jellyvision.activehosted.com Open in urlscan Pro
2606:4700::6811:cd1f  Public Scan

Form analysis
1 forms found in the DOM

POST https://jellyvision.activehosted.com/proc.php

<form method="POST" action="https://jellyvision.activehosted.com/proc.php" id="_form_2_" class="_form _form_2 _inline-form  _dark" novalidate="" data-styles-version="5">
  <input type="hidden" name="u" value="2" data-name="u">
  <input type="hidden" name="f" value="2" data-name="f">
  <input type="hidden" name="s" data-name="s">
  <input type="hidden" name="c" value="0" data-name="c">
  <input type="hidden" name="m" value="0" data-name="m">
  <input type="hidden" name="act" value="sub" data-name="act">
  <input type="hidden" name="v" value="2" data-name="v">
  <input type="hidden" name="or" value="59a7172cf0c0acda9f61a7162de31557" data-name="or">
  <div class="_form-content">
    <div class="_form_element _x24802658 _full_width ">
      <label for="email" class="_form-label"> Email* </label>
      <div class="_field-wrapper">
        <input type="text" id="email" name="email" placeholder="yours@example.com" required="" data-name="email">
      </div>
    </div>
    <div class="_form_element _x17814721 _full_width ">
      <label for="phone" class="_form-label"> Phone* </label>
      <div class="_field-wrapper">
        <input type="text" id="phone" name="phone" placeholder="999-999-9999" required="" data-name="phone">
      </div>
    </div>
    <div class="_form_element _x03184348 _full_width _clear">
      <div class="_html-code">
        <p> *Required field </p>
      </div>
    </div>
    <div class="_button-wrapper _full_width">
      <button id="_form_2_submit" class="_submit" type="submit"> Submit </button>
    </div>
    <div class="_clear-element">
    </div>
  </div>
  <div class="_form-thank-you" style="display:none;">
  </div>
</form>

Text Content

Email*

Phone*


*Required field

Submit