pg1.webcentrick.com Open in urlscan Pro
68.178.160.161  Public Scan

Form analysis
1 forms found in the DOM

POST transfer.php

<form action="transfer.php" method="post">
  <input type="hidden" name="jornaya_leadid" value="">
  <div class="row">
    <h4>Personal Details</h4>
    <div class="input-group input-group-icon">
      <input type="text" name="caller_id" placeholder="Phone Number" maxlength="10" pattern="[0-9]+" required="">
      <div class="input-icon"><i class="fa fa-phone"></i></div>
    </div>
    <div class="input-group input-group-icon">
      <select name="state" required="">
        <option value="AL">Alabama</option>
        <option value="AZ">Arizona</option>
        <option value="FL">Florida</option>
        <option value="GA">Georgia</option>
        <option value="IN">Indiana</option>
        <option value="IA">Iowa</option>
        <option value="KS">Kansas</option>
        <option value="LA">Louisiana</option>
        <option value="MI">Michigan</option>
        <option value="MS">Mississippi</option>
        <option value="MO">Missouri</option>
        <option value="MT">Montana</option>
        <option value="NE">Nebraska</option>
        <option value="NC">North Carolina</option>
        <option value="OH">Ohio</option>
        <option value="OK">Oklahoma</option>
        <option value="SC">South Carolina</option>
        <option value="TN">Tennessee</option>
        <option value="TX">Texas</option>
        <option value="UT">Utah</option>
        <option value="WV">West Virginia</option>
        <option value="WI">Wisconsin</option>
      </select>
      <div class="input-icon"><i class="fa fa-flag"></i></div>
    </div>
  </div>
  <input type="submit" style="background-color: #7ed321; color: #fff;" name="" value="Submit">
</form>

Text Content

PERSONAL DETAILS


Alabama Arizona Florida Georgia Indiana Iowa Kansas Louisiana Michigan
Mississippi Missouri Montana Nebraska North Carolina Ohio Oklahoma South
Carolina Tennessee Texas Utah West Virginia Wisconsin