www.webinar.medisetter.com Open in urlscan Pro
148.113.6.147  Public Scan

Form analysis
1 forms found in the DOM

POST javascript:void(0);

<form method="post" action="javascript:void(0);" id="submit_user_form" autocomplete="on">
  <input type="hidden" name="submit_user_form" value="true">
  <div class="row">
    <div class="col-md-12">
      <div class="form-group">
        <input type="text" name="f1" id="f1" class="form-control" placeholder="Name*" required="required">
      </div>
    </div>
  </div>
  <div class="row">
    <div class="col-md-12">
      <div class="form-group">
        <input type="text" name="f2" id="f2" class="form-control" placeholder="Uid*" required="required">
      </div>
    </div>
  </div>
  <div class="row">
    <div class="col-md-12">
      <div class="form-group">
        <input type="text" name="f3" id="f3" class="form-control" placeholder="City*" required="required">
      </div>
    </div>
  </div>
  <div class="row">
    <div class="col-md-12">
      <div class="form-group">
        <input type="text" name="f4" id="f4" class="form-control" placeholder="State*" required="required">
      </div>
    </div>
  </div>
  <div class="row">
    <div class="col-md-12">
      <div class="form-group">
        <input type="password" name="password" id="password" class="form-control" placeholder="Password" required="">
      </div>
    </div>
  </div>
  <div class="row">
    <div class="col-md-12">
      <div class="form-group">
        <input type="submit" name="submit_btn_add" id="submit_btn" class="btn btn-primary btn-theme_one theme_button" value="Login">
        <button type="button" class="btn btn-danger btn-theme_two" data-dismiss="modal">Close</button>
      </div>
    </div>
  </div>
</form>

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