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training.businessmanagementdaily.com Open in urlscan Pro
34.73.61.9  Public Scan

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Submitted URL: https://lt.businessmanagementdaily.com/e/c/eyJlbWFpbF9pZCI6ImRnUzVfQVFEQUlLWUc0Q1lHd0dJSmo2ZWM1QTYtSTBEeXBvbVJyZz0iLCJocmVmIjoiaHR0cHM6...
Effective URL: https://training.businessmanagementdaily.com/webinar-order/?campaigncode=3777A&utm_content=button3&_cio_id=b9fc040ee0c60182981b&cigx=d.ciobmd...
Submission: On May 16 via api from US — Scanned from DE

Form analysis 1 forms found in the DOM

Name: order-form — POST https://training.businessmanagementdaily.com/7902/thank-you-for-your-purchase-9/

<form id="order-form" name="order-form" method="POST" action="https://training.businessmanagementdaily.com/7902/thank-you-for-your-purchase-9/" class="form-horizontal" role="form">
  <input type="hidden" id="orderformversion" name="orderformversion" value="v2">
  <input type="hidden" id="company" name="company" value="bmd">
  <input id="mediacode" name="mediacode" type="hidden" value="TCNF">
  <input id="campaigncode" name="campaigncode" type="hidden" value="3777A">
  <input id="promotioncode" name="promotioncode" type="hidden" value="">
  <input id="rate" name="rate" type="hidden" value="">
  <input id="sourcetypecode" name="sourcetypecode" type="hidden" value="WEB">
  <input type="hidden" name="cigx" value="d.ciobmd,sid.0,stid.9344,mid.11261,shsh.418ebba1a797ae5337e443cbdefe2cdd,ct.newsletter,lkid.309568">
  <input type="hidden" name="opage"
    value="https://training.businessmanagementdaily.com/webinar-order/?campaigncode=3777A&amp;utm_content=button3&amp;_cio_id=b9fc040ee0c60182981b&amp;cigx=d.ciobmd,sid.0,stid.9344,mid.11261,shsh.418ebba1a797ae5337e443cbdefe2cdd,ct.newsletter,lkid.309568&amp;src=email.bmdcio_9344.hs-ciobmd.11261&amp;utm_campaign=promo_webinar&amp;utm_medium=email&amp;utm_source=hs-mktg_free">
  <input type="hidden" name="oref" value="">
  <input type="hidden" id="websourcecode" name="src" value="email.bmdcio_9344.hs-ciobmd.11261">
  <input type="hidden" name="maiguid" value="">
  <input type="hidden" name="seostring" value="">
  <input type="hidden" name="formpage"
    value="https://training.businessmanagementdaily.com/webinar-order/?campaigncode=3777A&amp;utm_content=button3&amp;_cio_id=b9fc040ee0c60182981b&amp;cigx=d.ciobmd%2Csid.0%2Cstid.9344%2Cmid.11261%2Cshsh.418ebba1a797ae5337e443cbdefe2cdd%2Cct.newsletter%2Clkid.309568&amp;src=email.bmdcio_9344.hs-ciobmd.11261&amp;utm_campaign=promo_webinar&amp;utm_medium=email&amp;utm_source=hs-mktg_free">
  <input type="hidden" name="ipaddress" value="217.64.151.6">
  <input type="hidden" name="ua" value="Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/113.0.5672.92 Safari/537.36">
  <input type="hidden" name="campaignname" value="">
  <input type="hidden" id="mediadisplayname" name="mediadisplayname" value="Paid Sick Leave: A Multi-State Update for Employers">
  <input type="hidden" id="usechildproducts" name="usechildproducts" value="0">
  <input type="hidden" name="gateway" value="paypal">
  <input type="hidden" id="child_mediacode_0" name="childproducts[0][mediacode]" value="TCNF">
  <input type="hidden" id="child_campaigncode_0" name="childproducts[0][campaigncode]" value="3777TP">
  <input type="hidden" id="child_promotioncode_0" name="childproducts[0][promotioncode]" value="OFF 1">
  <span class="h4">Order Information</span>
  <div class="spacer-10"></div>
  <div class="form-group has-icon">
    <div class="col-xs-12">
      <i class="fa fa-envelope-o"></i>
      <input type="email" class="form-control" id="email" name="order_email" placeholder="Email" value="slking@pbcgov.org">
    </div>
  </div>
  <div class="form-group has-icon">
    <div class="col-xs-12">
      <i class="fa fa-envelope-o"></i>
      <input type="email" class="form-control" id="email_confirm" name="order_email_confirm" placeholder="Type Email Again" value="slking@pbcgov.org">
    </div>
  </div>
  <hr>
  <div class="form-group">
    <div class="col-xs-6">
      <input type="text" class="form-control" id="first_name" name="order_forename" placeholder="First Name" value="">
    </div>
    <div class="col-xs-6">
      <input type="text" class="form-control" id="last_name" name="order_surname" placeholder="Last Name" value="">
    </div>
  </div>
  <div class="form-group">
    <div class="col-xs-12">
      <input type="text" class="form-control" id="company_name" name="order_companyname" placeholder="Company Name" value="">
    </div>
  </div>
  <div class="form-group">
    <div class="col-xs-12">
      <input type="text" class="form-control" id="job_title" name="order_jobtitle" placeholder="Job Title" value="" required="">
    </div>
  </div>
  <div class="form-group">
    <div class="col-xs-12">
      <input type="text" class="form-control" id="address1" name="order_addressline1" placeholder="Address" value="" data-stripe="address_line1">
    </div>
  </div>
  <div class="form-group">
    <div class="col-xs-12">
      <input type="text" class="form-control" id="address2" name="order_addressline2" placeholder="Address Line 2" value="" data-stripe="address_line2">
    </div>
  </div>
  <div class="form-group">
    <div class="col-xs-5">
      <input type="text" class="form-control" id="city" name="order_town" placeholder="City" value="" data-stripe="address_city">
    </div>
    <div class="col-xs-3">
      <input type="text" class="form-control" id="state" name="order_region" placeholder="State" value="" data-stripe="address_state">
    </div>
    <div class="col-xs-4">
      <input type="text" class="form-control" id="zipcode" name="order_postalcode" placeholder="Zipcode" value="" data-stripe="address_zip">
    </div>
  </div>
  <div class="form-group">
    <div class="col-xs-12">
      <select class="form-control" id="country" name="order_isocountrycode">
        <option value="US">United States</option>
        <option value="CA">Canada</option>
        <option value="">-----------------</option>
        <option value="AF">Afghanistan</option>
        <option value="AX">Aland Islands</option>
        <option value="AL">Albania</option>
        <option value="DZ">Algeria</option>
        <option value="AS">American Samoa</option>
        <option value="AD">Andorra</option>
        <option value="AO">Angola</option>
        <option value="AI">Anguilla</option>
        <option value="AQ">Antarctica</option>
        <option value="AG">Antigua And Barbuda</option>
        <option value="AR">Argentina</option>
        <option value="AM">Armenia</option>
        <option value="AW">Aruba</option>
        <option value="AU">Australia</option>
        <option value="AT">Austria</option>
        <option value="AZ">Azerbaijan</option>
        <option value="BS">Bahamas</option>
        <option value="BH">Bahrain</option>
        <option value="BD">Bangladesh</option>
        <option value="BB">Barbados</option>
        <option value="BY">Belarus</option>
        <option value="BE">Belgium</option>
        <option value="BZ">Belize</option>
        <option value="BJ">Benin</option>
        <option value="BM">Bermuda</option>
        <option value="BT">Bhutan</option>
        <option value="BO">Bolivia</option>
        <option value="BA">Bosnia And Herzegovina</option>
        <option value="BW">Botswana</option>
        <option value="BV">Bouvet Island</option>
        <option value="BR">Brazil</option>
        <option value="IO">British Indian Ocean Territory</option>
        <option value="BN">Brunei Darussalam</option>
        <option value="BG">Bulgaria</option>
        <option value="BF">Burkina Faso</option>
        <option value="BI">Burundi</option>
        <option value="KH">Cambodia</option>
        <option value="CM">Cameroon</option>
        <option value="CV">Cape Verde</option>
        <option value="CI">Cote D&amp;rsquo;ivoire</option>
        <option value="KY">Cayman Islands</option>
        <option value="CF">Central African Republic</option>
        <option value="TD">Chad</option>
        <option value="CL">Chile</option>
        <option value="CN">China</option>
        <option value="CX">Christmas Island</option>
        <option value="CC">Cocos (keeling) Islands</option>
        <option value="CO">Colombia</option>
        <option value="KM">Comoros</option>
        <option value="CG">Congo</option>
        <option value="CD">Congo, The Democratic Republic Of The</option>
        <option value="CK">Cook Islands</option>
        <option value="CR">Costa Rica</option>
        <option value="HR">Croatia</option>
        <option value="CU">Cuba</option>
        <option value="CY">Cyprus</option>
        <option value="CZ">Czech Republic</option>
        <option value="DK">Denmark</option>
        <option value="DJ">Djibouti</option>
        <option value="DM">Dominica</option>
        <option value="DO">Dominican Republic</option>
        <option value="EC">Ecuador</option>
        <option value="EG">Egypt</option>
        <option value="SV">El Salvador</option>
        <option value="GQ">Equatorial Guinea</option>
        <option value="ER">Eritrea</option>
        <option value="EE">Estonia</option>
        <option value="ET">Ethiopia</option>
        <option value="FK">Falkland Islands (malvinas)</option>
        <option value="FO">Faroe Islands</option>
        <option value="FJ">Fiji</option>
        <option value="FI">Finland</option>
        <option value="FR">France</option>
        <option value="GF">French Guiana</option>
        <option value="PF">French Polynesia</option>
        <option value="TF">French Southern Territories</option>
        <option value="GA">Gabon</option>
        <option value="GM">Gambia</option>
        <option value="GE">Georgia</option>
        <option value="DE">Germany</option>
        <option value="GH">Ghana</option>
        <option value="GI">Gibraltar</option>
        <option value="GR">Greece</option>
        <option value="GL">Greenland</option>
        <option value="GD">Grenada</option>
        <option value="GP">Guadeloupe</option>
        <option value="GU">Guam</option>
        <option value="GT">Guatemala</option>
        <option value="GN">Guinea</option>
        <option value="GW">Guinea-bissau</option>
        <option value="GY">Guyana</option>
        <option value="HT">Haiti</option>
        <option value="HM">Heard Island And Mcdonald Islands</option>
        <option value="VA">Holy See (vatican City State)</option>
        <option value="HN">Honduras</option>
        <option value="HK">Hong Kong</option>
        <option value="HU">Hungary</option>
        <option value="IS">Iceland</option>
        <option value="IN">India</option>
        <option value="ID">Indonesia</option>
        <option value="IR">Iran Islamic Republic Of</option>
        <option value="IQ">Iraq</option>
        <option value="IE">Ireland</option>
        <option value="IL">Israel</option>
        <option value="IT">Italy</option>
        <option value="JM">Jamaica</option>
        <option value="JP">Japan</option>
        <option value="JO">Jordan</option>
        <option value="KZ">Kazakhstan</option>
        <option value="KE">Kenya</option>
        <option value="KI">Kiribati</option>
        <option value="KP">Korea Democratic People&amp;rsquo;s Republic Of</option>
        <option value="KR">Korea Republic Of</option>
        <option value="KW">Kuwait</option>
        <option value="KG">Kyrgyzstan</option>
        <option value="LA">Lao People&amp;rsquo;s Democratic Republic</option>
        <option value="LV">Latvia</option>
        <option value="LB">Lebanon</option>
        <option value="LS">Lesotho</option>
        <option value="LR">Liberia</option>
        <option value="LY">Libyan Arab Jamahiriya</option>
        <option value="LI">Liechtenstein</option>
        <option value="LT">Lithuania</option>
        <option value="LU">Luxembourg</option>
        <option value="MO">Macao</option>
        <option value="MK">Macedonia, The Former Yugoslav Republic Of</option>
        <option value="MG">Madagascar</option>
        <option value="MW">Malawi</option>
        <option value="MY">Malaysia</option>
        <option value="MV">Maldives</option>
        <option value="ML">Mali</option>
        <option value="MT">Malta</option>
        <option value="MH">Marshall Islands</option>
        <option value="MQ">Martinique</option>
        <option value="MR">Mauritania</option>
        <option value="MU">Mauritius</option>
        <option value="YT">Mayotte</option>
        <option value="MX">Mexico</option>
        <option value="FM">Micronesia, Federated States Of</option>
        <option value="MD">Moldova, Republic Of</option>
        <option value="MC">Monaco</option>
        <option value="MN">Mongolia</option>
        <option value="MS">Montserrat</option>
        <option value="MA">Morocco</option>
        <option value="MZ">Mozambique</option>
        <option value="MM">Myanmar</option>
        <option value="NA">Namibia</option>
        <option value="NR">Nauru</option>
        <option value="NP">Nepal</option>
        <option value="NL">Netherlands</option>
        <option value="AN">Netherlands Antilles</option>
        <option value="NC">New Caledonia</option>
        <option value="NZ">New Zealand</option>
        <option value="NI">Nicaragua</option>
        <option value="NE">Niger</option>
        <option value="NG">Nigeria</option>
        <option value="NU">Niue</option>
        <option value="NF">Norfolk Island</option>
        <option value="MP">Northern Mariana Islands</option>
        <option value="NO">Norway</option>
        <option value="OM">Oman</option>
        <option value="PK">Pakistan</option>
        <option value="PW">Palau</option>
        <option value="PS">Palestinian Territory, Occupied</option>
        <option value="PA">Panama</option>
        <option value="PG">Papua New Guinea</option>
        <option value="PY">Paraguay</option>
        <option value="PE">Peru</option>
        <option value="PH">Philippines</option>
        <option value="PN">Pitcairn</option>
        <option value="PL">Poland</option>
        <option value="PT">Portugal</option>
        <option value="PR">Puerto Rico</option>
        <option value="QA">Qatar</option>
        <option value="RE">Reunion</option>
        <option value="RO">Romania</option>
        <option value="RU">Russian Federation</option>
        <option value="RW">Rwanda</option>
        <option value="SH">Saint Helena</option>
        <option value="KN">Saint Kitts And Nevis</option>
        <option value="LC">Saint Lucia</option>
        <option value="PM">Saint Pierre And Miquelon</option>
        <option value="VC">Saint Vincent And The Grenadines</option>
        <option value="WS">Samoa</option>
        <option value="SM">San Marino</option>
        <option value="ST">Sao Tome And Principe</option>
        <option value="SA">Saudi Arabia</option>
        <option value="SN">Senegal</option>
        <option value="CS">Serbia And Montenegro</option>
        <option value="SC">Seychelles</option>
        <option value="SL">Sierra Leone</option>
        <option value="SG">Singapore</option>
        <option value="SK">Slovakia</option>
        <option value="SI">Slovenia</option>
        <option value="SB">Solomon Islands</option>
        <option value="SO">Somalia</option>
        <option value="ZA">South Africa</option>
        <option value="GS">South Georgia And The South Sandwich Islands</option>
        <option value="ES">Spain</option>
        <option value="LK">Sri Lanka</option>
        <option value="SD">Sudan</option>
        <option value="SR">Suriname</option>
        <option value="SJ">Svalbard And Jan Mayen</option>
        <option value="SZ">Swaziland</option>
        <option value="SE">Sweden</option>
        <option value="CH">Switzerland</option>
        <option value="SY">Syrian Arab Republic</option>
        <option value="TW">Taiwan Province Of China</option>
        <option value="TJ">Tajikistan</option>
        <option value="TZ">Tanzania United Republic Of</option>
        <option value="TH">Thailand</option>
        <option value="TL">Timor-leste</option>
        <option value="TG">Togo</option>
        <option value="TK">Tokelau</option>
        <option value="TO">Tonga</option>
        <option value="TT">Trinidad And Tobago</option>
        <option value="TN">Tunisia</option>
        <option value="TR">Turkey</option>
        <option value="TM">Turkmenistan</option>
        <option value="TC">Turks And Caicos Islands</option>
        <option value="TV">Tuvalu</option>
        <option value="UG">Uganda</option>
        <option value="UA">Ukraine</option>
        <option value="AE">United Arab Emirates</option>
        <option value="GB">United Kingdom</option>
        <option value="UM">United States Minor Outlying Islands</option>
        <option value="UY">Uruguay</option>
        <option value="UZ">Uzbekistan</option>
        <option value="VU">Vanuatu</option>
        <option value="VE">Venezuela</option>
        <option value="VN">Vietnam</option>
        <option value="VG">Virgin Islands British</option>
        <option value="VI">Virgin Islands U.s.</option>
        <option value="WF">Wallis And Futuna</option>
        <option value="EH">Western Sahara</option>
        <option value="YE">Yemen</option>
        <option value="ZM">Zambia</option>
        <option value="ZW">Zimbabwe</option>
      </select>
    </div>
  </div>
  <div class="form-group has-icon">
    <div class="col-xs-12">
      <i class="fa fa-phone"></i>
      <input type="text" class="form-control" id="phone_number" name="order_telno" placeholder="Phone Number" value="">
    </div>
  </div>
  <div class="form-group">
    <div class="col-xs-12">
      <div class="checkbox">
        <label for="billtosameasorder"><input type="checkbox" id="billtosameasorder" name="billtosameasorder" value="1" style="margin-top: 4px;" checked=""> Billing address is same as above</label>
      </div>
    </div>
  </div>
  <div id="billing-fields">
    <h4>Billing Information</h4>
    <div class="form-group has-icon">
      <div class="col-xs-12">
        <i class="fa fa-envelope-o"></i>
        <input type="email" class="form-control" id="billing_email" name="billto_email" placeholder="Billing Email" value="" disabled="">
      </div>
    </div>
    <div class="form-group">
      <div class="col-xs-6">
        <input type="text" class="form-control" id="billing_first_name" name="billto_forename" placeholder="First Name" value="" disabled="">
      </div>
      <div class="col-xs-6">
        <input type="text" class="form-control" id="billing_last_name" name="billto_surname" placeholder="Last Name" value="" disabled="">
      </div>
    </div>
    <div class="form-group">
      <div class="col-xs-12">
        <input type="text" class="form-control" id="billing_company_name" name="billto_companyname" placeholder="Company Name" value="">
      </div>
    </div>
    <div class="form-group">
      <div class="col-xs-12">
        <input type="text" class="form-control" id="billing_job_title" name="billto_jobtitle" placeholder="Job Title" value="">
      </div>
    </div>
    <div class="form-group">
      <div class="col-xs-12">
        <input type="text" class="form-control" id="billing_address1" name="billto_addressline1" placeholder="Address" value="" disabled="">
      </div>
    </div>
    <div class="form-group">
      <div class="col-xs-12">
        <input type="text" class="form-control" id="billing_address2" name="billto_addressline2" placeholder="Address Line 2" value="" disabled="">
      </div>
    </div>
    <div class="form-group">
      <div class="col-xs-5">
        <input type="text" class="form-control" id="billing_city" name="billto_town" placeholder="City" value="" disabled="">
      </div>
      <div class="col-xs-3">
        <input type="text" class="form-control" id="billing_state" name="billto_region" placeholder="State" value="" disabled="">
      </div>
      <div class="col-xs-4">
        <input type="text" class="form-control" id="billing_zipcode" name="billto_postalcode" placeholder="Zipcode" value="" disabled="">
      </div>
    </div>
    <div class="form-group">
      <div class="col-xs-12">
        <select class="form-control" id="billing_country" name="billto_isocountrycode" disabled="">
          <option value="US">United States</option>
          <option value="CA">Canada</option>
          <option value="">-----------------</option>
          <option value="AF">Afghanistan</option>
          <option value="AX">Aland Islands</option>
          <option value="AL">Albania</option>
          <option value="DZ">Algeria</option>
          <option value="AS">American Samoa</option>
          <option value="AD">Andorra</option>
          <option value="AO">Angola</option>
          <option value="AI">Anguilla</option>
          <option value="AQ">Antarctica</option>
          <option value="AG">Antigua And Barbuda</option>
          <option value="AR">Argentina</option>
          <option value="AM">Armenia</option>
          <option value="AW">Aruba</option>
          <option value="AU">Australia</option>
          <option value="AT">Austria</option>
          <option value="AZ">Azerbaijan</option>
          <option value="BS">Bahamas</option>
          <option value="BH">Bahrain</option>
          <option value="BD">Bangladesh</option>
          <option value="BB">Barbados</option>
          <option value="BY">Belarus</option>
          <option value="BE">Belgium</option>
          <option value="BZ">Belize</option>
          <option value="BJ">Benin</option>
          <option value="BM">Bermuda</option>
          <option value="BT">Bhutan</option>
          <option value="BO">Bolivia</option>
          <option value="BA">Bosnia And Herzegovina</option>
          <option value="BW">Botswana</option>
          <option value="BV">Bouvet Island</option>
          <option value="BR">Brazil</option>
          <option value="IO">British Indian Ocean Territory</option>
          <option value="BN">Brunei Darussalam</option>
          <option value="BG">Bulgaria</option>
          <option value="BF">Burkina Faso</option>
          <option value="BI">Burundi</option>
          <option value="KH">Cambodia</option>
          <option value="CM">Cameroon</option>
          <option value="CV">Cape Verde</option>
          <option value="CI">Cote D&amp;rsquo;ivoire</option>
          <option value="KY">Cayman Islands</option>
          <option value="CF">Central African Republic</option>
          <option value="TD">Chad</option>
          <option value="CL">Chile</option>
          <option value="CN">China</option>
          <option value="CX">Christmas Island</option>
          <option value="CC">Cocos (keeling) Islands</option>
          <option value="CO">Colombia</option>
          <option value="KM">Comoros</option>
          <option value="CG">Congo</option>
          <option value="CD">Congo, The Democratic Republic Of The</option>
          <option value="CK">Cook Islands</option>
          <option value="CR">Costa Rica</option>
          <option value="HR">Croatia</option>
          <option value="CU">Cuba</option>
          <option value="CY">Cyprus</option>
          <option value="CZ">Czech Republic</option>
          <option value="DK">Denmark</option>
          <option value="DJ">Djibouti</option>
          <option value="DM">Dominica</option>
          <option value="DO">Dominican Republic</option>
          <option value="EC">Ecuador</option>
          <option value="EG">Egypt</option>
          <option value="SV">El Salvador</option>
          <option value="GQ">Equatorial Guinea</option>
          <option value="ER">Eritrea</option>
          <option value="EE">Estonia</option>
          <option value="ET">Ethiopia</option>
          <option value="FK">Falkland Islands (malvinas)</option>
          <option value="FO">Faroe Islands</option>
          <option value="FJ">Fiji</option>
          <option value="FI">Finland</option>
          <option value="FR">France</option>
          <option value="GF">French Guiana</option>
          <option value="PF">French Polynesia</option>
          <option value="TF">French Southern Territories</option>
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United States Canada ----------------- Afghanistan Aland Islands Albania Algeria
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Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados
Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia And Herzegovina
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Bulgaria Burkina Faso Burundi Cambodia Cameroon Cape Verde Cote D&rsquo;ivoire
Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos
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Cook Islands Costa Rica Croatia Cuba Cyprus Czech Republic Denmark Djibouti
Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea
Estonia Ethiopia Falkland Islands (malvinas) Faroe Islands Fiji Finland France
French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia
Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala
Guinea Guinea-bissau Guyana Haiti Heard Island And Mcdonald Islands Holy See
(vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran
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