btciservice.com Open in urlscan Pro
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Form analysis
1 forms found in the DOM

POST imemail/imEmailForm.php

<form id="imObjectForm_3" action="imemail/imEmailForm.php" method="post" enctype="multipart/form-data">
  <fieldset class="first" pagecount="1">
    <div>
      <div id="imObjectForm_3_1_container" class="imObjectFormFieldContainer"><label id="imObjectForm_3_1_label" for="imObjectForm_3_1"><span>First Name*</span></label>
        <div id="imObjectForm_3_1_field">
          <input type="text" class="mandatory " id="imObjectForm_3_1" name="imObjectForm_3_1">
        </div>
      </div>
      <div id="imObjectForm_3_2_container" class="imObjectFormFieldContainer"><label id="imObjectForm_3_2_label" for="imObjectForm_3_2"><span>Last Name*</span></label>
        <div id="imObjectForm_3_2_field">
          <input type="text" class="mandatory " id="imObjectForm_3_2" name="imObjectForm_3_2">
        </div>
      </div>
      <div id="imObjectForm_3_3_container" class="imObjectFormFieldContainer"><label id="imObjectForm_3_3_label" for="imObjectForm_3_3"><span>Email*</span></label>
        <div id="imObjectForm_3_3_field">
          <input type="text" class="mandatory valEmail" id="imObjectForm_3_3" name="imObjectForm_3_3">
        </div>
      </div>
      <div id="imObjectForm_3_4_container" class="imObjectFormFieldContainer"><label id="imObjectForm_3_4_label" for="imObjectForm_3_4"><span>Telephone*</span></label>
        <div id="imObjectForm_3_4_field">
          <input type="text" class="mandatory " id="imObjectForm_3_4" name="imObjectForm_3_4">
        </div>
      </div>
      <div id="imObjectForm_3_5_container" class="imObjectFormFieldContainer"><label id="imObjectForm_3_5_label" for="imObjectForm_3_5"><span>Country*</span></label>
        <div id="imObjectForm_3_5_field">
          <input type="text" class="mandatory " id="imObjectForm_3_5" name="imObjectForm_3_5">
        </div>
      </div>
      <div id="imObjectForm_3_6_container" class="imObjectFormFieldContainer"><label id="imObjectForm_3_6_label" for="imObjectForm_3_6"><span>Message*</span></label>
        <div id="imObjectForm_3_6_field">
          <textarea class="mandatory " id="imObjectForm_3_6" name="imObjectForm_3_6"></textarea>
        </div>
      </div>
    </div>
  </fieldset>
  <fieldset pagecount="1">
    <input type="text" id="imObjectForm_3_prot" name="imSpProt">
  </fieldset>
  <div id="imObjectForm_3_buttonswrap">
    <input type="button" id="imObjectForm_3_submit" value="Send">
    <input type="reset" value="Reset">
  </div>
  <input type="hidden" value="jsactive" name="imJsCheck">
</form>

Text Content

CONTACT US - :: WELCOME TO OUR SITE ::

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First Name*

Last Name*

Email*

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BTCI : Banque Togolaise pour le Commerce et l'Industrie

Address : 2610, Avenue de la Chance,
alépédogan, 522 R.P.T., Lome
111, Rue Sylvanus Olympio,
BP 363 Lomé - Togo
Tel: +228 98 14 51 46
Email: info@btciservice.com
Contact Person : Dr. Anderson Philips
Ref : 0303017/0017132013MSB-TG

 
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