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samsunglivequiz.voxline.ro Open in urlscan Pro
195.28.25.136  Public Scan

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URL: https://samsunglivequiz.voxline.ro/
Submission: On July 20 via api from US — Scanned from US

Form analysis 1 forms found in the DOM

<form wire:submit.prevent="submit">
  <div class="form-group row"><label for="nume" class="col-sm-3 col-md-2 col-form-label">Nume si Prenume</label>
    <div class="col-sm-9 col-md-10"><input type="text" placeholder="Introdu numele si prenumele tau complet" id="nume" wire:model.debounce.500ms.debounce.500ms="nume" autocomplete="off" class="form-control"> <span class="text-danger"></span></div>
  </div>
  <div class="form-group row"><label for="email" class="col-sm-3 col-md-2 col-form-label">Email</label>
    <div class="col-sm-9 col-md-10"><input type="text" placeholder="Introdu adresa ta de email" id="email" wire:model.debounce.500ms="email" autocomplete="off" class="form-control"> <span class="text-danger"></span></div>
  </div>
  <div class="form-group row"><label for="instagram" class="col-sm-3 col-md-2 col-form-label">Cont de Instagram</label>
    <div class="col-sm-9 col-md-10"><input type="text" placeholder="Introdu numele contului tau de Instagram" id="instagram" wire:model.debounce.500ms.debounce.500ms="instagram" autocomplete="off" class="form-control"> <span
        class="text-danger"></span></div>
  </div>
  <div class="form-group row"><label for="locatie" class="col-sm-3 col-md-2 col-form-label">Locatie Eveniment</label>
    <div class="col-sm-9 col-md-10"><select id="locatie" wire:model.debounce.500ms="locatie" class="form-control">
        <option value="" selected="selected">Selecteaza locatia in care vrei sa participi la evenimentul Samsung</option>
        <option value="Bucuresti - Promenada Mall">Bucuresti - Promenada Mall</option>
        <option value="Cluj - Iulius Mall">Cluj - Iulius Mall</option>
      </select> <span class="text-danger"></span></div>
  </div>
  <div class="form-group row">
    <div class="col-sm-3 col-md-2 col-form-label"></div>
    <div class="col-sm-9 col-md-10"><input type="checkbox" id="acord" wire:model.debounce.500ms="acord" class="mr-3"> <label for="acord" style="display: inline;">Am citit si sunt de acord cu prevederile <a href="#">Regulamentului Campaniei</a>,
        inclusiv cu prevederile <a href="#">Anexei 1 – Prelucrarea datelor cu caracter personal</a>.</label>
      <div><span class="text-danger"></span></div>
    </div>
  </div>
  <div class="form-group row">
    <div class="col-sm-3 col-md-2 col-form-label"></div>
    <div class="col-sm-9 col-md-10"><input type="checkbox" id="acord_18" wire:model.debounce.500ms="acord_18" class="mr-3"> <label for="acord_18" style="display: inline;">Declar ca am peste 18 ani.</label>
      <div><span class="text-danger"></span></div>
    </div>
  </div>
  <div class="action-buttons d-flex justify-content-center mt-5 mb-3"><button type="submit" class="btn btn-md btn-primary">Particip</button></div>
</form>

Text Content

INSCRIERE CAMPANIE "BOX MALL ACTIVATION"

Nume si Prenume

Email

Cont de Instagram

Locatie Eveniment
Selecteaza locatia in care vrei sa participi la evenimentul Samsung Bucuresti -
Promenada Mall Cluj - Iulius Mall
Am citit si sunt de acord cu prevederile Regulamentului Campaniei, inclusiv cu
prevederile Anexei 1 – Prelucrarea datelor cu caracter personal.

Declar ca am peste 18 ani.

Particip