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dagangjudi-pengaduan.com Open in urlscan Pro
2606:4700:3034::ac43:d075  Public Scan

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URL: https://dagangjudi-pengaduan.com/
Submission: On October 24 via api from BE — Scanned from DE

Form analysis 1 forms found in the DOM

<form id="formKeluhan">
  <!-- Username -->
  <div class="mb-3">
    <label for="username" class="form-label">Username</label>
    <input type="text" class="form-control" id="username" name="username" placeholder="Masukkan username" required="">
    <div id="errUsername" class="invalid-feedback"></div>
  </div>
  <!-- Phone -->
  <div class="mb-3">
    <label for="wa" class="form-label">WhatsApp Number</label>
    <input type="text" class="form-control" id="wa" name="wa" placeholder="Masukkan nomor whatsapp telepon anda" required="">
    <div id="errWA" class="invalid-feedback"></div>
  </div>
  <!-- Date -->
  <div class="mb-3">
    <label for="tanggal" class="form-label">Date</label>
    <input type="date" class="form-control" id="tanggal" name="tanggal" required="" max="2024-10-24">
    <div id="errTanggal" class="invalid-feedback"></div>
  </div>
  <!-- Kendala -->
  <div class="mb-3">
    <label for="kendala" class="form-label">Kendala</label>
    <input type="text" class="form-control" id="kendala" name="kendala" placeholder="Masukkan kendala anda" required="">
    <div id="errKendala" class="invalid-feedback"></div>
  </div>
  <div class="mb-3">
    <label for="desc" class="form-label">Desc</label>
    <textarea class="form-control" id="desc" name="desc" rows="3" placeholder="Jelaskan kendala Anda" required=""></textarea>
    <div id="errDesc" class="invalid-feedback"></div>
  </div>
  <!-- Upload Gambar -->
  <div class="mb-3">
    <label for="uploadFile" class="form-label">Upload Gambar</label>
    <input class="form-control" type="file" id="uploadFile" name="uploadFile" accept="image/*" onchange="preview()">
    <div id="errUploadFile" class=" invalid-feedback"></div>
  </div>
  <div class="mb-3">
    <img src="" id="frame" class="img-fluid" style="height: 80px; display: none">
  </div>
  <!-- Submit Button -->
  <div class="d-grid py-3">
    <button type="submit" id="kirimkeluhan" class="btn btn-primary fw-bold">Kirim Pengaduan</button>
  </div>
</form>

Text Content

LAYANAN PENGADUAN MEMBER SETIA DAGANGJUDI
Username

WhatsApp Number

Date

Kendala

Desc

Upload Gambar


Kirim Pengaduan