chrome/test/data/autofill/heuristics/input/16_crbug_98269.html

   1 <!-- https://quality-s.qvc.com/qic/qvcapp.aspx/view.1/app.multi/params.file.%7CCheckout%7CShipMethod,plex -->
   2 <form method="post" id="frmPaymentMethod" name="PaymentMethod" action="#">
   3   <div style="display:none;">
   4     <input type="hidden" name="NextURL" value="PaymentMethod.plex">
   5     <input type="hidden" name="RefererForm" value="PaymentMethod">
   6     <input type="hidden" name="WildCardCreditSw">
   7     <input type="hidden" name="NewMemberSw" id="NewMemberSw" value="0">
   8     <input type="hidden" name="Command">
   9     <input type="hidden" name="QSDiscountType">
  10     <input type="hidden" name="QSDiscountAmount">
  11     <input type="hidden" name="QSNextDiscountAmount">
  12     <input type="hidden" name="QSDiscountLimit">
  13     <input type="hidden" name="MyShowNewCardSw" value="1">
  14     <input type="hidden" name="MyNumErr">
  15     <input type="hidden" name="OrigEmailAddress" value="tester@example.com">
  16     <input type="hidden" name="ExpiredCreditCardExpYYMM">
  17     <input type="hidden" name="SelectedCreditTerms" id="SelectedCreditTerms">
  18     <input type="hidden" name="MustVerifySelection" id="MustVerifySelection" value="0">
  19     <input type="hidden" name="CreditTermLinesSelectedBackButtonCase" id="CreditTermLinesSelectedBackButtonCase">
  20     <input type="hidden" name="ElecGiftCardOnly" id="ElecGiftCardOnly">
  21   </div>
  22   <div class="paymentMethod" id="errorToggle_PayMeth">
  23     <p class="pad">
  24       <strong>Total Purchase (including tax and S&amp;H): $276.40</strong><br>
  25       Please select a payment method below. If you choose to enter a new card, you will be prompted to enter card type, number and expiration date.
  26     </p>
  27   </div><!-- end of total/credit paymentMethod div -->
  28   <br>
  29   <!-- begin creditterms loop -->
  30    <!-- end of creditterms loop -->
  31   <div class="paymentMethod">
  32     <!-- start of credit card list - paymentMethod div -->
  33     <p class="pad">
  34       <strong>Payment Methods</strong>
  35     </p>
  36     <div class="paymentBgShade" id="bml_0">
  37       <table class="creditNames">
  38         <tr>
  39           <td width="5">
  40             <input type="radio" tabindex="0" id="PaymentMethod" name="PaymentMethod" value="BL">
  41           </td>
  42           <td width="210">
  43             Bill Me Later<sup class="reg">®</sup>
  44           </td>
  45           <td colspan="3">
  46             <a target="_blank" href="#" title="See Terms">See Terms</a>
  47           </td>
  48         </tr>
  49       </table>
  50       <div id="bmltoggle" class="bmltoggle">
  51         <table cellpadding="0" cellspacing="0" border="0">
  52           <tr>
  53             <td>
  54               <div class="col1">
  55                 <ol class="bmlform">
  56                   <li class="bmltxt">
  57                     <span class="note">Please enter confirmation information below:</span><br>
  58                     Bill Me Later<sup class="reg">®</sup> is subject to credit approval. For verification purposes, please provide your date of birth and the last four digits of your social security number.<br>
  59                   </li>
  60                   <li>
  61                     <div id="trHomePhone">
  62                       <label><em>*</em> Home Phone:</label> <input type="text" name="txtHomePhone1" size="3" class="inputbox" maxlength="3" value=""> <input type="text" name="txtHomePhone2" size="3" class="inputbox" maxlength="3" value=""> <input type="text" name="txtHomePhone3" size="4" class="inputbox" maxlength="4" value="">
  63                     </div>
  64                     <div class="labelerror" id="BMLPhoneErrorMsg"></div>
  65                   </li>
  66                   <li>
  67                     <div id="trEmail">
  68                       <label><em>*</em> Email Address:</label> <input type="text" name="txtEmail" class="inputbox" size="28" maxlength="48">
  69                     </div>
  70                     <div class="labelerror" id="BMLEmailErrorMsg"></div>
  71                   </li>
  72                   <li>
  73                     <div id="trSSN">
  74                       <label><em>*</em> Social Security Number:</label> XXX-XX-<input type="text" name="txtSSN" size="4" class="inputbox" maxlength="4"> Last 4 digits only
  75                     </div>
  76                     <div class="labelerror" id="BMLSSNErrorMsg"></div>
  77                   </li>
  78                   <li>
  79                     <div id="trDOB">
  80                       <label><em>*</em> Date of Birth:</label> <select name="selBirthMonth" id="birthMonth" class="inputbox">
  81                         <option value="Month">
  82                           Month
  83                         </option>
  84                         <option value="01">
  85                           January
  86                         </option>
  87                         <option value="02">
  88                           February
  89                         </option>
  90                         <option value="03">
  91                           March
  92                         </option>
  93                         <option value="04">
  94                           April
  95                         </option>
  96                         <option value="05">
  97                           May
  98                         </option>
  99                         <option value="06">
 100                           June
 101                         </option>
 102                         <option value="07">
 103                           July
 104                         </option>
 105                         <option value="08">
 106                           August
 107                         </option>
 108                         <option value="09">
 109                           September
 110                         </option>
 111                         <option value="10">
 112                           October
 113                         </option>
 114                         <option value="11">
 115                           November
 116                         </option>
 117                         <option value="12">
 118                           December
 119                         </option>
 120                       </select> <select name="selBirthDate" id="birthDate" class="inputbox">
 121                         <option value="Date">
 122                           Date
 123                         </option>
 124                       </select> <select name="selBirthYear" id="birthYear" class="inputbox">
 125                         <option value="Year">
 126                           Year
 127                         </option>
 128                       </select>
 129                     </div>
 130                     <div class="labelerror" id="BMLBirthdateErrorMsg"></div>
 131                   </li>
 132                   <li class="bmltxt">
 133                     <span class="note">E-sign Consent and Terms and Conditions:</span>
 134                     <div>
 135                       You must read the E-sign Consent section of the Terms and Conditions prior to checking the box below.
 136                     </div>
 137                   </li>
 138                   <li class="bmlagree">
 139                     <em>*</em> <input type="checkbox" name="chkTAC"> I agree to have the <a target="_blank" href="#">Terms and Conditions</a> presented electronically.
 140                   </li>
 141                   <li style="list-style: none">
 142                     <div class="labelerror" id="BMLTACErrorMsg"></div>
 143                   </li>
 144                   <li>
 145                     <em>*</em> Required Fields
 146                   </li>
 147                 </ol>
 148               </div><!-- col1 END -->
 149             </td>
 150           </tr>
 151         </table>
 152       </div><!-- bmltoggle END -->
 153     </div><!-- paymentNoShade END -->
 154     <div class="paymentNoShade" id="paymentCheck">
 155       <table class="creditNames">
 156         <tr>
 157           <td width="5">
 158             <input type="radio" id="PaymentMethod" name="PaymentMethod" value="CK">
 159           </td>
 160           <td>
 161             Check / Money Order
 162           </td>
 163         </tr>
 164       </table><!-- <div class="clear"></div> -->
 165     </div>
 166     <div class="paymentBgShade" id="paymentNewCard">
 167       <table class="creditNames">
 168         <tr>
 169           <td width="5">
 170             <input type="radio" name="PaymentMethod" value="AddNew" id="radioNew" checked="checked">
 171           </td>
 172           <td>
 173             Enter New Card:
 174           </td>
 175         </tr>
 176       </table>
 177       <div id="newcardtoggle" class="newcardtoggle">
 178         <ol>
 179           <li>
 180             <label>Type:</label> <select id="cardType" name="cardType" class="inputbox">
 181               <option value="VI">
 182                 Visa
 183               </option>
 184               <option value="MC">
 185                 MasterCard
 186               </option>
 187               <option value="SI">
 188                 Discover Network
 189               </option>
 190               <option value="AX">
 191                 American Express
 192               </option>
 193               <option value="QV">
 194                 QCard
 195               </option>
 196               <option value="CB">
 197                 Carte Blanche
 198               </option>
 199               <option value="DC">
 200                 Diners Club
 201               </option>
 202             </select>
 203           </li>
 204           <li>
 205             <label>Number:</label><input type="text" maxlength="18" name="CreditCardNumber" class="inputbox">
 206           </li>
 207           <li>
 208             <div id="date_line">
 209               <label>Expiration:</label> <select name="CreditCardExpYYMM" class="inputbox">
 210                 <option value="092011">
 211                   09/2011
 212                 </option>
 213                 <option value="102011">
 214                   10/2011
 215                 </option>
 216                 <option value="112011">
 217                   11/2011
 218                 </option>
 219                 <option value="122011">
 220                   12/2011
 221                 </option>
 222                 <option value="012012">
 223                   01/2012
 224                 </option>
 225                 <option value="022012">
 226                   02/2012
 227                 </option>
 228                 <option value="032012">
 229                   03/2012
 230                 </option>
 231                 <option value="042012">
 232                   04/2012
 233                 </option>
 234                 <option value="052012">
 235                   05/2012
 236                 </option>
 237                 <option value="062012">
 238                   06/2012
 239                 </option>
 240                 <option value="072012">
 241                   07/2012
 242                 </option>
 243                 <option value="082012">
 244                   08/2012
 245                 </option>
 246                 <option value="092012">
 247                   09/2012
 248                 </option>
 249                 <option value="102012">
 250                   10/2012
 251                 </option>
 252                 <option value="112012">
 253                   11/2012
 254                 </option>
 255                 <option value="122012">
 256                   12/2012
 257                 </option>
 258                 <option value="012013">
 259                   01/2013
 260                 </option>
 261                 <option value="022013">
 262                   02/2013
 263                 </option>
 264                 <option value="032013">
 265                   03/2013
 266                 </option>
 267                 <option value="042013">
 268                   04/2013
 269                 </option>
 270                 <option value="052013">
 271                   05/2013
 272                 </option>
 273                 <option value="062013">
 274                   06/2013
 275                 </option>
 276                 <option value="072013">
 277                   07/2013
 278                 </option>
 279                 <option value="082013">
 280                   08/2013
 281                 </option>
 282                 <option value="092013">
 283                   09/2013
 284                 </option>
 285                 <option value="102013">
 286                   10/2013
 287                 </option>
 288                 <option value="112013">
 289                   11/2013
 290                 </option>
 291                 <option value="122013">
 292                   12/2013
 293                 </option>
 294                 <option value="012014">
 295                   01/2014
 296                 </option>
 297                 <option value="022014">
 298                   02/2014
 299                 </option>
 300                 <option value="032014">
 301                   03/2014
 302                 </option>
 303                 <option value="042014">
 304                   04/2014
 305                 </option>
 306                 <option value="052014">
 307                   05/2014
 308                 </option>
 309                 <option value="062014">
 310                   06/2014
 311                 </option>
 312                 <option value="072014">
 313                   07/2014
 314                 </option>
 315                 <option value="082014">
 316                   08/2014
 317                 </option>
 318                 <option value="092014">
 319                   09/2014
 320                 </option>
 321                 <option value="102014">
 322                   10/2014
 323                 </option>
 324                 <option value="112014">
 325                   11/2014
 326                 </option>
 327                 <option value="122014">
 328                   12/2014
 329                 </option>
 330                 <option value="012015">
 331                   01/2015
 332                 </option>
 333                 <option value="022015">
 334                   02/2015
 335                 </option>
 336                 <option value="032015">
 337                   03/2015
 338                 </option>
 339                 <option value="042015">
 340                   04/2015
 341                 </option>
 342                 <option value="052015">
 343                   05/2015
 344                 </option>
 345                 <option value="062015">
 346                   06/2015
 347                 </option>
 348                 <option value="072015">
 349                   07/2015
 350                 </option>
 351                 <option value="082015">
 352                   08/2015
 353                 </option>
 354                 <option value="092015">
 355                   09/2015
 356                 </option>
 357                 <option value="102015">
 358                   10/2015
 359                 </option>
 360                 <option value="112015">
 361                   11/2015
 362                 </option>
 363                 <option value="122015">
 364                   12/2015
 365                 </option>
 366                 <option value="012016">
 367                   01/2016
 368                 </option>
 369                 <option value="022016">
 370                   02/2016
 371                 </option>
 372                 <option value="032016">
 373                   03/2016
 374                 </option>
 375                 <option value="042016">
 376                   04/2016
 377                 </option>
 378                 <option value="052016">
 379                   05/2016
 380                 </option>
 381                 <option value="062016">
 382                   06/2016
 383                 </option>
 384                 <option value="072016">
 385                   07/2016
 386                 </option>
 387                 <option value="082016">
 388                   08/2016
 389                 </option>
 390                 <option value="092016">
 391                   09/2016
 392                 </option>
 393                 <option value="102016">
 394                   10/2016
 395                 </option>
 396                 <option value="112016">
 397                   11/2016
 398                 </option>
 399                 <option value="122016">
 400                   12/2016
 401                 </option>
 402                 <option value="012017">
 403                   01/2017
 404                 </option>
 405                 <option value="022017">
 406                   02/2017
 407                 </option>
 408                 <option value="032017">
 409                   03/2017
 410                 </option>
 411                 <option value="042017">
 412                   04/2017
 413                 </option>
 414                 <option value="052017">
 415                   05/2017
 416                 </option>
 417                 <option value="062017">
 418                   06/2017
 419                 </option>
 420                 <option value="072017">
 421                   07/2017
 422                 </option>
 423                 <option value="082017">
 424                   08/2017
 425                 </option>
 426                 <option value="092017">
 427                   09/2017
 428                 </option>
 429                 <option value="102017">
 430                   10/2017
 431                 </option>
 432                 <option value="112017">
 433                   11/2017
 434                 </option>
 435                 <option value="122017">
 436                   12/2017
 437                 </option>
 438                 <option value="012018">
 439                   01/2018
 440                 </option>
 441                 <option value="022018">
 442                   02/2018
 443                 </option>
 444                 <option value="032018">
 445                   03/2018
 446                 </option>
 447                 <option value="042018">
 448                   04/2018
 449                 </option>
 450                 <option value="052018">
 451                   05/2018
 452                 </option>
 453                 <option value="062018">
 454                   06/2018
 455                 </option>
 456                 <option value="072018">
 457                   07/2018
 458                 </option>
 459                 <option value="082018">
 460                   08/2018
 461                 </option>
 462                 <option value="092018">
 463                   09/2018
 464                 </option>
 465                 <option value="102018">
 466                   10/2018
 467                 </option>
 468                 <option value="112018">
 469                   11/2018
 470                 </option>
 471                 <option value="122018">
 472                   12/2018
 473                 </option>
 474                 <option value="012019">
 475                   01/2019
 476                 </option>
 477                 <option value="022019">
 478                   02/2019
 479                 </option>
 480                 <option value="032019">
 481                   03/2019
 482                 </option>
 483                 <option value="042019">
 484                   04/2019
 485                 </option>
 486                 <option value="052019">
 487                   05/2019
 488                 </option>
 489                 <option value="062019">
 490                   06/2019
 491                 </option>
 492                 <option value="072019">
 493                   07/2019
 494                 </option>
 495                 <option value="082019">
 496                   08/2019
 497                 </option>
 498                 <option value="092019">
 499                   09/2019
 500                 </option>
 501                 <option value="102019">
 502                   10/2019
 503                 </option>
 504                 <option value="112019">
 505                   11/2019
 506                 </option>
 507                 <option value="122019">
 508                   12/2019
 509                 </option>
 510                 <option value="012020">
 511                   01/2020
 512                 </option>
 513                 <option value="022020">
 514                   02/2020
 515                 </option>
 516                 <option value="032020">
 517                   03/2020
 518                 </option>
 519                 <option value="042020">
 520                   04/2020
 521                 </option>
 522                 <option value="052020">
 523                   05/2020
 524                 </option>
 525                 <option value="062020">
 526                   06/2020
 527                 </option>
 528                 <option value="072020">
 529                   07/2020
 530                 </option>
 531                 <option value="082020">
 532                   08/2020
 533                 </option>
 534                 <option value="092020">
 535                   09/2020
 536                 </option>
 537                 <option value="102020">
 538                   10/2020
 539                 </option>
 540                 <option value="112020">
 541                   11/2020
 542                 </option>
 543                 <option value="122020">
 544                   12/2020
 545                 </option>
 546                 <option value="012021">
 547                   01/2021
 548                 </option>
 549                 <option value="022021">
 550                   02/2021
 551                 </option>
 552                 <option value="032021">
 553                   03/2021
 554                 </option>
 555                 <option value="042021">
 556                   04/2021
 557                 </option>
 558                 <option value="052021">
 559                   05/2021
 560                 </option>
 561                 <option value="062021">
 562                   06/2021
 563                 </option>
 564                 <option value="072021">
 565                   07/2021
 566                 </option>
 567                 <option value="082021">
 568                   08/2021
 569                 </option>
 570               </select>
 571             </div>
 572           </li>
 573           <li>
 574             <div id="cvv_line">
 575               <label>Security Code:</label> <input type="text" name="CVV" size="4" class="inputbox" maxlength="4"> <a href="#" class="smoothbox third">What is this?</a>
 576             </div>
 577           </li>
 578         </ol><!-- <div class="clear"></div> -->
 579       </div><!-- <div class="clear"></div> -->
 580     </div>
 581   </div><br>
 582   <div class="paymentMethod">
 583     <div id="giftCard">
 584       <p class="pad">
 585         <strong>QVC Gift Cards</strong><br>
 586         <input type="checkbox" id="giftCardBox" name="useGiftCard"> Use a Gift Card.
 587       </p>
 588     </div>
 589     <div id="giftCardExpand" class="giftCardExpand">
 590       <p class="pad">
 591         If you wish to use more than one Gift Card, enter the first card number and Security ID Number and click the "Enter Another Card" button. If not, enter your card number and Security ID Number and click the "Continue Check-Out" button below.
 592       </p>
 593       <ol>
 594         <li>
 595           <label>Card Number:</label><input type="text" name="GiftCardNum" size="20" class="inputbox">
 596         </li>
 597         <li>
 598           <label>Security ID Number:</label><input type="text" name="GiftCardPIN" size="5" class="inputbox" onkeyup="return SelectDefaultButton(this,4);"> <input type="image" id="RedeemGiftCard" name="RedeemGiftCard" src="#" alt="Enter Another Card">
 599         </li>
 600       </ol>
 601       <p class="pad">
 602         Gift Cards you enter will be converted to QVC Credit and stored on your account. If your Gift Card does not cover your total purchase, the outstanding balance due will be charged to the credit card you selected above. <a href="#" class="smoothbox third">Learn more about Gift Cards</a>.
 603       </p><input type="hidden" name="RedeemedGiftCardSw">
 604     </div>
 605     <div class="clear"></div>
 606   </div><br>
 607   <div id="cancelContinue">
 608     <div class="buttonsDiv">
 609       <input type="image" id="continue" name="Continue" src="#" alt="Continue Check-Out"> <a href="#" class="primary" title="Cancel Order"><img src="#" alt="Cancel Order" width="103" height="19"></a>
 610     </div>
 611   </div>
 612 </form>