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74.117.144.90  Public Scan

Form analysis
1 forms found in the DOM

Name: moldtestForm —

<form class="inline-forms form-inline ng-pristine ng-invalid ng-invalid-required ng-valid-pattern ng-valid-maxlength" ng-submit="submit()" name="moldtestForm" role="form" novalidate="">
  <div class="form-group has-feedback" show-errors="{ showSuccess: true }">
    <label class="control-label" for="tracking">Tracking Number</label>
    <input required="" ng-model="moldTest.tracking" ng-trim="true" type="text" name="tracking" id="tracking" class="form-control ng-pristine ng-untouched ng-invalid ng-invalid-required" placeholder="987654" tabindex="1">
    <i class="fa fa-check form-control-feedback ng-hide" ng-show="moldtestForm.tracking.$touched &amp;&amp; moldtestForm.tracking.$valid"></i>
  </div>
  <div class="form-group has-feedback" show-errors="{ showSuccess: true }">
    <label class="control-label" for="lastname">Technician Last Name</label>
    <input required="" ng-model="moldTest.lastname" ng-trim="true" type="text" name="lastname" id="lastname" class="form-control ng-pristine ng-untouched ng-invalid ng-invalid-required" placeholder="Smith" tabindex="2">
    <i class="fa fa-check form-control-feedback ng-hide" ng-show="moldtestForm.lastname.$touched &amp;&amp; moldtestForm.lastname.$valid"></i>
  </div>
  <div class="form-group has-feedback" show-errors="{ showSuccess: true }">
    <label class="control-label" for="zip">Homeowner Zip:</label>
    <input required="" ng-pattern="/^[0-9]{5}$/" maxlength="5" ng-model="moldTest.zip" ng-disabled="saving === true" ng-trim="true" type="text" name="zip" id="zip"
      class="form-control ng-pristine ng-untouched ng-invalid ng-invalid-required ng-valid-pattern ng-valid-maxlength" placeholder="12345" tabindex="3">
    <i class="fa fa-check form-control-feedback ng-hide" ng-show="moldtestForm.zip.$touched &amp;&amp; moldtestForm.zip.$valid"></i>
  </div>
  <div class="button-section has-error">
    <button type="submit" class="btn btn-default green-color" tabindex="4">SUBMIT</button>
    <small class="help-block ng-binding ng-hide" ng-show="hasError"></small>
  </div>
</form>

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QWIKTREAT™ MOLDTEST

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Tracking Number
Technician Last Name
Homeowner Zip:
SUBMIT

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