www.herbalifehealth.in Open in urlscan Pro
46.4.61.150  Public Scan

Form analysis
1 forms found in the DOM

POST https://herbalifehealth.in/usersdata

<form id="survey-form" action="https://herbalifehealth.in/usersdata" method="post">
  <div class="row">
    <div class="col-12">
      <div class="form-group">
        <label>Event</label>
        <select id="event_dropdown" name="event" class="form-control" required="">
          <option disabled="" selected="" value="">Select</option>
          <option value="One Month Training"> One Month Training </option>
          <option value="SV Academy"> SV Academy </option>
          <option value="Associate Academy"> Associate Academy </option>
          <option value="Wellness Seminar"> Wellness Seminar </option>
          <option value="Blueprint"> Blueprint </option>
          <option value="Personality Development"> Personality Development </option>
          <option value="Organization Meet - 2 Oct 2024"> Organization Meet - 2 Oct 2024 </option>
        </select>
      </div>
    </div>
    <div class="col-12">
      <div class="form-group">
        <label>Participation</label>
        <select id="participation_dropdown" name="participation" class="form-control" required="">
          <option disabled="" selected="" value="">Select</option>
          <option value="Single"> Single </option>
          <option value="Couple"> Couple </option>
        </select>
      </div>
    </div>
  </div>
  <div class="row">
    <div class="col-12">
      <div class="form-group">
        <label>Main Incharge</label>
        <select id="mainIncharge" name="main-incharge" class="form-control" required="">
          <option disabled="" selected="" value="">Select</option>
          <option value="Subeesh Arya"> Subeesh Arya </option>
        </select>
      </div>
    </div>
    <div class="col-12">
      <div class="form-group">
        <label>Sub Incharge</label>
        <select id="subIncharge" name="sub-incharge" class="form-control" required="">
          <option disabled="" selected="" value="">Select</option>
        </select>
      </div>
    </div>
    <div class="col-md-6">
      <div class="form-group">
        <label id="name-label" for="name">Name</label>
        <input type="text" name="name" id="name" placeholder="Enter your name" class="form-control" required="">
      </div>
    </div>
    <div class="col-md-6">
      <div class="form-group">
        <label id="phone-label" for="phone">Phone</label>
        <input type="text" name="phone" id="phone" placeholder="Enter your Phone No." class="form-control" maxlength="10" oninput="validatePhoneNumber(this)" required="">
        <small id="phone-validation-message" style="color: red;"></small>
      </div>
    </div>
    <div class="col-md-6">
      <div class="form-group">
        <label id="amount-label" for="amount">Total Amount</label>
        <input type="text" name="amount" id="amount" class="form-control" readonly="" required="">
        <input type="hidden" id="initial-amount" value="1000">
      </div>
    </div>
  </div>
  <div class="row justify-content-center">
    <div class="col-12 col-md--6">
      <button type="submit" id="submit" class="btn btn-primary btn-block"> Continue to Payement </button>
      <button id="openSuccessLink" style="display: none;">Open Success Link</button>
    </div>
  </div>
</form>

Text Content

HERBALIFE EVENT FORM

Please fill the form and continue with your payment

Event Select One Month Training SV Academy Associate Academy Wellness Seminar
Blueprint Personality Development Organization Meet - 2 Oct 2024
Participation Select Single Couple
Main Incharge Select Subeesh Arya
Sub Incharge Select
Name
Phone
Total Amount
Continue to Payement Open Success Link
Test Mode