www.settm.be Open in urlscan Pro
91.121.218.98  Public Scan

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1 forms found in the DOM

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<form id="cntnt01moduleform_1" method="post" action="https://www.settm.be/" class="cms_form" enctype="multipart/form-data">
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      <div class="required form-group"><label for="fbrp__2">Nom*</label><input type="text" name="cntnt01fbrp__2" value="" size="25" maxlength="128" class="form-control" placeholder="" required="" id="fbrp__2">
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      <div class="required form-group"><label for="fbrp__33">Adresse*</label><input type="text" name="cntnt01fbrp__33" value="" size="25" maxlength="80" class="form-control" id="fbrp__33">
      </div>
      <div class="required form-group"><label for="fbrp__32">Tel*</label><input type="text" name="cntnt01fbrp__32" value="" size="25" maxlength="80" class="form-control" onfocus="if(this.value==this.defaultValue) this.value='';"
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      <div class="required form-group"><label for="fbrp__3">Email*</label><input type="email" name="cntnt01fbrp__3[]" value="" size="25" maxlength="128" class="form-control" placeholder="" required="" id="fbrp__3_1">
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    <div><label for="fbrp__52">Cadeau</label><select class="cms_dropdown form-control" name="cntnt01fbrp__52" id="fbrp__52">
        <option value="" selected="selected"> Sélectionnez-en un</option>
        <option value="1">apéros - 50€</option>
        <option value="2">visite jardin botanique - 55€</option>
        <option value="3">repas liophylisés - 60€</option>
        <option value="4">descente en traineau à Funchal - 70€ </option>
        <option value="5">compensation carbone (plantation arbre) - 75€</option>
        <option value="6">resto sur la plage - 100€</option>
        <option value="7">nuit d'hôtel - 110€</option>
        <option value="8">location voiture - 120€</option>
        <option value="9">bateau pour voir les baleines - 150€</option>
        <option value="10">sac à dos - 180€</option>
        <option value="11">billet d'avion - 250€</option>
        <option value="12">contribution libre</option>
      </select>
    </div>
    <div class=" form-group"><label for="fbrp__53">Votre message</label><textarea name="cntnt01fbrp__53" id="fbrp__53" class="cms_textarea cntnt01fbrp__53 form-control" cols="80" rows="15"></textarea></div>
    <div class="captcha">
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    <div class="submit"><input class="cms_submit fbsubmit btn btn-primary float-right d-block" name="cntnt01fbrp_submit" id="cntnt01fbrp_submit" value="Envoyer" type="submit"></div>
  </div>
</form>

Text Content

LE MARIAGE DE SANDRINE & THIERRY



Participation à notre voyage de noces

 


Nom*
Adresse*
Tel*
Email*
Cadeau Sélectionnez-en unapéros - 50€visite jardin botanique - 55€repas
liophylisés - 60€descente en traineau à Funchal - 70€ compensation carbone
(plantation arbre) - 75€resto sur la plage - 100€nuit d'hôtel - 110€location
voiture - 120€bateau pour voir les baleines - 150€sac à dos - 180€billet d'avion
- 250€contribution libre
Votre message






by WebKrea