testgravityform.shafiqulimasum.com
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192.110.165.157
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URL:
https://testgravityform.shafiqulimasum.com/
Submission: On June 19 via api from US — Scanned from DE
Submission: On June 19 via api from US — Scanned from DE
Form analysis 3 forms found in the DOM
Name: New Form — POST
<form class="elementor-form" method="post" name="New Form">
<input type="hidden" name="post_id" value="11">
<input type="hidden" name="form_id" value="04f2e63">
<input type="hidden" name="referer_title" value="">
<input type="hidden" name="queried_id" value="11">
<div class="elementor-form-fields-wrapper elementor-labels-above">
<div class="elementor-field-type-text elementor-field-group elementor-column elementor-field-group-fname elementor-col-50">
<label for="form-field-fname" class="elementor-field-label"> F Name </label>
<input size="1" type="text" name="form_fields[fname]" id="form-field-fname" class="elementor-field elementor-size-sm elementor-field-textual" placeholder="F Name">
</div>
<div class="elementor-field-type-text elementor-field-group elementor-column elementor-field-group-lname elementor-col-50">
<label for="form-field-lname" class="elementor-field-label"> L Name </label>
<input size="1" type="text" name="form_fields[lname]" id="form-field-lname" class="elementor-field elementor-size-sm elementor-field-textual" placeholder="L Name">
</div>
<div class="elementor-field-type-email elementor-field-group elementor-column elementor-field-group-email elementor-col-100 elementor-field-required">
<label for="form-field-email" class="elementor-field-label"> Email </label>
<input size="1" type="email" name="form_fields[email]" id="form-field-email" class="elementor-field elementor-size-sm elementor-field-textual" placeholder="Email" required="required" aria-required="true">
</div>
<div class="elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-message elementor-col-100">
<label for="form-field-message" class="elementor-field-label"> Message </label>
<textarea class="elementor-field-textual elementor-field elementor-size-sm" name="form_fields[message]" id="form-field-message" rows="4" placeholder="Message"></textarea>
</div>
<div class="elementor-field-group elementor-column elementor-field-type-submit elementor-col-25 e-form__buttons">
<button type="submit" class="elementor-button elementor-size-sm">
<span>
<span class=" elementor-button-icon">
</span>
<span class="elementor-button-text">Send</span>
</span>
</button>
</div>
</div>
</form>POST /#gf_3
<form method="post" enctype="multipart/form-data" id="gform_3" action="/#gf_3" data-formid="3" novalidate="">
<div id="gf_progressbar_wrapper_3" class="gf_progressbar_wrapper" data-start-at-zero="">
<p class="gf_progressbar_title">Step <span class="gf_step_current_page">1</span> of <span class="gf_step_page_count">3</span>
</p>
<div class="gf_progressbar gf_progressbar_blue" aria-hidden="true">
<div class="gf_progressbar_percentage percentbar_blue percentbar_33" style="width:33%;"><span>33%</span></div>
</div>
</div>
<div class="gform-body gform_body">
<div id="gform_page_3_1" class="gform_page " data-js="page-field-id-1">
<div class="gform_page_fields">
<div id="gform_fields_3" class="gform_fields top_label form_sublabel_below description_below validation_below">
<div id="field_3_1" class="gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_3_1"><label
class="gfield_label gform-field-label" for="input_3_1">Name</label>
<div class="ginput_container ginput_container_text"><input name="input_1" id="input_3_1" type="text" value="" class="large" aria-invalid="false"> </div>
</div>
<div id="field_3_9" class="gfield gfield--type-phone gfield--input-type-phone gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"
data-js-reload="field_3_9"><label class="gfield_label gform-field-label" for="input_3_9">Phone</label>
<div class="ginput_container ginput_container_phone"><input name="input_9" id="input_3_9" type="tel" value="" class="large" aria-invalid="false"></div>
</div>
<div id="field_3_10" class="gfield gfield--type-email gfield--input-type-email gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"
data-js-reload="field_3_10"><label class="gfield_label gform-field-label" for="input_3_10">Email</label>
<div class="ginput_container ginput_container_email">
<input name="input_10" id="input_3_10" type="email" value="" class="large" aria-invalid="false">
</div>
</div>
<div id="field_3_7" class="gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_3_7">
<label class="gfield_label gform-field-label" for="input_3_7">Father's Name</label>
<div class="ginput_container ginput_container_text"><input name="input_7" id="input_3_7" type="text" value="" class="large" aria-invalid="false"> </div>
</div>
<div id="field_3_6" class="gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_3_6">
<label class="gfield_label gform-field-label" for="input_3_6">Mother's Name</label>
<div class="ginput_container ginput_container_text"><input name="input_6" id="input_3_6" type="text" value="" class="large" aria-invalid="false"> </div>
</div>
<div id="field_3_4"
class="gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"
data-js-reload="field_3_4"><label class="gfield_label gform-field-label" for="input_3_4">Date of Birth</label>
<div class="ginput_container ginput_container_date">
<input name="input_4" id="input_3_4" type="text" value="" class="datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon hasDatepicker initialized" placeholder="mm/dd/yyyy" aria-describedby="input_3_4_date_format"
aria-invalid="false">
<span id="input_3_4_date_format" class="screen-reader-text">MM slash DD slash YYYY</span>
</div>
<input type="hidden" id="gforms_calendar_icon_input_3_4" class="gform_hidden" value="https://testgravityform.shafiqulimasum.com/wp-content/plugins/gravityforms/images/datepicker/datepicker.svg">
</div>
<div id="field_3_12" class="gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"
data-js-reload="field_3_12"><label class="gfield_label gform-field-label" for="input_3_12">Nationality</label>
<div class="ginput_container ginput_container_text"><input name="input_12" id="input_3_12" type="text" value="" class="large" aria-invalid="false"> </div>
</div>
<div id="field_3_13" class="gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"
data-js-reload="field_3_13"><label class="gfield_label gform-field-label" for="input_3_13">Religion</label>
<div class="ginput_container ginput_container_text"><input name="input_13" id="input_3_13" type="text" value="" class="large" aria-invalid="false"> </div>
</div>
<fieldset id="field_3_15" class="gfield gfield--type-address gfield--input-type-address gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"
data-js-reload="field_3_15">
<legend class="gfield_label gform-field-label gfield_label_before_complex">Address</legend>
<div class="ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gform-grid-row" id="input_3_15">
<span class="ginput_full address_line_1 ginput_address_line_1 gform-grid-col" id="input_3_15_1_container">
<input type="text" name="input_15.1" id="input_3_15_1" value="" aria-required="false">
<label for="input_3_15_1" id="input_3_15_1_label" class="gform-field-label gform-field-label--type-sub ">Street Address</label>
</span><span class="ginput_full address_line_2 ginput_address_line_2 gform-grid-col" id="input_3_15_2_container">
<input type="text" name="input_15.2" id="input_3_15_2" value="" aria-required="false">
<label for="input_3_15_2" id="input_3_15_2_label" class="gform-field-label gform-field-label--type-sub ">Address Line 2</label>
</span><span class="ginput_left address_city ginput_address_city gform-grid-col" id="input_3_15_3_container">
<input type="text" name="input_15.3" id="input_3_15_3" value="" aria-required="false">
<label for="input_3_15_3" id="input_3_15_3_label" class="gform-field-label gform-field-label--type-sub ">City</label>
</span><span class="ginput_right address_state ginput_address_state gform-grid-col" id="input_3_15_4_container">
<input type="text" name="input_15.4" id="input_3_15_4" value="" aria-required="false">
<label for="input_3_15_4" id="input_3_15_4_label" class="gform-field-label gform-field-label--type-sub ">State / Province / Region</label>
</span><span class="ginput_left address_zip ginput_address_zip gform-grid-col" id="input_3_15_5_container">
<input type="text" name="input_15.5" id="input_3_15_5" value="" aria-required="false">
<label for="input_3_15_5" id="input_3_15_5_label" class="gform-field-label gform-field-label--type-sub ">ZIP / Postal Code</label>
</span><span class="ginput_right address_country ginput_address_country gform-grid-col" id="input_3_15_6_container">
<select name="input_15.6" id="input_3_15_6" aria-required="false">
<option value="" selected="selected"></option>
<option value="Afghanistan">Afghanistan</option>
<option value="Albania">Albania</option>
<option value="Algeria">Algeria</option>
<option value="American Samoa">American Samoa</option>
<option value="Andorra">Andorra</option>
<option value="Angola">Angola</option>
<option value="Anguilla">Anguilla</option>
<option value="Antarctica">Antarctica</option>
<option value="Antigua and Barbuda">Antigua and Barbuda</option>
<option value="Argentina">Argentina</option>
<option value="Armenia">Armenia</option>
<option value="Aruba">Aruba</option>
<option value="Australia">Australia</option>
<option value="Austria">Austria</option>
<option value="Azerbaijan">Azerbaijan</option>
<option value="Bahamas">Bahamas</option>
<option value="Bahrain">Bahrain</option>
<option value="Bangladesh">Bangladesh</option>
<option value="Barbados">Barbados</option>
<option value="Belarus">Belarus</option>
<option value="Belgium">Belgium</option>
<option value="Belize">Belize</option>
<option value="Benin">Benin</option>
<option value="Bermuda">Bermuda</option>
<option value="Bhutan">Bhutan</option>
<option value="Bolivia">Bolivia</option>
<option value="Bonaire, Sint Eustatius and Saba">Bonaire, Sint Eustatius and Saba</option>
<option value="Bosnia and Herzegovina">Bosnia and Herzegovina</option>
<option value="Botswana">Botswana</option>
<option value="Bouvet Island">Bouvet Island</option>
<option value="Brazil">Brazil</option>
<option value="British Indian Ocean Territory">British Indian Ocean Territory</option>
<option value="Brunei Darussalam">Brunei Darussalam</option>
<option value="Bulgaria">Bulgaria</option>
<option value="Burkina Faso">Burkina Faso</option>
<option value="Burundi">Burundi</option>
<option value="Cabo Verde">Cabo Verde</option>
<option value="Cambodia">Cambodia</option>
<option value="Cameroon">Cameroon</option>
<option value="Canada">Canada</option>
<option value="Cayman Islands">Cayman Islands</option>
<option value="Central African Republic">Central African Republic</option>
<option value="Chad">Chad</option>
<option value="Chile">Chile</option>
<option value="China">China</option>
<option value="Christmas Island">Christmas Island</option>
<option value="Cocos Islands">Cocos Islands</option>
<option value="Colombia">Colombia</option>
<option value="Comoros">Comoros</option>
<option value="Congo">Congo</option>
<option value="Congo, Democratic Republic of the">Congo, Democratic Republic of the</option>
<option value="Cook Islands">Cook Islands</option>
<option value="Costa Rica">Costa Rica</option>
<option value="Croatia">Croatia</option>
<option value="Cuba">Cuba</option>
<option value="Curaçao">Curaçao</option>
<option value="Cyprus">Cyprus</option>
<option value="Czechia">Czechia</option>
<option value="Côte d'Ivoire">Côte d'Ivoire</option>
<option value="Denmark">Denmark</option>
<option value="Djibouti">Djibouti</option>
<option value="Dominica">Dominica</option>
<option value="Dominican Republic">Dominican Republic</option>
<option value="Ecuador">Ecuador</option>
<option value="Egypt">Egypt</option>
<option value="El Salvador">El Salvador</option>
<option value="Equatorial Guinea">Equatorial Guinea</option>
<option value="Eritrea">Eritrea</option>
<option value="Estonia">Estonia</option>
<option value="Eswatini">Eswatini</option>
<option value="Ethiopia">Ethiopia</option>
<option value="Falkland Islands">Falkland Islands</option>
<option value="Faroe Islands">Faroe Islands</option>
<option value="Fiji">Fiji</option>
<option value="Finland">Finland</option>
<option value="France">France</option>
<option value="French Guiana">French Guiana</option>
<option value="French Polynesia">French Polynesia</option>
<option value="French Southern Territories">French Southern Territories</option>
<option value="Gabon">Gabon</option>
<option value="Gambia">Gambia</option>
<option value="Georgia">Georgia</option>
<option value="Germany">Germany</option>
<option value="Ghana">Ghana</option>
<option value="Gibraltar">Gibraltar</option>
<option value="Greece">Greece</option>
<option value="Greenland">Greenland</option>
<option value="Grenada">Grenada</option>
<option value="Guadeloupe">Guadeloupe</option>
<option value="Guam">Guam</option>
<option value="Guatemala">Guatemala</option>
<option value="Guernsey">Guernsey</option>
<option value="Guinea">Guinea</option>
<option value="Guinea-Bissau">Guinea-Bissau</option>
<option value="Guyana">Guyana</option>
<option value="Haiti">Haiti</option>
<option value="Heard Island and McDonald Islands">Heard Island and McDonald Islands</option>
<option value="Holy See">Holy See</option>
<option value="Honduras">Honduras</option>
<option value="Hong Kong">Hong Kong</option>
<option value="Hungary">Hungary</option>
<option value="Iceland">Iceland</option>
<option value="India">India</option>
<option value="Indonesia">Indonesia</option>
<option value="Iran">Iran</option>
<option value="Iraq">Iraq</option>
<option value="Ireland">Ireland</option>
<option value="Isle of Man">Isle of Man</option>
<option value="Israel">Israel</option>
<option value="Italy">Italy</option>
<option value="Jamaica">Jamaica</option>
<option value="Japan">Japan</option>
<option value="Jersey">Jersey</option>
<option value="Jordan">Jordan</option>
<option value="Kazakhstan">Kazakhstan</option>
<option value="Kenya">Kenya</option>
<option value="Kiribati">Kiribati</option>
<option value="Korea, Democratic People's Republic of">Korea, Democratic People's Republic of</option>
<option value="Korea, Republic of">Korea, Republic of</option>
<option value="Kuwait">Kuwait</option>
<option value="Kyrgyzstan">Kyrgyzstan</option>
<option value="Lao People's Democratic Republic">Lao People's Democratic Republic</option>
<option value="Latvia">Latvia</option>
<option value="Lebanon">Lebanon</option>
<option value="Lesotho">Lesotho</option>
<option value="Liberia">Liberia</option>
<option value="Libya">Libya</option>
<option value="Liechtenstein">Liechtenstein</option>
<option value="Lithuania">Lithuania</option>
<option value="Luxembourg">Luxembourg</option>
<option value="Macao">Macao</option>
<option value="Madagascar">Madagascar</option>
<option value="Malawi">Malawi</option>
<option value="Malaysia">Malaysia</option>
<option value="Maldives">Maldives</option>
<option value="Mali">Mali</option>
<option value="Malta">Malta</option>
<option value="Marshall Islands">Marshall Islands</option>
<option value="Martinique">Martinique</option>
<option value="Mauritania">Mauritania</option>
<option value="Mauritius">Mauritius</option>
<option value="Mayotte">Mayotte</option>
<option value="Mexico">Mexico</option>
<option value="Micronesia">Micronesia</option>
<option value="Moldova">Moldova</option>
<option value="Monaco">Monaco</option>
<option value="Mongolia">Mongolia</option>
<option value="Montenegro">Montenegro</option>
<option value="Montserrat">Montserrat</option>
<option value="Morocco">Morocco</option>
<option value="Mozambique">Mozambique</option>
<option value="Myanmar">Myanmar</option>
<option value="Namibia">Namibia</option>
<option value="Nauru">Nauru</option>
<option value="Nepal">Nepal</option>
<option value="Netherlands">Netherlands</option>
<option value="New Caledonia">New Caledonia</option>
<option value="New Zealand">New Zealand</option>
<option value="Nicaragua">Nicaragua</option>
<option value="Niger">Niger</option>
<option value="Nigeria">Nigeria</option>
<option value="Niue">Niue</option>
<option value="Norfolk Island">Norfolk Island</option>
<option value="North Macedonia">North Macedonia</option>
<option value="Northern Mariana Islands">Northern Mariana Islands</option>
<option value="Norway">Norway</option>
<option value="Oman">Oman</option>
<option value="Pakistan">Pakistan</option>
<option value="Palau">Palau</option>
<option value="Palestine, State of">Palestine, State of</option>
<option value="Panama">Panama</option>
<option value="Papua New Guinea">Papua New Guinea</option>
<option value="Paraguay">Paraguay</option>
<option value="Peru">Peru</option>
<option value="Philippines">Philippines</option>
<option value="Pitcairn">Pitcairn</option>
<option value="Poland">Poland</option>
<option value="Portugal">Portugal</option>
<option value="Puerto Rico">Puerto Rico</option>
<option value="Qatar">Qatar</option>
<option value="Romania">Romania</option>
<option value="Russian Federation">Russian Federation</option>
<option value="Rwanda">Rwanda</option>
<option value="Réunion">Réunion</option>
<option value="Saint Barthélemy">Saint Barthélemy</option>
<option value="Saint Helena, Ascension and Tristan da Cunha">Saint Helena, Ascension and Tristan da Cunha</option>
<option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option>
<option value="Saint Lucia">Saint Lucia</option>
<option value="Saint Martin">Saint Martin</option>
<option value="Saint Pierre and Miquelon">Saint Pierre and Miquelon</option>
<option value="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines</option>
<option value="Samoa">Samoa</option>
<option value="San Marino">San Marino</option>
<option value="Sao Tome and Principe">Sao Tome and Principe</option>
<option value="Saudi Arabia">Saudi Arabia</option>
<option value="Senegal">Senegal</option>
<option value="Serbia">Serbia</option>
<option value="Seychelles">Seychelles</option>
<option value="Sierra Leone">Sierra Leone</option>
<option value="Singapore">Singapore</option>
<option value="Sint Maarten">Sint Maarten</option>
<option value="Slovakia">Slovakia</option>
<option value="Slovenia">Slovenia</option>
<option value="Solomon Islands">Solomon Islands</option>
<option value="Somalia">Somalia</option>
<option value="South Africa">South Africa</option>
<option value="South Georgia and the South Sandwich Islands">South Georgia and the South Sandwich Islands</option>
<option value="South Sudan">South Sudan</option>
<option value="Spain">Spain</option>
<option value="Sri Lanka">Sri Lanka</option>
<option value="Sudan">Sudan</option>
<option value="Suriname">Suriname</option>
<option value="Svalbard and Jan Mayen">Svalbard and Jan Mayen</option>
<option value="Sweden">Sweden</option>
<option value="Switzerland">Switzerland</option>
<option value="Syria Arab Republic">Syria Arab Republic</option>
<option value="Taiwan">Taiwan</option>
<option value="Tajikistan">Tajikistan</option>
<option value="Tanzania, the United Republic of">Tanzania, the United Republic of</option>
<option value="Thailand">Thailand</option>
<option value="Timor-Leste">Timor-Leste</option>
<option value="Togo">Togo</option>
<option value="Tokelau">Tokelau</option>
<option value="Tonga">Tonga</option>
<option value="Trinidad and Tobago">Trinidad and Tobago</option>
<option value="Tunisia">Tunisia</option>
<option value="Turkmenistan">Turkmenistan</option>
<option value="Turks and Caicos Islands">Turks and Caicos Islands</option>
<option value="Tuvalu">Tuvalu</option>
<option value="Türkiye">Türkiye</option>
<option value="US Minor Outlying Islands">US Minor Outlying Islands</option>
<option value="Uganda">Uganda</option>
<option value="Ukraine">Ukraine</option>
<option value="United Arab Emirates">United Arab Emirates</option>
<option value="United Kingdom">United Kingdom</option>
<option value="United States">United States</option>
<option value="Uruguay">Uruguay</option>
<option value="Uzbekistan">Uzbekistan</option>
<option value="Vanuatu">Vanuatu</option>
<option value="Venezuela">Venezuela</option>
<option value="Viet Nam">Viet Nam</option>
<option value="Virgin Islands, British">Virgin Islands, British</option>
<option value="Virgin Islands, U.S.">Virgin Islands, U.S.</option>
<option value="Wallis and Futuna">Wallis and Futuna</option>
<option value="Western Sahara">Western Sahara</option>
<option value="Yemen">Yemen</option>
<option value="Zambia">Zambia</option>
<option value="Zimbabwe">Zimbabwe</option>
<option value="Åland Islands">Åland Islands</option>
</select>
<label for="input_3_15_6" id="input_3_15_6_label" class="gform-field-label gform-field-label--type-sub ">Country</label>
</span>
<div class="gf_clear gf_clear_complex"></div>
</div>
</fieldset>
</div>
</div>
<div class="gform_page_footer before">
<input type="button" id="gform_next_button_3_16" class="gform_next_button gform-theme-button button" value="Next"
onclick="jQuery("#gform_target_page_number_3").val("2"); jQuery("#gform_3").trigger("submit",[true]); "
onkeypress="if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_3").val("2"); jQuery("#gform_3").trigger("submit",[true]); } ">
</div>
</div>
<div id="gform_page_3_2" class="gform_page" data-js="page-field-id-16" style="display:none;">
<div class="gform_page_fields">
<div id="gform_fields_3_2" class="gform_fields top_label form_sublabel_below description_below validation_below">
<fieldset id="field_3_24"
class="gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"
data-js-reload="field_3_24">
<legend class="gfield_label gform-field-label gfield_label_before_complex">Gender</legend>
<div class="ginput_container ginput_container_checkbox">
<div class="gfield_checkbox" id="input_3_24">
<div class="gchoice gchoice_3_24_1">
<input class="gfield-choice-input" name="input_24.1" type="checkbox" value="Male" id="choice_3_24_1">
<label for="choice_3_24_1" id="label_3_24_1" class="gform-field-label gform-field-label--type-inline">Male</label>
</div>
<div class="gchoice gchoice_3_24_2">
<input class="gfield-choice-input" name="input_24.2" type="checkbox" value="Female" id="choice_3_24_2">
<label for="choice_3_24_2" id="label_3_24_2" class="gform-field-label gform-field-label--type-inline">Female</label>
</div>
<div class="gchoice gchoice_3_24_3">
<input class="gfield-choice-input" name="input_24.3" type="checkbox" value="Others" id="choice_3_24_3">
<label for="choice_3_24_3" id="label_3_24_3" class="gform-field-label gform-field-label--type-inline">Others</label>
</div>
</div>
</div>
</fieldset>
</div>
</div>
<div class="gform_page_footer before">
<input type="button" id="gform_previous_button_3_20" class="gform_previous_button gform-theme-button gform-theme-button--secondary button" value="Previous"
onclick="jQuery("#gform_target_page_number_3").val("1"); jQuery("#gform_3").trigger("submit",[true]); "
onkeypress="if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_3").val("1"); jQuery("#gform_3").trigger("submit",[true]); } "> <input type="button" id="gform_next_button_3_20"
class="gform_next_button gform-theme-button button" value="Next" onclick="jQuery("#gform_target_page_number_3").val("3"); jQuery("#gform_3").trigger("submit",[true]); "
onkeypress="if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_3").val("3"); jQuery("#gform_3").trigger("submit",[true]); } ">
</div>
</div>
<div id="gform_page_3_3" class="gform_page" data-js="page-field-id-20" style="display:none;">
<div class="gform_page_fields">
<div id="gform_fields_3_3" class="gform_fields top_label form_sublabel_below description_below validation_below">
<div id="field_3_17" class="gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"
data-js-reload="field_3_17"><label class="gfield_label gform-field-label" for="input_3_17">Business Name</label>
<div class="ginput_container ginput_container_text"><input name="input_17" id="input_3_17" type="text" value="" class="large" aria-invalid="false"> </div>
</div>
<div id="field_3_26" class="gfield gfield--type-phone gfield--input-type-phone gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"
data-js-reload="field_3_26"><label class="gfield_label gform-field-label" for="input_3_26">Your Phone No</label>
<div class="ginput_container ginput_container_phone"><input name="input_26" id="input_3_26" type="tel" value="" class="large" aria-invalid="false"></div>
</div>
<div id="field_3_27" class="gfield gfield--type-email gfield--input-type-email gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"
data-js-reload="field_3_27"><label class="gfield_label gform-field-label" for="input_3_27">Your Email</label>
<div class="ginput_container ginput_container_email">
<input name="input_27" id="input_3_27" type="email" value="" class="large" aria-invalid="false">
</div>
</div>
<fieldset id="field_3_29" class="gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"
data-js-reload="field_3_29">
<legend class="gfield_label gform-field-label">You are a</legend>
<div class="ginput_container ginput_container_radio">
<div class="gfield_radio" id="input_3_29">
<div class="gchoice gchoice_3_29_0">
<input class="gfield-choice-input" name="input_29" type="radio" value="Business owner" id="choice_3_29_0" onchange="gformToggleRadioOther( this )">
<label for="choice_3_29_0" id="label_3_29_0" class="gform-field-label gform-field-label--type-inline">Business owner</label>
</div>
<div class="gchoice gchoice_3_29_1">
<input class="gfield-choice-input" name="input_29" type="radio" value="Client" id="choice_3_29_1" onchange="gformToggleRadioOther( this )">
<label for="choice_3_29_1" id="label_3_29_1" class="gform-field-label gform-field-label--type-inline">Client</label>
</div>
<div class="gchoice gchoice_3_29_2">
<input class="gfield-choice-input" name="input_29" type="radio" value="Others" id="choice_3_29_2" onchange="gformToggleRadioOther( this )">
<label for="choice_3_29_2" id="label_3_29_2" class="gform-field-label gform-field-label--type-inline">Others</label>
</div>
</div>
</div>
</fieldset>
<div id="field_3_30" class="gfield gfield--type-post_category gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"
data-js-reload="field_3_30"><label class="gfield_label gform-field-label" for="input_3_30">Business Category</label>
<div class="ginput_container ginput_container_select"><select name="input_30" id="input_3_30" class="large gfield_select" aria-invalid="false">
<option value="1" selected="selected">Uncategorized</option>
</select></div>
</div>
<div id="field_3_19" class="gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"
data-js-reload="field_3_19"><label class="gfield_label gform-field-label" for="input_3_19">How Many Employe</label>
<div class="ginput_container ginput_container_text"><input name="input_19" id="input_3_19" type="text" value="" class="large" aria-invalid="false"> </div>
</div>
<div id="field_3_31" class="gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"
data-js-reload="field_3_31"><label class="gfield_label gform-field-label" for="input_3_31">Your City</label>
<div class="ginput_container ginput_container_text"><input name="input_31" id="input_3_31" type="text" value="" class="large" aria-invalid="false"> </div>
</div>
</div>
</div>
<div class="gform_page_footer before"><input type="submit" id="gform_previous_button_3" class="gform_previous_button gform-theme-button gform-theme-button--secondary button" value="Previous"
onclick="if(window["gf_submitting_3"]){return false;} if( !jQuery("#gform_3")[0].checkValidity || jQuery("#gform_3")[0].checkValidity()){window["gf_submitting_3"]=true;} "
onkeypress="if( event.keyCode == 13 ){ if(window["gf_submitting_3"]){return false;} if( !jQuery("#gform_3")[0].checkValidity || jQuery("#gform_3")[0].checkValidity()){window["gf_submitting_3"]=true;} jQuery("#gform_3").trigger("submit",[true]); }">
<input type="submit" id="gform_submit_button_3" class="gform_button button" value="Submit"
onclick="if(window["gf_submitting_3"]){return false;} if( !jQuery("#gform_3")[0].checkValidity || jQuery("#gform_3")[0].checkValidity()){window["gf_submitting_3"]=true;} "
onkeypress="if( event.keyCode == 13 ){ if(window["gf_submitting_3"]){return false;} if( !jQuery("#gform_3")[0].checkValidity || jQuery("#gform_3")[0].checkValidity()){window["gf_submitting_3"]=true;} jQuery("#gform_3").trigger("submit",[true]); }">
<input type="hidden" class="gform_hidden" name="is_submit_3" value="1">
<input type="hidden" class="gform_hidden" name="gform_submit" value="3">
<input type="hidden" class="gform_hidden" name="gform_unique_id" value="">
<input type="hidden" class="gform_hidden" name="state_3"
value="WyJ7XCIyNC4xXCI6XCIxNWI3Yjg2N2UzMzU2YTgyMjI4NTQxMGJjOTE4YWQ3ZFwiLFwiMjQuMlwiOlwiMWU0OWFhNGRhZTYyMWQ5OTIxMDNhZTk0NzYwOGY4YTNcIixcIjI0LjNcIjpcIjUwMWQ0Mzk4YTJmOTY3YzlhZGI1NTU2NDcyYjRjMzZmXCIsXCIyOVwiOltcIjBlZWMyMGU3NGYxYmFmMWUyOTQxZTQ5NzBlNmI4ZTJiXCIsXCI0YzVhMGNlNzNhZjRlMjM4ZmIxYjQyNzhiNTIxOGVkMlwiLFwiNTAxZDQzOThhMmY5NjdjOWFkYjU1NTY0NzJiNGMzNmZcIl19IiwiNmE4NjgxZjAxYzcxOTJiM2M1NjE4ZDM4MDI3ZDg3YzEiXQ==">
<input type="hidden" class="gform_hidden" name="gform_target_page_number_3" id="gform_target_page_number_3" value="2">
<input type="hidden" class="gform_hidden" name="gform_source_page_number_3" id="gform_source_page_number_3" value="1">
<input type="hidden" name="gform_field_values" value="">
</div>
</div>
</div>
</form>POST /
<form method="post" enctype="multipart/form-data" id="gform_5" action="/" data-formid="5" novalidate="">
<div class="gform-body gform_body">
<div id="gform_fields_5" class="gform_fields top_label form_sublabel_below description_below validation_below">
<div id="field_5_4" class="gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_5_4">
<label class="gfield_label gform-field-label" for="input_5_4">Name</label>
<div class="ginput_container ginput_container_text"><input name="input_4" id="input_5_4" type="text" value="" class="large" aria-invalid="false"> </div>
</div>
<div id="field_5_5" class="gfield gfield--type-email gfield--input-type-email gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_5_5">
<label class="gfield_label gform-field-label" for="input_5_5">Email</label>
<div class="ginput_container ginput_container_email">
<input name="input_5" id="input_5_5" type="email" value="" class="large" aria-invalid="false">
</div>
</div>
<div id="field_5_6" class="gfield gfield--type-phone gfield--input-type-phone gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_5_6">
<label class="gfield_label gform-field-label" for="input_5_6">Phone</label>
<div class="ginput_container ginput_container_phone"><input name="input_6" id="input_5_6" type="tel" value="" class="large" aria-invalid="false"></div>
</div>
<div id="field_5_3"
class="gfield gfield--type-product gfield--input-type-singleproduct gfield--width-full gfield_price gfield_price_5_3 gfield_product_5_3 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"
data-js-reload="field_5_3"><label class="gfield_label gform-field-label gfield_label_before_complex" for="input_5_3_1"><span class="gform-field-label gfield_label_product">Orange</span> <span class="screen-reader-text">Quantity</span></label>
<div class="ginput_container ginput_container_singleproduct">
<input type="hidden" name="input_3.1" value="Orange" class="gform_hidden">
<div id="ginput_product_price_5_3" class="ginput_product_price_wrapper">
<span class="gform-field-label gform-field-label--type-sub-large ginput_product_price_label">Price:</span>
<span class="gform-field-label gform-field-label--type-sub-large ginput_product_price" id="input_5_3">$20.00</span>
</div>
<input type="hidden" name="input_3.2" id="ginput_base_price_5_3" class="gform_hidden" value="$20.00">
<span class="ginput_quantity_label gform-field-label" aria-hidden="true">Quantity</span> <input type="number" name="input_3.3" value="" id="input_5_3_1" class="ginput_quantity" size="10" min="0" aria-label="Quantity Orange"
aria-describedby="ginput_product_price_5_3">
</div>
</div>
<div id="field_5_14"
class="gfield gfield--type-product gfield--input-type-singleproduct gfield_price gfield_price_5_14 gfield_product_5_14 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"
data-js-reload="field_5_14"><label class="gfield_label gform-field-label gfield_label_before_complex" for="input_5_14_1"><span class="gform-field-label gfield_label_product">Apple</span> <span
class="screen-reader-text">Quantity</span></label>
<div class="ginput_container ginput_container_singleproduct">
<input type="hidden" name="input_14.1" value="Apple" class="gform_hidden">
<div id="ginput_product_price_5_14" class="ginput_product_price_wrapper">
<span class="gform-field-label gform-field-label--type-sub-large ginput_product_price_label">Price:</span>
<span class="gform-field-label gform-field-label--type-sub-large ginput_product_price" id="input_5_14">$30.00</span>
</div>
<input type="hidden" name="input_14.2" id="ginput_base_price_5_14" class="gform_hidden" value="$30.00">
<span class="ginput_quantity_label gform-field-label" aria-hidden="true">Quantity</span> <input type="number" name="input_14.3" value="" id="input_5_14_1" class="ginput_quantity" size="10" min="0" aria-label="Quantity Apple"
aria-describedby="ginput_product_price_5_14">
</div>
</div>
<div id="field_5_15"
class="gfield gfield--type-product gfield--input-type-singleproduct gfield--width-full gfield_price gfield_price_5_15 gfield_product_5_15 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"
data-js-reload="field_5_15"><label class="gfield_label gform-field-label gfield_label_before_complex" for="input_5_15_1">Banana</label>
<div class="ginput_container ginput_container_singleproduct">
<input type="hidden" name="input_15.1" value="Banana" class="gform_hidden">
<div id="ginput_product_price_5_15" class="ginput_product_price_wrapper">
<label for="ginput_price_5_15_2" class="gform-field-label gform-field-label--type-sub-large ginput_product_price_label">Price:</label>
<input type="text" readonly="" name="input_15.2" class="ginput_product_price gform-text-input-reset" id="ginput_base_price_5_15" value="$5.00">
</div>
</div>
</div>
<div id="field_5_17"
class="gfield gfield--type-quantity gfield--input-type-number gfield--width-full gfield_price gfield_price_5_15 gfield_quantity gfield_quantity_5_15 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"
data-js-reload="field_5_17"><label class="gfield_label gform-field-label" for="input_5_17">Banana Quantity</label>
<div class="ginput_container ginput_container_number"><input name="input_17" id="input_5_17" type="number" step="any" value="" class="large" aria-invalid="false"></div>
</div>
<fieldset id="field_5_26"
class="gfield gfield--type-product gfield--type-choice gfield--input-type-radio gfield--width-full gfield_price gfield_price_5_26 gfield_product_5_26 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"
data-js-reload="field_5_26">
<legend class="gfield_label gform-field-label">Mango</legend>
<div class="ginput_container ginput_container_radio">
<div class="gfield_radio" id="input_5_26">
<div class="gchoice gchoice_5_26_0">
<input class="gfield-choice-input" name="input_26" type="radio" value="1 kg 10|10" id="choice_5_26_0" onchange="gformToggleRadioOther( this )">
<label for="choice_5_26_0" id="label_5_26_0" class="gform-field-label gform-field-label--type-inline">1 kg 10</label>
</div>
<div class="gchoice gchoice_5_26_1">
<input class="gfield-choice-input" name="input_26" type="radio" value="2 Kg 18|18" id="choice_5_26_1" onchange="gformToggleRadioOther( this )">
<label for="choice_5_26_1" id="label_5_26_1" class="gform-field-label gform-field-label--type-inline">2 Kg 18</label>
</div>
<div class="gchoice gchoice_5_26_2">
<input class="gfield-choice-input" name="input_26" type="radio" value="3 Kg 22|22" id="choice_5_26_2" onchange="gformToggleRadioOther( this )">
<label for="choice_5_26_2" id="label_5_26_2" class="gform-field-label gform-field-label--type-inline">3 Kg 22</label>
</div>
</div>
</div>
</fieldset>
<div id="field_5_16"
class="gfield gfield--type-total gfield--input-type-total gfield--width-full gfield_price gfield_price_5_ gfield_total gfield_total_5_ field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"
aria-atomic="true" aria-live="polite" data-js-reload="field_5_16"><label class="gfield_label gform-field-label" for="input_5_16">Total</label>
<div class="ginput_container ginput_container_total">
<input type="text" readonly="" name="input_16" id="input_5_16" value="$0.00" class="gform-text-input-reset ginput_total ginput_total_5">
</div>
</div>
<div id="field_5_20" class="gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"
data-js-reload="field_5_20"><label class="gfield_label gform-field-label" for="input_5_20">Choice Payment method</label>
<div class="ginput_container ginput_container_select"><select name="input_20" id="input_5_20" class="large gfield_select" aria-invalid="false">
<option value="Paypal">Paypal</option>
<option value="Master Card">Master Card</option>
</select></div>
</div>
<div id="field_5_21" class="gfield gfield--type-stripe_creditcard gfield--input-type-stripe_creditcard gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"
data-js-reload="field_5_21" data-conditional-logic="hidden" style="display: none;"><label class="gfield_label gfield_label_before_complex" for="input_5_21_1">Credit Card</label>
<div class="ginput_complex ginput_container ginput_container_creditcard" id="input_5_21">
<div class="ginput_full" id="input_5_21_1_container">
<div id="input_5_21_1" class="StripeElement StripeElement--empty">
<div class="__PrivateStripeElement" style="margin: 0px !important; padding: 0px !important; border: none !important; display: block !important; background: transparent !important; position: relative !important; opacity: 1 !important;">
<iframe name="__privateStripeFrame4753" frameborder="0" allowtransparency="true" scrolling="no" role="presentation" allow="payment *"
src="https://js.stripe.com/v3/elements-inner-card-e00c87b2c7011677ba19cadda621a273.html#wait=false&mids[guid]=NA&mids[muid]=NA&mids[sid]=NA&hidePostalCode=false&rtl=false&componentName=card&keyMode=test&apiKey=pk_test_51PMNUvEFvWNPAgLyd4hlEhThSONpel5VVA5wHq6Xqp3Zq1uLA9XcKG30Exmz58cnSClG4AtNaVecsL4rje0igpIa00xELb7fbj&referrer=https%3A%2F%2Ftestgravityform.shafiqulimasum.com%2F&controllerId=__privateStripeController4751"
title="Secure card payment input frame"
style="border: 0px !important; margin: 0px !important; padding: 0px !important; width: 1px !important; min-width: 100% !important; overflow: hidden !important; display: block !important; user-select: none !important; transform: translate(0px) !important; color-scheme: light only !important; height: 16.8px;"></iframe><input
class="__PrivateStripeElement-input gf-default-disabled" aria-hidden="true" aria-label=" " autocomplete="false" maxlength="1"
style="border: none !important; display: block !important; position: absolute !important; height: 1px !important; top: -1px !important; left: 0px !important; padding: 0px !important; margin: 0px !important; width: 100% !important; opacity: 0 !important; background: transparent !important; pointer-events: none !important; font-size: 16px !important;">
</div>
</div>
<label for="input_5_21_1" id="input_5_21_1_label">Card Details</label>
</div>
<div class="ginput_full" id="input_5_21_5_container">
<input type="text" name="input_21.5" id="input_5_21_5" value="" disabled="disabled">
<label for="input_5_21_5" id="input_5_21_5_label">Cardholder Name</label>
</div>
</div>
</div>
</div>
</div>
<div class="gform_footer top_label"> <input type="submit" id="gform_submit_button_5" class="gform_button button" value="Submit"
onclick="if(window["gf_submitting_5"]){return false;} if( !jQuery("#gform_5")[0].checkValidity || jQuery("#gform_5")[0].checkValidity()){window["gf_submitting_5"]=true;} "
onkeypress="if( event.keyCode == 13 ){ if(window["gf_submitting_5"]){return false;} if( !jQuery("#gform_5")[0].checkValidity || jQuery("#gform_5")[0].checkValidity()){window["gf_submitting_5"]=true;} jQuery("#gform_5").trigger("submit",[true]); }">
<input type="hidden" class="gform_hidden" name="is_submit_5" value="1">
<input type="hidden" class="gform_hidden" name="gform_submit" value="5">
<input type="hidden" class="gform_hidden" name="gform_unique_id" value="">
<input type="hidden" class="gform_hidden" name="state_5"
value="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">
<input type="hidden" class="gform_hidden" name="gform_target_page_number_5" id="gform_target_page_number_5" value="0">
<input type="hidden" class="gform_hidden" name="gform_source_page_number_5" id="gform_source_page_number_5" value="1">
<input type="hidden" name="gform_field_values" value="">
</div>
</form>Text Content
Skip to content CUSTOMIZED GRAVITY FORM Test Customized Gravity form CONTACT US F Name L Name Email Message Send PERSONAL INFORMATION PERSONAL INFORMATION here Step 1 of 3 33% Name Phone Email Father's Name Mother's Name Date of Birth MM slash DD slash YYYY Nationality Religion Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Gender Male Female Others Business Name Your Phone No Your Email You are a Business owner Client Others Business Category Uncategorized How Many Employe Your City PAYPAL FORM Name Email Phone Orange Quantity Price: $20.00 Quantity Apple Quantity Price: $30.00 Quantity Banana Price: Banana Quantity Mango 1 kg 10 2 Kg 18 3 Kg 22 Total Choice Payment method PaypalMaster Card Credit Card Card Details Cardholder Name Test Customized Gravity form All rights reserved Notifications