Ryo Yamada asks for your credit card details.
No information is sent to the internet. The text boxes aren't connected to anything. This still makes two internet requests though: one to load the picture of Ryo Yamada and another to load the image that pops up when "Th-thanks" is pressed.
Based on this tweet and the age-old meme.
山田リョウベストガール。
AGPL v3.0. The most restrictive license for no actual reason. You're welcome.