uk-safetymanagement.uk
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Submitted URL: http://c.uk-safetymanagement.uk/C-1U-7AL-2V97I-EKE-IJUQK-765UUWDBD
Effective URL: https://uk-safetymanagement.uk/p/test/index.php?recid=31159388&sid=66&sendid=4817502
Submission Tags: falconsandbox
Submission: On July 05 via api from US — Scanned from GB
Effective URL: https://uk-safetymanagement.uk/p/test/index.php?recid=31159388&sid=66&sendid=4817502
Submission Tags: falconsandbox
Submission: On July 05 via api from US — Scanned from GB
Form analysis 1 forms found in the DOM
POST /p/test/index.php
<form id="enquiryform" action="/p/test/index.php" method="post">
<input type="hidden" name="recid" value="31159388">
<input type="hidden" name="sid" value="66">
<input type="hidden" name="sendid" value="4817502">
<input type="hidden" name="source" value="Testing/call schedule">
<h3 class="h3" align="left"><b>Submit your details and we'll be in touch shortly.</b></h3>
<div class="row">
<div class="col-6 form-group">
<div class="input-group">
<div class="input-group-prepend">
<span class="input-group-text" id="inputGroupPrepend"><svg class="svg-inline--fa fa-user fa-w-14" aria-hidden="true" focusable="false" data-prefix="fa" data-icon="user" role="img" xmlns="http://www.w3.org/2000/svg" viewBox="0 0 448 512"
data-fa-i2svg="">
<path fill="currentColor"
d="M224 256c70.7 0 128-57.3 128-128S294.7 0 224 0 96 57.3 96 128s57.3 128 128 128zm89.6 32h-16.7c-22.2 10.2-46.9 16-72.9 16s-50.6-5.8-72.9-16h-16.7C60.2 288 0 348.2 0 422.4V464c0 26.5 21.5 48 48 48h352c26.5 0 48-21.5 48-48v-41.6c0-74.2-60.2-134.4-134.4-134.4z">
</path>
</svg><!-- <i class="fa fa-user"></i> --></span>
</div><input class="form-control" type="text" name="fname" placeholder="First Name" required="">
</div>
</div>
<div class="col-6 form-group">
<div class="input-group">
<div class="input-group-prepend">
<span class="input-group-text" id="inputGroupPrepend"><svg class="svg-inline--fa fa-user fa-w-14" aria-hidden="true" focusable="false" data-prefix="fa" data-icon="user" role="img" xmlns="http://www.w3.org/2000/svg" viewBox="0 0 448 512"
data-fa-i2svg="">
<path fill="currentColor"
d="M224 256c70.7 0 128-57.3 128-128S294.7 0 224 0 96 57.3 96 128s57.3 128 128 128zm89.6 32h-16.7c-22.2 10.2-46.9 16-72.9 16s-50.6-5.8-72.9-16h-16.7C60.2 288 0 348.2 0 422.4V464c0 26.5 21.5 48 48 48h352c26.5 0 48-21.5 48-48v-41.6c0-74.2-60.2-134.4-134.4-134.4z">
</path>
</svg><!-- <i class="fa fa-user"></i> --></span>
</div><input class="form-control" type="text" name="sname" placeholder="Last Name" required="">
</div>
</div>
</div>
<div class="row">
<div class="col-12 form-group">
<div class="input-group">
<div class="input-group-prepend">
<span class="input-group-text" id="inputGroupPrepend">@</span>
</div><input class="form-control" type="text" name="email" placeholder="Email" required="">
</div>
</div>
</div>
<div class="row">
<div class="col-6 form-group">
<div class="input-group">
<div class="input-group-prepend">
<span class="input-group-text" id="inputGroupPrepend"><svg class="svg-inline--fa fa-phone fa-w-16" aria-hidden="true" focusable="false" data-prefix="fa" data-icon="phone" role="img" xmlns="http://www.w3.org/2000/svg" viewBox="0 0 512 512"
data-fa-i2svg="">
<path fill="currentColor"
d="M493.4 24.6l-104-24c-11.3-2.6-22.9 3.3-27.5 13.9l-48 112c-4.2 9.8-1.4 21.3 6.9 28l60.6 49.6c-36 76.7-98.9 140.5-177.2 177.2l-49.6-60.6c-6.8-8.3-18.2-11.1-28-6.9l-112 48C3.9 366.5-2 378.1.6 389.4l24 104C27.1 504.2 36.7 512 48 512c256.1 0 464-207.5 464-464 0-11.2-7.7-20.9-18.6-23.4z">
</path>
</svg><!-- <i class="fa fa-phone"></i> --></span>
</div><input class="form-control" type="text" name="telephone" placeholder="Telephone" required="">
</div>
</div>
<div class="col-6 form-group">
<div class="input-group">
<div class="input-group-prepend">
<span class="input-group-text" id="inputGroupPrepend"><svg class="svg-inline--fa fa-building fa-w-14" aria-hidden="true" focusable="false" data-prefix="fa" data-icon="building" role="img" xmlns="http://www.w3.org/2000/svg"
viewBox="0 0 448 512" data-fa-i2svg="">
<path fill="currentColor"
d="M436 480h-20V24c0-13.255-10.745-24-24-24H56C42.745 0 32 10.745 32 24v456H12c-6.627 0-12 5.373-12 12v20h448v-20c0-6.627-5.373-12-12-12zM128 76c0-6.627 5.373-12 12-12h40c6.627 0 12 5.373 12 12v40c0 6.627-5.373 12-12 12h-40c-6.627 0-12-5.373-12-12V76zm0 96c0-6.627 5.373-12 12-12h40c6.627 0 12 5.373 12 12v40c0 6.627-5.373 12-12 12h-40c-6.627 0-12-5.373-12-12v-40zm52 148h-40c-6.627 0-12-5.373-12-12v-40c0-6.627 5.373-12 12-12h40c6.627 0 12 5.373 12 12v40c0 6.627-5.373 12-12 12zm76 160h-64v-84c0-6.627 5.373-12 12-12h40c6.627 0 12 5.373 12 12v84zm64-172c0 6.627-5.373 12-12 12h-40c-6.627 0-12-5.373-12-12v-40c0-6.627 5.373-12 12-12h40c6.627 0 12 5.373 12 12v40zm0-96c0 6.627-5.373 12-12 12h-40c-6.627 0-12-5.373-12-12v-40c0-6.627 5.373-12 12-12h40c6.627 0 12 5.373 12 12v40zm0-96c0 6.627-5.373 12-12 12h-40c-6.627 0-12-5.373-12-12V76c0-6.627 5.373-12 12-12h40c6.627 0 12 5.373 12 12v40z">
</path>
</svg><!-- <i class="fa fa-building"></i> --></span>
</div><input class="form-control" type="text" name="company" placeholder="Company Name">
</div>
</div>
</div>
<div class="row">
<div class="col-12 form-group">
<div class="row">
<div class="col-lg-6"> Preferred contact method: </div>
<div class="col-lg-6">
<div class="form-check">
<input class="form-check-input" type="checkbox" name="contact_by[]" id="id_contact_byEmail" value="Email">
<label class="form-check-label" for="id_contact_byEmail">Email</label>
</div>
<div class="form-check">
<input class="form-check-input" type="checkbox" name="contact_by[]" id="id_contact_byPhone" value="Phone">
<label class="form-check-label" for="id_contact_byPhone">Phone</label>
</div>
</div>
</div>
</div>
</div>
<div class="row">
<div class="col-6 form-group"><select class="form-control" name="sites">
<option disabled="" selected="" value="">How many sites need servicing?</option>
<option value="One_site">One site</option>
<option value="multiple_sites">Multiple sites</option>
</select></div>
<div class="col-6 form-group"><select class="form-control" name="testing_amount">
<option disabled="" selected="" value="">How many appliances</option>
<option value="1 - 50">1 - 50</option>
<option value="50 - 100">50 - 100</option>
<option value="100 - 200">100 - 200</option>
<option value="200+">200+</option>
</select></div>
</div>
<div class="row">
<div class="col-12 form-group">
<div class="input-group">
<div class="input-group-prepend">
<span class="input-group-text" id="inputGroupPrepend"><svg class="svg-inline--fa fa-clock fa-w-16" aria-hidden="true" focusable="false" data-prefix="fa" data-icon="clock" role="img" xmlns="http://www.w3.org/2000/svg" viewBox="0 0 512 512"
data-fa-i2svg="">
<path fill="currentColor"
d="M256 8C119 8 8 119 8 256s111 248 248 248 248-111 248-248S393 8 256 8zm57.1 350.1L224.9 294c-3.1-2.3-4.9-5.9-4.9-9.7V116c0-6.6 5.4-12 12-12h48c6.6 0 12 5.4 12 12v137.7l63.5 46.2c5.4 3.9 6.5 11.4 2.6 16.8l-28.2 38.8c-3.9 5.3-11.4 6.5-16.8 2.6z">
</path>
</svg><!-- <i class="fa fa-clock"></i> --></span>
</div><input class="form-control" type="text" name="openhours" placeholder="Your Opening Hours">
</div>
</div>
</div>
<div class="row">
<div class="col-6 form-group"><label for="service"> </label><select class="form-control" name="service">
<option disabled="" selected="" value="">Booking Appointment For</option>
<option value="pat_testing">PAT testing</option>
<option value="fixed_wire_testing">Fixed Wire Testing (EICR)</option>
<option value="fire_extinguisher_servicing">Fire Extinguisher Servicing</option>
<option value="more_than_one_service">More than one service</option>
</select></div>
<div class="col-6 form-group"><label for="booking_date"><span style="color: #505960 !important;"><b>Booking date:</b></span></label>
<div class="input-group">
<div class="input-group-prepend">
<span class="input-group-text" id="inputGroupPrepend"><svg class="svg-inline--fa fa-calendar fa-w-14" aria-hidden="true" focusable="false" data-prefix="fa" data-icon="calendar" role="img" xmlns="http://www.w3.org/2000/svg"
viewBox="0 0 448 512" data-fa-i2svg="">
<path fill="currentColor"
d="M12 192h424c6.6 0 12 5.4 12 12v260c0 26.5-21.5 48-48 48H48c-26.5 0-48-21.5-48-48V204c0-6.6 5.4-12 12-12zm436-44v-36c0-26.5-21.5-48-48-48h-48V12c0-6.6-5.4-12-12-12h-40c-6.6 0-12 5.4-12 12v52H160V12c0-6.6-5.4-12-12-12h-40c-6.6 0-12 5.4-12 12v52H48C21.5 64 0 85.5 0 112v36c0 6.6 5.4 12 12 12h424c6.6 0 12-5.4 12-12z">
</path>
</svg><!-- <i class="fa fa-calendar"></i> --></span>
</div><input class="form-control datepicker hasDatepicker" type="text" name="booking_date" placeholder="DD/MM/YYYY" id="dp1688560983844">
</div>
</div>
<div class="col-6 form-group"><label for="service_renewal"> </label><select class="form-control" name="service_renewal">
<option disabled="" selected="" value="">Renewal Appointment For</option>
<option value="pat_testing">PAT testing</option>
<option value="fixed_wire_testing">Fixed Wire Testing (EICR)</option>
<option value="fire_extinguisher_servicing">Fire Extinguisher Servicing</option>
<option value="more_than_one_service">More than one service</option>
</select></div>
<div class="col-6 form-group"><label for="renewal_date"><span style="color: #505960 !important;"><b>Renewal date:</b></span></label>
<div class="input-group">
<div class="input-group-prepend">
<span class="input-group-text" id="inputGroupPrepend"><svg class="svg-inline--fa fa-calendar fa-w-14" aria-hidden="true" focusable="false" data-prefix="fa" data-icon="calendar" role="img" xmlns="http://www.w3.org/2000/svg"
viewBox="0 0 448 512" data-fa-i2svg="">
<path fill="currentColor"
d="M12 192h424c6.6 0 12 5.4 12 12v260c0 26.5-21.5 48-48 48H48c-26.5 0-48-21.5-48-48V204c0-6.6 5.4-12 12-12zm436-44v-36c0-26.5-21.5-48-48-48h-48V12c0-6.6-5.4-12-12-12h-40c-6.6 0-12 5.4-12 12v52H160V12c0-6.6-5.4-12-12-12h-40c-6.6 0-12 5.4-12 12v52H48C21.5 64 0 85.5 0 112v36c0 6.6 5.4 12 12 12h424c6.6 0 12-5.4 12-12z">
</path>
</svg><!-- <i class="fa fa-calendar"></i> --></span>
</div><input class="form-control datepicker hasDatepicker" type="text" name="renewal_date" placeholder="DD/MM/YYYY" id="dp1688560983845">
</div>
</div>
</div>
<div class="row">
<div class="col-12 form-group"><label for="txtarea_notes"></label>
<textarea class="form-control" name="notes" id="txtarea_notes" rows="1" placeholder="Additional Details"></textarea>
</div>
</div>
<div class="row mb-3">
<div class="col-12"><small id="emailHelp" class="form-text text-muted">We will only use your details to contact you about your enquiry.</small></div>
</div>
<div class="row">
<div class="col-12">
<button style="background-color:#505960;!important; color:#ffffff;" type="submit" id="submit" class="form-control btn">Submit enquiry</button>
</div>
</div>
</form>Text Content
Call our team on: 0333 188 6770 PRIVACY NOTICE × The data controller is UK Safety Management Ltd. The information you provide in this form will be collected by Merrehill Ltd on behalf of the data controller. Where a submission is made for reasons other than an enquiry about the products and services of the data controller, Merrehill may decide not to further process the form data. In all other cases it will be relayed to the data controller for the purpose of dealing with your enquiry. You can contact us by writing to Unit 5 Temple Point Finch Drive, Bullerthorpe Lane, Colton, Leeds, England, LS15 9JL , calling or sending an email to susan@seeddatasolutions.com. Any personal data you provide in this form will be used to inform our authorised staff of your enquiry so that they can take steps at your request to provide the information you require to decide whether you wish to purchase our products and services. The lawful basis for processing your personal data in this way is provided in Article 6(1)(b) of the General Data Protection Regulation. The information we collect is limited to your name, contact details, company name and any other details requested in this form. These will be stored according to our data protection policy and used as detailed above. A copy of our policy is available upon request. Close SUBMIT YOUR DETAILS AND WE'LL BE IN TOUCH SHORTLY. @ Preferred contact method: Email Phone How many sites need servicing?One siteMultiple sites How many appliances1 - 5050 - 100100 - 200200+ Booking Appointment ForPAT testingFixed Wire Testing (EICR)Fire Extinguisher ServicingMore than one service Booking date: Renewal Appointment ForPAT testingFixed Wire Testing (EICR)Fire Extinguisher ServicingMore than one service Renewal date: We will only use your details to contact you about your enquiry. Submit enquiry Company: UK Safety Management Ltd Company No. 08817304 :: Registered in England and Wales Unit 5 Temple Point Finch Drive, Bullerthorpe Lane, Colton, Leeds, England, LS15 9JL Privacy Notice