www.clientes.grupocouture.com Open in urlscan Pro
23.111.150.66 Public Scan

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URL:
https://www.clientes.grupocouture.com/
Submission: On August 21 via automatic, source certstream-suspicious (August 21st 2024, 7:13:08 pm UTC) — Scanned from DE

Form analysis
1 forms found in the DOM

POST https://www.clientes.grupocouture.com/registro

<form method="POST" action="https://www.clientes.grupocouture.com/registro" accept-charset="UTF-8"><input name="_token" type="hidden" value="5KLL2LPlEh227vBaotdsGxWFz2rZUXR5IzymneDl">
  <div id="field_gender" class="form-group">
    <label for="gender"> Género: </label>
    <select class="form-control form-control-lg" id="gender" name="gender">
      <option value="0">Seleccione</option>
      <option value="male">Masculino</option>
      <option value="female">Femenino</option>
    </select>
  </div>
  <div id="field_name" class="form-group">
    <label for="name"> Nombre: </label>
    <input class="form-control form-control-lg" id="name" name="name" type="text">
  </div>
  <div id="field_first_name" class="form-group">
    <label for="first_name"> Primer Apellido: </label>
    <input class="form-control form-control-lg" id="first_name" name="first_name" type="text">
  </div>
  <div id="field_last_name" class="form-group">
    <label for="last_name"> Segundo Apellido: </label>
    <input class="form-control form-control-lg" id="last_name" name="last_name" type="text">
  </div>
  <div id="field_identification" class="form-group">
    <label for="identification"> Cédula: </label>
    <input class="form-control form-control-lg" id="identification" name="identification" type="text">
  </div>
  <h4>Fecha de cumpleaños</h4>
  <div id="field_day" class="form-group">
    <label for="day"> Día: </label>
    <select class="form-control form-control-lg" id="day" name="day">
      <option value="0">Seleccione</option>
      <option value="1">1</option>
      <option value="2">2</option>
      <option value="3">3</option>
      <option value="4">4</option>
      <option value="5">5</option>
      <option value="6">6</option>
      <option value="7">7</option>
      <option value="8">8</option>
      <option value="9">9</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 id="field_month" class="form-group">
    <label for="month"> Mes: </label>
    <select class="form-control form-control-lg" id="month" name="month">
      <option value="0">Seleccione</option>
      <option value="1">Enero</option>
      <option value="2">Febrero</option>
      <option value="3">Marzo</option>
      <option value="4">Abril</option>
      <option value="5">Mayo</option>
      <option value="6">Junio</option>
      <option value="7">Julio</option>
      <option value="8">Agosto</option>
      <option value="9">Setiembre</option>
      <option value="10">Octubre</option>
      <option value="11">Noviembre</option>
      <option value="12">Diciembre</option>
    </select>
  </div>
  <div id="field_year" class="form-group">
    <label for="year"> Año: </label>
    <select class="form-control form-control-lg" id="year" name="year">
      <option value="0" selected="selected">Seleccione</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>
    </select>
  </div>
  <hr class="m-4">
  <div id="field_phone" class="form-group">
    <label for="phone"> Teléfono: </label>
    <input class="form-control form-control-lg" id="phone" name="phone" type="tel">
  </div>
  <div id="field_email" class="form-group">
    <label for="email"> Correo: </label>
    <input class="form-control form-control-lg" id="email" name="email" type="email">
  </div>
  <div id="field_province" class="form-group">
    <label for="province"> Provincia: </label>
    <select class="form-control form-control-lg" id="province" name="province">
      <option value="1">San José</option>
      <option value="2">Alajuela</option>
      <option value="3">Cartago</option>
      <option value="4">Heredia</option>
      <option value="5">Guanacaste</option>
      <option value="6">Puntarenas</option>
      <option value="7">Limón</option>
    </select>
  </div>
  <input type="hidden" name="province_id" id="province_id" value="1">
  <label for="canton" class="control-label">Cantón:</label>
  <select class="form-control form-control-lg " name="canton" id="canton">
    <option value="">Seleccione el cantón</option>
    <option value="12">Acosta</option>
    <option value="10">Alajuelita</option>
    <option value="6">Aserrí</option>
    <option value="18">Curridabat</option>
    <option value="3">Desamparados</option>
    <option value="17">Dota</option>
    <option value="2">Escazú</option>
    <option value="8">Goicoechea</option>
    <option value="20">León Cortés</option>
    <option value="15">Montes de Oca</option>
    <option value="7">Mora</option>
    <option value="14">Moravia</option>
    <option value="19">Pérez Zeledón</option>
    <option value="4">Puriscal</option>
    <option value="1">San José</option>
    <option value="9">Santa Ana</option>
    <option value="5">Tarrazú</option>
    <option value="13">Tibás</option>
    <option value="16">Turrubares</option>
    <option value="11">Vásquez de Coronado</option>
  </select>
  <input type="hidden" name="canton_id" id="canton_id" value="">
  <label for="district" class="control-label mb-4">Distrito:</label>
  <select class="form-control form-control-lg " name="district" id="district"></select>
  <input type="hidden" name="district_id" id="district_id" value="">
  <div id="field_direction" class="form-group">
    <label for="direction"> Dirección Exacta: </label>
    <textarea rows="3" class="form-control form-control-lg" id="direction" name="direction" cols="50"></textarea>
  </div>
  <input class="btn btn-success btn-block btn-lg rounded-pill" type="submit" value="Registrarme">
</form>

Text Content

ACTUALIZA TUS DATOS

Género: SeleccioneMasculinoFemenino
Nombre:
Primer Apellido:
Segundo Apellido:
Cédula:

FECHA DE CUMPLEAÑOS

Día: Seleccione12345678910111213141516171819202122232425262728293031
Mes:
SeleccioneEneroFebreroMarzoAbrilMayoJunioJulioAgostoSetiembreOctubreNoviembreDiciembre
Año:
Seleccione2010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920191919181917191619151914191319121911191019091908190719061905

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Teléfono:
Correo:
Provincia: San JoséAlajuelaCartagoHerediaGuanacastePuntarenasLimón
Cantón: Seleccione el
cantónAcostaAlajuelitaAserríCurridabatDesamparadosDotaEscazúGoicoecheaLeón
CortésMontes de OcaMoraMoraviaPérez ZeledónPuriscalSan JoséSanta
AnaTarrazúTibásTurrubaresVásquez de Coronado Distrito:
Dirección Exacta:

www.clientes.grupocouture.com Open in urlscan Pro 23.111.150.66 Public Scan

Form analysis 1 forms found in the DOM

POST https://www.clientes.grupocouture.com/registro

Text Content

www.clientes.grupocouture.com Open in urlscan Pro
23.111.150.66 Public Scan

Form analysis
1 forms found in the DOM