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formulir.bitrix24.site Open in urlscan Pro
52.59.124.117  Public Scan

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Submitted URL: http://helpdeskahu.ms-indo.co.id/
Effective URL: https://formulir.bitrix24.site/crm_form_bmliz/
Submission: On June 09 via api from US — Scanned from DE

Form analysis 1 forms found in the DOM

POST 

<form method="post" novalidate="novalidate"><!---->
  <div>
    <div class="b24-form-field b24-form-field-string b24-form-control-string">
      <div>
        <div>
          <div class="b24-form-control-container b24-form-control-icon-after"><input type="string" class="b24-form-control">
            <div class="b24-form-control-label"> Name <span class="b24-form-control-required" style="display: none;">*</span></div> <!----> <!---->
            <div class="b24-form-control-alert-message" style="display: none;">
            </div>
          </div>
        </div> <!----> <!---->
      </div> <!---->
    </div>
    <div class="b24-form-field b24-form-field-string b24-form-control-string">
      <div>
        <div>
          <div class="b24-form-control-container b24-form-control-icon-after"><input type="string" class="b24-form-control">
            <div class="b24-form-control-label"> Posisi <span class="b24-form-control-required" style="display: none;">*</span></div> <!----> <!---->
            <div class="b24-form-control-alert-message" style="display: none;">
            </div>
          </div>
        </div> <!----> <!---->
      </div> <!---->
    </div>
    <div class="b24-form-field b24-form-field-email b24-form-control-string">
      <div>
        <div>
          <div class="b24-form-control-container b24-form-control-icon-after"><input name="email" autocomplete="email" type="email" class="b24-form-control">
            <div class="b24-form-control-label"> E-mail <span class="b24-form-control-required" style="display: none;">*</span></div> <!----> <!---->
            <div class="b24-form-control-alert-message" style="display: none;">
            </div>
          </div>
        </div> <!----> <!---->
      </div> <!---->
    </div>
    <div class="b24-form-field b24-form-field-list b24-form-control-list"><!---->
      <div>
        <div>
          <div class="b24-form-control-container b24-form-control-icon-after"><input readonly="readonly" type="text" class="b24-form-control">
            <div class="b24-form-control-label"> Gallery <span class="b24-form-control-required" style="display: none;">*</span></div> <!---->
            <div class="b24-form-control-alert-message" style="display: none;">
            </div>
            <div class="b24-form-dropdown"><!----></div> <!----> <!---->
          </div> <!---->
          <div class="b24-form-dropdown"><!----></div>
        </div> <!---->
      </div>
    </div>
    <div class="b24-form-field b24-form-field-datetime b24-form-control-string">
      <div>
        <div>
          <div>
            <div class="b24-form-control-container b24-form-control-icon-after"><input readonly="readonly" type="string" class="b24-form-control">
              <div class="b24-form-control-label"> Tanggal Laporan <span class="b24-form-control-required" style="display: none;">*</span></div> <!----> <!---->
              <div class="b24-form-control-alert-message" style="display: none;">
              </div>
            </div>
            <div class="b24-form-dropdown"><!----></div>
          </div>
        </div> <!---->
        <div class="b24-form-control-comment">Diisi tanggal laporan (default : tanggal dan waktu saat lapor)</div>
      </div> <!---->
    </div>
    <div class="b24-form-field b24-form-field-list b24-form-control-list"><!---->
      <div>
        <div>
          <div class="b24-form-control-container b24-form-control-icon-after"><input readonly="readonly" type="text" class="b24-form-control">
            <div class="b24-form-control-label"> Kategori Ticket <span class="b24-form-control-required" style="display: none;">*</span></div> <!---->
            <div class="b24-form-control-alert-message" style="display: none;">
            </div>
            <div class="b24-form-dropdown"><!----></div> <!----> <!---->
          </div> <!---->
          <div class="b24-form-dropdown"><!----></div>
        </div>
        <div class="b24-form-control-comment">diisi sesuai dengan level penanganan yang diinginkan. major dan critical hanya untuk apabila layanan terhenti</div>
      </div>
    </div>
    <div class="b24-form-field b24-form-field-list b24-form-control-list b24-form-control-group"><!---->
      <div>
        <div>
          <div class="b24-form-control-container b24-form-control-icon-after"><input readonly="readonly" type="text" class="b24-form-control">
            <div class="b24-form-control-label"> Jenis Ticket <span class="b24-form-control-required" style="display: none;">*</span></div> <!---->
            <div class="b24-form-control-alert-message" style="display: none;">
            </div>
            <div class="b24-form-dropdown"><!----></div> <!----> <!---->
          </div> <!---->
          <div class="b24-form-dropdown"><!----></div>
        </div> <!---->
      </div>
    </div>
    <div class="b24-form-field b24-form-field-list b24-form-control-list"><!---->
      <div>
        <div>
          <div class="b24-form-control-container b24-form-control-icon-after"><input readonly="readonly" type="text" class="b24-form-control">
            <div class="b24-form-control-label"> Jenis Kendala <span class="b24-form-control-required" style="display: none;">*</span></div> <!---->
            <div class="b24-form-control-alert-message" style="display: none;">
            </div>
            <div class="b24-form-dropdown"><!----></div> <!----> <!---->
          </div> <!---->
          <div class="b24-form-dropdown"><!----></div>
        </div> <!---->
      </div>
    </div>
    <div class="b24-form-field b24-form-field-string b24-form-control-string">
      <div>
        <div>
          <div class="b24-form-control-container b24-form-control-icon-after"><input type="string" class="b24-form-control">
            <div class="b24-form-control-label"> SN Barang <span class="b24-form-control-required" style="display: none;">*</span></div> <!----> <!---->
            <div class="b24-form-control-alert-message" style="display: none;">
            </div>
          </div>
        </div> <!---->
        <div class="b24-form-control-comment">Serial Number wajib ada untuk penukaran perangkat atau claim Garansi</div>
      </div> <!---->
    </div>
    <div class="b24-form-field b24-form-field-string b24-form-control-string">
      <div>
        <div>
          <div class="b24-form-control-container b24-form-control-icon-after"><input type="string" class="b24-form-control">
            <div class="b24-form-control-label"> Laporan insiden / case <span class="b24-form-control-required" style="display: none;">*</span></div> <!----> <!---->
            <div class="b24-form-control-alert-message" style="display: none;">
            </div>
          </div>
        </div> <!---->
        <div class="b24-form-control-comment">Jelaskan kondisi/kendala yang dialami</div>
      </div> <!---->
    </div>
    <div class="b24-form-field b24-form-field-file b24-form-control-file b24-form-control-group"><!---->
      <div>
        <div class="b24-form-control-container">
          <div class="b24-form-control-label"> Foto / capture dan Problem yang di alami <span class="b24-form-control-required" style="display: none;">*</span>
            <div hidden="hidden" v-bind="0" class="b24-form-control-field-file-summary-size"><span class="b24-form-control-field-file-summary-size-text"> 0.00 / 1000 MB </span></div>
          </div>
          <div class="b24-form-control-filelist">
            <div><!---->
              <div class="b24-form-control-file-item-empty" style="display: none;"><span class="b24-form-control-string">Mengunggah file...</span></div>
              <div class="b24-form-control-file-item-empty"><label class="b24-form-control"> Pilih file <input type="file" accept="" style="display: none;"></label>
                <div class="b24-form-control-alert-message"></div>
              </div>
            </div>
            <div class="b24-form-control-alert-message" style="display: none;">
            </div>
          </div>
        </div>
        <div class="b24-form-control-comment">Foto kendala yang dialami untuk validasi</div>
      </div>
    </div>
    <div class="b24-form-field b24-form-field-string b24-form-control-string">
      <div>
        <div>
          <div class="b24-form-control-container b24-form-control-icon-after"><input type="string" class="b24-form-control">
            <div class="b24-form-control-label"> Noted Handling <span class="b24-form-control-required" style="display: none;">*</span></div> <!----> <!---->
            <div class="b24-form-control-alert-message" style="display: none;">
            </div>
          </div>
        </div> <!----> <!---->
      </div> <!---->
    </div>
  </div>
  <div>
    <div class="v-portal" style="display: none;"></div>
  </div> <!---->
  <div class="b24-form-btn-container"><!----> <!---->
    <div class="b24-form-btn-block"><button type="submit" class="b24-form-btn"> Kirim </button></div>
  </div> <span style="color: red; display: none;"> Debug: fill fields </span>
</form>

Text Content

Name *

Posisi *

E-mail *

Gallery *



Tanggal Laporan *


Diisi tanggal laporan (default : tanggal dan waktu saat lapor)
Kategori Ticket *



diisi sesuai dengan level penanganan yang diinginkan. major dan critical hanya
untuk apabila layanan terhenti
Jenis Ticket *



Jenis Kendala *



SN Barang *

Serial Number wajib ada untuk penukaran perangkat atau claim Garansi
Laporan insiden / case *

Jelaskan kondisi/kendala yang dialami
Foto / capture dan Problem yang di alami *
0.00 / 1000 MB
Mengunggah file...
Pilih file


Foto kendala yang dialami untuk validasi
Noted Handling *


Kirim
Debug: fill fields

Permintaan sudah dikirim!







Kirim ulang


Formulir dinonaktifkan


ua vn de id ms ja hi en ar in fr it th tc pl sc ru la br tr
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Bitrix24 tidak bertanggung jawab atas informasi yang diberikan dalam formulir
ini. Namun demikian, Anda dapat selalu melaporkan pelanggaran.

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