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104.16.88.5  Public Scan

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Submitted URL: https://order.weshield.us/e3t/Btc/RI+113/cZZj304/VWQLJc5sJ5t-W59m4-52kG4kzVGwS3m4FfsW4N8tN9Ck3lLBmV1-WJV7CgKLgW5NV_Kx6swmd...
Effective URL: https://share.hsforms.com/1jcWbDp9mS9yfyd1kqBCN3w4vbx3?utm_medium=email&_hsmi=203128299&_hsenc=p2ANqtz-9wDhsw0iEXquXw_F3eI...
Submission: On February 08 via api from US — Scanned from US

Form analysis 1 forms found in the DOM

<form id="hs-form-8dc59b0e-9f66-4bdc-9fc9-dd64a8108ddf-5dc1e8e3-b6bc-4e8d-92ee-02983742badc" class="hs-form-8dc59b0e-9f66-4bdc-9fc9-dd64a8108ddf hs-form hs-form_theme-canvas" data-instance-id="5dc1e8e3-b6bc-4e8d-92ee-02983742badc"
  data-form-id="8dc59b0e-9f66-4bdc-9fc9-dd64a8108ddf" data-portal-id="8180247" lang="en" data-hs-cf-bound="true">
  <div class="hs-form__pagination-content-container">
    <div class="hs-form__row">
      <div class="hs-form__group">
        <div class="hs-form__richtext"><img src="https://f.hubspotusercontent40.net/hubfs/8180247/WeShield%20logo%20new%20no%20bkgd.png" style="max-width: 100%; max-height: 100%; display:block; margin-left:auto; margin-right:auto;"
            alt="WeShield logo new no bkgd" width="200" data-img-aspect-ratio="1"></div>
      </div>
    </div>
    <div class="hs-form__row">
      <div class="hs-form__group">
        <div class="hs-form__richtext">
          <p style="text-align: center;"><span style="font-family: 'Trebuchet MS', Geneva, Tahoma, sans-serif;">Complete the form below to secure lowest pricing </span><span style="font-family: 'Trebuchet MS', Geneva, Tahoma, sans-serif;">on rapid
              at-home and</span></p>
          <p style="text-align: center;"><span style="font-family: 'Trebuchet MS', Geneva, Tahoma, sans-serif;">point-of-care COVID-19 test kits and safety supplies.</span></p>
        </div>
      </div>
    </div>
    <div class="hs-form__row">
      <div class="hs-form__group">
        <div class="hs-form__field-row">
          <div class="hs-form__field-row__column">
            <div class="hs-form__field hs-form__field-email hs-email"><label id="email-label" for="email-input" class="hs-form__field__label hs-form__field__label--required" data-required="true"><span>Email</span></label><input id="email-input"
                class="hs-form__field__input" type="email" name="email" required="" autocomplete="email" inputmode="email" aria-invalid="false" aria-required="true" aria-labelledby="email-label" aria-describedby="email-description" value=""></div>
          </div>
        </div>
      </div>
    </div>
    <div class="hs-form__row">
      <div class="hs-form__group">
        <div class="hs-form__field-row">
          <div class="hs-form__field-row__column">
            <div class="hs-form__field hs-form__field-firstname hs-firstname"><label id="firstname-label" for="firstname-input" class="hs-form__field__label hs-form__field__label--required" data-required="true"><span>First name</span></label><input
                id="firstname-input" class="hs-form__field__input" type="string" name="firstname" required="" autocomplete="given-name" inputmode="text" aria-invalid="false" aria-required="true" aria-labelledby="firstname-label"
                aria-describedby="firstname-description" value=""></div>
          </div>
          <div class="hs-form__field-row__column">
            <div class="hs-form__field hs-form__field-lastname hs-lastname"><label id="lastname-label" for="lastname-input" class="hs-form__field__label hs-form__field__label--required" data-required="true"><span>Last name</span></label><input
                id="lastname-input" class="hs-form__field__input" type="string" name="lastname" required="" autocomplete="family-name" inputmode="text" aria-invalid="false" aria-required="true" aria-labelledby="lastname-label"
                aria-describedby="lastname-description" value=""></div>
          </div>
        </div>
      </div>
    </div>
    <div class="hs-form__row">
      <div class="hs-form__group">
        <div class="hs-form__field-row">
          <div class="hs-form__field-row__column">
            <div class="hs-form__field hs-form__field-company hs-company"><label id="company-label" for="company-input" class="hs-form__field__label" data-required="false"><span>Company name</span></label><input id="company-input"
                class="hs-form__field__input" type="string" name="company" autocomplete="organization" inputmode="text" aria-invalid="false" aria-required="false" aria-labelledby="company-label" aria-describedby="company-description" value=""></div>
          </div>
        </div>
      </div>
    </div>
    <div class="hs-form__row">
      <div class="hs-form__group">
        <div class="hs-form__field-row">
          <div class="hs-form__field-row__column">
            <div class="hs-form__field hs-form__field-phone hs-phone"><label id="phone-label" for="phone-input" class="hs-form__field__label" data-required="false"><span>Phone number</span></label>
              <div class="hs-form__field__phone"><input id="phone-input" class="hs-form__field__input" type="tel" name="phone" autocomplete="tel" inputmode="tel" aria-invalid="false" aria-required="false" aria-labelledby="phone-label"
                  aria-describedby="phone-description" value=""></div>
            </div>
          </div>
        </div>
      </div>
    </div>
  </div>
  <div class="hs-form__row">
    <div class="hs-form__actions"><button type="submit" name="Submit" class="hs-form__actions__submit">Submit</button></div>
  </div>
</form>

Text Content

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point-of-care COVID-19 test kits and safety supplies.

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