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Checkout form joincheckout.com p2

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Dec 26th, 2017
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  1. <!-- Temp: style06 -->
  2. <!DOCTYPE HTML>
  3. <html lang="en-US">
  4. <head>
  5. <meta charset="UTF-8">
  6. <title>dsewsg.com</title>
  7. <link rel="stylesheet" type="text/css" href="/common_tpls/style06/css/base.css"> <script type="text/javascript">
  8. commonPath = "/common_tpls";
  9. </script>
  10. <script language="javascript" type="text/javascript" src="/common_tpls/js/form_support.js"></script>
  11. <script language="javascript" type="text/javascript" src="/common_tpls/js/validate_form.js"></script>
  12. <script language="javascript" type="text/javascript" src="/common_tpls/js/validate_cc.js"></script>
  13. </head>
  14. <body>
  15. <div id="cage">
  16. <div id="header">
  17. <h1>100% Secure Transaction</h1>
  18. </div><!-- #header -->
  19.  
  20. <div id="infoArea">
  21. <h2><span>You are buying access to:</span> Discover New Singles</h2>
  22. <h2><span>Your card statement will be billed as:</span> dsewsg.com (866)988-1936</h2> </div><!-- #infoArea -->
  23.  
  24. <div id="joinWidget">
  25.  
  26. <script src="//ajax.googleapis.com/ajax/libs/jquery/1.8.3/jquery.min.js"></script>
  27. <div id="plainWrapper">
  28. <p class="mediumText">Verification Process</p>
  29. <p class="smallText">Fill this form out for quick access:</p>
  30. <form class="mainForm" method="POST" action="" target="_top" >
  31. <input type="hidden" name="SID" value="SOMETHING">
  32. <input type='hidden' id='step' name='step' value='j1'>
  33.  
  34. <label for="username">Create A Username:</label><input type="text" id="username" name="formdata[username]" value="" data-alert_name="Username"> <span id="j1_password" >
  35. <br>
  36. <label for="password">Choose A Password:</label><input type="password" id="password" name="formdata[password]" value="" data-alert_name="Password"></span><br/><label for="email">Email:</label><input type="text" id="email" name="formdata[email]" value="" data-alert_name="Email"> <span id="j1_firstname" style="display:none;">
  37. <br>
  38. <label for="first_name">First Name:</label><input type="text" id="first_name" name="formdata[firstname]" value="" data-alert_name="First Name"> </span>
  39. <span id="j1_lastname" style="display:none;">
  40. <br>
  41. <label for="last_name">Last Name:</label><input type="text" id="last_name" name="formdata[lastname]" value="" data-alert_name="Last Name"> </span>
  42. <span id="j1_country" style="display:none;">
  43. <br>
  44. <label for="country">Country:</label><select id="country" name="formdata[country]" data-alert_name="Country" class="join_select"> <option label="Aeland Islands" value="AX">Aeland Islands</option>
  45. <!-- <option label="Afghanistan" value="AF">Afghanistan</option> -->
  46. <!-- <option label="Albania" value="AL">Albania</option> -->
  47. <option label="Algeria" value="DZ">Algeria</option>
  48. <option label="American Samoa" value="AS">American Samoa</option>
  49. <option label="Andorra" value="AD">Andorra</option>
  50. <option label="Angola" value="AO">Angola</option>
  51. <option label="Anguilla" value="AI">Anguilla</option>
  52. <option label="Antarctica" value="AQ">Antarctica</option>
  53. <option label="Antigua And Barbuda" value="AG">Antigua And Barbuda</option>
  54. <!-- <option label="Argentina" value="AR">Argentina</option> -->
  55. <option label="Armenia" value="AM">Armenia</option>
  56. <option label="Aruba" value="AW">Aruba</option>
  57. <option label="Australia" value="AU">Australia</option>
  58. <option label="Austria" value="AT">Austria</option>
  59. <option label="Azerbaijan" value="AZ">Azerbaijan</option>
  60. <option label="Bahamas" value="BS">Bahamas</option>
  61. <option label="Bahrain" value="BH">Bahrain</option>
  62. <!-- <option label="Bangladesh" value="BD">Bangladesh</option> -->
  63. <option label="Barbados" value="BB">Barbados</option>
  64. <!-- <option label="Belarus" value="BY">Belarus</option> -->
  65. <option label="Belgium" value="BE">Belgium</option>
  66. <option label="Belize" value="BZ">Belize</option>
  67. <option label="Benin" value="BJ">Benin</option>
  68. <option label="Bermuda" value="BM">Bermuda</option>
  69. <option label="Bhutan" value="BT">Bhutan</option>
  70. <option label="Bolivia" value="BO">Bolivia</option>
  71. <!-- <option label="Bosnia And Herzegowina" value="BA">Bosnia And Herzegowina</option> -->
  72. <option label="Botswana" value="BW">Botswana</option>
  73. <option label="Bouvet Island" value="BV">Bouvet Island</option>
  74. <!-- <option label="Brazil" value="BR">Brazil</option> -->
  75. <!-- <option label="British Indian Ocean" value="IO">British Indian Ocean</option> -->
  76. <!-- <option label="Brunei Darussalam" value="BN">Brunei Darussalam</option> -->
  77. <!-- <option label="Bulgaria" value="BG">Bulgaria</option> -->
  78. <option label="Burkina Faso" value="BF">Burkina Faso</option>
  79. <option label="Burundi" value="BI">Burundi</option>
  80. <!-- <option label="Cambodia" value="KH">Cambodia</option> -->
  81. <option label="Cameroon" value="CM">Cameroon</option>
  82. <option label="Canada" value="CA">Canada</option>
  83. <option label="Cape Verde" value="CV">Cape Verde</option>
  84. <!-- <option label="Cayman Islands" value="KY">Cayman Islands</option> -->
  85. <option label="Central African Republic" value="CF">Central African Republic</option>
  86. <option label="Chad" value="TD">Chad</option>
  87. <!-- <option label="Chile" value="CL">Chile</option> -->
  88. <!-- <option label="China" value="CN">China</option> -->
  89. <option label="Christmas Island" value="CX">Christmas Island</option>
  90. <option label="Cocos (keeling) Islands" value="CC">Cocos (keeling) Islands</option>
  91. <!-- <option label="Colombia" value="CO">Colombia</option> -->
  92. <option label="Comoros" value="KM">Comoros</option>
  93. <!-- <option label="Congo" value="CG">Congo</option> -->
  94. <!--<option label="Congo, Democratic Republic of the" value="CD">Congo, Democratic Republic of the</option>-->
  95. <option label="Cook Islands" value="CK">Cook Islands</option>
  96. <!-- <option label="Costa Rica" value="CR">Costa Rica</option><!-- --> -->
  97. <!-- <option label="Cote D'ivoire" value="CI">Cote D'ivoire</option> -->
  98. <!-- <option label="Croatia" value="HR">Croatia</option> -->
  99. <!-- <option label="Cuba" value="CU">Cuba</option> -->
  100. <option label="Cyprus" value="CY">Cyprus</option>
  101. <!-- <option label="Czech Republic" value="CZ">Czech Republic</option> -->
  102. <option label="Denmark" value="DK">Denmark</option>
  103. <option label="Djibouti" value="DJ">Djibouti</option>
  104. <option label="Dominica" value="DM">Dominica</option>
  105. <!-- <option label="Dominican Republic" value="DO">Dominican Republic</option> -->
  106. <option label="East Timor" value="TP">East Timor</option>
  107. <!-- <option label="Ecuador" value="EC">Ecuador</option> -->
  108. <!-- <option label="Egypt" value="EG">Egypt</option> -->
  109. <!-- <option label="El Salvador" value="SV">El Salvador</option> -->
  110. <option label="Equatorial Guinea" value="GQ">Equatorial Guinea</option>
  111. <option label="Eritrea" value="ER">Eritrea</option>
  112. <!-- <option label="Estonia" value="EE">Estonia</option> -->
  113. <option label="Ethiopia" value="ET">Ethiopia</option>
  114. <option label="Falkland Islands" value="FK">Falkland Islands</option>
  115. <option label="Faroe Islands" value="FO">Faroe Islands</option>
  116. <!-- <option label="Fiji" value="FJ">Fiji</option> -->
  117. <!-- <option label="Finland" value="FI">Finland</option> -->
  118. <option label="France" value="FR">France</option>
  119. <option label="France, Metropolitan" value="FX">France, Metropolitan</option>
  120. <option label="French Guiana" value="GF">French Guiana</option>
  121. <option label="French Polynesia" value="PF">French Polynesia</option>
  122. <option label="French Southern Territories" value="TF">French Southern Territories</option>
  123. <option label="Gabon" value="GA">Gabon</option>
  124. <option label="Gambia" value="GM">Gambia</option>
  125. <option label="Georgia" value="GE">Georgia</option>
  126. <option label="Germany" value="DE">Germany</option>
  127. <!-- <option label="Ghana" value="GH">Ghana</option> -->
  128. <option label="Gibraltar" value="GI">Gibraltar</option>
  129. <!-- <option label="Greece" value="GR">Greece</option> -->
  130. <option label="Greenland" value="GL">Greenland</option>
  131. <!-- <option label="Grenada" value="GD">Grenada</option> -->
  132. <option label="Guadeloupe" value="GP">Guadeloupe</option>
  133. <option label="Guam" value="GU">Guam</option>
  134. <option label="Guatemala" value="GT">Guatemala</option>
  135. <option label="Guernsey" value="GG">Guernsey</option>
  136. <option label="Guinea" value="GN">Guinea</option>
  137. <option label="Guinea-bissau" value="GW">Guinea-bissau</option>
  138. <option label="Guyana" value="GY">Guyana</option>
  139. <option label="Haiti" value="HT">Haiti</option>
  140. <option label="Heard And Mc Donald Isl." value="HM">Heard And Mc Donald Isl.</option>
  141. <option label="Honduras" value="HN">Honduras</option>
  142. <option label="Hong Kong" value="HK">Hong Kong</option>
  143. <!-- <option label="Hungary" value="HU">Hungary</option> -->
  144. <!-- <option label="Iceland" value="IS">Iceland</option> -->
  145. <option label="Isle of Man" value="IM">Isle of Man</option>
  146. <!-- <option label="India" value="IN">India</option> -->
  147. <!-- <option label="Indonesia" value="ID">Indonesia</option> -->
  148. <!-- <option label="Iran" value="IR">Iran</option> -->
  149. <!-- <option label="Iraq" value="IQ">Iraq</option> -->
  150. <option label="Ireland" value="IE">Ireland</option>
  151. <!-- <option label="Israel" value="IL">Israel</option> -->
  152. <option label="Italy" value="IT">Italy</option>
  153. <!-- <option label="Jamaica" value="JM">Jamaica</option> -->
  154. <option label="Japan" value="JP">Japan</option>
  155. <option label="Jersey" value="JE">Jersey</option>
  156. <!-- <option label="Jordan" value="JO">Jordan</option> -->
  157. <!-- <option label="Kazakhstan" value="KZ">Kazakhstan</option> -->
  158. <!-- <option label="Kenya" value="KE">Kenya</option> -->
  159. <option label="Kiribati" value="KI">Kiribati</option>
  160. <!-- <option label="Kuwait" value="KW">Kuwait</option> -->
  161. <option label="Kyrgyzstan" value="KG">Kyrgyzstan</option>
  162. <!--<option label="Lao People's Democratic Republic" value="LA">Lao People's Democratic Republic</option>-->
  163. <option label="Latvia" value="LV">Latvia</option>
  164. <!-- <option label="Lebanon" value="LB">Lebanon</option> -->
  165. <option label="Lesotho" value="LS">Lesotho</option>
  166. <!-- <option label="Liberia" value="LR">Liberia</option> -->
  167. <!-- <option label="Libyan Arab Jamahiriya" value="LY">Libyan Arab Jamahiriya</option> -->
  168. <option label="Liechtenstein" value="LI">Liechtenstein</option>
  169. <option label="Lithuania" value="LT">Lithuania</option>
  170. <option label="Luxembourg" value="LU">Luxembourg</option>
  171. <option label="Macau" value="MO">Macau</option>
  172. <!-- <option label="Macedonia" value="MK">Macedonia</option> -->
  173. <option label="Madagascar" value="MG">Madagascar</option>
  174. <option label="Malawi" value="MW">Malawi</option>
  175. <!-- <option label="Malaysia" value="MY">Malaysia</option> -->
  176. <option label="Maldives" value="MV">Maldives</option>
  177. <option label="Mali" value="ML">Mali</option>
  178. <!-- <option label="Malta" value="MT">Malta</option> -->
  179. <option label="Marshall Islands" value="MH">Marshall Islands</option>
  180. <option label="Martinique" value="MQ">Martinique</option>
  181. <option label="Mauritania" value="MR">Mauritania</option>
  182. <!-- <option label="Mauritius" value="MU">Mauritius</option> -->
  183. <option label="Mayotte" value="YT">Mayotte</option>
  184. <option label="Mexico" value="MX">Mexico</option>
  185. <option label="Micronesia" value="FM">Micronesia</option>
  186. <!-- <option label="Moldova, Republic Of" value="MD">Moldova, Republic Of</option> -->
  187. <option label="Monaco" value="MC">Monaco</option>
  188. <option label="Mongolia" value="MN">Mongolia</option>
  189. <!-- <option label="Montenegro" value="ME">Montenegro</option> -->
  190. <option label="Montserrat" value="MS">Montserrat</option>
  191. <option label="Morocco" value="MA">Morocco</option>
  192. <option label="Mozambique" value="MZ">Mozambique</option>
  193. <!-- <option label="Myanmar" value="MM">Myanmar</option> -->
  194. <option label="Namibia" value="NA">Namibia</option>
  195. <option label="Nauru" value="NR">Nauru</option>
  196. <option label="Nepal" value="NP">Nepal</option>
  197. <option label="Netherlands" value="NL">Netherlands</option>
  198. <!-- <option label="Netherlands Antilles" value="AN">Netherlands Antilles</option> -->
  199. <option label="New Caledonia" value="NC">New Caledonia</option>
  200. <!-- <option label="New Zealand" value="NZ">New Zealand</option> -->
  201. <!-- <option label="Nicaragua" value="NI">Nicaragua</option> -->
  202. <option label="Niger" value="NE">Niger</option>
  203. <!-- <option label="Nigeria" value="NG">Nigeria</option> -->
  204. <option label="Niue" value="NU">Niue</option>
  205. <option label="Norfolk Island" value="NF">Norfolk Island</option>
  206. <option label="Northern Mariana Islands" value="MP">Northern Mariana Islands</option>
  207. <option label="Norway" value="NO">Norway</option>
  208. <!-- <option label="Oman" value="OM">Oman</option> -->
  209. <!-- <option label="Pakistan" value="PK">Pakistan</option> -->
  210. <option label="Palau" value="PW">Palau</option>
  211. <option label="Palestinian Territory, Occupied" value="PS">Palestinian Territory, Occupied</option>
  212. <!-- <option label="Panama" value="PA">Panama</option> -->
  213. <option label="Papua New Guinea" value="PG">Papua New Guinea</option>
  214. <!-- <option label="Paraguay" value="PY">Paraguay</option> -->
  215. <!-- <option label="Peru" value="PE">Peru</option> -->
  216. <!-- <option label="Philippines" value="PH">Philippines</option> -->
  217. <option label="Pitcairn" value="PN">Pitcairn</option>
  218. <!-- <option label="Poland" value="PL">Poland</option> -->
  219. <!-- <option label="Portugal" value="PT">Portugal</option> -->
  220. <!-- <option label="Puerto Rico" value="PR">Puerto Rico</option> -->
  221. <option label="Qatar" value="QA">Qatar</option>
  222. <option label="Reunion" value="RE">Reunion</option>
  223. <!-- <option label="Romania" value="RO">Romania</option> -->
  224. <!-- <option label="Russian Federation" value="RU">Russian Federation</option> -->
  225. <option label="Rwanda" value="RW">Rwanda</option>
  226. <option label="Saint Kitts And Nevis" value="KN">Saint Kitts And Nevis</option>
  227. <option label="Saint Lucia" value="LC">Saint Lucia</option>
  228. <option label="Saint Vincent, The Grenadines" value="VC">Saint Vincent, The Grenadines</option>
  229. <option label="Samoa" value="WS">Samoa</option>
  230. <option label="San Marino" value="SM">San Marino</option>
  231. <option label="Sao Tome And Principe" value="ST">Sao Tome And Principe</option>
  232. <option label="Saudi Arabia" value="SA">Saudi Arabia</option>
  233. <!-- <option label="Senegal" value="SN">Senegal</option> -->
  234. <!-- <option label="Serbia and Montenegro" value="CS">Serbia and Montenegro</option> -->
  235. <!-- <option label="Serbia" value="RS">Serbia</option> -->
  236. <option label="Seychelles" value="SC">Seychelles</option>
  237. <option label="Sierra Leone" value="SL">Sierra Leone</option>
  238. <option label="Singapore" value="SG">Singapore</option>
  239. <option label="Slovakia (slovak Republic)" value="SK">Slovakia (slovak Republic)</option>
  240. <!-- <option label="Slovenia" value="SI">Slovenia</option> -->
  241. <option label="Solomon Islands" value="SB">Solomon Islands</option>
  242. <!-- <option label="Somalia" value="SO">Somalia</option> -->
  243. <!-- <option label="South Africa" value="ZA">South Africa</option> -->
  244. <!-- <option label="South Georgia, South Sandwich Isl." value="GS">South Georgia, South Sandwich Isl.</option>-->
  245. <!-- <option label="Spain" value="ES">Spain</option> -->
  246. <!-- <option label="Sri Lanka" value="LK">Sri Lanka</option> -->
  247. <option label="St. Helena" value="SH">St. Helena</option>
  248. <option label="St. Pierre And Miquelon" value="PM">St. Pierre And Miquelon</option>
  249. <!-- <option label="Sudan" value="SD">Sudan</option> -->
  250. <option label="Suriname" value="SR">Suriname</option>
  251. <!-- <option label="Svalbard And Jan Mayen Islands" value="SJ">Svalbard And Jan Mayen Islands</option>-->
  252. <option label="Swaziland" value="SZ">Swaziland</option>
  253. <option label="Sweden" value="SE">Sweden</option>
  254. <option label="Switzerland" value="CH">Switzerland</option>
  255. <!-- <option label="Syrian Arab Republic" value="SY">Syrian Arab Republic</option> -->
  256. <option label="Taiwan" value="TW">Taiwan</option>
  257. <option label="Tajikistan" value="TJ">Tajikistan</option>
  258. <option label="Tanzania, United Republic Of" value="TZ">Tanzania, United Republic Of</option>
  259. <!-- <option label="Thailand" value="TH">Thailand</option> -->
  260. <option label="Timor-Leste" value="TL">Timor-Leste</option>
  261. <option label="Togo" value="TG">Togo</option>
  262. <option label="Tokelau" value="TK">Tokelau</option>
  263. <!-- <option label="Tonga" value="TO">Tonga</option> -->
  264. <!-- <option label="Trinidad And Tobago" value="TT">Trinidad And Tobago</option> -->
  265. <!-- <option label="Tunisia" value="TN">Tunisia</option> -->
  266. <!-- <option label="Turkey" value="TR">Turkey</option> -->
  267. <option label="Turkmenistan" value="TM">Turkmenistan</option>
  268. <option label="Turks And Caicos Islands" value="TC">Turks And Caicos Islands</option>
  269. <option label="Tuvalu" value="TV">Tuvalu</option>
  270. <option label="Uganda" value="UG">Uganda</option>
  271. <!-- <option label="Ukraine" value="UA">Ukraine</option> -->
  272. <option label="United Arab Emirates" value="AE">United Arab Emirates</option>
  273. <option label="United Kingdom" value="GB">United Kingdom</option>
  274. <option label="United States" value="US" selected="selected">United States</option>
  275. <option label="United States Minor Outlying Isl." value="UM">United States Minor Outlying Isl.</option>
  276. <!-- <option label="Uruguay" value="UY">Uruguay</option> -->
  277. <option label="Uzbekistan" value="UZ">Uzbekistan</option>
  278. <option label="Vanuatu" value="VU">Vanuatu</option>
  279. <option label="Vatican City State" value="VA">Vatican City State</option>
  280. <!-- <option label="Venezuela" value="VE">Venezuela</option> -->
  281. <option label="Viet Nam" value="VN">Viet Nam</option>
  282. <option label="Virgin Islands (british)" value="VG">Virgin Islands (british)</option>
  283. <option label="Virgin Islands (u.s.)" value="VI">Virgin Islands (u.s.)</option>
  284. <option label="Wallis, Futuna Islands" value="WF">Wallis, Futuna Islands</option>
  285. <option label="Western Sahara" value="EH">Western Sahara</option>
  286. <!-- <option label="Yemen" value="YE">Yemen</option> -->
  287. <option label="Yugoslavia" value="YU">Yugoslavia</option>
  288. <option label="Zaire" value="ZR">Zaire</option>
  289. <option label="Zambia" value="ZM">Zambia</option>
  290. <!-- <option label="Zimbabwe" value="ZW">Zimbabwe</option> --> </select>
  291. </span>
  292. <span id="j1_zip" style="display:none;">
  293. <br>
  294. <label for="zip">Zip:</label><input type="text" id="zip" name="formdata[zip]" value="" data-alert_name="Zip" size="10" maxlength="10"> </span>
  295.  
  296.  
  297.  
  298. <script type='text/javascript'>
  299. datingId = 4507;
  300. </script>
  301.  
  302.  
  303. <br>
  304. <label for="seeking">Seeking:</label>
  305. <select id="seeking" name="formdata[seeking]">
  306. <option value="M">Man seeking a woman</option>
  307. <option value="G">Man seeking a man</option>
  308. <option value="F">Woman seeking a man</option>
  309. <option value="L">Woman seeking a woman</option>
  310. </select>
  311. <br>
  312. <input type='hidden' id='dob' name='formdata[dob]' value=''>
  313. <label>Date of Birth:</label>
  314. <select id="dob_month" name="dob_month" onchange="doDob();">
  315. <option value='01'>Jan</option>
  316. <option value='02'>Feb</option>
  317. <option value='03'>Mar</option>
  318. <option value='04'>Apr</option>
  319. <option value='05'>May</option>
  320. <option value='06'>Jun</option>
  321. <option value='07'>Jul</option>
  322. <option value='08'>Aug</option>
  323. <option value='09'>Sep</option>
  324. <option value='10'>Oct</option>
  325. <option value='11'>Nov</option>
  326. <option value='12'>Dec</option>
  327. </select>
  328. <select id="dob_day" name="dob_day" onchange="doDob();">
  329. <script type='text/javascript'>
  330. for(var i =1;i<32;i++) {
  331. if(i<10)
  332. i="0"+i;
  333. document.write("<option value='"+i+"'>"+ i +"</option>");
  334. }
  335. </script>
  336. </select>
  337. <select id="dob_year" name="dob_year" onchange="doDob();">
  338. <script type='text/javascript'>
  339. $year = new Date().getFullYear();
  340. for(var i =$year-90;i<=($year-19);i++) {
  341. var selected = "";
  342. if(i == $year-40)
  343. selected = "selected";
  344. document.write("<option value='"+i+"' "+ selected +">"+ i +"</option>");
  345. }
  346. </script>
  347. </select>
  348. <script type='text/javascript'>
  349. function doDob() {
  350. var mon = document.getElementById('dob_month');
  351. var day = document.getElementById('dob_day');
  352. var year = document.getElementById('dob_year');
  353. var dob = document.getElementById('dob');
  354.  
  355. dob.value = mon.value + '-' + day.value + '-' + year.value;
  356. }
  357.  
  358. var oldDob = '';
  359. if(oldDob != '') {
  360. var parts = oldDob.split('-');
  361. selectInList(document.getElementById('dob_month'),parts[0]);
  362. selectInList(document.getElementById('dob_day'),parts[1]);
  363. selectInList(document.getElementById('dob_year'),parts[2]);
  364. }
  365.  
  366. selectInList(document.getElementById('seeking'),"");
  367.  
  368. doDob();
  369. </script>
  370.  
  371. <br>
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  373. <select name="formdata[product_id]" id="mtype">
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  384.  
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  386. <div id="button">
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  389. <div class="clear"></div>
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  391. <p class="safe">100% safe and secure verification</p>
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  403. <div class="clear"></div><!-- .clear -->
  404. <p>Retrotrade Limited | 81 Derwent Road, Thatcham RG19 3UR, United Kingdom</p>
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