www.drcoffeeservice.be Open in urlscan Pro
137.117.224.218  Public Scan

Form analysis
1 forms found in the DOM

POST /

<form action="/" method="post" novalidate="novalidate" class="ng-pristine ng-valid"><input name="__RequestVerificationToken" type="hidden"
    value="BWh7Oh3j1GPNb8oUBz73RrmJUR7Ekm4Vx3i0FDfv2PhY6lUpUA855jLhH9hz5POOfi39oiDun3QykjNZsoLJRVBms_rwRdWAO56fgSeuNZI1">
  <div class="col-sm-6">
    <div class="form-group">
      <input class="form-control" id="059ac056-f1f6-4742-97d2-0f4a5b2f0cab" name="Fields[0].Value" placeholder="Naam" required="required" type="text" value=""><input data-val="true" data-val-required="The FieldType field is required."
        id="Fields_0__FieldType" name="Fields[0].FieldType" type="hidden" value="Text"><input id="Fields_0__Label" name="Fields[0].Label" type="hidden" value="Naam">
      <span class="field-validation-valid text-danger" data-valmsg-for="Field_0_Required" data-valmsg-replace="true"></span>
    </div>
  </div>
  <div class="col-sm-6">
    <div class="form-group">
      <input class="form-control" id="d97a918d-02a9-4fec-b12b-dd3543b597bc" name="Fields[1].Value" placeholder="Voornaam" required="required" type="text" value=""><input data-val="true" data-val-required="The FieldType field is required."
        id="Fields_1__FieldType" name="Fields[1].FieldType" type="hidden" value="Text"><input id="Fields_1__Label" name="Fields[1].Label" type="hidden" value="Voornaam">
      <span class="field-validation-valid text-danger" data-valmsg-for="Field_1_Required" data-valmsg-replace="true"></span>
    </div>
  </div>
  <div class="col-sm-12 ">
    <div class="form-group">
      <input class="form-control" id="57834561-4229-485e-bb34-d05d17460a2f" name="Fields[2].Value" placeholder="E-mail" required="required" type="email" value=""><input data-val="true" data-val-required="The FieldType field is required."
        id="Fields_2__FieldType" name="Fields[2].FieldType" type="hidden" value="Email"><input id="Fields_2__Label" name="Fields[2].Label" type="hidden" value="E-mail">
      <span class="field-validation-valid text-danger" data-valmsg-for="Field_2_Required" data-valmsg-replace="true"></span>
    </div>
  </div>
  <div class="col-sm-12 ">
    <div class="form-group">
      <input class="form-control" id="94ae15aa-0387-431d-9760-4b67158a83e2" name="Fields[3].Value" placeholder="Telefoon" type="text" value=""><input data-val="true" data-val-required="The FieldType field is required." id="Fields_3__FieldType"
        name="Fields[3].FieldType" type="hidden" value="Text"><input id="Fields_3__Label" name="Fields[3].Label" type="hidden" value="Telefoon">
      <span class="field-validation-valid text-danger" data-valmsg-for="Field_3_Required" data-valmsg-replace="true"></span>
    </div>
  </div>
  <div class="col-sm-12 ">
    <div class="form-group">
      <textarea class="form-control" cols="20" id="2abfb0e2-d4b6-405a-b90c-68e29cdc50ff" name="Fields[4].Value" placeholder="Uw bericht" required="required" rows="3"></textarea><input data-val="true"
        data-val-required="The FieldType field is required." id="Fields_4__FieldType" name="Fields[4].FieldType" type="hidden" value="BigText"><input id="Fields_4__Label" name="Fields[4].Label" type="hidden" value="Uw bericht">
      <span class="field-validation-valid text-danger" data-valmsg-for="Field_4_Required" data-valmsg-replace="true"></span>
    </div>
  </div>
  <div class="col-sm-12 email2">
    <div class="form-group">
      <input class="form-control" id="43fbfe9a-c1af-411f-9f84-b3fe7edf32b4" name="Fields[5].Value" placeholder="Email2" type="text" value=""><input data-val="true" data-val-required="The FieldType field is required." id="Fields_5__FieldType"
        name="Fields[5].FieldType" type="hidden" value="Text"><input id="Fields_5__Label" name="Fields[5].Label" type="hidden" value="Email2">
      <span class="field-validation-valid text-danger" data-valmsg-for="Field_5_Required" data-valmsg-replace="true"></span>
    </div>
  </div>
  <div class="col-sm-12">
    <div class="form-group">
      <button type="submit" class="btn btn-send  form-control">Verzenden</button>
      <img src="/Content/Images/Loaders/ajax-loader.gif" class="img-responsive horizontal-center loader">
    </div>
  </div>
</form>

Text Content

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DR COFFEE SERVICE

Wim De Reu

Reigerstraat 1
8755 Ruiselede

info@drcoffeeservice.be

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