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35.201.118.58  Public Scan

Form analysis
1 forms found in the DOM

Name: form_221859259806872 — POST https://submit.jotform.com/submit/221859259806872

<form class="jotform-form" onsubmit="return typeof testSubmitFunction !== 'undefined' &amp;&amp; testSubmitFunction();" action="https://submit.jotform.com/submit/221859259806872" method="post" enctype="multipart/form-data" name="form_221859259806872"
  id="221859259806872" accept-charset="utf-8" autocomplete="on" novalidate="true"><input type="hidden" name="formID" value="221859259806872"><input type="hidden" id="JWTContainer" value=""><input type="hidden" id="cardinalOrderNumber" value=""><input
    type="hidden" id="jsExecutionTracker" name="jsExecutionTracker" value="build-date-1721783615828=>init-started:1722039025588=>validator-called:1722039025678=>validator-mounted-true:1722039025679=>init-complete:1722039025683"><input type="hidden"
    id="submitSource" name="submitSource" value="mounted"><input type="hidden" id="buildDate" name="buildDate" value="1721783615828">
  <div id="formCoverLogo" style="margin-bottom:10px" class="form-cover-wrapper form-has-cover form-page-cover-image-align-left">
    <div class="form-page-cover-image-wrapper" style="max-width:752px"><img src="https://www.jotform.com/uploads/jrchs/form_files/logo black.61e83a9d45f6e7.70366542.png" class="form-page-cover-image" width="140" height="28" aria-label="Form Logo"
        style="aspect-ratio:140/28"></div>
  </div>
  <div role="main" class="form-all">
    <ul class="form-section page-section">
      <li class="form-line jf-required" data-type="control_fullname" id="id_3" data-css-selector="id_3"><label class="form-label form-label-top form-label-auto" id="label_3" for="first_3" aria-hidden="false"> Contacto<span
            class="form-required">*</span> </label>
        <div id="cid_3" class="form-input-wide jf-required" data-layout="full">
          <div data-wrapper-react="true"><span class="form-sub-label-container" style="vertical-align:top" data-input-type="first"><input type="text" id="first_3" name="q3_contacto[first]" class="form-textbox validate[required]" data-defaultvalue=""
                autocomplete="section-input_3 given-name" size="10" data-component="first" aria-labelledby="label_3 sublabel_3_first" required="" value=""><label class="form-sub-label" for="first_3" id="sublabel_3_first"
                style="min-height:13px">Nombre</label></span><span class="form-sub-label-container" style="vertical-align:top" data-input-type="last"><input type="text" id="last_3" name="q3_contacto[last]" class="form-textbox validate[required]"
                data-defaultvalue="" autocomplete="section-input_3 family-name" size="15" data-component="last" aria-labelledby="label_3 sublabel_3_last" required="" value=""><label class="form-sub-label" for="last_3" id="sublabel_3_last"
                style="min-height:13px">Apellido</label></span></div>
        </div>
      </li>
      <li class="form-line" data-type="control_textbox" id="id_28" data-css-selector="id_28"><label class="form-label form-label-top form-label-auto" id="label_28" for="input_28" aria-hidden="false"> Nombre de la Empresa </label>
        <div id="cid_28" class="form-input-wide" data-layout="half"> <input type="text" id="input_28" name="q28_nombreDe" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:310px" size="310" data-component="textbox"
            aria-labelledby="label_28" value=""> </div>
      </li>
      <li class="form-line jf-required" data-type="control_email" id="id_30" data-css-selector="id_30"><label class="form-label form-label-top form-label-auto" id="label_30" for="input_30" aria-hidden="false"> Email<span
            class="form-required">*</span> </label>
        <div id="cid_30" class="form-input-wide jf-required" data-layout="half"> <span class="form-sub-label-container" style="vertical-align:top"><input type="email" id="input_30" name="q30_email" class="form-textbox validate[required, Email]"
              data-defaultvalue="" autocomplete="section-input_30 email" style="width:310px" size="310" data-component="email" aria-labelledby="label_30 sublabel_input_30" required="" value=""><label class="form-sub-label" for="input_30"
              id="sublabel_input_30" style="min-height:13px">ejemplo@ejemplo.com</label></span> </div>
      </li>
      <li class="form-line jf-required" data-type="control_address" id="id_4" data-css-selector="id_4"><label class="form-label form-label-top form-label-auto" id="label_4" for="input_4_addr_line1" aria-hidden="false"> Dirección de envío<span
            class="form-required">*</span> </label>
        <div id="cid_4" class="form-input-wide jf-required" data-layout="full">
          <div summary="" class="form-address-table jsTest-addressField">
            <div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-street-line jsTest-address-lineField"><span class="form-sub-label-container" style="vertical-align:top"><input type="text"
                    id="input_4_addr_line1" name="q4_direccionDe4[addr_line1]" class="form-textbox validate[required] form-address-line" data-defaultvalue="" autocomplete="section-input_4 address-line1" data-component="address_line_1"
                    aria-labelledby="label_4 sublabel_4_addr_line1" required="" value="" maxlength="100"><label class="form-sub-label" for="input_4_addr_line1" id="sublabel_4_addr_line1" style="min-height:13px">Dirección exacta para poder enviar el
                    producto</label></span></span></div>
            <div class="form-address-line-wrapper jsTest-address-line-wrapperField" style="display:none"><span class="form-address-line form-address-street-line jsTest-address-lineField"><span class="form-sub-label-container"
                  style="vertical-align:top"><input type="text" id="input_4_addr_line2" name="q4_direccionDe4[addr_line2]" class="form-textbox form-address-line" data-defaultvalue="" autocomplete="section-input_4 off" data-component="address_line_2"
                    aria-labelledby="label_4 sublabel_4_addr_line2" value="" maxlength="100"><label class="form-sub-label" for="input_4_addr_line2" id="sublabel_4_addr_line2" style="min-height:13px">Street Address Line 2</label></span></span></div>
            <div class="form-address-line-wrapper jsTest-address-line-wrapperField" style="display:none"><span class="form-address-line form-address-city-line jsTest-address-lineField form-address-hiddenLine" style="display:none"><span
                  class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_4_city" name="q4_direccionDe4[city]" class="form-textbox form-address-city" data-defaultvalue="" autocomplete="section-input_4 off"
                    data-component="city" aria-labelledby="label_4 sublabel_4_city" value="" maxlength="60"><label class="form-sub-label" for="input_4_city" id="sublabel_4_city" style="min-height:13px">City</label></span></span><span
                class="form-address-line form-address-state-line jsTest-address-lineField form-address-hiddenLine" style="display:none"><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_4_state"
                    name="q4_direccionDe4[state]" class="form-textbox form-address-state" data-defaultvalue="" autocomplete="section-input_4 off" data-component="state" aria-labelledby="label_4 sublabel_4_state" value="" maxlength="60"><label
                    class="form-sub-label" for="input_4_state" id="sublabel_4_state" style="min-height:13px">State / Province</label></span></span></div>
            <div class="form-address-line-wrapper jsTest-address-line-wrapperField" style="display:none"><span class="form-address-line form-address-zip-line jsTest-address-lineField form-address-hiddenLine" style="display:none"><span
                  class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_4_postal" name="q4_direccionDe4[postal]" class="form-textbox form-address-postal" data-defaultvalue="" autocomplete="section-input_4 off"
                    data-component="zip" aria-labelledby="label_4 sublabel_4_postal" value="" maxlength="20"><label class="form-sub-label" for="input_4_postal" id="sublabel_4_postal" style="min-height:13px">Postal / Zip Code</label></span></span>
            </div>
          </div>
        </div>
      </li>
      <li class="form-line form-line-column form-col-1 jf-required" data-type="control_phone" id="id_5" data-css-selector="id_5"><label class="form-label form-label-top" id="label_5" for="input_5_full"> Teléfono<span class="form-required">*</span>
        </label>
        <div id="cid_5" class="form-input-wide jf-required" data-layout="half"> <span class="form-sub-label-container" style="vertical-align:top"><input type="tel" id="input_5_full" name="q5_telefono5[full]" data-type="mask-number"
              class="mask-phone-number form-textbox validate[required, Fill Mask]" data-defaultvalue="" autocomplete="section-input_5 tel-local" style="width:310px" data-masked="true" placeholder="0000-0000" data-component="phone"
              aria-labelledby="label_5" required="" value="" inputmode="text" maskvalue="####-####"></span> </div>
      </li>
      <li class="form-line form-line-column form-col-2 jf-required" data-type="control_datetime" id="id_15" data-css-selector="id_15"><label class="form-label form-label-top" id="label_15" for="lite_mode_15" aria-hidden="false"> Fecha de compra del
          producto <span class="form-required">*</span> </label>
        <div id="cid_15" class="form-input-wide jf-required" data-layout="half">
          <div data-wrapper-react="true">
            <div style="display:none"><span class="form-sub-label-container" style="vertical-align:top"><input type="tel" class="form-textbox validate[required, limitDate]" id="day_15" name="q15_fechaDe[day]" size="2" data-maxlength="2" data-age=""
                  maxlength="2" value="" required="" autocomplete="off" aria-labelledby="label_15 sublabel_15_day" inputmode="numeric"><span class="date-separate" aria-hidden="true">&nbsp;-</span><label class="form-sub-label" for="day_15"
                  id="sublabel_15_day" style="min-height:13px">Día</label></span><span class="form-sub-label-container" style="vertical-align:top"><input type="tel" class="form-textbox validate[required, limitDate]" id="month_15"
                  name="q15_fechaDe[month]" size="2" data-maxlength="2" data-age="" maxlength="2" value="" required="" autocomplete="off" aria-labelledby="label_15 sublabel_15_month" inputmode="numeric"><span class="date-separate"
                  aria-hidden="true">&nbsp;-</span><label class="form-sub-label" for="month_15" id="sublabel_15_month" style="min-height:13px">Mes</label></span><span class="form-sub-label-container" style="vertical-align:top"><input type="tel"
                  class="form-textbox validate[required, limitDate]" id="year_15" name="q15_fechaDe[year]" size="4" data-maxlength="4" data-age="" maxlength="4" value="" required="" autocomplete="off"
                  aria-labelledby="label_15 sublabel_15_year"><label class="form-sub-label" for="year_15" id="sublabel_15_year" style="min-height:13px">Año</label></span></div><span class="form-sub-label-container" style="vertical-align:top"><input
                type="text" class="form-textbox validate[required, limitDate, validateLiteDate]" id="lite_mode_15" size="12" data-maxlength="12" data-age="" value="" required="" data-format="ddmmyyyy" data-seperator="-" placeholder="DD-MM-YYYY"
                data-placeholder="DD-MM-YYYY" autocomplete="off" aria-labelledby="label_15" inputmode="numeric"><img class=" newDefaultTheme-dateIcon icon-liteMode" alt="Pick a Date" id="input_15_pick" src="https://cdn.jotfor.ms/images/calendar.png"
                data-component="datetime" aria-hidden="false" data-allow-time="No" data-version="v2" aria-label="Choose Date" role="button" tabindex="0" aria-haspopup="dialog" aria-expanded="false"><label class="form-sub-label is-empty"
                for="lite_mode_15" id="sublabel_15_litemode" style="min-height:13px"></label></span>
          </div>
        </div>
      </li>
      <li class="form-line form-line-column form-col-3 jf-required" data-type="control_dropdown" id="id_8" data-css-selector="id_8"><label class="form-label form-label-top" id="label_8" for="input_8" aria-hidden="false"> ¿En dónde adquiriste el
          producto?<span class="form-required">*</span> </label>
        <div id="cid_8" class="form-input-wide jf-required" data-layout="half"> <select class="form-dropdown validate[required]" id="input_8" name="q8_enDonde8" style="width:310px" data-component="dropdown" required=""
            aria-label="¿En dónde adquiriste el producto?">
            <option value="">Please Select</option>
            <option value="Página web">Página web</option>
            <option value="WhatsApp">WhatsApp</option>
            <option value="Correo Electrónico">Correo Electrónico</option>
            <option value="Llamada">Llamada</option>
            <option value="ShowRoom">ShowRoom</option>
          </select> </div>
      </li>
      <li class="form-line form-line-column form-col-4 jf-required" data-type="control_dropdown" id="id_18" data-css-selector="id_18"><label class="form-label form-label-top" id="label_18" for="input_18" aria-hidden="false"> ¿Cómo te enviamos el
          producto?<span class="form-required">*</span> </label>
        <div id="cid_18" class="form-input-wide jf-required" data-layout="half"> <select class="form-dropdown validate[required]" id="input_18" name="q18_comoTe18" style="width:310px" data-component="dropdown" required=""
            aria-label="¿Cómo te enviamos el producto?">
            <option value="">Please Select</option>
            <option value="Mensajero">Mensajero</option>
            <option value="Forza">Forza</option>
            <option value="Cargo Expreso">Cargo Expreso</option>
            <option value="Guatex">Guatex</option>
            <option value=""></option>
          </select> </div>
      </li>
      <li class="form-line form-line-column form-col-5" data-type="control_datetime" id="id_19" data-css-selector="id_19"><label class="form-label form-label-top" id="label_19" for="lite_mode_19" aria-hidden="false"> Fecha de recepción del producto
        </label>
        <div id="cid_19" class="form-input-wide" data-layout="half">
          <div data-wrapper-react="true">
            <div style="display:none"><span class="form-sub-label-container" style="vertical-align:top"><input type="tel" class="form-textbox validate[limitDate]" id="day_19" name="q19_fechaDe19[day]" size="2" data-maxlength="2" data-age=""
                  maxlength="2" value="" autocomplete="off" aria-labelledby="label_19 sublabel_19_day" inputmode="numeric"><span class="date-separate" aria-hidden="true">&nbsp;-</span><label class="form-sub-label" for="day_19" id="sublabel_19_day"
                  style="min-height:13px">Día</label></span><span class="form-sub-label-container" style="vertical-align:top"><input type="tel" class="form-textbox validate[limitDate]" id="month_19" name="q19_fechaDe19[month]" size="2"
                  data-maxlength="2" data-age="" maxlength="2" value="" autocomplete="off" aria-labelledby="label_19 sublabel_19_month" inputmode="numeric"><span class="date-separate" aria-hidden="true">&nbsp;-</span><label class="form-sub-label"
                  for="month_19" id="sublabel_19_month" style="min-height:13px">Mes</label></span><span class="form-sub-label-container" style="vertical-align:top"><input type="tel" class="form-textbox validate[limitDate]" id="year_19"
                  name="q19_fechaDe19[year]" size="4" data-maxlength="4" data-age="" maxlength="4" value="" autocomplete="off" aria-labelledby="label_19 sublabel_19_year"><label class="form-sub-label" for="year_19" id="sublabel_19_year"
                  style="min-height:13px">Año</label></span></div><span class="form-sub-label-container" style="vertical-align:top"><input type="text" class="form-textbox validate[limitDate, validateLiteDate]" id="lite_mode_19" size="12"
                data-maxlength="12" data-age="" value="" data-format="ddmmyyyy" data-seperator="-" placeholder="DD-MM-YYYY" data-placeholder="DD-MM-YYYY" autocomplete="off" aria-labelledby="label_19 sublabel_19_litemode" inputmode="numeric"><img
                class=" newDefaultTheme-dateIcon icon-liteMode" alt="Pick a Date" id="input_19_pick" src="https://cdn.jotfor.ms/images/calendar.png" data-component="datetime" aria-hidden="false" data-allow-time="No" data-version="v2"
                aria-label="Choose Date" role="button" tabindex="0" aria-haspopup="dialog" aria-expanded="false"><label class="form-sub-label" for="lite_mode_19" id="sublabel_19_litemode" style="min-height:13px">*Aplica para envíos de Forza, Cargo
                Expreso y Guatex</label></span>
          </div>
        </div>
      </li>
      <li class="form-line form-line-column form-col-6 jf-required" data-type="control_dropdown" id="id_16" data-css-selector="id_16"><label class="form-label form-label-top" id="label_16" for="input_16" aria-hidden="false"> Tipo de producto<span
            class="form-required">*</span> </label>
        <div id="cid_16" class="form-input-wide jf-required" data-layout="half"> <select class="form-dropdown validate[required]" id="input_16" name="q16_tipoDe16" style="width:310px" data-component="dropdown" required=""
            aria-label="Tipo de producto">
            <option value="">Please Select</option>
            <option value="Estuches">Estuches</option>
            <option value="Cables">Cables</option>
            <option value="Audifonos">Audifonos</option>
            <option value="Magnéticos">Magnéticos</option>
            <option value="Batería portable">Batería portable</option>
            <option value="Cargador de carro">Cargador de carro</option>
            <option value="Cargador de pared">Cargador de pared</option>
            <option value="Protector de pantallas">Protector de pantallas</option>
            <option value="Reparación ">Reparación </option>
            <option value="Otro">Otro</option>
          </select> </div>
      </li>
      <li class="form-line form-line-column form-col-7" data-type="control_textbox" id="id_17" data-css-selector="id_17"><label class="form-label form-label-top" id="label_17" for="input_17" aria-hidden="false"> Número de pedido / factura </label>
        <div id="cid_17" class="form-input-wide" data-layout="half"> <span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_17" name="q17_numeroDe" data-type="input-textbox" class="form-textbox"
              data-defaultvalue="" style="width:310px" size="310" data-component="textbox" aria-labelledby="label_17 sublabel_input_17" value=""><label class="form-sub-label" for="input_17" id="sublabel_input_17" style="min-height:13px">Si realizaste
              la compra en nuestra página web debes de ingresar el numero del pedido o numero de factura.</label></span> </div>
      </li>
      <li class="form-line jf-required" data-type="control_textarea" id="id_12" data-css-selector="id_12"><label class="form-label form-label-top form-label-auto" id="label_12" for="input_12" aria-hidden="false"> Comentarios del problema<span
            class="form-required">*</span> </label>
        <div id="cid_12" class="form-input-wide jf-required" data-layout="full"> <textarea id="input_12" class="form-textarea validate[required] custom-hint-group form-custom-hint" name="q12_comentariosDel" style="width:648px;height:163px"
            data-component="textarea" required="" aria-labelledby="label_12" data-customhint="Escriba aquí..." customhinted="true" placeholder="Escriba aquí..." spellcheck="false"></textarea> </div>
      </li>
      <li class="form-line" data-type="control_text" id="id_25" data-css-selector="id_25">
        <div id="cid_25" class="form-input-wide" data-layout="full">
          <div id="text_25" class="form-html" data-component="text" tabindex="0">
            <p>Se tiene que adjuntar las fotografías para que el proceso pueda ser más rápido en la revisión.</p>
          </div>
        </div>
      </li>
      <li class="form-line jf-required" data-type="control_fileupload" id="id_29" data-css-selector="id_29"><label class="form-label form-label-top form-label-auto" id="label_29" for="input_29" aria-hidden="false"> Carga de Archivo<span
            class="form-required">*</span> </label>
        <div id="cid_29" class="form-input-wide jf-required" data-layout="full">
          <div class="jfQuestion-fields" data-wrapper-react="true">
            <div class="jfField isFilled">
              <div class="jfUpload-wrapper">
                <div class="jfUpload-container">
                  <div class="jfUpload-button-container">
                    <div class="jfUpload-button" aria-hidden="true" tabindex="0" style="display:none" data-version="v2">Buscar archivos<div class="jfUpload-heading forDesktop">Drag and drop files here</div>
                      <div class="jfUpload-heading forMobile">Choose a file</div>
                    </div>
                  </div>
                </div>
                <div class="jfUpload-files-container">
                  <div class="validate[multipleUpload] validate[required]">
                    <div class="qq-uploader">
                      <div class="qq-upload-drop-area" style="display: none;"><span>Drop files here to upload</span></div>
                      <div class="qq-upload-button " aria-hidden="true" style="position: relative; overflow: hidden; direction: ltr;">Buscar archivos<div class="jfUpload-heading forDesktop">Drag and drop files here</div>
                        <div class="jfUpload-heading forMobile">Choose a file</div>
                      </div>
                      <div class="inputContainer" role="button" aria-label="Buscar archivos
Drag and drop files here" tabindex="0"><input multiple="multiple" class="fileupload-input" id="input_29" type="file" name="file" aria-labelledby="label_29" aria-hidden="true" tabindex="-1"></div><label class="form-sub-label" aria-hidden="true"
                        for="input_29" id="sublabel_29"></label><span style="display:none" class="multipleFileUploadLabels cancelText">Cancel</span><span style="display:none" class="multipleFileUploadLabels ofText">of</span>
                      <ul class="qq-upload-list" aria-label="Uploaded files"></ul>
                    </div>
                  </div>
                </div>
              </div><span class="form-sub-label-container" style="vertical-align:top"><label class="form-sub-label" for="input_29" id="sublabel_input_29" style="min-height:13px">Se pueden adjuntar varias fotografías o documentos.</label></span>
            </div><span style="display:none" class="cancelText">Cancel</span><span style="display:none" class="ofText">of</span>
          </div>
        </div>
      </li>
      <li class="form-line" data-type="control_button" id="id_2" data-css-selector="id_2">
        <div id="cid_2" class="form-input-wide" data-layout="full">
          <div data-align="center" class="form-buttons-wrapper form-buttons-center   jsTest-button-wrapperField"><button id="input_2" type="submit"
              class="form-submit-button form-submit-button-black_blue submit-button jf-form-buttons jsTest-submitField" data-component="button" data-content="" aria-live="polite">ENVIAR</button></div>
        </div>
      </li>
      <li style="clear:both"></li>
      <li style="display:none">Should be Empty: <input type="text" name="website" value=""></li>
    </ul>
  </div>
  <script>
    JotForm.showJotFormPowered = "0";
  </script>
  <script>
    JotForm.poweredByText = "Powered by Jotform";
  </script><input type="hidden" class="simple_spc" id="simple_spc" name="simple_spc" value="221859259806872-221859259806872">
  <script type="text/javascript">
    var all_spc = document.querySelectorAll("form[id='221859259806872'] .si" + "mple" + "_spc");
    for (var i = 0; i < all_spc.length; i++) {
      all_spc[i].value = "221859259806872-221859259806872";
    }
  </script><input type="hidden" id="input_31" name="q31_orden" class="form-textbox form-hidden" data-defaultvalue="GM-6" data-component="autoincrement" aria-labelledby="label_31" value="GM-6">
  <input type="hidden" name="event_id" value="1722039025588_221859259806872_HRMnKzx"><input type="hidden" name="timeToSubmit" value="3"><input type="hidden" name="temp_upload_folder" value="221859259806872_66a43af15b730">
</form>

Text Content

 * Contacto*
   NombreApellido
 * Nombre de la Empresa
   
 * Email*
   ejemplo@ejemplo.com
 * Dirección de envío*
   Dirección exacta para poder enviar el producto
   Street Address Line 2
   CityState / Province
   Postal / Zip Code
 * Teléfono*
   
 * Fecha de compra del producto *
    -Día -MesAño
 * ¿En dónde adquiriste el producto?*
   Please Select Página web WhatsApp Correo Electrónico Llamada ShowRoom
 * ¿Cómo te enviamos el producto?*
   Please Select Mensajero Forza Cargo Expreso Guatex
 * Fecha de recepción del producto
    -Día -MesAño
   *Aplica para envíos de Forza, Cargo Expreso y Guatex
 * Tipo de producto*
   Please Select Estuches Cables Audifonos Magnéticos Batería portable Cargador
   de carro Cargador de pared Protector de pantallas Reparación Otro
 * Número de pedido / factura
   Si realizaste la compra en nuestra página web debes de ingresar el numero del
   pedido o numero de factura.
 * Comentarios del problema*
   

 * Se tiene que adjuntar las fotografías para que el proceso pueda ser más
   rápido en la revisión.

 * Carga de Archivo*
   Buscar archivos
   Drag and drop files here
   Choose a file
   Drop files here to upload
   Buscar archivos
   Drag and drop files here
   Choose a file
   
   Cancelof
   Se pueden adjuntar varias fotografías o documentos.
   Cancelof
 * ENVIAR
 * 
 * Should be Empty:

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