www.slotbooking.kuhdawah.com Open in urlscan Pro
91.197.228.36  Public Scan

Form analysis
1 forms found in the DOM

POST https://www.slotbooking.kuhdawah.com/slots

<form action="https://www.slotbooking.kuhdawah.com/slots" class="form-sample" autocomplete="off" method="post" enctype="multipart/form-data">
  <input type="hidden" name="_token" value="x5WtgxRlDsRKtDhb7SDf2KLw5tFehAyD0BxJmEOn" autocomplete="off">
  <div class="row mt-5">
    <div class="tabs active">
      <div class="col-md-12 mb-5 text-primary text-left" align="center">
        <h2><b>Book Your Slot </b><br> <small> Supermarket Collection </small></h2>
      </div>
      <div class="col-md-12 row mb-5 text-left" align="left">
        <div class="col-md-4"></div>
        <div class="col-md-4">
          <label for="fname" class="mt-3">First name <span class="text-danger">*</span></label>
          <input id="fname" class="form-control mb-2" name="fname" type="text">
          <br>
          <label for="lname" class="mt-3">Last name <span class="text-danger">*</span></label>
          <input id="lname" class="form-control mb-2" name="lname" type="text">
          <br>
          <label for="mobile" class="mt-3">Phone <span class="text-danger">*</span></label>
          <input id="mobile" class="form-control mb-2" name="phone" type="text" oninput="removeSpaces()" maxlength="12">
          <br>
          <div class="form-group">
            <label for="area" class="mt-3">Area</label>
            <select id="area" class="form-control mb-2" name="area">
              <option value="Qutbi">Qutbi</option>
              <option value="Ajmeri">Ajmeri</option>
              <option value="Nizami">Nizami</option>
              <option value="Faizi">Faizi</option>
              <option value="Fareedi">Fareedi</option>
              <option value="Walsall">Walsall</option>
            </select>
            <span id="alert-mobile" class="text-danger"></span><br>
            <label for="collection" class="mt-3">Collection</label>
            <select id="collection" class="form-control mb-2" name="collection">
              <option value="Alum Rock Rd: Pak Supermarket">Alum Rock Rd: Pak Supermarket</option>
              <option value="Coventry Rd: Pak Supermarket">Coventry Rd: Pak Supermarket</option>
            </select>
            <br>
            <label for="date" class="mt-3">Date</label>
            <input id="date" class="form-control mb-2" name="date" type="date" min="2024-03-01" max="2024-04-13">
            <br>
            <label for="time" class="mt-3">Time</label>
            <select id="time" class="form-control mb-2" name="time">
              <option value="10:00 AM - 2:30 PM">10:00 AM - 2:30 PM</option>
              <option value="2:30 PM - 7:00 PM">2:30 PM - 7:00 PM</option>
            </select>
          </div>
          <div class="col-md-4"></div>
        </div>
      </div>
    </div>
    <div class="col-md-12 text-center" align="center">
      <button type="submit" id="submit" class="btn btn-primary w-25">Submit</button>
    </div>
  </div>
</form>

Text Content

 * Login Register

SIDEBAR SKINS


Light

Dark

HEADER SKINS


 * CHATS


 * SLOT BOOKING
   
   KANZ UL HUDA

 * Confirmed Slot


BOOK YOUR SLOT
SUPERMARKET COLLECTION

First name *
Last name *
Phone *

Area Qutbi Ajmeri Nizami Faizi Fareedi Walsall
Collection Alum Rock Rd: Pak Supermarket Coventry Rd: Pak Supermarket
Date
Time 10:00 AM - 2:30 PM 2:30 PM - 7:00 PM

Submit