www.b2biogenics.com Open in urlscan Pro
86.105.245.69  Public Scan

Form analysis
1 forms found in the DOM

POST routes/ajax_actions/landing_themes/add_inquiry_cap.ajaxa.php

<form action="routes/ajax_actions/landing_themes/add_inquiry_cap.ajaxa.php" method="post" class="odf_ajax" data-target="form_feedback" autocomplete="off" id="contact_form">
  <input type="hidden" name="domain_id" value="639000">
  <input type="hidden" name="user_id" value="2891">
  <div id="form_feedback">
  </div>
  <div class="row">
    <div class="col-sm-6">
      <div class="form-group row mb-2">
        <label for="name" class="col-sm-3 col-form-label">Name</label>
        <div class="col-sm-9">
          <input type="text" name="name" id="name" autocomplete="off" class="form-control" required="">
        </div>
      </div>
    </div>
    <div class="col-sm-6">
      <div class="form-group row mb-2">
        <label for="email" class="col-sm-3 col-form-label">Email</label>
        <div class="col-sm-9">
          <input type="email" name="email" id="email" autocomplete="off" class="form-control" required="">
        </div>
      </div>
    </div>
  </div>
  <div class="row">
    <div class="col-sm-6">
      <div class="form-group row mb-2">
        <label for="phone" class="col-sm-3 col-form-label">Phone</label>
        <div class="col-sm-9">
          <input type="text" name="phone" id="phone" autocomplete="off" class="form-control" required="">
        </div>
      </div>
    </div>
    <div class="col-sm-6">
      <div class="form-group row mb-2">
        <label for="name" class="col-sm-3 col-form-label">Offer</label>
        <div class="col-sm-9">
          <input type="text" placeholder="Offer in USD" name="offer" id="offer" autocomplete="off" class="form-control" required="">
        </div>
      </div>
    </div>
  </div>
  <div class="row">
    <div class="col-sm-12">
      <label for="name" class="col-sm-2 pl-0 col-form-label">Message</label>
      <textarea class="form-control" name="message" rows="3" autocomplete="off" required=""></textarea>
    </div>
  </div>
  <div class="form-group row mb-0 mt-2">
    <div class="col-sm-8">
      <div class="g-recaptcha" data-sitekey="6LfLJxMTAAAAACSYGZUH0OCGhnoq50xexhkAGCe7" style="">
        <div style="width: 304px; height: 78px;">
          <div><iframe title="reCAPTCHA"
              src="https://www.google.com/recaptcha/api2/anchor?ar=1&amp;k=6LfLJxMTAAAAACSYGZUH0OCGhnoq50xexhkAGCe7&amp;co=aHR0cHM6Ly93d3cuYjJiaW9nZW5pY3MuY29tOjQ0Mw..&amp;hl=en&amp;v=Km9gKuG06He-isPsP6saG8cn&amp;size=normal&amp;cb=oikg4bu6mafr"
              width="304" height="78" role="presentation" name="a-bdlqnk9lu888" frameborder="0" scrolling="no"
              sandbox="allow-forms allow-popups allow-same-origin allow-scripts allow-top-navigation allow-modals allow-popups-to-escape-sandbox"></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>
    <div class="col-sm-4 text-right">
      <input type="submit" class="btn btn-lg btn-primary mt-1 pl-4 pr-4" value="&nbsp;&nbsp;&nbsp;Send">
    </div>
  </div>
</form>

Text Content

B2BIOGENICS.COM




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