secclicktest.dpg.lk
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20.24.132.75
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URL:
https://secclicktest.dpg.lk/
Submission: On June 25 via api from US — Scanned from SG
Submission: On June 25 via api from US — Scanned from SG
Form analysis
1 forms found in the DOMName: inquery_form —
<form name="inquery_form">
<div class="form-group">
<label for="name" class="control-label">Name:</label>
<input type="text" class="form-control" id="name" name="name" value="" tabindex="1">
</div>
<div class="form-group">
<label for="email" class="control-label">Email:</label>
<input type="email" class="form-control" id="email" name="email" value="" tabindex="2">
</div>
<div class="form-group">
<label for="tel" class="control-label">Tel:</label>
<input type="text" class="form-control" id="tel" name="telephone" value="" maxlength="10" tabindex="3">
</div>
<div class="form-group inqu-msg-w">
<label for="message-text" class="control-label">Address:</label>
<textarea class="form-control inqu-msg" rows="2" cols="" id="address-text" name="address" tabindex="4"></textarea>
</div>
<div class="form-group inqu-msg-w">
<label for="message-text" class="control-label">Message:</label>
<textarea class="form-control inqu-msg" rows="4" cols="" id="message-text" name="message" tabindex="5"></textarea>
</div>
<input type="hidden" name="hidden_insurance_category_id" value="" id="hidden_insurance_category_id">
</form>
Text Content
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