lt01.labina24.de Open in urlscan Pro
167.233.10.34  Public Scan

Form analysis
1 forms found in the DOM

POST /

<form class="plineccf" action="/" method="post" enctype="multipart/form-data">
  <select id="plineccf-salutation" name="plineccf-salutation" class="select" value="">
    <option selected="selected" disabled="disabled" value="">Title*</option>
    <option value="Herr">Mr</option>
    <option value="Frau">Mrs</option>
  </select>
  <input type="text" id="plineccf-firm" name="plineccf-firm" class="input-text" placeholder="Company name" value="">
  <label for="plineccf-attachment">Business License</label>
  <input type="file" name="plineccf-attachment" class="file-upload form-control" accept="image/*,.pdf">
  <input type="text" id="plineccf-fname" name="plineccf-fname" class="input-text" placeholder="First name*" required="" value="">
  <input type="text" id="plineccf-lname" name="plineccf-lname" class="input-text" placeholder="Surname*" required="" value="">
  <input type="text" id="plineccf-street" name="plineccf-street" class="input-text" placeholder="Street and house number*" required="" value="">
  <input type="text" id="plineccf-postcode" name="plineccf-postcode" class="input-text" placeholder="Postcode*" required="" value="">
  <input type="text" id="plineccf-city" name="plineccf-city" class="input-text" placeholder="City*" required="" value="">
  <input type="text" id="plineccf-instagram" name="plineccf-instagram" class="input-text" placeholder="Instagram" value="">
  <input type="text" id="plineccf-facebook" name="plineccf-facebook" class="input-text" placeholder="Facebook" value="">
  <input type="text" id="plineccf-website" name="plineccf-website" class="input-text" placeholder="Website" value="">
  <input type="email" id="plineccf-email" name="plineccf-email" class="input-text" placeholder="Email address*" required="" value="">
  <input type="text" id="plineccf-phone" name="plineccf-phone" class="input-text" placeholder="Phone number*" required="" value="">
  <textarea rows="10" cols="35" id="plineccf-shade-selection" name="plineccf-shade-selection" placeholder="I would like to test the following*" required="" class="input-text-area"></textarea>
  <div class="data-protection">
    <input type="checkbox" id="plineccf-dataprotection" class="input-check" name="plineccf-dataprotection" required="">
    <label for="plineccf-dataprotection" class="label-check">Data privacy statement*</label>
  </div>
  <p class="form-description dataprotection">I understand and accept the data privacy statement: You can read the statement at https://www.labina24.de/en/Legal/Data-protection/</p><br>
  <p class="form-description form-required">The fields marked with * are required.</p>
  <div class="g-recaptcha" data-sitekey="6LcJhTskAAAAAHJkgXzo-x5z09v-MD9r6fPGu1L2">
    <div style="width: 304px; height: 78px;">
      <div><iframe title="reCAPTCHA" width="304" height="78" role="presentation" name="a-h67col983nsz" frameborder="0" scrolling="no"
          sandbox="allow-forms allow-popups allow-same-origin allow-scripts allow-top-navigation allow-modals allow-popups-to-escape-sandbox allow-storage-access-by-user-activation"
          src="https://www.google.com/recaptcha/api2/anchor?ar=1&amp;k=6LcJhTskAAAAAHJkgXzo-x5z09v-MD9r6fPGu1L2&amp;co=aHR0cHM6Ly9sdDAxLmxhYmluYTI0LmRlOjQ0Mw..&amp;hl=de&amp;v=rKbTvxTxwcw5VqzrtN-ICwWt&amp;size=normal&amp;cb=fdmi84uwt1ag"></iframe>
      </div><textarea id="g-recaptcha-response" name="g-recaptcha-response" class="g-recaptcha-response"
        style="width: 250px; height: 40px; border: 1px solid rgb(193, 193, 193); margin: 10px 25px; padding: 0px; resize: none; display: none;"></textarea>
    </div><iframe style="display: none;"></iframe>
  </div>
  <div id="error-message" class="error-message"></div>
  <div class="button-wrap">
    <input class="required submit-button" type="submit" name="plineccf-submitted" value="Send">
  </div>
</form>

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Title* Mr Mrs Business License
Data privacy statement*

I understand and accept the data privacy statement: You can read the statement
at https://www.labina24.de/en/Legal/Data-protection/


The fields marked with * are required.