virusverzekeringen.nl Open in urlscan Pro
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Form analysis
1 forms found in the DOM

POST index.php#form

<form id="contact-form" action="index.php#form" method="post" enctype="multipart/form-data">
  <div class="row">
    <div class="col-lg-6">
      <div class="contact_input_container contact_input_container_4"><img src="images/check-agreed.jpg" width="30" height="28" alt="Interesse / prijs op site is 1.500 euro / equivalent in crypto">Ja, ik heb interesse in deze
        domeinnaam.<br>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Neem contact met me op.<br><br>
      </div>
    </div>
    <div class="col-lg-6">
      <div class="contact_input_container contact_input_container_4">
        <select class="contact_input" placeholder="Je valuta" name="your_currency">
          <option style="width: 190px" value="Kies">Kies te betalen valuta</option>
          <option style="width: 190px" value="Euro" selected="">Valuta: Euro ( of selecteer hier crypto)</option>
          <option style="width: 190px" value="Bitcoin">Bitcoin (BTC)</option>
          <option style="width: 190px" value="Ethereum">Ethereum (ETH)</option>
          <option style="width: 190px" value="LiteCoin">LiteCoin (LTC)</option>
          <option style="width: 190px" value="Ripple">Ripple (XRP)</option>
          <option style="width: 190px" value="Shiba Inu">Shiba Inu (SHIB)</option>
          <option style="width: 190px" value="Doge">Dogecoin (DOGE)</option>
        </select>
      </div>
    </div>
    <div class="col-lg-6">
      <div class="contact_input_container contact_input_container_4">
        <input type="text" class="contact_input" placeholder="Je naam" name="your_name">
      </div>
    </div>
    <div class="col-lg-6">
      <div class="contact_input_container contact_input_container_4">
        <input type="email" class="contact_input" placeholder="Je emailadres" name="your_email">
      </div>
    </div>
    <div class="col-lg-6">
      <div class="contact_input_container contact_input_container_4">Ter voorkoming van spambots, wat is&nbsp;9 + 5&nbsp;? <input type="text" name="user_answer" class="contact_input" placeholder="Antwoord..."><input type="hidden" name="answer"
          value="38922bcc25"></div>
    </div>
    <div class="col-lg-6">
      <div class="contact_input_container contact_input_container_4"> Ruimte voor<br>
        <input type="text" class="contact_input" placeholder="Vraag, opmerking of aanvullende info..." name="your_info">
      </div>
    </div>
  </div>
  <div>
    <button class="contact_button button submit" type="submit" name="contact_submitted">Verstuur!</button>
  </div>
</form>

Text Content

Beschikbaar: virusverzekeringen.nl
Interesse in virusverzekeringen.nl ?

Prijs voor virusverzekeringen.nl : 1.500 euro (of dezelfde waarde in crypto).
Betaal je liever in crypto dan in euro? We accepteren naast de euro de volgende
cryptovaluta:
BTC (Bitcoin), ETH (Ethereum), LTC (Litecoin), XRP (Ripple), SHIB (Shiba Inu) &
DOGE (Dogecoin).  


Ja, ik heb interesse in deze domeinnaam.
        Neem contact met me op.


Kies te betalen valuta Valuta: Euro ( of selecteer hier crypto) Bitcoin (BTC)
Ethereum (ETH) LiteCoin (LTC) Ripple (XRP) Shiba Inu (SHIB) Dogecoin (DOGE)


Ter voorkoming van spambots, wat is 9 + 5 ?
Ruimte voor

Verstuur!

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