  <option value="8">Rapitizer 200 ml (200.00ml.)</option>
                  <option value="9">TN Oil 100 ml (100.00ml.)</option>
                  <option value="10">Arthra 60 Nos Bottle (60.00no.)</option>
                  <option value="11">Lipodip 60 Nos Bottle (60.00no.)</option>
                  <option value="12">Libid forte 30 Nos Bottle (30.00no.)</option>
                  <option value="13">Neuro10 60Nos Bottle (60.00no.)</option>
                  <option value="14">Stonil 60 Nos Bottle (60.00no.)</option>
                  <option value="15">Tonsilin 60bNos Bottle (60.00no.)</option>
                  <option value="16">Ulcin 60 Nos Bottle (60.00no.)</option>
                  <option value="17">Asthanil 100 ml (100.00ml.)</option>
                  <option value="18">Respi Cough 100 ml (100.00ml.)</option>
                  <option value="19">Rabna 120ml (120.00ml.)</option>
                  <option value="20">Rasomin 60 Nos Bottle (60.00no.)</option>
                  <option value="21">Brami Forte 30 Nos Bottle (30.00no.)</option>
                  <option value="22">Migracet 60 Nos Bottle (60.00no.)</option>
                  <option value="23">IBS 60 Nos Bottle (60.00no.)</option>
                  <option value="24">Chyavanaprasam 500g (500.00gm.)</option>
                  <option value="25">Dasamoolarishtam (500.00ml.)</option>
                  <option value="26">Migrainoil 200 ml (200.00ml.)</option>
                  <option value="27">Migrainoil 500 ml (500.00ml.)</option>
                </select>
              </div>
              <div class="col-lg-2 col-xs-0 col-md-0 col-sm-0"></div>
              <div class="col-lg-3 col-xs-6 col-md-6 col-sm-6 formentry">
                <div id="divMRP" style="display: none;">MRP *</div>
                <input name="ctl00$ContentPlaceHolder1$txtMRP" type="text" value="229.00" id="ContentPlaceHolder1_txtMRP" disabled="disabled" class="aspNetDisabled form-control textbox textright" autocomplete="off" placeholder="0.00"
                  style="display: none;">
                <div id="divQuantity">No. of Quantity *</div>
                <select name="ctl00$ContentPlaceHolder1$ddlQuantity" id="ContentPlaceHolder1_ddlQuantity" class="form-control dropdown" onchange="CalculateTotal()">
                  <option selected="selected" value="1">1</option>
                  <option value="2">2</option>
                  <option value="3">3</option>
                  <option value="4">4</option>
                  <option value="5">5</option>
                </select>
              </div>
              <div class="col-lg-2 col-xs-0 col-md-0 col-sm-0"></div>
            </div>
            <div class="row form-inline">
              <div class="col-lg-2 col-xs-0 col-md-0 col-sm-0"></div>
              <div class="col-lg-3 col-xs-6 col-md-6 col-sm-6 formentry">
                <div id="divPaymentMode">Payment Mode *<small><b>[Rs.15 Discount on Google Pay]</b></small></div>
                <select name="ctl00$ContentPlaceHolder1$ddlPaymentMode" id="ContentPlaceHolder1_ddlPaymentMode" class="form-control dropdown" onchange="CalculateTotal()">
                  <option value="0">Select</option>
                  <option selected="selected" value="1">Cash On Delivery</option>
                  <option value="2">Google Pay</option>
                </select>
              </div>
              <div class="col-lg-2 col-xs-0 col-md-0 col-sm-0"></div>
              <div class="col-lg-3 col-xs-6 col-md-6 col-sm-6 formentry">
                <div id="divDeliveryCharge" style="display: none;">Delivery Charge (Including Postal Commission)</div>
                <input name="ctl00$ContentPlaceHolder1$txtDeliveryCharge" type="text" value="48.00" id="ContentPlaceHolder1_txtDeliveryCharge" disabled="disabled" class="aspNetDisabled form-control textbox textright" autocomplete="off"
                  style="display: none;">
                <div id="divTotalAmount">Total Amount (Including All Charges) *</div>
                <input name="ctl00$ContentPlaceHolder1$txtTotalAmount" type="text" id="ContentPlaceHolder1_txtTotalAmount" disabled="disabled" class="aspNetDisabled form-control textbox textright" autocomplete="off" placeholder="0.00">
              </div>
              <div class="col-lg-2 col-xs-0 col-md-0 col-sm-0"></div>
            </div>
            <div class="row form-inline">
              <div class="col-lg-2 col-xs-0 col-md-0 col-sm-0"></div>
              <div class="col-lg-3 col-xs-6 col-md-6 col-sm-6 formentry">
                <div id="divComments">Comments</div>
                <input name="ctl00$ContentPlaceHolder1$txtComments" type="text" id="ContentPlaceHolder1_txtComments" class="form-control textbox" autocomplete="off">
              </div>
              <div class="col-lg-2 col-xs-0 col-md-0 col-sm-0"></div>
              <div class="col-lg-3 col-xs-6 col-md-6 col-sm-6 formentry">
              </div>
              <div class="col-lg-2 col-xs-0 col-md-0 col-sm-0"></div>
            </div>
            <div class="row form-inline pt-3 pb-2">
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                <br> Google Pay : Delivery within 3-4 Working Days. <br> Cash on Delivery : Delivery within 4-7 Working Days.
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Text Content

New Order for Migrainoil 100 ml
Full Name *

Phone Number *

House / Office Name *

Road Name / Area / Colony

Landmark / Place / City

State *
Select Kerala Puducherry Tamilnadu Karnataka Jammu and Kashmir Himachal Pradesh
Punjab Chandigarh Uttarakhand Haryana Delhi Rajasthan Uttar Pradesh Bihar Sikkim
Arunachal Pradesh Nagaland Manipur Mizoram Tripura Meghalaya Assam West Bengal
Jharkhand Odisha Chhattisgarh Madhya Pradesh Gujarat Daman and Diu Dadra and
Nagar Haveli Maharashtra Goa Lakshadweep Andaman and Nicobar Islands Telangana
Ladakh Foreign Country Other Territory Andhra Pradesh Kerala

Post Office *

Pin Code *

Product *
Select Tonnoil 120 ml (120.00ml.) Tonnoil 200 ml (200.00ml.) Migrainoil 100 ml
(100.00ml.) Dermol 200 ml (200.00ml.) MG Oil 100 ml (100.00ml.) Rapitizer 200 ml
(200.00ml.) TN Oil 100 ml (100.00ml.) Arthra 60 Nos Bottle (60.00no.) Lipodip 60
Nos Bottle (60.00no.) Libid forte 30 Nos Bottle (30.00no.) Neuro10 60Nos Bottle
(60.00no.) Stonil 60 Nos Bottle (60.00no.) Tonsilin 60bNos Bottle (60.00no.)
Ulcin 60 Nos Bottle (60.00no.) Asthanil 100 ml (100.00ml.) Respi Cough 100 ml
(100.00ml.) Rabna 120ml (120.00ml.) Rasomin 60 Nos Bottle (60.00no.) Brami Forte
30 Nos Bottle (30.00no.) Migracet 60 Nos Bottle (60.00no.) IBS 60 Nos Bottle
(60.00no.) Chyavanaprasam 500g (500.00gm.) Dasamoolarishtam (500.00ml.)
Migrainoil 200 ml (200.00ml.) Migrainoil 500 ml (500.00ml.)

MRP *
No. of Quantity *
1 2 3 4 5

Payment Mode *[Rs.15 Discount on Google Pay]
Select Cash On Delivery Google Pay

Delivery Charge (Including Postal Commission)
Total Amount (Including All Charges) *

Comments



Currently we are Accepting only Cash On Delivery & Google Pay (Rs.15 Discount)
Google Pay : Delivery within 3-4 Working Days.
Cash on Delivery : Delivery within 4-7 Working Days.