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138.108.26.208  Public Scan

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Submitted URL: http://afflat3a2.com/trk/lnk/c76f8b4a-8559-4e59-9cf0-2f94fb053c34/?o=26649&c=918277&a=37505&k=719ee4f46b1de33eac3f09f...
Effective URL: https://join.pineconeresearch.com/
Submission: On May 30 via api from US — Scanned from CA

Form analysis 1 forms found in the DOM

<form class="form">
  <div class="form-group user-info-row">
    <div class="mr-2 w-100"><label class="input-label">Email</label><input type="email" name="emailid" class="form-control form-control-fontSize " placeholder="example@example.com" required="" value=""><small hidden=""
        class="text-danger email-error-cls">Email Id is invalid</small></div>
    <div class="field-box"><label class="input-label">First name</label><input class="form-control form-control-fontSize" type="text" name="firstname" placeholder="First name" required="" pattern="[^!#$%^&amp;*()@+=?><]*" value=""></div>
    <div class="field-box"><label class="input-label">Last name</label><input class="form-control form-control-fontSize" type="text" name="lastname" placeholder="Last name" required="" pattern="[^!#$%^&amp;*()@+=?><]*" value=""></div>
    <div class="form-group field-box date-box"><label class="input-label date-label">DOB</label><input class="form-control form-control-fontSize" type="text" name="dob" placeholder="MM/DD/YYYY" autocomplete="off" required=""
        pattern="[0-9][0-9]/[0-9][0-9]/[0-9][0-9][0-9][0-9]" value=""></div>
    <div class="field-box"><label class="input-label">Gender</label><select class="form-control form-control-fontSize" name="gender" attrcode="174" required="">
        <option value="" disabled="">Please Select...</option>
        <option metacode="1" value="1" title="Male">Male</option>
        <option metacode="2" value="2" title="Female">Female</option>
        <option metacode="3" value="3" title="Non-binary">Non-binary</option>
        <option metacode="4" value="4" title="Prefer to self describe">Prefer to self describe</option>
      </select></div>
  </div>
  <div class="mt-4">
    <div class="custom-control custom-checkbox"><input class="custom-control-input" type="checkbox" name="tnc" id="tnc" required=""><label class="custom-control-label tnc-lbl" for="tnc">I Agree to both the
        <a target="_blank" rel="noopener noreferrer" href="https://members.pineconeresearch.com/#/registration/MembershipAgreement?lang=eng">Membership Agreement</a><span class="text-black"> and
        </span><a target="_blank" rel="noopener noreferrer" href="https://members.pineconeresearch.com/#/registration/PrivacyPolicy?lang=eng">Privacy Policy</a></label></div><button class="btn btn-sm btn-epanel submit-btn">SIGN UP NOW</button>
  </div>
</form>

Text Content

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EmailEmail Id is invalid
First name
Last name
DOB
GenderPlease Select...MaleFemaleNon-binaryPrefer to self describe
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