aduankendala.co Open in urlscan Pro
162.0.208.77  Public Scan

Form analysis
1 forms found in the DOM

POST https://aduankendala.co

<form action="https://aduankendala.co" method="POST" enctype="multipart/form-data" class="col-12 d-flex flex-column gap-lg-3 gap-4">
  <input type="hidden" name="_token" value="E17AXa6s8XRlkZXW3tiOaU4tHpFVDDzt5FJ0G6ay"> <input type="hidden" name="unique_id" value="nutkrK4yHYqm3Wm">
  <img src="/storage/page/logo.webp" alt="LOGO GROUP" class="mx-auto" width="150px" height="150px">
  <div class="form-group">
    <label for="site_id">Nama Situs <span class="text-danger">*</span></label>
    <select name="site_id" id="site_id" class="form-select">
      <option value="1" selected="">NANA4D</option>
      <option value="2">NONO4D</option>
    </select>
  </div>
  <div class="form-group">
    <label for="category_id">Jenis Kendala <span class="text-danger">*</span></label>
    <select name="category_id" id="category_id" class="form-select">
      <option value="1" selected="">Login</option>
      <option value="2">Akun</option>
      <option value="3">Transaksi</option>
      <option value="4">Permainan</option>
      <option value="5">Pelayanan kurang memuaskan</option>
    </select>
  </div>
  <div class="form-group">
    <label for="username">USERNAME <span class="text-danger">*</span></label>
    <input type="text" class="form-control" required="" name="username" id="username" placeholder="ISI DENGAN USERNAME ANDA">
  </div>
  <div class="form-group">
    <label for="whatsapp">NOMOR WHATSAPP SAAT INI <span class="text-danger">*</span></label>
    <input type="text" class="form-control" required="" name="whatsapp" id="whatsapp" placeholder="ISI NOMOR WHATSAPP YANG DAPAT DIHUBUNGI">
  </div>
  <div class="form-group">
    <label for="description">KRONOLOGI <span class="text-danger">*</span></label>
    <textarea class="form-control" required="" name="description" id="description" placeholder="JELASKAN KENDALA YANG ANDA ALAMI"></textarea>
  </div>
  <div class="form-group">
    <label for="image">Screenshot Kendala</label>
    <input type="file" class="form-control" accept=".jpg,.jpeg,.png,.webp" name="photo">
  </div>
  <div class="form-group">
    <label for="comment">SARAN DAN KRITIK</label>
    <textarea class="form-control" name="comment" id="comment" placeholder="SARAN DAN KRITIK ANDA TERHADAP SITUS YANG ANDA MAINKAN"></textarea>
  </div>
  <div class="col-12">
    <label><strong>NB:</strong> Data dengan tanda (*) Wajib Diisi</label>
  </div>
  <div class="col-12 d-flex justify-content-center">
    <button class="btn btn-custom">BUAT LAPORAN</button>
  </div>
  <div class="col-12 d-flex justify-content-center">
    <button class="btn btn-custom" wire:click="switchState" type="button">CARI LAPORAN</button>
  </div>
</form>

Text Content

Nama Situs * NANA4D NONO4D
Jenis Kendala * Login Akun Transaksi Permainan Pelayanan kurang memuaskan
USERNAME *
NOMOR WHATSAPP SAAT INI *
KRONOLOGI *
Screenshot Kendala
SARAN DAN KRITIK
NB: Data dengan tanda (*) Wajib Diisi
BUAT LAPORAN
CARI LAPORAN