info.mijn-offertes.be Open in urlscan Pro
3.69.136.55  Public Scan

Submitted URL: http://news.belgiumnewsletter.be/re?l=D0Ie4kqmuI454ka1vI9ITkxovl4dk&s=CHGLEGAPNKKPNGBF
Effective URL: https://info.mijn-offertes.be/schilderwerken-offertes/?aff=amsterdam_nl&utm_source=202005-benl-paint
Submission: On January 03 via api from BE — Scanned from DE

Form analysis 1 forms found in the DOM

POST /fsg?pageId=95cf33f6-a5ac-4913-968e-4a4d08db9a56&variant=b

<form action="/fsg?pageId=95cf33f6-a5ac-4913-968e-4a4d08db9a56&amp;variant=b" method="POST"><input type="hidden" name="pageId" value="95cf33f6-a5ac-4913-968e-4a4d08db9a56"><input type="hidden" name="pageVariant" value="b">
  <div class="fields">
    <div class="lp-pom-form-field drop-down" id="container_XML_extra_check" style="top: 0px;"><label class="main lp-form-label" for="XML_extra_check" id="label_XML_extra_check" style="height: auto;"><span class="label-style">Waar moeten de
          schilderwerken plaatsvinden?</span></label><select id="XML_extra_check" name="XML_extra_check" class="ub-input-item single form_elem_XML_extra_check">
        <option value="1">Binnenshuis</option>
        <option value="2">Buitenshuis</option>
        <option value="3">Beide</option>
      </select></div>
    <div class="lp-pom-form-field multi-line-text multi-group hide" id="container_XML_remarks" style="top: 0px;"><label class="main lp-form-label" for="XML_remarks" id="label_XML_remarks" style="height: auto;"><span class="label-style">Extra info
          voor de schilder:</span></label><textarea id="XML_remarks" name="XML_remarks" class="ub-input-item single text form_elem_XML_remarks"
        placeholder="Geef indien mogelijk meer informatie over de gewenste schilderwerken: kleur, oppervlakte, stijl,..."></textarea></div>
    <div class="lp-pom-form-field single-line-text hide" id="container_firstName" style="top: 0px;"><label class="main lp-form-label" for="firstName" id="label_firstName" style="height: auto;"><span
          class="label-style">Voornaam&nbsp;*</span></label><input id="firstName" name="firstName" type="text" class="ub-input-item single text form_elem_firstName" placeholder="Voornaam" required=""></div>
    <div class="lp-pom-form-field single-line-text hide" id="container_lastName" style="top: 0px;"><label class="main lp-form-label" for="lastName" id="label_lastName" style="height: auto;"><span
          class="label-style">Achternaam&nbsp;*</span></label><input id="lastName" name="lastName" type="text" class="ub-input-item single text form_elem_lastName" placeholder="Achternaam" required=""></div>
    <div class="lp-pom-form-field single-line-text hide" id="container_address1" style="top: 0px;"><label class="main lp-form-label" for="address1" id="label_address1" style="height: auto;"><span class="label-style">Adres&nbsp;*</span></label><input
        id="address1" name="address1" type="text" class="ub-input-item single text form_elem_address1" placeholder="Adres" required=""></div>
    <div class="lp-pom-form-field single-line-text hide" id="container_XML_postcode" style="top: 0px;"><label class="main lp-form-label" for="XML_postcode" id="label_XML_postcode" style="height: auto;"><span
          class="label-style">Postcode&nbsp;*</span></label><input id="XML_postcode" name="XML_postcode" type="text" class="ub-input-item single text form_elem_XML_postcode" placeholder="Postcode" required=""></div>
    <div class="lp-pom-form-field single-line-text hide" id="container_XML_email" style="top: 0px;"><label class="main lp-form-label" for="XML_email" id="label_XML_email" style="height: auto;"><span
          class="label-style">E-mail&nbsp;*</span></label><input id="XML_email" name="XML_email" type="text" class="ub-input-item single text form_elem_XML_email" placeholder="E-mailadres" required=""></div>
    <div class="lp-pom-form-field single-line-text hide" id="container_XML_telephone" style="top: 0px;"><label class="main lp-form-label" for="XML_telephone" id="label_XML_telephone" style="height: auto;"><span
          class="label-style">Telefoonnummer&nbsp;*</span></label><input id="XML_telephone" name="XML_telephone" type="tel" class="ub-input-item single text form_elem_XML_telephone" placeholder="Telefoonnummer" required=""
        pattern="^\+?( ?\(?-?\d\)?){6,13}$"></div>
    <div class="lp-pom-form-field checkbox-group multi-group hide" id="container_terms" style="top: 0px;"><label class="main lp-form-label" for="terms" id="label_terms" style="height: auto;"><span class="label-style">Bevestiging&nbsp;*</span></label>
      <div class="ub-input-item input-wrap optionsList" id="group_terms">
        <div class="option" id="ub-option-terms-item-0"><input type="checkbox" id="terms_ja_ik_wens_gratis_offertes_te_vergelijken" name="terms" value="Ja, ik wens gratis offertes te vergelijken."
            class="checkbox form-builder-checkbox-input form_elem_terms" data-required=""><label for="terms_ja_ik_wens_gratis_offertes_te_vergelijken" class="opt-label form-builder-checkbox-label"><span class="label-style">Ja, ik wens gratis offertes
              te vergelijken.</span></label></div>
      </div>
    </div><input id="aff" name="aff" type="hidden" class="hidden" value="amsterdam_nl"><input id="utm_source" name="utm_source" type="hidden" class="hidden" value="202005-benl-paint"><input id="utm_medium" name="utm_medium" type="hidden"
      class="hidden" value="aff"><input id="utm_campaign" name="utm_campaign" type="hidden" class="hidden" value=""><input id="type_id" name="type_id" type="hidden" class="hidden" value="11996"><input id="rem_id" name="rem_id" type="hidden"
      class="hidden" value="20220103054259135"><input id="rem_source" name="rem_source" type="hidden" class="hidden" value="Mijn-Offertes.be"><input id="pixel_id" name="pixel_id" type="hidden" class="hidden" value=""><input id="click_id"
      name="click_id" type="hidden" class="hidden" value=""><input id="language" name="language" type="hidden" class="hidden" value="nl"><input id="promoOptin" name="promoOptin" type="hidden" class="hidden" value="true"><input id="bobx" name="bobx"
      type="hidden" class="hidden" value=""><input id="XML_extra_check2" name="XML_extra_check2" type="hidden" class="hidden" value="">
  </div><button class="lp-element lp-pom-button hide" id="lp-pom-button-44" type="submit"><span class="label">Verzenden</span></button>
  <input type="hidden" name="ubafs-jev" id="ubafs-jev"
    value="{&quot;date&quot;:&quot;2022-01-03T05:42:59.132Z&quot;,&quot;agent&quot;:&quot;Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/96.0.4664.93 Safari/537.36&quot;,&quot;screen&quot;:{&quot;availWidth&quot;:1600,&quot;availHeight&quot;:1200,&quot;width&quot;:1600,&quot;height&quot;:1200},&quot;window&quot;:{&quot;innerWidth&quot;:1600,&quot;innerHeight&quot;:1200},&quot;hasPlugins&quot;:true}">
</form>

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Waar moeten de schilderwerken plaatsvinden?BinnenshuisBuitenshuisBeide
Extra info voor de schilder:
Voornaam *
Achternaam *
Adres *
Postcode *
E-mail *
Telefoonnummer *
Bevestiging *
Ja, ik wens gratis offertes te vergelijken.
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