bldngrlvbrckbybrck.com Open in urlscan Pro
207.120.33.5  Public Scan

Form analysis
1 forms found in the DOM

POST

<form role="form" class="mainForm" method="POST" action="">
  <input type="hidden" name="SID" value="4ee9cf489d9e81796d49856d8a75eaa3">
  <input type="hidden" id="step" name="step" value="j1">
  <input type="hidden" id="ip" name="ip" value="149.56.153.188">
  <div class="alert alert-danger error-message" style="display:none;">
    <span class="error-text"></span>
  </div>
  <div class="form-group"><label for="username">Create A Username:</label><input type="text" id="username" name="formdata[username]" data-alert_name="Username" validate_type="username" validate_min_length="4" validate_max_length="30"
      class="form-control input-sm placeholder" placeholder="Username"></div>
  <div class="form-group"><label for="password">Choose A Password:</label><input type="password" id="password" name="formdata[password]" data-alert_name="Password" validate_type="textnosp" validate_min_length="6" validate_max_length="32"
      class="form-control input-sm placeholder" placeholder="Password"></div>
  <div class="form-group"><label for="email">Email:</label><input type="text" id="email" name="formdata[email]" data-alert_name="Email" autocomplete="email" validate_type="email" class="form-control input-sm placeholder" placeholder="Email"></div>
  <p id="login_set" class="inputNote help-block">(Your login will be sent to this email address)</p>
  <p id="age_verify" class="inputNote help-block hidden"><span>You must provide a valid form of age verification.</span> <span class="noCharge">Your account will not be charged!</span></p>
  <input type="hidden" name="formdata[product_id]" value="327942">
  <div id="btnSubmit">
    <button input="" id="nextBtn" type="submit" class="btn btn-info btn-lg"> NEXT <span class="glyphicon glyphicon-arrow-right"></span></button>
  </div>
</form>

Text Content

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FREE VERIFICATION PROCESS

Fill this form out for quick access:

Create A Username:
Choose A Password:
Email:

(Your login will be sent to this email address)

You must provide a valid form of age verification. Your account will not be
charged!

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