www.smartplansystems.com Open in urlscan Pro
45.33.90.183  Public Scan

Form analysis
1 forms found in the DOM

POST #

<form class="request_form" action="#" accept-charset="UTF-8" method="post" novalidate="novalidate"><input type="hidden" name="authenticity_token" value="4YdXFJuphSqQQjHdZj6kxKNBFi4wiUPVH4Fn86WXqr6ClDNdtUcwvQxP2-HJfSjmZUvDdDJlUrMZhwH9Tm-1wQ">
  <div class="modal-body">
    <div class="modal-body">
      <div class="row">
        <div class="col-lg-6">
          <div class="form-group">
            <label for="first_name">First Name*</label>
            <input type="text" name="first_name" id="first_name" class="form-control" placeholder="First Name">
          </div>
        </div>
        <div class="col-lg-6">
          <div class="form-group">
            <label for="last_name">Last Name*</label>
            <input type="text" name="last_name" id="last_name" class="form-control" placeholder="Last Name">
          </div>
        </div>
      </div>
      <div class="row">
        <div class="col-lg-6">
          <div class="form-group">
            <label for="email">Email Address*</label>
            <input type="email" name="email" id="email" class="form-control" placeholder="Email Address">
          </div>
        </div>
        <div class="col-lg-6">
          <div class="form-group">
            <label for="contact_number">Contact Number*</label>
            <input type="tel" name="contact_number" id="contact_number" class="form-control" placeholder="Contact Number">
          </div>
        </div>
      </div>
      <div class="row">
        <div class="col-lg-12" id="agency_name_field">
          <div class="form-group">
            <label for="agency_name">Agency Name*</label>
            <input type="text" name="agency_name" id="agency_name" class="form-control" placeholder="Agency Name">
          </div>
        </div>
      </div>
      <div class="row">
        <div class="col-lg-12" id="message_field">
          <div class="form-group">
            <label for="message">Message*</label>
            <textarea name="message" id="message" class="form-control" placeholder="Message"></textarea>
          </div>
        </div>
        <div class="col-lg-6">
          <div class="form-group">
            <script src="https://www.recaptcha.net/recaptcha/api.js" async="" defer=""></script>
            <div data-sitekey="6LeD34kaAAAAAL2eOk5HYi5xuf2gcXuzRpbumhBj" class="g-recaptcha ">
              <div style="width: 304px; height: 78px;">
                <div><iframe title="reCAPTCHA" width="304" height="78" role="presentation" name="a-5xh8gz65k7ro" frameborder="0" scrolling="no"
                    sandbox="allow-forms allow-popups allow-same-origin allow-scripts allow-top-navigation allow-modals allow-popups-to-escape-sandbox allow-storage-access-by-user-activation"
                    src="https://www.recaptcha.net/recaptcha/api2/anchor?ar=1&amp;k=6LeD34kaAAAAAL2eOk5HYi5xuf2gcXuzRpbumhBj&amp;co=aHR0cHM6Ly93d3cuc21hcnRwbGFuc3lzdGVtcy5jb206NDQz&amp;hl=en&amp;v=x5WWoE57Fv0d6ATKsLDIAKnt&amp;size=normal&amp;cb=sk92cjr4pglm"></iframe>
                </div><textarea id="g-recaptcha-response" name="g-recaptcha-response" class="g-recaptcha-response"
                  style="width: 250px; height: 40px; border: 1px solid rgb(193, 193, 193); margin: 10px 25px; padding: 0px; resize: none; display: none;"></textarea>
              </div><iframe style="display: none;"></iframe>
            </div>
            <noscript>
              <div>
                <div style="width: 302px; height: 422px; position: relative;">
                  <div style="width: 302px; height: 422px; position: absolute;">
                    <iframe src="https://www.recaptcha.net/recaptcha/api/fallback?k=6LeD34kaAAAAAL2eOk5HYi5xuf2gcXuzRpbumhBj" name="ReCAPTCHA" style="width: 302px; height: 422px; border-style: none; border: 0; overflow: hidden;">
                    </iframe>
                  </div>
                </div>
                <div style="width: 300px; height: 60px; border-style: none;
                bottom: 12px; left: 25px; margin: 0px; padding: 0px; right: 25px;
                background: #f9f9f9; border: 1px solid #c1c1c1; border-radius: 3px;">
                  <textarea id="g-recaptcha-response" name="g-recaptcha-response" class="g-recaptcha-response" style="width: 250px; height: 40px; border: 1px solid #c1c1c1;
                  margin: 10px 25px; padding: 0px; resize: none;">                </textarea>
                </div>
              </div>
            </noscript>
          </div>
        </div>
      </div>
    </div>
  </div>
  <div class="modal-footer">
    <button type="submit" class="btn vit-bg-dark-gray text-white" data-disable-with="Processing...">Submit</button>
  </div>
</form>

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