chromium/components/test/data/autofill/heuristics/input/134_bug_471748.html

<head>
  <title>Payment Information</title>
</head>
<form name="info" method="post" action="https://www.runningwarehouse.com/finalcheckout.html" id="creditcard">
  <div class="pay_method">
    <h3 class="h_check">Pay with Credit Card:</h3>

    <div class="saved_wrap clearfix">

    </div>

    <div id="fade_card">
      <div class="cc_row card_type cf">
        <label for="cctype">Card Type:</label>
        <div class="cc_selwrap">
          <div class="dropdownbox"><div class="current_selection"><span class="selection_text" title="Visa">Visa</span><span class="drop_arrow"><span></span></span></div><ul class="optionslist"><li class="option selected">Visa</li><li class="option">MasterCard</li><li class="option">American Express</li><li class="option">Discover</li></ul></div><select name="ccType" id="cctype" class="fancy_select" style="display: none;">
            <option value="VISA" selected="">Visa</option>
            <option value="MASTERCARD">MasterCard</option>
            <option value="AMEX">American Express</option>
            <option value="DISCOVER">Discover</option>
          </select>
        </div>
        <div class="cc_iconwrap">
          <span class="cc_icon ic_visa selected">Visa</span>
          <span class="cc_icon ic_mc">MasterCard</span>
          <span class="cc_icon ic_ae">American Express</span>
          <span class="cc_icon ic_disc">Discover</span>
        </div>
      </div>
      <div class="cc_row cc_num">
        <label for="cardnum">Card #:</label>
        <input type="text" name="cardnum" id="cardnum" maxlength="19" class="check_text">
      </div>
      <div class="cc_row">
        <label for="expdate">Expire Date:</label>
        <input type="text" name="expdate" id="expdate" maxlength="5" class="check_text">
        <span>MM/YY</span>
      </div>
      <div class="cc_row">
        <label for="cvv2">CCV2:</label>
        <input type="text" name="cvv2" id="cvv2" maxlength="4" class="check_text">
        <a href="https://www.runningwarehouse.com/cvv2.html#cvv2_info" class="lightboxpop" data-boxheight="375" data-boxwidth="500">what's this?</a>
      </div>
    </div>
  </div>
</form>