wandering-jakarta-nwd9g5i9c8rw.vapor-farm-a1.com Open in urlscan Pro
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Form analysis
1 forms found in the DOM

Name: wf-form-CD-Signature-Programme — POST https://wandering-jakarta-nwd9g5i9c8rw.vapor-farm-a1.com/submit

<form id="wf-form-CD-Signature-Programme" name="wf-form-CD-Signature-Programme" data-name="CD Signature Programme" class="cd-form" action="https://wandering-jakarta-nwd9g5i9c8rw.vapor-farm-a1.com/submit" method="post"
  data-wf-page-id="65897e711b71908f029ff36a" data-wf-element-id="72545818-1e3b-82fd-c407-2a8963401805" aria-label="CD Signature Programme">
  <input type="hidden" name="_token" value="St5lBWX86N9Nfb3FNkbZkkoyqS4G1PxkEcEjW8Vc" autocomplete="off">
  <div class="cd-input-block">
    <p class="cd-paragraph-10"><strong>Please input your details</strong><br></p>
    <div class="cd-input-row">
      <div class="cd-input-col">
        <div class="cd-input-container">
          <input type="email" x-model="email" class="cd-input-text w-input" id="email-input" x-on:change.debounce="validateInput()" :readonly="isDisableInput" maxlength="99" name="email" required="">
          <label for="email-input" class="cd-input-label input">Email Address: johndoe@companydomain.com*</label>
        </div>
      </div>
      <div class="cd-input-col">
        <div class="cd-input-container" x-init="$watch('msisdn', value => validatePhoneNumber())">
          <input type="text" x-model="msisdn" class="cd-input-text w-input" id="msisdn-input" x-on:change.debounce="validateInput()" :readonly="isDisableInput" x-mask:dynamic="'99999999999'" maxlength="12" name="msisdn" minlength="10" required="">
          <label for="msisdn-input" class="cd-input-label input">Mobile Number: 0123456789*</label>
        </div>
      </div>
    </div>
    <p class="cd-paragraph-10" x-show="isValidatingAndRequestingOtp" x-html="eligibleMessage" style="display: none;"></p>
  </div>
  <div class="cd-button-wrapper-6">
    <button type="button" @click.prevent="requestOtp" x-show="!isEligible" :class="{'disabled':!isValidInput }" :disabled="!isValidInput" class="cd-button-17 w-button req-otp disabled" disabled="disabled">Check Eligibility</button>
  </div>
  <div class="cd-input-block" style="margin-top: 0px; display: none;" x-show="isEligible">
    <p class="cd-paragraph-10"><strong>Please input the OTPs from your mobile number and company email</strong><br></p>
    <div class="cd-input-row align-center">
      <div class="cd-input-col">
        <div class="cd-input-container">
          <input type="text" x-mask:dynamic="'999999'" id="mobile-otp-input" x-on:change.debounce="verifyOtp(otps.mobile.value, 1)" x-model="otps.mobile.value" :readonly="otps.mobile.verified" class="cd-input-text w-input" maxlength="6"
            name="mobile_otp" minlength="6" required="">
          <label for="mobile-otp-input" class="cd-input-label input">6-digit OTP from mobile number*</label>
        </div>
        <span x-html="otps.mobile.statusMessage"></span>
      </div>
    </div>
    <div class="cd-input-row align-center">
      <div class="cd-input-col">
        <div class="cd-input-container">
          <input type="text" x-mask:dynamic="'999999'" id="email-otp-input" x-on:change.debounce="verifyOtp(otps.email.value, 2)" x-model="otps.email.value" :readonly="otps.email.verified" class="cd-input-text w-input" maxlength="6" name="email_otp"
            minlength="6" required="">
          <label for="email-otp-input" class="cd-input-label input">6-digit OTP from company email*</label>
        </div>
        <span x-html="otps.email.statusMessage"></span>
      </div>
    </div>
    <div class="cd-input-row align-center" x-show="isPendingWhitelistDomain" style="display: none;">
      <div class="cd-input-col">
        <div class="cd-input-container">
          <input type="text" x-model="orgName" class="cd-input-text w-input" id="orgname-input" maxlength="70" name="organisation_name" :required="isPendingWhitelistDomain">
          <label for="orgname-input" class="cd-input-label input">Company Name*</label>
        </div>
      </div>
    </div>
    <div class="cd-input-row">
      <div class="cd-input-col">
        <label class="w-checkbox cd-checkbox-field">
          <input type="checkbox" x-model="tnc" name="tnc" class="w-checkbox-input cd-checkbox" required="">
          <span class="cd-checkbox-label w-form-label" for="tnc">I have read and understood the <a href="https://www.celcom.com.my/legal/terms-and-conditions">Terms &amp; Conditions </a>and
            <a href="https://www.celcom.com.my/legal/privacy-notice">Privacy Notice</a>, and I acknowledge and agree that I have provided true, accurate, complete and correct information in this form.</span>
        </label>
      </div>
    </div>
  </div>
  <span x-html="reReqOtpstatusMessage"></span>
  <div class="cd-button-wrapper-6" x-show="isEligible" style="display: none;">
    <button type="button" :class="{'disabled': bothOtpsVerified() }" :disabled="bothOtpsVerified()" class="cd-button-17 w-button req-otp" @click.prevent="reRequestOtp">Did not receive OTP? Request OTP again</button>
  </div>
  <div class="cd-button-wrapper-6" x-show="isEligible" style="display: none;">
    <button type="submit" :class="{'disabled': allowSubmit &amp;&amp; (!bothOtpsVerified() || !tnc) }" :disabled="allowSubmit &amp;&amp; (!bothOtpsVerified() || !tnc)" x-on:click="allowSubmit = false"
      class="cd-button-17 w-button req-otp disabled">Submit</button>
  </div>
</form>

Text Content

Please input your details


Email Address: johndoe@companydomain.com*
Mobile Number: 0123456789*



Check Eligibility

Please input the OTPs from your mobile number and company email


6-digit OTP from mobile number*
6-digit OTP from company email*
Company Name*
I have read and understood the Terms & Conditions and Privacy Notice, and I
acknowledge and agree that I have provided true, accurate, complete and correct
information in this form.
Did not receive OTP? Request OTP again
Submit