www.shellagricnationalpromotion.co.za
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197.189.204.234
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Submitted URL: https://shellagricnationalpromotion.co.za/
Effective URL: https://www.shellagricnationalpromotion.co.za/
Submission: On June 25 via api from US — Scanned from DE
Effective URL: https://www.shellagricnationalpromotion.co.za/
Submission: On June 25 via api from US — Scanned from DE
Form analysis 1 forms found in the DOM
POST /
<form method="post" enctype="multipart/form-data" id="gform_1" action="/" data-formid="1" novalidate="">
<div class="gform-body gform_body">
<div id="gform_fields_1" class="gform_fields top_label form_sublabel_below description_below validation_below">
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<label class="gfield_label gform-field-label" for="input_1_1">Name<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_text"><input name="input_1" id="input_1_1" type="text" value="" class="large" aria-required="true" aria-invalid="false"> </div>
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<label class="gfield_label gform-field-label" for="input_1_3">Surname<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_text"><input name="input_3" id="input_1_3" type="text" value="" class="large" aria-required="true" aria-invalid="false"> </div>
</div>
<div id="field_1_4" class="gfield gfield--type-phone gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_1_4">
<label class="gfield_label gform-field-label" for="input_1_4">Phone<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_phone"><input name="input_4" id="input_1_4" type="tel" value="" class="large" aria-required="true" aria-invalid="false"></div>
</div>
<div id="field_1_5" class="gfield gfield--type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_1_5">
<label class="gfield_label gform-field-label" for="input_1_5">Email<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_email">
<input name="input_5" id="input_1_5" type="email" value="" class="large" aria-required="true" aria-invalid="false">
</div>
</div>
<div id="field_1_11" class="gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"
data-js-reload="field_1_11"><label class="gfield_label gform-field-label" for="input_1_11">Are you a first time Shell buyer?<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_11" id="input_1_11" class="large gfield_select" aria-required="true" aria-invalid="false">
<option value="" selected="selected" class="gf_placeholder">-- Select --</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select></div>
</div>
<div id="field_1_13" class="gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_1_13">
<label class="gfield_label gform-field-label" for="input_1_13">Name of the store you purchased from<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_text"><input name="input_13" id="input_1_13" type="text" value="" class="large" aria-required="true" aria-invalid="false"> </div>
</div>
<div id="field_1_6" class="gfield gfield--type-fileupload gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"
data-js-reload="field_1_6"><label class="gfield_label gform-field-label" for="input_1_6">Photo of Slip<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_fileupload"><input type="hidden" name="MAX_FILE_SIZE" value="33554432"><input name="input_6" id="input_1_6" type="file" class="large" aria-describedby="gfield_upload_rules_1_6"
onchange="javascript:gformValidateFileSize( this, 33554432 );"><span class="gfield_description gform_fileupload_rules" id="gfield_upload_rules_1_6">Max. file size: 32 MB.</span>
<div class="gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty" id="live_validation_message_1_6"></div>
</div>
</div>
<fieldset id="field_1_7" class="gfield gfield--type-consent gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"
data-js-reload="field_1_7">
<legend class="gfield_label gform-field-label gfield_label_before_complex">Consent<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></legend>
<div class="ginput_container ginput_container_consent"><input name="input_7.1" id="input_1_7_1" type="checkbox" value="1" aria-required="true" aria-invalid="false"> <label
class="gform-field-label gform-field-label--type-inline gfield_consent_label" for="input_1_7_1">I agree to the
<a href="https://www.shellagricnationalpromotion.co.za/wp-content/uploads/2024/02/Shell-National-Agric-Promotion-Terms-and-Conditions.pdf" target="_blank">Terms & Conditions.</a></label><input type="hidden" name="input_7.2"
value="I agree to the <a href="https://www.shellagricnationalpromotion.co.za/wp-content/uploads/2024/02/Shell-National-Agric-Promotion-Terms-and-Conditions.pdf" target="_blank">Terms & Conditions.</a>"
class="gform_hidden"><input type="hidden" name="input_7.3" value="1" class="gform_hidden"></div>
</fieldset>
<fieldset id="field_1_12" class="gfield gfield--type-consent gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_1_12">
<legend class="gfield_label gform-field-label gfield_label_before_complex">Marketing Consent</legend>
<div class="ginput_container ginput_container_consent"><input name="input_12.1" id="input_1_12_1" type="checkbox" value="1" aria-invalid="false"> <label class="gform-field-label gform-field-label--type-inline gfield_consent_label"
for="input_1_12_1">I agree to receiving emails regarding Shell products & latest news.</label><input type="hidden" name="input_12.2" value="I agree to receiving emails regarding Shell products & latest news."
class="gform_hidden"><input type="hidden" name="input_12.3" value="1" class="gform_hidden"></div>
</fieldset>
<div id="field_1_14" class="gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_1_14"><label
class="gfield_label gform-field-label" for="input_1_14">Phone</label>
<div class="ginput_container"><input name="input_14" id="input_1_14" type="text" value="" autocomplete="new-password"></div>
<div class="gfield_description" id="gfield_description_1_14">This field is for validation purposes and should be left unchanged.</div>
</div>
</div>
</div>
<div class="gform_footer top_label"> <input type="submit" id="gform_submit_button_1" class="gform_button button" value="Submit Entry"
onclick="if(window["gf_submitting_1"]){return false;} if( !jQuery("#gform_1")[0].checkValidity || jQuery("#gform_1")[0].checkValidity()){window["gf_submitting_1"]=true;} "
onkeypress="if( event.keyCode == 13 ){ if(window["gf_submitting_1"]){return false;} if( !jQuery("#gform_1")[0].checkValidity || jQuery("#gform_1")[0].checkValidity()){window["gf_submitting_1"]=true;} jQuery("#gform_1").trigger("submit",[true]); }">
<input type="hidden" class="gform_hidden" name="is_submit_1" value="1">
<input type="hidden" class="gform_hidden" name="gform_submit" value="1">
<input type="hidden" class="gform_hidden" name="gform_unique_id" value="">
<input type="hidden" class="gform_hidden" name="state_1"
value="WyJ7XCI3LjFcIjpcIjAxMDU3NGRkZTVmZTJhYjY5OTdmYTk2ZTRlYWU4MzdkXCIsXCI3LjJcIjpcIjgyNTRhOGI5N2Q4MTU0M2FmNGEyZThmZDRhYjFmNGI5XCIsXCI3LjNcIjpcIjAxMDU3NGRkZTVmZTJhYjY5OTdmYTk2ZTRlYWU4MzdkXCIsXCIxMi4xXCI6XCIwMTA1NzRkZGU1ZmUyYWI2OTk3ZmE5NmU0ZWFlODM3ZFwiLFwiMTIuMlwiOlwiMWQxNDM3ZjBkYjNhYmQ1YTkzN2Y2YzNkZTk3MmQzODRcIixcIjEyLjNcIjpcIjAxMDU3NGRkZTVmZTJhYjY5OTdmYTk2ZTRlYWU4MzdkXCJ9IiwiNmQzMDNmMDdiMjcwODk0ZmNjNDVkOGU4NzZhZTUyMGMiXQ==">
<input type="hidden" class="gform_hidden" name="gform_target_page_number_1" id="gform_target_page_number_1" value="0">
<input type="hidden" class="gform_hidden" name="gform_source_page_number_1" id="gform_source_page_number_1" value="1">
<input type="hidden" name="gform_field_values" value="">
</div>
</form>Text Content
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