Payment.html (44129B)
1 <!DOCTYPE html> 2 <html lang="en"> 3 <head> 4 <meta http-equiv="Content-Type" content="text/html; charset=UTF-8"> 5 <meta feature="9.1.4"> 6 <title>Costco - Payment</title> 7 <meta name="currentBuildNumber" content="3.0.29057.0"> 8 <meta name="ServerName" content="www.costco.com "> 9 <meta name="LocalAddress" content="xxx.xxx.xxx.48"> 10 <meta name="LocalName" content="TP26"> 11 </head> 12 <body> 13 <form name="CheckoutPaymentForm" id="CheckoutPaymentForm" method="post" action="https://www.costco.com/CostcoBillingPayment"> 14 <input type="hidden" name="selfAddressId" id="hiddenSelfAddressId" value=""> 15 <input type="hidden" id="billHiddenInput0" name="billHideenInput" value=""> 16 <input type="hidden" id="billAddrId" name="billAddrId" value=""> 17 <input type="hidden" id="membershipNumber" name="membershipNum"> 18 <input type="hidden" name="orderItemsCount" value="1"> 19 <input type="hidden" value="" id="selectedAddressId" name="selectedAddressId"> 20 <input type="hidden" name="orderId" value="644156669" id="WC_CheckoutPaymentsAndBillingAddressf_orderId"> 21 <input type="hidden" name="storeId" value="10301" id="CheckoutPayment_inputs_1"> 22 <input type="hidden" name="catalogId" value="10701" id="CheckoutPayment_inputs_2"> 23 <input type="hidden" name="langId" value="-1" id="CheckoutPayment_inputs_3"> 24 <input type="hidden" name="curr_year" value="2017" id="CheckoutPayment_inputs_5"> 25 <input type="hidden" name="curr_month" value="3" id="CheckoutPayment_inputs_6"> 26 <input type="hidden" name="curr_date" value="19" id="CheckoutPayment_inputs_7"> 27 <input type="hidden" name="URL" value="OrderPrepare?URL=CheckoutReviewView"> 28 <input type="hidden" name="xCreditCardId" value=""> 29 <input type="hidden" name="ccLastFour" value=""> 30 <input type="hidden" name="checkCCValue" value="false"> 31 <input type="hidden" name="backURL" value=""> 32 <input type="hidden" name="piAmount" value="84.99000"> 33 <input type="hidden" name="cardNumberValueHolder" value=""> 34 <input type="hidden" name="authToken" value="312"> 35 <div> 36 <label for="billMeLater"> 37 <input type="radio" checked="checked" id="billMeLater" name="billMeLater" value="no" 38 title="overall type: UNKNOWN_TYPE 39 server type: NO_SERVER_DATA 40 heuristic type: UNKNOWN_TYPE 41 label: Payment Method 42 parseable name: billMeLater 43 field signature: 1700925171 44 form signature: 4979691664972472743" 45 autofill-prediction="UNKNOWN_TYPE" 46 > 47 </label> 48 <br> 49 <div> 50 <div> 51 <label for="payMethodId">Card Type</label> 52 <select name="payMethodId" id="payMethodId" 53 title="overall type: CREDIT_CARD_TYPE 54 server type: CREDIT_CARD_TYPE 55 heuristic type: CREDIT_CARD_TYPE 56 label: Card Type 57 parseable name: payMethodId 58 field signature: 3668211827 59 form signature: 4979691664972472743" 60 autofill-prediction="CREDIT_CARD_TYPE" 61 > 62 <option value="Costco Credit Card">Costco Credit Card</option> 63 <option value="Discover">Discover</option> 64 <option value="Master Card">MasterCard</option> 65 <option value="VISA" selected="selected">VISA</option> 66 </select> 67 </div> 68 <div> 69 <label for="account">Card number</label> 70 <input 71 title="overall type: CREDIT_CARD_NUMBER 72 server type: NO_SERVER_DATA 73 heuristic type: CREDIT_CARD_NUMBER 74 label: Card number 75 parseable name: account 76 field signature: 3715653537 77 form signature: 4979691664972472743" type="text" id="account" name="account" value="" autocomplete="off" 78 autofill-prediction="CREDIT_CARD_NUMBER" 79 > 80 </div> 81 </div> 82 <div> 83 <div> 84 <label for="expire_month">Expiration Date</label> 85 <select 86 title="overall type: CREDIT_CARD_EXP_MONTH 87 server type: CREDIT_CARD_EXP_MONTH 88 heuristic type: CREDIT_CARD_EXP_MONTH 89 label: Expiration Date 90 parseable name: expire_month 91 field signature: 3078539387 92 form signature: 4979691664972472743" id="expire_month" name="expire_month" 93 autofill-prediction="CREDIT_CARD_EXP_MONTH" 94 > 95 <option value="Month">Month</option> 96 <option value="01">1</option> 97 <option value="02">2</option> 98 <option value="03">3</option> 99 <option value="04">4</option> 100 <option value="05">5</option> 101 <option value="06">6</option> 102 <option value="07">7</option> 103 <option value="08">8</option> 104 <option value="09">9</option> 105 <option value="10">10</option> 106 <option value="11">11</option> 107 <option value="12">12</option> 108 </select> 109 <select 110 title="overall type: CREDIT_CARD_EXP_4_DIGIT_YEAR 111 server type: CREDIT_CARD_EXP_4_DIGIT_YEAR 112 heuristic type: CREDIT_CARD_EXP_4_DIGIT_YEAR 113 label: Expiration Date 114 parseable name: expire_year 115 field signature: 2521850425 116 form signature: 4979691664972472743" name="expire_year" 117 autofill-prediction="CREDIT_CARD_EXP_4_DIGIT_YEAR" 118 > 119 <option value="Year">Year</option> 120 <option value="2017">2017</option> 121 <option value="2018">2018</option> 122 <option value="2019">2019</option> 123 <option value="2020">2020</option> 124 <option value="2021">2021</option> 125 <option value="2022">2022</option> 126 <option value="2023">2023</option> 127 <option value="2024">2024</option> 128 <option value="2025">2025</option> 129 <option value="2026">2026</option> 130 <option value="2027">2027</option> 131 </select> 132 </div> 133 <div> 134 <label for="cc_cvc">CVV Code</label> 135 <input 136 title="overall type: CREDIT_CARD_VERIFICATION_CODE 137 server type: NO_SERVER_DATA 138 heuristic type: CREDIT_CARD_VERIFICATION_CODE 139 label: CVV Code 140 parseable name: cc_cvc 141 field signature: 1956128288 142 form signature: 4979691664972472743" type="text" id="cc_cvc" name="cc_cvc" value="" maxlength="4" autocomplete="off" 143 autofill-prediction="CREDIT_CARD_VERIFICATION_CODE" 144 > 145 <span> <span>?</span> 146 </span> 147 </div> 148 </div> 149 <div> 150 <label for="cc_nameoncard">Cardholder Name</label> 151 <input 152 title="overall type: CREDIT_CARD_NAME_FULL 153 server type: CREDIT_CARD_NAME_FULL 154 heuristic type: CREDIT_CARD_NAME_FULL 155 label: Cardholder Name 156 parseable name: cc_nameoncard 157 field signature: 1086986730 158 form signature: 4979691664972472743" type="text" id="cc_nameoncard" name="cc_nameoncard" value="" autocomplete="off" 159 autofill-prediction="CREDIT_CARD_NAME_FULL" 160 > 161 </div> 162 <div> 163 <input 164 title="overall type: UNKNOWN_TYPE 165 server type: NO_SERVER_DATA 166 heuristic type: UNKNOWN_TYPE 167 label: Save this as my default payment card 168 parseable name: save_CC 169 field signature: 3060743727 170 form signature: 4979691664972472743" type="checkbox" name="save_CC" id="save_CC" 171 autofill-prediction="UNKNOWN_TYPE" 172 > 173 <label for="save_CC">Save this as my default payment card</label> 174 </div> 175 </div> 176 </form> 177 <form name="CashCardForm" method="post" action="https://www.costco.com/CostcoCashCardProcess" id="CashCardForm"> 178 <input type="hidden" name="storeId" value="10301"> 179 <input type="hidden" name="langId" value="-1"> 180 <input type="hidden" name="orderId" value="644156669"> 181 <input type="hidden" name="catalogId" value="10701"> 182 <input type="hidden" name="addressId" value=""> 183 <input type="hidden" name="cc_payMethodId" value="CostcoCashCard"> 184 <input type="hidden" name="action" value=""> 185 <input type="hidden" name="URL" value="CheckoutPaymentView"> 186 <input type="hidden" name="account" value=""> 187 <input type="hidden" name="expire_month" value=""> 188 <input type="hidden" name="expire_year" value=""> 189 <input type="hidden" name="cc_nameoncard" value=""> 190 <input type="hidden" name="payMethodId" value=""> 191 <input type="hidden" name="xCreditCardId" value=""> 192 <input type="hidden" name="ccLastFour" value=""> 193 <input type="hidden" name="authToken" value="312404731%2cKsqvty%2bpMJ%2bCAl3XeIkCxSEgLa4%3d"> 194 <div> 195 <div> 196 <label for="cash_account">Costco Cash Card Number</label> 197 <input 198 title="Costco Cash Card Number" type="text" id="cash_account" name="cash_account" value="" maxlength="19" autocomplete="off"> 199 </div> 200 <div> 201 <label for="cash_pin">PIN</label> 202 <input 203 title="PIN" type="password" id="cash_pin" name="cash_pin" value="" maxlength="8" autocomplete="off"> 204 <span> <span>?</span> 205 </span> 206 <div> 207 <span> More Info - Costco Cash Card</span> 208 <span> 209 <i>Costco Cash</i> Card Number</span> 210 <span>This image highlights the unique number</span> 211 <img src="./Costco - Payment_files/cashcard-us.gif" alt="cashcard-us.gif"> 212 <span>used to identify your <i>Costco Cash</i> card.</span> 213 <span> Pin Number</span> 214 <span>This number is used to access your</span> 215 <span> 216 <i>Costco Cash</i> card. The image shows</span> 217 <span>where this number is located.</span> 218 <span>@ 1998-2016 Costco Wholesale Corporation. All rights reserved.</span> 219 </div> 220 </div> 221 </div> 222 </form> 223 <form name="RefreshBilling" method="post" action="https://www.costco.com/CostcoBillingPayment" id="RefreshBilling"> 224 <input type="hidden" name="storeId" value="10301"> 225 <input type="hidden" name="langId" value="-1"> 226 <input type="hidden" name="orderId" value="644156669"> 227 <input type="hidden" name="catalogId" value="10701"> 228 <input type="hidden" name="actionType" value="refresh"> 229 <input type="hidden" name="authToken" value="312404731%2cKsqvty%2bpMJ%2bCAl3XeIkCxSEgLa4%3d"> 230 <input type="hidden" name="deviceId" value=""> 231 </form> 232 <form name="PromotionCodeForm" method="post" action="https://www.costco.com/CostcoManagePromotionCmd" id="PromotionCodeForm"> 233 <input type="hidden" name="storeId" value="10301"> 234 <input type="hidden" name="langId" value="-1"> 235 <input type="hidden" name="orderId" value="644156669"> 236 <input type="hidden" name="catalogId" value="10701"> 237 <input type="hidden" name="taskType" value="A"> 238 <input type="hidden" name="URL" value="OrderCalculate?updatePrices=1&calculationUsageId=-1&URL=OrderPrepare?URL=CostcoPostPromotionCodeAddRemove&orderId=."> 239 <input type="hidden" name="errorViewName" value="CheckoutPaymentView"> 240 <input type="hidden" name="account" value=""> 241 <input type="hidden" name="expire_month" value=""> 242 <input type="hidden" name="expire_year" value=""> 243 <input type="hidden" name="cc_nameoncard" value=""> 244 <input type="hidden" name="payMethodId" value=""> 245 <input type="hidden" name="xCreditCardId" value=""> 246 <input type="hidden" name="ccLastFour" value=""> 247 <input type="hidden" name="checkCCValue" value="false"> 248 <input type="hidden" id="billHiddenInput0" name="billHideenInput" value=""> 249 <input type="hidden" id="billAddrId" name="billAddrId" value=""> 250 <input type="hidden" name="addressId" value=""> 251 <input type="hidden" name="cc_cvc" value=""> 252 <input type="hidden" name="piAmount" value="84.99000"> 253 <div> 254 <label for="PromotionCodeForm_1">Promo Code</label> 255 <input 256 title="Promo Code" type="text" size="10" name="promoCode" id="PromotionCodeForm_1" value=""> 257 </div> 258 </form> 259 <form id="AddressFormModal-Form" name="AddressFormModal-Form" autocomplete="on" method="post"> 260 <div> 261 <input type="hidden" name="addressType" value="B"> 262 <p id="addressFormModalRequired" tabindex="-1"> 263 <span>*</span> Required fields</p> 264 <div id="personName"> 265 <div> 266 <label for="addressFormModalFirstName">FIRST NAME<span>*</span> 267 </label> 268 <input id="addressFormModalFirstName" name="addressFormModalFirstName" 269 title="overall type: NAME_FIRST 270 server type: NAME_FIRST 271 heuristic type: NAME_FIRST 272 label: FIRST NAME* 273 parseable name: addressFormModalFirstName 274 field signature: 2222266781 275 form signature: 8397269939060577503" type="text" maxlength="40" 276 autofill-prediction="NAME_FIRST" 277 > 278 </div> 279 <div> 280 <label for="addressFormModalMiddleInitial">M.I.</label> 281 <input id="addressFormModalMiddleInitial" name="addressFormModalMiddleInitial" 282 title="overall type: NAME_MIDDLE_INITIAL 283 server type: NAME_MIDDLE_INITIAL 284 heuristic type: NAME_MIDDLE_INITIAL 285 label: M.I. 286 parseable name: addressFormModalMiddleInitial 287 field signature: 3540652809 288 form signature: 8397269939060577503" type="text" maxlength="1" 289 autofill-prediction="NAME_MIDDLE_INITIAL" 290 > 291 </div> 292 <div> 293 <label for="addressFormModalLastName">LAST NAME<span>*</span> 294 </label> 295 <input id="addressFormModalLastName" name="addressFormModalLastName" 296 title="overall type: NAME_LAST 297 server type: NAME_LAST 298 heuristic type: NAME_LAST 299 label: LAST NAME* 300 parseable name: addressFormModalLastName 301 field signature: 4218996568 302 form signature: 8397269939060577503" type="text" maxlength="40" 303 autofill-prediction="NAME_LAST" 304 > 305 </div> 306 </div> 307 <div> 308 <label for="addressFormModalCompany">COMPANY NAME</label> 309 <input id="addressFormModalCompany" name="addressFormModalCompany" type="text" maxlength="40" 310 title="overall type: COMPANY_NAME 311 server type: COMPANY_NAME 312 heuristic type: COMPANY_NAME 313 label: COMPANY NAME 314 parseable name: addressFormModalCompany 315 field signature: 1845178698 316 form signature: 8397269939060577503" 317 autofill-prediction="COMPANY_NAME" 318 > 319 </div> 320 <div> 321 <label for="addressFormModalCountry">COUNTRY<span>*</span> 322 </label> 323 <select id="addressFormModalCountry" name="addressFormModalCountry" 324 title="overall type: ADDRESS_HOME_COUNTRY 325 server type: ADDRESS_HOME_COUNTRY 326 heuristic type: ADDRESS_HOME_COUNTRY 327 label: COUNTRY* 328 parseable name: addressFormModalCountry 329 field signature: 4052501735 330 form signature: 8397269939060577503" 331 autofill-prediction="ADDRESS_HOME_COUNTRY" 332 > 333 <option value="CA">Canada</option> 334 <option value="US">United States</option> 335 </select> 336 </div> 337 <div id="streetAddress"> 338 <legend> 339 <label for="addressFormModalAddressLine1">STREET ADDRESS<span>*</span> 340 </label> 341 </legend> 342 <div> 343 <input id="addressFormModalAddressLine1" name="addressFormModalAddressLine1" placeholder="Address Line 1" type="text" maxlength="30" 344 title="overall type: ADDRESS_HOME_LINE1 345 server type: ADDRESS_HOME_LINE1 346 heuristic type: ADDRESS_HOME_LINE1 347 label: STREET ADDRESS* 348 parseable name: addressFormModalAddressLine1 349 field signature: 1532865404 350 form signature: 8397269939060577503" 351 autofill-prediction="ADDRESS_HOME_LINE1" 352 > 353 </div> 354 <div> 355 <input id="addressFormModalAddressLine2" name="addressFormModalAddressLine2" placeholder="Address Line 2" type="text" maxlength="30" 356 title="overall type: ADDRESS_HOME_LINE2 357 server type: ADDRESS_HOME_LINE2 358 heuristic type: ADDRESS_HOME_LINE2 359 label: Address Line 2 360 parseable name: addressFormModalAddressLine2 361 field signature: 2315514959 362 form signature: 8397269939060577503" 363 autofill-prediction="ADDRESS_HOME_LINE2" 364 > 365 </div> 366 </div> 367 <div id="city"> 368 <label for="addressFormModalCity">CITY<span>*</span> 369 </label> 370 <input id="addressFormModalCity" name="addressFormModalCity" type="text" maxlength="40" 371 title="overall type: ADDRESS_HOME_CITY 372 server type: ADDRESS_HOME_CITY 373 heuristic type: ADDRESS_HOME_CITY 374 label: CITY* 375 parseable name: addressFormModalCity 376 field signature: 4130865920 377 form signature: 8397269939060577503" 378 autofill-prediction="ADDRESS_HOME_CITY" 379 > 380 </div> 381 <div id="stateAndZip"> 382 <div> 383 <label for="addressFormModalState">STATE / PROVINCE<span>*</span> 384 </label> 385 <select id="addressFormModalState" name="addressFormModalState" 386 title="overall type: ADDRESS_HOME_STATE 387 server type: ADDRESS_HOME_STATE 388 heuristic type: ADDRESS_HOME_STATE 389 label: STATE / PROVINCE* 390 parseable name: addressFormModalState 391 field signature: 4026908515 392 form signature: 8397269939060577503" 393 autofill-prediction="ADDRESS_HOME_STATE" 394 > 395 <option value="NO_STATE_TYPE_SELECTED" selected="selected">* Select</option> 396 <option value="Aa">AA - Armed Forces America</option> 397 <option value="Ae">AE - Armed Forces Europe</option> 398 <option value="AL">Alabama</option> 399 <option value="AK">Alaska</option> 400 <option value="Ap">AP - Armed Forces Pacific</option> 401 <option value="AZ">Arizona</option> 402 <option value="AR">Arkansas</option> 403 <option value="CA">California</option> 404 <option value="CO">Colorado</option> 405 <option value="CT">Connecticut</option> 406 <option value="DE">Delaware</option> 407 <option value="DC">District of Columbia</option> 408 <option value="FL">Florida</option> 409 <option value="GA">Georgia</option> 410 <option value="HI">Hawaii</option> 411 <option value="ID">Idaho</option> 412 <option value="IL">Illinois</option> 413 <option value="IN">Indiana</option> 414 <option value="IA">Iowa</option> 415 <option value="KS">Kansas</option> 416 <option value="KY">Kentucky</option> 417 <option value="LA">Louisiana</option> 418 <option value="ME">Maine</option> 419 <option value="MD">Maryland</option> 420 <option value="MA">Massachusetts</option> 421 <option value="MI">Michigan</option> 422 <option value="MN">Minnesota</option> 423 <option value="MS">Mississippi</option> 424 <option value="MO">Missouri</option> 425 <option value="MT">Montana</option> 426 <option value="NE">Nebraska</option> 427 <option value="NV">Nevada</option> 428 <option value="NH">New Hampshire</option> 429 <option value="NJ">New Jersey</option> 430 <option value="NM">New Mexico</option> 431 <option value="NY">New York</option> 432 <option value="NC">North Carolina</option> 433 <option value="ND">North Dakota</option> 434 <option value="OH">Ohio</option> 435 <option value="OK">Oklahoma</option> 436 <option value="OR">Oregon</option> 437 <option value="PA">Pennsylvania</option> 438 <option value="PR">Puerto Rico</option> 439 <option value="RI">Rhode Island</option> 440 <option value="SC">South Carolina</option> 441 <option value="SD">South Dakota</option> 442 <option value="TN">Tennessee</option> 443 <option value="TX">Texas</option> 444 <option value="UT">Utah</option> 445 <option value="VT">Vermont</option> 446 <option value="VA">Virginia</option> 447 <option value="WA">Washington</option> 448 <option value="WV">West Virginia</option> 449 <option value="WI">Wisconsin</option> 450 <option value="WY">Wyoming</option> 451 </select> 452 </div> 453 <div> 454 <label for="addressFormModalZip">ZIP / POSTAL CODE<span>*</span> 455 </label> 456 <input id="addressFormModalZip" name="addressFormModalZip" type="text" maxlength="10" 457 title="overall type: ADDRESS_HOME_ZIP 458 server type: ADDRESS_HOME_ZIP 459 heuristic type: ADDRESS_HOME_ZIP 460 label: ZIP / POSTAL CODE* 461 parseable name: addressFormModalZip 462 field signature: 2383002781 463 form signature: 8397269939060577503" 464 autofill-prediction="ADDRESS_HOME_ZIP" 465 > 466 </div> 467 </div> 468 <div id="phoneNumber"> 469 <label for="addressFormModalPhoneNumber">PHONE NUMBER<span>*</span> 470 </label> 471 <input id="addressFormModalPhoneNumber" name="addressFormModalPhoneNumber" type="text" maxlength="32" 472 title="overall type: PHONE_HOME_CITY_AND_NUMBER 473 server type: PHONE_HOME_CITY_AND_NUMBER 474 heuristic type: PHONE_HOME_WHOLE_NUMBER 475 label: PHONE NUMBER* 476 parseable name: addressFormModalPhoneNumber 477 field signature: 1884423068 478 form signature: 8397269939060577503" 479 autofill-prediction="PHONE_HOME_CITY_AND_NUMBER" 480 > 481 </div> 482 <div id="email"> 483 <label for="addressFormModalEmail" id="addressFormModalEmailLabel">EMAIL<span>*</span> 484 </label> 485 <input id="addressFormModalEmail" name="addressFormModalEmail" type="text" maxlength="40" 486 title="overall type: EMAIL_ADDRESS 487 server type: EMAIL_ADDRESS 488 heuristic type: EMAIL_ADDRESS 489 label: EMAIL* 490 parseable name: addressFormModalEmail 491 field signature: 1977954575 492 form signature: 8397269939060577503" 493 autofill-prediction="EMAIL_ADDRESS" 494 > 495 </div> 496 <div id="addressNickname"> 497 <label for="addressFormModalAddressNickName">ADDRESS NICKNAME<span>*</span> 498 <span> <span>?</span> 499 </span> 500 <span>The Address Nickname is a short name you create to help you easily identify this address within your address book.</span> 501 </label> 502 <input id="addressFormModalAddressNickName" name="addressFormModalAddressNickName" type="text" maxlength="35" placeholder="Holly at school, Mom, etc." 503 title="overall type: ADDRESS_HOME_STREET_ADDRESS 504 server type: ADDRESS_HOME_STREET_ADDRESS 505 heuristic type: UNKNOWN_TYPE 506 label: ADDRESS NICKNAME* The Address Nickname is a short name you create to help you easily identify this a 507 parseable name: addressFormModalAddressNickName 508 field signature: 605446661 509 form signature: 8397269939060577503" 510 autofill-prediction="ADDRESS_HOME_STREET_ADDRESS" 511 > 512 </div> 513 <div> 514 <input name="saveAddressCheckbox" id="saveAddressCheckbox" type="checkbox" 515 title="overall type: UNKNOWN_TYPE 516 server type: NO_SERVER_DATA 517 heuristic type: UNKNOWN_TYPE 518 label: Add to address book. 519 parseable name: saveAddressCheckbox 520 field signature: 784127875 521 form signature: 8397269939060577503" 522 autofill-prediction="UNKNOWN_TYPE" 523 > 524 <label for="saveAddressCheckbox">Add to address book. </label> 525 </div> 526 <div> 527 <input name="setDefaultCheckbox" id="setDefaultCheckbox" type="checkbox" disabled="true" 528 title="overall type: UNKNOWN_TYPE 529 server type: NO_SERVER_DATA 530 heuristic type: UNKNOWN_TYPE 531 label: Save as default shipping address in Address Book 532 parseable name: setDefaultCheckbox 533 field signature: 1479095059 534 form signature: 8397269939060577503" 535 autofill-prediction="UNKNOWN_TYPE" 536 > 537 <label for="setDefaultCheckbox" id="setDefaultCheckboxModalLabel">Save as default billing address in Address Book</label> 538 </div> 539 </div> 540 </form> 541 <form id="AddressFormInline-Form" name="AddressFormInline-Form" autocomplete="on" method="post"> 542 <div> 543 <input type="hidden" name="addressType" value="B"> 544 <p id="addressFormInlineRequired" tabindex="-1"> 545 <span>*</span> Required fields</p> 546 <div id="personName"> 547 <div> 548 <label for="addressFormInlineFirstName">FIRST NAME<span>*</span> 549 </label> 550 <div> 551 <input id="addressFormInlineFirstName" name="addressFormInlineFirstName" 552 title="overall type: NAME_FIRST 553 server type: NAME_FIRST 554 heuristic type: NAME_FIRST 555 label: FIRST NAME* 556 parseable name: addressFormInlineFirstName 557 field signature: 3938958812 558 form signature: 16870043504464996221" type="text" maxlength="40" 559 autofill-prediction="NAME_FIRST" 560 > 561 </div> 562 </div> 563 <div> 564 <label for="addressFormInlineMiddleInitial">M.I.</label> 565 <div> 566 <input id="addressFormInlineMiddleInitial" name="addressFormInlineMiddleInitial" 567 title="overall type: NAME_MIDDLE_INITIAL 568 server type: NAME_MIDDLE_INITIAL 569 heuristic type: NAME_MIDDLE_INITIAL 570 label: M.I. 571 parseable name: addressFormInlineMiddleInitial 572 field signature: 3429701181 573 form signature: 16870043504464996221" type="text" maxlength="1" 574 autofill-prediction="NAME_MIDDLE_INITIAL" 575 > 576 </div> 577 </div> 578 <div> 579 <label for="addressFormInlineLastName">LAST NAME<span>*</span> 580 </label> 581 <div> 582 <input id="addressFormInlineLastName" name="addressFormInlineLastName" 583 title="overall type: NAME_LAST 584 server type: NAME_LAST 585 heuristic type: NAME_LAST 586 label: LAST NAME* 587 parseable name: addressFormInlineLastName 588 field signature: 2108416564 589 form signature: 16870043504464996221" type="text" maxlength="40" 590 autofill-prediction="NAME_LAST" 591 > 592 </div> 593 </div> 594 </div> 595 <div id="city"> 596 <label for="addressFormInlineCompany">COMPANY NAME</label> 597 <div> 598 <input id="addressFormInlineCompany" name="addressFormInlineCompany" type="text" maxlength="40" 599 title="overall type: COMPANY_NAME 600 server type: COMPANY_NAME 601 heuristic type: COMPANY_NAME 602 label: COMPANY NAME 603 parseable name: addressFormInlineCompany 604 field signature: 4087238350 605 form signature: 16870043504464996221" 606 autofill-prediction="COMPANY_NAME" 607 > 608 </div> 609 </div> 610 <div> 611 <label for="addressFormInlineCountry">COUNTRY<span>*</span> 612 </label> 613 <div> 614 <select id="addressFormInlineCountry" name="addressFormInlineCountry" 615 title="overall type: ADDRESS_HOME_COUNTRY 616 server type: ADDRESS_HOME_COUNTRY 617 heuristic type: ADDRESS_HOME_COUNTRY 618 label: COUNTRY* 619 parseable name: addressFormInlineCountry 620 field signature: 695762362 621 form signature: 16870043504464996221" 622 autofill-prediction="ADDRESS_HOME_COUNTRY" 623 > 624 <option value="CA">Canada</option> 625 <option value="US">United States</option> 626 </select> 627 </div> 628 </div> 629 <div id="streetAddress"> 630 <legend> 631 <label for="addressFormInlineAddressLine1">STREET ADDRESS<span>*</span> 632 </label> 633 </legend> 634 <div> 635 <input id="addressFormInlineAddressLine1" name="addressFormInlineAddressLine1" placeholder="Address Line 1" type="text" maxlength="30" 636 title="overall type: ADDRESS_HOME_LINE1 637 server type: ADDRESS_HOME_LINE1 638 heuristic type: ADDRESS_HOME_LINE1 639 label: STREET ADDRESS* 640 parseable name: addressFormInlineAddressLine1 641 field signature: 1040409778 642 form signature: 16870043504464996221" 643 autofill-prediction="ADDRESS_HOME_LINE1" 644 > 645 </div> 646 <input id="addressFormInlineAddressLine2" name="addressFormInlineAddressLine2" placeholder="Address Line 2" type="text" maxlength="30" 647 title="overall type: ADDRESS_HOME_LINE2 648 server type: ADDRESS_HOME_LINE2 649 heuristic type: ADDRESS_HOME_LINE2 650 label: Address Line 2 651 parseable name: addressFormInlineAddressLine2 652 field signature: 1640842807 653 form signature: 16870043504464996221" 654 autofill-prediction="ADDRESS_HOME_LINE2" 655 > 656 </div> 657 <div id="city"> 658 <label for="addressFormInlineCity">CITY<span>*</span> 659 </label> 660 <div> 661 <input id="addressFormInlineCity" name="addressFormInlineCity" type="text" maxlength="40" 662 title="overall type: ADDRESS_HOME_CITY 663 server type: ADDRESS_HOME_CITY 664 heuristic type: ADDRESS_HOME_CITY 665 label: CITY* 666 parseable name: addressFormInlineCity 667 field signature: 2829321141 668 form signature: 16870043504464996221" 669 autofill-prediction="ADDRESS_HOME_CITY" 670 > 671 </div> 672 </div> 673 <div id="state"> 674 <div> 675 <label for="addressFormInlineState">STATE / PROVINCE<span>*</span> 676 </label> 677 <div> 678 <select id="addressFormInlineState" name="addressFormInlineState" 679 title="overall type: ADDRESS_HOME_STATE 680 server type: ADDRESS_HOME_STATE 681 heuristic type: ADDRESS_HOME_STATE 682 label: STATE / PROVINCE* 683 parseable name: addressFormInlineState 684 field signature: 3295167441 685 form signature: 16870043504464996221" 686 autofill-prediction="ADDRESS_HOME_STATE" 687 > 688 <option value="NO_STATE_TYPE_SELECTED" selected="selected">* Select</option> 689 <option value="Aa">AA - Armed Forces America</option> 690 <option value="Ae">AE - Armed Forces Europe</option> 691 <option value="AL">Alabama</option> 692 <option value="AK">Alaska</option> 693 <option value="Ap">AP - Armed Forces Pacific</option> 694 <option value="AZ">Arizona</option> 695 <option value="AR">Arkansas</option> 696 <option value="CA">California</option> 697 <option value="CO">Colorado</option> 698 <option value="CT">Connecticut</option> 699 <option value="DE">Delaware</option> 700 <option value="DC">District of Columbia</option> 701 <option value="FL">Florida</option> 702 <option value="GA">Georgia</option> 703 <option value="HI">Hawaii</option> 704 <option value="ID">Idaho</option> 705 <option value="IL">Illinois</option> 706 <option value="IN">Indiana</option> 707 <option value="IA">Iowa</option> 708 <option value="KS">Kansas</option> 709 <option value="KY">Kentucky</option> 710 <option value="LA">Louisiana</option> 711 <option value="ME">Maine</option> 712 <option value="MD">Maryland</option> 713 <option value="MA">Massachusetts</option> 714 <option value="MI">Michigan</option> 715 <option value="MN">Minnesota</option> 716 <option value="MS">Mississippi</option> 717 <option value="MO">Missouri</option> 718 <option value="MT">Montana</option> 719 <option value="NE">Nebraska</option> 720 <option value="NV">Nevada</option> 721 <option value="NH">New Hampshire</option> 722 <option value="NJ">New Jersey</option> 723 <option value="NM">New Mexico</option> 724 <option value="NY">New York</option> 725 <option value="NC">North Carolina</option> 726 <option value="ND">North Dakota</option> 727 <option value="OH">Ohio</option> 728 <option value="OK">Oklahoma</option> 729 <option value="OR">Oregon</option> 730 <option value="PA">Pennsylvania</option> 731 <option value="PR">Puerto Rico</option> 732 <option value="RI">Rhode Island</option> 733 <option value="SC">South Carolina</option> 734 <option value="SD">South Dakota</option> 735 <option value="TN">Tennessee</option> 736 <option value="TX">Texas</option> 737 <option value="UT">Utah</option> 738 <option value="VT">Vermont</option> 739 <option value="VA">Virginia</option> 740 <option value="WA">Washington</option> 741 <option value="WV">West Virginia</option> 742 <option value="WI">Wisconsin</option> 743 <option value="WY">Wyoming</option> 744 </select> 745 </div> 746 </div> 747 <div> 748 <label for="addressFormInlineZip">ZIP / POSTAL CODE<span>*</span> 749 </label> 750 <div> 751 <input id="addressFormInlineZip" name="addressFormInlineZip" type="text" maxlength="10" 752 title="overall type: ADDRESS_HOME_ZIP 753 server type: ADDRESS_HOME_ZIP 754 heuristic type: ADDRESS_HOME_ZIP 755 label: ZIP / POSTAL CODE* 756 parseable name: addressFormInlineZip 757 field signature: 3060672026 758 form signature: 16870043504464996221" 759 autofill-prediction="ADDRESS_HOME_ZIP" 760 > 761 </div> 762 </div> 763 </div> 764 <div id="phoneNumber"> 765 <label for="addressFormInlinePhoneNumber">PHONE NUMBER<span>*</span> 766 </label> 767 <div> 768 <input id="addressFormInlinePhoneNumber" name="addressFormInlinePhoneNumber" type="text" maxlength="32" 769 title="overall type: PHONE_HOME_CITY_AND_NUMBER 770 server type: PHONE_HOME_CITY_AND_NUMBER 771 heuristic type: PHONE_HOME_WHOLE_NUMBER 772 label: PHONE NUMBER* 773 parseable name: addressFormInlinePhoneNumber 774 field signature: 1198968276 775 form signature: 16870043504464996221" 776 autofill-prediction="PHONE_HOME_CITY_AND_NUMBER" 777 > 778 </div> 779 </div> 780 <div id="email"> 781 <label for="addressFormInlineEmail" id="addressFormInlineEmailLabel">EMAIL<span>*</span> 782 </label> 783 <div> 784 <input id="addressFormInlineEmail" name="addressFormInlineEmail" type="text" maxlength="40" value="" 785 title="overall type: EMAIL_ADDRESS 786 server type: EMAIL_ADDRESS 787 heuristic type: EMAIL_ADDRESS 788 label: EMAIL* 789 parseable name: addressFormInlineEmail 790 field signature: 2460631353 791 form signature: 16870043504464996221" 792 autofill-prediction="EMAIL_ADDRESS" 793 > 794 </div> 795 </div> 796 <div id="addressNickname"> 797 <label for="addressFormInlineAddressNickName">ADDRESS NICKNAME<span>*</span> 798 <span> <span>?</span> 799 </span> 800 <span>The Address Nickname is a short name you create to help you easily identify this address within your address book.</span> 801 </label> 802 <div> 803 <input id="addressFormInlineAddressNickName" name="addressFormInlineAddressNickName" type="text" maxlength="35" placeholder="Holly at school, Mom, etc." 804 title="overall type: UNKNOWN_TYPE 805 server type: NO_SERVER_DATA 806 heuristic type: UNKNOWN_TYPE 807 label: ADDRESS NICKNAME* The Address Nickname is a short name you create to help you easily identify this a 808 parseable name: addressFormInlineAddressNickName 809 field signature: 2948011243 810 form signature: 16870043504464996221" 811 autofill-prediction="UNKNOWN_TYPE" 812 > 813 </div> 814 </div> 815 <div> 816 <input name="saveAddressCheckboxInline" id="saveAddressCheckboxInline" type="checkbox" 817 title="overall type: UNKNOWN_TYPE 818 server type: NO_SERVER_DATA 819 heuristic type: UNKNOWN_TYPE 820 label: Add to address book. 821 parseable name: saveAddressCheckboxInline 822 field signature: 3323717546 823 form signature: 16870043504464996221" 824 autofill-prediction="UNKNOWN_TYPE" checked="checked" 825 > 826 <label for="saveAddressCheckboxInline">Add to address book. </label> 827 </div> 828 <div> 829 <input name="setDefaultCheckboxInline" id="setDefaultCheckboxInline" type="checkbox" 830 title="overall type: UNKNOWN_TYPE 831 server type: NO_SERVER_DATA 832 heuristic type: UNKNOWN_TYPE 833 label: Save as default shipping address in Address Book 834 parseable name: setDefaultCheckboxInline 835 field signature: 2923970107 836 form signature: 16870043504464996221" 837 autofill-prediction="UNKNOWN_TYPE" 838 > 839 <label for="setDefaultCheckboxInline" id="setDefaultCheckboxInlineLabel">Save as default billing address in Address Book</label> 840 </div> 841 <div id="defaultAddressChangeInline"> 842 <div id="WC_ContentAreaESpot_div_1_rx-DefaultAddrConfirm"> 843 <div id="WC_ContentAreaESpot_div_2_rx-DefaultAddrConfirm">[rx-DefaultAddrConfirm]</div> 844 <div> 845 <ul> 846 <li value="1"> 847 You are changing your Costco Default Shipping Address. All future orders from Costco.com, including Pharmacy Prescription Orders, will be sent to this Address. 848 </li> 849 </ul> 850 </div> 851 </div> 852 </div> 853 <div id="button-container"> 854 <div> 855 <div> 856 <button id="addressFormInlineButton" type="button"> 857 <span> 858 <span>Save Address</span> 859 </span> 860 </button> 861 </div> 862 </div> 863 </div> 864 </div> 865 </form> 866 <div id="footer-find-warehouse-block"> 867 <label for="footer-search-field">Find a Warehouse</label> 868 <form id="WarehouseSearchForm" action="https://www.costco.com/warehouse-locations" novalidate="novalidate"> 869 <div> 870 <input id="footer-search-field" type="search" name="location" tabindex="1" placeholder="City, state or zip" value="" 871 title="Search"> 872 <input type="submit" id="searchClear" value="Clear"> 873 <input type="hidden" id="fromWLocSubmit" name="fromWLocSubmit" value="true"> 874 <input type="hidden" id="numOfWarehouses" name="numOfWarehouses" value="10"> 875 </div> 876 </form> 877 </div> 878 <div id="footer-email-offers-block"> 879 <label for="footer-email-offers">Get Email Offers</label> 880 <form 881 title="" action="https://www.costco.com/EmailSubscription" id="EmailOffersForm"> 882 <div> 883 <input type="text" name="emailSignUp" id="footer-email-offers" placeholder="Enter your email"> 884 <span> 885 <button type="submit" alt="Go">Go</button> 886 </span> 887 </div> 888 </form> 889 </div> 890 <input type="hidden" name="typeAheadDisabled" id="typeAheadDisabled" value="false"> 891 </body> 892 </html>