support.annexmed.co Open in urlscan Pro
2606:4700:4400::ac40:9934  Public Scan

Form analysis
1 forms found in the DOM

POST

<form id="form" action="" method="POST">
  <input type="hidden" name="from_v2" value="true">
  <input type="hidden" name="csrfmiddlewaretoken" value="6O1Mp5P5CZnpD1cSmbVtKNWhOVw7WQmL">
  <div class="hf-form-field">
    <label for="id_useremail" class="hf-form-field_label">Email Address</label>
    <input class="hf-form-field_value" type="text" id="id_useremail" name="useremail" value="" placeholder="Enter email" autofocus="">
    <span class="hf-form-field_error-text"></span>
  </div>
  <div class="hf-form-field">
    <label for="id_ticketnum" class="hf-form-field_label">Ticket ID</label>
    <input class="hf-form-field_value" type="text" id="id_ticketnum" name="ticketnum" placeholder="Enter ticket ID">
    <span class="hf-form-field_error-text"></span>
  </div>
  <!-- Google reCaptcha -->
  <div style="display: none;" id="google_recaptcha" class="g-recaptcha" data-sitekey="6LcoTEwUAAAAAM0Mst78EhadVrHJDjCONZBcIvz8">
    <div style="width: 304px; height: 78px;">
      <div><iframe title="reCAPTCHA"
          src="https://www.recaptcha.net/recaptcha/api2/anchor?ar=1&amp;k=6LcoTEwUAAAAAM0Mst78EhadVrHJDjCONZBcIvz8&amp;co=aHR0cHM6Ly9zdXBwb3J0LmFubmV4bWVkLmNvOjQ0Mw..&amp;hl=en&amp;v=3TZgZIog-UsaFDv31vC4L9R_&amp;size=normal&amp;cb=mx8nfo5p531v"
          width="304" height="78" role="presentation" name="a-8ygomb1fdm8l" frameborder="0" scrolling="no" sandbox="allow-forms allow-popups allow-same-origin allow-scripts allow-top-navigation allow-modals allow-popups-to-escape-sandbox"></iframe>
      </div><textarea id="g-recaptcha-response" name="g-recaptcha-response" class="g-recaptcha-response"
        style="width: 250px; height: 40px; border: 1px solid rgb(193, 193, 193); margin: 10px 25px; padding: 0px; resize: none; display: none;"></textarea>
    </div><iframe style="display: none;"></iframe>
  </div>
  <input id="is_captcha_displayed" type="hidden" name="is_captcha_displayed" value="false">
  <div class="hf-form-field">
    <button type="submit" id="submit" class="hf-form-field_btn">Login</button>
  </div>
</form>

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