www.havellsfestivehealth.bigcityexperience.com Open in urlscan Pro
35.200.190.225  Public Scan

Form analysis
1 forms found in the DOM

POST https://www.havellsfestivehealth.bigcityexperience.com/login

<form id="loginForm" method="POST" action="https://www.havellsfestivehealth.bigcityexperience.com/login" enctype="multipart/form-data">
  <div class="form-group">
    <label class="label-text">Enter Your Voucher Code*</label>
    <input class="form-control custom__forms_fileds" type="text" id="vouchercode" name="vouchercode" required="" minlength="12" maxlength="12" placeholder="12 digit alphanumeric">
  </div>
  <div class="form-group">
    <label class="label-text">Enter Your Name*</label>
    <input type="text" class="form-control custom__forms_fileds" id="name" placeholder="" name="name" required="" minlength="3" pattern="\s*(\S\s*){3,}" onkeydown="return /[a-zA-Z, ]/i.test(event.key)"
      onblur="if (this.value == '') {this.value = '';}" onfocus="if (this.value == '') {this.value = '';}" oninvalid="setCustomValidity('Please enter correct name.')" onchange="try{setCustomValidity('')}catch(e){}">
  </div>
  <div class="form-group">
    <label class="label-text">Enter Your Email*</label>
    <input type="email" class="form-control custom__forms_fileds" id="email" placeholder="" name="email" required="" onblur="if (this.value == '') {this.value = '';}" onfocus="if (this.value == '') {this.value = '';}"
      oninvalid="setCustomValidity('Please enter valid email ID.')" onchange="try{setCustomValidity('')}catch(e){}">
  </div>
  <div class="form-group">
    <label class="label-text">Enter Your Mobile*</label>
    <input type="text" class="form-control custom__forms_fileds" id="mobile" placeholder="" name="mobile" required="" maxlength="10" pattern="[5-9][0-9]{9}" oninvalid="setCustomValidity('Please enter a 10 digit number')"
      oninput="setCustomValidity('')">
  </div>
  <div class="form-group">
    <label class="label-text">Date of Purchase*</label>
    <input type="text" class="form-control custom__forms_fileds hasDatepicker" id="dateofpurchase" placeholder="" name="dateofpurchase" required="" readonly="readonly">
  </div>
  <div class="form-group">
    <label class="label-text">Select Your State *</label>
    <select class="form-control custom__forms_fileds" id="state" name="state" required="" style="background-color: #fff;">
      <option value=""></option>
      <option value="1">ANDAMAN AND NICOBAR ISLANDS</option>
      <option value="2">ANDHRA PRADESH</option>
      <option value="3">ARUNACHAL PRADESH</option>
      <option value="4">ASSAM</option>
      <option value="5">BIHAR</option>
      <option value="6">CHANDIGARH</option>
      <option value="7">CHHATTISGARH</option>
      <option value="8">DADRA AND NAGAR HAVELI</option>
      <option value="9">DAMAN AND DIU</option>
      <option value="10">DELHI</option>
      <option value="11">GOA</option>
      <option value="12">GUJARAT</option>
      <option value="13">HARYANA</option>
      <option value="14">HIMACHAL PRADESH</option>
      <option value="15">JAMMU AND KASHMIR</option>
      <option value="16">JHARKHAND</option>
      <option value="17">KARNATAKA</option>
      <option value="34">KERALA</option>
      <option value="18">MADHYA PRADESH</option>
      <option value="19">MAHARASHTRA</option>
      <option value="20">MANIPUR</option>
      <option value="21">MEGHALAYA</option>
      <option value="22">MIZORAM</option>
      <option value="23">NAGALAND</option>
      <option value="24">ODISHA</option>
      <option value="25">PUDUCHERRY</option>
      <option value="26">PUNJAB</option>
      <option value="27">RAJASTHAN</option>
      <option value="28">SIKKIM</option>
      <option value="35">TAMIL NADU</option>
      <option value="29">TELANGANA</option>
      <option value="30">TRIPURA</option>
      <option value="31">UTTAR PRADESH</option>
      <option value="32">UTTARAKHAND</option>
      <option value="33">WEST BENGAL</option>
    </select>
  </div>
  <div class="form-group">
    <label>City Of Purchase*</label>
    <select class="form-control custom__forms_fileds" id="city_id" name="city_id" required="">
      <option value="">Please Select</option>
    </select>
  </div>
  <div id="otherscity"></div>
  <div class="form-group">
    <label class="label-text">Store Name*</label>
    <input type="text" class="form-control custom__forms_fileds" id="store_name" placeholder="" name="store_name" required="">
  </div>
  <div class="form-group">
    <label class="label-text">SKU Purchased*</label>
    <input type="text" class="form-control custom__forms_fileds" id="sku_purchase" placeholder="" name="sku_purchase" required="" maxlength="70">
  </div>
  <div class="form-group">
    <label class="label-text">Product Serial Number*</label>
    <input type="text" class="form-control custom__forms_fileds" id="serial_number" placeholder="" required="" name="serial_number" maxlength="50">
  </div>
  <div class="form-group">
    <label class="label-text">Invoice/Bill No*</label>
    <input type="text" class="form-control custom__forms_fileds" id="bill_no" placeholder="" name="bill_no" required="" maxlength="50">
  </div>
  <style type="text/css">
    .bill_rec_outer {
      display: flex;
      align-content: center;
      justify-content: space-between;
      height: 100%;
    }

    .bill_rec_outer p {
      align-self: center;
      margin-right: 30px;
      cursor: pointer;
    }
  </style>
  <div class="form-group pt-2">
    <div class="upload-btn-wrapper-mbl">
      <button class="btn upload_btn_mbl"> <span><i class="fa fa-upload" aria-hidden="true"></i></span> &nbsp; Upload a copy of your Bill/Invoice*</button>
      <input type="file" name="image" id="upload_bill" accept="application/pdf, image/*" required="">
    </div>
    <div id="fileError" style="color: red; display: none;">Invalid file type. Please select a JPEG, PNG, or GIF file.</div>
  </div>
  <span id="view_bill"></span>
  <div class="col-md-12 p-0">
    <div class="verify-code">
      <!-- <div class="g-recaptcha" data-sitekey="0x4AAAAAAAZ4kgkdV2A3fLv_" data-callback="enableBtn"></div> -->
      <div class="cf-turnstile" data-sitekey="0x4AAAAAAAZ4kgkdV2A3fLv_" data-theme="light" data-callback="enableBtn">
        <div><input type="hidden" name="cf-turnstile-response" id="cf-chl-widget-r4vji_response"></div>
      </div>
    </div>
  </div>
  <div class="pt-3">
    <label for="registration-agreeterms">
      <input type="checkbox" id="registration-agreeterms" name="terms_cond" value="1" required=""> I agree to the
      <a target="_blank" href="https://www.havellsfestivehealth.bigcityexperience.com/terms-and-condition"><span style="#383939 !important">Terms &amp; Conditions</span></a>
    </label>
  </div>
  <input type="hidden" name="st_time" id="st_time" value="3">
  <div class="form-group">
    <button type="submit" id="enbBtn" class="btn btn-primary submit__form register-step" name="contact-button" disabled="disabled">Submit</button>
  </div>
</form>

Text Content

 * HOME
 * HOW TO PARTICIPATE
 * TERMS AND CONDITIONS
 * CONTACT US




REGISTRATION FORM

Enter Your Voucher Code*
Enter Your Name*
Enter Your Email*
Enter Your Mobile*
Date of Purchase*
Select Your State * ANDAMAN AND NICOBAR ISLANDS ANDHRA PRADESH ARUNACHAL PRADESH
ASSAM BIHAR CHANDIGARH CHHATTISGARH DADRA AND NAGAR HAVELI DAMAN AND DIU DELHI
GOA GUJARAT HARYANA HIMACHAL PRADESH JAMMU AND KASHMIR JHARKHAND KARNATAKA
KERALA MADHYA PRADESH MAHARASHTRA MANIPUR MEGHALAYA MIZORAM NAGALAND ODISHA
PUDUCHERRY PUNJAB RAJASTHAN SIKKIM TAMIL NADU TELANGANA TRIPURA UTTAR PRADESH
UTTARAKHAND WEST BENGAL
City Of Purchase* Please Select

Store Name*
SKU Purchased*
Product Serial Number*
Invoice/Bill No*
  Upload a copy of your Bill/Invoice*
Invalid file type. Please select a JPEG, PNG, or GIF file.

I agree to the Terms & Conditions
Submit
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