request-portal-3ad557.zapier.app
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76.76.21.98
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Submitted URL: https://panosmellow.com/
Effective URL: https://request-portal-3ad557.zapier.app/submit-ticket
Submission: On April 11 via api from US — Scanned from DE
Effective URL: https://request-portal-3ad557.zapier.app/submit-ticket
Submission: On April 11 via api from US — Scanned from DE
Form analysis 1 forms found in the DOM
<form aria-label="form">
<fieldset class="m-0 flex flex-col flex-nowrap gap-y-[30px] rounded-xl border-none bg-zi-white p-[30px] shadow-subtle"><!--$-->
<div class="relative w-full">
<div class="relative my-0 mx-auto max-w-full">
<div class="relative scroll-mx-0 scroll-my-10"><!--$-->
<div class="flex flex-col gap-y-2.5">
<div><label class="grid auto-cols-auto grid-flow-col items-start justify-start gap-[5px] text-base font-semibold text-zi-text [&[data-state~='errored']]:text-zi-formError" data-align-items="start" data-justify-content="start"
data-size="small" for="store-name"><span>Store Name</span></label></div>
<div class="custom-select css-b62m3t-container"><span id="react-select-13-live-region" class="css-7pg0cj-a11yText"></span><span aria-live="polite" aria-atomic="false" aria-relevant="additions text" class="css-7pg0cj-a11yText"></span>
<div class="Select__control css-1s2u09g-control">
<div class="Select__value-container css-1d8n9bt">
<div class="Select__placeholder css-14el2xx-placeholder" id="react-select-13-placeholder">Select...</div>
<div class="Select__input-container css-ackcql" data-value=""><input class="Select__input"
style="label:input;color:inherit;background:0;opacity:1;width:100%;grid-area:1 / 2;font:inherit;min-width:2px;border:0;margin:0;outline:0;padding:0" autocapitalize="none" autocorrect="off" id="store-name" spellcheck="false"
tabindex="0" type="text" aria-autocomplete="list" aria-expanded="false" aria-haspopup="true" role="combobox" aria-describedby="react-select-13-placeholder" value=""></div>
</div>
<div class="Select__indicators css-1wy0on6"><span class="Select__indicator-separator css-1okebmr-indicatorSeparator"></span>
<div class="Select__indicator Select__dropdown-indicator css-tlfecz-indicatorContainer" aria-hidden="true"><svg height="20" width="20" viewBox="0 0 20 20" aria-hidden="true" focusable="false" class="css-8mmkcg">
<path
d="M4.516 7.548c0.436-0.446 1.043-0.481 1.576 0l3.908 3.747 3.908-3.747c0.533-0.481 1.141-0.446 1.574 0 0.436 0.445 0.408 1.197 0 1.615-0.406 0.418-4.695 4.502-4.695 4.502-0.217 0.223-0.502 0.335-0.787 0.335s-0.57-0.112-0.789-0.335c0 0-4.287-4.084-4.695-4.502s-0.436-1.17 0-1.615z">
</path>
</svg></div>
</div>
</div><input name="store-name" type="hidden" value="">
</div>
</div><!--/$-->
</div>
</div>
</div><!--/$--><!--$-->
<div class="relative w-full">
<div class="relative my-0 mx-auto max-w-full">
<div class="relative scroll-mx-0 scroll-my-10"><!--$-->
<div class="flex flex-col gap-y-2.5">
<div><label class="grid auto-cols-auto grid-flow-col items-start justify-start gap-[5px] text-base font-semibold text-zi-text [&[data-state~='errored']]:text-zi-formError" data-align-items="start" data-justify-content="start"
data-size="small" for="name"><span>Name</span></label></div>
<div data-errored="false"
class="flex h-[50px] flex-row flex-nowrap items-center gap-x-2.5 overflow-hidden rounded-lg border-2 border-zi-lightGray bg-zi-superLightGray px-4 py-0 text-[17px] text-zi-text transition-colors duration-150 focus-within:border-zi-primary data-[size=small]:h-10 data-[errored=true]:border-zi-formError data-[size=small]:text-[15px]">
<input id="name" name="name" type="text" class="block h-full w-0 grow border-none bg-transparent px-0 py-4 text-inherit outline-none placeholder:text-zi-placeholder" value=""></div>
</div><!--/$-->
</div>
</div>
</div><!--/$--><!--$-->
<div class="relative w-full">
<div class="relative my-0 mx-auto max-w-full">
<div class="relative scroll-mx-0 scroll-my-10"><!--$-->
<div class="flex flex-col gap-y-2.5">
<div><label class="grid auto-cols-auto grid-flow-col items-start justify-start gap-[5px] text-base font-semibold text-zi-text [&[data-state~='errored']]:text-zi-formError" data-align-items="start" data-justify-content="start"
data-size="small" for="request-type"><span>Request Type</span></label></div>
<div class="custom-select css-b62m3t-container"><span id="react-select-14-live-region" class="css-7pg0cj-a11yText"></span><span aria-live="polite" aria-atomic="false" aria-relevant="additions text" class="css-7pg0cj-a11yText"></span>
<div class="Select__control css-1s2u09g-control">
<div class="Select__value-container css-1d8n9bt">
<div class="Select__placeholder css-14el2xx-placeholder" id="react-select-14-placeholder">Select...</div>
<div class="Select__input-container css-ackcql" data-value=""><input class="Select__input"
style="label:input;color:inherit;background:0;opacity:1;width:100%;grid-area:1 / 2;font:inherit;min-width:2px;border:0;margin:0;outline:0;padding:0" autocapitalize="none" autocorrect="off" id="request-type" spellcheck="false"
tabindex="0" type="text" aria-autocomplete="list" aria-expanded="false" aria-haspopup="true" role="combobox" aria-describedby="react-select-14-placeholder" value=""></div>
</div>
<div class="Select__indicators css-1wy0on6"><span class="Select__indicator-separator css-1okebmr-indicatorSeparator"></span>
<div class="Select__indicator Select__dropdown-indicator css-tlfecz-indicatorContainer" aria-hidden="true"><svg height="20" width="20" viewBox="0 0 20 20" aria-hidden="true" focusable="false" class="css-8mmkcg">
<path
d="M4.516 7.548c0.436-0.446 1.043-0.481 1.576 0l3.908 3.747 3.908-3.747c0.533-0.481 1.141-0.446 1.574 0 0.436 0.445 0.408 1.197 0 1.615-0.406 0.418-4.695 4.502-4.695 4.502-0.217 0.223-0.502 0.335-0.787 0.335s-0.57-0.112-0.789-0.335c0 0-4.287-4.084-4.695-4.502s-0.436-1.17 0-1.615z">
</path>
</svg></div>
</div>
</div><input name="request-type" type="hidden" value="">
</div>
</div><!--/$-->
</div>
</div>
</div><!--/$--><!--$-->
<div class="relative w-full">
<div class="relative my-0 mx-auto max-w-full">
<div class="relative scroll-mx-0 scroll-my-10"><!--$-->
<div class="flex flex-col gap-y-2.5">
<div><label class="grid auto-cols-auto grid-flow-col items-start justify-start gap-[5px] text-base font-semibold text-zi-text [&[data-state~='errored']]:text-zi-formError" data-align-items="start" data-justify-content="start"
data-size="small" for="request"><span>Request</span></label></div><textarea id="request" name="request" rows="3"
class="block min-h-[50px] w-full rounded-lg border-2 border-solid border-zi-lightGray bg-zi-superLightGray p-[15px] text-[17px] text-zi-text focus-within:border-zi-primary resize-y" style="height: 60px !important;"></textarea>
</div><!--/$-->
</div>
</div>
</div><!--/$-->
<div class="relative scroll-mx-0 scroll-my-10"><button
class="relative w-full cursor-pointer rounded-lg border-2 border-solid px-[15px] py-0 transition-all duration-150 focus-visible:outline-none focus-visible:ring-2 focus-visible:ring-offset-2 focus-visible:ring-offset-zi-white active:brightness-100 disabled:cursor-not-allowed disabled:border-gray-300 disabled:bg-gray-200 disabled:text-gray-400 [&:not(:disabled):hover]:brightness-110 border-zi-primary bg-zi-primary font-semibold text-zi-white focus-visible:ring-zi-primary h-[50px] text-[17px]"
type="submit"><span style="opacity:1">Submit</span></button></div>
</fieldset>
</form>Text Content
Store Name Select... Name Request Type Select... Request Submit Built on