www.rexelusa.com
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192.138.162.65
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Submitted URL: https://store.rexelusa.com/contact-us?utm_medium=email&utm_source=300&utm_campaign=_[9499917]&utm_content=footer
Effective URL: https://www.rexelusa.com/contact-us?utm_medium=email&utm_source=300&utm_campaign=_[9499917]&utm_content=footer
Submission: On September 13 via api from US — Scanned from DE
Effective URL: https://www.rexelusa.com/contact-us?utm_medium=email&utm_source=300&utm_campaign=_[9499917]&utm_content=footer
Submission: On September 13 via api from US — Scanned from DE
Form analysis 1 forms found in the DOM
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<div>
<div class="row no-gutters">
<div class="col-lg-6 col-12">
<div class="row no-gutters">
<div class="text-h6 pb-3 col col-12"> What would you like help with? </div>
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<div class="v-select__slot"><label for="input-98" class="v-label theme--light" style="left:0px;right:auto;position:absolute;">Select a reason *</label>
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<div class="v-text-field__slot"><label for="input-105" class="v-label theme--light" style="left:0px;right:auto;position:absolute;">Email address *</label><input id="input-105" type="text"></div>
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<div class="v-text-field__slot"><label for="input-108" class="v-label theme--light" style="left:0px;right:auto;position:absolute;">Company name</label><input id="input-108" type="text"></div>
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<fieldset aria-hidden="true">
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<div class="v-text-field__slot"><label for="input-111" class="v-label theme--light" style="left:0px;right:auto;position:absolute;">First name</label><input id="input-111" type="text"></div>
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<div class="v-input__control">
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<fieldset aria-hidden="true">
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<div class="col col-12"><span outlined="" dense="" inputmode="tel" maxlength="14" label="Phone Number" placeholder="XXX-XXX-XXXX" value="">
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<div class="col col-12"><span outlined="" auto-grow="" dense="" rows="2" label="Comment">
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<div class="v-text-field__slot"><label for="input-125" class="v-label theme--light" style="left:0px;right:auto;position:absolute;">Comment *</label><textarea id="input-125" rows="2" style="height: 48px;"></textarea></div>
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<div class="text-right pb-5 col col-12"><button type="button" class="v-btn v-btn--disabled v-btn--has-bg theme--light v-size--default" disabled="disabled"><span class="v-btn__content"> Submit </span></button></div>
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</form>Text Content
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