chatleadershop.phonex-servicios.com Open in urlscan Pro
189.201.153.145  Public Scan

Form analysis
1 forms found in the DOM

POST /index.php/chat/startchat

<form id="form-start-chat" method="post" action="/index.php/chat/startchat" onsubmit="return lhinst.addCaptcha('1631379907',$(this))">
  <input type="hidden" name="onlyBotOnline" value="0">
  <div class="form-group">
    <label class="col-form-label">Name</label>
    <input maxlength="100" autofocus="autofocus" aria-label="Enter your name" placeholder="Enter your name" class="form-control form-control-sm" type="text" name="Username" value="">
  </div>
  <div class="form-group">
    <label class="col-form-label">E-mail</label>
    <input autofocus="autofocus" aria-label="Enter your email address" placeholder="Enter your email address" class="form-control form-control-sm" type="text" name="Email" value="">
  </div>
  <div class="row">
    <input type="hidden" name="show_admin_item[0]" value="true">
    <div class="col-12">
      <div class="form-group">
        <label class="col-form-label" id="label-additional_admin_0">Apellido&nbsp;</label>
        <input class="form-control form-control-sm" aria-labelledby="label-additional_admin_0" type="text" name="value_items_admin[0]" value="">
      </div>
    </div>
    <input type="hidden" name="show_admin_item[1]" value="true">
    <div class="col-12">
      <div class="form-group">
        <label class="col-form-label" id="label-additional_admin_1">Pais de recidencia&nbsp;</label>
        <input class="form-control form-control-sm" aria-labelledby="label-additional_admin_1" type="text" name="value_items_admin[1]" value="">
      </div>
    </div>
    <input type="hidden" name="show_admin_item[2]" value="true">
    <div class="col-12">
      <div class="form-group">
        <label class="col-form-label" id="label-additional_admin_2">Estado de Recidencia&nbsp;</label>
        <input class="form-control form-control-sm" aria-labelledby="label-additional_admin_2" type="text" name="value_items_admin[2]" value="">
      </div>
    </div>
    <input type="hidden" name="show_admin_item[3]" value="true">
    <div class="col-12">
      <div class="form-group">
        <label class="col-form-label" id="label-additional_admin_3">Nos está contactando porque...&nbsp;</label>
        <select name="value_items_admin[3]" class="form-control form-control-sm">
          <option value="">Please choose</option>
          <option value="Recibió una invitación
">Recibió una invitación </option>
          <option value="Mandó una invitación
">Mandó una invitación </option>
          <option value="Preguntas Generales">Preguntas Generales</option>
        </select>
      </div>
    </div>
  </div>
  <input type="hidden" name="user_timezone" value="">
  <script>
    $(document).ready(function() {
      Date.prototype.stdTimezoneOffset = function() {
        var jan = new Date(this.getFullYear(), 0, 1);
        var jul = new Date(this.getFullYear(), 6, 1);
        return Math.max(jan.getTimezoneOffset(), jul.getTimezoneOffset());
      };
      Date.prototype.dst = function() {
        return this.getTimezoneOffset() < this.stdTimezoneOffset();
      };
      var today = new Date();
      var timeZoneOffset = 0;
      if (today.dst()) {
        timeZoneOffset = today.getTimezoneOffset();
      } else {
        timeZoneOffset = today.getTimezoneOffset() - 60;
      };
      $('input[name=user_timezone]').val(((timeZoneOffset) / 60) * -1);
    });
  </script>
  <div class="btn-group" role="group" aria-label="...">
    <input type="submit" class="btn btn-primary btn-sm startchat" value="Start chat" name="StartChatAction">
  </div>
  <input type="hidden" value="" name="URLRefer">
  <input type="hidden" value="" name="r">
  <input type="hidden" value="0" name="operator">
  <input type="hidden" value="1" name="StartChat">
</form>

Text Content

close

FILL OUT THIS FORM TO START A CHAT

Name
E-mail
Apellido 
Pais de recidencia 
Estado de Recidencia 
Nos está contactando porque...  Please choose Recibió una invitación Mandó una
invitación Preguntas Generales


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