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94.180.250.121  Public Scan

Form analysis
1 forms found in the DOM

POST /submit

<form action="/submit" method="POST">
  <div class="container mt-5">
    <h3>Customer name</h3>
    <input type="text" name="customer" placeholder="Name of vehicle owner">
  </div>
  <div class="container mt-5">
    <h3>Dealer</h3>
    <select name="dealer">
      <option value="">Select dealer</option>
      <option value="Tom Smith">Tom Smith</option>
      <option value="Karen Swanson">Karen Swanson</option>
      <option value="Jim Johnson">Jim Johnson</option>
      <option value="Shauna Gifford">Shauna Gifford</option>
    </select>
  </div>
  <div class="container mt-5">
    <h3>Please rate your dealer</h3>
    <input type="radio" name="rating" value="1"> 1 <input type="radio" name="rating" value="2"> 2 <input type="radio" name="rating" value="3"> 3 <input type="radio" name="rating" value="4"> 4 <input type="radio" name="rating" value="5"> 5 <input
      type="radio" name="rating" value="6"> 6 <input type="radio" name="rating" value="7"> 7 <input type="radio" name="rating" value="8"> 8 <input type="radio" name="rating" value="9"> 9 <input type="radio" name="rating" value="10" checked=""> 10
  </div>
  <div class="container mt-5">
    <h3>Comments about your experience</h3>
    <textarea name="comments" id="" cols="50" rows="7" placeholder="Tell us what you liked and/or did not like"></textarea>
  </div>
  <input type="submit" value="Submit" class="btn btn-success">
</form>

Text Content

Home Feedbacks


CUSTOMER NAME


DEALER

Select dealer Tom Smith Karen Swanson Jim Johnson Shauna Gifford


PLEASE RATE YOUR DEALER

1 2 3 4 5 6 7 8 9 10


COMMENTS ABOUT YOUR EXPERIENCE