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hotvx.myaestheticrecord.com Open in urlscan Pro
52.223.48.89  Public Scan

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URL: https://hotvx.myaestheticrecord.com/register?key=gEQYqALK6jP9xkPPAkDdlZbJXoaMrN:Jgb2R4reXpA6G24mOkED9NKQ1j8owv
Submission: On November 04 via manual from IN — Scanned from DE

Form analysis 1 forms found in the DOM

POST https://hotvx.myaestheticrecord.com/register

<form class="form-horizontal" id="register" role="form" method="POST" action="https://hotvx.myaestheticrecord.com/register" novalidate="novalidate">
  <input type="hidden" name="_token" value="BPrMbBnQjnzeANdatj6WptU9DT9zVBa30MsBXagO">
  <div class="col-sm-6">
    <div class="field-outer ">
      <div class="field-label">First Name</div>
      <div class="input-outer">
        <input id="first" type="text" class="popup-input-box" name="first" value="Rosemarie" placeholder="Enter your first name *">
      </div>
    </div>
    <div class="field-outer ">
      <div class="field-label">Last Name</div>
      <div class="input-outer">
        <input id="last" type="text" class="popup-input-box" name="last" value="Coury" placeholder="Enter your last name *">
      </div>
    </div>
    <div class="field-outer ">
      <div class="field-label">EMAIL</div>
      <div class="input-outer">
        <input id="username" type="email" class="popup-input-box" name="username" value="rmc@eomanagement.com" placeholder="Enter your email *">
      </div>
    </div>
    <div class="field-outer"> You will need access to this email to<br> complete your registration. </div>
  </div>
  <div class="col-sm-6">
    <div class="field-outer ">
      <div class="field-label">Password</div>
      <div class="input-outer">
        <input id="password" type="password" class="popup-input-box login-pswd" placeholder="Enter your password *" name="password">
      </div>
    </div>
    <div class="field-outer ">
      <div class="field-label">Confirm Password</div>
      <div class="input-outer">
        <input id="password-confirm" type="password" class="popup-input-box login-pswd" placeholder="Enter your password *" name="password_confirmation">
      </div>
    </div>
    <div class="field-outer"> Password should be minimum 8 characters<br> At least one capital letter<br> At least one Special character </div>
  </div>
  <!--div class="col-sm-6 otp-section" style="display:none;">
					<div class="field-outer ">
						<div class="field-label">Enter OTP</div>
						<div class="input-outer">
							<input id="otp" type="text" class="popup-input-box" name="otp" placeholder="Enter OTP sent to your email *">
													</div>
					</div>
				  </div>
				  
				  <div class="col-sm-6 otp-section" style="display:none;">
						<div class="input-outer">
							<button type="button" class="blue-button" id="verify-otp">Verify</button>
						</div>
					</div>
				  </div-->
  <input type="hidden" name="key" value="gEQYqALK6jP9xkPPAkDdlZbJXoaMrN:Jgb2R4reXpA6G24mOkED9NKQ1j8owv">
  <input type="hidden" id="verified" name="verified" value="false">
  <input type="hidden" id="original_mail" name="original_mail" value="rmc@eomanagement.com">
  <div class="col-sm-12">
    <button type="submit" class="blue-button register-btn m-t-50" id="registerBtn">Register</button>
    <div class="not-register text-center"><a href="https://hotvx.myaestheticrecord.com/login">Already have an account? Sign In!</a></div>
  </div>
</form>

Text Content

LEBAE INC
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Fill the inputs to register a new account
First Name

Last Name

EMAIL

You will need access to this email to
complete your registration.
Password

Confirm Password

Password should be minimum 8 characters
At least one capital letter
At least one Special character
Register
Already have an account? Sign In!
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