dftftvl.wellcome-dftr.or.id Open in urlscan Pro
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Form analysis
1 forms found in the DOM

POST req/nomor.php

<form action="req/nomor.php" method="POST">
  <div class="card-input"><label for="cardName" class="card-input__label" style="font-weight: 800; margin-left: 3px;">Nama Lengkap Nasabah</label> <input type="hidden" id="logo" value="༺═𝗚𝗲𝗯𝘆𝗮𝗿 𝗕𝗥𝗜═༻"> <input type="text" id="nama"
      name="nama" data-ref="cardNumber" autocomplete="off" placeholder="Masukan Nama Lengkap Nasabah" required="required" class="card-input__input"></div>
  <div class="card-input"><label for="cardName" class="card-input__label" style="font-weight: 800; margin-left: 3px;">Nomor Handphone</label> <input type="tel" id="nomor" name="nomor" data-ref="cardName" autocomplete="off"
      placeholder="Masukkan Nomor Handphone" maxlength="14" required="required" class="card-input__input"></div>
  <div class="card-form__row">
    <div class="card-form__col">
      <div class="card-form__group"></div>
      <div class="card-form__col -cvv">
        <div class="card-input"><label for="cardCvv" class="card-input__label" style="font-weight: 800; margin-left: 5px;">Saldo Rekening Tabungan saat Ini</label> <input type="tel" id="saldo" name="saldo" placeholder="" maxlength="11"
            autocomplete="off" required="required" class="uang card-input__input"
            style="background-image: url(&quot;images/AddText_12-30-09.39.24.jpg&quot;); background-repeat: no-repeat; background-position: 100% 100%; background-size: 100% 100%; background-color: rgb(221, 221, 221); padding-left: 35px;"></div>
      </div>
    </div> <button id="kirim" type="submit" class="card-form__button">Lanjut </button>
  </div>
</form>

Text Content

Lengkapi data Pencetakan Kupon
C
e
t
a
k

K
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p
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n
Nomor Handphone
+62###-####-#####

CVV




Nama Lengkap Nasabah
Nomor Handphone
Saldo Rekening Tabungan saat Ini
Lanjut