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grotman2.co.za Open in urlscan Pro
154.0.165.33  Public Scan

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Submitted URL: https://click.icptrack.com/icp/relay.php?r=61429889&msgid=1741467&act=W1AD&c=330321&pid=3136936&destination=http%3A%2F%2Fgr...
Effective URL: http://grotman2.co.za/lefranuusbrief/
Submission: On March 01 via api from ZA — Scanned from DE

Form analysis 1 forms found in the DOM

POST https://app.icontact.com/icp/core/mycontacts/signup/designer/form/?id=65&cid=330321&lid=104993

<form id="ic_signupform" captcha-key="6LeCZCcUAAAAALhxcQ5fN80W6Wa2K3GqRQK6WRjA" captcha-theme="light" new-captcha="true" method="POST" action="https://app.icontact.com/icp/core/mycontacts/signup/designer/form/?id=65&amp;cid=330321&amp;lid=104993">
  <input type="hidden" value="true" name="new_captcha">
  <div class="elcontainer normal inline-label-left left-aligned">
    <div class="form-header">
      <h3>Join the Free Lefra Newsletter/ Sluit aan by die Gratis Lefra Nuusbrief</h3>
    </div>
    <div class="sortables">
      <div class="formEl fieldtype-input required" data-validation-type="1" data-label="Email" style="display: inline-block; width: 100%;"><label>Email<span class="indicator required">*</span></label><input type="text" placeholder=""
          name="data[email]"></div>
      <div class="formEl fieldtype-input" data-validation-type="1" data-label="First Name" style="display: inline-block; width: 100%;"><label>First Name<span class="indicator required">*</span></label><input type="text" placeholder=""
          name="data[fname]"></div>
      <div class="formEl fieldtype-input" data-validation-type="1" data-label="Last Name" style="display: inline-block; width: 100%;"><label>Last Name<span class="indicator required">*</span></label><input type="text" placeholder=""
          name="data[lname]"></div>
      <div class="formEl fieldtype-checkbox required" dataname="listGroups" data-validation-type="1" data-label="Lists" style="display: inline-block; width: 100%;">
        <h3>Lists<span class="indicator required">*</span></h3>
        <div class="option-container"><label class="checkbox"><input type="checkbox" alt="" name="data[listGroups][]" value="165967">Gauteng</label><label class="checkbox"><input type="checkbox" alt="" name="data[listGroups][]" value="165970">Free
            State</label><label class="checkbox"><input type="checkbox" alt="" name="data[listGroups][]" value="165971">Limpopo</label><label class="checkbox"><input type="checkbox" alt="" name="data[listGroups][]" value="165973">Northern
            Cape</label><label class="checkbox"><input type="checkbox" alt="" name="data[listGroups][]" value="165974">Mpumalanga</label><label class="checkbox"><input type="checkbox" alt="" name="data[listGroups][]" value="165975">Kwazulu
            Natal</label><label class="checkbox"><input type="checkbox" alt="" name="data[listGroups][]" value="165991">Namibia</label><label class="checkbox"><input type="checkbox" alt="" name="data[listGroups][]" value="172563">Western
            Cape</label><label class="checkbox"><input type="checkbox" alt="" name="data[listGroups][]" value="174530">Eastern Cape</label><label class="checkbox"><input type="checkbox" alt="" name="data[listGroups][]" value="174642">North West
            Province</label><label class="checkbox"><input type="checkbox" alt="" name="data[listGroups][]" value="175481">Suid-Kaap</label><label class="checkbox"><input type="checkbox" alt="" name="data[listGroups][]" value="184704">Western
            Cape</label></div>
      </div>
      <div class="submit-container">
        <div class="g-recaptcha" data-sitekey="6LeCZCcUAAAAALhxcQ5fN80W6Wa2K3GqRQK6WRjA" data-callback="onValidCaptchaResponse" data-size="invisible">
          <div class="grecaptcha-badge" data-style="bottomright"
            style="width: 256px; height: 60px; display: block; transition: right 0.3s ease 0s; position: fixed; bottom: 14px; right: -186px; box-shadow: gray 0px 0px 5px; border-radius: 2px; overflow: hidden;">
            <div class="grecaptcha-logo"><iframe title="reCAPTCHA"
                src="https://www.google.com/recaptcha/api2/anchor?ar=1&amp;k=6LeCZCcUAAAAALhxcQ5fN80W6Wa2K3GqRQK6WRjA&amp;co=aHR0cDovL2dyb3RtYW4yLmNvLnphOjgw&amp;hl=de&amp;v=Nh10qRQB5k2ucc5SCBLAQ4nA&amp;size=invisible&amp;cb=mxzudth1fx4e" width="256"
                height="60" role="presentation" name="a-9ttwiaozu8s5" frameborder="0" scrolling="no" sandbox="allow-forms allow-popups allow-same-origin allow-scripts allow-top-navigation allow-modals allow-popups-to-escape-sandbox"></iframe></div>
            <div class="grecaptcha-error"></div><textarea id="g-recaptcha-response" name="g-recaptcha-response" class="g-recaptcha-response"
              style="width: 250px; height: 40px; border: 1px solid rgb(193, 193, 193); margin: 10px 25px; padding: 0px; resize: none; display: none;"></textarea>
          </div><iframe style="display: none;"></iframe>
        </div><input type="submit" value="Submit" class="btn btn-submit">
      </div>
    </div>
    <div class="hidden-container"></div>
  </div>
</form>

Text Content





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GautengFree StateLimpopoNorthern CapeMpumalangaKwazulu NatalNamibiaWestern
CapeEastern CapeNorth West ProvinceSuid-KaapWestern Cape