info.mijn-offertes.be Open in urlscan Pro
3.126.202.50  Public Scan

Submitted URL: https://naturecloths.com/trk/click.php?lg=mte5ntKWlujfoZS1nJiTmtyXms0XnJeXoZSXmZu0odS7mJmXmJe7o2G7oZS7AM9IC09MzMvYmJaYmq==
Effective URL: https://info.mijn-offertes.be/waterverzachter-offertes/?aff=110067&pixel_id=531&utm_source=1356&click_id=1027ea2defc6ef7389d89...
Submission: On April 11 via api from BE — Scanned from DE

Form analysis 1 forms found in the DOM

POST /fsg?pageId=9a6fabb3-2a46-46d4-b7d3-20b653a068bf&variant=d

<form action="/fsg?pageId=9a6fabb3-2a46-46d4-b7d3-20b653a068bf&amp;variant=d" method="POST"><input type="hidden" name="pageId" value="9a6fabb3-2a46-46d4-b7d3-20b653a068bf"><input type="hidden" name="pageVariant" value="d">
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      <div class="ub-input-item input-wrap optionsList" id="group_XML_remarks">
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              installeren</span></label></div>
        <div class="option" id="ub-option-XML_remarks-item-1"><input type="radio" id="XML_remarks_bestaande_waterverzachter_vervangen" name="XML_remarks" value="Bestaande waterverzachter vervangen"
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              vervangen</span></label></div>
      </div>
    </div>
    <div class="lp-pom-form-field single-line-text hide" id="container_firstName" style="top: 0px;"><label class="main lp-form-label" for="firstName" id="label_firstName" style="height: auto;"><span
          class="label-style">Voornaam&nbsp;*</span></label><input id="firstName" name="firstName" type="text" class="ub-input-item single text form_elem_firstName" placeholder="Voornaam" required=""></div>
    <div class="lp-pom-form-field single-line-text hide" id="container_lastName" style="top: 0px;"><label class="main lp-form-label" for="lastName" id="label_lastName" style="height: auto;"><span
          class="label-style">Achternaam&nbsp;*</span></label><input id="lastName" name="lastName" type="text" class="ub-input-item single text form_elem_lastName" placeholder="Achternaam" required=""></div>
    <div class="lp-pom-form-field single-line-text hide" id="container_address1" style="top: 0px;"><label class="main lp-form-label" for="address1" id="label_address1" style="height: auto;"><span class="label-style">Adres&nbsp;*</span></label><input
        id="address1" name="address1" type="text" class="ub-input-item single text form_elem_address1" placeholder="Straat + huisnummer" required=""></div>
    <div class="lp-pom-form-field single-line-text hide" id="container_XML_postcode" style="top: 0px;"><label class="main lp-form-label" for="XML_postcode" id="label_XML_postcode" style="height: auto;"><span
          class="label-style">Postcode&nbsp;*</span></label><input id="XML_postcode" name="XML_postcode" type="text" class="ub-input-item single text form_elem_XML_postcode" placeholder="Postcode" required=""></div>
    <div class="lp-pom-form-field single-line-text hide" id="container_XML_email" style="top: 0px;"><label class="main lp-form-label" for="XML_email" id="label_XML_email" style="height: auto;"><span
          class="label-style">E-mail&nbsp;*</span></label><input id="XML_email" name="XML_email" type="text" class="ub-input-item single text form_elem_XML_email" placeholder="E-mail" required=""></div>
    <div class="lp-pom-form-field single-line-text hide" id="container_XML_telephone" style="top: 0px;"><label class="main lp-form-label" for="XML_telephone" id="label_XML_telephone" style="height: auto;"><span
          class="label-style">Telefoonnummer&nbsp;*</span></label><input id="XML_telephone" name="XML_telephone" type="tel" class="ub-input-item single text form_elem_XML_telephone" placeholder="Telefoonnummer" required=""
        pattern="^\+?( ?\(?-?\d\)?){6,13}$"></div>
    <div class="lp-pom-form-field checkbox-group multi-group hide" id="container_terms" style="top: 0px;"><label class="main lp-form-label" for="terms" id="label_terms" style="height: auto;"><span class="label-style">Bevestiging&nbsp;*</span></label>
      <div class="ub-input-item input-wrap optionsList" id="group_terms">
        <div class="option" id="ub-option-terms-item-0"><input type="checkbox" id="terms_ja_ik_wens_gratis_offertes_te_vergelijken" name="terms" value="Ja, ik wens gratis offertes te vergelijken."
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              te vergelijken.</span></label></div>
      </div>
    </div>
    <div class="lp-pom-form-field checkbox-group multi-group hide" id="container_optin" style="top: 0px;"><label class="main lp-form-label" for="optin" id="label_optin" style="height: auto;"><span class="label-style">Inschrijven op de nieuwsbrief?
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      <div class="ub-input-item input-wrap optionsList" id="group_optin">
        <div class="option" id="ub-option-optin-item-0"><input type="checkbox" id="optin_ja_ik_wens_de_nieuwsbrief_te_ontvangen" name="optin" value="Ja, ik wens de nieuwsbrief te ontvangen"
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              ontvangen</span></label></div>
      </div>
    </div><input id="aff" name="aff" type="hidden" class="hidden" value="110067"><input id="utm_source" name="utm_source" type="hidden" class="hidden" value="1356"><input id="utm_medium" name="utm_medium" type="hidden" class="hidden" value=""><input
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      name="rem_id" type="hidden" class="hidden" value="20220411003555978"><input id="bobx" name="bobx" type="hidden" class="hidden" value=""><input id="XML_extra_check" name="XML_extra_check" type="hidden" class="hidden" value=""><input
      id="XML_extra_radio3" name="XML_extra_radio3" type="hidden" class="hidden" value=""><input id="XML_extra_radio4" name="XML_extra_radio4" type="hidden" class="hidden" value="4">
  </div><button class="lp-element lp-pom-button hide" id="lp-pom-button-44" type="submit"><span class="label"><strong>Verzenden</strong></span></button>
  <input type="hidden" name="ubafs-jev" id="ubafs-jev"
    value="{&quot;date&quot;:&quot;2022-04-11T00:35:55.966Z&quot;,&quot;agent&quot;:&quot;Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/100.0.4896.75 Safari/537.36&quot;,&quot;screen&quot;:{&quot;availWidth&quot;:1600,&quot;availHeight&quot;:1200,&quot;width&quot;:1600,&quot;height&quot;:1200},&quot;window&quot;:{&quot;innerWidth&quot;:1600,&quot;innerHeight&quot;:1200},&quot;hasPlugins&quot;:true}">
</form>

Text Content

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Waar wenst u meer info over? *
Nieuwe waterverzachter installeren
Bestaande waterverzachter vervangen
Voornaam *
Achternaam *
Adres *
Postcode *
E-mail *
Telefoonnummer *
Bevestiging *
Ja, ik wens gratis offertes te vergelijken.
Inschrijven op de nieuwsbrief? (niet verplicht)
Ja, ik wens de nieuwsbrief te ontvangen
Verzenden
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