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Form analysis
1 forms found in the DOM

POST welcome.php

<form class="form-horizontal well " id="usr_form" role="form" method="post" action="welcome.php" style="margin-bottom: 1rem;margin-top: 0rem;" autocomplete="off">
  <div class="form-group" style="margin-bottom: 5px;">
    <div class="col-sm-12">
      <h2 style="font-weight: 600;text-align: center;font-size: 22px;margin-top: 0px;margin-bottom: 15px;"> USER LOGIN</h2>
    </div>
  </div>
  <div class="form-group" style="margin-bottom: 0px;">
    <div class="col-sm-12">
      <div class="inner-addon ">
        <select class="form-control" name="medicine" id="medicine">
          <option value="Medecine">Medecine </option>
          <option value="Infirmier">Infirmier</option>
          <option value="pharmacy">Pharmacy</option>
        </select>
      </div>
    </div>
    <div class="col-sm-12">
      <div class="inner-addon left-addon">
        <input type="text" name="username" id="username" class="form-control" placeholder="Name*" required="" autocomplete="off">
        <span id="lblError" class="help-block"></span>
      </div>
    </div>
    <div class="col-sm-12">
      <div class="inner-addon left-addon">
        <input type="text" name="city" id="city" class="form-control" placeholder="Nom du délégué qui vous rencontre" autocomplete="off" style="display: none;">
      </div>
    </div>
    <div class="inner-addon left-addon">
      <input type="text" name="mobile" id="mobile" required="" class="form-control" placeholder="Mobile*" pattern="[0-9]*" inputmode="numeric" autocomplete="off">
    </div>
    <div class="col-sm-12">
      <div class="inner-addon ">
        <select class="form-control" name="zone" id="zone" style="display: none;">
          <option value="localisation" selected="" disabled=""> localisation </option>
          <option value="Kinshasa"> Kinshasa</option>
          <option value="Kimpese"> Kimpese</option>
          <option value="Mbanza-Ngungu"> Mbanza-Ngungu</option>
          <option value="Matadi"> Matadi</option>
          <option value="Kinzau"> Kinzau</option>
          <option value="Boma"> Boma</option>
          <option value="Moanda"> Moanda</option>
          <option value="Lubumbashi"> Lubumbashi</option>
          <option value="Fungrume"> Fungrume</option>
          <option value="Kasumbalesa"> Kasumbalesa</option>
          <option value="Likasi"> Likasi</option>
          <option value="Kolwezi"> Kolwezi</option>
          <option value="Kisangani"> Kisangani</option>
          <option value="Isiro"> Isiro</option>
          <option value="Durba"> Durba</option>
          <option value="Bunia"> Bunia</option>
          <option value="Mbandaka"> Mbandaka</option>
          <option value="Bandundu">Bandundu</option>
          <option value="Kananga"> Kananga</option>
          <option value="Mbuji Mbuji">Mbuji Mayi</option>
          <option value="Kenge"> Kenge</option>
          <option value="Kikwit"> Kikwit</option>
          <option value="Tshikapa"> Tshikapa</option>
          <option value="Goma"> Goma</option>
          <option value="Bukavu"> Bukavu</option>
          <option value="Butembo"> Butembo</option>
          <option value="Kindu"> Kindu</option>
          <option value="Ouvira"> Ouvira</option>
          <option value="Beni"> Beni</option>
          <option value="Kalemie"> Kalemie</option>
          <option value="Bumba"> Bumba</option>
        </select>
      </div>
    </div>
    <div class="col-sm-12">
      <div class="inner-addon left-addon">
        <input type="text" name="location" id="location" class="form-control" placeholder="Nom du delegue" autocomplete="off">
      </div>
    </div>
    <div class="col-sm-12">
      <!-- <div class="inner-addon left-addon">
                <img class="glyphicon " id="emailicon" src="images/email.png">
                  <input type="email" name="email" id="email" class="form-control" placeholder="Email " autocomplete="off">
                </div>

                <div class="inner-addon left-addon">
                  <img class="glyphicon " id="mobileicon" src="images/smartphone.png">
                  <input type="text" name="mobile" id="mobile" class="form-control" placeholder="Mobile " autocomplete="off">
                </div>
                -->
      <div class="inner-addon left-addon">
        <input type="email" name="email" id="email" class="form-control" placeholder="Email" autocomplete="off" style="display: none;">
      </div>
      <div class="inner-addon left-addon">
        <input type="password" name="pwd" id="pwd" required="" class="form-control" placeholder="Password*" autocomplete="off">
      </div>
    </div>
    <div align="center">
      <strong style="color:red"></strong>
    </div>
    <div align="center">
      <button class="nwstl" type="submit" name="reg_user" id="reg_user"> Soumettre </button>
    </div>
    <div class="col-sm-12">
      <div class="inner-addon left-addon">
        <div align="center" id="pwdicon_text" name="pwdicon_text">
          <h5>Mot de passe: daviclav</h5>
        </div>
      </div>
    </div>
  </div>
</form>

Text Content

USER LOGIN

Medecine Infirmier Pharmacy



localisation Kinshasa Kimpese Mbanza-Ngungu Matadi Kinzau Boma Moanda Lubumbashi
Fungrume Kasumbalesa Likasi Kolwezi Kisangani Isiro Durba Bunia Mbandaka
Bandundu Kananga Mbuji Mayi Kenge Kikwit Tshikapa Goma Bukavu Butembo Kindu
Ouvira Beni Kalemie Bumba



Soumettre

MOT DE PASSE: DAVICLAV