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johnson-sbbarrier-twitter-quiz1c4c4262.shuttlerock-form.com Open in urlscan Pro
54.247.69.169  Public Scan

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URL: https://johnson-sbbarrier-twitter-quiz1c4c4262.shuttlerock-form.com/
Submission: On October 27 via automatic, source ayashige — Scanned from DE

Form analysis 1 forms found in the DOM

POST /confirm

<form id="form" class="h-adr" novalidate="novalidate" action="/confirm" accept-charset="UTF-8" method="post"><input type="hidden" name="authenticity_token"
    value="IKNJ/kVVMt7cIhww3WwHQ+UuEl20gLLdw7m5R/6htZfhBLg++9btS933sMIcCJr3FStoANBRVBcQVNrXUO5rhg==" autocomplete="off">
  <div class="row py-3 border-bottom">
    <div class="col-sm-3 text-start"><span class="fw-bold" id="label_field_275b89c8-8d8d-4815-a60d-ae730ce03bee">お名前</span><span class="text-danger">*</span></div>
    <div class="col-sm-9 position-relative"><input value="275b89c8-8d8d-4815-a60d-ae730ce03bee" autocomplete="off" type="hidden" name="response[responses_fields_attributes[][field_id]]" id="response_responses_fields_attributes[][field_id]"><input
        id="field_275b89c8-8d8d-4815-a60d-ae730ce03bee" class="form-control" placeholder="" required="required" maxlength="1024" size="1024" type="text" name="response[responses_fields_attributes[][value]]"></div>
  </div>
  <div class="row py-3 border-bottom">
    <div class="col-sm-3 text-start"><span class="fw-bold" id="label_field_a372fc23-320d-45da-9549-3ef52f1f4c91">郵便番号</span><span class="text-danger">*</span><br><small>（ハイフンなしでご記入ください）</small></div>
    <div class="col-sm-9 position-relative"><input value="a372fc23-320d-45da-9549-3ef52f1f4c91" autocomplete="off" type="hidden" name="response[responses_fields_attributes[][field_id]]" id="response_responses_fields_attributes[][field_id]"><input
        id="field_a372fc23-320d-45da-9549-3ef52f1f4c91" class="form-control" placeholder="" required="required" maxlength="8" size="8" type="text" name="response[responses_fields_attributes[][value]]"></div>
  </div>
  <div class="row py-3 border-bottom">
    <div class="col-sm-3 text-start"><span class="fw-bold" id="label_field_1c359b18-4bd0-4ca2-9a38-dbd2b6842efc">都道府県</span><span class="text-danger">*</span></div>
    <div class="col-sm-9 position-relative"><input value="1c359b18-4bd0-4ca2-9a38-dbd2b6842efc" autocomplete="off" type="hidden" name="response[responses_fields_attributes[][field_id]]" id="response_responses_fields_attributes[][field_id]"><input
        id="field_1c359b18-4bd0-4ca2-9a38-dbd2b6842efc" class="form-control" placeholder="" required="required" maxlength="1024" size="1024" type="text" name="response[responses_fields_attributes[][value]]"></div>
  </div>
  <div class="row py-3 border-bottom">
    <div class="col-sm-3 text-start"><span class="fw-bold" id="label_field_f1f69ffa-a42a-4000-bded-2c013bdb9858">市区町村</span><span class="text-danger">*</span></div>
    <div class="col-sm-9 position-relative"><input value="f1f69ffa-a42a-4000-bded-2c013bdb9858" autocomplete="off" type="hidden" name="response[responses_fields_attributes[][field_id]]" id="response_responses_fields_attributes[][field_id]"><input
        id="field_f1f69ffa-a42a-4000-bded-2c013bdb9858" class="form-control" placeholder="" required="required" maxlength="1024" size="1024" type="text" name="response[responses_fields_attributes[][value]]"></div>
  </div>
  <div class="row py-3 border-bottom">
    <div class="col-sm-3 text-start"><span class="fw-bold" id="label_field_24ed2ac8-9301-407e-941d-44ac43c25068">番地</span><span class="text-danger">*</span></div>
    <div class="col-sm-9 position-relative"><input value="24ed2ac8-9301-407e-941d-44ac43c25068" autocomplete="off" type="hidden" name="response[responses_fields_attributes[][field_id]]" id="response_responses_fields_attributes[][field_id]"><input
        id="field_24ed2ac8-9301-407e-941d-44ac43c25068" class="form-control" placeholder="" required="required" maxlength="1024" size="1024" type="text" name="response[responses_fields_attributes[][value]]"></div>
  </div>
  <div class="row py-3 border-bottom">
    <div class="col-sm-3 text-start"><span class="fw-bold" id="label_field_52c98596-3027-4526-8b71-a68b9c094e87">建物名・部屋番号</span></div>
    <div class="col-sm-9 position-relative"><input value="52c98596-3027-4526-8b71-a68b9c094e87" autocomplete="off" type="hidden" name="response[responses_fields_attributes[][field_id]]" id="response_responses_fields_attributes[][field_id]"><input
        id="field_52c98596-3027-4526-8b71-a68b9c094e87" class="form-control" placeholder="" maxlength="1024" size="1024" type="text" name="response[responses_fields_attributes[][value]]"></div>
  </div>
  <div class="row py-3 border-bottom">
    <div class="col-sm-3 text-start"><span class="fw-bold" id="label_field_dd8f6b27-a20a-443c-8c6e-21731dc9fc76">お電話番号</span><span class="text-danger">*</span><br><small>（ハイフンなしでご記入ください）</small></div>
    <div class="col-sm-9 position-relative"><input value="dd8f6b27-a20a-443c-8c6e-21731dc9fc76" autocomplete="off" type="hidden" name="response[responses_fields_attributes[][field_id]]" id="response_responses_fields_attributes[][field_id]"><input
        id="field_dd8f6b27-a20a-443c-8c6e-21731dc9fc76" class="form-control" placeholder="" required="required" maxlength="11" size="11" type="text" name="response[responses_fields_attributes[][value]]"></div>
  </div>
  <div class="row py-3 border-bottom">
    <div class="col-sm-3 text-start"><span class="fw-bold" id="label_field_94c5ee45-4f39-4db0-bcfe-3a827154df79">Twitterユーザー名</span><span class="text-danger">*</span><br><small>(@は含まずご記入ください)</small></div>
    <div class="col-sm-9 position-relative"><input value="94c5ee45-4f39-4db0-bcfe-3a827154df79" autocomplete="off" type="hidden" name="response[responses_fields_attributes[][field_id]]" id="response_responses_fields_attributes[][field_id]"><input
        id="field_94c5ee45-4f39-4db0-bcfe-3a827154df79" class="form-control" placeholder="" required="required" maxlength="1024" size="1024" type="text" name="response[responses_fields_attributes[][value]]"></div>
  </div>
  <div class="terms ql-editor card mt-4 p-3 overflow-auto">
    <p><strong>個人情報の取り扱いについて</strong></p>
    <p>お客様からいただいた個人情報は、当企画の運営業務にのみ利用させていただきます。</p>
    <p>また、当該業務の委託に必要な範囲内で委託先に提供する場合を除き、</p>
    <p>個人情報をお客様の承認無く、第三者に提供することはありません。</p>
  </div>
  <div class="my-5 form-check d-flex justify-content-center">
    <div class="terms-checkbox"><label class="form-check"><input name="response[confirmation_term]" type="hidden" value="0" autocomplete="off"><input class="form-check-input" type="checkbox" value="1" name="response[confirmation_term]"
          id="response_confirmation_term">個人情報の取り扱いについて同意する</label>
      <div class="invalid-tooltip"></div>
    </div>
  </div>
  <div class="text-center"><input type="submit" name="commit" value="確認する" class="btn btn-dark px-5 py-3 rounded-pill" data-disable-with="確認する"></div>
</form>

Text Content

賞品発送のための必要情報を

ご入力いただくようお願い申し上げます。

お名前*

郵便番号*
（ハイフンなしでご記入ください）

都道府県*

市区町村*

番地*

建物名・部屋番号

お電話番号*
（ハイフンなしでご記入ください）

Twitterユーザー名*
(@は含まずご記入ください)


個人情報の取り扱いについて

お客様からいただいた個人情報は、当企画の運営業務にのみ利用させていただきます。

また、当該業務の委託に必要な範囲内で委託先に提供する場合を除き、

個人情報をお客様の承認無く、第三者に提供することはありません。

個人情報の取り扱いについて同意する