top_sites/CostCo/Payment.html

<!DOCTYPE html> <html lang="en"> <head> <meta http-equiv="Content-Type" content="text/html; charset=UTF-8"> <meta feature="9.1.4"> <title>Costco - Payment</title> <meta name="currentBuildNumber" content="3.0.29057.0"> <meta name="ServerName" content="www.costco.com "> <meta name="LocalAddress" content="xxx.xxx.xxx.48"> <meta name="LocalName" content="TP26"> </head> <body waid71fa0d88-5390-4b5b-a2f4-e45fa93d85e2="SA password protect entry checker"> <form name="CheckoutPaymentForm" id="CheckoutPaymentForm" method="post" action="https://www.costco.com/CostcoBillingPayment"> <input type="hidden" name="selfAddressId" id="hiddenSelfAddressId" value=""> <input type="hidden" id="billHiddenInput0" name="billHideenInput" value=""> <input type="hidden" id="billAddrId" name="billAddrId" value=""> <input type="hidden" id="membershipNumber" name="membershipNum"> <input type="hidden" name="orderItemsCount" value="1"> <input type="hidden" value="" id="selectedAddressId" name="selectedAddressId"> <input type="hidden" name="orderId" value="644156669" id="WC_CheckoutPaymentsAndBillingAddressf_orderId"> <input type="hidden" name="storeId" value="10301" id="CheckoutPayment_inputs_1"> <input type="hidden" name="catalogId" value="10701" id="CheckoutPayment_inputs_2"> <input type="hidden" name="langId" value="-1" id="CheckoutPayment_inputs_3"> <input type="hidden" name="curr_year" value="2017" id="CheckoutPayment_inputs_5"> <input type="hidden" name="curr_month" value="3" id="CheckoutPayment_inputs_6"> <input type="hidden" name="curr_date" value="19" id="CheckoutPayment_inputs_7"> <input type="hidden" name="URL" value="OrderPrepare?URL=CheckoutReviewView"> <input type="hidden" name="xCreditCardId" value=""> <input type="hidden" name="ccLastFour" value=""> <input type="hidden" name="checkCCValue" value="false"> <input type="hidden" name="backURL" value=""> <input type="hidden" name="piAmount" value="84.99000"> <input type="hidden" name="cardNumberValueHolder" value=""> <input type="hidden" name="authToken" value="312404731%2cKsqvty%2bpMJ%2bCAl3XeIkCxSEgLa4%3d"> <div> <label for="billMeLater"> <input type="radio" checked="checked" id="billMeLater" name="billMeLater" value="no" title="overall type: UNKNOWN_TYPE server type: NO_SERVER_DATA heuristic type: UNKNOWN_TYPE label: Payment Method parseable name: billMeLater field signature: 1700925171 form signature: 4979691664972472743" autofill-prediction="UNKNOWN_TYPE"> </label> <br> <div> <div> <label for="payMethodId">Card Type</label> <select name="payMethodId" id="payMethodId" aria-describedby="payMethodId_validation" title="overall type: CREDIT_CARD_TYPE server type: CREDIT_CARD_TYPE heuristic type: CREDIT_CARD_TYPE label: Card Type parseable name: payMethodId field signature: 3668211827 form signature: 4979691664972472743" autofill-prediction="CREDIT_CARD_TYPE"> <option value="Costco Credit Card">Costco Credit Card</option> <option value="Discover">Discover</option> <option value="Master Card">MasterCard</option> <option value="VISA" selected="selected">VISA</option> </select> </div> <div> <label for="account">Card number</label> <input title="overall type: CREDIT_CARD_NUMBER server type: NO_SERVER_DATA heuristic type: CREDIT_CARD_NUMBER label: Card number parseable name: account field signature: 3715653537 form signature: 4979691664972472743" type="text" id="account" aria-describedby="account_validation" name="account" value="" onchange="checkCCValueChange()" autocomplete="off" autofill-prediction="CREDIT_CARD_NUMBER"> </div> </div> <div> <div> <label for="expire_month">Expiration Date</label> <select title="overall type: CREDIT_CARD_EXP_MONTH server type: CREDIT_CARD_EXP_MONTH heuristic type: CREDIT_CARD_EXP_MONTH label: Expiration Date parseable name: expire_month field signature: 3078539387 form signature: 4979691664972472743" id="expire_month" aria-describedby="expire_month_validation" name="expire_month" autofill-prediction="CREDIT_CARD_EXP_MONTH"> <option value="Month">Month</option> <option value="01">1</option> <option value="02">2</option> <option value="03">3</option> <option value="04">4</option> <option value="05">5</option> <option value="06">6</option> <option value="07">7</option> <option value="08">8</option> <option value="09">9</option> <option value="10">10</option> <option value="11">11</option> <option value="12">12</option> </select> <select title="overall type: CREDIT_CARD_EXP_4_DIGIT_YEAR server type: CREDIT_CARD_EXP_4_DIGIT_YEAR heuristic type: CREDIT_CARD_EXP_4_DIGIT_YEAR label: Expiration Date parseable name: expire_year field signature: 2521850425 form signature: 4979691664972472743" name="expire_year" aria-describedby="expire_year_validation" autofill-prediction="CREDIT_CARD_EXP_4_DIGIT_YEAR"> <option value="Year">Year</option> <option value="2017">2017</option> <option value="2018">2018</option> <option value="2019">2019</option> <option value="2020">2020</option> <option value="2021">2021</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> </select> </div> <div> <label for="cc_cvc">CVV Code</label> <input title="overall type: CREDIT_CARD_VERIFICATION_CODE server type: NO_SERVER_DATA heuristic type: CREDIT_CARD_VERIFICATION_CODE label: CVV Code parseable name: cc_cvc field signature: 1956128288 form signature: 4979691664972472743" type="text" id="cc_cvc" aria-describedby="cc_cvc_validation" name="cc_cvc" value="" maxlength="4" autocomplete="off" autofill-prediction="CREDIT_CARD_VERIFICATION_CODE"> <span> <span>?</span></span> </div> </div> <div> <label for="cc_nameoncard">Cardholder Name</label> <input title="overall type: CREDIT_CARD_NAME_FULL server type: CREDIT_CARD_NAME_FULL heuristic type: CREDIT_CARD_NAME_FULL label: Cardholder Name parseable name: cc_nameoncard field signature: 1086986730 form signature: 4979691664972472743" type="text" id="cc_nameoncard" aria-describedby="cc_nameoncard_validation" name="cc_nameoncard" value="" autocomplete="off" autofill-prediction="CREDIT_CARD_NAME_FULL"> </div> <div> <input title="overall type: UNKNOWN_TYPE server type: NO_SERVER_DATA heuristic type: UNKNOWN_TYPE label: Save this as my default payment card parseable name: save_CC field signature: 3060743727 form signature: 4979691664972472743" type="checkbox" name="save_CC" id="save_CC" autofill-prediction="UNKNOWN_TYPE"> <label for="save_CC">Save this as my default payment card</label> </div> </div> </form> <form name="CashCardForm" method="post" action="https://www.costco.com/CostcoCashCardProcess" id="CashCardForm"> <input type="hidden" name="storeId" value="10301"> <input type="hidden" name="langId" value="-1"> <input type="hidden" name="orderId" value="644156669"> <input type="hidden" name="catalogId" value="10701"> <input type="hidden" name="addressId" value=""> <input type="hidden" name="cc_payMethodId" value="CostcoCashCard"> <input type="hidden" name="action" value=""> <input type="hidden" name="URL" value="CheckoutPaymentView"> <input type="hidden" name="account" value=""> <input type="hidden" name="expire_month" value=""> <input type="hidden" name="expire_year" value=""> <input type="hidden" name="cc_nameoncard" value=""> <input type="hidden" name="payMethodId" value=""> <input type="hidden" name="xCreditCardId" value=""> <input type="hidden" name="ccLastFour" value=""> <input type="hidden" name="authToken" value="312404731%2cKsqvty%2bpMJ%2bCAl3XeIkCxSEgLa4%3d"> <div> <div> <label for="cash_account">Costco Cash Card Number</label> <input title="Costco Cash Card Number" type="text" id="cash_account" name="cash_account" value="" maxlength="19" autocomplete="off"> </div> <div> <label for="cash_pin">PIN</label> <input title="PIN" type="password" id="cash_pin" name="cash_pin" value="" maxlength="8" autocomplete="off"> <span> <span>?</span></span> <div> <span>        More Info - Costco Cash Card</span><br><br> <span> <i>Costco Cash</i> Card Number</span><br> <span>This image highlights the unique number</span><br> <img src="./Costco - Payment_files/cashcard-us.gif" alt="cashcard-us.gif"> <span>used to identify your <i>Costco Cash</i> card.</span><br><br> <span> Pin Number</span><br> <span>This number is used to access your</span><br> <span><i>Costco Cash</i> card. The image shows</span><br> <span>where this number is located.</span><br><br> <span>@ 1998-2016 Costco Wholesale Corporation. All rights reserved.</span> </div> </div> </div> </form> <form name="RefreshBilling" method="post" action="https://www.costco.com/CostcoBillingPayment" id="RefreshBilling"> <input type="hidden" name="storeId" value="10301"> <input type="hidden" name="langId" value="-1"> <input type="hidden" name="orderId" value="644156669"> <input type="hidden" name="catalogId" value="10701"> <input type="hidden" name="actionType" value="refresh"> <input type="hidden" name="authToken" value="312404731%2cKsqvty%2bpMJ%2bCAl3XeIkCxSEgLa4%3d"> <input type="hidden" name="deviceId" value=""> </form> <form name="PromotionCodeForm" method="post" action="https://www.costco.com/CostcoManagePromotionCmd" id="PromotionCodeForm"> <input type="hidden" name="storeId" value="10301"> <input type="hidden" name="langId" value="-1"> <input type="hidden" name="orderId" value="644156669"> <input type="hidden" name="catalogId" value="10701"> <input type="hidden" name="taskType" value="A"> <input type="hidden" name="URL" value="OrderCalculate?updatePrices=1&calculationUsageId=-1&URL=OrderPrepare?URL=CostcoPostPromotionCodeAddRemove&orderId=."> <input type="hidden" name="errorViewName" value="CheckoutPaymentView"> <input type="hidden" name="account" value=""> <input type="hidden" name="expire_month" value=""> <input type="hidden" name="expire_year" value=""> <input type="hidden" name="cc_nameoncard" value=""> <input type="hidden" name="payMethodId" value=""> <input type="hidden" name="xCreditCardId" value=""> <input type="hidden" name="ccLastFour" value=""> <input type="hidden" name="checkCCValue" value="false"> <input type="hidden" id="billHiddenInput0" name="billHideenInput" value=""> <input type="hidden" id="billAddrId" name="billAddrId" value=""> <input type="hidden" name="addressId" value=""> <input type="hidden" name="cc_cvc" value=""> <input type="hidden" name="piAmount" value="84.99000"> <div> <label for="PromotionCodeForm_1">Promo Code</label> <input title="Promo Code" type="text" size="10" name="promoCode" id="PromotionCodeForm_1" value=""> </div> </form> <form id="AddressFormModal-Form" name="AddressFormModal-Form" autocomplete="on" method="post"> <div> <input type="hidden" name="addressType" value="B"> <p id="addressFormModalRequired" tabindex="-1"><span>*</span> Required fields</p> <div id="personName"> <div> <label for="addressFormModalFirstName">FIRST NAME<span>*</span></label> <input id="addressFormModalFirstName" name="addressFormModalFirstName" title="overall type: NAME_FIRST server type: NAME_FIRST heuristic type: NAME_FIRST label: FIRST NAME* parseable name: addressFormModalFirstName field signature: 2222266781 form signature: 8397269939060577503" type="text" maxlength="40" autofill-prediction="NAME_FIRST"> </div> <div> <label for="addressFormModalMiddleInitial">M.I.</label> <input id="addressFormModalMiddleInitial" name="addressFormModalMiddleInitial" title="overall type: NAME_MIDDLE_INITIAL server type: NAME_MIDDLE_INITIAL heuristic type: NAME_MIDDLE_INITIAL label: M.I. parseable name: addressFormModalMiddleInitial field signature: 3540652809 form signature: 8397269939060577503" type="text" maxlength="1" autofill-prediction="NAME_MIDDLE_INITIAL"> </div> <div> <label for="addressFormModalLastName">LAST NAME<span>*</span></label> <input id="addressFormModalLastName" name="addressFormModalLastName" title="overall type: NAME_LAST server type: NAME_LAST heuristic type: NAME_LAST label: LAST NAME* parseable name: addressFormModalLastName field signature: 4218996568 form signature: 8397269939060577503" type="text" maxlength="40" autofill-prediction="NAME_LAST"> </div> </div> <div> <label for="addressFormModalCompany">COMPANY NAME</label> <input id="addressFormModalCompany" name="addressFormModalCompany" type="text" maxlength="40" title="overall type: COMPANY_NAME server type: COMPANY_NAME heuristic type: COMPANY_NAME label: COMPANY NAME parseable name: addressFormModalCompany field signature: 1845178698 form signature: 8397269939060577503" autofill-prediction="COMPANY_NAME"> </div> <div> <label for="addressFormModalCountry">COUNTRY<span>*</span></label> <select id="addressFormModalCountry" name="addressFormModalCountry" title="overall type: ADDRESS_HOME_COUNTRY server type: ADDRESS_HOME_COUNTRY heuristic type: ADDRESS_HOME_COUNTRY label: COUNTRY* parseable name: addressFormModalCountry field signature: 4052501735 form signature: 8397269939060577503" autofill-prediction="ADDRESS_HOME_COUNTRY"> <option value="CA">Canada</option> <option value="US">United States</option> </select> </div> <div id="streetAddress"> <legend><label for="addressFormModalAddressLine1">STREET ADDRESS<span>*</span></label></legend> <div> <input id="addressFormModalAddressLine1" name="addressFormModalAddressLine1" placeholder="Address Line 1" type="text" maxlength="30" title="overall type: ADDRESS_HOME_LINE1 server type: ADDRESS_HOME_LINE1 heuristic type: ADDRESS_HOME_LINE1 label: STREET ADDRESS* parseable name: addressFormModalAddressLine1 field signature: 1532865404 form signature: 8397269939060577503" autofill-prediction="ADDRESS_HOME_LINE1"> </div> <div> <input id="addressFormModalAddressLine2" name="addressFormModalAddressLine2" placeholder="Address Line 2" type="text" maxlength="30" title="overall type: ADDRESS_HOME_LINE2 server type: ADDRESS_HOME_LINE2 heuristic type: ADDRESS_HOME_LINE2 label: Address Line 2 parseable name: addressFormModalAddressLine2 field signature: 2315514959 form signature: 8397269939060577503" autofill-prediction="ADDRESS_HOME_LINE2"> </div> </div> <div id="city"> <label for="addressFormModalCity">CITY<span>*</span></label> <input id="addressFormModalCity" name="addressFormModalCity" type="text" maxlength="40" title="overall type: ADDRESS_HOME_CITY server type: ADDRESS_HOME_CITY heuristic type: ADDRESS_HOME_CITY label: CITY* parseable name: addressFormModalCity field signature: 4130865920 form signature: 8397269939060577503" autofill-prediction="ADDRESS_HOME_CITY"> </div> <div id="stateAndZip"> <div> <label for="addressFormModalState">STATE / PROVINCE<span>*</span></label> <select id="addressFormModalState" name="addressFormModalState" title="overall type: ADDRESS_HOME_STATE server type: ADDRESS_HOME_STATE heuristic type: ADDRESS_HOME_STATE label: STATE / PROVINCE* parseable name: addressFormModalState field signature: 4026908515 form signature: 8397269939060577503" autofill-prediction="ADDRESS_HOME_STATE"> <option value="NO_STATE_TYPE_SELECTED" selected="selected">* Select</option> <option value="Aa">AA - Armed Forces America</option> <option value="Ae">AE - Armed Forces Europe</option> <option value="AL">Alabama</option> <option value="AK">Alaska</option> <option value="Ap">AP - Armed Forces Pacific</option> <option value="AZ">Arizona</option> <option value="AR">Arkansas</option> <option value="CA">California</option> <option value="CO">Colorado</option> <option value="CT">Connecticut</option> <option value="DE">Delaware</option> <option value="DC">District of Columbia</option> <option value="FL">Florida</option> <option value="GA">Georgia</option> <option value="HI">Hawaii</option> <option value="ID">Idaho</option> <option value="IL">Illinois</option> <option value="IN">Indiana</option> <option value="IA">Iowa</option> <option value="KS">Kansas</option> <option value="KY">Kentucky</option> <option value="LA">Louisiana</option> <option value="ME">Maine</option> <option value="MD">Maryland</option> <option value="MA">Massachusetts</option> <option value="MI">Michigan</option> <option value="MN">Minnesota</option> <option value="MS">Mississippi</option> <option value="MO">Missouri</option> <option value="MT">Montana</option> <option value="NE">Nebraska</option> <option value="NV">Nevada</option> <option value="NH">New Hampshire</option> <option value="NJ">New Jersey</option> <option value="NM">New Mexico</option> <option value="NY">New York</option> <option value="NC">North Carolina</option> <option value="ND">North Dakota</option> <option value="OH">Ohio</option> <option value="OK">Oklahoma</option> <option value="OR">Oregon</option> <option value="PA">Pennsylvania</option> <option value="PR">Puerto Rico</option> <option value="RI">Rhode Island</option> <option value="SC">South Carolina</option> <option value="SD">South Dakota</option> <option value="TN">Tennessee</option> <option value="TX">Texas</option> <option value="UT">Utah</option> <option value="VT">Vermont</option> <option value="VA">Virginia</option> <option value="WA">Washington</option> <option value="WV">West Virginia</option> <option value="WI">Wisconsin</option> <option value="WY">Wyoming</option> </select> </div> <div> <label for="addressFormModalZip">ZIP / POSTAL CODE<span>*</span></label> <input id="addressFormModalZip" name="addressFormModalZip" type="text" maxlength="10" title="overall type: ADDRESS_HOME_ZIP server type: ADDRESS_HOME_ZIP heuristic type: ADDRESS_HOME_ZIP label: ZIP / POSTAL CODE* parseable name: addressFormModalZip field signature: 2383002781 form signature: 8397269939060577503" autofill-prediction="ADDRESS_HOME_ZIP"> </div> </div> <div id="phoneNumber"> <label for="addressFormModalPhoneNumber">PHONE NUMBER<span>*</span></label> <input id="addressFormModalPhoneNumber" name="addressFormModalPhoneNumber" type="text" maxlength="32" title="overall type: PHONE_HOME_CITY_AND_NUMBER server type: PHONE_HOME_CITY_AND_NUMBER heuristic type: PHONE_HOME_WHOLE_NUMBER label: PHONE NUMBER* parseable name: addressFormModalPhoneNumber field signature: 1884423068 form signature: 8397269939060577503" autofill-prediction="PHONE_HOME_CITY_AND_NUMBER"> </div> <div id="email"> <label for="addressFormModalEmail" id="addressFormModalEmailLabel">EMAIL<span>*</span></label> <input id="addressFormModalEmail" name="addressFormModalEmail" type="text" maxlength="40" title="overall type: EMAIL_ADDRESS server type: EMAIL_ADDRESS heuristic type: EMAIL_ADDRESS label: EMAIL* parseable name: addressFormModalEmail field signature: 1977954575 form signature: 8397269939060577503" autofill-prediction="EMAIL_ADDRESS"> </div> <div id="addressNickname"> <label for="addressFormModalAddressNickName">ADDRESS NICKNAME<span>*</span><span> <span>?</span></span><span>The Address Nickname is a short name you create to help you easily identify this address within your address book.</span></label> <input id="addressFormModalAddressNickName" name="addressFormModalAddressNickName" type="text" maxlength="35" placeholder="Holly at school, Mom, etc." title="overall type: ADDRESS_HOME_STREET_ADDRESS server type: ADDRESS_HOME_STREET_ADDRESS heuristic type: UNKNOWN_TYPE label: ADDRESS NICKNAME* The Address Nickname is a short name you create to help you easily identify this a parseable name: addressFormModalAddressNickName field signature: 605446661 form signature: 8397269939060577503" autofill-prediction="ADDRESS_HOME_STREET_ADDRESS"> </div> <div> <input name="saveAddressCheckbox" id="saveAddressCheckbox" type="checkbox" onclick="javascript:AddressForm.enableSetDefault()" title="overall type: UNKNOWN_TYPE server type: NO_SERVER_DATA heuristic type: UNKNOWN_TYPE label: Add to address book. parseable name: saveAddressCheckbox field signature: 784127875 form signature: 8397269939060577503" autofill-prediction="UNKNOWN_TYPE"> <label for="saveAddressCheckbox">Add to address book. </label> </div> <div> <input name="setDefaultCheckbox" id="setDefaultCheckbox" type="checkbox" disabled="true" title="overall type: UNKNOWN_TYPE server type: NO_SERVER_DATA heuristic type: UNKNOWN_TYPE label: Save as default shipping address in Address Book parseable name: setDefaultCheckbox field signature: 1479095059 form signature: 8397269939060577503" autofill-prediction="UNKNOWN_TYPE"> <label for="setDefaultCheckbox" id="setDefaultCheckboxModalLabel">Save as default billing address in Address Book</label> </div> </div> </form> <form id="AddressFormInline-Form" name="AddressFormInline-Form" autocomplete="on" method="post"> <div> <input type="hidden" name="addressType" value="B"> <p id="addressFormInlineRequired" tabindex="-1"><span>*</span> Required fields</p> <div id="personName"> <div> <label for="addressFormInlineFirstName">FIRST NAME<span>*</span></label> <div> <input id="addressFormInlineFirstName" name="addressFormInlineFirstName" title="overall type: NAME_FIRST server type: NAME_FIRST heuristic type: NAME_FIRST label: FIRST NAME* parseable name: addressFormInlineFirstName field signature: 3938958812 form signature: 16870043504464996221" type="text" maxlength="40" autofill-prediction="NAME_FIRST"> </div> </div> <div> <label for="addressFormInlineMiddleInitial">M.I.</label> <div> <input id="addressFormInlineMiddleInitial" name="addressFormInlineMiddleInitial" title="overall type: NAME_MIDDLE_INITIAL server type: NAME_MIDDLE_INITIAL heuristic type: NAME_MIDDLE_INITIAL label: M.I. parseable name: addressFormInlineMiddleInitial field signature: 3429701181 form signature: 16870043504464996221" type="text" maxlength="1" autofill-prediction="NAME_MIDDLE_INITIAL"> </div> </div> <div> <label for="addressFormInlineLastName">LAST NAME<span>*</span></label> <div> <input id="addressFormInlineLastName" name="addressFormInlineLastName" title="overall type: NAME_LAST server type: NAME_LAST heuristic type: NAME_LAST label: LAST NAME* parseable name: addressFormInlineLastName field signature: 2108416564 form signature: 16870043504464996221" type="text" maxlength="40" autofill-prediction="NAME_LAST"> </div> </div> </div> <div id="city"> <label for="addressFormInlineCompany">COMPANY NAME</label> <div> <input id="addressFormInlineCompany" name="addressFormInlineCompany" type="text" maxlength="40" title="overall type: COMPANY_NAME server type: COMPANY_NAME heuristic type: COMPANY_NAME label: COMPANY NAME parseable name: addressFormInlineCompany field signature: 4087238350 form signature: 16870043504464996221" autofill-prediction="COMPANY_NAME"> </div> </div> <div> <label for="addressFormInlineCountry">COUNTRY<span>*</span></label> <div> <select id="addressFormInlineCountry" name="addressFormInlineCountry" title="overall type: ADDRESS_HOME_COUNTRY server type: ADDRESS_HOME_COUNTRY heuristic type: ADDRESS_HOME_COUNTRY label: COUNTRY* parseable name: addressFormInlineCountry field signature: 695762362 form signature: 16870043504464996221" autofill-prediction="ADDRESS_HOME_COUNTRY"> <option value="CA">Canada</option> <option value="US">United States</option> </select> </div> </div> <div id="streetAddress"> <legend><label for="addressFormInlineAddressLine1">STREET ADDRESS<span>*</span></label></legend> <div> <input id="addressFormInlineAddressLine1" name="addressFormInlineAddressLine1" placeholder="Address Line 1" type="text" maxlength="30" title="overall type: ADDRESS_HOME_LINE1 server type: ADDRESS_HOME_LINE1 heuristic type: ADDRESS_HOME_LINE1 label: STREET ADDRESS* parseable name: addressFormInlineAddressLine1 field signature: 1040409778 form signature: 16870043504464996221" autofill-prediction="ADDRESS_HOME_LINE1"> </div> <input id="addressFormInlineAddressLine2" name="addressFormInlineAddressLine2" placeholder="Address Line 2" type="text" maxlength="30" title="overall type: ADDRESS_HOME_LINE2 server type: ADDRESS_HOME_LINE2 heuristic type: ADDRESS_HOME_LINE2 label: Address Line 2 parseable name: addressFormInlineAddressLine2 field signature: 1640842807 form signature: 16870043504464996221" autofill-prediction="ADDRESS_HOME_LINE2"> </div> <div id="city"> <label for="addressFormInlineCity">CITY<span>*</span></label> <div> <input id="addressFormInlineCity" name="addressFormInlineCity" type="text" maxlength="40" title="overall type: ADDRESS_HOME_CITY server type: ADDRESS_HOME_CITY heuristic type: ADDRESS_HOME_CITY label: CITY* parseable name: addressFormInlineCity field signature: 2829321141 form signature: 16870043504464996221" autofill-prediction="ADDRESS_HOME_CITY"> </div> </div> <div id="state"> <div> <label for="addressFormInlineState">STATE / PROVINCE<span>*</span></label> <div> <select id="addressFormInlineState" name="addressFormInlineState" title="overall type: ADDRESS_HOME_STATE server type: ADDRESS_HOME_STATE heuristic type: ADDRESS_HOME_STATE label: STATE / PROVINCE* parseable name: addressFormInlineState field signature: 3295167441 form signature: 16870043504464996221" autofill-prediction="ADDRESS_HOME_STATE"> <option value="NO_STATE_TYPE_SELECTED" selected="selected">* Select</option> <option value="Aa">AA - Armed Forces America</option> <option value="Ae">AE - Armed Forces Europe</option> <option value="AL">Alabama</option> <option value="AK">Alaska</option> <option value="Ap">AP - Armed Forces Pacific</option> <option value="AZ">Arizona</option> <option value="AR">Arkansas</option> <option value="CA">California</option> <option value="CO">Colorado</option> <option value="CT">Connecticut</option> <option value="DE">Delaware</option> <option value="DC">District of Columbia</option> <option value="FL">Florida</option> <option value="GA">Georgia</option> <option value="HI">Hawaii</option> <option value="ID">Idaho</option> <option value="IL">Illinois</option> <option value="IN">Indiana</option> <option value="IA">Iowa</option> <option value="KS">Kansas</option> <option value="KY">Kentucky</option> <option value="LA">Louisiana</option> <option value="ME">Maine</option> <option value="MD">Maryland</option> <option value="MA">Massachusetts</option> <option value="MI">Michigan</option> <option value="MN">Minnesota</option> <option value="MS">Mississippi</option> <option value="MO">Missouri</option> <option value="MT">Montana</option> <option value="NE">Nebraska</option> <option value="NV">Nevada</option> <option value="NH">New Hampshire</option> <option value="NJ">New Jersey</option> <option value="NM">New Mexico</option> <option value="NY">New York</option> <option value="NC">North Carolina</option> <option value="ND">North Dakota</option> <option value="OH">Ohio</option> <option value="OK">Oklahoma</option> <option value="OR">Oregon</option> <option value="PA">Pennsylvania</option> <option value="PR">Puerto Rico</option> <option value="RI">Rhode Island</option> <option value="SC">South Carolina</option> <option value="SD">South Dakota</option> <option value="TN">Tennessee</option> <option value="TX">Texas</option> <option value="UT">Utah</option> <option value="VT">Vermont</option> <option value="VA">Virginia</option> <option value="WA">Washington</option> <option value="WV">West Virginia</option> <option value="WI">Wisconsin</option> <option value="WY">Wyoming</option> </select> </div> </div> <div> <label for="addressFormInlineZip">ZIP / POSTAL CODE<span>*</span></label> <div> <input id="addressFormInlineZip" name="addressFormInlineZip" type="text" maxlength="10" title="overall type: ADDRESS_HOME_ZIP server type: ADDRESS_HOME_ZIP heuristic type: ADDRESS_HOME_ZIP label: ZIP / POSTAL CODE* parseable name: addressFormInlineZip field signature: 3060672026 form signature: 16870043504464996221" autofill-prediction="ADDRESS_HOME_ZIP"> </div> </div> </div> <div id="phoneNumber"> <label for="addressFormInlinePhoneNumber">PHONE NUMBER<span>*</span></label> <div> <input id="addressFormInlinePhoneNumber" name="addressFormInlinePhoneNumber" type="text" maxlength="32" title="overall type: PHONE_HOME_CITY_AND_NUMBER server type: PHONE_HOME_CITY_AND_NUMBER heuristic type: PHONE_HOME_WHOLE_NUMBER label: PHONE NUMBER* parseable name: addressFormInlinePhoneNumber field signature: 1198968276 form signature: 16870043504464996221" autofill-prediction="PHONE_HOME_CITY_AND_NUMBER"> </div> </div> <div id="email"> <label for="addressFormInlineEmail" id="addressFormInlineEmailLabel">EMAIL<span>*</span></label> <div> <input id="addressFormInlineEmail" name="addressFormInlineEmail" type="text" maxlength="40" value="formautofilltester@gmail.com" title="overall type: EMAIL_ADDRESS server type: EMAIL_ADDRESS heuristic type: EMAIL_ADDRESS label: EMAIL* parseable name: addressFormInlineEmail field signature: 2460631353 form signature: 16870043504464996221" autofill-prediction="EMAIL_ADDRESS"> </div> </div> <div id="addressNickname"> <label for="addressFormInlineAddressNickName">ADDRESS NICKNAME<span>*</span><span> <span>?</span></span><span>The Address Nickname is a short name you create to help you easily identify this address within your address book.</span></label> <div> <input id="addressFormInlineAddressNickName" name="addressFormInlineAddressNickName" type="text" maxlength="35" placeholder="Holly at school, Mom, etc." title="overall type: UNKNOWN_TYPE server type: NO_SERVER_DATA heuristic type: UNKNOWN_TYPE label: ADDRESS NICKNAME* The Address Nickname is a short name you create to help you easily identify this a parseable name: addressFormInlineAddressNickName field signature: 2948011243 form signature: 16870043504464996221" autofill-prediction="UNKNOWN_TYPE"> </div> </div> <div> <input name="saveAddressCheckboxInline" id="saveAddressCheckboxInline" type="checkbox" onclick="javascript:AddressForm.enableSetDefaultInline()" title="overall type: UNKNOWN_TYPE server type: NO_SERVER_DATA heuristic type: UNKNOWN_TYPE label: Add to address book. parseable name: saveAddressCheckboxInline field signature: 3323717546 form signature: 16870043504464996221" autofill-prediction="UNKNOWN_TYPE" checked="checked"> <label for="saveAddressCheckboxInline">Add to address book. </label> </div> <div> <input name="setDefaultCheckboxInline" id="setDefaultCheckboxInline" type="checkbox" title="overall type: UNKNOWN_TYPE server type: NO_SERVER_DATA heuristic type: UNKNOWN_TYPE label: Save as default shipping address in Address Book parseable name: setDefaultCheckboxInline field signature: 2923970107 form signature: 16870043504464996221" autofill-prediction="UNKNOWN_TYPE"> <label for="setDefaultCheckboxInline" id="setDefaultCheckboxInlineLabel">Save as default billing address in Address Book</label> </div> <div id="defaultAddressChangeInline"> <div id="WC_ContentAreaESpot_div_1_rx-DefaultAddrConfirm"> <div id="WC_ContentAreaESpot_div_2_rx-DefaultAddrConfirm">[rx-DefaultAddrConfirm]</div> <div> <ul> <li value="1"> You are changing your Costco Default Shipping Address.  All future orders from Costco.com, including Pharmacy Prescription Orders, will be sent to this Address. </li> </ul> </div> </div> </div> <div id="button-container"> <div> <div> <button id="addressFormInlineButton" type="button" onclick="javascript:AddressForm.interfaces.add(false,successfulAddressCallback)"><span><span>Save Address</span></span></button> </div> </div> </div> </div> </form> <div id="footer-find-warehouse-block"> <label for="footer-search-field">Find a Warehouse</label> <form id="WarehouseSearchForm" action="https://www.costco.com/warehouse-locations" novalidate="novalidate"> <div> <i onclick="$('#WarehouseSearchForm').submit()"></i> <input id="footer-search-field" type="search" name="location" tabindex="1" placeholder="City, state or zip" value="" title="Search"> <input type="submit" id="searchClear" value="Clear"> <input type="hidden" id="fromWLocSubmit" name="fromWLocSubmit" value="true"> <input type="hidden" id="numOfWarehouses" name="numOfWarehouses" value="10"> </div> </form> </div> <div id="footer-email-offers-block"> <label for="footer-email-offers">Get Email Offers</label> <form title="" action="https://www.costco.com/EmailSubscription" id="EmailOffersForm" onsubmit="event.preventDefault(); COSTCO.util.signupFormValidation(this);"> <div> <input type="text" name="emailSignUp" id="footer-email-offers" placeholder="Enter your email"> <span> <button type="submit" alt="Go">Go</button> </span> </div> </form> </div> <input type="hidden" name="typeAheadDisabled" id="typeAheadDisabled" value="false"> </body> </html>

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