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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<meta http-equiv="X-UA-Compatible" content="IE=edge">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<title>Global.direct.asda.com</title>
</head>
<body>
<form action="/1/Payments/HandleCreditCardRequestV2?mode=13534" method="post" id="paymentFrm" novalidate="novalidate">
<div class="clearfix" id="secureContainer" data-culture="en-GB" data-direction="ltr">
<div class="form-horizontal">
<div class="form-group has-error has-feedback">
<label for="cardNum" class="col-sm-4 col-xs-12 control-label fcap paylabel">Card number<div data-show="true"
class="glyphicon glyphicon-star astrsk"></div></label>
<div class="col-sm-8 col-xs-12 fval" id="CreditCardCell" data-cc-valid="false">
<input aria-label="Card number" autocomplete="off" class="form-control input-validation-error"
data-type="unknown" data-type-id="1" data-val="true" data-val-luhn="Card number not valid"
data-val-luhn-allowempty="False" data-val-luhn-allowspaces="False" data-val-required="Card number"
id="cardNum" name="PaymentData.cardNum" pattern="[0-9]{13,16}" placeholder="Card number" type="tel"
value="" aria-required="true"><span class="glyphicon glyphicon-remove form-control-feedback"
aria-hidden="true"></span>
<div id="cardTypeInfo">
<div class="isvisa pm_visa pm_general"></div>
<div class="ismastercard pm_mastercard pm_general"></div>
<div class="isamex pm_amex pm_general"></div>
<div class="ismaestro pm_maestro pm_general"></div>
<div class="isjcb pm_jcb pm_general"></div>
<div class="isdiners pm_diners pm_general"></div>
<div class="isdiscover pm_discover pm_general"></div>
<div class="ismir pm_mir pm_general"></div>
<div class="isdefault pm_default pm_general"></div>
</div>
</div>
</div>
<div class="form-group">
<label for="cardExpiryMonth" class="col-sm-4 col-xs-12 control-label fcap paylabel">Expiry date<div
data-show="true" class="glyphicon glyphicon-star astrsk"></div></label>
<div class="col-sm-8 col-xs-12 fval">
<div class="row" id="expDateRow">
<div class="col-xs-6">
<div class="FSelect">
<div class="arrow"></div>
<div class="FCurValue">Month</div><select aria-label="Month" class="form-control"
data-tooltip-special-pos="top left;bottom left" data-val="true"
data-val-datemustbeequalorgreaterthancurrentdate="The credit card expiration date you provided has already expired."
data-val-required="Expiry date" data-widget="lightcombobox" id="cardExpiryMonth"
name="PaymentData.cardExpiryMonth" data-rendered="true" aria-required="true">
<option selected="selected" value="">Month</option>
<option value="1">01</option>
<option value="2">02</option>
<option value="3">03</option>
<option value="4">04</option>
<option value="5">05</option>
<option value="6">06</option>
<option value="7">07</option>
<option value="8">08</option>
<option value="9">09</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
</select>
</div>
</div>
<div class="col-xs-6">
<div class="FSelect">
<div class="arrow"></div>
<div class="FCurValue">Year</div><select aria-label="Year" class="form-control"
data-tooltip-special-pos="top right;bottom right" data-val="true"
data-val-datemustbeequalorgreaterthancurrentdate="The credit card expiration date you provided has already expired."
data-val-required="Expiry date" data-widget="lightcombobox" id="cardExpiryYear"
name="PaymentData.cardExpiryYear" data-rendered="true" aria-required="true">
<option selected="selected" value="">Year</option>
<option value="2022">2022</option>
<option value="2023">2023</option>
<option value="2024">2024</option>
<option value="2025">2025</option>
<option value="2026">2026</option>
<option value="2027">2027</option>
<option value="2028">2028</option>
<option value="2029">2029</option>
<option value="2030">2030</option>
<option value="2031">2031</option>
<option value="2032">2032</option>
<option value="2033">2033</option>
<option value="2034">2034</option>
<option value="2035">2035</option>
<option value="2036">2036</option>
<option value="2037">2037</option>
<option value="2038">2038</option>
<option value="2039">2039</option>
<option value="2040">2040</option>
<option value="2041">2041</option>
<option value="2042">2042</option>
</select>
</div>
</div>
</div>
</div>
</div>
<div id="cvvContainer" class="form-group">
<label for="cvdNumber" class="col-sm-4 col-xs-12 control-label fcap paylabel">Security code<div
data-show="true" class="glyphicon glyphicon-star astrsk"></div></label>
<div class="col-sm-8 col-xs-12 fval">
<input aria-label="Security code" autocomplete="off" class="form-control" data-tt-pos="top" data-val="true"
data-val-cvvval="Please enter a valid CVV" data-val-cvvval-otherpropertyname=""
data-val-required="Security code" id="cvdNumber" name="PaymentData.cvdNumber" pattern="[0-9]{3,4}"
placeholder="CVV" type="tel" value="" aria-required="true">
<span id="cvvDescriptionContainer" data-toggle="tooltip" data-placement="top" title=""
data-original-title="The Security Code on your credit card or debit card is a 3 digit number on the back of your VISA®, MasterCard® and Discover® branded credit and debit cards. On your American Express® branded credit or debit card it is a 4 digit numeric code on the front of the card.">
<label tabindex="0" class="control-label" id="cvvInfo"> What is this?</label>
<label class="control-label secureinfolabel"><span class="secureInfo lazy"></span></label>
</span>
</div>
</div>
</div>
</div>
<!--#region Hidden Payment Parameters-->
<input type="hidden" name="PaymentData.checkoutV2" value="true">
<input type="hidden" name="PaymentData.cartToken" id="cartToken" value="045078e1-dafa-4d42-8e1a-a8a8dc3c2234">
<input type="hidden" name="PaymentData.gatewayId" id="gatewayId" value="2">
<input type="hidden" name="PaymentData.paymentMethodId" id="paymentMethodId" value="1">
<input type="hidden" name="PaymentData.machineId" id="machineId">
<!--Needs to be updated by script-->
<input type="hidden" name="PaymentData.createTransaction" id="createTransaction" value="true">
<input type="hidden" name="PaymentData.checkoutCDNEnabled" id="checkoutURL" value="value">
<input type="hidden" name="PaymentData.recapchaToken" id="recapchaToken">
<!--Needs to be updated by script-->
<input type="hidden" name="PaymentData.recapchaTime" id="recapchaTime">
<!--Needs to be updated by script-->
<input type="hidden" name="PaymentData.customerScreenColorDepth" id="customerScreenColorDepth">
<!--Needs to be updated by script-->
<input type="hidden" name="PaymentData.customerScreenWidth" id="customerScreenWidth">
<!--Needs to be updated by script-->
<input type="hidden" name="PaymentData.customerScreenHeight" id="customerScreenHeight">
<!--Needs to be updated by script-->
<input type="hidden" name="PaymentData.customerTimeZoneOffset" id="customerTimeZoneOffset">
<!--Needs to be updated by script-->
<input type="hidden" name="PaymentData.customerLanguage" id="customerLanguage">
<!--Needs to be updated by script-->
<input type="hidden" name="PaymentData.UrlStructureTokenEncoded" id="UrlStructureTokenEncoded"
value="eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJFbmNvZGVkTWVyY2hhbnRJZCI6IjhybzgiLCJDYXJ0VG9rZW4iOiIwNDUwNzhlMS1kYWZhLTRkNDItOGUxYS1hOGE4ZGMzYzIyMzQiLCJJc1JlcXVpcmVkVG9QYXlXaXRoRGVjb2RlZE1lcmNoYW50SWRBbmRUb2tlbkluVXJsIjpmYWxzZX0.NaxXTwl3w9OurCnPmosjy0P0kSvvs9JfY1OnRVI_w_4">
<!--#endregion-->
</form>
</body>
</html>
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