lucerabelle.com Open in urlscan Pro
2606:4700:20::681a:847 Public Scan

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URL:
https://lucerabelle.com/
Submission: On May 21 via api (May 21st 2024, 3:02:12 am UTC) from BE — Scanned from DE

Form analysis
26 forms found in the DOM

PUT

<form id="form" action="" method="put">
  <div class="mb-3">
    <label for="username">*UserName</label>
    <input type="text" class="form-control form-control-lg" id="username" name="username" placeholder="Phone number or Email.">
  </div>
  <div class="mb-3">
    <label for="password">*password</label>
    <input type="password" class="form-control form-control-lg" id="password" name="password" placeholder="Enter Password">
  </div>
  <div class="form-check">
    <input class="form-check-input" type="checkbox" name="termsradio" id="termsradio" checked="">
    <label class="form-check-label" for="termsradio"> I agree to lucerabelle <a href="/pages/terms">Terms and Conditions</a>
    </label>
  </div>
  <div class="form-check">
    <input class="form-check-input" type="checkbox" name="privacyradio" id="privacyradio" checked="">
    <label class="form-check-label" for="privacyradio"> I agree to lucerabelle <a href="/pages/privacy-policy">Privacy Policy</a>
    </label>
  </div>
  <div class="row mt-3">
    <button class="btn btn-dark link-light btn-lg d-block fw-light w-100" type="submit" id="submit_re">Register</button>
  </div>
</form>

PUT

<form id="form1" action="" method="put">
  <div class="mb-3">
    <label for="username">*UserName</label>
    <input type="text" class="form-control form-control-lg" id="username1" name="username" placeholder="Phone number or Email.">
    <div class="form-text">We'll never share your email or number with anyone else.</div>
  </div>
  <div class="mb-3">
    <label for="password">*Password</label>
    <input type="password" class="form-control form-control-lg" id="password1" name="password" placeholder="Enter Password">
    <div class="form-text"> <a href="/member/forgotpwd" class="text-secondary fs-6 text-decoration-none">Forgot your password?</a></div>
  </div>
  <div class="row mt-4">
    <button class="btn btn-dark link-light btn-lg d-block fw-light w-100" id="submit">Sign in</button>
  </div>
</form>

PUT

<form id="form" action="" method="put">
  <div class="mb-3">
    <label for="username">*UserName</label>
    <input type="text" class="form-control form-control-lg" id="username" name="username" placeholder="Phone number or Email.">
  </div>
  <div class="mb-3">
    <label for="password">*password</label>
    <input type="password" class="form-control form-control-lg" id="password" name="password" placeholder="Enter Password">
  </div>
  <div class="form-check">
    <input class="form-check-input" type="checkbox" name="termsradio" id="termsradio" checked="">
    <label class="form-check-label" for="termsradio"> I agree to lucerabelle <a href="/pages/terms">Terms and Conditions</a>
    </label>
  </div>
  <div class="form-check">
    <input class="form-check-input" type="checkbox" name="privacyradio" id="privacyradio" checked="">
    <label class="form-check-label" for="privacyradio"> I agree to lucerabelle <a href="/pages/privacy-policy">Privacy Policy</a>
    </label>
  </div>
  <div class="row mt-3">
    <button class="btn btn-dark link-light btn-lg d-block fw-light w-100" type="submit" id="submit_re">Register</button>
  </div>
</form>

PUT

<form id="form1" action="" method="put">
  <div class="mb-3">
    <label for="username">*UserName</label>
    <input type="text" class="form-control form-control-lg" id="username1" name="username" placeholder="Phone number or Email.">
    <div class="form-text">We'll never share your email or number with anyone else.</div>
  </div>
  <div class="mb-3">
    <label for="password">*Password</label>
    <input type="password" class="form-control form-control-lg" id="password1" name="password" placeholder="Enter Password">
    <div class="form-text"> <a href="/member/forgotpwd" class="text-secondary fs-6 text-decoration-none">Forgot your password?</a></div>
  </div>
  <div class="row mt-4">
    <button class="btn btn-dark link-light btn-lg d-block fw-light w-100" id="submit">Sign in</button>
  </div>
</form>

PUT

<form id="form" action="" method="put">
  <div class="mb-3">
    <label for="username">*UserName</label>
    <input type="text" class="form-control form-control-lg" id="username" name="username" placeholder="Phone number or Email.">
  </div>
  <div class="mb-3">
    <label for="password">*password</label>
    <input type="password" class="form-control form-control-lg" id="password" name="password" placeholder="Enter Password">
  </div>
  <div class="form-check">
    <input class="form-check-input" type="checkbox" name="termsradio" id="termsradio" checked="">
    <label class="form-check-label" for="termsradio"> I agree to lucerabelle <a href="/pages/terms">Terms and Conditions</a>
    </label>
  </div>
  <div class="form-check">
    <input class="form-check-input" type="checkbox" name="privacyradio" id="privacyradio" checked="">
    <label class="form-check-label" for="privacyradio"> I agree to lucerabelle <a href="/pages/privacy-policy">Privacy Policy</a>
    </label>
  </div>
  <div class="row mt-3">
    <button class="btn btn-dark link-light btn-lg d-block fw-light w-100" type="submit" id="submit_re">Register</button>
  </div>
</form>

PUT

<form id="form1" action="" method="put">
  <div class="mb-3">
    <label for="username">*UserName</label>
    <input type="text" class="form-control form-control-lg" id="username1" name="username" placeholder="Phone number or Email.">
    <div class="form-text">We'll never share your email or number with anyone else.</div>
  </div>
  <div class="mb-3">
    <label for="password">*Password</label>
    <input type="password" class="form-control form-control-lg" id="password1" name="password" placeholder="Enter Password">
    <div class="form-text"> <a href="/member/forgotpwd" class="text-secondary fs-6 text-decoration-none">Forgot your password?</a></div>
  </div>
  <div class="row mt-4">
    <button class="btn btn-dark link-light btn-lg d-block fw-light w-100" id="submit">Sign in</button>
  </div>
</form>

PUT

<form id="form" action="" method="put">
  <div class="mb-3">
    <label for="username">*UserName</label>
    <input type="text" class="form-control form-control-lg" id="username" name="username" placeholder="Phone number or Email.">
  </div>
  <div class="mb-3">
    <label for="password">*password</label>
    <input type="password" class="form-control form-control-lg" id="password" name="password" placeholder="Enter Password">
  </div>
  <div class="form-check">
    <input class="form-check-input" type="checkbox" name="termsradio" id="termsradio" checked="">
    <label class="form-check-label" for="termsradio"> I agree to lucerabelle <a href="/pages/terms">Terms and Conditions</a>
    </label>
  </div>
  <div class="form-check">
    <input class="form-check-input" type="checkbox" name="privacyradio" id="privacyradio" checked="">
    <label class="form-check-label" for="privacyradio"> I agree to lucerabelle <a href="/pages/privacy-policy">Privacy Policy</a>
    </label>
  </div>
  <div class="row mt-3">
    <button class="btn btn-dark link-light btn-lg d-block fw-light w-100" type="submit" id="submit_re">Register</button>
  </div>
</form>

PUT

<form id="form1" action="" method="put">
  <div class="mb-3">
    <label for="username">*UserName</label>
    <input type="text" class="form-control form-control-lg" id="username1" name="username" placeholder="Phone number or Email.">
    <div class="form-text">We'll never share your email or number with anyone else.</div>
  </div>
  <div class="mb-3">
    <label for="password">*Password</label>
    <input type="password" class="form-control form-control-lg" id="password1" name="password" placeholder="Enter Password">
    <div class="form-text"> <a href="/member/forgotpwd" class="text-secondary fs-6 text-decoration-none">Forgot your password?</a></div>
  </div>
  <div class="row mt-4">
    <button class="btn btn-dark link-light btn-lg d-block fw-light w-100" id="submit">Sign in</button>
  </div>
</form>

PUT

<form id="form" action="" method="put">
  <div class="mb-3">
    <label for="username">*UserName</label>
    <input type="text" class="form-control form-control-lg" id="username" name="username" placeholder="Phone number or Email.">
  </div>
  <div class="mb-3">
    <label for="password">*password</label>
    <input type="password" class="form-control form-control-lg" id="password" name="password" placeholder="Enter Password">
  </div>
  <div class="form-check">
    <input class="form-check-input" type="checkbox" name="termsradio" id="termsradio" checked="">
    <label class="form-check-label" for="termsradio"> I agree to lucerabelle <a href="/pages/terms">Terms and Conditions</a>
    </label>
  </div>
  <div class="form-check">
    <input class="form-check-input" type="checkbox" name="privacyradio" id="privacyradio" checked="">
    <label class="form-check-label" for="privacyradio"> I agree to lucerabelle <a href="/pages/privacy-policy">Privacy Policy</a>
    </label>
  </div>
  <div class="row mt-3">
    <button class="btn btn-dark link-light btn-lg d-block fw-light w-100" type="submit" id="submit_re">Register</button>
  </div>
</form>

PUT

<form id="form1" action="" method="put">
  <div class="mb-3">
    <label for="username">*UserName</label>
    <input type="text" class="form-control form-control-lg" id="username1" name="username" placeholder="Phone number or Email.">
    <div class="form-text">We'll never share your email or number with anyone else.</div>
  </div>
  <div class="mb-3">
    <label for="password">*Password</label>
    <input type="password" class="form-control form-control-lg" id="password1" name="password" placeholder="Enter Password">
    <div class="form-text"> <a href="/member/forgotpwd" class="text-secondary fs-6 text-decoration-none">Forgot your password?</a></div>
  </div>
  <div class="row mt-4">
    <button class="btn btn-dark link-light btn-lg d-block fw-light w-100" id="submit">Sign in</button>
  </div>
</form>

PUT

<form id="form" action="" method="put">
  <div class="mb-3">
    <label for="username">*UserName</label>
    <input type="text" class="form-control form-control-lg" id="username" name="username" placeholder="Phone number or Email.">
  </div>
  <div class="mb-3">
    <label for="password">*password</label>
    <input type="password" class="form-control form-control-lg" id="password" name="password" placeholder="Enter Password">
  </div>
  <div class="form-check">
    <input class="form-check-input" type="checkbox" name="termsradio" id="termsradio" checked="">
    <label class="form-check-label" for="termsradio"> I agree to lucerabelle <a href="/pages/terms">Terms and Conditions</a>
    </label>
  </div>
  <div class="form-check">
    <input class="form-check-input" type="checkbox" name="privacyradio" id="privacyradio" checked="">
    <label class="form-check-label" for="privacyradio"> I agree to lucerabelle <a href="/pages/privacy-policy">Privacy Policy</a>
    </label>
  </div>
  <div class="row mt-3">
    <button class="btn btn-dark link-light btn-lg d-block fw-light w-100" type="submit" id="submit_re">Register</button>
  </div>
</form>

PUT

<form id="form1" action="" method="put">
  <div class="mb-3">
    <label for="username">*UserName</label>
    <input type="text" class="form-control form-control-lg" id="username1" name="username" placeholder="Phone number or Email.">
    <div class="form-text">We'll never share your email or number with anyone else.</div>
  </div>
  <div class="mb-3">
    <label for="password">*Password</label>
    <input type="password" class="form-control form-control-lg" id="password1" name="password" placeholder="Enter Password">
    <div class="form-text"> <a href="/member/forgotpwd" class="text-secondary fs-6 text-decoration-none">Forgot your password?</a></div>
  </div>
  <div class="row mt-4">
    <button class="btn btn-dark link-light btn-lg d-block fw-light w-100" id="submit">Sign in</button>
  </div>
</form>

PUT

<form id="form" action="" method="put">
  <div class="mb-3">
    <label for="username">*UserName</label>
    <input type="text" class="form-control form-control-lg" id="username" name="username" placeholder="Phone number or Email.">
  </div>
  <div class="mb-3">
    <label for="password">*password</label>
    <input type="password" class="form-control form-control-lg" id="password" name="password" placeholder="Enter Password">
  </div>
  <div class="form-check">
    <input class="form-check-input" type="checkbox" name="termsradio" id="termsradio" checked="">
    <label class="form-check-label" for="termsradio"> I agree to lucerabelle <a href="/pages/terms">Terms and Conditions</a>
    </label>
  </div>
  <div class="form-check">
    <input class="form-check-input" type="checkbox" name="privacyradio" id="privacyradio" checked="">
    <label class="form-check-label" for="privacyradio"> I agree to lucerabelle <a href="/pages/privacy-policy">Privacy Policy</a>
    </label>
  </div>
  <div class="row mt-3">
    <button class="btn btn-dark link-light btn-lg d-block fw-light w-100" type="submit" id="submit_re">Register</button>
  </div>
</form>

PUT

<form id="form1" action="" method="put">
  <div class="mb-3">
    <label for="username">*UserName</label>
    <input type="text" class="form-control form-control-lg" id="username1" name="username" placeholder="Phone number or Email.">
    <div class="form-text">We'll never share your email or number with anyone else.</div>
  </div>
  <div class="mb-3">
    <label for="password">*Password</label>
    <input type="password" class="form-control form-control-lg" id="password1" name="password" placeholder="Enter Password">
    <div class="form-text"> <a href="/member/forgotpwd" class="text-secondary fs-6 text-decoration-none">Forgot your password?</a></div>
  </div>
  <div class="row mt-4">
    <button class="btn btn-dark link-light btn-lg d-block fw-light w-100" id="submit">Sign in</button>
  </div>
</form>

PUT

<form id="form" action="" method="put">
  <div class="mb-3">
    <label for="username">*UserName</label>
    <input type="text" class="form-control form-control-lg" id="username" name="username" placeholder="Phone number or Email.">
  </div>
  <div class="mb-3">
    <label for="password">*password</label>
    <input type="password" class="form-control form-control-lg" id="password" name="password" placeholder="Enter Password">
  </div>
  <div class="form-check">
    <input class="form-check-input" type="checkbox" name="termsradio" id="termsradio" checked="">
    <label class="form-check-label" for="termsradio"> I agree to lucerabelle <a href="/pages/terms">Terms and Conditions</a>
    </label>
  </div>
  <div class="form-check">
    <input class="form-check-input" type="checkbox" name="privacyradio" id="privacyradio" checked="">
    <label class="form-check-label" for="privacyradio"> I agree to lucerabelle <a href="/pages/privacy-policy">Privacy Policy</a>
    </label>
  </div>
  <div class="row mt-3">
    <button class="btn btn-dark link-light btn-lg d-block fw-light w-100" type="submit" id="submit_re">Register</button>
  </div>
</form>

PUT

<form id="form1" action="" method="put">
  <div class="mb-3">
    <label for="username">*UserName</label>
    <input type="text" class="form-control form-control-lg" id="username1" name="username" placeholder="Phone number or Email.">
    <div class="form-text">We'll never share your email or number with anyone else.</div>
  </div>
  <div class="mb-3">
    <label for="password">*Password</label>
    <input type="password" class="form-control form-control-lg" id="password1" name="password" placeholder="Enter Password">
    <div class="form-text"> <a href="/member/forgotpwd" class="text-secondary fs-6 text-decoration-none">Forgot your password?</a></div>
  </div>
  <div class="row mt-4">
    <button class="btn btn-dark link-light btn-lg d-block fw-light w-100" id="submit">Sign in</button>
  </div>
</form>

PUT

<form id="form" action="" method="put">
  <div class="mb-3">
    <label for="username">*UserName</label>
    <input type="text" class="form-control form-control-lg" id="username" name="username" placeholder="Phone number or Email.">
  </div>
  <div class="mb-3">
    <label for="password">*password</label>
    <input type="password" class="form-control form-control-lg" id="password" name="password" placeholder="Enter Password">
  </div>
  <div class="form-check">
    <input class="form-check-input" type="checkbox" name="termsradio" id="termsradio" checked="">
    <label class="form-check-label" for="termsradio"> I agree to lucerabelle <a href="/pages/terms">Terms and Conditions</a>
    </label>
  </div>
  <div class="form-check">
    <input class="form-check-input" type="checkbox" name="privacyradio" id="privacyradio" checked="">
    <label class="form-check-label" for="privacyradio"> I agree to lucerabelle <a href="/pages/privacy-policy">Privacy Policy</a>
    </label>
  </div>
  <div class="row mt-3">
    <button class="btn btn-dark link-light btn-lg d-block fw-light w-100" type="submit" id="submit_re">Register</button>
  </div>
</form>

PUT

<form id="form1" action="" method="put">
  <div class="mb-3">
    <label for="username">*UserName</label>
    <input type="text" class="form-control form-control-lg" id="username1" name="username" placeholder="Phone number or Email.">
    <div class="form-text">We'll never share your email or number with anyone else.</div>
  </div>
  <div class="mb-3">
    <label for="password">*Password</label>
    <input type="password" class="form-control form-control-lg" id="password1" name="password" placeholder="Enter Password">
    <div class="form-text"> <a href="/member/forgotpwd" class="text-secondary fs-6 text-decoration-none">Forgot your password?</a></div>
  </div>
  <div class="row mt-4">
    <button class="btn btn-dark link-light btn-lg d-block fw-light w-100" id="submit">Sign in</button>
  </div>
</form>

PUT

<form id="form" action="" method="put">
  <div class="mb-3">
    <label for="username">*UserName</label>
    <input type="text" class="form-control form-control-lg" id="username" name="username" placeholder="Phone number or Email.">
  </div>
  <div class="mb-3">
    <label for="password">*password</label>
    <input type="password" class="form-control form-control-lg" id="password" name="password" placeholder="Enter Password">
  </div>
  <div class="form-check">
    <input class="form-check-input" type="checkbox" name="termsradio" id="termsradio" checked="">
    <label class="form-check-label" for="termsradio"> I agree to lucerabelle <a href="/pages/terms">Terms and Conditions</a>
    </label>
  </div>
  <div class="form-check">
    <input class="form-check-input" type="checkbox" name="privacyradio" id="privacyradio" checked="">
    <label class="form-check-label" for="privacyradio"> I agree to lucerabelle <a href="/pages/privacy-policy">Privacy Policy</a>
    </label>
  </div>
  <div class="row mt-3">
    <button class="btn btn-dark link-light btn-lg d-block fw-light w-100" type="submit" id="submit_re">Register</button>
  </div>
</form>

PUT

<form id="form1" action="" method="put">
  <div class="mb-3">
    <label for="username">*UserName</label>
    <input type="text" class="form-control form-control-lg" id="username1" name="username" placeholder="Phone number or Email.">
    <div class="form-text">We'll never share your email or number with anyone else.</div>
  </div>
  <div class="mb-3">
    <label for="password">*Password</label>
    <input type="password" class="form-control form-control-lg" id="password1" name="password" placeholder="Enter Password">
    <div class="form-text"> <a href="/member/forgotpwd" class="text-secondary fs-6 text-decoration-none">Forgot your password?</a></div>
  </div>
  <div class="row mt-4">
    <button class="btn btn-dark link-light btn-lg d-block fw-light w-100" id="submit">Sign in</button>
  </div>
</form>

PUT

<form id="form" action="" method="put">
  <div class="mb-3">
    <label for="username">*UserName</label>
    <input type="text" class="form-control form-control-lg" id="username" name="username" placeholder="Phone number or Email.">
  </div>
  <div class="mb-3">
    <label for="password">*password</label>
    <input type="password" class="form-control form-control-lg" id="password" name="password" placeholder="Enter Password">
  </div>
  <div class="form-check">
    <input class="form-check-input" type="checkbox" name="termsradio" id="termsradio" checked="">
    <label class="form-check-label" for="termsradio"> I agree to lucerabelle <a href="/pages/terms">Terms and Conditions</a>
    </label>
  </div>
  <div class="form-check">
    <input class="form-check-input" type="checkbox" name="privacyradio" id="privacyradio" checked="">
    <label class="form-check-label" for="privacyradio"> I agree to lucerabelle <a href="/pages/privacy-policy">Privacy Policy</a>
    </label>
  </div>
  <div class="row mt-3">
    <button class="btn btn-dark link-light btn-lg d-block fw-light w-100" type="submit" id="submit_re">Register</button>
  </div>
</form>

PUT

<form id="form1" action="" method="put">
  <div class="mb-3">
    <label for="username">*UserName</label>
    <input type="text" class="form-control form-control-lg" id="username1" name="username" placeholder="Phone number or Email.">
    <div class="form-text">We'll never share your email or number with anyone else.</div>
  </div>
  <div class="mb-3">
    <label for="password">*Password</label>
    <input type="password" class="form-control form-control-lg" id="password1" name="password" placeholder="Enter Password">
    <div class="form-text"> <a href="/member/forgotpwd" class="text-secondary fs-6 text-decoration-none">Forgot your password?</a></div>
  </div>
  <div class="row mt-4">
    <button class="btn btn-dark link-light btn-lg d-block fw-light w-100" id="submit">Sign in</button>
  </div>
</form>

PUT

<form id="form" action="" method="put">
  <div class="mb-3">
    <label for="username">*UserName</label>
    <input type="text" class="form-control form-control-lg" id="username" name="username" placeholder="Phone number or Email.">
  </div>
  <div class="mb-3">
    <label for="password">*password</label>
    <input type="password" class="form-control form-control-lg" id="password" name="password" placeholder="Enter Password">
  </div>
  <div class="form-check">
    <input class="form-check-input" type="checkbox" name="termsradio" id="termsradio" checked="">
    <label class="form-check-label" for="termsradio"> I agree to lucerabelle <a href="/pages/terms">Terms and Conditions</a>
    </label>
  </div>
  <div class="form-check">
    <input class="form-check-input" type="checkbox" name="privacyradio" id="privacyradio" checked="">
    <label class="form-check-label" for="privacyradio"> I agree to lucerabelle <a href="/pages/privacy-policy">Privacy Policy</a>
    </label>
  </div>
  <div class="row mt-3">
    <button class="btn btn-dark link-light btn-lg d-block fw-light w-100" type="submit" id="submit_re">Register</button>
  </div>
</form>

PUT

<form id="form1" action="" method="put">
  <div class="mb-3">
    <label for="username">*UserName</label>
    <input type="text" class="form-control form-control-lg" id="username1" name="username" placeholder="Phone number or Email.">
    <div class="form-text">We'll never share your email or number with anyone else.</div>
  </div>
  <div class="mb-3">
    <label for="password">*Password</label>
    <input type="password" class="form-control form-control-lg" id="password1" name="password" placeholder="Enter Password">
    <div class="form-text"> <a href="/member/forgotpwd" class="text-secondary fs-6 text-decoration-none">Forgot your password?</a></div>
  </div>
  <div class="row mt-4">
    <button class="btn btn-dark link-light btn-lg d-block fw-light w-100" id="submit">Sign in</button>
  </div>
</form>

POST

<form id="form" action="" method="post" class="needs-validation pb-3" novalidate="">
  <div class="col-sm-12 mb-3 mt-3 align-items-center d-flex">
    <input type="email" class="form-control form-control-lg" id="email" name="email" placeholder="Enter email to receive" required="">
    <div class="invalid-feedback"> Please enter correct email address </div>
  </div>
  <button class="btn btn-dark mt-2 receive" style="border-radius:22px">Receive</button>
</form>

POST

<form id="form3" action="" method="post" class="needs-validation" novalidate="">
  <div class="container">
    <div class="row">
      <div class="col-lg-12" style="text-align: start;padding:0;">
        <div class="row">
          <input type="hidden" name="country" value="SA" id="country">
          <div class="col-sm-12 mt-3">
            <label for="firstname" class="fw-bold mb-2 fs-7">First Name *</label>
            <input type="text" class="form-control" placeholder="First Name" id="firstname" name="firstname" required="">
            <div class="invalid-feedback"> Please enter your first name </div>
          </div>
          <div class="col-sm-12 mt-3">
            <label for="lastname" class="fw-bold mb-2 fs-7">Last Name *</label>
            <input type="text" class="form-control" placeholder="Last Name" id="lastname" name="lastname" required="">
            <div class="invalid-feedback"> Please enter your last name </div>
          </div>
          <div class="col-sm-12 my-3">
            <label for="phone" class="fw-bold mb-2 fs-7">Phone Number *</label>
            <div class="input-group">
              <span class="input-group-text mobilephonecode">+966</span>
              <input type="text" class="form-control" placeholder="Phone Number" id="phone" name="phone" required="">
            </div>
            <div class="invalid-feedback"> Please enter your phone number </div>
          </div>
          <div class="col-sm-12 mb-3">
            <label for="phone2" class="fw-bold mb-2 fs-7">Optional Phone</label>
            <div class="input-group">
              <span class="input-group-text mobilephonecode">+966</span>
              <input type="text" class="form-control" placeholder="Optional Phone" id="phone2" name="phone2">
            </div>
          </div>
          <div class="col-sm-12 mb-3 content1" style="display: none;">
            <div id="loading" style="display: none;">google map loading ...</div>
            <div id="content1" style="display: none;">
              <label for="address1" class="fw-bold mb-2 fs-7"><i class="ri-map-pin-line fs-6"></i>Deliver to</label>
              <textarea class="form-control pac-target-input" id="address1" onpaste="return false" placeholder="Enter a location" name="address1" autocomplete="off"></textarea>
            </div>
          </div>
          <div id="result">
            <div class="col-sm-12">
              <label for="state" class="fw-bold mb-2 fs-7">State/Province *</label>
              <!--								<select class="form-select form-select-lg" id="state" name="state" required>-->
              <!--								</select>-->
              <input type="text" class="form-control" placeholder="State/Province" id="state" name="state" required="">
              <div class="invalid-feedback"> Please enter your State </div>
            </div>
            <div class="col-sm-12 mt-3">
              <label for="city" class="fw-bold mb-2 fs-7">City *</label>
              <!--								<ins id="cityins" style="display:none"></ins>-->
              <input type="text" class="form-control" placeholder="City" id="city" name="city" required="">
              <div class="invalid-feedback"> Please enter your city </div>
            </div>
            <div class="col-sm-12 mt-3 dist" style="display: none;">
              <label for="dist" class="fw-bold mb-2 fs-7">District</label>
              <!--								<ins id="cityins" style="display:none"></ins>-->
              <input type="text" class="form-control" placeholder="District(optional)" id="dist" name="dist">
            </div>
          </div>
          <div class="col-12 my-3">
            <label for="address" class="fw-bold mb-2 fs-7">House Number/Street *</label>
            <textarea class="form-control fs-6" id="address" name="address" placeholder="House Number/Street" required=""></textarea>
            <div class="invalid-feedback"> Please enter a detailed delivery address </div>
          </div>
          <div class="col-sm-12 mb-3">
            <label for="zipcode" class="fw-bold mb-2 fs-7">Zip code *</label>
            <input type="text" class="form-control" placeholder="Zip code" id="zipcode" name="zipcode" required="">
            <div class="invalid-feedback"> Please enter your Zip code </div>
          </div>
          <div class="col-sm-12 mb-3">
            <label for="email3" class="fw-bold mb-2 fs-7">Email *</label>
            <input type="email" class="form-control" placeholder="Email" id="email3" name="email" required="">
            <div class="invalid-feedback"> Please enter your Email </div>
          </div>
          <div class="col-12 my-3 pb-4">
            <button class="btn btn-dark btn-lg d-block fw-bold w-100" style="position: fixed;bottom: 0;left: 0;" type="submit" id="saveAddress">Save</button>
          </div>
        </div>
      </div>
    </div>
  </div>
</form>

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lucerabelle.com Open in urlscan Pro
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26 forms found in the DOM