www.divineimaging.com Open in urlscan Pro
107.180.1.244  Public Scan

Form analysis
1 forms found in the DOM

mail_script.php

<form action="mail_script.php">
  <table width="100%" border="0" cellspacing="10" cellpadding="0">
    <tbody>
      <tr>
        <td><label for="first_name">
            <div align="right">First Name</div>
          </label></td>
        <td>
          <div align="left"><input id="first_name" maxlength="40" name="first_name" size="20" type="text"></div>
        </td>
      </tr>
      <tr>
        <td><label for="last_name">
            <div align="right">Last Name</div>
          </label></td>
        <td>
          <div align="left"><input id="last_name2" maxlength="80" name="last_name" size="20" type="text"></div>
        </td>
      </tr>
      <tr>
        <td>
          <div align="right"><label for="dept">Dept/Agency</label></div>
        </td>
        <td>
          <div align="left">
            <input id="dept" maxlength="80" name="dept" size="20" type="text">
          </div>
        </td>
      </tr>
      <tr>
        <td>
          <div align="right"><label for="email">Email</label></div>
        </td>
        <td>
          <div align="left"><input id="email" maxlength="40" name="email" size="20" type="text"></div>
        </td>
      </tr>
      <tr>
        <td>
          <div align="right"><label for="state">State/Province</label></div>
        </td>
        <td>
          <div align="left"><input id="state" maxlength="20" name="state" size="20" type="text"></div>
        </td>
      </tr>
      <tr>
        <td>
          <div align="right"><label for="city">City</label></div>
        </td>
        <td>
          <div align="left"><input id="city" maxlength="40" name="city" size="20" type="text"></div>
        </td>
      </tr>
      <tr>
        <td>
          <div align="right"><label for="phone">Phone</label></div>
        </td>
        <td>
          <div align="left"><input id="phone" maxlength="40" name="phone" size="20" type="text"></div>
        </td>
      </tr>
      <tr>
        <td>
          <div align="right">
            <label for="fax">Fax</label>
          </div>
        </td>
        <td>
          <div align="left"><input id="fax" maxlength="40" name="fax" size="20" type="text"></div>
        </td>
      </tr>
      <tr>
        <td>
          <div align="right"><label for="street">Address</label></div>
        </td>
        <td>
          <div align="left"><textarea name="street"></textarea></div>
        </td>
      </tr>
      <tr>
        <td>
          <div align="right"><label for="zip">Zip</label></div>
        </td>
        <td>
          <div align="left"><input id="zip" maxlength="20" name="zip" size="20" type="text"></div>
        </td>
      </tr>
      <tr>
        <td>
          <div align="right"><label for="description">Description</label></div>
        </td>
        <td>
          <div align="left"><textarea name="description"></textarea></div>
        </td>
      </tr>
      <tr>
        <td>
          <div align="right"></div>
        </td>
        <td>
          <div align="left"></div>
        </td>
      </tr>
      <tr>
        <td>
          <div align="right">
            <input type="submit" name="submit2">
          </div>
        </td>
        <td>
          <div align="left"></div>
        </td>
      </tr>
    </tbody>
  </table>
</form>

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First Name

Last Name

Dept/Agency

Email

State/Province

City

Phone

Fax

Address

Zip

Description













DIVINE IMAGING, INC
21323 Pacific Coast Hwy., Suite 101, Malibu, CA 90265
Telephone: 310-579-4000 | Fax: 310-579-4001




Copyright © 2020 Divine Imaging, Inc.,and divineimaging.com,
All brand names and trademarks are copyrighted by their respective holders.
Website and Malibu photo by Affirm Design.