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1 forms found in the DOM

Name: mc-embedded-subscribe-form — POST https://dreamlab.us19.list-manage.com/subscribe/post?u=04b490c8b35b5812a8bb23d71&id=927205029c&f_id=005354e4f0

<form class="validate" name="mc-embedded-subscribe-form" id="mc-embedded-subscribe-form" method="post" action="https://dreamlab.us19.list-manage.com/subscribe/post?u=04b490c8b35b5812a8bb23d71&amp;id=927205029c&amp;f_id=005354e4f0" target="_blank"
  novalidate="novalidate">
  <div id="mc_embed_signup_scroll">
    <h2>Registra tu Garantía</h2>
    <div class="indicates-required">
      <span class="asterisk">*</span> indica campos requeridos
    </div>
    <div class="mc-field-group">
      <label for="mce-EMAIL">Correo Electrónico <span class="asterisk">*</span></label> <input value="" required="" id="mce-EMAIL" class="required email" name="EMAIL" type="email" aria-required="true">
    </div>
    <div class="mc-field-group">
      <label for="mce-FNAME">Nombre y Apellido <span class="asterisk">*</span></label> <input value="" required="" id="mce-FNAME" class="required text" name="FNAME" type="text" aria-required="true">
    </div>
    <div class="mc-field-group">
      <label for="mce-PHONE">Número Celular</label> <input value="" id="mce-PHONE" class="REQ_CSS" name="PHONE" type="text">
    </div>
    <div class="mc-field-group input-group">
      <strong>Canal de compra <span class="asterisk">*</span></strong>
      <ul>
        <li>
          <input value="Amazon" id="mce-CANAL0" name="CANAL" type="radio"><label for="mce-CANAL0">Amazon</label>
        </li>
        <li>
          <input value="Mercado Libre" id="mce-CANAL1" name="CANAL" type="radio"><label for="mce-CANAL1">Mercado Libre</label>
        </li>
        <li>
          <input value="Walmart" id="mce-CANAL2" name="CANAL" type="radio"><label for="mce-CANAL2">Walmart</label>
        </li>
        <li>
          <input value="Dreamlab Mx" id="mce-CANAL3" name="CANAL" type="radio"><label for="mce-CANAL3">Dreamlab Mx</label>
        </li>
      </ul>
    </div>
    <div class="mc-field-group size1of2">
      <label for="mce-FECHACOMPR-month">Fecha de compra <span class="asterisk">*</span></label>
      <div class="datefield">
        <span class="subfield dayfield"> <input value="" id="mce-FECHACOMPR-day" name="FECHACOMPR[day]" maxlength="2" size="2" placeholder="DD" pattern="[0-9]*" type="text" class="datepart required" aria-required="true"> </span> / <span
          class="subfield monthfield"> <input value="" id="mce-FECHACOMPR-month" name="FECHACOMPR[month]" maxlength="2" size="2" placeholder="MM" pattern="[0-9]*" type="text" class="datepart required" aria-required="true"> </span> / <span
          class="subfield yearfield"> <input value="" id="mce-FECHACOMPR-year" name="FECHACOMPR[year]" maxlength="4" size="4" placeholder="YYYY" pattern="[0-9]*" type="text" class="datepart required" aria-required="true"> </span> <span
          class="small-meta nowrap">( dd / mm / yyyy )</span>
      </div>
    </div>
    <div class="mc-field-group">
      <label for="mce-NUMPEDIDO">Número de Pedido <span class="asterisk">*</span></label> <input value="" required="" id="mce-NUMPEDIDO" class="required text" name="NUMPEDIDO" type="text" aria-required="true"> <span class="helper_text"
        id="mce-NUMPEDIDO-HELPERTEXT">N° Caracteres Amz: 17 | MeLi: 16 | WM: 12 | DreamlabMX: 4</span>
    </div>
    <div class="mc-field-group">
      <label for="mce-CANTPEDIDO">Cantidad de productos del pedido <span class="asterisk">*</span></label> <input value="" required="" id="mce-CANTPEDIDO" class="required number" name="CANTPEDIDO" type="number" aria-required="true">
    </div>
    <div class="mc-field-group input-group">
      <strong>Productos Ubbe </strong>
      <ul>
        <li>
          <input value="" id="mce-group[179536]-179536-0" name="group[179536][64]" type="checkbox"><label for="mce-group[179536]-179536-0">Almohada</label>
        </li>
        <li>
          <input value="" id="mce-group[179536]-179536-1" name="group[179536][128]" type="checkbox"><label for="mce-group[179536]-179536-1">Sábanas</label>
        </li>
        <li>
          <input value="" id="mce-group[179536]-179536-2" name="group[179536][256]" type="checkbox"><label for="mce-group[179536]-179536-2">Protector de colchón</label>
        </li>
      </ul>
    </div>
    <div id="mce-responses" class="clear">
      <div style="display: none;" id="mce-error-response" class="response"></div>
      <div style="display: none;" id="mce-success-response" class="response"></div>
    </div>
    <div style="position: absolute; left: -5000px;" aria-hidden="true"><input value="" tabindex="-1" name="b_04b490c8b35b5812a8bb23d71_927205029c" type="text"></div>
    <div class="clear"><input value="Registrar" class="button" id="mc-embedded-subscribe" name="subscribe" type="submit"></div>
  </div>
</form>

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UBBE GARANTÍAS


REGISTRA TU GARANTÍA

* indica campos requeridos
Correo Electrónico *
Nombre y Apellido *
Número Celular
Canal de compra *
 * Amazon
 * Mercado Libre
 * Walmart
 * Dreamlab Mx

Fecha de compra *
/ / ( dd / mm / yyyy )
Número de Pedido * N° Caracteres Amz: 17 | MeLi: 16 | WM: 12 | DreamlabMX: 4
Cantidad de productos del pedido *
Productos Ubbe
 * Almohada
 * Sábanas
 * Protector de colchón