info.diasorin.com
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Submitted URL: https://info.diasorin.com/e3t/Ctc/WT+113/bQW-04/MWVJk-1VxTPW36ZwSY6NNRNvW91lZlN5p9rwfN5NMMmd3qgyTW7Y8-PT6lZ3lBW1gRjDK2gMgc...
Effective URL: https://info.diasorin.com/research/sales-contact-request?utm_campaign=2024%20xMAP%20Ecosystem&utm_medium=email&_hsenc=p2AN...
Submission Tags: falconsandbox
Submission: On December 05 via api from US — Scanned from PL
Effective URL: https://info.diasorin.com/research/sales-contact-request?utm_campaign=2024%20xMAP%20Ecosystem&utm_medium=email&_hsenc=p2AN...
Submission Tags: falconsandbox
Submission: On December 05 via api from US — Scanned from PL
Form analysis 1 forms found in the DOM
POST https://forms.hsforms.com/submissions/v3/public/submit/formsnext/multipart/128032/166d5e89-cf6e-4e7c-b723-d61ce908f8a4
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<div class="input"><input id="firstname-166d5e89-cf6e-4e7c-b723-d61ce908f8a4_7531" name="firstname" required="" placeholder="" type="text" class="hs-input" inputmode="text" autocomplete="given-name" value=""></div>
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for="lastname-166d5e89-cf6e-4e7c-b723-d61ce908f8a4_7531"><span>Last Name</span><span class="hs-form-required">*</span></label>
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<div class="input"><input id="lastname-166d5e89-cf6e-4e7c-b723-d61ce908f8a4_7531" name="lastname" required="" placeholder="" type="text" class="hs-input" inputmode="text" autocomplete="family-name" value=""></div>
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<div class="input"><input id="company-166d5e89-cf6e-4e7c-b723-d61ce908f8a4_7531" name="company" required="" placeholder="" type="text" class="hs-input" inputmode="text" autocomplete="organization" value=""></div>
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<legend class="hs-field-desc" style="display: none;"></legend>
<div class="input"><input id="email-166d5e89-cf6e-4e7c-b723-d61ce908f8a4_7531" name="email" required="" placeholder="" type="email" class="hs-input" inputmode="email" autocomplete="email" value=""></div>
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for="phone-166d5e89-cf6e-4e7c-b723-d61ce908f8a4_7531"><span>Phone Number</span></label>
<legend class="hs-field-desc" style="display: none;"></legend>
<div class="input"><input id="phone-166d5e89-cf6e-4e7c-b723-d61ce908f8a4_7531" name="phone" placeholder="" type="tel" class="hs-input" inputmode="tel" autocomplete="tel" value=""></div>
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for="address-166d5e89-cf6e-4e7c-b723-d61ce908f8a4_7531"><span>Street Address</span></label>
<legend class="hs-field-desc" style="display: none;"></legend>
<div class="input"><input id="address-166d5e89-cf6e-4e7c-b723-d61ce908f8a4_7531" name="address" placeholder="" type="text" class="hs-input" inputmode="text" autocomplete="address-line1" value=""></div>
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for="city-166d5e89-cf6e-4e7c-b723-d61ce908f8a4_7531"><span>City</span></label>
<legend class="hs-field-desc" style="display: none;"></legend>
<div class="input"><input id="city-166d5e89-cf6e-4e7c-b723-d61ce908f8a4_7531" name="city" placeholder="" type="text" class="hs-input" inputmode="text" autocomplete="address-level2" value=""></div>
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for="state-166d5e89-cf6e-4e7c-b723-d61ce908f8a4_7531"><span>State/Region</span></label>
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<div class="input"><input id="state-166d5e89-cf6e-4e7c-b723-d61ce908f8a4_7531" name="state" placeholder="" type="text" class="hs-input" inputmode="text" autocomplete="address-level1" value=""></div>
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<div class="input"><input id="zip-166d5e89-cf6e-4e7c-b723-d61ce908f8a4_7531" name="zip" required="" placeholder="" type="text" class="hs-input" inputmode="text" autocomplete="postal-code" value=""></div>
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for="country-166d5e89-cf6e-4e7c-b723-d61ce908f8a4_7531"><span>Country</span><span class="hs-form-required">*</span></label>
<legend class="hs-field-desc" style="display: none;"></legend>
<div class="input"><select id="country-166d5e89-cf6e-4e7c-b723-d61ce908f8a4_7531" required="" class="hs-input is-placeholder" name="country">
<option disabled="" value="">- Please Select -</option>
<option value="United States">United States</option>
<option value="Afghanistan">Afghanistan</option>
<option value="Aland Islands">Aland Islands</option>
<option value="Albania">Albania</option>
<option value="Algeria">Algeria</option>
<option value="American Samoa">American Samoa</option>
<option value="Andorra">Andorra</option>
<option value="Angola">Angola</option>
<option value="Anguilla">Anguilla</option>
<option value="Antigua and Barbuda">Antigua and Barbuda</option>
<option value="Argentina">Argentina</option>
<option value="Armenia">Armenia</option>
<option value="Aruba">Aruba</option>
<option value="Australia">Australia</option>
<option value="Austria">Austria</option>
<option value="Azerbaijan">Azerbaijan</option>
<option value="Bahamas">Bahamas</option>
<option value="Bahrain">Bahrain</option>
<option value="Bangladesh">Bangladesh</option>
<option value="Barbados">Barbados</option>
<option value="Belarus">Belarus</option>
<option value="Belgium">Belgium</option>
<option value="Belize">Belize</option>
<option value="Benin">Benin</option>
<option value="Bermuda">Bermuda</option>
<option value="Bhutan">Bhutan</option>
<option value="Bolivia">Bolivia</option>
<option value="Bonaire">Bonaire</option>
<option value="Bosnia and Herzegovina">Bosnia and Herzegovina</option>
<option value="Botswana">Botswana</option>
<option value="Bouvet Island">Bouvet Island</option>
<option value="Brazil">Brazil</option>
<option value="British Indian Ocean Territory">British Indian Ocean Territory</option>
<option value="Brunei Darussalam">Brunei</option>
<option value="Bulgaria">Bulgaria</option>
<option value="Burkina Faso">Burkina Faso</option>
<option value="Burundi">Burundi</option>
<option value="Cambodia">Cambodia</option>
<option value="Cameroon">Cameroon</option>
<option value="Canada">Canada</option>
<option value="Cape Verde">Cape Verde</option>
<option value="Cayman Islands">Cayman Islands</option>
<option value="Central African Republic">Central African Republic</option>
<option value="Chad">Chad</option>
<option value="Chile">Chile</option>
<option value="China">China</option>
<option value="Christmas Island">Christmas Island</option>
<option value="Cocos (keeling) Islands">Cocos (keeling) Islands</option>
<option value="Colombia">Colombia</option>
<option value="Comoros">Comoros</option>
<option value="Congo, The Democratic Republic of The">Congo, The Democratic Republic of The</option>
<option value="Cook Islands">Cook Islands</option>
<option value="Costa Rica">Costa Rica</option>
<option value="Cote d'Ivoire">Cote d'Ivoire</option>
<option value="Croatia">Croatia</option>
<option value="Cuba">Cuba</option>
<option value="Cyprus">Cyprus</option>
<option value="Czech Republic">Czech Republic</option>
<option value="Denmark">Denmark</option>
<option value="Djibouti">Djibouti</option>
<option value="Dominica">Dominica</option>
<option value="Dominican Republic">Dominican Republic</option>
<option value="Ecuador">Ecuador</option>
<option value="Egypt">Egypt</option>
<option value="El Salvador">El Salvador</option>
<option value="Equatorial Guinea">Equatorial Guinea</option>
<option value="Eritrea">Eritrea</option>
<option value="Estonia">Estonia</option>
<option value="Ethiopia">Ethiopia</option>
<option value="Falkland Islands (malvinas)">Falkland Islands (malvinas)</option>
<option value="Faroe Islands">Faroe Islands</option>
<option value="Fiji">Fiji</option>
<option value="Finland">Finland</option>
<option value="France">France</option>
<option value="French Guiana">French Guiana</option>
<option value="French Polynesia">French Polynesia</option>
<option value="French Southern Territories">French Southern Territories</option>
<option value="Gabon">Gabon</option>
<option value="Gambia">Gambia</option>
<option value="Georgia">Georgia</option>
<option value="Germany">Germany</option>
<option value="Ghana">Ghana</option>
<option value="Gibraltar">Gibraltar</option>
<option value="Greece">Greece</option>
<option value="Grenada">Grenada</option>
<option value="Guadeloupe">Guadeloupe</option>
<option value="Guam">Guam</option>
<option value="Guatemala">Guatemala</option>
<option value="Guernsey">Guernsey</option>
<option value="Guinea">Guinea</option>
<option value="Guinea-Bissau">Guinea-Bissau</option>
<option value="Guyana">Guyana</option>
<option value="Haiti">Haiti</option>
<option value="Heard Island and Mcdonald Islands">Heard Island and Mcdonald Islands</option>
<option value="Holy See (Vatican City State)">Holy See (Vatican City State)</option>
<option value="Honduras">Honduras</option>
<option value="Hong Kong">Hong Kong</option>
<option value="Hungary">Hungary</option>
<option value="Iceland">Iceland</option>
<option value="India">India</option>
<option value="Indonesia">Indonesia</option>
<option value="Iran, Islamic Republic of">Iran, Islamic Republic of</option>
<option value="Iraq">Iraq</option>
<option value="Ireland">Ireland</option>
<option value="Isle of Man">Isle of Man</option>
<option value="Israel">Israel</option>
<option value="Italy">Italy</option>
<option value="Jamaica">Jamaica</option>
<option value="Japan">Japan</option>
<option value="Jersey">Jersey</option>
<option value="Jordan">Jordan</option>
<option value="Kazakhstan">Kazakhstan</option>
<option value="Kenya">Kenya</option>
<option value="Kiribati">Kiribati</option>
<option value="Korea, Democratic People's Republic of">Korea, Democratic People's Republic of</option>
<option value="Korea, Republic of">Korea, Republic of</option>
<option value="Kosovo">Kosovo</option>
<option value="Kuwait">Kuwait</option>
<option value="Kyrgyzstan">Kyrgyzstan</option>
<option value="Lao People's Democratic Republic">Lao People's Democratic Republic</option>
<option value="Latvia">Latvia</option>
<option value="Lebanon">Lebanon</option>
<option value="Lesotho">Lesotho</option>
<option value="Liberia">Liberia</option>
<option value="Libya">Libya</option>
<option value="Liechtenstein">Liechtenstein</option>
<option value="Lithuania">Lithuania</option>
<option value="Luxembourg">Luxembourg</option>
<option value="Macau">Macau</option>
<option value="Macedonia, Republic of North">Macedonia, Republic of North</option>
<option value="Madagascar">Madagascar</option>
<option value="Malawi">Malawi</option>
<option value="Malaysia">Malaysia</option>
<option value="Maldives">Maldives</option>
<option value="Mali">Mali</option>
<option value="Malta">Malta</option>
<option value="Marshall Islands">Marshall Islands</option>
<option value="Martinique">Martinique</option>
<option value="Mauritania">Mauritania</option>
<option value="Mauritius">Mauritius</option>
<option value="Mayotte">Mayotte</option>
<option value="Mexico">Mexico</option>
<option value="Micronesia, Federated States of">Micronesia, Federated States of</option>
<option value="Moldova, Republic of">Moldova, Republic of</option>
<option value="Monaco">Monaco</option>
<option value="Mongolia">Mongolia</option>
<option value="Montenegro">Montenegro</option>
<option value="Montserrat">Montserrat</option>
<option value="Morocco">Morocco</option>
<option value="Mozambique">Mozambique</option>
<option value="Myanmar">Myanmar</option>
<option value="Namibia">Namibia</option>
<option value="Nauru">Nauru</option>
<option value="Nepal">Nepal</option>
<option value="Netherlands">Netherlands</option>
<option value="New Caledonia">New Caledonia</option>
<option value="New Zealand">New Zealand</option>
<option value="Nicaragua">Nicaragua</option>
<option value="Niger">Niger</option>
<option value="Nigeria">Nigeria</option>
<option value="Niue">Niue</option>
<option value="Norfolk Island">Norfolk Island</option>
<option value="Northern Mariana Islands">Northern Mariana Islands</option>
<option value="Norway">Norway</option>
<option value="Oman">Oman</option>
<option value="Pakistan">Pakistan</option>
<option value="Palau">Palau</option>
<option value="Palestine, State of">Palestine, State of</option>
<option value="Panama">Panama</option>
<option value="Papua New Guinea">Papua New Guinea</option>
<option value="Paraguay">Paraguay</option>
<option value="Peru">Peru</option>
<option value="Philippines">Philippines</option>
<option value="Pitcairn">Pitcairn</option>
<option value="Poland">Poland</option>
<option value="Portugal">Portugal</option>
<option value="Puerto Rico">Puerto Rico</option>
<option value="Qatar">Qatar</option>
<option value="Reunion">Reunion</option>
<option value="Romania">Romania</option>
<option value="Russian Federation">Russian Federation</option>
<option value="Rwanda">Rwanda</option>
<option value="Saint Barthélemy">Saint Barthélemy</option>
<option value="Saint Helena">Saint Helena</option>
<option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option>
<option value="Saint Lucia">Saint Lucia</option>
<option value="Saint Martin (French Part)">Saint Martin</option>
<option value="Saint Pierre and Miquelon">Saint Pierre and Miquelon</option>
<option value="Saint Vincent and The Grenadines">Saint Vincent and The Grenadines</option>
<option value="Samoa">Samoa</option>
<option value="San Marino">San Marino</option>
<option value="Sao Tome and Principe">Sao Tome and Principe</option>
<option value="Saudi Arabia">Saudi Arabia</option>
<option value="Senegal">Senegal</option>
<option value="Serbia">Serbia</option>
<option value="Seychelles">Seychelles</option>
<option value="Sierra Leone">Sierra Leone</option>
<option value="Singapore">Singapore</option>
<option value="Slovakia">Slovakia</option>
<option value="Slovenia">Slovenia</option>
<option value="Solomon Islands">Solomon Islands</option>
<option value="Somalia">Somalia</option>
<option value="South Africa">South Africa</option>
<option value="South Georgia and The South Sandwich Islands">South Georgia and The South Sandwich Islands</option>
<option value="South Sudan">South Sudan</option>
<option value="Spain">Spain</option>
<option value="Sri Lanka">Sri Lanka</option>
<option value="Sudan">Sudan</option>
<option value="Suriname">Suriname</option>
<option value="Svalbard and Jan Mayen">Svalbard and Jan Mayen</option>
<option value="Swaziland">Swaziland</option>
<option value="Sweden">Sweden</option>
<option value="Switzerland">Switzerland</option>
<option value="Syrian Arab Republic">Syria</option>
<option value="Taiwan">Taiwan</option>
<option value="Tajikistan">Tajikistan</option>
<option value="Tanzania, United Republic of">Tanzania, United Republic of</option>
<option value="Thailand">Thailand</option>
<option value="Timor-Leste">Timor-Leste</option>
<option value="Togo">Togo</option>
<option value="Tokelau">Tokelau</option>
<option value="Tonga">Tonga</option>
<option value="Trinidad and Tobago">Trinidad and Tobago</option>
<option value="Tunisia">Tunisia</option>
<option value="Turkey">Turkey</option>
<option value="Turkmenistan">Turkmenistan</option>
<option value="Turks and Caicos Islands">Turks and Caicos Islands</option>
<option value="Tuvalu">Tuvalu</option>
<option value="Uganda">Uganda</option>
<option value="Ukraine">Ukraine</option>
<option value="United Arab Emirates">United Arab Emirates</option>
<option value="United Kingdom">United Kingdom</option>
<option value="United States Minor Outlying Islands">United States Minor Outlying Islands</option>
<option value="Uruguay">Uruguay</option>
<option value="Uzbekistan">Uzbekistan</option>
<option value="Vanuatu">Vanuatu</option>
<option value="Venezuela">Venezuela</option>
<option value="Viet Nam">Viet Nam</option>
<option value="Virgin Islands, British">Virgin Islands, British</option>
<option value="Virgin Islands, U.S.">Virgin Islands, U.S.</option>
<option value="Wallis and Futuna">Wallis and Futuna</option>
<option value="Western Sahara">Western Sahara</option>
<option value="Yemen">Yemen</option>
<option value="Zambia">Zambia</option>
<option value="Zimbabwe">Zimbabwe</option>
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<div class="hs_comments_from_customer__c hs-comments_from_customer__c hs-fieldtype-textarea field hs-form-field"><label id="label-comments_from_customer__c-166d5e89-cf6e-4e7c-b723-d61ce908f8a4_7531" class=""
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<legend class="hs-field-desc" style="display: none;"></legend>
<div class="input"><textarea id="comments_from_customer__c-166d5e89-cf6e-4e7c-b723-d61ce908f8a4_7531" class="hs-input hs-fieldtype-textarea" name="comments_from_customer__c" required="" placeholder=""></textarea></div>
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<fieldset class="form-columns-1">
<div class="hs_current_customer__c hs-current_customer__c hs-fieldtype-booleancheckbox field hs-form-field">
<legend class="hs-field-desc" style="display: none;"></legend>
<div class="input">
<ul class="inputs-list">
<li class="hs-form-booleancheckbox"><label for="current_customer__c-166d5e89-cf6e-4e7c-b723-d61ce908f8a4_7531" class="hs-form-booleancheckbox-display"><input id="current_customer__c-166d5e89-cf6e-4e7c-b723-d61ce908f8a4_7531"
class="hs-input" type="checkbox" name="current_customer__c" value="true"><span>I am already a Luminex customer.</span></label></li>
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<fieldset class="form-columns-1">
<div class="hs_wants_sales_rep__c hs-wants_sales_rep__c hs-fieldtype-booleancheckbox field hs-form-field" style="display: none;">
<legend class="hs-field-desc" style="display: none;"></legend>
<div class="input"><input name="wants_sales_rep__c" class="hs-input" type="hidden" value="true"></div>
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<div class="hs_market_segment__c hs-market_segment__c hs-fieldtype-checkbox field hs-form-field" style="display: none;"><label id="label-market_segment__c-166d5e89-cf6e-4e7c-b723-d61ce908f8a4_7531" class="" placeholder="Enter your Market Segment"
for="market_segment__c-166d5e89-cf6e-4e7c-b723-d61ce908f8a4_7531"><span>Market Segment</span></label>
<legend class="hs-field-desc" style="display: none;"></legend>
<div class="input"><input name="market_segment__c" class="hs-input" type="hidden" value="Licensed Technology Group"></div>
</div>
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