nouveiie-aquitaine.fr Open in urlscan Pro
2606:4700:3036::6815:435d  Public Scan

Form analysis
1 forms found in the DOM

POST

<form action="" method="POST">
  <div class="item">
    <p>Nom complet</p>
    <div class="name-item">
      <input type="text" name="prénom" placeholder="Prenom" value="Sebastien">
      <input type="text" name="nom" placeholder="Nom" value="CHAUMET">
    </div>
  </div>
  <div class="contact-item">
    <div class="item">
      <p>Email</p>
      <input type="text" name="mail" value="sebastien.chaumet@nouvelle-aquitaine.fr">
      <label for="mail">ex:nom.prenom@nouvelle-aquitaine.fr</label>
    </div>
    <div class="item">
      <p>Téléphone</p>
      <input type="text" name="phone" id="tel">
      <label for="phone">06XXXXXXXX</label>
    </div>
  </div>
  <div class="item">
    <p>Site / Lycée</p>
    <input type="text" name="site" value="Lycée">
  </div>
  <div class="item">
    <p>IBAN</p>
    <input type="text" name="IBAN" value="FR76 3000 6000 0112 3456 7890 189">
    <label for="IBAN">FR76 XXXX XXXX XXXX XXXX XXXX XXX</label>
  </div>
  <div class="item">
    <p>Adresse personnelle</p>
    <input type="text" name="address" value="12 All. de la Pinède">
  </div>
  <div class="contact-item">
    <div class="item">
      <p style="">Code Postal</p>
      <input type="text" name="CP" style="width: 100%;" value="33610">
      <label for="CP">33XXX</label>
    </div>
    <div class="item">
      <p>Ville</p>
      <input type="text" name="city" style="width: 100%;" value="Cestas">
    </div>
  </div>
  <div class="btn-block">
    <button type="submit" href="/">Valider</button>
  </div>
</form>

Text Content

Nom complet



Email

ex:nom.prenom@nouvelle-aquitaine.fr

Téléphone

06XXXXXXXX

Site / Lycée

IBAN

FR76 XXXX XXXX XXXX XXXX XXXX XXX

Adresse personnelle

Code Postal

33XXX

Ville

Valider