assurance.maladie.osilog.fr Open in urlscan Pro
195.134.166.41  Public Scan

Form analysis
2 forms found in the DOM

Name: authentification — POST identification.php

<form name="authentification" action="identification.php" method="post" onsubmit="return true;" style="border:0px solid blue;">
  <input type="hidden" name="origin" value="identification">
  <input id="login" type="text" name="login" value="" maxlength="36" placeholder="Identifiant">
  <input id="passwd" type="password" name="passwd" value="" placeholder="Mot de passe">
  <button>se connecter</button><br>
  <p>Mot de passe oublié ? <a href="getident.php">Cliquez ici.</a></p>
</form>

Name: formcontacthelp — POST contacthelp.php

<form method="post" name="formcontacthelp" action="contacthelp.php" onsubmit="javascript:return verif_formcontacthelp();">
  <div class="row">
    <label>Nom * <input type="text" name="nom" placeholder="Votre nom complet">
    </label>
  </div>
  <div class="row">
    <label>Société * <input type="text" name="soc" placeholder="Votre compte Osilog Online">
    </label>
  </div>
  <div class="row">
    <label>Email * <input type="email" name="email" placeholder="Votre adresse email">
    </label>
  </div>
  <div class="row">
    <label>Message * <textarea name="mess" rows="5" placeholder="Votre message" style="resize:none;"></textarea>
    </label>
  </div>
  <div class="contact-panel-actions">
    <input type="submit" class="button submit-button" value="Envoyer">
    <!--<button class="submit-button" data-toggle="contact-panel">Envoyer</button>-->
    <button class="cancel-button" data-toggle="contact-panel" onclick="javascript:$('.contact-panel').css('bottom', '-385px');">Annuler</button>
  </div>
</form>

Text Content

mercredi 15 mai 12:27:23


Merci de vous authentifier

se connecter


Mot de passe oublié ? Cliquez ici.


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Nom *
Société *
Email *
Message *
Annuler