uat-shippinglabel.promo-trak.com Open in urlscan Pro
52.228.84.35  Public Scan

Form analysis
1 forms found in the DOM

POST /

<form id="requestForm" action="/" method="post" novalidate="novalidate">
  <br>
  <div class="form-group">
    <label class="form-label" for="RetailerNumber">Retailer Account Number</label>
    <label>(1234567)</label>
    <input class="textbox form-control" type="text" maxlength="7" style="width: 8em;" id="RetailerNumber" name="RetailerNumber" value="">
    <span class="text-danger field-validation-valid" data-valmsg-for="RetailerNumber" data-valmsg-replace="true"></span>
  </div>
  <br>
  <div class="form-group">
    <label class="form-label" for="PostalCode">Postal Code</label>
    <label>(format with no spaces i.e A1A1A1).</label>
    <input class="textbox form-control" maxlength="7" style="width: 8em;" type="text" id="PostalCode" name="PostalCode" value="">
    <span class="text-danger field-validation-valid" data-valmsg-for="PostalCode" data-valmsg-replace="true"></span>
  </div>
  <br>
  <br>
  <div>
    <span class="LinkButton btn-info smaller" onclick="toggleSampleReports()">Find your account # on your supporting documents</span>
  </div>
  <br>
  <br>
  <div id="divSampleReport" runat="server" style="display: none">
    <img src="/images/dummy_fininvprntr_reg_CHQ.jpg" width="602px" height="784px">
    <hr>
    <img src="/images/dummy_trdupt_noncon_CHQ.jpg" width="917px" height="616px">
  </div>
  <div class="form-group">
    <input type="hidden" data-val="true" data-val-required="The CaptchaToken field is required." id="CaptchaToken" name="CaptchaToken" value="">
    <div>
      <div class="grecaptcha-badge" data-style="bottomleft"
        style="width: 256px; height: 60px; display: block; transition: left 0.3s ease 0s; position: fixed; bottom: 14px; left: -186px; box-shadow: gray 0px 0px 5px; border-radius: 2px; overflow: hidden;">
        <div class="grecaptcha-logo"><iframe title="reCAPTCHA" width="256" height="60" role="presentation" name="a-7lfunvk5srj1" frameborder="0" scrolling="no"
            sandbox="allow-forms allow-popups allow-same-origin allow-scripts allow-top-navigation allow-modals allow-popups-to-escape-sandbox allow-storage-access-by-user-activation"
            src="https://www.google.com/recaptcha/api2/anchor?ar=1&amp;k=6Ld16FEmAAAAAKhjEM5dfEgkdUwePK4se4GJ89Rm&amp;co=aHR0cHM6Ly91YXQtc2hpcHBpbmdsYWJlbC5wcm9tby10cmFrLmNvbTo0NDM.&amp;hl=en&amp;v=1kRDYC3bfA-o6-tsWzIBvp7k&amp;size=invisible&amp;badge=bottomleft&amp;sa=submit&amp;cb=p7rpeiln5t6y"></iframe>
        </div>
        <div class="grecaptcha-error"></div><textarea id="g-recaptcha-response" name="g-recaptcha-response" class="g-recaptcha-response"
          style="width: 250px; height: 40px; border: 1px solid rgb(193, 193, 193); margin: 10px 25px; padding: 0px; resize: none; display: none;"></textarea>
      </div><iframe style="display: none;"></iframe>
    </div><button id="btnSubmit" class="LinkButton PrimaryAction g-recaptcha" data-sitekey="6Ld16FEmAAAAAKhjEM5dfEgkdUwePK4se4GJ89Rm" data-callback="onSubmit" data-action="submit" data-error-callback="onRecaptchaError"
      data-expired-callback="onRecaptchaExpiredError" data-badge="bottomleft"> Request Label </button>
    <a id="btnResetForm" class="LinkButton PrimaryAction" href="/">
                    Reset
                </a>
  </div>
  <input name="__RequestVerificationToken" type="hidden" value="CfDJ8G_-SVLav1FLtK-zc-fu-10k9UMN3MTbbd8l9yZCSYcEKxzTL5xG6K-pOpdrvcED6QUAyaecR5z5jN9Ag615WaOBLH16Om0Hwb1dRsLwkcmBhHTenuV6Vp7Dz0aQSJg2j9HPmXpa1IGczzWpYwNGErc">
</form>

Text Content

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REQUEST SHIPPING LABEL

ENTER YOUR RETAILER ACCOUNT NUMBER AND POSTAL CODE TO SUBMIT YOUR REQUEST FOR A
SHIPPING LABEL.

--------------------------------------------------------------------------------



Retailer Account Number (1234567)

Postal Code (format with no spaces i.e A1A1A1).


Find your account # on your supporting documents



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Request Label Reset

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