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us-bokoupremnew-tp.lpus.foryoupromo.com Open in urlscan Pro
162.159.140.98  Public Scan

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Submitted URL: https://frstafflinks.com/?a=1313&oc=38101&c=71715&m=7&s1=553277&s3=lead&s2=1673248940&s4=25404
Effective URL: https://us-bokoupremnew-tp.lpus.foryoupromo.com/
Submission: On December 24 via api from US — Scanned from CA

Form analysis 1 forms found in the DOM

<form>
  <div class="static bg-white   
                        py-2 md:mb-1 lg:px-0">
    <div class="py-2 border-t border-b border-black md:border-t-2 md:border-b-2 mb-3 md:mb-6">
      <h3 class="text-base leading-6 text-center"> Where do we ship your FREE prize? </h3>
    </div>
    <div class="flex flex-col relative undefined">
      <div class="flex gap-1 mb-1"><button type="button" class="radio-rewards-inactive mb-3">Mr.</button><button type="button" class="radio-rewards-inactive mb-3">Mrs</button></div>
    </div>
    <div class="flex flex-col relative undefined">
      <div class="flex flex-row w-full gap-1">
        <div class="flex w-1/2">
          <div class="w-full relative">
            <div class="relative input-wrapper"><input min="" max="" name="first_name" type="text" placeholder="First name"
                class="border border-[#707070] rounded-md mb-4 px-3 py-2 w-full h-[61px] flex items-center pl-6 text-[16px] focus:outline-none focus:ring-0 focus:border-[#707070] disabled:bg-slate-100 placeholder-[#555]"></div>
          </div>
        </div>
        <div class="flex w-1/2">
          <div class="w-full relative">
            <div class="relative input-wrapper"><input min="" max="" name="last_name" type="text" placeholder="Last name"
                class="border border-[#707070] rounded-md mb-4 px-3 py-2 w-full h-[61px] flex items-center pl-6 text-[16px] focus:outline-none focus:ring-0 focus:border-[#707070] disabled:bg-slate-100 placeholder-[#555]"></div>
          </div>
        </div>
      </div>
    </div>
    <div class="flex flex-col relative undefined">
      <div class="w-full relative">
        <div class="relative input-wrapper"><input name="email_address" min="" max="" type="email" placeholder="Email"
            class="border border-[#707070] rounded-md mb-4 px-3 py-2 w-full h-[61px] flex items-center pl-6 text-[16px] focus:outline-none focus:ring-0 focus:border-[#707070] disabled:bg-slate-100 placeholder-[#555]" maxlength="50"></div>
      </div>
    </div>
    <div class="flex flex-col relative undefined"><span class="text-sm text-left pb-1 pl-1 font-bold">Date of birth</span>
      <div class="flex flex-row w-full gap-1">
        <div class="w-full relative">
          <div class="relative input-wrapper"><select min="1" max="12" name="MM" type="tel" placeholder="Month"
              class="border border-[#707070] rounded-md mb-4 px-3 py-2 w-full h-[61px] flex items-center pl-6 text-[16px] focus:outline-none focus:ring-0 focus:border-[#707070] disabled:bg-slate-100 placeholder-[#555] text-[#555]">
              <option> Month </option>
              <option value="01">January</option>
              <option value="02">February</option>
              <option value="03">March</option>
              <option value="04">April</option>
              <option value="05">May</option>
              <option value="06">June</option>
              <option value="07">July</option>
              <option value="08">August</option>
              <option value="09">September</option>
              <option value="10">October</option>
              <option value="11">November</option>
              <option value="12">December</option>
            </select></div>
        </div>
        <div class="w-full relative">
          <div class="relative input-wrapper"><select min="1" max="31" name="DD" type="tel" placeholder="Day"
              class="border border-[#707070] rounded-md mb-4 px-3 py-2 w-full h-[61px] flex items-center pl-6 text-[16px] focus:outline-none focus:ring-0 focus:border-[#707070] disabled:bg-slate-100 placeholder-[#555] text-[#555]">
              <option> Day </option>
              <option value="1">01</option>
              <option value="2">02</option>
              <option value="3">03</option>
              <option value="4">04</option>
              <option value="5">05</option>
              <option value="6">06</option>
              <option value="7">07</option>
              <option value="8">08</option>
              <option value="9">09</option>
              <option value="10">10</option>
              <option value="11">11</option>
              <option value="12">12</option>
              <option value="13">13</option>
              <option value="14">14</option>
              <option value="15">15</option>
              <option value="16">16</option>
              <option value="17">17</option>
              <option value="18">18</option>
              <option value="19">19</option>
              <option value="20">20</option>
              <option value="21">21</option>
              <option value="22">22</option>
              <option value="23">23</option>
              <option value="24">24</option>
              <option value="25">25</option>
              <option value="26">26</option>
              <option value="27">27</option>
              <option value="28">28</option>
              <option value="29">29</option>
              <option value="30">30</option>
              <option value="31">31</option>
            </select></div>
        </div>
        <div class="w-full relative">
          <div class="relative input-wrapper"><select min="1904" max="2010" name="YYYY" type="tel" placeholder="Year"
              class="border border-[#707070] rounded-md mb-4 px-3 py-2 w-full h-[61px] flex items-center pl-6 text-[16px] focus:outline-none focus:ring-0 focus:border-[#707070] disabled:bg-slate-100 placeholder-[#555] text-[#555]">
              <option> Year </option>
              <option value="2010">2010</option>
              <option value="2009">2009</option>
              <option value="2008">2008</option>
              <option value="2007">2007</option>
              <option value="2006">2006</option>
              <option value="2005">2005</option>
              <option value="2004">2004</option>
              <option value="2003">2003</option>
              <option value="2002">2002</option>
              <option value="2001">2001</option>
              <option value="2000">2000</option>
              <option value="1999">1999</option>
              <option value="1998">1998</option>
              <option value="1997">1997</option>
              <option value="1996">1996</option>
              <option value="1995">1995</option>
              <option value="1994">1994</option>
              <option value="1993">1993</option>
              <option value="1992">1992</option>
              <option value="1991">1991</option>
              <option value="1990">1990</option>
              <option value="1989">1989</option>
              <option value="1988">1988</option>
              <option value="1987">1987</option>
              <option value="1986">1986</option>
              <option value="1985">1985</option>
              <option value="1984">1984</option>
              <option value="1983">1983</option>
              <option value="1982">1982</option>
              <option value="1981">1981</option>
              <option value="1980">1980</option>
              <option value="1979">1979</option>
              <option value="1978">1978</option>
              <option value="1977">1977</option>
              <option value="1976">1976</option>
              <option value="1975">1975</option>
              <option value="1974">1974</option>
              <option value="1973">1973</option>
              <option value="1972">1972</option>
              <option value="1971">1971</option>
              <option value="1970">1970</option>
              <option value="1969">1969</option>
              <option value="1968">1968</option>
              <option value="1967">1967</option>
              <option value="1966">1966</option>
              <option value="1965">1965</option>
              <option value="1964">1964</option>
              <option value="1963">1963</option>
              <option value="1962">1962</option>
              <option value="1961">1961</option>
              <option value="1960">1960</option>
              <option value="1959">1959</option>
              <option value="1958">1958</option>
              <option value="1957">1957</option>
              <option value="1956">1956</option>
              <option value="1955">1955</option>
              <option value="1954">1954</option>
              <option value="1953">1953</option>
              <option value="1952">1952</option>
              <option value="1951">1951</option>
              <option value="1950">1950</option>
              <option value="1949">1949</option>
              <option value="1948">1948</option>
              <option value="1947">1947</option>
              <option value="1946">1946</option>
              <option value="1945">1945</option>
              <option value="1944">1944</option>
              <option value="1943">1943</option>
              <option value="1942">1942</option>
              <option value="1941">1941</option>
              <option value="1940">1940</option>
              <option value="1939">1939</option>
              <option value="1938">1938</option>
              <option value="1937">1937</option>
              <option value="1936">1936</option>
              <option value="1935">1935</option>
              <option value="1934">1934</option>
              <option value="1933">1933</option>
              <option value="1932">1932</option>
              <option value="1931">1931</option>
              <option value="1930">1930</option>
              <option value="1929">1929</option>
              <option value="1928">1928</option>
              <option value="1927">1927</option>
              <option value="1926">1926</option>
              <option value="1925">1925</option>
              <option value="1924">1924</option>
              <option value="1923">1923</option>
              <option value="1922">1922</option>
              <option value="1921">1921</option>
              <option value="1920">1920</option>
              <option value="1919">1919</option>
              <option value="1918">1918</option>
              <option value="1917">1917</option>
              <option value="1916">1916</option>
              <option value="1915">1915</option>
              <option value="1914">1914</option>
              <option value="1913">1913</option>
              <option value="1912">1912</option>
              <option value="1911">1911</option>
              <option value="1910">1910</option>
              <option value="1909">1909</option>
              <option value="1908">1908</option>
              <option value="1907">1907</option>
              <option value="1906">1906</option>
              <option value="1905">1905</option>
              <option value="1904">1904</option>
            </select></div>
        </div>
      </div>
    </div>
    <div class="flex flex-col relative undefined"><span class="pl-1 pb-1 text-sm text-left"></span>
      <div class="w-full relative">
        <div class="relative input-wrapper"><input name="phone_cell" min="" max="" type="tel" placeholder="Mobile number"
            class="border border-[#707070] rounded-md mb-4 px-3 py-2 w-full h-[61px] flex items-center pl-6 text-[16px] focus:outline-none focus:ring-0 focus:border-[#707070] disabled:bg-slate-100 placeholder-[#555]" maxlength="10" value=""></div>
      </div>
    </div>
    <div class="flex flex-col relative undefined">
      <div>
        <div class="flex w-full gap-1">
          <div class="w-1/3">
            <div class="">
              <div class="w-full relative">
                <div class="relative input-wrapper"><input id="zip_code" min="" max="" name="zip_code" type="tel" placeholder="ZIP code"
                    class="border border-[#707070] rounded-md mb-4 px-3 py-2 w-full h-[61px] flex items-center pl-6 text-[16px] focus:outline-none focus:ring-0 focus:border-[#707070] disabled:bg-slate-100 placeholder-[#555]" maxlength="5"></div>
              </div>
            </div>
          </div>
          <div class="w-2/3">
            <div class="">
              <div class="w-full relative">
                <div class="relative input-wrapper"><input id="address" min="" max="" name="address" type="text" placeholder="Street Address"
                    class="border border-[#707070] rounded-md mb-4 px-3 py-2 w-full h-[61px] flex items-center pl-6 text-[16px] focus:outline-none focus:ring-0 focus:border-[#707070] disabled:bg-slate-100 placeholder-[#555]" maxlength="50"></div>
              </div>
            </div>
          </div>
        </div>
      </div>
    </div>
  </div>
  <div class="text-center">
    <div class="text-[11px]">By pressing the button below, you agree to the <a href="https://foryoupromo.com/us/sample-page/official-rules/" target="blank">Official Rules</a>,
      <a href="http://foryoupromo.com/us/us/privacy-policy/" target="blank">Privacy Policy</a> and <a href="http://foryoupromo.com/us/us/terms-of-use/" target="blank">Terms of Use</a> of this website.</div><button class="mt-5 md:mt-3 px-4 py-3 border-[3px] 
                        border-white shadow-lg font-semibold text-center text-shadow-md w-full mb-2  text-white uppercase text-xl bg-greenButtonS5">Continue</button>
  </div><input type="hidden" name="xxTrustedFormCertUrl" value="https://cert.trustedform.com/6226ac7a5692fec326b2e4ae71e6b57e1e291ece" id="xxTrustedFormCertUrl_0"><input type="hidden" name="xxTrustedFormToken"
    value="https://cert.trustedform.com/6226ac7a5692fec326b2e4ae71e6b57e1e291ece" id="xxTrustedFormToken_0"><input type="hidden" name="xxTrustedFormPingUrl"
    value="https://ping.trustedform.com/0.ar_F6FDvcZtzGEGi4XZXFOmbSDbFoRDS6aMuo3GPLsb6DWjbhM9gzaXjWQH4SwNBfSXCtHU.EWOdObh5yN4BoQCDtF0CvQ.P6g9OO3ea8vopiC3zRehlg" id="xxTrustedFormPingUrl_0">
</form>

Text Content

Limited supply! Be quick!
Average user rating: ★★★★☆
Sandra V. just finished a Survey!
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Almost There!

Almost There!
8935168982


WHERE DO WE SHIP YOUR FREE PRIZE?

Mr.Mrs


Date of birth
Month JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember
Day 01020304050607080910111213141516171819202122232425262728293031
Year
20102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904


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For You Promo
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December 2024 (trimester 3).



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