loyalty.htp.com.bh Open in urlscan Pro
192.254.188.95  Public Scan

Form analysis
1 forms found in the DOM

POST /CustomerRegistration.php

<form method="post" action="/CustomerRegistration.php">
  <label for="first_name">First Name: <input type="text" id="first_name" name="first_name" value="">
    <span class="error"></span>
  </label>
  <label for="last_name">Last Name: <input type="text" id="last_name" name="last_name" value="">
    <span class="error"></span>
  </label>
  <label for="dob">Date of Birth: <input type="date" id="dob" name="dob" value="">
    <span class="error"></span>
  </label>
  <label for="gender">Gender: <select id="gender" name="gender">
      <option value="" disabled="" selected="">Select your gender</option>
      <option value="Male">Male</option>
      <option value="Female">Female</option>
    </select>
    <span class="error"></span>
  </label>
  <label for="phone">Phone Number: <input type="text" id="phone" name="phone" value="">
    <span class="error"></span>
  </label>
  <label for="email">Email: <input type="email" id="email" name="email" value="">
    <span class="error"></span>
  </label>
  <label for="country">Country: <input type="text" id="country" name="country" value="">
    <span class="error"></span>
  </label>
  <input type="submit" value="Submit">
</form>

Text Content

CUSTOMER REGISTRATION

First Name: Last Name: Date of Birth: Gender: Select your gender Male Female
Phone Number: Email: Country: