Paytronix Form Testing

Login Form

Sign Up Form

Personal Information
Name*
First Name Last Name
Mobile Phone*
Email Address*
Birthdate*
Month
Day
YYYY
Zip/Postal Code*
ZIP / Postal Code
Password*
Confirm Password*
Password requirements:
- At least 8 characters
- At least 1 uppercase character
- At least 1 lowercase character
- At least 1 number
- At least 1 special character
- Avoid commonly used patterns and easily recognizable terms (e.g. QuickChek)
Favorite Location
Select Favorite Store*
Personal Preferences
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- Email Opt In
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