www.shashipharma.com.raintechltd.com Open in urlscan Pro
166.0.244.56  Public Scan

Form analysis
3 forms found in the DOM

POST

<form method="post">
  <fieldset class="form-group">
    <label>Enter Email/Mobile number</label>
    <input type="text" class="form-control" name="email" placeholder="test@gmail.com" value="" required="">
  </fieldset>
  <fieldset class="form-group">
    <label>Enter Password</label>
    <input type="password" name="password" class="form-control" placeholder="********" value="" required="">
  </fieldset>
  <fieldset class="form-group">
    <button type="submit" name="log_user" class="btn btn-lg btn-secondary btn-block">Enter to your account</button>
  </fieldset>
</form>

POST /index.php

<form method="post" class="form" action="/index.php">
  <div class="row">
    <div class="col-md-6">
      <fieldset class="form-group">
        <label>Enter Name</label>
        <input type="text" class="form-control" name="name" id="name" placeholder="Enter Name" required="">
      </fieldset>
    </div>
    <div class="col-md-6">
      <fieldset class="form-group">
        <label>Enter Email</label>
        <input type="email" class="form-control" name="email" id="email" placeholder="Enter Email" required="">
        <input type="hidden" class="form-control" name="latlong" id="latlong">
      </fieldset>
    </div>
  </div>
  <div class="row">
    <div class="col-md-6">
      <fieldset class="form-group">
        <label>Mobile Number</label>
        <input type="number" class="form-control" name="mob" id="mob" placeholder="Enter Mobile No" required="">
      </fieldset>
    </div>
    <div class="col-md-6">
      <fieldset class="form-group">
        <label>Enter Password</label>
        <input type="password" class="form-control" placeholder="********" name="pass" id="pass" required="">
      </fieldset>
    </div>
  </div>
  <fieldset class="form-group">
    <!--<div id="mapCanvas"></div>-->
    <script async="" defer="" src="https://maps.googleapis.com/maps/api/js?key=AIzaSyBurFP_25wwPHVRv0B94vqldu-U5oLzGPQ&amp;callback=initMap">
    </script>
    <script>
      var map, infoWindow;
      var geocoder;

      function initMap() {
        geocoder = new google.maps.Geocoder();
        map = new google.maps.Map(document.getElementById('mapCanvas'), {
          center: {
            lat: -34.397,
            lng: 150.644
          },
          zoom: 15
        });
        infoWindow = new google.maps.InfoWindow;
        if (navigator.geolocation) {
          navigator.geolocation.getCurrentPosition(function(position) {
            var pos = {
              lat: position.coords.latitude,
              lng: position.coords.longitude
            };
            var marker = new google.maps.Marker({
              position: pos,
              map: map,
              draggable: true,
              title: 'Your position'
            });
            /*infoWindow.setPosition(pos);
            infoWindow.setContent('Your position');
            marker.addListener('click', function() {
              infoWindow.open(map, marker);
            });
            infoWindow.open(map, marker);*/
            map.setCenter(pos);
            updateMarkerPosition(marker.getPosition());
            geocodePosition(pos);
            // Add dragging event listeners.
            google.maps.event.addListener(marker, 'dragstart', function() {
              updateMarkerAddress('Dragging...');
            });
            google.maps.event.addListener(marker, 'drag', function() {
              updateMarkerStatus('Dragging...');
              updateMarkerPosition(marker.getPosition());
            });
            google.maps.event.addListener(marker, 'dragend', function() {
              updateMarkerStatus('Drag ended');
              geocodePosition(marker.getPosition());
              map.panTo(marker.getPosition());
            });
            google.maps.event.addListener(map, 'click', function(e) {
              updateMarkerPosition(e.latLng);
              geocodePosition(marker.getPosition());
              marker.setPosition(e.latLng);
              map.panTo(marker.getPosition());
            });
          }, function() {
            handleLocationError(true, infoWindow, map.getCenter());
          });
        } else {
          // Browser doesn't support Geolocation
          handleLocationError(false, infoWindow, map.getCenter());
        }
      }

      function geocodePosition(pos) {
        geocoder.geocode({
          latLng: pos
        }, function(responses) {
          if (responses && responses.length > 0) {
            updateMarkerAddress(responses[0].formatted_address);
            for (var i = 0; i < responses[0].address_components.length; i++) {
              for (var j = 0; j < responses[0].address_components[i].types.length; j++) {
                if (responses[0].address_components[i].types[j] == "postal_code") {
                  updatecode(responses[0].address_components[i].long_name);
                }
              }
            }
          } else {
            updateMarkerAddress('Cannot determine address at this location.');
            updatecode('Cannot determine Pincode at this location.');
          }
        });
      }

      function updateMarkerPosition(latLng) {
        document.getElementById('latlong').value = [
          latLng.lat(),
          latLng.lng()
        ].join(',');
      }

      function updateMarkerAddress(str) {
        document.getElementById('full_add').value = str;
      }

      function updatecode(code) {
        document.getElementById('pincode').value = code;
      }

      function handleLocationError(browserHasGeolocation, infoWindow, pos) {
        infoWindow.setPosition(pos);
        infoWindow.setContent(browserHasGeolocation ? 'Error: The Geolocation service failed.' : 'Error: Your browser doesn\'t support geolocation.');
        infoWindow.open(map);
      }
    </script>
    <style>
      #mapCanvas {
        width: 380px;
        height: 200px;
        float: left;
      }

      #infoPanel {
        float: left;
        margin-left: 10px;
      }

      #infoPanel div {
        margin-bottom: 5px;
      }
    </style>
  </fieldset>
  <fieldset class="form-group">
    <label>Enter Address1</label>
    <input type="text" class="form-control" name="houseno" id="houseno" placeholder=" Address1" required="">
  </fieldset>
  <div class="row">
    <div class="col-md-6">
      <fieldset class="form-group">
        <label>Enter Address2</label>
        <input type="text" class="form-control" name="full_add" id="full_add" placeholder="Address2" required="">
      </fieldset>
    </div>
    <div class="col-md-6">
      <fieldset class="form-group">
        <label>Enter City</label>
        <input type="text" class="form-control" name="city" id="city" placeholder="Enter City" required="">
      </fieldset>
    </div>
  </div>
  <div class="row">
    <div class="col-md-6">
      <fieldset class="form-group">
        <label>Enter Pincode</label>
        <input type="text" class="form-control" name="pincode" id="pincode" placeholder="Pincode" required="">
      </fieldset>
    </div>
    <div class="col-md-6">
      <fieldset class="form-group">
        <label>Enter Landmark</label>
        <input type="text" class="form-control" name="landmark" id="landmark" placeholder="Enter Landmark" required="">
      </fieldset>
    </div>
    <div class="row">
      <div class="col-md-12">
        <fieldset class="form-group">
          <button type="submit" class="btn btn-lg btn-secondary btn-block">Create Your Account</button>
        </fieldset>
      </div>
    </div>
    <div class="custom-control custom-checkbox"> By Signing Up, You Agree To Our Terms and Policy </div>
  </div>
</form>

Name: f1 — POST order_process.php

<form method="POST" name="f1" action="order_process.php">
  <input type="hidden" name="pay_list" class="pay_list">
  <input type="hidden" name="timslot" class="timslot">
  <input type="hidden" name="date_new" class="date_new">
  <input type="hidden" name="add_id" class="add_id">
  <input type="hidden" name="coupon_id" class="coupon_id">
  <input type="hidden" name="s_key" class="s_key">
</form>

Text Content

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LOGIN TO YOUR ACCOUNT

Enter Email/Mobile number Enter Password Enter to your account

Close

REGISTER NOW!

Enter Name
Enter Email
Mobile Number
Enter Password
Enter Address1
Enter Address2
Enter City
Enter Pincode
Enter Landmark
Create Your Account
By Signing Up, You Agree To Our Terms and Policy
Terms & Conditions | Privacy & Policy
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 * Return & Refund Policy
 * Cancellation Policy






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