farmer.pmhserver.name.ng
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173.208.213.194
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URL:
https://farmer.pmhserver.name.ng/
Submission: On November 14 via api from US — Scanned from CA
Submission: On November 14 via api from US — Scanned from CA
Form analysis 1 forms found in the DOM
POST
<form method="POST" action="">
<div class="ed-element ed-form-input" id="ed-435054077"><input placeholder="Full Name" required="required" type="text" name="form_435054074[ed-f-435054077]" value="" id="form_435054074_ed-f-435054077"></div>
<div class="ed-element ed-form-input" id="ed-435054080"><input placeholder="Address " required="required" type="text" name="form_435054074[ed-f-435054080]" value="" id="form_435054074_ed-f-435054080"></div>
<div class="ed-element ed-form-email" id="ed-435054083"><input placeholder="E-Mail" required="required" type="email" name="form_435054074[ed-f-435054083]" value="" class="border-color-primary" id="form_435054074_ed-f-435054083"></div>
<div class="ed-element ed-form-input" id="ed-435054086"><input placeholder="Farm location" required="required" type="text" name="form_435054074[ed-f-435054086]" value="" id="form_435054074_ed-f-435054086"></div>
<div class="ed-element ed-form-input" id="ed-435054089"><input placeholder="LGA" required="required" type="text" name="form_435054074[ed-f-435054089]" value="" id="form_435054074_ed-f-435054089"></div>
<div class="ed-element ed-form-input" id="ed-435054092"><input placeholder="State" required="required" type="text" name="form_435054074[ed-f-435054092]" value="" id="form_435054074_ed-f-435054092"></div>
<div class="ed-element ed-form-input" id="ed-435054095"><input placeholder="Phone Number" required="required" type="text" name="form_435054074[ed-f-435054095]" value="" id="form_435054074_ed-f-435054095"></div>
<div class="ed-element ed-form-input" id="ed-435054098"><label for="form_435054074_ed-f-435054098">PLEASE TYPE IN THIS FORMAT: NIN-1234 OR BVN-1234</label><input placeholder="BVN OR NIN" required="required" type="text"
name="form_435054074[ed-f-435054098]" value="" id="form_435054074_ed-f-435054098"></div>
<div class="ed-element ed-form-upload" id="ed-435079600"><input required="required" accept=".jpg,.jpeg,.png" type="file" name="form_435054074[ed-f-435079600]" value="" id="form_435054074_ed-f-435079600"></div>
<div class="ed-element ed-form-captcha" id="ed-435054104">
<div class="image"><img
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alt=""></div>
<div class="input"><input placeholder="Captcha" required="required" type="text" name="form_435054074[ed-f-435054104][text]" value="" id="form_435054074_ed-f-435054104_text"><input type="hidden" name="form_435054074[ed-f-435054104][hash]"
id="form_435054074_ed-f-435054104_hash" value="2eee9dcfa49b33c44625321dc522b7be1d604d0e503ca051d3d7815c2e2cae52"></div>
<div class="regenerate"><a href="#" class="regenerate">Unreadable? Regenerate</a></div>
</div>
<div class="ed-element ed-form-button custom-theme" id="ed-435054107"><button type="submit" value="start the download" name="form_19680387[ed-f-19680399]" id="form_19680387_ed-f-19680399">COMPLETE REGISTERATION</button></div><input
type="checkbox" name="news" checked="checked" value="1" style="display: none;"><input type="checkbox" name="tos" value="1" style="display: none;">
</form>Text Content
RFAN RICE FARMERS ASSOCIATION OF NIGERIA FARMS REGISTRATION FORM PLEASE TYPE IN THIS FORMAT: NIN-1234 OR BVN-1234 Unreadable? Regenerate COMPLETE REGISTERATION