nawalight.site Open in urlscan Pro
139.162.42.165  Public Scan

URL: https://nawalight.site/
Submission: On November 05 via api from BE — Scanned from SG

Form analysis 2 forms found in the DOM

Name: mc-embedded-subscribe-formPOST #

<form action="#" class="_contact-form" method="post" id="contact-form" name="mc-embedded-subscribe-form" target="_blank">
  <div class="form-group mb-3">
    <input type="email" class="form-control _field-email" name="email" id="email" placeholder="Enter your email" data-parsley-required="" data-parsley-length="[8, 191]">
  </div>
  <div class="form-group mb-3">
    <input type="text" class="form-control _field-subject" name="subject" id="subject" placeholder="Enter your subject" data-parsley-required="" data-parsley-length="[3, 100]">
  </div>
  <div class="form-group mb-3">
    <input type="number" class="form-control _field-phone" name="phone" id="phone" placeholder="Enter your phone" data-parsley-required="" data-parsley-length="[8, 50]">
  </div>
  <div class="form-group mb-3">
    <textarea type="text" class="form-control _field-message" name="message" id="message" placeholder="Enter your messages" row="4" data-parsley-required="" data-parsley-length="[3, 2000]"></textarea>
  </div>
  <button type="submit" class="btn btn-solid sendMsg _send-message" id="mc-submit">Kirim Pesan</button>
</form>

<form action="" style="max-height: 362px; overflow: auto; overflow-x: hidden;" id="form_checkout">
  <div class="form-group">
    <div class="row">
      <div class="col-12 col-md-6">
        <h6 class="fw-bold card-title">Nama Lengkap</h6>
        <input id="name" class="form-control" type="text" style="color: #777777;" data-parsley-required="" data-parsley-length="[3, 100]">
      </div>
      <div class="col-12 col-md-6">
        <h6 class="fw-bold card-title">Nomor Telepon</h6>
        <input id="no_tlp" class="form-control" type="text" style="color: #777777;" data-parsley-required="" data-parsley-length="[7, 50]">
      </div>
      <div class="col-12 col-md-6">
        <h6 class="fw-bold card-title">Email</h6>
        <input id="buyer_email" class="form-control" type="email" style="color: #777777;" data-parsley-required="" data-parsley-length="[3, 191]">
      </div>
    </div>
  </div>
  <div class="form-group is-digital-product">
    <h6 class="fw-bold card-title">Provinsi</h6>
    <select id="_provinsi" style="width: 100%; color: #777777;" class="form-select provinsi is-digital-product-inner" data-parsley-required="">
      <option hidden="" value="true">Pilih Provinsi...</option>
    </select>
  </div>
  <div class="form-group is-digital-product">
    <h6 class="fw-bold">Kabupaten/Kota</h6>
    <select id="_kota" style="width: 100%; color: #777777;" class="form-select kota is-digital-product-inner" data-parsley-required="">
      <option hidden="" value="true">Pilih Kabupaten/Kota...</option>
    </select>
  </div>
  <div class="form-group is-digital-product">
    <h6 class="fw-bold">Kecamatan</h6>
    <select id="_kecamatan" style="width: 100%; color: #777777;" class="form-select kecamatan is-digital-product-inner" data-parsley-required="">
      <option hidden="" value="true">Pilih Kecamatan...</option>
    </select>
  </div>
  <div class="form-group is-digital-product">
    <h6 class="fw-bold">Nama Jalan, Gedung, No. Rumah</h6>
    <textarea id="address" cols="30" rows="3" style="width: 100%; color: #777777;" class="form-control is-digital-product-inner" data-parsley-required="" data-parsley-length="[3, 191]"></textarea>
  </div>
  <div class="form-group is-digital-product">
    <h6 class="fw-bold">Kurir</h6>
    <select id="_kurir" style="width: 100%; color: #777777;" class="form-select is-digital-product-inner" data-parsley-required="">
      <option hidden="" value="true">Pilih Kurir...</option>
    </select>
  </div>
  <div class="form-group is-digital-product">
    <h6 class="fw-bold">Metode Pengiriman</h6>
    <select id="_pengiriman" style="width: 100%; color: #777777;" class="form-select is-digital-product-inner" data-parsley-required="">
      <option hidden="" value="true">Pilih Metode Pengiriman...</option>
    </select>
  </div>
</form>

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PROVINSI

Pilih Provinsi...

KABUPATEN/KOTA

Pilih Kabupaten/Kota...

KECAMATAN

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NAMA JALAN, GEDUNG, NO. RUMAH

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