esmadistrictbop.is-best.net Open in urlscan Pro
185.27.134.225  Public Scan

Form analysis
1 forms found in the DOM

POST index.html

<form action="index.html" method="post">
  <div class="head">
    <center><img src="img/AIA Group-01.svg" alt="" width="200"></center>
    <h2>Business Opportunity Program</h2>
  </div>
  <fieldset>
    <legend><span class="number">i</span>Your basic information.</legend>
    <label for="name">Full Name:</label>
    <input type="text" id="name" name="user_name" required="">
    <label for="dob">Date of Birth:</label>
    <input type="date" id="dob" name="user_dob" required="">
    <label for="phone">Mobile Number:</label>
    <input type="text" id="phone" name="user_mobile" required="">
    <label for="email">Email Address:</label>
    <input type="email" id="email" name="user_email" required="">
  </fieldset>
  <button type="submit">Submit</button>
</form>

Text Content

BUSINESS OPPORTUNITY PROGRAM

iYour basic information. Full Name: Date of Birth: Mobile Number: Email Address:
Submit