www.tiraisobat.com Open in urlscan Pro
188.114.96.3  Public Scan

Form analysis
1 forms found in the DOM

POST

<form method="POST" onsubmit="event.preventDefault(); return Register()">
  <div class="mb-3">
    <label for="register_username" class="form-label" style="color: rgb(255, 255, 255);">Nama Pengguna</label>
    <input type="text" class="form-control" id="register_username" onchange="checkUserExist()" required="">
    <div id="register_username_warning" class="form-text text-danger d-none"></div>
  </div>
  <div class="mb-3">
    <label for="register_password" class="form-label" style="color: rgb(255, 255, 255);">Password</label>
    <input type="password" name="password" class="form-control" id="register_password" onkeyup="passwordPattern()" onchange="passwordValidation()" required="">
    <div id="password-match" class="form-text text-danger"></div>
  </div>
  <div class="mb-3">
    <label for="register_password_retype" class="form-label" style="color: rgb(255, 255, 255);">Ulangi Password</label>
    <input type="password" class="form-control" name="retypePassword" id="register_password_retype" onchange="passwordValidation()">
    <div id="password-validation" class="form-text text-danger"></div>
  </div>
  <div class="mb-3">
    <label for="register_phone_number" class="form-label" style="color: rgb(255, 255, 255);">Nomor Telepon</label>
    <div class="d-flex">
      <select name="" id="register_phone_format">
        <option value="62">+62</option>
      </select>
      <input type="text" class="form-control" id="register_phone_number" placeholder="ex: 8123456" name="register-phone" pattern="[0-9]{9,12}" onkeyup="return phoneNumberValidation(event)" required="">
    </div>
    <div id="phone_number_validation" class="form-text text-danger"></div>
    <div id="phone_number_exist" class="form-text text-danger"></div>
  </div>
  <div id="bank_form_input" style="display: none;">
    <div id="" class="mb-3">
      <label class="form-label" style="color: rgb(255, 255, 255);">Bank</label>
      <select onchange="changeMaxInput()" name="" id="register_bank_selection" class="form-control">
        <option value="">- Pilih Bank Anda -</option>
        <option value="BANK LAIN, 0">BANK LAIN LAIN</option>
        <option value="BCA, 10">BANK CENTRAL BCA</option>
        <option value="BNI, 10">BANK NEGARA INDONESIA</option>
        <option value="BRI, 0">BANK RAKYAT INDONESIA</option>
        <option value="BSI, 10">BANK SYARIAH INDONESIA</option>
        <option value="BTN, 16">BANK TABUNGAN NEGARA</option>
        <option value="CIMB, 0">BANK CIMB</option>
        <option value="JAGO, 12">BANK JAGO</option>
        <option value="MANDIRI, 13">BANK MANDIRI</option>
        <option value="PERMATA, 10">BANK PERMATA</option>
        <option value="SEA, 0">SEA BANK</option>
        <option value="DANA, 0">DANA</option>
        <option value="GOPAY, 0">GOPAY</option>
        <option value="LINK AJA, 0">LINK AJA</option>
        <option value="OVO, 0">OVO</option>
        <option value="SAKUKU, 0">SAKUKU</option>
        <option value="SHOPEE, 0">SHOPEE</option>
      </select>
    </div>
    <div id="" class="mb-3">
      <label class="form-label" style="color: rgb(255, 255, 255);">Bank Account Name</label>
      <input type="text" class="form-control" name="register-bank-account-name" id="register_bank_account_name" onkeyup="bankAccountNamePattern()">
      <div id="register_bank_account_name_warning" class="form-text text-danger"></div>
    </div>
    <div id="" class="mb-3">
      <label class="form-label" style="color: rgb(255, 255, 255);">Bank Account Number</label>
      <input type="text" class="form-control" id="register_bank_account_number">
    </div>
  </div>
  <div class="mb-3" hidden="">
    <label for="register_channel" class="form-label" style="color: rgb(255, 255, 255);">Channel</label>
    <input type="text" class="form-control" id="register_channel">
  </div>
  <div class="mb-3" hidden="">
    <label for="register_referral" class="form-label" style="color: rgb(255, 255, 255);">Kode Referral</label>
    <input type="text" class="form-control" id="register_referral">
  </div>
  <div class="mb-3" hidden="">
    <label for="register_referral" class="form-label" style="color: rgb(255, 255, 255);">Channel</label>
    <input type="text" class="form-control" id="register_channel">
  </div>
  <div class="mb-3">
    <button type="submit" class="btn register-btn" style="color: rgb(255, 255, 255); background-color: rgb(1, 14, 168);">DAFTAR</button>
  </div>
</form>

Text Content

DAFTAR

Nama Pengguna

Password

Ulangi Password

Nomor Telepon
+62


Bank - Pilih Bank Anda - BANK LAIN LAIN BANK CENTRAL BCA BANK NEGARA INDONESIA
BANK RAKYAT INDONESIA BANK SYARIAH INDONESIA BANK TABUNGAN NEGARA BANK CIMB BANK
JAGO BANK MANDIRI BANK PERMATA SEA BANK DANA GOPAY LINK AJA OVO SAKUKU SHOPEE
Bank Account Name

Bank Account Number
Channel
Kode Referral
Channel
DAFTAR
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