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drogao-net.parceriasonline.com.br Open in urlscan Pro
54.233.115.49  Public Scan

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Submitted URL: https://drogao-net.parceriasonline.com.br/
Effective URL: https://drogao-net.parceriasonline.com.br/partner/create
Submission: On July 17 via api from US — Scanned from US

Form analysis 1 forms found in the DOM

POST https://drogao-net.parceriasonline.com.br/partner/store

<form method="POST" action="https://drogao-net.parceriasonline.com.br/partner/store">
  <input type="hidden" name="_token" value="sTtn6wstE5nNRcWszmjZ2XapGO2RPzcFUCHbH7G7">
  <div class="col-md-12">
    <div class="form-group group ">
      <input type="text" name="name" id="name" class="form-control field nome" placeholder="Nome" value="" required="" autofocus="">
    </div>
  </div>
  <div class="col-md-12">
    <div class="form-group group ">
      <input type="email" name="email" id="email" class="form-control field email" placeholder="E-mail" value="">
    </div>
  </div>
  <div class="col-xs-12 col-md-2 group-ddd">
    <div class="form-group group">
      <input id="ddd-phone" type="text" class="form-control field ddd" placeholder="DDD" name="ddd-phone" value="" maxlength="2" onkeyup="functions.filterDataEntries(this); return false;">
    </div>
  </div>
  <div class="col-xs-12 col-md-10 group-telephone">
    <div class="form-group group ">
      <input id="phone" type="text" class="form-control field telefone" placeholder="Telefone" name="phone" value="" maxlength="8" onkeyup="functions.filterDataEntries(this); return false;">
    </div>
  </div>
  <div class="col-md-12">
    <div class="form-group group ">
      <input type="text" name="branch" value="" id="branch" class="form-control field ramal" placeholder="Ramal" onkeyup="functions.filterDataEntries(this); return false;">
    </div>
  </div>
  <div class="col-xs-12 col-md-2 group-ddd">
    <input id="ddd-cell" type="text" class="form-control field ddd" placeholder="DDD" name="ddd-cell" value="" maxlength="2" onkeyup="functions.filterDataEntries(this); return false;">
  </div>
  <div class="col-xs-12 col-md-10 group-telephone">
    <div class="form-group group ">
      <input type="text" name="cell-phone" value="" id="cell" class="form-control field celular" placeholder="Celular" maxlength="9" onkeyup="functions.filterDataEntries(this); return false;">
    </div>
  </div>
  <div class="col-md-12">
    <div class="form-group group ">
      <input type="password" name="password" id="password" class="form-control field senha" placeholder="Escolha uma senha" required="required">
    </div>
  </div>
  <div id="cnpjBox" class="col-lg-12">
    <div class="form-group">
      <input id="cnpj" type="text" onkeyup="functions.maskCNPJ(this.value)" onchange="functions.validarCNPJ(this.value); return false;" class="form-control" placeholder="CNPJ" name="cnpj" value="" maxlength="14">
      <span class="help-block">
      </span>
    </div>
  </div>
  <div class="col-md-12">
    <div class="form-group group">
      <input type="submit" class="form-control field submit" id="submit" value="CADASTRE-SE">
      <p class="error" id="error_form"></p>
    </div>
  </div>
  <div class="col-md-12">
    <div class="form-group group">
    </div>
  </div>
</form>

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