chrome/test/data/autofill/heuristics/input/16_crbug_98152.html

   1 <!DOCTYPE html PUBLIC "-//W3C//DTD HTML 4.01//EN">
   2 <html>
   3   <head>
   4     <title></title>
   5   </head>
   6   <body>
   7     <form name="creditCardForm" method="post" action="#" id="creditCardForm">
   8       <input type="hidden" name="CCForm.addNewCO" value="true">
   9       <table>
  10         <col width="135">
  11         <col width="550">
  12         <tr valign="top">
  13           <td>
  14             <img src="#" width="125" height="80" alt="">
  15             <table>
  16               <col width="65">
  17               <col width="60">
  18               <tr>
  19                 <td>
  20                   <img src="#" width="60" height="38" alt="">
  21                 </td>
  22                 <td>
  23                   <img src="#" width="60" height="38" alt="">
  24                 </td>
  25               </tr>
  26               <tr>
  27                 <td colspan="2" height="5"></td>
  28               </tr>
  29               <tr>
  30                 <td>
  31                   <img src="#" width="60" height="38" alt="">
  32                 </td>
  33                 <td>
  34                   <img src="#" width="60" height="38" alt="">
  35                 </td>
  36               </tr>
  37             </table>
  38           </td>
  39           <td>
  40             <!-- begin billingPageCreditCards -->
  41             <div class="BodyXLBold">
  42               Pay With a Credit Card or Debit Card
  43             </div>
  44             <div class="BodyM">
  45               Make the most of your shopping experience with the Walmart Discover® or Walmart Credit Card®. <a href="javascript:triggerChildOmniture('Pay%20with%20a%20Credit%20Card%20or%20Debit%20Card','Learn%20More');%20popupHelp('/cservice/contextual_help_popup.gsp?modId=447772',%20'',%20600,%20350);">Learn More</a> or <a href="/instantcredit/StartApplicationFromBilling.do">Apply Now</a>.<br>
  46               Debit cards (also called check cards, ATM cards or bank cards) are accepted if they have a Visa or MasterCard logo.
  47             </div><!-- end billingPageCreditCards -->
  48             <table>
  49               <col width="135">
  50               <col width="415">
  51               <tr>
  52                 <td class="BodyMBold">
  53                   Type of Card
  54                 </td>
  55                 <td class="BodyM">
  56                   <select name="CCForm.cardType">
  57                     <option value="">
  58                       Enter a new card
  59                     </option>
  60                     <option value="Wal-Mart Credit Card">
  61                       Wal-Mart Credit Card
  62                     </option>
  63                     <option value="Wal-Mart Discover">
  64                       Wal-Mart Discover
  65                     </option>
  66                     <option value="DISCOVER">
  67                       DISCOVER
  68                     </option>
  69                     <option value="VISA">
  70                       VISA
  71                     </option>
  72                     <option value="MASTERCARD">
  73                       MASTERCARD
  74                     </option>
  75                     <option value="AMEX">
  76                       AMEX
  77                     </option>
  78                   </select>
  79                 </td>
  80               </tr>
  81               <tr>
  82                 <td colspan="2" height="10"></td>
  83               </tr><!-- CC Number -->
  84               <tr>
  85                 <td class="BodyMBold">
  86                   Card number
  87                 </td>
  88                 <td class="BodyM">
  89                   <input type="text" name="CCForm.cardNumber" maxlength="125" size="16" value="">
  90                 </td>
  91               </tr>
  92               <tr>
  93                 <td colspan="2" height="10"></td>
  94               </tr><!-- Expiration Date -->
  95               <tr>
  96                 <td class="BodyMBold">
  97                   Expiration date
  98                 </td>
  99                 <td>
 100                   <select name="CCForm.expirationMonth">
 101                     <option value="1">
 102                       1
 103                     </option>
 104                     <option value="2">
 105                       2
 106                     </option>
 107                     <option value="3">
 108                       3
 109                     </option>
 110                     <option value="4">
 111                       4
 112                     </option>
 113                     <option value="5">
 114                       5
 115                     </option>
 116                     <option value="6">
 117                       6
 118                     </option>
 119                     <option value="7">
 120                       7
 121                     </option>
 122                     <option value="8">
 123                       8
 124                     </option>
 125                     <option value="9" selected="selected">
 126                       9
 127                     </option>
 128                     <option value="10">
 129                       10
 130                     </option>
 131                     <option value="11">
 132                       11
 133                     </option>
 134                     <option value="12">
 135                       12
 136                     </option>
 137                   </select> <select name="CCForm.expirationYear">
 138                     <option value="2011" selected="selected">
 139                       2011
 140                     </option>
 141                     <option value="2012">
 142                       2012
 143                     </option>
 144                     <option value="2013">
 145                       2013
 146                     </option>
 147                     <option value="2014">
 148                       2014
 149                     </option>
 150                     <option value="2015">
 151                       2015
 152                     </option>
 153                     <option value="2016">
 154                       2016
 155                     </option>
 156                     <option value="2017">
 157                       2017
 158                     </option>
 159                     <option value="2018">
 160                       2018
 161                     </option>
 162                     <option value="2019">
 163                       2019
 164                     </option>
 165                     <option value="2020">
 166                       2020
 167                     </option>
 168                     <option value="2021">
 169                       2021
 170                     </option>
 171                     <option value="2022">
 172                       2022
 173                     </option>
 174                   </select>
 175                 </td>
 176               </tr>
 177               <tr>
 178                 <td></td>
 179                 <td class="BodyM">
 180                   Not required for Walmart Credit Card
 181                 </td>
 182               </tr>
 183               <tr>
 184                 <td colspan="2" height="10"></td>
 185               </tr>
 186               <tr>
 187                 <td class="BodyMBold">
 188                   Name as it appears on card
 189                 </td>
 190                 <td class="BodyM">
 191                   <input type="text" name="CCForm.name" size="20" value="">
 192                 </td>
 193               </tr>
 194               <tr>
 195                 <td colspan="2" height="10"></td>
 196               </tr><!-- CID Editor -->
 197               <tr valign="top">
 198                 <td class="BodyMBold">
 199                   Card Identification Number
 200                 </td>
 201                 <td class="BodyM">
 202                   <table>
 203                     <tr valign="top">
 204                       <td>
 205                         <input type="text" name="CCForm.cid" size="5" value="">
 206                       </td>
 207                       <td>
 208                         <img src="#" width="36" height="24" alt="">
 209                       </td>
 210                       <td>
 211                         <div class="BodyMBold">
 212                           Visa, MasterCard, Discover, Walmart Cards:
 213                         </div>
 214                         <div class="BodyM">
 215                           Last 3 digits on back of card.
 216                         </div>
 217                       </td>
 218                     </tr>
 219                     <tr>
 220                       <td colspan="3" height="5"></td>
 221                     </tr>
 222                     <tr valign="top">
 223                       <td></td>
 224                       <td>
 225                         <img src="#" width="36" height="24" alt="">
 226                       </td>
 227                       <td>
 228                         <div class="BodyMBold">
 229                           <span class="CheckoutBodyTextAccent">American Express:</span>
 230                         </div>
 231                         <div class="BodyM">
 232                           <span class="CheckoutBodyTextAccent">Last 4 digits in small print on front of card.</span>
 233                         </div>
 234                       </td>
 235                     </tr>
 236                     <tr>
 237                       <td></td>
 238                       <td colspan="2" class="BodyM">
 239                         <a href="#" onclick="triggerChildOmniture('Card Identification Number','Need Help?'); window.open('/cservice/cid_help_popup.gsp','cidhelp','width=550,height=650')">Need help?</a>
 240                       </td>
 241                     </tr>
 242                   </table>
 243                 </td>
 244               </tr>
 245             </table>
 246             <h4>
 247               Billing Address
 248             </h4>
 249             <p class="BodyM">
 250               This address must match your credit card's billing address.
 251             </p>
 252             <div>
 253               <input id="checkForBillingAddress" name="isBillingAddress" type="checkbox" onclick="javascript:clickBillCheckbox()"> <span class="BodyM">Same as Shipping address</span>
 254             </div>
 255             <table>
 256               <col width="135">
 257               <col width="415"><!-- Company Name -->
 258               <tr>
 259                 <td class="BodyM">
 260                   Company Name
 261                 </td>
 262                 <td>
 263                   <input type="text" name="CCForm.companyName" maxlength="40" size="30" value=""> <span>(optional)</span>
 264                 </td>
 265               </tr>
 266               <tr>
 267                 <td colspan="2" height="7"></td>
 268               </tr>
 269               <tr>
 270                 <td colspan="2">
 271                   <!-- begin ccAddressFields -->
 272                   <table>
 273                     <col width="135">
 274                     <col width="260"><!-- STREET 1 -->
 275                     <tr>
 276                       <td class="BodyMBold">
 277                         Address Line 1
 278                       </td>
 279                       <td>
 280                         <input type="text" name="addressForm.street1" maxlength="125" size="30">
 281                       </td>
 282                     </tr>
 283                     <tr>
 284                       <td colspan="2" height="7"></td>
 285                     </tr><!-- STREET2 -->
 286                     <tr>
 287                       <td class="BodyM">
 288                         Address Line 2
 289                       </td>
 290                       <td>
 291                         <input type="text" name="addressForm.street2" maxlength="125" size="30"> <span>(optional)</span>
 292                       </td>
 293                     </tr>
 294                     <tr>
 295                       <td colspan="2" height="7"></td>
 296                     </tr><!-- CITY -->
 297                     <tr>
 298                       <td class="BodyMBold">
 299                         City
 300                       </td>
 301                       <td>
 302                         <input type="text" name="addressForm.city" maxlength="125" size="30">
 303                       </td>
 304                     </tr>
 305                     <tr>
 306                       <td colspan="2" height="7"></td>
 307                     </tr><!-- STATE -->
 308                     <tr>
 309                       <td class="BodyMBold">
 310                         State
 311                       </td>
 312                       <td>
 313                         <select name="addressForm.state">
 314                           <option value="">
 315                             Choose State
 316                           </option>
 317                           <option value="AL">
 318                             Alabama
 319                           </option>
 320                           <option value="AK">
 321                             Alaska
 322                           </option>
 323                           <option value="AZ">
 324                             Arizona
 325                           </option>
 326                           <option value="AR">
 327                             Arkansas
 328                           </option>
 329                           <option value="CA">
 330                             California
 331                           </option>
 332                           <option value="CO">
 333                             Colorado
 334                           </option>
 335                           <option value="CT">
 336                             Connecticut
 337                           </option>
 338                           <option value="DE">
 339                             Delaware
 340                           </option>
 341                           <option value="DC">
 342                             District Of Columbia
 343                           </option>
 344                           <option value="FL">
 345                             Florida
 346                           </option>
 347                           <option value="GA">
 348                             Georgia
 349                           </option>
 350                           <option value="HI">
 351                             Hawaii
 352                           </option>
 353                           <option value="ID">
 354                             Idaho
 355                           </option>
 356                           <option value="IL">
 357                             Illinois
 358                           </option>
 359                           <option value="IN">
 360                             Indiana
 361                           </option>
 362                           <option value="IA">
 363                             Iowa
 364                           </option>
 365                           <option value="KS">
 366                             Kansas
 367                           </option>
 368                           <option value="KY">
 369                             Kentucky
 370                           </option>
 371                           <option value="LA">
 372                             Louisiana
 373                           </option>
 374                           <option value="ME">
 375                             Maine
 376                           </option>
 377                           <option value="MD">
 378                             Maryland
 379                           </option>
 380                           <option value="MA">
 381                             Massachusetts
 382                           </option>
 383                           <option value="MI">
 384                             Michigan
 385                           </option>
 386                           <option value="MN">
 387                             Minnesota
 388                           </option>
 389                           <option value="MS">
 390                             Mississippi
 391                           </option>
 392                           <option value="MO">
 393                             Missouri
 394                           </option>
 395                           <option value="MT">
 396                             Montana
 397                           </option>
 398                           <option value="NE">
 399                             Nebraska
 400                           </option>
 401                           <option value="NV">
 402                             Nevada
 403                           </option>
 404                           <option value="NH">
 405                             New Hampshire
 406                           </option>
 407                           <option value="NJ">
 408                             New Jersey
 409                           </option>
 410                           <option value="NM">
 411                             New Mexico
 412                           </option>
 413                           <option value="NY">
 414                             New York
 415                           </option>
 416                           <option value="NC">
 417                             North Carolina
 418                           </option>
 419                           <option value="ND">
 420                             North Dakota
 421                           </option>
 422                           <option value="OH">
 423                             Ohio
 424                           </option>
 425                           <option value="OK">
 426                             Oklahoma
 427                           </option>
 428                           <option value="OR">
 429                             Oregon
 430                           </option>
 431                           <option value="PA">
 432                             Pennsylvania
 433                           </option>
 434                           <option value="RI">
 435                             Rhode Island
 436                           </option>
 437                           <option value="SC">
 438                             South Carolina
 439                           </option>
 440                           <option value="SD">
 441                             South Dakota
 442                           </option>
 443                           <option value="TN">
 444                             Tennessee
 445                           </option>
 446                           <option value="TX">
 447                             Texas
 448                           </option>
 449                           <option value="UT">
 450                             Utah
 451                           </option>
 452                           <option value="VT">
 453                             Vermont
 454                           </option>
 455                           <option value="VA">
 456                             Virginia
 457                           </option>
 458                           <option value="WA">
 459                             Washington
 460                           </option>
 461                           <option value="WV">
 462                             West Virginia
 463                           </option>
 464                           <option value="WI">
 465                             Wisconsin
 466                           </option>
 467                           <option value="WY">
 468                             Wyoming
 469                           </option>
 470                           <option value="AA">
 471                             Armed Forces Americas
 472                           </option>
 473                           <option value="AP">
 474                             Armed Forces Pacific
 475                           </option>
 476                           <option value="AE">
 477                             Armed Forces other
 478                           </option>
 479                           <option value="AS">
 480                             American Samoa
 481                           </option>
 482                           <option value="GU">
 483                             Guam
 484                           </option>
 485                           <option value="MP">
 486                             Northern Mariana Islands
 487                           </option>
 488                           <option value="PW">
 489                             Palau
 490                           </option>
 491                           <option value="PR">
 492                             Puerto Rico
 493                           </option>
 494                           <option value="VI">
 495                             Virgin Islands
 496                           </option>
 497                         </select>
 498                       </td>
 499                     </tr>
 500                     <tr>
 501                       <td colspan="2" height="7"></td>
 502                     </tr><!-- ZIP -->
 503                     <tr>
 504                       <td class="BodyMBold">
 505                         Zip Code
 506                       </td>
 507                       <td>
 508                         <input type="text" name="addressForm.zip" maxlength="20" size="10">
 509                       </td>
 510                     </tr>
 511                     <tr>
 512                       <td colspan="2" height="7"></td>
 513                     </tr><!-- PHONE -->
 514                     <tr>
 515                       <td class="BodyMBold">
 516                         Phone Number
 517                       </td>
 518                       <td>
 519                         <input type="text" name="addressForm.phone" maxlength="20" size="25"> <span class="BodyM">(Must be the number associated with your credit card)</span>
 520                       </td>
 521                     </tr>
 522                   </table><!-- end ccAddressFields -->
 523                 </td>
 524               </tr>
 525               <tr>
 526                 <td colspan="2" height="10"></td>
 527               </tr>
 528               <tr>
 529                 <td></td>
 530                 <td>
 531                   <input type="image" src="#" width="86" height="25" alt="Continue">
 532                 </td>
 533               </tr>
 534             </table>
 535           </td>
 536         </tr>
 537       </table>
 538     </form>
 539   </body>
 540 </html>