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

Submitted URL: http://echo4.bluehornet.com/ct/101272958:7BvIyFoVN:m:1:3466376955:67213634FAA9D5E0D589B0E3E8DF2C17:r
Effective URL: https://info.mijn-offertes.be/dak-ontmossen/?aff=ibiza_nl&utm_source=ontmossen_daken&pixel_id=383
Submission: On May 23 via api from BE — Scanned from DE

Form analysis 1 forms found in the DOM

POST /fsg?pageId=bdf049c9-7cb8-4c11-8596-5ada189811bd&variant=a

<form action="/fsg?pageId=bdf049c9-7cb8-4c11-8596-5ada189811bd&amp;variant=a" method="POST"><input type="hidden" name="pageId" value="bdf049c9-7cb8-4c11-8596-5ada189811bd"><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">Welk type
          dak heeft u?</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_hellend_dak" name="XML_extra_radio" value="Hellend dak" class="radio form-builder-radio-input form_elem_XML_extra_radio"><label
            for="XML_extra_radio_hellend_dak" class="opt-label form-builder-radio-label"><span class="label-style">Hellend dak</span></label></div>
        <div class="option" id="ub-option-XML_extra_radio-item-1"><input type="radio" id="XML_extra_radio_plat_dak" name="XML_extra_radio" value="Plat dak" class="radio form-builder-radio-input form_elem_XML_extra_radio"><label
            for="XML_extra_radio_plat_dak" class="opt-label form-builder-radio-label"><span class="label-style">Plat dak</span></label></div>
        <div class="option" id="ub-option-XML_extra_radio-item-2"><input type="radio" id="XML_extra_radio_ander_type_dak" name="XML_extra_radio" value="Ander type dak" class="radio form-builder-radio-input form_elem_XML_extra_radio"><label
            for="XML_extra_radio_ander_type_dak" class="opt-label form-builder-radio-label"><span class="label-style">Ander type dak</span></label></div>
      </div>
    </div>
    <div class="lp-pom-form-field radio-group multi-group hide" id="container_XML_extra_radio4" style="top: 0px;"><label class="main lp-form-label" for="XML_extra_radio4" id="label_XML_extra_radio4" style="height: auto;"><span class="label-style">Hoe
          groot is uw dak?</span></label>
      <div class="ub-input-item input-wrap optionsList" id="group_XML_extra_radio4">
        <div class="option" id="ub-option-XML_extra_radio4-item-0"><input type="radio" id="XML_extra_radio4_minder_dan_30_m" name="XML_extra_radio4" value="Minder dan 30 m²" class="radio form-builder-radio-input form_elem_XML_extra_radio4"><label
            for="XML_extra_radio4_minder_dan_30_m" class="opt-label form-builder-radio-label"><span class="label-style">Minder dan 30 m²</span></label></div>
        <div class="option" id="ub-option-XML_extra_radio4-item-1"><input type="radio" id="XML_extra_radio4_tussen_30_en_100_m" name="XML_extra_radio4" value="Tussen 30 en 100 m²"
            class="radio form-builder-radio-input form_elem_XML_extra_radio4"><label for="XML_extra_radio4_tussen_30_en_100_m" class="opt-label form-builder-radio-label"><span class="label-style">Tussen 30 en 100 m²</span></label></div>
        <div class="option" id="ub-option-XML_extra_radio4-item-2"><input type="radio" id="XML_extra_radio4_tussen_100_en_500_m" name="XML_extra_radio4" value="Tussen 100 en 500 m²"
            class="radio form-builder-radio-input form_elem_XML_extra_radio4"><label for="XML_extra_radio4_tussen_100_en_500_m" class="opt-label form-builder-radio-label"><span class="label-style">Tussen 100 en 500 m²</span></label></div>
        <div class="option" id="ub-option-XML_extra_radio4-item-3"><input type="radio" id="XML_extra_radio4_meer_dan_500_m" name="XML_extra_radio4" value="Meer dan 500 m²" class="radio form-builder-radio-input form_elem_XML_extra_radio4"><label
            for="XML_extra_radio4_meer_dan_500_m" class="opt-label form-builder-radio-label"><span class="label-style">Meer dan 500 m²</span></label></div>
      </div>
    </div>
    <div class="lp-pom-form-field multi-line-text multi-group hide" id="container_XML_remarks" style="top: 0px;"><label class="main lp-form-label" for="XML_remarks" id="label_XML_remarks" style="height: auto;"><span class="label-style">Vragen /
          opmerkingen:</span></label><textarea id="XML_remarks" name="XML_remarks" class="ub-input-item single text form_elem_XML_remarks"></textarea></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_dakreiniging_offertes_te_vergelijken" name="terms" value="Ja, ik wens gratis dakreiniging offertes te vergelijken."
            class="checkbox form-builder-checkbox-input form_elem_terms" data-required=""><label for="terms_ja_ik_wens_gratis_dakreiniging_offertes_te_vergelijken" class="opt-label form-builder-checkbox-label"><span class="label-style">Ja, ik wens
              gratis dakreiniging offertes te vergelijken.</span></label></div>
      </div>
    </div><input id="aff" name="aff" type="hidden" class="hidden" value="ibiza_nl"><input id="utm_source" name="utm_source" type="hidden" class="hidden" value="ontmossen_daken"><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="30154"><input id="rem_id" name="rem_id" type="hidden" class="hidden"
      value="20220523164135633"><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="383"><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="false"><input id="bobx" name="bobx" type="hidden"
      class="hidden" value="">
  </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;2022-05-23T16:41:35.630Z&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>

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Welk type dak heeft u?
Hellend dak
Plat dak
Ander type dak
Hoe groot is uw dak?
Minder dan 30 m²
Tussen 30 en 100 m²
Tussen 100 en 500 m²
Meer dan 500 m²
Vragen / opmerkingen:
Voornaam  *
Achternaam *
Adres *
Postcode *
E-mail *
Telefoonnummer *
Bevestiging *
Ja, ik wens gratis dakreiniging offertes te vergelijken.
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