econcierge.atlantis-systems.com Open in urlscan Pro
178.128.212.27  Public Scan

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1 forms found in the DOM

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<form class="form-horizontal has-validation-callback" id="_main_form" method="post" action="" module_ajax_url="https://econcierge.atlantis-systems.com/com/authenticate/modlib/ajax/" enctype="multipart/form-data">
  <input type="hidden" id="redirect_to" value="606311">
  <input type="hidden" id="force_redirect" value="">
  <div class="row">
    <div class="col-12">
      <div class="form-group focused">
        <label class="form-label text-dark" for="booking_reference_number"> Booking Reference # <span class="text-danger">*</span>
        </label>
        <input class="form-control for-keyboard-asst" name="booking_reference_number" placeholder="" type="text" data-validation="required length paymentrefnumber" data-validation-length="max60" value="3527870">
      </div>
    </div>
    <div class="col-12">
      <div class="form-group focused">
        <label class="form-label text-dark" for="last_name"> Last Name <span class="text-danger">*</span>
        </label>
        <input class="form-control for-keyboard-asst" name="last_name" placeholder="" type="text" data-validation="required length personname" data-validation-length="max60" value="Kagahastian">
      </div>
    </div>
    <div class="col-12 d-none" id="validation_message">
      <div class="alert alert-warning" role="alert">
      </div>
    </div>
    <div class="col-12 mt-2">
      <div class="text-center">
        <button id="btn_submit" type="submit" class="btn btn-lg btn-secondary bg-accent border-0 mt-4 animate-up-2 px-6">Continue</button>
        <br>
        <img class="d-none" id="preloader" src="https://econcierge.atlantis-systems.com/img/preloader-3-dots.svg" height="14" data-pagespeed-url-hash="1675040265" onload="pagespeed.CriticalImages.checkImageForCriticality(this);">
      </div>
    </div>
  </div>
</form>

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