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Submission Tags: falconsandbox
Submission: On June 28 via api from US — Scanned from DE
Submission Tags: falconsandbox
Submission: On June 28 via api from US — Scanned from DE
Form analysis 1 forms found in the DOM
<form>
<div>
<div class="nf-before-form-content"><nf-section>
<div class="nf-form-fields-required">Fields marked with an <span class="ninja-forms-req-symbol">*</span> are required</div>
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<div class="nf-form-content "><nf-fields-wrap><nf-field>
<div id="nf-field-38-container" class="nf-field-container textbox-container label-above one-half first ">
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<label for="nf-field-38" id="nf-label-field-38" class=""> First Name <span class="ninja-forms-req-symbol">*</span>
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<div class="nf-field-element">
<input type="text" value="" class="ninja-forms-field nf-element" id="nf-field-38" name="nf-field-38" aria-invalid="false" aria-describedby="nf-error-38" aria-labelledby="nf-label-field-38" aria-required="true" required="">
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<div id="nf-field-42-container" class="nf-field-container textbox-container label-above one-half ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-42-wrap" class="field-wrap textbox-wrap" data-field-id="42">
<div class="nf-field-label">
<label for="nf-field-42" id="nf-label-field-42" class=""> Last Name <span class="ninja-forms-req-symbol">*</span>
</label>
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<div class="nf-field-element">
<input type="text" value="" class="ninja-forms-field nf-element" id="nf-field-42" name="nf-field-42" aria-invalid="false" aria-describedby="nf-error-42" aria-labelledby="nf-label-field-42" aria-required="true" required="">
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<div id="nf-error-42" class="nf-error-wrap nf-error" role="alert"></div>
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</nf-field><nf-field>
<div id="nf-field-39-container" class="nf-field-container email-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-39-wrap" class="field-wrap email-wrap" data-field-id="39">
<div class="nf-field-label">
<label for="nf-field-39" id="nf-label-field-39" class=""> Email <span class="ninja-forms-req-symbol">*</span>
</label>
</div>
<div class="nf-field-element">
<input type="email" value="" class="ninja-forms-field nf-element" id="nf-field-39" name="email" autocomplete="email" aria-invalid="false" aria-describedby="nf-error-39" aria-labelledby="nf-label-field-39" aria-required="true"
required="">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-39" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field><nf-field>
<div id="nf-field-417-container" class="nf-field-container listradio-container label-above list-container">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-417-wrap" class="field-wrap listradio-wrap list-wrap list-radio-wrap" data-field-id="417">
<div class="nf-field-label">
<span id="nf-label-field-417" class="nf-label-span "> Are you a customer of the 365Pay app? <span class="ninja-forms-req-symbol">*</span>
</span>
</div>
<div class="nf-field-element">
<ul aria-describedby="nf-error-417">
<li>
<input type="radio" id="nf-field-417-0" name="nf-field-417" class="ninja-forms-field nf-element " value="Yes" aria-labelledby="nf-label-class-field-417-0" tabindex="0" required="" aria-required="true">
<label for="nf-field-417-0" id="nf-label-class-field-417-0" class="">Yes</label>
</li>
<li>
<input type="radio" id="nf-field-417-1" name="nf-field-417" class="ninja-forms-field nf-element " value="No" aria-labelledby="nf-label-class-field-417-1" tabindex="0" required="" aria-required="true">
<label for="nf-field-417-1" id="nf-label-class-field-417-1" class="">No</label>
</li>
</ul>
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-417" class="nf-error-wrap nf-error" role="alert"></div>
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</div>
</nf-field><nf-field>
<div id="nf-field-418-container" class="nf-field-container textbox-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-418-wrap" class="field-wrap textbox-wrap" data-field-id="418">
<div class="nf-field-label">
<label for="nf-field-418" id="nf-label-field-418" class=""> Market/Building Name <span class="ninja-forms-req-symbol">*</span>
</label>
</div>
<div class="nf-field-element">
<input type="text" value="" class="ninja-forms-field nf-element" id="nf-field-418" name="nf-field-418" aria-invalid="false" aria-describedby="nf-error-418" aria-labelledby="nf-label-field-418" aria-required="true" required="">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-418" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field><nf-field>
<div id="nf-field-436-container" class="nf-field-container textbox-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-436-wrap" class="field-wrap textbox-wrap" data-field-id="436">
<div class="nf-field-label">
<label for="nf-field-436" id="nf-label-field-436" class=""> Market/Building Location <span class="ninja-forms-req-symbol">*</span>
</label>
</div>
<div class="nf-field-element">
<input type="text" value="" class="ninja-forms-field nf-element" id="nf-field-436" name="nf-field-436" aria-invalid="false" aria-describedby="nf-error-436" aria-labelledby="nf-label-field-436" aria-required="true" required="">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-436" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field><nf-field>
<div id="nf-field-400-container" class="nf-field-container city-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-400-wrap" class="field-wrap city-wrap" data-field-id="400">
<div class="nf-field-label">
<label for="nf-field-400" id="nf-label-field-400" class=""> City </label>
</div>
<div class="nf-field-element">
<input type="text" value="" class="ninja-forms-field nf-element" id="nf-field-400" name="city" autocomplete="address-level2" aria-invalid="false" aria-describedby="nf-error-400" aria-labelledby="nf-label-field-400">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-400" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field><nf-field>
<div id="nf-field-401-container" class="nf-field-container liststate-container label-above list-container">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-401-wrap" class="field-wrap liststate-wrap list-wrap list-select-wrap" data-field-id="401">
<div class="nf-field-label">
<label for="nf-field-401" id="nf-label-field-401" class=""> State </label>
</div>
<div class="nf-field-element">
<select id="nf-field-401" name="nf-field-401" aria-invalid="false" aria-describedby="nf-error-401" class="ninja-forms-field nf-element" aria-labelledby="nf-label-field-401">
<option value="" selected="selected">- Select State -</option>
<option value="AL">Alabama</option>
<option value="AK">Alaska</option>
<option value="AZ">Arizona</option>
<option value="AR">Arkansas</option>
<option value="CA">California</option>
<option value="CO">Colorado</option>
<option value="CT">Connecticut</option>
<option value="DE">Delaware</option>
<option value="FL">Florida</option>
<option value="GA">Georgia</option>
<option value="HI">Hawaii</option>
<option value="ID">Idaho</option>
<option value="IL">Illinois</option>
<option value="IN">Indiana</option>
<option value="IA">Iowa</option>
<option value="KS">Kansas</option>
<option value="KY">Kentucky</option>
<option value="LA">Louisiana</option>
<option value="ME">Maine</option>
<option value="MD">Maryland</option>
<option value="MA">Massachusetts</option>
<option value="MI">Michigan</option>
<option value="MN">Minnesota</option>
<option value="MS">Mississippi</option>
<option value="MO">Missouri</option>
<option value="MT">Montana</option>
<option value="NE">Nebraska</option>
<option value="NV">Nevada</option>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NY">New York</option>
<option value="NC">North Carolina</option>
<option value="ND">North Dakota</option>
<option value="OH">Ohio</option>
<option value="OK">Oklahoma</option>
<option value="OR">Oregon</option>
<option value="PA">Pennsylvania</option>
<option value="RI">Rhode Island</option>
<option value="SC">South Carolina</option>
<option value="SD">South Dakota</option>
<option value="TN">Tennessee</option>
<option value="TX">Texas</option>
<option value="UT">Utah</option>
<option value="VT">Vermont</option>
<option value="VA">Virginia</option>
<option value="WA">Washington</option>
<option value="WV">West Virginia</option>
<option value="WI">Wisconsin</option>
<option value="WY">Wyoming</option>
<option value="DC">Washington DC</option>
<option value="AE">ARMED FORCES AFRICA \ CANADA \ EUROPE \ MIDDLE EAST</option>
<option value="AA">ARMED FORCES AMERICA (EXCEPT CANADA)</option>
<option value="AP">ARMED FORCES PACIFIC</option>
</select>
<div for="nf-field-401"></div>
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-401" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field><nf-field>
<div id="nf-field-420-container" class="nf-field-container listselect-container label-above list-container">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-420-wrap" class="field-wrap listselect-wrap list-wrap list-select-wrap" data-field-id="420">
<div class="nf-field-label">
<label for="nf-field-420" id="nf-label-field-420" class=""> Country </label>
</div>
<div class="nf-field-element">
<select id="nf-field-420" name="nf-field-420" aria-invalid="false" aria-describedby="nf-error-420" class="ninja-forms-field nf-element" aria-labelledby="nf-label-field-420">
<option value="None Selected" selected="selected">- Select Country -</option>
<option value="Australia">Australia</option>
<option value="Bahrain">Bahrain</option>
<option value="Belgium">Belgium</option>
<option value="Canada">Canada</option>
<option value="England">England</option>
<option value="France">France</option>
<option value="Germany">Germany</option>
<option value="Guam">Guam</option>
<option value="Ireland">Ireland</option>
<option value="Italy">Italy</option>
<option value="Netherlands">Netherlands</option>
<option value="Spain">Spain</option>
<option value="Switzerland">Switzerland</option>
<option value="USA">USA</option>
</select>
<div for="nf-field-420"></div>
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-420" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field><nf-field>
<div id="nf-field-421-container" class="nf-field-container address-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-421-wrap" class="field-wrap address-wrap" data-field-id="421">
<div class="nf-field-label">
<label for="nf-field-421" id="nf-label-field-421" class=""> Address </label>
</div>
<div class="nf-field-element">
<input type="text" value="" class="ninja-forms-field nf-element" id="nf-field-421" name="address" autocomplete="address-line1" aria-invalid="false" aria-describedby="nf-error-421" aria-labelledby="nf-label-field-421">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-421" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field><nf-field>
<div id="nf-field-422-container" class="nf-field-container listselect-container label-above list-container">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-422-wrap" class="field-wrap listselect-wrap list-wrap list-select-wrap" data-field-id="422">
<div class="nf-field-label">
<label for="nf-field-422" id="nf-label-field-422" class=""> Purpose of Contact <span class="ninja-forms-req-symbol">*</span>
</label>
</div>
<div class="nf-field-element">
<select id="nf-field-422" name="nf-field-422" aria-invalid="false" aria-describedby="nf-error-422" class="ninja-forms-field nf-element" aria-labelledby="nf-label-field-422" aria-required="true" required="">
<option value="select-purpose" selected="selected">- Select Purpose -</option>
<option value="Id like an electroinic copy of my personal data.">I'd like an electroinic copy of my personal data.</option>
<option value="Id like to delete my account and receive a refund if applicable.">I'd like to delete my account and receive a refund (if applicable).</option>
<option value="Id like to make corrections to the personal data on my account.">I'd like to make corrections to the personal data on my account.</option>
<option value="Id like to stop receiving marketing emails.">I'd like to stop receiving marketing emails.</option>
<option value="Id like to delete the biometric data stored on my account if applicable.">I'd like to delete the biometric data stored on my account (if applicable).</option>
<option value="I have other questions related to your data privacy policies.">I have other questions related to your data privacy policies.</option>
</select>
<div for="nf-field-422"></div>
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-422" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field><nf-field>
<div id="nf-field-40-container" class="nf-field-container textarea-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-40-wrap" class="field-wrap textarea-wrap" data-field-id="40">
<div class="nf-field-label">
<label for="nf-field-40" id="nf-label-field-40" class=""> Please Explain Purpose of Contact <span class="ninja-forms-req-symbol">*</span>
</label>
</div>
<div class="nf-field-element">
<textarea id="nf-field-40" name="nf-field-40" aria-invalid="false" aria-describedby="nf-error-40" class="ninja-forms-field nf-element" aria-labelledby="nf-label-field-40" aria-required="true" required=""></textarea>
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-40" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field><nf-field>
<div id="nf-field-41-container" class="nf-field-container submit-container label-above textbox-container">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-41-wrap" class="field-wrap submit-wrap textbox-wrap" data-field-id="41">
<div class="nf-field-label"></div>
<div class="nf-field-element">
<input id="nf-field-41" class="ninja-forms-field nf-element " type="submit" value="Submit">
</div>
<div class="nf-error-wrap"></div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-41" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields-wrap></div>
<div class="nf-after-form-content"><nf-section>
<div id="nf-form-errors-6" class="nf-form-errors" role="alert"><nf-errors></nf-errors></div>
<div class="nf-form-hp"><nf-section>
<label id="nf-label-field-hp-6" for="nf-field-hp-6" aria-hidden="true"> If you are a human seeing this field, please leave it empty. <input id="nf-field-hp-6" name="nf-field-hp" class="nf-element nf-field-hp" type="text" value=""
aria-labelledby="nf-label-field-hp-6">
</label>
</nf-section></div>
</nf-section></div>
</div>
</form>Text Content
This website stores cookies on your computer. These cookies are used to improve
your website experience and provide more personalized services to you, both on
this website and through other media. To find out more about the cookies we use,
see our Privacy Policy.
We won't track your information when you visit our site. But in order to comply
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Consumer PolicyDylan Buckley2023-06-16T08:56:53-04:00
PRIVACY @ 365
365 Retail Markets, owner of Avanti, Company Kitchen, LightSpeed and Stockwell,
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CONTACT OUR DATA PROTECTION OFFICER
This form allows you to contact us directly with your requests as covered by
GDPR.
Fields marked with an * are required
First Name *
Last Name *
Email *
Are you a customer of the 365Pay app? *
* Yes
* No
Market/Building Name *
Market/Building Location *
City
State
- Select State - Alabama Alaska Arizona Arkansas California Colorado Connecticut
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Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West
Virginia Wisconsin Wyoming Washington DC ARMED FORCES AFRICA \ CANADA \ EUROPE \
MIDDLE EAST ARMED FORCES AMERICA (EXCEPT CANADA) ARMED FORCES PACIFIC
Country
- Select Country - Australia Bahrain Belgium Canada England France Germany Guam
Ireland Italy Netherlands Spain Switzerland USA
Address
Purpose of Contact *
- Select Purpose - I'd like an electroinic copy of my personal data. I'd like to
delete my account and receive a refund (if applicable). I'd like to make
corrections to the personal data on my account. I'd like to stop receiving
marketing emails. I'd like to delete the biometric data stored on my account (if
applicable). I have other questions related to your data privacy policies.
Please Explain Purpose of Contact *
If you are a human seeing this field, please leave it empty.
Additional languages coming soon.
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