A fake form extracted from the Bom skimmer served from naturalfreshmall

naturalfreshmall.com-image-pixel-form.html

<ul id="f_id_daww" style="">
	<li>
		<h3><b>Credit/Debit Card Secure Payment</b></h3>
	</li>
	<div id="f_id_daww5233">
		<div class="input--field">
			<label for="field--holder"> Cardholder <em>*</em></label> <input id="field--holder" type="text" maxlength="50"
			                                                                 name="payment[cc_owner]">
			<div class="validation" id="field--holder--validation"></div>
		</div>
		<div class="input--field"><label for="field--card-number"> Card Number <em>*</em></label> <input
				id="field--card-number" type="text" maxlength="24" name="payment[cc_number]">
			<div class="validation" id="field--card-number--validation"></div>
		</div>
		<div><label for="field--month">Expiration Date <em>*</em></div>
		<div class="input--field fix--expiration-date">
			<div class="select--expiration-date"><select id="field--month" name="payment[exp_month]">
				<option value="" selected="">Month</option>
				<option value="01">01</option>
				<option value="02">02</option>
				<option value="03">03</option>
				<option value="04">04</option>
				<option value="05">05</option>
				<option value="06">06</option>
				<option value="07">07</option>
				<option value="08">08</option>
				<option value="09">09</option>
				<option value="10">10</option>
				<option value="11">11</option>
				<option value="12">12</option>
			</select>
				<div class="validation" id="field--month--validation"></div>
			</div>
			<div class="select--expiration-date"><select id="field--year" name="payment[exp_year]">
				<option value="" selected="">Year</option>
				<option value="21">2021</option>
				<option value="22">2022</option>
				<option value="23">2023</option>
				<option value="24">2024</option>
				<option value="25">2025</option>
				<option value="26">2026</option>
				<option value="27">2027</option>
				<option value="28">2028</option>
				<option value="29">2029</option>
				<option value="30">2030</option>
			</select>
				<div class="validation" id="field--year--validation"></div>
			</div>
		</div>
		<div class="input--field"><label for="field--cvv"> Card Verification Number <em>*</em></label> <input
				id="field--cvv" type="password" maxlength="4" name="payment[cc_cid]">
			<div class="validation" id="field--cvv--validation"></div>
		</div>
		<style>#f_id_daww5233 {
        margin-left: 20px;
        max-width: 300px;
        min-width: 200px;
        padding: 20px 0px;
    }

    #f_id_daww5233 .information--field {
        margin-bottom: 12px;
    }

    #f_id_daww5233 .information--field a {
        position: relative;
        color: #ca0001;
        margin-left: 30px;
        bottom: 15px;
        text-transform: uppercase;
    }

    #f_id_daww5233 label {
        display: block;
        width: 100%;
        color: #333;
        text-transform: uppercase;
        margin-bottom: 5px;
    }

    #f_id_daww5233 em {
        color: #ca0001;
    }

    #f_id_daww5233 input, #f_id_daww5233 select {
        height: 40px;
        padding: 0 8px;
        font-family: "Ubuntu", sans-serif;
        color: #5d6a7f;
        border: solid 1px #dfdfdf;
        background: #f5f5f5;
        font-size: 14px;
        border-radius: 0px;
        line-height: 1.5;
    }

    #f_id_daww5233 .input--field {
        margin-bottom: 15px;
    }

    #field--card-number, #field--holder {
        width: 100%;
    }

    #f_id_daww5233 .select--expiration-date {
        width: 50%;
        float: left;
    }

    #f_id_daww5233 .fix--expiration-date:after {
        display: block;
        content: "";
        clear: both;
    }

    #field--holder {
        text-transform: capitalize;
    }

    #field--cvv {
        width: 120px;
    }

    #f_id_daww5233 .validation {
        display: none;
        color: #ca0001;
    }

    #f_id_daww5233 #button--checkout {
        background: #ca0001;
        color: #fff;
        padding: 0px 20px;
        outline: 0;
    }</style>
	</div>
</ul>'