info.mijn-offertes.be Open in urlscan Pro
3.69.136.55  Public Scan

Submitted URL: http://echo4.bluehornet.com/ct/101235960:TuxYOZoND:m:1:3466318831:1821E8EA0F7F8FF1951D082034BCB16F:r
Effective URL: https://info.mijn-offertes.be/mazouttank-verwijderen/?aff=elvis&utm_source=1192&pixel_id=516
Submission: On May 12 via api from BE — Scanned from DE

Form analysis 1 forms found in the DOM

POST /fsg?pageId=9d85e0e0-2a25-4196-9216-4cfd5ebed9f8&variant=a

<form action="/fsg?pageId=9d85e0e0-2a25-4196-9216-4cfd5ebed9f8&amp;variant=a" method="POST"><input type="hidden" name="pageId" value="9d85e0e0-2a25-4196-9216-4cfd5ebed9f8"><input type="hidden" name="pageVariant" value="a">
  <div class="fields">
    <div class="lp-pom-form-field radio-group multi-group" id="container_XML_extra_radio" style="top: 0px;"><label class="main lp-form-label" for="XML_extra_radio" id="label_XML_extra_radio" style="height: auto;"><span class="label-style">Waar
          bevindt de mazouttank zich?</span></label>
      <div class="ub-input-item input-wrap optionsList" id="group_XML_extra_radio">
        <div class="option" id="ub-option-XML_extra_radio-item-0"><input type="radio" id="XML_extra_radio_ondergronds" name="XML_extra_radio" value="1" class="radio form-builder-radio-input form_elem_XML_extra_radio"><label
            for="XML_extra_radio_ondergronds" class="opt-label form-builder-radio-label"><span class="label-style">Ondergronds</span></label></div>
        <div class="option" id="ub-option-XML_extra_radio-item-1"><input type="radio" id="XML_extra_radio_bovengronds" name="XML_extra_radio" value="2" class="radio form-builder-radio-input form_elem_XML_extra_radio"><label
            for="XML_extra_radio_bovengronds" class="opt-label form-builder-radio-label"><span class="label-style">Bovengronds</span></label></div>
      </div>
    </div>
    <div class="lp-pom-form-field radio-group multi-group hide" id="container_XML_extra_radio2" style="top: 0px;"><label class="main lp-form-label" for="XML_extra_radio2" id="label_XML_extra_radio2" style="height: auto;"><span
          class="label-style">Welk type sanering wenst u?</span></label>
      <div class="ub-input-item input-wrap optionsList" id="group_XML_extra_radio2">
        <div class="option" id="ub-option-XML_extra_radio2-item-0"><input type="radio" id="XML_extra_radio2_enkel_mazouttank_reinigen" name="XML_extra_radio2" value="1" class="radio form-builder-radio-input form_elem_XML_extra_radio2"><label
            for="XML_extra_radio2_enkel_mazouttank_reinigen" class="opt-label form-builder-radio-label"><span class="label-style">Enkel mazouttank reinigen</span></label></div>
        <div class="option" id="ub-option-XML_extra_radio2-item-1"><input type="radio" id="XML_extra_radio2_tank_reinigen_verwijderen" name="XML_extra_radio2" value="2" class="radio form-builder-radio-input form_elem_XML_extra_radio2"><label
            for="XML_extra_radio2_tank_reinigen_verwijderen" class="opt-label form-builder-radio-label"><span class="label-style">Tank reinigen + verwijderen</span></label></div>
        <div class="option" id="ub-option-XML_extra_radio2-item-2"><input type="radio" id="XML_extra_radio2_tank_reinigen_opvullen" name="XML_extra_radio2" value="3" class="radio form-builder-radio-input form_elem_XML_extra_radio2"><label
            for="XML_extra_radio2_tank_reinigen_opvullen" class="opt-label form-builder-radio-label"><span class="label-style">Tank reinigen + opvullen</span></label></div>
        <div class="option" id="ub-option-XML_extra_radio2-item-3"><input type="radio" id="XML_extra_radio2_ik_weet_het_niet_graag_advies" name="XML_extra_radio2" value="4" class="radio form-builder-radio-input form_elem_XML_extra_radio2"><label
            for="XML_extra_radio2_ik_weet_het_niet_graag_advies" class="opt-label form-builder-radio-label"><span class="label-style">Ik weet het niet, graag advies</span></label></div>
      </div>
    </div>
    <div class="lp-pom-form-field radio-group multi-group hide" id="container_XML_extra_radio3" style="top: 0px;"><label class="main lp-form-label" for="XML_extra_radio3" id="label_XML_extra_radio3" style="height: auto;"><span
          class="label-style">Wanneer wenst u de tank te saneren?</span></label>
      <div class="ub-input-item input-wrap optionsList" id="group_XML_extra_radio3">
        <div class="option" id="ub-option-XML_extra_radio3-item-0"><input type="radio" id="XML_extra_radio3_zo_snel_mogelijk" name="XML_extra_radio3" value="1" class="radio form-builder-radio-input form_elem_XML_extra_radio3"><label
            for="XML_extra_radio3_zo_snel_mogelijk" class="opt-label form-builder-radio-label"><span class="label-style">Zo snel mogelijk</span></label></div>
        <div class="option" id="ub-option-XML_extra_radio3-item-1"><input type="radio" id="XML_extra_radio3_binnen_1_tot_3_maanden" name="XML_extra_radio3" value="2" class="radio form-builder-radio-input form_elem_XML_extra_radio3"><label
            for="XML_extra_radio3_binnen_1_tot_3_maanden" class="opt-label form-builder-radio-label"><span class="label-style">Binnen 1 tot 3 maanden</span></label></div>
        <div class="option" id="ub-option-XML_extra_radio3-item-2"><input type="radio" id="XML_extra_radio3_binnen_3_tot_6_maanden" name="XML_extra_radio3" value="3" class="radio form-builder-radio-input form_elem_XML_extra_radio3"><label
            for="XML_extra_radio3_binnen_3_tot_6_maanden" class="opt-label form-builder-radio-label"><span class="label-style">Binnen 3 tot 6 maanden</span></label></div>
      </div>
    </div>
    <div class="lp-pom-form-field single-line-text hide" id="container_firstName" style="top: 0px;"><label class="main lp-form-label" for="firstName" id="label_firstName" style="height: auto;"><span
          class="label-style">Voornaam&nbsp;*</span></label><input id="firstName" name="firstName" type="text" class="ub-input-item single text form_elem_firstName" placeholder="Voornaam" required=""></div>
    <div class="lp-pom-form-field single-line-text hide" id="container_lastName" style="top: 0px;"><label class="main lp-form-label" for="lastName" id="label_lastName" style="height: auto;"><span
          class="label-style">Achternaam&nbsp;*</span></label><input id="lastName" name="lastName" type="text" class="ub-input-item single text form_elem_lastName" placeholder="Achternaam" required=""></div>
    <div class="lp-pom-form-field single-line-text hide" id="container_address1" style="top: 0px;"><label class="main lp-form-label" for="address1" id="label_address1" style="height: auto;"><span class="label-style">Adres&nbsp;*</span></label><input
        id="address1" name="address1" type="text" class="ub-input-item single text form_elem_address1" placeholder="Adres" required=""></div>
    <div class="lp-pom-form-field single-line-text hide" id="container_XML_postcode" style="top: 0px;"><label class="main lp-form-label" for="XML_postcode" id="label_XML_postcode" style="height: auto;"><span
          class="label-style">Postcode&nbsp;*</span></label><input id="XML_postcode" name="XML_postcode" type="text" class="ub-input-item single text form_elem_XML_postcode" placeholder="Postcode" required=""></div>
    <div class="lp-pom-form-field single-line-text hide" id="container_XML_email" style="top: 0px;"><label class="main lp-form-label" for="XML_email" id="label_XML_email" style="height: auto;"><span
          class="label-style">E-mail&nbsp;*</span></label><input id="XML_email" name="XML_email" type="text" class="ub-input-item single text form_elem_XML_email" placeholder="E-mail" required=""></div>
    <div class="lp-pom-form-field single-line-text hide" id="container_XML_telephone" style="top: 0px;"><label class="main lp-form-label" for="XML_telephone" id="label_XML_telephone" style="height: auto;"><span
          class="label-style">Telefoonnummer&nbsp;*</span></label><input id="XML_telephone" name="XML_telephone" type="tel" class="ub-input-item single text form_elem_XML_telephone" placeholder="Telefoonnummer" required=""
        pattern="^\+?( ?\(?-?\d\)?){6,13}$"></div>
    <div class="lp-pom-form-field checkbox-group multi-group hide" id="container_terms" style="top: 0px;"><label class="main lp-form-label" for="terms" id="label_terms" style="height: auto;"><span class="label-style">Bevestiging&nbsp;*</span></label>
      <div class="ub-input-item input-wrap optionsList" id="group_terms">
        <div class="option" id="ub-option-terms-item-0"><input type="checkbox" id="terms_ja_ik_wens_gratis_offertes_te_ontvangen" name="terms" value="Ja, ik wens gratis offertes te ontvangen."
            class="checkbox form-builder-checkbox-input form_elem_terms" data-required=""><label for="terms_ja_ik_wens_gratis_offertes_te_ontvangen" class="opt-label form-builder-checkbox-label"><span class="label-style">Ja, ik wens gratis offertes
              te ontvangen.</span></label></div>
      </div>
    </div><input id="aff" name="aff" type="hidden" class="hidden" value="elvis"><input id="utm_source" name="utm_source" type="hidden" class="hidden" value="1192"><input id="utm_medium" name="utm_medium" type="hidden" class="hidden" value=""><input
      id="utm_campaign" name="utm_campaign" type="hidden" class="hidden" value=""><input id="type_id" name="type_id" type="hidden" class="hidden" value="100044"><input id="rem_id" name="rem_id" type="hidden" class="hidden"
      value="20220512043445749"><input id="rem_source" name="rem_source" type="hidden" class="hidden" value="Mijn-Offertes.be"><input id="pixel_id" name="pixel_id" type="hidden" class="hidden" value="516"><input id="click_id" name="click_id"
      type="hidden" class="hidden" value=""><input id="language" name="language" type="hidden" class="hidden" value="nl"><input id="promoOptin" name="promoOptin" type="hidden" class="hidden" value="true"><input id="bobx" name="bobx" type="hidden"
      class="hidden" value=""><input id="companyCity" name="companyCity" type="hidden" class="hidden" value=""><input id="XML_remarks" name="XML_remarks" type="hidden" class="hidden"
      value="Ik wens gratis offertes te ontvangen om een mazouttank te verwijderen">
  </div><button class="lp-element lp-pom-button hide" id="lp-pom-button-44" type="submit"><span class="label">Verzenden</span></button>
  <input type="hidden" name="ubafs-jev" id="ubafs-jev"
    value="{&quot;date&quot;:&quot;2022-05-12T04:34:45.729Z&quot;,&quot;agent&quot;:&quot;Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/101.0.4951.64 Safari/537.36&quot;,&quot;screen&quot;:{&quot;availWidth&quot;:1600,&quot;availHeight&quot;:1200,&quot;width&quot;:1600,&quot;height&quot;:1200},&quot;window&quot;:{&quot;innerWidth&quot;:1600,&quot;innerHeight&quot;:1200},&quot;hasPlugins&quot;:true}">
</form>

Text Content

Mazouttank verwijderen

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Waar bevindt de mazouttank zich?
Ondergronds
Bovengronds
Welk type sanering wenst u?
Enkel mazouttank reinigen
Tank reinigen + verwijderen
Tank reinigen + opvullen
Ik weet het niet, graag advies
Wanneer wenst u de tank te saneren?
Zo snel mogelijk
Binnen 1 tot 3 maanden
Binnen 3 tot 6 maanden
Voornaam *
Achternaam *
Adres *
Postcode *
E-mail *
Telefoonnummer *
Bevestiging *
Ja, ik wens gratis offertes te ontvangen.
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