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<!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>
<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="312">
<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"
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" name="account" value="" 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" 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"
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" 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" 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>
<span>
<i>Costco Cash</i> Card Number</span>
<span>This image highlights the unique number</span>
<img src="./Costco - Payment_files/cashcard-us.gif" alt="cashcard-us.gif">
<span>used to identify your <i>Costco Cash</i> card.</span>
<span> Pin Number</span>
<span>This number is used to access your</span>
<span>
<i>Costco Cash</i> card. The image shows</span>
<span>where this number is located.</span>
<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"
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=""
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"
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">
<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>
<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
<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>