www.monespace.lamie-mutuelle.com Open in urlscan Pro
46.105.48.196  Public Scan

Form analysis
1 forms found in the DOM

POST /Account/MarshallingYardLogin

<form method="post" class="form" role="form" action="/Account/MarshallingYardLogin">
  <div class="pb-13 pt-lg-0 pt-5 text-center">
    <h3 class="font-weight-bolder">Bienvenue sur votre espace adhérent ! </h3>
    <span>Merci de renseigner votre numéro de contrat </span>
  </div>
  <div class="form-group">
    <label class="font-size-h6 font-weight-bolder text-dark">N° de contrat </label>
    <span role="button" data-toggle="tooltip" data-placement="top" data-html="true" title=""
      data-original-title="<div style='display:block;width:200px !important;'><p>Vous trouverez votre n° de contrat sur vos contrats &amp; votre carte de tiers payant. </p><br/><img src='/images/ouretrouveznumero.png' /></div>">
      <svg xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink" x="0px" y="0px" viewBox="0 0 1000 1000" version="1.1" style="cursor: pointer; margin-left: 10px; width: 24px !important; ">
        <g>
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          </path>
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        </g>
      </svg>
    </span>
    <input class="form-control form-control-solid h-auto py-6 px-6 rounded-lg" data-val="true" data-val-required="Le numéro de contrat est obligatoire" id="ContractNumber" name="ContractNumber" placeholder="N° de contrat " type="text" value="">
    <span class="text-danger"><span class="field-validation-valid" data-valmsg-for="ContractNumber" data-valmsg-replace="true"></span></span>
  </div>
  <div class="pb-lg-0 pb-5">
    <button type="submit" class="btn btn-snpc btn-block font-weight-bolder font-size-h6 px-8 py-4 my-3 mr-3" style="color:white;background-color:#3c387b !important">OK </button>
    <span class="text-danger"><span class="field-validation-valid" data-valmsg-for="BadLogin" data-valmsg-replace="true"></span></span>
  </div>
  <input name="__RequestVerificationToken" type="hidden" value="CfDJ8FTAqfgxVgRCiY9MIFZS3GNkAp8Vs6gr1RIYYhNzleVm_drTZGLF7kROqxwKnKsQEOVC2WvlZKaeViSW41k1OSpYKfF34dGWrokzo9wdNocSCR95p0apmr5rrRskovI2Qs3IsLiwPSzpKcsC7YsqeEo">
</form>

Text Content

BIENVENUE SUR VOTRE ESPACE ADHÉRENT !

Merci de renseigner votre numéro de contrat
N° de contrat
OK