kaarten.arsretailservice.nl Open in urlscan Pro
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Form analysis
1 forms found in the DOM

Name: survey_196 — POST https://kaarten.arsretailservice.nl/?survey=196

<form method="post" action="https://kaarten.arsretailservice.nl/?survey=196" name="survey_196">
  <div class="survey page_1" id="survey_196_page_1">
    <div class="introduction-block">
      <h1 class="survey-title"> </h1>
      <p class="introduction"></p>
      <p>Heeft u een Audi dinerbon uitgegeven? Registreer via onderstaande formulier de uitgegeven dinerbon d.m.v. klantnaam, komnummer en boncode.&nbsp;</p>
      <p>Alvast vriendelijk bedankt voor uw medewerking!</p>
      <p></p>
    </div>
    <div class="question row" id="survey_196_question_1">
      <div class="open">
        <div class="number">1</div>
        <div class="open_question_wrapper">
          <div for="2f594db2d1039dccb4653261a0b4d9f8" class="question_title">Klantnaam</div>
          <div class="normal open_question input-field col"><textarea cols="40" rows="5" name="2f594db2d1039dccb4653261a0b4d9f8" class="materialize-textarea"></textarea></div>
        </div>
      </div>
    </div>
    <div class="question row" id="survey_196_question_2">
      <div class="open">
        <div class="number">2</div>
        <div class="open_question_wrapper">
          <div for="529f5227e99d3ddef882588a09c67274" class="question_title">Komnummer</div>
          <div class="normal open_question input-field col"><textarea cols="40" rows="5" name="529f5227e99d3ddef882588a09c67274" class="materialize-textarea"></textarea></div>
        </div>
      </div>
    </div>
    <div class="question row" id="survey_196_question_3">
      <div class="open">
        <div class="number">3</div>
        <div class="open_question_wrapper">
          <div for="62a0145b5a61ca09b6780f802ca33ee7" class="question_title">Audi dinerbon code</div>
          <div class="normal open_question input-field col"><textarea cols="40" rows="5" name="62a0145b5a61ca09b6780f802ca33ee7" class="materialize-textarea"></textarea></div>
        </div>
      </div>
      <div class="description">
        <div class="icon"><i class="material-icons">error_outline</i></div>
        <div class="text">Zie code 7-cijfer/lettercombinatie op achterzijde van de Audi dinerbon</div>
      </div>
    </div>
    <div class="question row" id="survey_196_question_4">
      <div class="open">
        <div class="number">4</div>
        <div class="open_question_wrapper">
          <div for="5bfa6be3042c93534e35290329a69c5a" class="question_title">Dealernaam</div>
          <div class="normal open_question input-field col"><textarea cols="40" rows="5" name="5bfa6be3042c93534e35290329a69c5a" class="materialize-textarea"></textarea></div>
        </div>
      </div>
    </div>
    <div class="question row" id="survey_196_question_5">
      <div class="open">
        <div class="number">5</div>
        <div class="open_question_wrapper">
          <div for="7ae9a5696e9bbb7c78fcfa7904feb1ab" class="question_title">Contactpersoon</div>
          <div class="normal open_question input-field col"><textarea cols="40" rows="5" name="7ae9a5696e9bbb7c78fcfa7904feb1ab" class="materialize-textarea"></textarea></div>
        </div>
      </div>
    </div>
    <div class="form-controls"><input type="submit" class="submit_button form-button btn" value="Doorgeven"></div>
  </div>
</form>

Text Content

Heeft u een Audi dinerbon uitgegeven? Registreer via onderstaande formulier de
uitgegeven dinerbon d.m.v. klantnaam, komnummer en boncode. 

Alvast vriendelijk bedankt voor uw medewerking!



1
Klantnaam

2
Komnummer

3
Audi dinerbon code

error_outline
Zie code 7-cijfer/lettercombinatie op achterzijde van de Audi dinerbon
4
Dealernaam

5
Contactpersoon


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