leisureconcepts.cloudpsaservice.com.au Open in urlscan Pro
119.148.67.67  Public Scan

Form analysis
2 forms found in the DOM

Name: register_form — POST /action/register_member

<form name="register_form" id="register_form" method="post" action="/action/register_member" onsubmit="return verifyform(this);">
  <input type="hidden" name="act" value="register_member">
  <input type="hidden" name="start_data_fields" value="start_data_fields">
  <ul>
    <li><label>Company:</label><input type="text" name="company" class="input MANDATORY" title="Enter your company name"></li>
    <li class="half left"><label>First Name:</label><input type="text" name="name" class="input MANDATORY" title="Enter your first name"></li>
    <li class="half left"><label>Last Name:</label><input type="text" name="surname" class="input MANDATORY" title="Enter your last name"></li>
    <li class="third left"><label>Mobile / Phone:</label><input type="text" name="mobile" class="input PHONE MANDATORY" title="Enter a phone number">
    </li>
    <li class="third left"><label>Other Phone:</label><input type="text" name="phone" class="input PHONE" title="Enter a phone number"></li>
    <li class="third left"><label>Fax:</label><input type="text" name="fax" class="input PHONE" title="Enter a fax number"></li>
    <li class="hr"></li>
    <li><label>Main Email: <span class="normal">This will be used to log in with</span></label><input type="text" name="email" class="input EMAIL MANDATORY" id="email_check" title="Enter a valid email address"></li>
    <li><label>Email 2:</label><input type="text" name="email2" class="input EMAIL" title="Enter a valid email address"></li>
    <li><label>Email 3:</label><input type="text" name="email3" class="input EMAIL" title="Enter a valid email address"></li>
    <li class="hr"></li>
    <li class="half left"><label>Choose Password:</label><input type="password" name="password" value="" class="input MANDATORY PASSCHECK" id="P1" title="Enter password"></li>
    <li class="half left"><label>Re-Enter Password:</label><input type="password" name="password" value="" class="input MANDATORY PASSCHECK" id="P2" title="Enter password"></li>
    <li class="hr">&nbsp;</li>
    <li><label>Address:</label><input type="text" name="address" class="input MANDATORY" title="Enter your address"></li>
    <li><label>Address 2:</label><input type="text" name="address2" class="input"></li>
    <li class="third left"><label>State:</label>
      <select name="state" class="input MANDATORY" title="Select a state">
        <option value="">Select...</option>
        <option value="ACT">ACT</option>
        <option value="NSW">NSW</option>
        <option value="NT">NT</option>
        <option value="QLD">QLD</option>
        <option value="SA">SA</option>
        <option value="TAS">TAS</option>
        <option value="VIC">VIC</option>
        <option value="WA">WA</option>
      </select>
    </li>
    <li class="third left"><label>City/Suburb:</label><input type="text" name="city" class="input MANDATORY" title="Enter your city/suburb"></li>
    <li class="third left"><label>Postcode:</label><input type="text" name="postcode" maxlength="4" class="input NUMBER MANDATORY" title="Enter your postcode"></li>
    <input type="hidden" name="end_data_fields" value="end_data_fields">
    <li class="hr">&nbsp;</li>
    <li class=""><label>Enter Code:</label><img src="/includes/captcha/make_captcha.php" border="0" align="absmiddle" style="margin:2px; cursor:pointer;" onclick="this.src='/includes/captcha/make_captcha.php?'+Math.random()*10;"
        title="Hard to read? Click here to generate a new code."><input name="captcha" type="text" title="Please enter the above code" value="" size="15" class="input MANDATORY" style="width:100px;"></li>
    <li class="textright"><input type="submit" name="submit" value="Register" class="formbutton"></li>
  </ul>
</form>

Name: login_form — POST /action/login

<form name="login_form" id="login_form" method="post" action="/action/login" onsubmit="return verifyform(this,'verify');">
  <input type="hidden" name="act" value="login">
  <ul>
    <li class="half left"><label>Email:</label><input type="text" name="email" value="" class="input MANDATORY EMAIL" title="Enter a valid email address"></li>
    <li class="half left"><label>Password:</label><input type="password" name="password" value="" class="input MANDATORY" title="Enter password"></li>
    <li class="textright"><input type="submit" name="submit" value="Login" class="formbutton"></li>
    <li><a href="page/lostpass">Forgot password?</a></li>
  </ul>
</form>

Text Content

Login

To submit your service request, please login below.

 * Company:
 * First Name:
 * Last Name:
 * Mobile / Phone:
 * Other Phone:
 * Fax:
 * 
 * Main Email: This will be used to log in with
 * Email 2:
 * Email 3:
 * 
 * Choose Password:
 * Re-Enter Password:
 *  
 * Address:
 * Address 2:
 * State: Select... ACT NSW NT QLD SA TAS VIC WA
 * City/Suburb:
 * Postcode:
   
 *  
 * Enter Code:
 * 

 * Email:
 * Password:
 * 
 * Forgot password?

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