lmg-surfboard.jimbeampromotions.com.au Open in urlscan Pro
2606:4700:3034::6815:3b45  Public Scan

Form analysis
1 forms found in the DOM

Name: form1 — POST

<form name="form1" id="entryForm" method="post" class="form" action="" enctype="multipart/form-data" novalidate="novalidate">
  <p class="enter-text">Enter your details below for your chance to win a Jim Beam Surfboard</p>
  <div class="form-item half">
    <input type="text" name="firstName" id="firstName" maxlength="255" placeholder="First Name*" class="required">
  </div>
  <div class="form-item half">
    <input type="text" name="lastName" id="lastName" maxlength="255" placeholder="Last Name*" class="required">
  </div>
  <div class="form-item">
    <input type="email" name="email" id="email" maxlength="255" placeholder="Email Address*" class="required email">
  </div>
  <div class="form-item half">
    <input type="text" name="phone" id="phone" maxlength="255" placeholder="Phone Number*" class="required" minlength="8" pattern="[0-9]*">
  </div>
  <div class="form-item half">
    <input readonly="value" type="text" class="birthday hasDatepicker" name="dob" id="dob" placeholder="Date of birth - DD/MM/YYYY*" maxlength="10" pattern="\d{1,2}\/\d{1,2}\/\d{4}" required="required">
  </div>
  <div class="form-item half">
    <input type="text" name="postcode" id="postcode" maxlength="255" placeholder="Postcode*" class="required" pattern="[0-9]*">
  </div>
  <div class="form-item half">
    <select name="states" id="state" class="required select">
      <option value="">State*</option>
      <option value="ACT">Australian Capital Territory</option>
      <option value="NSW">New South Wales</option>
      <option value="NT">Northern Territory</option>
      <option value="QLD">Queensland</option>
      <option value="SA ">South Australia</option>
      <option value="TAS">Tasmania</option>
      <option value="VIC">Victoria</option>
      <option value="WA">Western Australia</option>
    </select>
  </div>
  <div class="form-item">
    <select name="store" id="store" class="select">
      <option value="">Purchased from</option>
      <option value="BottleMart">BottleMart</option>
      <option value="Sip N Save">Sip N Save</option>
      <option value="Harry Brown">Harry Brown</option>
      <option value="Thirsty Camel (WA)">Thirsty Camel (WA)</option>
    </select>
  </div>
  <div class="form-item upload-item">
    <div class="box">
      <input type="file" name="uploaded_file" id="uploaded_file" class="inputfile inputfile-1 required" data-multiple-caption="{count} files selected" multiple="">
      <label for="uploaded_file"><svg xmlns="http://www.w3.org/2000/svg" width="20" height="17" viewBox="0 0 20 17">
          <path
            d="M10 0l-5.2 4.9h3.3v5.1h3.8v-5.1h3.3l-5.2-4.9zm9.3 11.5l-3.2-2.1h-2l3.4 2.6h-3.5c-.1 0-.2.1-.2.1l-.8  2.3h-6l-.8-2.2c-.1-.1-.1-.2-.2-.2h-3.6l3.4-2.6h-2l-3.2 2.1c-.4.3-.7 1-.6 1.5l.6 3.1c.1.5.7.9 1.2.9h16.3c.6 0 1.1-.4 1.3-.9l.6-3.1c.1-.5-.2-1.2-.7-1.5z">
          </path>
        </svg><span>Upload your receipt*</span>
      </label>
    </div>
    <div class="upload-terms">
      <ul>
        <li>In order to validate your claim, we require an image of your original purchase receipt. It must clearly show the purchase amount, products purchased, retailer name and purchase date.</li>
        <li>You can either upload a scanned copy or a clear photograph of your receipt. It’s really important that the image is clear and legible for validation.</li>
        <li>Permitted file types: pdf, jpg or png only. File upload size is limited to 2Mb.</li>
      </ul>
    </div>
  </div>
  <div class="checkbox-container">
    <div class="checkbox-item">
      <input type="checkbox" name="termsAndConditions" class="checkbox required">&nbsp; I accept the <a target="_blank" href="terms-and-conditions.php">Conditions of Entry</a>*
    </div>
    <div class="checkbox-item">
      <input type="checkbox" name="privacyPolicy" class="checkbox required">&nbsp; I accept the <a target="_blank" href="https://www.jimbeam.com/privacy">Jim Beam Privacy Policy</a>*
    </div>
    <div class="checkbox-item">
      <input type="checkbox" name="receipt" class="checkbox required">&nbsp; I confirm I have my original purchase receipt as proof of purchase. I understand that if I am drawn as a winner, I will be required to provide a copy.*
    </div>
    <div class="checkbox-item">
      <input type="checkbox" name="beamOptIn" class="checkbox">&nbsp; I would like to hear from Jim Beam
    </div>
  </div>
  <div class="callout"><span class="req">*</span> Required fields</div>
  <input name="submit" id="submit" value="Submit" type="submit">
</form>

Text Content

 * enter
 * winners
 * Contact Us
 * Terms and Conditions
 * Privacy Policy



ENTER

Enter your details below for your chance to win a Jim Beam Surfboard







State* Australian Capital Territory New South Wales Northern Territory
Queensland South Australia Tasmania Victoria Western Australia
Purchased from BottleMart Sip N Save Harry Brown Thirsty Camel (WA)
Upload your receipt*
 * In order to validate your claim, we require an image of your original
   purchase receipt. It must clearly show the purchase amount, products
   purchased, retailer name and purchase date.
 * You can either upload a scanned copy or a clear photograph of your receipt.
   It’s really important that the image is clear and legible for validation.
 * Permitted file types: pdf, jpg or png only. File upload size is limited to
   2Mb.

  I accept the Conditions of Entry*
  I accept the Jim Beam Privacy Policy*
  I confirm I have my original purchase receipt as proof of purchase. I
understand that if I am drawn as a winner, I will be required to provide a
copy.*
  I would like to hear from Jim Beam
* Required fields


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