test.dev.browntech.co Open in urlscan Pro
89.117.54.242  Public Scan

URL: https://test.dev.browntech.co/
Submission: On June 08 via api from US — Scanned from DE

Form analysis 3 forms found in the DOM

GET ./search/

<form action="./search/" method="get" id="search_my_site2" class="search-form">
  <div class="input-group"> <input type="text" name="searchtext" autocomplete="off" placeholder="Search " class="form-control search-input"> <button class="btn" type="submit"> <i class="navbar-toggler-icon fas fa-search"></i> </button> </div>
</form>

POST https://test.dev.browntech.co/popup-eval-info/

<form method="post" action="https://test.dev.browntech.co/popup-eval-info/" class="form" id="popup-eval-info-form">
  <div class="row m-0">
    <div class="col-7 p-0">
      <div class="row m-0 h-100">
        <div class="col-6 p-0">
          <a title="Call us about this Medical LCD Monitor" href="tel:6503360064" class="d-block text-center h-100"><img src="./assets/images/phone-512.png" class="img-fluid d-block mx-auto"><span class="d-block mt-2">(650) 336-0064</span> </a>
        </div>
        <div class="col-6 p-0">
          <a title=" Chat now about this Medical LCD Monitor" class="chat_now d-block text-center h-100" href="https://www.livehelpnow.net/lhn/lcv.aspx?d=40777&amp;lhnid=34723" onclick="window.open('https://www.livehelpnow.net/lhn/lcv.aspx?d=40777&amp;lhnid=34723','popup','width=600,height=600'); return false;"><img src="./assets/images/chat-512.png" class="img-fluid d-block mx-auto"><span class="d-block mt-2">Chat Now</span> </a>
        </div>
      </div>
    </div>
    <div class="col-5 p-0"> </div>
  </div>
  <p class="mt-4"><span class="text-danger">*</span> All Fields Required</p>
  <div class="msg-area"></div>
  <div class="form-group"><input value="" type="text" placeholder="First Name" name="form[firstname]" class="form-control" required=""></div>
  <div class="form-group"><input value="" type="text" placeholder="Last Name" name="form[lastname]" class="form-control" required=""></div>
  <div class="form-group"><input value="" type="email" placeholder="Email" name="form[email]" class="form-control" required=""></div>
  <div class="form-group"><input value="" type="text" placeholder="Organization" name="form[organization]" class="form-control" required=""></div>
  <div class="form-group"><input value="" type="text" placeholder="State" name="form[state]" class="form-control" required=""></div>
  <div class="form-group"><input value="" type="text" placeholder="Phone Number" name="form[phone]" class="form-control" required=""></div>
  <div class="form-group input-group">
    <div class="form-radio me-5"> <input type="radio" id="Evaluate" name="form[type]" value="Evaluate" class="form-radio-input" checked=""> <label for="Evaluate" class="form-radio-label" style="">Evaluate</label> </div>
    <div class="form-radio"> <input type="radio" id="requestQuote" name="form[type]" value="Quote" class="form-radio-input"> <label for="requestQuote" class="form-radio-label" style="">Request for Quote</label> </div>
  </div> <input type="hidden" name="form[request_type]" value="evaluation_unit"> <input type="hidden" id="ip_addres_user" name="form[ip_address]" value="146.70.117.103"> <input type="hidden" class="form-control" id="referral" name="form[referral]">
  <div class="form-group"> <select class="form-control form-select" required="" name="form[quantity]">
      <option value="">Number of Quantity </option>
      <option value="0-50">0-50 </option>
      <option value="50-250">50-250 </option>
      <option value="250+">250+ </option>
    </select> </div>
  <div class="form-group">
    <div id="recaptcha"></div>
  </div>
  <hr> <input value="ajax" type="hidden" name="form[method]"> <input value="" type="hidden" name="page"> <button type="submit" class="btn btn-primary" name="submit" data-tooltip="Please note evaluation equipment comes in a standard configuration."
    value="Submit Request">Submit Request</button>
</form>

POST ./eval-info-form-submit/

<form method="post" action="./eval-info-form-submit/" id="myform">
  <fieldset id="info1" class="">
    <div class="row">
      <div class="col-sm-6">
        <h2>Send My Eval</h2>
        <h3></h3>
      </div>
      <div class="col-sm-6 img-eval"> <img src="./assets/images/medix-c22-IP65-front-panel-medical-pc.png" alt="Medix C22" title="Medix C22" class="pop-up-img"> </div>
    </div>
    <div class="clear"></div> <input value="" type="hidden" name="to_mail"> <input value="Eval Info: " type="hidden" name="subject2"> <input value="" type="hidden" name="product">
    <div class="form-group"><input type="text" id="fullname" placeholder="Full Name" name="fullname"></div>
    <div class="form-group"><input type="email" placeholder="Email" name="email"></div>
    <div class="form-group"><input type="text" placeholder="Phone Number" name="phone"></div>
    <p> </p>
    <div class="need-card"> No Credit Card Needed </div> <a class="btn btn-primary next">Submit</a>
    <p></p>
  </fieldset>
  <fieldset id="info2" class="">
    <h3 class="text-right"></h3>
    <h2>Shipping Address</h2>
    <div class="form-group"> <select id="country" name="country" placeholder="Country">
        <option value="AF">Afghanistan</option>
        <option value="AX">Åland Islands</option>
        <option value="AL">Albania</option>
        <option value="DZ">Algeria</option>
        <option value="AS">American Samoa</option>
        <option value="AD">Andorra</option>
        <option value="AO">Angola</option>
        <option value="AI">Anguilla</option>
        <option value="AQ">Antarctica</option>
        <option value="AG">Antigua and Barbuda</option>
        <option value="AR">Argentina</option>
        <option value="AM">Armenia</option>
        <option value="AW">Aruba</option>
        <option value="AU">Australia</option>
        <option value="AT">Austria</option>
        <option value="AZ">Azerbaijan</option>
        <option value="BS">Bahamas</option>
        <option value="BH">Bahrain</option>
        <option value="BD">Bangladesh</option>
        <option value="BB">Barbados</option>
        <option value="BY">Belarus</option>
        <option value="BE">Belgium</option>
        <option value="BZ">Belize</option>
        <option value="BJ">Benin</option>
        <option value="BM">Bermuda</option>
        <option value="BT">Bhutan</option>
        <option value="BO">Bolivia, Plurinational State of</option>
        <option value="BQ">Bonaire, Sint Eustatius and Saba</option>
        <option value="BA">Bosnia and Herzegovina</option>
        <option value="BW">Botswana</option>
        <option value="BV">Bouvet Island</option>
        <option value="BR">Brazil</option>
        <option value="IO">British Indian Ocean Territory</option>
        <option value="BN">Brunei Darussalam</option>
        <option value="BG">Bulgaria</option>
        <option value="BF">Burkina Faso</option>
        <option value="BI">Burundi</option>
        <option value="KH">Cambodia</option>
        <option value="CM">Cameroon</option>
        <option value="CA">Canada</option>
        <option value="CV">Cape Verde</option>
        <option value="KY">Cayman Islands</option>
        <option value="CF">Central African Republic</option>
        <option value="TD">Chad</option>
        <option value="CL">Chile</option>
        <option value="CN">China</option>
        <option value="CX">Christmas Island</option>
        <option value="CC">Cocos (Keeling) Islands</option>
        <option value="CO">Colombia</option>
        <option value="KM">Comoros</option>
        <option value="CG">Congo</option>
        <option value="CD">Congo, the Democratic Republic of the</option>
        <option value="CK">Cook Islands</option>
        <option value="CR">Costa Rica</option>
        <option value="CI">Côte d'Ivoire</option>
        <option value="HR">Croatia</option>
        <option value="CU">Cuba</option>
        <option value="CW">Curaçao</option>
        <option value="CY">Cyprus</option>
        <option value="CZ">Czech Republic</option>
        <option value="DK">Denmark</option>
        <option value="DJ">Djibouti</option>
        <option value="DM">Dominica</option>
        <option value="DO">Dominican Republic</option>
        <option value="EC">Ecuador</option>
        <option value="EG">Egypt</option>
        <option value="SV">El Salvador</option>
        <option value="GQ">Equatorial Guinea</option>
        <option value="ER">Eritrea</option>
        <option value="EE">Estonia</option>
        <option value="ET">Ethiopia</option>
        <option value="FK">Falkland Islands (Malvinas)</option>
        <option value="FO">Faroe Islands</option>
        <option value="FJ">Fiji</option>
        <option value="FI">Finland</option>
        <option value="FR">France</option>
        <option value="GF">French Guiana</option>
        <option value="PF">French Polynesia</option>
        <option value="TF">French Southern Territories</option>
        <option value="GA">Gabon</option>
        <option value="GM">Gambia</option>
        <option value="GE">Georgia</option>
        <option value="DE">Germany</option>
        <option value="GH">Ghana</option>
        <option value="GI">Gibraltar</option>
        <option value="GR">Greece</option>
        <option value="GL">Greenland</option>
        <option value="GD">Grenada</option>
        <option value="GP">Guadeloupe</option>
        <option value="GU">Guam</option>
        <option value="GT">Guatemala</option>
        <option value="GG">Guernsey</option>
        <option value="GN">Guinea</option>
        <option value="GW">Guinea-Bissau</option>
        <option value="GY">Guyana</option>
        <option value="HT">Haiti</option>
        <option value="HM">Heard Island and McDonald Islands</option>
        <option value="VA">Holy See (Vatican City State)</option>
        <option value="HN">Honduras</option>
        <option value="HK">Hong Kong</option>
        <option value="HU">Hungary</option>
        <option value="IS">Iceland</option>
        <option value="IN">India</option>
        <option value="ID">Indonesia</option>
        <option value="IR">Iran, Islamic Republic of</option>
        <option value="IQ">Iraq</option>
        <option value="IE">Ireland</option>
        <option value="IM">Isle of Man</option>
        <option value="IL">Israel</option>
        <option value="IT">Italy</option>
        <option value="JM">Jamaica</option>
        <option value="JP">Japan</option>
        <option value="JE">Jersey</option>
        <option value="JO">Jordan</option>
        <option value="KZ">Kazakhstan</option>
        <option value="KE">Kenya</option>
        <option value="KI">Kiribati</option>
        <option value="KP">Korea, Democratic People's Republic of</option>
        <option value="KR">Korea, Republic of</option>
        <option value="KW">Kuwait</option>
        <option value="KG">Kyrgyzstan</option>
        <option value="LA">Lao People's Democratic Republic</option>
        <option value="LV">Latvia</option>
        <option value="LB">Lebanon</option>
        <option value="LS">Lesotho</option>
        <option value="LR">Liberia</option>
        <option value="LY">Libya</option>
        <option value="LI">Liechtenstein</option>
        <option value="LT">Lithuania</option>
        <option value="LU">Luxembourg</option>
        <option value="MO">Macao</option>
        <option value="MK">Macedonia, the former Yugoslav Republic of</option>
        <option value="MG">Madagascar</option>
        <option value="MW">Malawi</option>
        <option value="MY">Malaysia</option>
        <option value="MV">Maldives</option>
        <option value="ML">Mali</option>
        <option value="MT">Malta</option>
        <option value="MH">Marshall Islands</option>
        <option value="MQ">Martinique</option>
        <option value="MR">Mauritania</option>
        <option value="MU">Mauritius</option>
        <option value="YT">Mayotte</option>
        <option value="MX">Mexico</option>
        <option value="FM">Micronesia, Federated States of</option>
        <option value="MD">Moldova, Republic of</option>
        <option value="MC">Monaco</option>
        <option value="MN">Mongolia</option>
        <option value="ME">Montenegro</option>
        <option value="MS">Montserrat</option>
        <option value="MA">Morocco</option>
        <option value="MZ">Mozambique</option>
        <option value="MM">Myanmar</option>
        <option value="NA">Namibia</option>
        <option value="NR">Nauru</option>
        <option value="NP">Nepal</option>
        <option value="NL">Netherlands</option>
        <option value="NC">New Caledonia</option>
        <option value="NZ">New Zealand</option>
        <option value="NI">Nicaragua</option>
        <option value="NE">Niger</option>
        <option value="NG">Nigeria</option>
        <option value="NU">Niue</option>
        <option value="NF">Norfolk Island</option>
        <option value="MP">Northern Mariana Islands</option>
        <option value="NO">Norway</option>
        <option value="OM">Oman</option>
        <option value="PK">Pakistan</option>
        <option value="PW">Palau</option>
        <option value="PS">Palestinian Territory, Occupied</option>
        <option value="PA">Panama</option>
        <option value="PG">Papua New Guinea</option>
        <option value="PY">Paraguay</option>
        <option value="PE">Peru</option>
        <option value="PH">Philippines</option>
        <option value="PN">Pitcairn</option>
        <option value="PL">Poland</option>
        <option value="PT">Portugal</option>
        <option value="PR">Puerto Rico</option>
        <option value="QA">Qatar</option>
        <option value="RE">Réunion</option>
        <option value="RO">Romania</option>
        <option value="RU">Russian Federation</option>
        <option value="RW">Rwanda</option>
        <option value="BL">Saint Barthélemy</option>
        <option value="SH">Saint Helena, Ascension and Tristan da Cunha</option>
        <option value="KN">Saint Kitts and Nevis</option>
        <option value="LC">Saint Lucia</option>
        <option value="MF">Saint Martin (French part)</option>
        <option value="PM">Saint Pierre and Miquelon</option>
        <option value="VC">Saint Vincent and the Grenadines</option>
        <option value="WS">Samoa</option>
        <option value="SM">San Marino</option>
        <option value="ST">Sao Tome and Principe</option>
        <option value="SA">Saudi Arabia</option>
        <option value="SN">Senegal</option>
        <option value="RS">Serbia</option>
        <option value="SC">Seychelles</option>
        <option value="SL">Sierra Leone</option>
        <option value="SG">Singapore</option>
        <option value="SX">Sint Maarten (Dutch part)</option>
        <option value="SK">Slovakia</option>
        <option value="SI">Slovenia</option>
        <option value="SB">Solomon Islands</option>
        <option value="SO">Somalia</option>
        <option value="ZA">South Africa</option>
        <option value="GS">South Georgia and the South Sandwich Islands</option>
        <option value="SS">South Sudan</option>
        <option value="ES">Spain</option>
        <option value="LK">Sri Lanka</option>
        <option value="SD">Sudan</option>
        <option value="SR">Suriname</option>
        <option value="SJ">Svalbard and Jan Mayen</option>
        <option value="SZ">Swaziland</option>
        <option value="SE">Sweden</option>
        <option value="CH">Switzerland</option>
        <option value="SY">Syrian Arab Republic</option>
        <option value="TW">Taiwan, Province of China</option>
        <option value="TJ">Tajikistan</option>
        <option value="TZ">Tanzania, United Republic of</option>
        <option value="TH">Thailand</option>
        <option value="TL">Timor-Leste</option>
        <option value="TG">Togo</option>
        <option value="TK">Tokelau</option>
        <option value="TO">Tonga</option>
        <option value="TT">Trinidad and Tobago</option>
        <option value="TN">Tunisia</option>
        <option value="TR">Turkey</option>
        <option value="TM">Turkmenistan</option>
        <option value="TC">Turks and Caicos Islands</option>
        <option value="TV">Tuvalu</option>
        <option value="UG">Uganda</option>
        <option value="UA">Ukraine</option>
        <option value="AE">United Arab Emirates</option>
        <option value="GB">United Kingdom</option>
        <option value="US">United States</option>
        <option value="UM">United States Minor Outlying Islands</option>
        <option value="UY">Uruguay</option>
        <option value="UZ">Uzbekistan</option>
        <option value="VU">Vanuatu</option>
        <option value="VE">Venezuela, Bolivarian Republic of</option>
        <option value="VN">Viet Nam</option>
        <option value="VG">Virgin Islands, British</option>
        <option value="VI">Virgin Islands, U.S.</option>
        <option value="WF">Wallis and Futuna</option>
        <option value="EH">Western Sahara</option>
        <option value="YE">Yemen</option>
        <option value="ZM">Zambia</option>
        <option value="ZW">Zimbabwe</option>
      </select> <input type="hidden" name="countryname" id="countryname"> </div>
    <div class="form-group"><input type="text" placeholder="Address line 1" name="address_line1" id="address_line1"></div>
    <div class="form-group"><input type="text" placeholder="Address line 2" name="address_line2" id="address_line2"></div>
    <div id="locality-fields">
      <div class="form-group"> <label for="city">City</label> <input type="text" id="city" name="city" placeholder="City"> </div>
      <div class="form-group"> <label for="state">State or Province</label> <input type="text" id="state" name="state" placeholder="State"> </div>
      <div class="form-group"> <input type="text" id="zip" name="zip" placeholder="Zip"> </div>
    </div>
    <p> </p>
    <div class="need-card shipping"> Free Fast shipping <br>both ways </div><a class="btn btn-primary next">Submit</a>
    <p></p>
  </fieldset>
  <fieldset id="info3" class="">
    <h3 class="text-right"></h3>
    <h2>Final Step</h2>
    <div class="form-group"><input type="text" placeholder="Organization Name" name="organization"></div>
    <div class="form-group"> <input type="text" placeholder="Projected Annual Order Quantity" name="quantity"></div>
    <div class="form-group"> <input style="width:unset;height:unset;" type="checkbox" name="request" value="Yes" class="tr1"> <span class="ttr">Request for Quote </span> </div>
    <div class="clear"></div>
    <div class="form-group"><input style="width:unset;height:unset" type="checkbox" name="agree" value="Yes" class="tr1"> <span class="ttr">I agree to return this evaluation unit <br> in "like new" condition within 60 days of receipt. </span></div>
    <div class="clear"></div>
    <div class="done-box">
      <div class="need-card sendMail"> Send My Eval!</div> <input type="submit" class="btn btn-primary done" name="submit" value="Done">
    </div>
  </fieldset>
  <fieldset id="thankyou">
    <h3>Thank You</h3>
    <h4> Eval Request</h4>
    <p class="sh-text">Ship to:</p>
    <p class="shipto"></p>
    <p class="text-center success_close">Success</p>
  </fieldset>
</form>

Text Content

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MEDICAL COMPUTERS

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MEDICAL TABLETS

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MEDICAL COMPUTERS

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SHIPPING ADDRESS

Afghanistan Åland Islands Albania Algeria American Samoa Andorra Angola Anguilla
Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria
Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin
Bermuda Bhutan Bolivia, Plurinational State of Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean
Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon
Canada Cape Verde Cayman Islands Central African Republic Chad Chile China
Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, the
Democratic Republic of the Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba
Curaçao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic
Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland
Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French
Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana
Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea
Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See (Vatican
City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran, Islamic
Republic of Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan
Kazakhstan Kenya Kiribati Korea, Democratic People's Republic of Korea, Republic
of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho
Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia, the former
Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall
Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated
States of Moldova, Republic of Monaco Mongolia Montenegro Montserrat Morocco
Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand
Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman
Pakistan Palau Palestinian Territory, Occupied Panama Papua New Guinea Paraguay
Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Réunion Romania
Russian Federation Rwanda Saint Barthélemy Saint Helena, Ascension and Tristan
da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint
Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome
and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint
Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa
South Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka Sudan
Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab
Republic Taiwan, Province of China Tajikistan Tanzania, United Republic of
Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey
Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates
United Kingdom United States United States Minor Outlying Islands Uruguay
Uzbekistan Vanuatu Venezuela, Bolivarian Republic of Viet Nam Virgin Islands,
British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia
Zimbabwe


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FINAL STEP



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