www.offroad-register.com
Open in
urlscan Pro
2400:d400:2:98c::2
Public Scan
Submitted URL: https://offroad-register.com/
Effective URL: https://www.offroad-register.com/en
Submission: On April 29 via api from US — Scanned from NZ
Effective URL: https://www.offroad-register.com/en
Submission: On April 29 via api from US — Scanned from NZ
Form analysis 7 forms found in the DOM
POST /en/newsletters/registration/apply
<form action="/en/newsletters/registration/apply" method="post">
<input type="text" class="form-control input-sm no_border_radius" name="name" required="" placeholder="Name" aria-describedby="basic-addon1">
<input type="text" class="form-control input-sm no_border_radius margin_top_5" name="email" required="" placeholder="Email" aria-describedby="basic-addon1">
<input type="text" required="" color="#FFF; !important;" pattern="[A-Za-z]{5}" class="form-control input-sm no_border_radius margin_top_5 margin_bottom_5" name="captchaMontlyPromotions" placeholder="Enter Captcha" autocomplete="off">
<div style="text-align: center;">
<div class="realperson-challenge">
<div class="realperson-text">
***** ****** ****** ******* ******* <br>* * * * * * * * <br>* * * * * * * <br>* ****** ****** * * <br>* * * * * * * <br>* * * * * * * * <br> ***** * * * * ******* ******* <br>
</div>
<div class="realperson-regen">Click to change</div>
</div>
<div class="captchaMontlyPromotions margin_top_5 is-realperson" style="text-align: center;"></div>
</div>
<button type="submit" class="btn btn-block black_gradient btn-sm btn_join margin_top_5">JOIN</button>
</form><form>
<div class="form-group">
<label>Email *</label>
<input type="email" class="form-control-sm form-control" required="" id="email_search_user_tool" value="" placeholder="Type email">
</div>
<div class="form-group text-center">
<button type="button" class="btn btn-success" id="btn_type_search_user_tool">Search</button>
</div>
</form><form>
<div class="form-group">
<label>Name</label>
<input type="email" class="form-control-sm form-control" required="" id="name_search_entity_memebr_tool" value="" placeholder="Type name">
</div>
<div class="form-group">
<label>Email</label>
<input type="email" class="form-control-sm form-control" required="" id="email_search_user_tool" value="" placeholder="Type email">
</div>
<div class="form-group text-center">
<button type="button" class="btn btn-success" id="btn_type_search_user_tool">Search</button>
</div>
</form>Name: login-form — POST
<form name="login-form" method="post">
<input type="hidden" name="continue" value="">
<div class="col-sm-12">
<div class="form-group">
<label class="col-form-label col-sm-12">Email</label>
<div class="col-sm-12">
<input type="email" name="email" required="" class="form-control form-control-sm" placeholder="some@mail.xx" value="">
</div>
<div class="clearfix"></div>
</div>
<div class="form-group">
<label class="col-form-label col-sm-12">Password</label>
<div class="col-sm-12">
<input type="password" required="" class="form-control form-control-sm" name="password" placeholder="Password" autocomplete="off">
</div>
<div class="clearfix"></div>
</div>
<div class="form-group">
<div class="col-12 text-center">
<label class="col-form-label col-sm-12">
<a href="#forgot-password" class="forgot_password_button">Forgot Your Password? </a>
</label>
<label class="col-form-label col-sm-12">
<a href="/en/register/resend" class="forgot_password_button">Resend Activation Email</a>
</label>
</div>
</div>
<div class="form-group">
<div class="col-12 text-right">
<button type="submit" class="btn btn-sm btn-success"><span class="letter">LOGIN </span> <span class="round"><i aria-hidden="true" class="fa fa-arrow-right"></i></span>
</button>
<button type="reset" class="btn btn-sm btn-danger" data-dismiss="modal"><span class="letter">CANCEL </span> <span class="round"><i class="fa fa-times"></i></span></button>
</div>
<div class="clearfix"></div>
</div>
</div>
<div class="clearfix"></div>
</form>Name: recovery-form — POST /en/recovery
<form name="recovery-form" method="post" action="/en/recovery">
<div class="col-sm-12">
<div class="form-group">
<label class="col-form-label col-sm-12 font_14"><i>Please enter your email to retrieve it</i></label>
<div class="clearfix"></div>
</div>
<div class="form-group">
<label class="col-form-label col-sm-12">Email</label>
<div class="col-sm-12">
<input type="email" class="form-control form-control-sm" name="email" required="" autocomplete="off" placeholder="Type Something">
</div>
<div class="clearfix"></div>
</div>
<div class="clearfix"></div>
<div class="form-group">
<div class="col-sm-12 no_padding_left no_padding_right">
<label class="col-form-label col-sm-12">Enter Captcha*</label>
<div class="col-sm-6">
<input type="text" required="" pattern="[A-Za-z]{5}" class="form-control form-control-sm" autocomplete="off" name="defaultReal" placeholder="Type text displayed">
</div>
<div class="col-sm-6 text-center">
<div class="realperson-challenge">
<div class="realperson-text">
* ****** * * ***** ***** <br> * * * * * * * * * <br> * * * * * * * * <br> * ****** * * * * <br> * * * * * * * * *** <br>* * * * * * * * * <br> ***** * * * **** * ***** <br>
</div>
<div class="realperson-regen">Click to change</div>
</div>
<div class="defaultReal is-realperson"></div>
</div>
</div>
<div class="clearfix"></div>
</div>
<div class="form-group">
<div class="col-sm-12 text-right">
<a href="#" type="button" class="btn btn-primary btn-sm" data-dismiss="modal">CLOSE</a>
<button type="submit" class="btn btn-warning btn-sm">SUBMIT</button>
</div>
<div class="clearfix"></div>
</div>
<div class="form-group">
<div class="col-sm-12">
<a href="#sign-up" type="button" class="btn btn-success btn-block sign_up" data-dismiss="modal">Not a Member of the VisualCMS System Yet!<br>SIGN UP TODAY!</a>
</div>
<div class="clearfix"></div>
</div>
</div>
<div class="clearfix"></div>
</form>POST /en/front-access/validate-email-apply
<form action="/en/front-access/validate-email-apply" method="post" id="frm-validate-email-principal_login_1714392552">
<input type="hidden" name="module_params[sign_up_type]" value="">
<input type="hidden" name="module_params[key_module]" value="principal_login_1714392552">
<input type="hidden" name="module_params[div_content_module]" value="div_content_front_access_1714392552">
<input type="hidden" name="module_params[type_continue]" value="refresh">
<input type="hidden" name="module_params[fields_class]" value="col-12 col-sm-4">
<input type="hidden" name="module_params[method_continue]" value="">
<input type="hidden" name="module_params[method_params]" value="">
<div class="form-group">
<label>Email *</label>
<input type="email" class="form-control-sm form-control" required="" name="email" value="" placeholder="Type your email">
</div>
<div class="form-group margin_top_10">
<div class="col-sm-12 no_padding">
<div class="col-12 col-sm-12">
<div class="realperson-challenge">
<div class="realperson-text">
***** * * ******* * * ***** <br>* * * * * * * * * <br>* * * * * * * * <br>* * * * * * <br>* * * * * * * * *** <br>* * * * * * * * <br> **** * * ******* * * ***** <br>
</div>
<div class="realperson-regen">Click to change</div>
</div>
<div class="captchaSignUp is-realperson"></div>
</div>
<label class="col-form-label col-sm-12 no_padding">Enter Captcha *</label>
<div class="col-12 col-sm-12 no_padding">
<input type="text" required="" color="#FFF; !important;" pattern="[A-Za-z]{5}" class="form-control form-control-sm" name="captchaSignUp" placeholder="Type text displayed" autocomplete="off">
</div>
</div>
<div class="clearfix"></div>
</div>
<div class="clearfix"></div>
<div class="form-group">
<button type="submit" class="btn btn-md btn-success">NEXT</button>
<br>
</div>
<div class="clearfix"></div>
<div class="form-group">
<p style="color: white;">Note: If you do not remember your password, in the next step you will have the option to recover</p>
</div>
<p style="color: #FFF;">* Are compulsory</p>
</form>Name: quick-register-form — POST /en/module/quick-sign-up/sign-up-apply
<form name="quick-register-form" action="/en/module/quick-sign-up/sign-up-apply" method="post">
<section class="dashboard">
<section style="margin-top:20px;margin-bottom:20px;" class="page_child_option_menu clearfix">
<ul id="navTabs" class="nav nav-tabs no_bg">
<li class="active">
<a href="#sign_up_simple_tab" data-toggle="tab" class="font_16" data-id="sign_up_simple_tab">Sign Up</a>
</li>
<li>
<a href="#sign_up_complete_tab" data-toggle="tab" class="font_16 d-none" data-id="sign_up_complete_tab">Complete your Registration</a>
</li>
</ul>
<div class="tab-content with_padding">
<div class="tab-pane margin_bottom_10 active" id="sign_up_simple_tab">
<section class="details">
<div class="col-12 col-md-3 no_padding_left">
<div class="form-group clearfix" id="registry-type">
<div class="btn-group margin_bottom_10 col-sm-12 no_padding">
<button type="button" class="btn btn-secondary btn_grey" registry-type="0">Company</button>
<button type="button" class="btn btn-secondary btn_grey active" registry-type="1">Individual</button>
</div>
<input type="hidden" name="registry_type" value="1">
</div>
</div>
<div class="col-12 col-md-6 no_padding_left">
<div class="form-group clearfix" id="membership-type">
<div class="btn-group margin_bottom_10 col-sm-12 no_padding">
<button type="button" class="btn btn-secondary btn_grey active" membership-type="1">Register as Private User</button>
<button type="button" class="btn btn-secondary btn_grey " membership-type="2">Register as Professional Business</button>
</div>
<input type="hidden" name="customer_membership_id" value="1">
</div>
</div>
<div id="company_section" class="d-none">
<div class="clearfix"></div>
<div class="col-12 col-md-3 col-sm-3 no_padding_left">
<div class="form-group clearfix">
<label class="col-form-label" for="company">Company Name: *</label>
<div class="col-md-12 clearfix no_padding">
<input type="text" class="form-control form-control-sm" name="company" id="company" value="" data-test="1">
</div>
</div>
</div>
<div class="col-12 col-md-3 col-sm-3 no_padding_left">
<div class="form-group clearfix">
<label class="col-form-label" for="abn">ABN:</label>
<div class="col-md-12 clearfix no_padding">
<input type="text" class="form-control form-control-sm" name="abn" id="abn" value="">
</div>
</div>
</div>
<div class="col-12 col-md-3 col-sm-3 no_padding_left">
<div class="form-group clearfix">
<label class="col-form-label" for="company_email">Email:</label>
<div class="col-md-12 clearfix no_padding">
<input type="text" class="form-control form-control-sm" name="company_email" value="">
</div>
</div>
</div>
</div>
<div class="clearfix"></div>
<div class="col-12 col-sm-3 col-md-3 no_padding_left">
<div class="form-group clearfix">
<label class="col-form-label" for="title_id">Title: *</label>
<div class="col-md-12 clearfix no_padding">
<select class="form-control form-control-sm" name="title_id" required="">
<option value="9">Ms</option>
<option value="10">Miss</option>
<option value="12">Mrs</option>
<option value="13">Mr</option>
<option value="14">Dr</option>
<option value="15">Other</option>
</select>
</div>
</div>
</div>
<div class="col-12 col-md-3 col-sm-3 no_padding_left">
<div class="form-group clearfix">
<label class="col-form-label" for="nickname">Nickname:</label>
<div class="col-md-12 clearfix no_padding">
<input type="text" class="form-control form-control-sm" name="nickname" id="nickname" value="">
</div>
</div>
</div>
<div class="col-12 col-md-3 col-sm-3 no_padding_left">
<div class="form-group clearfix">
<label class="col-form-label" for="name">First Name: *</label>
<div class="col-md-12 clearfix no_padding">
<input type="text" class="form-control form-control-sm" name="name" required="" value="">
</div>
</div>
</div>
<div class="col-12 col-md-3 col-sm-3 no_padding_left">
<div class="form-group clearfix">
<label class="col-form-label" for="last_name">Surname: *</label>
<div class="col-md-12 clearfix no_padding">
<input type="text" class="form-control form-control-sm" name="last_name" required="" value="">
</div>
</div>
</div>
<div class="clearfix"></div>
<div class="col-12 col-sm-3 col-md-3 no_padding_left">
<div class="form-group clearfix">
<label class="col-form-label" for="email">Email: *</label>
<div class="col-md-12 clearfix no_padding">
<input type="text" class="form-control form-control-sm" name="email" required="" value="">
</div>
</div>
</div>
<div class="col-12 col-md-3 col-sm-3 no_padding_left">
<div class="form-group clearfix">
<label class="col-form-label" for="password">Password: *</label>
<div class="col-md-12 clearfix no_padding">
<input type="password" class="form-control form-control-sm" name="password" value="" autocomplete="off">
</div>
</div>
</div>
<div class="col-12 col-md-3 col-sm-3 no_padding_left">
<div class="form-group clearfix">
<label class="col-form-label" for="confirm_password">Confirm Password: *</label>
<div class="col-md-12 clearfix no_padding">
<input type="password" class="form-control form-control-sm" name="confirm_password" value="" autocomplete="off">
</div>
</div>
</div>
<div class="col-12 col-sm-3 col-md-3 no_padding_left">
<div class="form-group clearfix">
<label class="col-form-label">DOB: </label>
<div class="col-md-12 clearfix no_padding">
<div class="input-group date">
<input type="text" class="form-control form-control-sm" placeholder="" aria-describedby="basic-addon1" name="birth_date" value="">
<span class="input-group-addon form-control-md cursor_pointer" id="basic-addon1"><i class="fa fa-calendar"></i></span>
</div>
</div>
</div>
</div>
<div class="col-12 col-sm-3 col-md-3 no_padding_left">
<div class="form-group clearfix">
<label class="col-form-label" for="phone">Phone Number:</label>
<div class="col-md-12 clearfix no_padding">
<input type="text" class="form-control form-control-sm" name="phone" value="">
</div>
</div>
</div>
<div class="col-12 col-sm-3 col-md-3 no_padding_left">
<div class="form-group clearfix">
<label class="col-form-label" for="mobile">Mobile Number:</label>
<div class="col-md-12 clearfix no_padding">
<input type="text" class="form-control form-control-sm" name="mobile" value="">
</div>
</div>
</div>
<div class="clearfix"></div>
<div class="commercial_settings_form">
<div class="form-group" id="captcha_section">
<div class="col-sm-12 no_padding_left no_padding_right">
<label class="col-form-label col-sm-12 no_padding">Enter Captcha*</label>
<div class="col-sm-6 no_padding">
<input type="text" required="" pattern="[A-Za-z]{5}" class="form-control form-control-md" name="defaultReal" placeholder="Type text displayed on the right">
</div>
<div class="col-sm-6 text-center">
<div class="realperson-challenge">
<div class="realperson-text">
******* * * ***** * * ***** <br> * * * * * * * * * <br> * * * * * * * * <br> * * * * * ******* * * <br> * * * * * * *** * * * * <br> * ** ** * * * * * * <br>******* * * ***** * * ***** <br>
</div>
<div class="realperson-regen">Click to change</div>
</div>
<div class="defaultReal is-realperson"></div>
</div>
</div>
<div class="clearfix"></div>
</div>
<div class="clearfix"></div>
<div class="form-group">
<div class="col-sm-12 no_padding">
<label for="newsletter">
<input type="checkbox" value="1" name="newsletter" id="newsletter"> I accept to receive newsletters and special offers from time to time.</label>
</div>
<div class="clearfix"></div>
</div>
<div class="clearfix"></div>
<div class="form-group">
<div class="col-sm-12 no_padding">
<label for="terms_conditions">
<input type="checkbox" value="1" name="terms_conditions" id="terms_conditions" required=""> I have read and agree to the <a href="/en/terms-and-conditions">terms and conditions</a> </label>
</div>
<div class="clearfix"></div>
</div>
</div>
</section>
</div>
<div class="tab-pane margin_bottom_10" id="sign_up_complete_tab">
<section class="details">
<div class="col-12 col-sm-12 col-md-12 no_padding_left">
<div class="form-group clearfix">
<label class="col-form-label" for="professional_description">Professional Description (Displays in Store and to Your Customers):</label>
<div class="col-md-12 clearfix no_padding">
<textarea class="form-control form-control-sm" name="professional_description"></textarea>
</div>
</div>
</div>
<div class="clearfix"></div>
<fieldset class="scheduler-border">
<legend class="scheduler-border">Language Preferences</legend>
<div class="col-12 col-md-3 col-sm-6 no_padding_left">
<div class="form-group clearfix">
<label class="col-form-label" for="language_id">Preferred Language: *</label>
<div class="col-md-12 clearfix no_padding">
<select class="form-control form-control-sm" name="language_id">
<option value="4">English - Australia (en_AU)</option>
<option value="9">Greek (Greece) (el_GR)</option>
<option value="14">Italian (Italy) (it_IT)</option>
<option value="15">Chinese (S) (zh_CN)</option>
<option value="18">Hindi (India) (hi_IN)</option>
<option value="26">Vietnamese - Vietnam (vi_VN)</option>
<option value="27">Indonesian (Indonesia) (id_ID)</option>
<option value="28">Hebrew (Israel) (he_IL)</option>
</select>
</div>
</div>
</div>
</fieldset>
<div class="clearfix"></div>
<fieldset class="scheduler-border">
<legend class="scheduler-border">Contact Details</legend>
<div class="col-12 col-md-3 col-sm-3 no_padding_left">
<div class="form-group clearfix">
<label class="col-form-label" for="website">Website:</label>
<div class="col-md-12 clearfix no_padding">
<input type="text" class="form-control form-control-sm" name="website" value="">
</div>
</div>
</div>
<div class="col-12 col-md-3 col-sm-3 no_padding_left">
<div class="form-group clearfix">
<label class="col-form-label" for="address_site">Site:</label>
<div class="col-md-12 clearfix no_padding">
<input type="text" class="form-control form-control-sm" name="address_site" value="">
</div>
</div>
</div>
<div class="col-12 col-md-3 col-sm-3 no_padding_left">
<div class="form-group clearfix">
<label class="col-form-label">Country:</label>
<div class="col-md-12 clearfix no_padding">
<select class="form-control form-control-md" name="country_id" id="country_id">
<option selected="" value="14">Australia</option>
</select>
</div>
</div>
</div>
<div class="col-12 col-md-3 col-sm-3 no_padding_left">
<div class="form-group clearfix">
<label class="col-form-label" for="address_lot_number">Lot Number:</label>
<div class="col-md-12 clearfix no_padding">
<input type="text" class="form-control form-control-sm" name="address_lot_number" value="">
</div>
</div>
</div>
<div class="clearfix"></div>
<div class="col-12 col-md-3 col-sm-3 no_padding_left">
<div class="form-group clearfix">
<label class="col-form-label" for="address_sub_number">Unit:</label>
<div class="col-md-12 clearfix no_padding">
<input type="text" class="form-control form-control-sm" name="address_sub_number" value="">
</div>
</div>
</div>
<div class="col-12 col-md-2 col-sm-2 no_padding_left">
<div class="form-group clearfix">
<label class="col-form-label" for="address_street_number">Street Number:</label>
<div class="col-md-12 clearfix no_padding">
<input type="text" class="form-control form-control-sm" name="address_street_number" id="address_street_number_quick_sign_up_form" value="">
</div>
</div>
</div>
<div class="col-12 col-md-3 col-sm-3 no_padding_left">
<div class="form-group clearfix">
<label class="col-form-label" for="address">Street Name:</label>
<div class="input-group input-group-sm">
<input type="hidden" name="address_public" value="0">
<span class="input-group-addon">
<input type="checkbox" name="address_public" value="1">
</span>
<input type="text" class="form-control form-control-sm" name="address" id="address_quick_sign_up_form" value="">
</div>
<p style="font-size: 1.3rem;">Tick if you want it to be published</p>
</div>
</div>
<div class="col-12 col-md-4 col-sm-4 no_padding_left">
<div class="form-group clearfix">
<label class="col-form-label" id="location-label">State, Suburb, Post Code</label>
<div class="col-md-12 clearfix no_padding">
<span class="twitter-typeahead" style="position: relative; display: inline-block;"><input class="form-control form-control-md la-hint" data-country="#country_id" data-name="location_id" data-label="#location-label"
data-limit="500" value="" data-value="" field-id="0" data-url="/en/public/location-autocomplete" readonly="" autocomplete="off" spellcheck="false" tabindex="-1" dir="ltr"
style="position: absolute; top: 0px; left: 0px; border-color: transparent; box-shadow: none; opacity: 1; background: none 0% 0% / auto repeat scroll padding-box padding-box rgb(255, 255, 255);"><input
class="form-control form-control-md la-input" data-country="#country_id" name="formatted_location" id="formatted_location_quick_sign_up_form" data-name="location_id" data-label="#location-label" data-limit="500" value=""
data-value="" field-id="0" data-url="/en/public/location-autocomplete" autocomplete="off" spellcheck="false" dir="auto" style="position: relative; vertical-align: top; background-color: transparent;"
placeholder="State, Suburb, Post Code">
<pre aria-hidden="true"
style="position: absolute; visibility: hidden; white-space: pre; font-family: Lato, sans-serif; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; word-spacing: 0px; letter-spacing: 0px; text-indent: 0px; text-rendering: auto; text-transform: none;"></pre>
<div class="la-menu" style="position: absolute; top: 100%; left: 0px; z-index: 100; display: none;">
<div class="la-dataset la-dataset-location_autocomplete"></div>
</div>
</span>
</div>
<input type="hidden" class="form-control input-sm" id="location_id_0" name="location_id" value="">
<div id="location_loading_0" class="autocomplete-loading" style="margin-right: 10px;display:none;"> <i class="fa fa-spin fa-spinner"></i></div>
</div>
</div>
<div class="col-12 col-md-8 col-sm-8 no_padding">
<label class="col-form-label">Geo Find Address</label><br>
<div class="col-md-7 clearfix no_padding">
<input id="geo_address" value="" type="text" class="form-control form-control-sm">
</div>
<div class="col-md-5 clearfix">
<input type="button" value="Post the previous to google map" class="btn btn-sm btn-danger" onclick="generate_loadMapa_member_details();" style="width: 100%;"><br>
<input type="button" value="Enter for google map" class="btn btn-sm btn-danger" onclick="loadMapa_member_details();" style="width: 100%; margin-top: 5px;">
</div>
<div class="clearfix"></div>
</div>
<div class="col-12 col-md-2 col-sm-2 no_padding_left">
<div class="form-group clearfix">
<label class="col-form-label" for="address">Longitude:</label>
<div class="col-md-12 clearfix no_padding">
<input type="text" class="form-control form-control-sm" name="longitude" id="longitude" readonly="readonly" value="">
</div>
</div>
</div>
<div class="col-12 col-md-2 col-sm-2 no_padding_left">
<div class="form-group clearfix">
<label class="col-form-label" for="address">Latitude:</label>
<div class="col-md-12 clearfix no_padding">
<input type="text" class="form-control form-control-sm" name="latitude" id="latitude" readonly="readonly" value="">
</div>
</div>
</div>
<div class="col-12 col-md-6 col-sm-6 no_padding_left">
<div class="form-group clearfix">
<label class="col-form-label" for="address">Google Address:</label>
<div class="col-md-12 clearfix no_padding">
<input type="text" class="form-control form-control-sm" name="google_address" id="google_address" readonly="readonly" value="">
</div>
</div>
</div>
<div class="form-group">
<div class="col-12 col-md-6 col-sm-6 no_padding_left" style="margin-top: 20px;">
<label class="col-form-label " style="text-align:left;">
<input type="hidden" name="publish_map" value="0">
<input type="checkbox" name="publish_map" value="1"> Publish Map</label>
</div>
</div>
<div class="clearfix"></div>
<div class="col-sm-6 col-md-6 no_padding">
<div class="col-sm-12 no_padding">
<p class="help-block">Drag the icon to find the right location.</p>
<div style="margin-top:10px;">
<div id="member_details_map" style="width:100%;height:350px;" class="google-map" data-address=""></div>
</div>
</div>
</div>
</fieldset>
<div class="clearfix"></div>
<fieldset class="scheduler-border">
<legend class="scheduler-border"><label><input type="hidden" name="billing_address_active" value="0"><input type="checkbox" name="billing_address_active" value="1"> Billing Address (Select if different to above address)</label></legend>
<div id="div_billing_address" class="d-none">
<div class="col-12 col-sm-3 no_padding_left">
<div class="form-group clearfix">
<label class="col-form-label" for="billing_address_site">Site:</label>
<div class="col-md-12 clearfix no_padding">
<input type="text" class="form-control form-control-sm" name="billing_address_site" value="">
</div>
</div>
</div>
<div class="col-12 col-sm-3 no_padding_left">
<div class="form-group clearfix">
<label class="col-form-label">Country:</label>
<div class="col-md-12 clearfix no_padding">
<select class="form-control form-control-sm" name="billing_country_id" id="billing_country_id">
<option selected="" value="14">Australia</option>
</select>
</div>
</div>
</div>
<div class="col-12 col-sm-3 no_padding_left">
<div class="form-group clearfix">
<label class="col-form-label" for="billing_address_lot_number">Lot Number:</label>
<div class="col-md-12 clearfix no_padding">
<input type="text" class="form-control form-control-sm" name="billing_address_lot_number" value="">
</div>
</div>
</div>
<div class="col-12 col-sm-3 no_padding_left">
<div class="form-group clearfix">
<label class="col-form-label" for="billing_address_sub_number">Unit:</label>
<div class="col-md-12 clearfix no_padding">
<input type="text" class="form-control form-control-sm" name="billing_address_sub_number" value="">
</div>
</div>
</div>
<div class="col-12 col-sm-3 no_padding_left">
<div class="form-group clearfix">
<label class="col-form-label" for="billing_address_street_number">Street Number:</label>
<div class="col-md-12 clearfix no_padding">
<input type="text" class="form-control form-control-sm" name="billing_address_street_number" value="">
</div>
</div>
</div>
<div class="col-12 col-sm-3 no_padding_left">
<div class="form-group clearfix">
<label class="col-form-label" for="billing_address">Street Name: *</label>
<div class="col-md-12 clearfix no_padding">
<input type="text" class="form-control form-control-sm" name="billing_address" value="">
</div>
</div>
</div>
<div class="col-sm-6 no_padding_left">
<div class="form-group clearfix">
<label class="col-form-label" id="location-billing-label">State, Suburb, Post Code</label>
<div class="col-md-12 clearfix no_padding">
<span class="twitter-typeahead" style="position: relative; display: inline-block;"><input class="form-control form-control-md la-hint" data-country="#billing_country_id" data-name="billing_location_id"
data-label="#location-billing-label" data-limit="500" value="" data-value="" field-id="1" data-url="/en/public/location-autocomplete" readonly="" autocomplete="off" spellcheck="false" tabindex="-1" dir="ltr"
style="position: absolute; top: 0px; left: 0px; border-color: transparent; box-shadow: none; opacity: 1; background: none 0% 0% / auto repeat scroll padding-box padding-box rgb(255, 255, 255);"><input
class="form-control form-control-md la-input" data-country="#billing_country_id" name="formatted_location_billing" data-name="billing_location_id" data-label="#location-billing-label" data-limit="500" value="" data-value=""
field-id="1" data-url="/en/public/location-autocomplete" autocomplete="off" spellcheck="false" dir="auto" style="position: relative; vertical-align: top; background-color: transparent;"
placeholder="State, Suburb, Post Code">
<pre aria-hidden="true"
style="position: absolute; visibility: hidden; white-space: pre; font-family: Lato, sans-serif; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; word-spacing: 0px; letter-spacing: 0px; text-indent: 0px; text-rendering: auto; text-transform: none;"></pre>
<div class="la-menu" style="position: absolute; top: 100%; left: 0px; z-index: 100; display: none;">
<div class="la-dataset la-dataset-location_autocomplete"></div>
</div>
</span>
</div>
<input type="hidden" class="form-control input-sm" id="location_id_1" name="billing_location_id" value="">
<div id="location_loading_1" class="autocomplete-loading" style="margin-right: 10px;display:none;"> <i class="fa fa-spin fa-spinner"></i></div>
</div>
</div>
</div>
</fieldset>
<div class="clearfix"></div>
<fieldset class="scheduler-border">
<div class="form-group clearfix">
<div class="col-sm-12">
<label for="how_should_contact" class="">How should business contact you?</label><br>
<div class="btn-group" style="width: 100%;">
<label class="btn btn_grey chk_fixed_len_btn " id="how_should_contact_chk_1">
<input type="radio" value="1" name="how_should_contact"> Email Me </label>
<label class="btn btn_grey chk_fixed_len_btn " id="how_should_contact_chk_2">
<input type="radio" value="2" name="how_should_contact"> Call or Text Me </label>
</div>
</div>
</div>
<div class="form-group call_preference_div clearfix ">
<div class="col-sm-12">
<label for="" class="">What is the best time to contact you?</label><br>
<div class="btn-group">
<label class="btn btn_grey chk_fixed_len_btn " id="best_time_contact_chk_1">
<input type="radio" name="best_time_contact" value="1"> AnyTime </label>
<label class="btn btn_grey chk_fixed_len_btn " id="best_time_contact_chk_2">
<input type="radio" name="best_time_contact" value="2"> Business Hours(9am - 5:30pm) </label>
<label class="btn btn_grey chk_fixed_len_btn " id="best_time_contact_chk_3">
<input type="radio" name="best_time_contact" value="3"> After Hours(after 5:30pm) </label>
<label class="btn btn_grey chk_fixed_len_btn " id="best_time_contact_chk_4">
<input type="radio" name="best_time_contact" value="4">
<input type="text" name="best_time_contact_specification" placeholder="specific time" class="form-control form-control-md input_radio_fixed_width" value="">
</label>
</div>
</div>
</div>
</fieldset>
<div class="clearfix"></div>
</section>
</div>
</div>
<div class="clearfix"></div>
<div class="form-group">
<div class="col-sm-12 text-right">
<button type="button" class="btn btn-secondary" data-dismiss="modal">Close</button>
<button type="submit" class="btn btn-success small_btn" id="btn_button_sign_up">Sign Up Now</button>
</div>
<div class="clearfix"></div>
</div>
</section>
</section>
</form>Text Content
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