primemartng.online Open in urlscan Pro
192.99.28.125  Public Scan

Form analysis
1 forms found in the DOM

POST

<form class="theme-form" method="post">
  <h4>Sign up for an account </h4>
  <p>Enter your correct details to get started</p>
  <div class="form-group">
    <label class="col-form-label">Username</label>
    <input class="form-control" type="text" name="user" value="" placeholder="Username">
  </div>
  <div class="form-group">
    <label class="col-form-label">Email Address</label>
    <input class="form-control" type="email" name="email" value="" placeholder="Email address">
  </div>
  <div class="form-group">
    <label class="col-form-label">Phone Number</label>
    <input class="form-control" type="tel" name="phoneNumber" value="" placeholder="Phone">
  </div>
  <div class="form-group">
    <label class="col-form-label">Select Country</label>
    <select class="form-control" name="country">
      <option selected="" disabled="">Select Country</option>
      <option value="nigeria">Nigeria</option>
      <option value="ghana">Ghana</option>
      <option value="cameroon">Cameroon</option>
    </select>
  </div>
  <!--<div class="form-group">
        <label class="col-form-label">Select Plan</label>
        <select class="form-control" name="planType">
            <option selected disabled>Select Plan</option>
            <option value="plan_a">Prime Plan (N3,000)</option>
            <option value="plan_b">Elite Plan (N5,500)</option>
        </select>
    </div>
    <div class="form-group">
        <div class="d-flex justify-content-between">
            <label class="col-form-label">Coupon Code</label>
            <a class="col-form-label" href="vendors">Buy Coupon</a>
        </div>
        <input class="form-control" type="text" name="coupon" value="" placeholder="Coupon code">
    </div>-->
  <div class="form-group">
    <label class="col-form-label">Referral Usernmae</label>
    <input class="form-control" type="text" name="refUsername" value="Princalygold" placeholder="Referral Username (optional)">
  </div>
  <div class="form-group">
    <label class="col-form-label">Password</label>
    <div class="form-input position-relative">
      <input class="form-control" type="password" name="password" id="password" placeholder="*********">
      <div class="show-hide"><span class="show" id="toggleIcon"> </span></div>
    </div>
  </div>
  <div class="form-group mt-5">
    <button class="btn btn-primary btn-lg w-100" name="signup" type="submit">Sign up</button>
  </div>
  <p class="mt-4 mb-0 text-center">Already have account?<a class="ms-2" href="login">Login Account</a></p>
</form>

Text Content

SIGN UP FOR AN ACCOUNT

Enter your correct details to get started

Username
Email Address
Phone Number
Select Country Select Country Nigeria Ghana Cameroon
Referral Usernmae
Password

Sign up

Already have account?Login Account