103.53.40.4 Open in urlscan Pro
103.53.40.4  Public Scan

Form analysis
1 forms found in the DOM

Name: app_form — POST add_axis_bank

<form id="app_form" name="app_form" action="add_axis_bank" method="POST" class="form form-horizontal" enctype="multipart/form-data" autocomplete="off" novalidate="novalidate">
  <input type="hidden" name="app_id" class="app_id" value="SA2400010">
  <input type="hidden" readonly="" name="user_id" class="user_id" value="">
  <input type="hidden" readonly="" name="id" class="id" value="">
  <div class="div2 " style="padding: 5px;background:#fff;margin:10px 5px 5px 5px;">
    <div class="text-center" style="margin-top: 20px;font-weight: 100;font-size: 30px;">
      <strong>Apply Now</strong>
    </div>
    <div class="" style="margin:20px 20px;">
      <div class="net_banking_div ">
        <div class="col-md-12 mt-2">
          <div class="row required" aria-required="true">
            <b for="name" class="col-md-5 col-form-label">Name</b>
            <div class="col-md-7">
              <input type="text" id="name" class="form-control allow_name" required="" name="name" value="" aria-required="true">
            </div>
          </div>
        </div>
        <div class="col-md-12 mt-2">
          <div class="row required" aria-required="true">
            <b for="email" class="col-md-5 col-form-label">Email</b>
            <div class="col-md-7">
              <input type="email" id="email" class="form-control" required="" name="email" placeholder="Email" aria-required="true">
            </div>
          </div>
        </div>
        <div class="col-md-12 mt-2">
          <div class="row required" aria-required="true">
            <b for="mobile_no" class="col-md-5 col-form-label">Mobile No.</b>
            <div class="col-md-7">
              <input type="text" required="" class="form-control allow_number" maxlength="10" onkeypress="if(this.value.length==10) return false;" onchange="validatePhone('mobile_no')" placeholder="Mobile No" name="mobile_no" id="mobile_no" value=""
                aria-required="true">
            </div>
          </div>
        </div>
        <div class="col-md-12 mt-2 hidden">
          <div class="row required" aria-required="true">
            <b for="name" class="col-md-5 col-form-label">Date of Birth</b>
            <div class="col-md-7">
              <input type="text" id="dob" class="form-control" name="dob">
            </div>
          </div>
        </div>
        <div class="col-md-12 mt-2 hidden">
          <div class="row required" aria-required="true">
            <b for="name" class="col-md-5 col-form-label">City</b>
            <div class="col-md-7">
              <input type="text" id="city" required="" class="form-control" name="city" aria-required="true">
            </div>
          </div>
        </div>
        <div class="col-md-12 mt-2">
          <div class="row required" aria-required="true">
            <b for="credit_limit" class="col-md-5 col-form-label">Card Limit</b>
            <div class="col-md-7">
              <input type="text" id="credit_limit" class="form-control " required="" name="credit_limit" aria-required="true">
            </div>
          </div>
        </div>
        <div style="margin-top: 10px;">
          <button type="submit" class="btn btn-know div_btn btn-block" style="width:100%">Proceed</button>
        </div>
      </div>
    </div>
  </div>
</form>

Text Content

Apply Now
Name

Email

Mobile No.

Date of Birth

City

Card Limit

Proceed


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