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POST https://captcha.goebber.uvensys.net

<form class="form" action="https://captcha.goebber.uvensys.net" method="POST">
  <div class="form-group mb-3">
    <div class="form-check form-check-inline"><input class="form-check-input" type="radio" name="inlineRadioOptions" id="radioMan" value="Frau"><label class="form-check-label" for="radioMan">Frau</label></div>
    <div class="form-check form-check-inline"><input class="form-check-input" type="radio" name="inlineRadioOptions" id="radioWoman" value="Mann"><label class="form-check-label" for="radioWoman">Mann</label></div>
    <div class="form-check form-check-inline"><input class="form-check-input" type="radio" name="inlineRadioOptions" id="radioCompany" value="Firma"><label class="form-check-label" for="radioCompany">Firma</label></div>
  </div>
  <div class="row">
    <div class="col-md-6 col-12">
      <div class="form-group mb-3"><input type="text" class="form-control" id="inputFirstname" name="inputFirstname" placeholder="Vorname" required=""></div>
    </div>
    <div class="col-md-6 col-12">
      <div class="form-group mb-3"><input type="text" class="form-control" id="inputLastname" name="inputLastname" placeholder="Nachname" required=""></div>
    </div>
  </div>
  <div class="row">
    <div class="col-md-3">
      <div class="form-group mb-3"><input type="number" class="form-control" id="inputPLZ" name="inputPLZ" placeholder="PLZ" required=""></div>
    </div>
    <div class="col-md-9">
      <div class="form-group mb-3"><input type="text" class="form-control" id="inputCity" name="inputCity" placeholder="Ort" required=""></div>
    </div>
  </div>
  <div class="form-group mb-3"><input type="email" class="form-control" id="inputMail" name="inputMail" placeholder="E-Mail" required=""></div>
  <div class="form-group mb-3"><input type="tel" class="form-control" id="inputPhone" name="inputPhone" placeholder="Telefon" required=""></div>
  <div class="form-group mb-3"><select class="form-control" id="selectTopic" name="selectTopic" required="">
      <option disabled="" value="">Bitte wählen</option>
      <option value="Produkte">Produkte</option>
      <option value="Rezepte">Rezepte</option>
      <option value="Lob/Kritik">Lob/Kritik</option>
      <option value="Grossverbraucher">Großverbraucher</option>
      <option value="Backhandwerk">Backhandwerk</option>
      <option value="Lebensmittelindustrie">Lebensmittelindustrie</option>
      <option value="Allgemeine Mitteilung">Allgemeine Mitteilung</option>
    </select></div>
  <div class="form-group mb-3"><textarea class="form-control" id="message" name="message" rows="3" placeholder="Ihre Nachricht" required=""></textarea></div>
  <div class="form-check mb-5"><input type="checkbox" class="form-check-input" id="sendToMe" name="sendToMe"><label class="form-check-label" for="sendToMe">Eine E-Mail-Kopie an mich senden, damit ich meine Anfrage bei Ihnen auch in meinem E-Mail
      Postfach finden kann</label></div>
  <div class="row mb-3">
    <div class="col-md-6 col-12">
      <div class="form-group" id="captcha-div"><img id="captcha" src="" width="280" height="90"><br><button class="btn btn-secondary" type="button" id="refreshBtn"><i class="fa-solid fa-arrow-rotate-left"></i> Neues Bild</button></div><br>
    </div>
    <div class="col-md-6 col-12">
      <div class="form-group mb-3"> Geben Sie die in dem Bild stehenden Zahlen / Buchstaben ein<br><input type="text" name="solution" class="form-control" placeholder="Captcha..."></div>
    </div>
  </div><!--Display none = not visible for User--><input type="text" id="hiddenCaptchaForSolution" style="display: none;"><button class="btn btn-primary" type="submit">Senden</button>
</form>

Text Content

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Frau
Mann
Firma




Bitte
wählenProdukteRezepteLob/KritikGroßverbraucherBackhandwerkLebensmittelindustrieAllgemeine
Mitteilung

Eine E-Mail-Kopie an mich senden, damit ich meine Anfrage bei Ihnen auch in
meinem E-Mail Postfach finden kann

Neues Bild

Geben Sie die in dem Bild stehenden Zahlen / Buchstaben ein

Senden