wp.xav.im Open in urlscan Pro
104.21.36.83  Public Scan

Form analysis
1 forms found in the DOM

POST

<form method="post" enctype="multipart/form-data" id="srfm-form-77" class="srfm-form " form-id="77" after-submission="hide form" message-type="same page" success-url="" ajaxurl="https://wp.xav.im/wp-admin/admin-ajax.php" nonce="98edc5c404">
  <input type="hidden" id="sureforms_form_submit" name="sureforms_form_submit" value="6ea6d80946"><input type="hidden" name="_wp_http_referer" value="/">
  <input type="hidden" value="77" name="form-id">
  <input type="hidden" value="" name="srfm-sender-email-field" id="srfm-sender-email">
  <input type="hidden" value="" id="srfm-page-break">
  <div data-block-id="c664c6ad" class="srfm-block-single srfm-block srfm-input-block srf-input-c664c6ad-block srfm-block-width-50 77">
    <label id="srfm-label-c664c6ad-lbl-Rmlyc3QgTmFtZQ" for="srfm-input-c664c6ad-lbl-Rmlyc3QgTmFtZQ" class="srfm-block-label">First Name<span class="srfm-required" aria-label="Required"><span aria-hidden="true"> *</span></span></label>
    <div class="srfm-block-wrap">
      <input class="srfm-input-common srfm-input-input" type="text" name="srfm-input-c664c6ad-lbl-Rmlyc3QgTmFtZQ-first-name" id="srfm-input-c664c6ad-lbl-Rmlyc3QgTmFtZQ" aria-describedby="srfm-error-c664c6ad" data-required="true" data-unique="false"
        maxlength="100" value="" data-srfm-mask="none">
    </div>
    <div class="srfm-error-wrap">
      <div class="srfm-error-message" data-srfm-id="srfm-error-c664c6ad" data-error-msg="This field is required." data-unique-msg="Value needs to be unique.">This field is required.</div>
    </div>
  </div>
  <div data-block-id="4d39e265" class="srfm-block-single srfm-block srfm-input-block srf-input-4d39e265-block srfm-block-width-50 77">
    <label id="srfm-label-4d39e265-lbl-TGFzdCBOYW1l" for="srfm-input-4d39e265-lbl-TGFzdCBOYW1l" class="srfm-block-label">Last Name<span class="srfm-required" aria-label="Required"><span aria-hidden="true"> *</span></span></label>
    <div class="srfm-block-wrap">
      <input class="srfm-input-common srfm-input-input" type="text" name="srfm-input-4d39e265-lbl-TGFzdCBOYW1l-last-name" id="srfm-input-4d39e265-lbl-TGFzdCBOYW1l" aria-describedby="srfm-error-4d39e265" data-required="true" data-unique="false"
        maxlength="100" value="" data-srfm-mask="none">
    </div>
    <div class="srfm-error-wrap">
      <div class="srfm-error-message" data-srfm-id="srfm-error-4d39e265" data-error-msg="This field is required." data-unique-msg="Value needs to be unique.">This field is required.</div>
    </div>
  </div>
  <div data-block-id="58d44afc" class="srfm-block-single srfm-block srfm-email-block-wrap srfm-block-width-100 77">
    <div class="srfm-email-block srf-email-58d44afc-block">
      <label id="srfm-label-58d44afc-lbl-RW1haWw" for="srfm-email-58d44afc-lbl-RW1haWw" class="srfm-block-label">Email<span class="srfm-required" aria-label="Required"><span aria-hidden="true"> *</span></span></label>
      <div class="srfm-block-wrap">
        <input class="srfm-input-common srfm-input-email" type="email" name="srfm-email-58d44afc-lbl-RW1haWw-srfm-email" id="srfm-email-58d44afc-lbl-RW1haWw" aria-describedby="srfm-error-58d44afc" data-required="true" data-unique="false">
        <span class="srfm-icon srfm-error-icon"><svg width="14" height="14" viewBox="0 0 14 14" fill="none" xmlns="http://www.w3.org/2000/svg">
            <path d="M7 5V7.5M13 7C13 10.3137 10.3137 13 7 13C3.68629 13 1 10.3137 1 7C1 3.68629 3.68629 1 7 1C10.3137 1 13 3.68629 13 7ZM7 9.5H7.005V9.505H7V9.5Z" stroke="currentColor" stroke-width="1.33" stroke-linecap="round"
              stroke-linejoin="round"></path>
          </svg></span>
      </div>
      <div class="srfm-error-wrap">
        <div class="srfm-error-message" data-srfm-id="srfm-error-58d44afc" data-error-msg="This field is required." data-unique-msg="Value needs to be unique.">This field is required.</div>
      </div>
    </div>
  </div>
  <div data-block-id="b0dade0e" class="srfm-block-single srfm-block srfm-textarea-block srf-textarea-b0dade0e-block srfm-block-width-100 77">
    <label id="srfm-label-b0dade0e-lbl-TWVzc2FnZQ" for="srfm-textarea-b0dade0e-lbl-TWVzc2FnZQ" class="srfm-block-label">Message</label>
    <div class="srfm-block-wrap">
      <textarea class="srfm-input-common srfm-input-textarea" name="srfm-textarea-b0dade0e-lbl-TWVzc2FnZQ-message" id="srfm-textarea-b0dade0e-lbl-TWVzc2FnZQ" aria-describedby="srfm-error-b0dade0e" data-required="false" rows="4"></textarea>
    </div>
    <div class="srfm-error-wrap">
    </div>
  </div>
  <div class="srfm-submit-container ">
    <div style="width: ; text-align: center" class="wp-block-button">
      <button style="width:" id="srfm-submit-btn" class="srfm-btn-frontend srfm-button srfm-submit-button">
        <div class="srfm-submit-wrap"> Submit <div class="srfm-loader"></div>
        </div>
      </button>
    </div>
  </div>
  <p id="srfm-error-message" class="srfm-error-message" hidden="true">There was an error trying to submit your form. Please try again.</p>
</form>

Text Content

Skip to content

KINGMED

 * Products
 * Contact Us


PROFESSIONAL SUPPLIER

We started to deal in Medical Consumables since 2014, such as Bandage, Gauze,
Dressing, Tape and Non woven products. With years of hard work and development,
we get approval and trust from customers.

Explore Products


TOP PRODUCTS



SHOP PRODUCTS


CONTACT US

First Name *

This field is required.
Last Name *

This field is required.
Email *

This field is required.
Message


Submit


There was an error trying to submit your form. Please try again.



KINGMED

kingmed@china-kingmai.com