403Webshell
Server IP : 10.200.247.200  /  Your IP : 216.73.217.19
Web Server : Apache
System : Linux synergy-usa-sites 6.8.0-138-generic #138-Ubuntu SMP PREEMPT_DYNAMIC Fri Jul 31 22:41:49 UTC 2026 x86_64
User : jeremy ( 1001)
PHP Version : 8.4.25
Disable Function : NONE
MySQL : OFF  |  cURL : ON  |  WGET : ON  |  Perl : ON  |  Python : OFF  |  Sudo : ON  |  Pkexec : OFF
Directory :  /var/www/usa_sites/pcisecureform.com/

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Current File : /var/www/usa_sites/pcisecureform.com/index.php
<?php
	session_start();
	require_once($_SERVER['DOCUMENT_ROOT'].'/php/mysql.php');
	
	function time_left($str) {
		$secs = strtotime($str) - time();
		$minutes = floor($secs / 60);
		$seconds = $secs % 60;
		return str_pad($minutes,2,'0',STR_PAD_LEFT).':'.str_pad($seconds,2,'0',STR_PAD_LEFT).' mins';
	}
	
	function pretty_phone($str) {
		$str = preg_replace('/[^0-9]/','',$str);
		return '('.substr($str,0,3).') '.substr($str,3,3).'-'.substr($str,6);
	}
	
	if(!empty($_POST['action'])) {
		if($_POST['action']=='save_cc_info') {
			$errors = '';
			$filled_out_id = 0;
			$cc = (empty($_POST['cc_num'])) ? '' : preg_replace('/[^0-9]/','',$_POST['cc_num']);
			$cc_passed = strtoupper($_POST['cc_type']).', '.strlen($cc);
			$res = $db->get_results("SELECT * FROM lc2admin.cc_info_request WHERE id='".$db->clean($_POST['cid'])."'");
			if(empty($res)) {
				die('There was an error processing your request. Please have your representative send you a new link.');
			} else {
				$db->query("INSERT INTO lc2admin.cc_info_request_filled_out
							(
								code
								,site_code
								,lead_id
								,allocator_id
								,ts
								,cc_passed
								,user_agent
								,client_ip_address
								,marketer_ip_address
							) VALUES (
								'".$db->clean($res[0]->code)."'
								,'".$db->clean($res[0]->site_code)."'
								,'".$db->clean($res[0]->lead_id)."'
								,'".$db->clean($res[0]->allocator_id)."'
								,NOW()
								,'".$db->clean($cc_passed)."'
								,'".$db->clean($_SERVER['HTTP_USER_AGENT'])."'
								,'".$db->clean($_SERVER['REMOTE_ADDR'])."'
								,'".$db->clean($res[0]->marketer_ip_address)."'
							)");
				$filled_out_id = $db->last_insert_id();
				
				if($res[0]->marketer_ip_address == $_SERVER['REMOTE_ADDR']) {
					//The marketer is filling it out
					$body = '<p>Client Name: '.$_POST['first'].' '.$_POST['last'].'</p>
							<p>Marketer: '.$marketer_res[0]->marketer.'</p>
							<p>IP Address: '.$res[0]->marketer_ip_address.'</p>
							<p>It appears that the marketer filled out this form as their ip addresses match.</p>';
					
					require_once($_SERVER['DOCUMENT_ROOT'].'/php/mailgun.php');
					mailgun_send_message('jeremy@usbusinessfundingsolutions.com','NoReply@surfcrm.com','PCI Customer Vault Filled Out By Marketer',$body,1,'PCI Customer Vault Filled Out By Marketer','heinz57@gmail.com,golfjrk@gmail.com','','',0,array(),'',0);
				}
			}
			if(empty($_POST['cc_num'])) {
				$errors .= ($errors=='') ? 'You must enter a credit card number.' : "\n".'You must enter a credit card number.';
			} else {
				$_POST['cc_num'] = preg_replace('/[^0-9]/','',$_POST['cc_num']);
				if(empty($_POST['cc_num'])) {
					$errors .= ($errors=='') ? 'You must enter a credit card number.' : "\n".'You must enter a credit card number.';
				} else {
					if(substr($_POST['cc_num'],0,1)=='3') {
						if(strlen($_POST['cc_num'])!=15) {
							$errors .= ($errors=='') ? 'American Express cards should be 15 digits long. You have entered '.strlen($_POST['cc_num']).' digits.' : "\n".'American Express cards should be 15 digits long. You have entered '.strlen($_POST['cc_num']).' digits.';
						}
					} else {
						if(strlen($_POST['cc_num'])!=16) {
							$errors .= ($errors=='') ? 'Your credit card should be 16 digits long. You have entered '.strlen($_POST['cc_num']).' digits.' : "\n".'Your credit card should be 15 digits long. You have entered '.strlen($_POST['cc_num']).' digits.';
						}
					}
				}
			}
			if(empty($_POST['cc_exp_month'])) {
				$errors .= ($errors=='') ? 'You must enter an expiration month.' : "\n".'You must enter an expiration month.';
			}
			if(empty($_POST['cc_exp_year'])) {
				$errors .= ($errors=='') ? 'You must enter an expiration year.' : "\n".'You must enter an expiration year.';
			}
			if(($_POST['cc_exp_year'] < date('Y')) || ($_POST['cc_exp_year']==date('Y') && ($_POST['cc_exp_month']*1) < (date('m')*1))) {
				$errors .= ($errors=='') ? 'The credit card expiration has expired.' : "\n".'The credit card expiration has expired.';
			}
			if(empty($_POST['cc_cvv'])) {
				if(substr($_POST['cc_first_four'],0,1)!=3) {
					$errors .= ($errors=='') ? 'You must enter an CVV number (3 digits on back of card).' : "\n".'You must enter an CVV number (3 digits on back of card).';
				} else {
					$errors .= ($errors=='') ? 'You must enter an CVV number (4 digits on front of card near the top right).' : "\n".'You must enter an CVV number (4 digits on front of card near the top right).';
				}
			}
			if(empty($_POST['first'])) {
				$errors .= ($errors=='') ? 'You must enter your first name.' : "\n".'You must enter your first name.';
			}
			if(empty($_POST['last'])) {
				$errors .= ($errors=='') ? 'You must enter your last name.' : "\n".'You must enter your last name.';
			}
			if(empty($_POST['email'])) {
				$errors .= ($errors=='') ? 'You must enter your email.' : "\n".'You must enter your email.';
			}
			if(empty($_POST['phone_1'])) {
				$errors .= ($errors=='') ? 'You must enter your phone.' : "\n".'You must enter your phone.';
			} else {
				$_POST['phone_1'] = preg_replace('/[^0-9]/','',$_POST['phone_1']);
			}
			if(empty($_POST['zip'])) {
				$errors .= ($errors=='') ? 'You must enter the zip code.' : "\n".'You must enter the zip code.';
			}
			if(!empty($errors)) {
				$db->query("UPDATE lc2admin.cc_info_request_filled_out
							SET
								result='error'
								,error_message='".$db->clean($errors)."'
							WHERE id='".$db->clean($filled_out_id)."'");
				die($errors);
			}
			
			$responses = array();
			$c_url = "https://secure.networkmerchants.com/api/transact.php";
			$query = "customer_vault=add_customer";

			$query .= "&username=usagrantAPI";
			$query .= "&password=MillerTime57&";
			// Sales Information
			$query .= "ccnumber=" . urlencode($_POST['cc_num']) . "&";
			$query .= "ccexp=" . urlencode($_POST['cc_exp_month'] . substr($_POST['cc_exp_year'],-2)) . "&";
			// Order Information
			$query .= "ipaddress=" . urlencode($_SERVER['REMOTE_ADDR']) . "&";
			$query .= "ponumber=" . urlencode($_POST['phone_1']) . "&";
			// Billing Information
			$query .= "firstname=" . urlencode($_POST['first']) . "&";
			$query .= "lastname=" . urlencode($_POST['last']) . "&";
			$query .= "company=" . urlencode('') . "&";
			$query .= "address1=" . urlencode($_POST['street_address']) . "&";
			$query .= "address2=" . urlencode('') . "&";
			$query .= "city=" . urlencode($_POST['city']) . "&";
			$query .= "state=" . urlencode($_POST['state']) . "&";
			$query .= "zip=" . urlencode($_POST['zip']) . "&";
			$query .= "country=" . urlencode('US') . "&";
			$query .= "phone=" . urlencode($_POST['phone_1']) . "&";
			$query .= "fax=" . urlencode('') . "&";
			$query .= "email=" . urlencode($_POST['email']) . "&";
			$query .= "website=" . urlencode('') . "&";
			// Shipping Information
			$query .= "shipping_firstname=" . urlencode($_POST['first']) . "&";
			$query .= "shipping_lastname=" . urlencode($_POST['last']) . "&";
			$query .= "shipping_company=" . urlencode('') . "&";
			$query .= "shipping_address1=" . urlencode($_POST['street_address']) . "&";
			$query .= "shipping_address2=" . urlencode('') . "&";
			$query .= "shipping_city=" . urlencode($_POST['city']) . "&";
			$query .= "shipping_state=" . urlencode($_POST['state']) . "&";
			$query .= "shipping_zip=" . urlencode($_POST['zip']) . "&";
			$query .= "shipping_country=" . urlencode('US') . "&";
			$query .= "shipping_email=" . urlencode($_POST['email']);
			
			$data = shell_exec('curl --tlsv1.2 --data "'.$query.'" '.$c_url);
			$data = explode("&",$data);

			$responses = array();
			for($i=0;$i<count($data);$i++) {
				$rdata = explode("=",$data[$i]);
				$responses[$rdata[0]] = $rdata[1];
			}
			
			if(!empty($responses['customer_vault_id'])) {
				$db->query("INSERT INTO allocator.leads_customer_vault
								(
									lead_id
									,customer_vault_id
									,bin_number
									,last_four
									,exp_month
									,exp_year
								) VALUES (
									'".$db->clean($_POST['aid'])."'
									,'".$db->clean($responses['customer_vault_id'])."'
									,'".$db->clean(substr($_POST['cc_num'],0,6))."'
									,'".$db->clean(substr($_POST['cc_num'],-4))."'
									,'".$db->clean($_POST['cc_exp_month'])."'
									,'".$db->clean($_POST['cc_exp_year'])."'
								)");
				$db->query("UPDATE lc2admin.cc_info_request_filled_out
							SET
								result='success'
								,error_message='".$db->clean($responses['customer_vault_id'])."'
							WHERE id='".$db->clean($filled_out_id)."'");
			} else {
				$marketer_res = $db->get_results("SELECT marketer FROM lc2admin.cc_info_request WHERE id='".$db->clean($_POST['cid'])."'");
				$body = '<p>Client Name: '.$_POST['first'].' '.$_POST['last'].'</p>
						<p>Marketer: '.$marketer_res[0]->marketer.'</p>
						<p>CC Type: '.$_POST['cc_type'].'</p>
						<p>Card Length: '.strlen($_POST['cc_num']).'</p>
						<pre>'.print_r($responses,true).'</pre>';
				
				require_once($_SERVER['DOCUMENT_ROOT'].'/php/mailgun.php');
				mailgun_send_message('jeremy@usbusinessfundingsolutions.com','NoReply@surfcrm.com','PCI Customer Vault Failed',$body,1,'PCI Customer Vault Failed','heinz57@gmail.com,golfjrk@gmail.com','','',0,array(),'',0);
				
				if(strpos($responses['responsetext'],'REFID:')!==false) {
					$arr = explode('REFID:',$responses['responsetext']);
					$responses['responsetext'] = trim($arr[0]);
				}
				$cc_passed = strtoupper($_POST['cc_type']).', '.strlen($_POST['cc_num']);
				
				$db->query("INSERT INTO lc2admin.cc_info_errors
							(
								request_type
								,request_id
								,error_message
								,cc_passed
								,ts
							) VALUES (
								'marketer'
								,'".$db->clean($_POST['cid'])."'
								,'".$db->clean($responses['responsetext'])."'
								,'".$db->clean($cc_passed)."'
								,NOW()
							)");
				$db->query("UPDATE lc2admin.cc_info_request_filled_out
							SET
								result='error'
								,error_message='".$db->clean($responses['responsetext'])."'
							WHERE id='".$db->clean($filled_out_id)."'");
				echo 'There was a problem saving your card: '.$responses['responsetext'];
			}
		}
		die();
	}
	
	$res = $db->get_results("SELECT c.*
							FROM lc2admin.cc_info_request c
							WHERE c.code='".$db->clean($_GET['c'])."'
							ORDER BY id DESC LIMIT 1");
	if(!empty($res)) {
		$siteCode = $res[0]->site_code;
		$res = $db->get_results("SELECT c.*,r.id as rid,r.first,r.last,r.address1,r.city,r.state,r.zip,r.phone,r.email
							FROM lc2admin.cc_info_request c
							LEFT JOIN lc2{$siteCode}_lc.lc_leads r ON r.id=c.lead_id
							WHERE c.code='".$db->clean($_GET['c'])."'
							AND c.site_code='".$db->clean($siteCode)."'
							AND c.expires >= NOW()");
	}
	if(empty($siteCode)) {
		$siteCode = 'usafa'; //default to usafa if they just show up here.
	}
?>
<!doctype html>
<html>
	<head>
		<title>PCI Compliant Credit Card Form</title>
		<meta name="viewport" content="width=device-width, initial-scale=1.0">
		<style type="text/css">
			.container {
				width:500px;
				max-width:100%;
				margin:0px auto;
				text-align:center;
				font-size:16px;
				background:white;
			}
			.header {
				text-align:center;
			}
			.header img {
				width:100%;
			}
			.main_area {
				text-align:left;
				padding:10px;
			}
			.big_line {
				margin:20px 0px;
			}
			.big_text {
				font-size:28px;
				color:#1e3891;
				padding-bottom:10px;
			}
			.pci_logo {
				float:right;
			}
			input[type=text],input[type=tel],select {
				padding:10px 20px;
				width:90%;
				margin:0px auto;
				font-size:20px;
			}
			#submit_button {
				background:#dfedd6;
				color:black;
				border:1px solid black;
				border-radius:5px;
				cursor:pointer;
				text-align:center;
				padding:20px 0px;
				font-size:20px;
				width:90%;
			}
		</style>
		<script type="text/javascript" src="/js/jquery-1.9.1.js"></script>
		<script type="text/javascript" src="/js/jquery.formatter.min.js"></script>
		<script type="text/javascript">
			$(document).ready(function(){
				$('input[name=cc_num]').formatter({
				  'pattern': '{{9999}}-{{9999}}-{{9999}}-{{9999}}',
				  'persistent': false
				});
				$('input[name=cc_num]').formatter({
				  'pattern': '{{9999}}-{{9999}}-{{9999}}-{{9999}}',
				  'persistent': false
				});
				$('input[name=phone_1]').formatter({
				  'pattern': '({{999}}) {{999}}-{{9999}}',
				  'persistent': false
				});
			});
			
			function change_cc_type() {
				if($('[name=cc_type]:checked').val()=='amex') {
					$('input[name=cc_num]').formatter().resetPattern('{{9999}}-{{999999}}-{{99999}}');
					$('input[name=cc_cvv]').formatter().resetPattern('{{9999}}');
					$('.cvv_info_not_amex').hide();
					$('.cvv_info_amex').show();
				} else {
					$('input[name=cc_num]').formatter().resetPattern('{{9999}}-{{9999}}-{{9999}}-{{9999}}');
					$('input[name=cc_cvv]').formatter().resetPattern('{{999}}');
					$('.cvv_info_not_amex').show();
					$('.cvv_info_amex').hide();
				}
			}
			
			function save_cc_info(frm) {
				var str="action=save_cc_info";
				$(frm).find('input,select,textarea').each(function() {
					if(this.type=='checkbox' || this.type=='radio') {
						if($(this).is(':checked')) {
							str += "&" + encodeURIComponent(this.name) + '=' + encodeURIComponent($(this).val());
						}
					} else {
						str += "&" + encodeURIComponent(this.name) + '=' + encodeURIComponent($(this).val());
					}
				});
				$.ajax({
					url:"/index.php",
					cache: false,
					type: "POST",
					data: str,
					success: function(results) {
						if(results!='') {
							alert(results);
						} else {
							$(frm)[0].outerHTML = '<p>Thank you for submitting your payment information.</p>';
						}
					},
					error: function(jqXHR, textStatus, errorThrown) {
					}
				});
			}
		</script>
	</head>
	<body>
		<div class="container">
			<div class="main_area">
				<div class="big_line">
					<div class="pci_logo"><img src="/images/pci_logo.png" /></div>
					<div class="big_text">PCI Compliant Secure Form</div>
					<div style="clear:both;"></div>
				</div>
				<?php if(empty($res)) { ?>
				<p>Our goal is to ensure that best practice guidelines are distributed to create a more robust security environment for all organizations. We partner with companies to help them maintain PCI compliance standards.</p>
				<p>PCI compliance refers to the set of security standards developed by the Payment Card Industry Security Standards Council (PCI SSC) to protect credit card data and prevent fraud. The standards apply to all organizations that accept credit card payments, including merchants, payment processors, and service providers.</p>
				<p>PCI compliance is important for users because it helps ensure that their credit card information is protected when they make purchases online. By complying with PCI standards, businesses demonstrate their commitment to protecting customer data, which can increase consumer trust and confidence in their brand.</p>
				<?php } else {
					function convert_offset_to_timezone($offset,$dst) {
						$tz = timezone_name_from_abbr(null, $offset * 3600, $dst);
						return timezone_abbr_from_name($tz);
					}
					function timezone_abbr_from_name($timezone_name){
						$dateTime = new DateTime(); 
						$dateTime->setTimeZone(new DateTimeZone($timezone_name)); 
						return $dateTime->format('T'); 
					}
					$expires_time = date('g:i a',strtotime($res[0]->expires)).' MST';
					if(!empty($res[0]->zip)) {
						$ares = $db->get_results("SELECT city,state,zip,IF(-8 - CAST(REPLACE(TIMEDIFF(NOW(), UTC_TIMESTAMP()), ':00:00', '') AS SIGNED)=1,timezone+dst,timezone) as timezone, (-8 - CAST(REPLACE(TIMEDIFF(NOW(), UTC_TIMESTAMP()), ':00:00', '') AS SIGNED)=1) as isDst FROM geo.zip_codes WHERE zip='{$res[0]->zip}'");
						if(!empty($ares)) {
							$arow = $ares[0];
							$time_offset = $arow->timezone + 7;
							$expires = strtotime($res[0]->expires) + ($time_offset*3600);
							if($arow->state=='HI') {
								$expires_time = date('g:i a',$expires).' HST';
							} else {
								$expires_time = date('g:i a',$expires).' '.convert_offset_to_timezone($arow->timezone,$arow->isDst);
							}
						} else {
							$ares = $db->get_results("SELECT state_short,IF(-8 - CAST(REPLACE(TIMEDIFF(NOW(), UTC_TIMESTAMP()), ':00:00', '') AS SIGNED)=1,timezone_offset,timezone_offset) as timezone, (-8 - CAST(REPLACE(TIMEDIFF(NOW(), UTC_TIMESTAMP()), ':00:00', '') AS SIGNED)=1) as isDst FROM geo.states WHERE state_short='{$res[0]->state}'");
							if(!empty($ares)) {
								$arow = $ares[0];
								$time_offset = $arow->timezone + 7;
								$expires = strtotime($res[0]->expires) + ($time_offset*3600);
								$expires_time = date('g:i a',$expires).' '.convert_offset_to_timezone($arow->timezone,$arow->isDst);
							} else {
								$expires_time = date('g:i a',strtotime($res[0]->expires)).' MST';
							}
						}
					} else {
						$area_code = substr($res[0]->phone_1,0,3);
						$ares = $db->get_results("SELECT state,IF(-8 - CAST(REPLACE(TIMEDIFF(NOW(), UTC_TIMESTAMP()), ':00:00', '') AS SIGNED)=1,timezone_offset,timezone_offset) as timezone, (-8 - CAST(REPLACE(TIMEDIFF(NOW(), UTC_TIMESTAMP()), ':00:00', '') AS SIGNED)=1) as isDst FROM geo.area_codes WHERE area_code='{$area_code}'");
						if(!empty($ares)) {
							$arow = $ares[0];
							$time_offset = $arow->timezone + 7;
							$expires = strtotime($res[0]->expires) + ($time_offset*3600);
							if($arow->state=='Hawaii') {
								$expires_time = date('g:i a',$expires).' HST';
							} else {
								$expires_time = date('g:i a',$expires).' '.convert_offset_to_timezone($arow->timezone,$arow->isDst);
							}
						} else {
							$ares = $db->get_results("SELECT state_short,IF(-8 - CAST(REPLACE(TIMEDIFF(NOW(), UTC_TIMESTAMP()), ':00:00', '') AS SIGNED)=1,timezone_offset,timezone_offset) as timezone, (-8 - CAST(REPLACE(TIMEDIFF(NOW(), UTC_TIMESTAMP()), ':00:00', '') AS SIGNED)=1) as isDst FROM geo.states WHERE state_short='{$res[0]->state}'");
							if(!empty($ares)) {
								$arow = $ares[0];
								$time_offset = $arow->timezone + 7;
								$expires = strtotime($res[0]->expires) + ($time_offset*3600);
								$expires_time = date('g:i a',$expires).' '.convert_offset_to_timezone($arow->timezone,$arow->isDst);
							} else {
								$expires_time = date('g:i a',strtotime($res[0]->expires)).' MST';
							}
						}
					}
					
					$is_dst = date('I')*1;
					if($is_dst) {
						$original_appointment_time = $expires;
						$expires_time = str_replace('ST','DT',$expires_time);
						if(!empty($arow)) {
							if($arow->state=='AZ') {
								$expires_time = $original_appointment_time;
							}
						}
					}
				?>
				<div><i>Secure Payment Form Expires at <strong id="expire_timer"><?= $expires_time;?></strong></i></div>
				<form onsubmit="save_cc_info(this); return false;">
					<input type="hidden" name="cid" value="<?= $res[0]->id;?>" />
					<input type="hidden" name="aid" value="<?= $res[0]->allocator_id;?>" />
					<input type="hidden" name="action" value="save_cc_info" />
					<div class="big_line">
						<div class="big_text">
							Client Information
							<a href="#" onclick="$('.real_client_address,.display_client_address').toggle(); return false;" style="font-size:12px;">Edit</a>
						</div>
						<div style="padding-left:30px;font-size:18px;" class="display_client_address">
							<div><?= $res[0]->first.' '.$res[0]->last;?></div>
							<div><?= $res[0]->address1;?></div>
							<div><?= $res[0]->city.', '.$res[0]->state.' '.$res[0]->zip;?></div>
							<div><?= pretty_phone($res[0]->phone);?></div>
							<div><?= $res[0]->email;?></div>
						</div>
						<div style="padding-left:30px;display:none;" class="real_client_address">
							<div>
								<label>First Name<br />
									<input type="text" name="first" value="<?= $res[0]->first;?>" />
								</label>
							</div>
							<div>
								<label>Last Name<br />
									<input type="text" name="last" value="<?= $res[0]->last;?>" />
								</label>
							</div>
							<div>
								<label>Street Address<br />
									<input type="text" name="street_address" value="<?= $res[0]->address1;?>" />
								</label>
							</div>
							<div>
								<label>City<br />
									<input type="text" name="city" value="<?= $res[0]->city;?>" />
								</label>
							</div>
							<div>
								<label>State<br />
									<input type="text" name="state" value="<?= $res[0]->state;?>" />
								</label>
							</div>
							<div>
								<label>Zip<br />
									<input type="tel" name="zip" value="<?= $res[0]->zip;?>" />
								</label>
							</div>
							<div>
								<label>Phone<br />
									<input type="tel" name="phone_1" value="<?= pretty_phone($res[0]->phone);?>" />
								</label>
							</div>
							<div>
								<label>Email<br />
									<input type="text" name="email" value="<?= $res[0]->email;?>" />
								</label>
							</div>
						</div>
					</div>
					<div class="big_line">
						<div class="big_text">Card Type</div>
						<div class="credit_cards">
							<label><input type="radio" name="cc_type" value="visa" onclick="change_cc_type();" required style="vertical-align:middle;width:20px;height:20px;" /> <img src="/images/visa.png" style="vertical-align:middle;" /></label>
							<label><input type="radio" name="cc_type" value="mast" onclick="change_cc_type();" required style="vertical-align:middle;width:20px;height:20px;" /> <img src="/images/mast.png" style="vertical-align:middle;" /></label>
							<label><input type="radio" name="cc_type" value="disc" onclick="change_cc_type();" required style="vertical-align:middle;width:20px;height:20px;" /> <img src="/images/disc.png" style="vertical-align:middle;" /></label>
							<label><input type="radio" name="cc_type" value="amex" onclick="change_cc_type();" required style="vertical-align:middle;width:20px;height:20px;" /> <img src="/images/amex.png" style="vertical-align:middle;" /></label>
						</div>
					</div>
					<div class="big_line">
						<input type="tel" id="cc_num" name="cc_num" placeholder="Credit Card Number" required />
					</div>
					<div class="big_line">
						<div style="display:inline-block;vertical-align:middle;">
							<div style="display:inline-block;width:70px;">Expires</div>
							<select name="cc_exp_month" style="width:100px;padding:10px 0px;" required>
								<option value="">MM</option>
								<?php for($i=1;$i<=12;$i++) {?>
									<option value="<?= str_pad($i,2,'0',STR_PAD_LEFT);?>"><?= str_pad($i,2,'0',STR_PAD_LEFT);?></option>
								<?php } ?>
							</select> /
							<select name="cc_exp_year" style="width:150px;padding:10px 0px;" required>
								<option value="">YYYY</option>
								<?php $this_year = date('Y');
								$end_year = $this_year*1 + 10;
								for($i=$this_year;$i<=$end_year;$i++) { ?>
									<option value="<?= $i;?>"><?= $i;?></option>
								<?php } ?>
							</select>
						</div>
						<div style="margin-top:10px;">
							<div style="display:inline-block;vertical-align:middle;">
								<div style="display:inline-block;width:70px;">CVV</div>
								<input type="tel" name="cc_cvv" placeholder="333" style="width:100px;" required />
							</div>
						</div>
						<div class="cvv_info_not_amex" style="display:none;"><i style="font-size:14px;">* The CVV is a 3 digit number on the back of your card.</i></div>
						<div class="cvv_info_amex" style="display:none;"><i style="font-size:14px;">* The CVV is a 4 digit number on the front of your card.</i></div>
					</div>
					<div class="big_line">
						<center><input type="submit" value="Submit" id="submit_button" /></center>
					</div>
				</form>
				<div class="big_line">
					<center><img src="/images/ssl_logo.png" /></center>
				</div>
				<?php } ?>
			</div>
		</div>
	</body>
</html>

Youez - 2016 - github.com/yon3zu
LinuXploit