link.wearmedicine.com Open in urlscan Pro
91.199.51.78  Public Scan

Form analysis
1 forms found in the DOM

POST /pc/ksG/a/FvZK/3cc5ceea

<form action="/pc/ksG/a/FvZK/3cc5ceea" method="post"><input id="EncodedServiceId" name="EncodedServiceId" type="hidden" value="ksG"><input id="EncodedListId" name="EncodedListId" type="hidden" value="a"><input id="EncodedSubscriberId"
    name="EncodedSubscriberId" type="hidden" value="FvZK"><input id="ControlSum" name="ControlSum" type="hidden" value="3cc5ceea">
  <div class="fieldWrapper">
    <span class="fieldContent">
      <label style="" class="lGray formLabel" for="Firstname">Imię<span style="color: red"></span>:</label>
      <p style="margin: 6px 0 0 0; padding: 0;"></p>
      <input id="Firstname" name="Firstname" type="text" value="Savings Account">
    </span>
  </div>
  <div class="fieldWrapper">
    <span class="fieldContent">
      <label style="" class="lGray formLabel" for="Lastname">Nazwisko<span style="color: red"></span>:</label>
      <p style="margin: 6px 0 0 0; padding: 0;"></p>
      <input id="Lastname" name="Lastname" type="text" value="Gutowicz">
    </span>
  </div>
  <div class="box box-shadow">
    <h2 class="sectionLabel">Cechy</h2>
  </div>
  <div class="box box-shadow">
    <div class="fieldWrapper">
      <span class="fieldContent">
        <label style="" class="lGray formLabel" for="property_20">Chcę otrzymywać newsletter męski oraz damski:<span style="color: red"></span>:</label>
        <p style="margin: 6px 0 0 0; padding: 0;"></p>
        <input checked="checked" id="Customs_property_20" name="Customs.property_20" type="checkbox" value="true"><input name="Customs.property_20" type="hidden" value="false">
      </span>
    </div>
    <div class="fieldWrapper">
      <span class="fieldContent">
        <label style="" class="lGray formLabel" for="property_8">Płeć<span style="color: red"></span>:</label>
        <p style="margin: 6px 0 0 0; padding: 0;"></p>
        <span title="" class="k-widget k-dropdown k-header" unselectable="on" role="listbox" aria-haspopup="true" aria-expanded="false" tabindex="0" aria-owns="Customs_property_8_listbox" aria-live="polite" aria-disabled="false" aria-busy="false"
          aria-activedescendant="1c2b2261-0ed7-4588-b9e0-9fcd9ca0ef57" style="width: 205px;"><span unselectable="on" class="k-dropdown-wrap k-state-default"><span unselectable="on" class="k-input">Nie ustawiono</span><span unselectable="on"
              class="k-select" aria-label="select"><span class="k-icon k-i-arrow-60-down"></span></span></span><input id="Customs_property_8" name="Customs.property_8" style="width: 205px; display: none;" type="text" data-role="dropdownlist"></span>
        <script>
          kendo.syncReady(function() {
            jQuery("#Customs_property_8").kendoDropDownList({
              "close": function(data) {
                $('#Customs_property_8').trigger('closing', data)
              },
              "dataSource": [{
                "Text": "Nie ustawiono",
                "Value": ""
              }, {
                "Text": "ONA",
                "Value": "1"
              }, {
                "Text": "ON",
                "Value": "3"
              }],
              "dataTextField": "Text",
              "dataValueField": "Value"
            });
          });
        </script>
      </span>
    </div>
  </div>
  <div class="box box-shadow">
    <h2 class="sectionLabel">Wstrzymaj subskrypcję</h2>
  </div>
  <div class="box box-shadow">
    <div class="fieldWrapper">
      <span class="fieldContent">
        <p style="margin: 6px 0 0 0; padding: 0;"></p> Wstrzymaj subskrypcję na okres <!-- teraz obslugujemy string i int -->
        <span class="k-widget k-numerictextbox" style="width: 50px;"><span class="k-numeric-wrap k-state-default"><input type="text" class="k-formatted-value k-input" title="0" tabindex="0" role="spinbutton" aria-valuemin="0"
              aria-valuemax="2147483647" aria-valuenow="0" aria-disabled="false" style=""><input id="SnoozeSubscriptionWeeks" max="2147483647" min="0" name="SnoozeSubscriptionWeeks" style="display: none;" type="text" value="0"
              data-role="numerictextbox" role="spinbutton" aria-valuemin="0" aria-valuemax="2147483647" class="k-input" aria-valuenow="0" aria-disabled="false"><span class="k-icon k-i-warning" style="display: none;"></span><span
              class="k-select"><span unselectable="on" class="k-link k-link-increase" aria-label="Increase value" title="Increase value"><span unselectable="on" class="k-icon k-i-arrow-60-up"></span></span><span unselectable="on"
                class="k-link k-link-decrease" aria-label="Decrease value" title="Decrease value"><span unselectable="on" class="k-icon k-i-arrow-60-down"></span></span></span></span></span>
        <script>
          kendo.syncReady(function() {
            jQuery("#SnoozeSubscriptionWeeks").kendoNumericTextBox({
              "format": "n0",
              "spinners": true,
              "decimals": 0
            });
          });
        </script> tygodni. W tym czasie przestaniemy wysyłać Ci maile.
      </span>
    </div>
  </div><input class="k-button" type="submit" name="Save" value="Zapisz zmiany">
</form>

Text Content

CENTRUM USTAWIEŃ


ZMIEŃ SWOJE IMIĘ I INNE OPCJE SUBSKRYPCJI.

Email: rgrzybowska@levi.com
Imię:



Nazwisko:




CECHY

Chcę otrzymywać newsletter męski oraz damski::



Płeć:



Nie ustawiono


WSTRZYMAJ SUBSKRYPCJĘ



Wstrzymaj subskrypcję na okres tygodni. W tym czasie przestaniemy wysyłać Ci
maile.
 * Nie ustawiono
 * ONA
 * ON

No data found.