www.superofferwinner.com Open in urlscan Pro
74.206.174.138  Public Scan

Submitted URL: https://clkmt.com/?repid=1043&offerid=950&sub1=50gik
Effective URL: https://www.superofferwinner.com/lqscr1?x_aff=2003&x_s=mdra&x_offer=1301&x_subaff1=1043&x_subaff2=EXyVQMi&x_subaff3=50gik&click_i...
Submission: On February 18 via manual from US — Scanned from NL

Form analysis 1 forms found in the DOM

POST

<form class="applyform  has-validation-callback" method="post" action="">
  <input type="hidden" name="offer" value="offer315">
  <input type="hidden" name="affid" value="mdra_2003-1301">
  <input type="hidden" name="aff_sub" value="1043">
  <input type="hidden" name="aff_sub2" value="EXyVQMi">
  <input type="hidden" name="aff_sub3" value="50gik">
  <input type="hidden" name="clickid" value="085178d9491db355f3b7246ec53c5984">
  <input type="hidden" name="country" value="US">
  <div id="shipping-form" style="">
    <div class="row">
      <div class="col sm-2-2">
        <h2>FILL OUT THE INFO BELOW</h2>
      </div>
    </div>
    <div id="ember6" class="ember-view">
      <div class="row">
        <div class="col xs-1-2">
          <div id="ember7" class="ember-view"><label for="ship-first-name">First Name</label>
            <div id="ship-first-name-input-wrapper" class="input-wrapper ">
              <input type="text" id="ship-first-name" class="form-control" name="firstname" placeholder="First Name">
            </div>
          </div>
        </div>
        <div class="col xs-1-2">
          <div id="ember9" class="ember-view"><label for="ship-last-name">Last Name</label>
            <div id="ship-last-name-input-wrapper" class="input-wrapper ">
              <input type="text" id="ship-last-name" class="form-control" name="lastname" placeholder="Last Name">
            </div>
          </div>
        </div>
      </div>
      <div class="row">
        <div class="col xs-2-2">
          <div id="ember9" class="ember-view"><label for="ship-last-name">Address</label>
            <div id="ship-last-name-input-wrapper" class="input-wrapper ">
              <input id="ship-address" name="address" placeholder="Address" class="form-control" type="text" required="">
            </div>
          </div>
        </div>
      </div>
      <div class="row">
        <div class="col xs-1-2">
          <div id="ember13" class="ember-view"><label for="ship-email">City</label>
            <div id="ship-email-input-wrapper" class="input-wrapper ">
              <input id="ship-city" class="form-control" type="text" placeholder="City" name="city" required="">
            </div>
          </div>
        </div>
        <div class="col xs-1-2">
          <div id="ember11" class="ember-view"><label for="ship-phone">Zip Code</label>
            <div id="ship-phone-input-wrapper" class="input-wrapper ">
              <div class="intl-tel-input separate-dial-code iti-sdc-2">
                <input type="text" class="form-control" id="ship-zip-code" name="code" inputmode="numeric" required="" placeholder="Zip Code">
              </div>
            </div>
          </div>
        </div>
      </div>
      <div class="row">
        <div class="col xs-1-2">
          <div id="ember13" class="ember-view"><label for="ship-email">Email</label>
            <div id="ship-email-input-wrapper" class="input-wrapper ">
              <input type="email" class="form-control" name="email" inputmode="email" placeholder="Email" id="ship-email">
            </div>
          </div>
        </div>
        <div class="col xs-1-2">
          <div id="ember11" class="ember-view"><label for="ship-phone">Phone</label>
            <div id="ship-phone-input-wrapper" class="input-wrapper ">
              <div class="intl-tel-input separate-dial-code iti-sdc-2">
                <input type="text" id="ship-phone" name="phone" inputmode="numeric" class="form-control" placeholder="Phone">
              </div>
            </div>
          </div>
        </div>
      </div>
      <div class="row">
        <div class="col xs-2-2">
          <p style="text-align:center;color:red;" class="appendError"></p>
        </div>
      </div>
      <div class="row">
        <div class="col xs-2-2">
          <div id="ember15" class="ember-view">
            <div id="ship-button-wrapper" style="text-align: center;">
              <button id="ship-form-button" class="validation-btn ship-first-name-pass ship-last-name-pass ship-phone-pass ship-email-pass" type="submit" style="">CONTINUE</button>
            </div>
          </div>
        </div>
      </div>
    </div>
  </div>
</form>

Text Content

FILL OUT THE INFO BELOW

First Name

Last Name

Address

City

Zip Code

Email

Phone




CONTINUE

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