chrome/test/data/autofill/heuristics/input/12_register_pyramidcollection.com.html

   1 <html>
   2 <!--Form Location: https://www.pyramidcollection.com/OrderForm.asp?customer=new--><head>
   3 <meta property="fb:page_id" content="99531208380">
   4 <title>New Age, Spiritual Gifts Yoga, Wicca, Gothic, Reiki, Celtic, Crystal, Tarot at Pyramid Collection</title>
   5 <meta name="description" content=" - New Age, Spiritual Gifts Yoga, Wicca, Gothic, Reiki, Celtic, Crystal, Tarot at Pyramid Collection">
   6 <meta name="ROBOTS" content="index">
   7 <meta name="ROBOTS" content="follow">
   8 <meta http-equiv="Content-Language" content="en-us">
   9
  10 <meta name="verify-v1" content="Q/442Buxya7xZm2hnQq83/oAy0HD7KHrE/JFTwkrqog=">
  11 </head>
  12 <!--<body style="background-image:url('images_0106/ShadowBG.png'); background-color:#F7F7F7; background-repeat:repeat-y; background-position:center;">--><body bgcolor="#F7F7F7" style="padding-top:5px; ">
  13
  14
  15
  16 <form action="http://www.pyramidcollection.com/search.aspx?q=" method="GET" name="searchFrm" >
  17                          <span class="searchTxt">search&#160;</span>
  18                          <input type="text" name="q" size="40" class="searchInput" style="border: 1px solid #664C80; padding-left: 4px; padding-right: 4px; padding-top: 1px; padding-bottom: 1px;
  19                                  font-size: 10pt; font-family: Verdana" value="enter keyword(s) or item number">
  20                          &#160;
  21                          <input type="image" name="I2" src="#" alt="GO" title="GO" style="vertical-align: top" >&#160;
  22 </form>
  23
  24
  25
  26
  27
  28
  29
  30 <form id="frmOrderForm" method="post" action="/OrderForm_Step2.asp">
  31         <input type="hidden" name="step1" value="true"><input type="hidden" name="customer" value="new"><table style="border:1px silver solid; padding:5px 5px 5px 5px;" width="780">
  32 <tr>
  33 <td align="left" class="Standard_Lrg_GrayFont">
  34                                 CHECKOUT
  35                                 <br><br>
  36 </td>
  37                         <td align="right" class="section_heading_step">
  38                                 CHECKOUT STEP 1 of 4
  39                                 <br><br>
  40 </td>
  41                 </tr>
  42 <tr>
  43 <td align="left" class="section_heading_1">
  44                                 BILLING AND SHIPPING INFORMATION
  45                         </td>
  46                         <td align="right" class="status_message">
  47                                 &#160;* Indicates required information
  48                         </td>
  49                 </tr>
  50 <tr>
  51 <td colspan="2">
  52                                 <hr noshade style="height:1px">
  53 </td>
  54                 </tr>
  55 <tr>
  56 <td colspan="2">
  57                                 <div id="errormessage" class="error_message" style="display:none;"></div>
  58                         </td>
  59                 </tr>
  60 <tr>
  61 <td align="left" valign="top" class="section_heading_1">
  62                                 BILLING ADDRESS<br><br><font class="status_message">Address where you receive your credit card statement.</font>
  63                         </td>
  64                         <td align="left" valign="top" class="section_heading_1">
  65                                 SHIPPING ADDRESS
  66                         </td>
  67                 </tr>
  68 <tr>
  69 <td align="left" valign="top">
  70                                 <!-- BILLING FORM STARTS HERE -->
  71                                 <table style="margin-left:5px;" cellpadding="3">
  72 <tr>
  73 <th width="170" align="left" class="Standard_MdB_Font">Email Address<span class="required_indication_text">&#160;*</span>
  74 </th>
  75                                             <td>
  76                                                 <input type="text" size="26" maxlength="47" name="E1" id="E1" value="" class="textbox_01">
  77 </td>
  78                                             <td>
  79                                                 <div id="E1e" style="visibility:hidden; font-size:9pt; color:red; font-weight:bold">&#160;[!]</div>
  80                                             </td>
  81                                         </tr>
  82 <tr>
  83 <th align="left" class="Standard_MdB_Font">First Name<span class="required_indication_text">&#160;*</span>
  84 </th>
  85                                             <td><input type="text" size="26" maxlength="16" name="F1" id="F1" value="" class="textbox_01"></td>
  86                                             <td>
  87                                                 <div id="F1e" style="visibility:hidden; font-size:9pt; color:red; font-weight:bold">&#160;[!]</div>
  88                                             </td>
  89                                         </tr>
  90 <tr>
  91 <th align="left" class="Standard_MdB_Font">Last Name<span class="required_indication_text">&#160;*</span>
  92 </th>
  93                                             <td><input type="text" size="26" maxlength="16" name="L1" id="L1" value="" class="textbox_01"></td>
  94                                             <td>
  95                                                 <div id="L1e" style="visibility:hidden; font-size:9pt; color:red; font-weight:bold">&#160;[!]</div>
  96                                             </td>
  97                                         </tr>
  98 <tr>
  99 <th align="left" class="Standard_MdB_Font">Address Line 1<span class="required_indication_text">&#160;*</span>
 100 </th>
 101                                             <td><input type="text" size="26" maxlength="30" name="S1" id="S1" value="" class="textbox_01"></td>
 102                                             <td>
 103                                                 <div id="S1e" style="visibility:hidden; font-size:9pt; color:red; font-weight:bold">&#160;[!]</div>
 104                                             </td>
 105                                         </tr>
 106 <tr>
 107 <th align="left" class="Standard_MdB_Font">Address Line 2</th>
 108                                             <td><input type="text" size="26" maxlength="30" name="R1" id="R1" value="" class="textbox_01"></td>
 109                                             <td>&#160;</td>
 110                                         </tr>
 111 <tr>
 112 <th align="left" class="Standard_MdB_Font">City<span class="required_indication_text">&#160;*</span>
 113 </th>
 114                                             <td><input type="text" size="26" maxlength="30" name="C2" id="C2" value="" class="textbox_01"></td>
 115                                             <td>
 116                                                 <div id="C2e" style="visibility:hidden; font-size:9pt; color:red; font-weight:bold">&#160;[!]</div>
 117                                             </td>
 118                                         </tr>
 119 <tr>
 120 <th align="left" class="Standard_MdB_Font">State<span class="required_indication_text">&#160;*</span>
 121 </th>
 122                                             <td>
 123                                                          <select name="S2" id="S2" class="textbox_01" style=" width:200PX;"><option value="">Select State</option>
 124 <optgroup id="S2_USA">
 125 <option value="AK"> Alaska</option>
 126 <option value="AL"> Alabama</option>
 127 <option value="AZ"> Arizona</option>
 128 <option value="AR"> Arkansas</option>
 129 <option value="CA"> California</option>
 130 <option value="CO"> Colorado</option>
 131 <option value="CT"> Connecticut</option>
 132 <option value="DE"> Delaware</option>
 133 <option value="DC"> District Of Columbia</option>
 134 <option value="FL"> Florida</option>
 135 <option value="GA"> Georgia</option>
 136 <option value="GU"> Guam</option>
 137 <option value="HI"> Hawaii</option>
 138 <option value="ID"> Idaho</option>
 139 <option value="IL"> Illinois</option>
 140 <option value="IN"> Indiana</option>
 141 <option value="IA"> Iowa</option>
 142 <option value="KS"> Kansas</option>
 143 <option value="KY"> Kentucky</option>
 144 <option value="LA"> Louisiana</option>
 145 <option value="ME"> Maine</option>
 146 <option value="MD"> Maryland</option>
 147 <option value="MA"> Massachusetts</option>
 148 <option value="MI"> Michigan</option>
 149 <option value="MN"> Minnesota</option>
 150 <option value="MS"> Mississippi</option>
 151 <option value="MO"> Missouri</option>
 152 <option value="MT"> Montana</option>
 153 <option value="NE"> Nebraska</option>
 154 <option value="NV"> Nevada</option>
 155 <option value="NH"> New Hampshire</option>
 156 <option value="NJ"> New Jersey</option>
 157 <option value="NM"> New Mexico</option>
 158 <option value="NY"> New York</option>
 159 <option value="NC"> North Carolina</option>
 160 <option value="ND"> North Dakota</option>
 161 <option value="OH"> Ohio</option>
 162 <option value="OK"> Oklahoma</option>
 163 <option value="OR"> Oregon</option>
 164 <option value="PA"> Pennsylvania</option>
 165 <option value="PR"> Puerto Rico</option>
 166 <option value="RI"> Rhode Island</option>
 167 <option value="SC"> South Carolina</option>
 168 <option value="SD"> South Dakota</option>
 169 <option value="TN"> Tennessee</option>
 170 <option value="TX"> Texas</option>
 171 <option value="UT"> Utah</option>
 172 <option value="VT"> Vermont</option>
 173 <option value="VI"> Virgin Islands</option>
 174 <option value="VA"> Virginia</option>
 175 <option value="WA"> Washington</option>
 176 <option value="WV"> West Virginia</option>
 177 <option value="WI"> Wisconsin</option>
 178 <option value="WY"> Wyoming</option>
 179 <option value="AA"> Military AA</option>
 180 <option value="AE"> Military AE</option>
 181 <option value="AP"> Military AP</option>
 182 </optgroup>
 183 <optgroup id="S2_CANADA">
 184 <option value="AB">Alberta</option>
 185 <option value="BC">British Columbia</option>
 186 <option value="MB">Manitoba</option>
 187 <option value="NB">New Brunswick</option>
 188 <option value="NL">Newfoundland/Labrador</option>
 189 <option value="NT">Northwest Territories</option>
 190 <option value="NS">Nova Scotia</option>
 191 <option value="NU">Nunuvut</option>
 192 <option value="ON">Ontario</option>
 193 <option value="PE">Prince Edward
 194                                         Island</option>
 195 <option value="QC">Quebec</option>
 196 <option value="SK">Saskatchewan</option>
 197 <option value="YT">Yukon Territory</option>
 198 </optgroup>
 199 <optgroup id="S2_INTL">
 200 <!--option value="YT"> Yukon Territory</option--><option value="FN"> International</option>
 201 </optgroup></select><!-- Populate state via javaScript if turned on -->
 202 </td>
 203                                                 <td>
 204                                                 <div id="S2e" style="visibility:hidden; font-size:9pt; color:red; font-weight:bold">&#160;[!]</div>
 205                                             </td>
 206                                         </tr>
 207 <tr>
 208 <th align="left" class="Standard_MdB_Font">Country<span class="required_indication_text">&#160;*</span>
 209 </th>
 210                                             <td>
 211                                                 <select name="C3" id="C3" class="textbox_01"><option value="0000">USA</option>
 212 <option value="0001">CANADA</option></select>
 213 </td>
 214                                                 <td>
 215                                                 <div id="C3e" style="visibility:hidden; font-size:9pt; color:red; font-weight:bold">&#160;[!]</div>
 216                                             </td>
 217                                         </tr>
 218 <tr>
 219 <th align="left" class="Standard_MdB_Font">Zip Code<span class="required_indication_text">&#160;*</span>
 220 </th>
 221                                             <td><input type="text" size="26" maxlength="9" name="Z1" id="Z1" value="" class="textbox_01"></td>
 222                                                 <td>
 223                                                 <div id="Z1e" style="visibility:hidden; font-size:9pt; color:red; font-weight:bold">&#160;[!]</div>
 224                                             </td>
 225                                         </tr>
 226 <tr>
 227 <th align="left" class="Standard_MdB_Font">Day Phone<span class="required_indication_text">&#160;*</span>
 228 </th>
 229                                             <td><input type="text" size="26" maxlength="14" name="P2" id="P2" value="" class="textbox_01"></td>
 230                                                 <td>
 231                                                 <div id="P2e" style="visibility:hidden; font-size:9pt; color:red; font-weight:bold">&#160;[!]</div>
 232                                             </td>
 233                                         </tr>
 234 <tr>
 235 <th align="left" class="Standard_MdB_Font">Evening Phone</th>
 236                                             <td><input type="text" size="26" maxlength="14" name="P3" id="P3" value="" class="textbox_01"></td>
 237                                             <td>&#160;</td>
 238                                         </tr>
 239 <tr>
 240 <th align="left" class="Standard_MdB_Font">
 241                                                 Create Password
 242                                                 <span class="required_indication_text">&#160;*</span>
 243 </th>
 244                                             <td>
 245                                                 <input type="password" name="P1" id="P1" size="26" maxlength="16" value="" class="textbox_01">
 246 </td>
 247                                                 <td>
 248                                                 <div id="P1e" style="visibility:hidden; font-size:9pt; color:red; font-weight:bold">&#160;[!]</div>
 249                                             </td>
 250                                         </tr>
 251 <tr>
 252 <th align="left" class="Standard_MdB_Font">Confirm Password<span class="required_indication_text">&#160;*</span>
 253 </th>
 254                                             <td>
 255                                                 <input type="password" name="PasswordConfirm" id="PasswordConfirm" size="26" maxlength="16" value="" class="textbox_01">
 256 </td>
 257                                             <td>
 258                                                 <div id="PasswordConfirmE" style="visibility:hidden; font-size:9pt; color:red; font-weight:bold">&#160;[!]</div>
 259                                             </td>
 260                                         </tr>
 261 </table>
 262 </td>
 263                         <!-- BILLING FORM ENDS HERE -->
 264
 265                         <!-- SHIPPING FORM STARTS HERE -->
 266                         <td align="left" style="border-left:1px silver dotted" valign="top">
 267                                 <table id="shiptoinformation" style="margin-left:5px;" cellpadding="3">
 268 <tr>
 269 <th width="170" align="left" class="Standard_MdB_Font">First Name<span class="required_indication_text">&#160;*</span>
 270 </th>
 271                                             <td><input type="text" size="26" maxlength="16" name="SF1" id="SF1" value="" class="textbox_01"></td>
 272                                             <td>
 273                                                 <div id="SF1e" style="visibility:hidden; font-size:9pt; color:red; font-weight:bold">&#160;[!]</div>
 274                                             </td>
 275                                         </tr>
 276 <tr>
 277 <th align="left" class="Standard_MdB_Font">Last Name<span class="required_indication_text">&#160;*</span>
 278 </th>
 279                                             <td><input type="text" size="26" maxlength="16" name="SL1" id="SL1" value="" class="textbox_01"></td>
 280                                             <td>
 281                                                 <div id="SL1e" style="visibility:hidden; font-size:9pt; color:red; font-weight:bold">&#160;[!]</div>
 282                                             </td>
 283                                         </tr>
 284 <tr>
 285 <th align="left" class="Standard_MdB_Font">Address Line 1<span class="required_indication_text">&#160;*</span>
 286 </th>
 287                                             <td><input type="text" size="26" maxlength="30" name="SS1" id="SS1" value="" class="textbox_01"></td>
 288                                             <td>
 289                                                 <div id="SS1e" style="visibility:hidden; font-size:9pt; color:red; font-weight:bold">&#160;[!]</div>
 290                                             </td>
 291                                         </tr>
 292 <tr>
 293 <th align="left" class="Standard_MdB_Font">Address Line 2</th>
 294                                             <td><input type="text" size="26" maxlength="30" name="SR1" id="SR1" value="" class="textbox_01"></td>
 295                                             <td>&#160;</td>
 296                                         </tr>
 297 <tr>
 298 <th align="left" class="Standard_MdB_Font">City<span class="required_indication_text">&#160;*</span>
 299 </th>
 300                                             <td><input type="text" size="26" maxlength="30" name="SC2" id="SC2" value="" class="textbox_01"></td>
 301                                             <td>
 302                                                 <div id="SC2e" style="visibility:hidden; font-size:9pt; color:red; font-weight:bold">&#160;[!]</div>
 303                                             </td>
 304                                         </tr>
 305 <tr>
 306 <th align="left" class="Standard_MdB_Font">State<span class="required_indication_text">&#160;*</span>
 307 </th>
 308                                             <td>
 309                                                          <select name="SS2" id="SS2" class="textbox_01" style=" width:200px;"><option value=""> Select State</option>
 310 <optgroup id="SS2_USA">
 311 <option value="AK"> Alaska</option>
 312 <option value="AL"> Alabama</option>
 313 <option value="AZ"> Arizona</option>
 314 <option value="AR"> Arkansas</option>
 315 <option value="CA"> California</option>
 316 <option value="CO"> Colorado</option>
 317 <option value="CT"> Connecticut</option>
 318 <option value="DE"> Delaware</option>
 319 <option value="DC"> District Of Columbia</option>
 320 <option value="FL"> Florida</option>
 321 <option value="GA"> Georgia</option>
 322 <option value="GU"> Guam</option>
 323 <option value="HI"> Hawaii</option>
 324 <option value="ID"> Idaho</option>
 325 <option value="IL"> Illinois</option>
 326 <option value="IN"> Indiana</option>
 327 <option value="IA"> Iowa</option>
 328 <option value="KS"> Kansas</option>
 329 <option value="KY"> Kentucky</option>
 330 <option value="LA"> Louisiana</option>
 331 <option value="ME"> Maine</option>
 332 <option value="MD"> Maryland</option>
 333 <option value="MA"> Massachusetts</option>
 334 <option value="MI"> Michigan</option>
 335 <option value="MN"> Minnesota</option>
 336 <option value="MS"> Mississippi</option>
 337 <option value="MO"> Missouri</option>
 338 <option value="MT"> Montana</option>
 339 <option value="NE"> Nebraska</option>
 340 <option value="NV"> Nevada</option>
 341 <option value="NH"> New Hampshire</option>
 342 <option value="NJ"> New Jersey</option>
 343 <option value="NM"> New Mexico</option>
 344 <option value="NY"> New York</option>
 345 <option value="NC"> North Carolina</option>
 346 <option value="ND"> North Dakota</option>
 347 <option value="OH"> Ohio</option>
 348 <option value="OK"> Oklahoma</option>
 349 <option value="OR"> Oregon</option>
 350 <option value="PA"> Pennsylvania</option>
 351 <option value="PR"> Puerto Rico</option>
 352 <option value="RI"> Rhode Island</option>
 353 <option value="SC"> South Carolina</option>
 354 <option value="SD"> South Dakota</option>
 355 <option value="TN"> Tennessee</option>
 356 <option value="TX"> Texas</option>
 357 <option value="UT"> Utah</option>
 358 <option value="VT"> Vermont</option>
 359 <option value="VI"> Virgin Islands</option>
 360 <option value="VA"> Virginia</option>
 361 <option value="WA"> Washington</option>
 362 <option value="WV"> West Virginia</option>
 363 <option value="WI"> Wisconsin</option>
 364 <option value="WY"> Wyoming</option>
 365 <option value="AA"> Military AA</option>
 366 <option value="AE"> Military AE</option>
 367 <option value="AP"> Military AP</option>
 368 </optgroup>
 369 <optgroup id="SS2_CANADA">
 370 <option value="AB">Alberta</option>
 371 <option value="BC">British Columbia</option>
 372 <option value="MB">Manitoba</option>
 373 <option value="NB">New Brunswick</option>
 374 <option value="NL">Newfoundland/Labrador</option>
 375 <option value="NT">Northwest Territories</option>
 376 <option value="NS">Nova Scotia</option>
 377 <option value="NU">Nunuvut</option>
 378 <option value="ON">Ontario</option>
 379 <option value="PE">Prince Edward
 380                                         Island</option>
 381 <option value="QC">Quebec</option>
 382 <option value="SK">Saskatchewan</option>
 383 <option value="YT">Yukon Territory</option>
 384 </optgroup>
 385 <optgroup id="SS2_INTL">
 386 <!--option value="YT"> Yukon Territory</option--><option value="FN"> International</option>
 387 </optgroup></select><!-- Populate state via javaScript if turned on -->
 388 </td>
 389                                             <td>
 390                                                 <div id="SS2e" style="visibility:hidden; font-size:9pt; color:red; font-weight:bold">&#160;[!]</div>
 391                                             </td>
 392                                         </tr>
 393 <tr>
 394 <th align="left" class="Standard_MdB_Font">Country<span class="required_indication_text">&#160;*</span>
 395 </th>
 396                                             <td>
 397                                                 <select name="SC3" id="SC3" class="textbox_01"><option value="0000">USA</option>
 398 <option value="0001">CANADA</option></select>
 399 </td>
 400                                             <td>
 401                                                 <div id="SC3e" style="visibility:hidden; font-size:9pt; color:red; font-weight:bold">&#160;[!]</div>
 402                                             </td>
 403                                         </tr>
 404 <tr>
 405 <th align="left" class="Standard_MdB_Font">Zip Code<span class="required_indication_text">&#160;*</span>
 406 </th>
 407                                             <td><input type="text" size="26" maxlength="9" name="SZ1" id="SZ1" value="" class="textbox_01"></td>
 408                                             <td>
 409                                                 <div id="SZ1e" style="visibility:hidden; font-size:9pt; color:red; font-weight:bold">&#160;[!]</div>
 410                                             </td>
 411                                         </tr>
 412 <tr>
 413 <th align="left" class="Standard_MdB_Font">Day Phone<span class="required_indication_text">&#160;*</span>
 414 </th>
 415                                             <td><input type="text" size="26" maxlength="14" name="SP2" id="SP2" value="" class="textbox_01"></td>
 416                                             <td>
 417                                                 <div id="SP2e" style="visibility:hidden; font-size:9pt; color:red; font-weight:bold">&#160;[!]</div>
 418                                             </td>
 419                                         </tr>
 420 <tr>
 421 <th align="left" class="Standard_MdB_Font">Evening Phone</th>
 422                                             <td><input type="text" size="26" maxlength="14" name="SP3" id="SP3" value="" class="textbox_01"></td>
 423                                             <td>&#160;</td>
 424                                         </tr>
 425 </table>
 426 </td>
 427                         <!-- SHIPPING FORM ENDS HERE -->
 428                 </tr>
 429 <tr>
 430 <td colspan="2">
 431                                 <div class="subtext_2" style="border:1px #000000 solid; margin-top:5px; padding-bottom:5px">
 432                                         <input type="checkbox" name="sameAsBilling" id="sameAsBilling" ><strong>My Shipping address is same as billing address.</strong>
 433                                 </div>
 434
 435                                 <!--<div id="errormessage2" class="error_message" style="display:none;"></div>-->
 436
 437                                 <div align="center" class="continue_button" style="padding-top:5px;">
 438                                         <input type="image" alt="Continue" name="B1" src="#" >
 439 </div>
 440                         </td>
 441                 </tr>
 442 </table>
 443 <input type="hidden" name="GEN7" value=""><input type="hidden" name="GEN6" value=""><input type="hidden" name="ORDER_FORM" value="Y"><input type="hidden" name="then" value="">
 444 </form>
 445
 446
 447
 448
 449
 450
 451
 452 <form name="getEmail2" action="/EnterToWin2.asp" method="post" >
 453                         <input type="hidden" name="loc" value="footer"><td align="center" height="26" style="font-family: Tahoma, Arial, Helvetica, sans-serif;
 454                                 font-size: 12px; font-weight: bold; color: #FFFFFF;">
 455                         <!--<form name="getEmail2" action="EnterToWin2.asp" method="post">-->
 456
 457
 458                                 ENTER TO WIN A $100 GIFT CARD!&#160;&#160;<input type="text" style="border:1px solid white; font-size:10px; text-align:center; height: 18px;" id="email" name="email" size="40" value="enter email address" >&#160;&#160;
 459                                 <input type="image" src="#" width="50" height="18" style="vertical-align:top" value="Submit">
 460 </td>
 461 </form>
 462
 463
 464
 465 </body>
 466 </html>