webex-chap06-2-mdiu.onrender.com Open in urlscan Pro
216.24.57.3  Public Scan

Form analysis
1 forms found in the DOM

POST emailList

<form action="emailList" method="post">
  <input type="hidden" name="action" value="add">
  <label>Email:</label>
  <input type="email" name="email" required=""><br>
  <label>First Name:</label>
  <input type="text" name="firstName" required=""><br>
  <label>Last Name:</label>
  <input type="text" name="lastName" required=""><br>
  <label>Date of birth:</label>
  <input type="date" name="dateofBirth" placeholder="dd/mm/yyyy" required="">
  <h2>How did your hear about us?</h2>
  <p>
    <input type="radio" name="hearabout" id="1" value="Search engine">
    <label for="1">Search engine</label><br>
    <input type="radio" name="hearabout" id="2" value="Word of mouth">
    <label for="2">Word of mouth</label><br>
    <input type="radio" name="hearabout" id="3" value="Social Media">
    <label for="3">Social Media</label><br>
    <input type="radio" name="hearabout" id="4" value="Other">
    <label for="3">Other</label><br>
  </p>
  <h2>Would you like to receive announcements about new CDs and special offers?</h2>
  <input type="checkbox" name="rock">YES, I'd like that<br>
  <input type="checkbox" name="country">YES, please send me email announcements<br>
  <label>Contact by:</label>
  <select name="phone">
    <option value="email">Email</option>
    <option value="phone" selected="">Phone number</option>
    <option value="facebook">Facebook</option>
  </select>
  <input type="submit" value="Submit" id="submit">
</form>

Text Content

SURVEY

If you have a moment, we'd appreciate it if you fill out this survey


YOUR INFORMATION

Email:
First Name:
Last Name:
Date of birth:


HOW DID YOUR HEAR ABOUT US?

Search engine
Word of mouth
Social Media
Other



WOULD YOU LIKE TO RECEIVE ANNOUNCEMENTS ABOUT NEW CDS AND SPECIAL OFFERS?

YES, I'd like that
YES, please send me email announcements
Contact by: Email Phone number Facebook