www.insurance-design.buskoticket.com Open in urlscan Pro
78.47.246.140  Public Scan

Form analysis
2 forms found in the DOM

POST #

<form action="#" method="post">
  <input type="email" name="Email" placeholder="Enter your email...">
  <button><i class="fa fa-envelope" aria-hidden="true"></i></button>
</form>

<form>
  <div class="col-sm-12 d-flex justify-content-center">
    <div class="col-sm-6">
      <div class="form-group">
        <label for="exampleInputEmail1">First Name</label>
        <input type="text" class="form-control" placeholder="First Name">
      </div>
    </div>
    <div class="col-sm-6">
      <div class="form-group">
        <label for="exampleInputEmail1">Last Name</label>
        <input type="text" class="form-control" placeholder="Last Name">
      </div>
    </div>
  </div>
  <div class="col-sm-12 d-flex justify-content-center">
    <div class="col-sm-6">
      <div class="form-group">
        <label for="exampleInputEmail1">Email</label>
        <input type="email" class="form-control" placeholder="Enter Email">
      </div>
    </div>
    <div class="col-sm-6">
      <div class="form-group">
        <label for="exampleInputEmail1">Phone Number</label>
        <input type="text" class="form-control" placeholder="Enter Phone Number">
      </div>
    </div>
  </div>
  <div class="col-sm-12 d-flex justify-content-center">
    <div class="col-sm-6">
      <div class="form-group">
        <label for="exampleInputEmail1">Brand</label>
        <select class="form-control">
          <option>Brand</option>
          <option>Hero</option>
          <option>Suzuki</option>
        </select>
      </div>
    </div>
    <div class="col-sm-6">
      <div class="form-group">
        <label for="exampleInputEmail1">Model</label>
        <select class="form-control">
          <option>Model</option>
          <option>1</option>
          <option>2</option>
        </select>
      </div>
    </div>
  </div>
  <div class="col-sm-12 d-flex justify-content-center">
    <div class="col-sm-6">
      <div class="form-group">
        <label for="exampleInputEmail1">Variant</label>
        <select class="form-control">
          <option>Variant</option>
          <option>1</option>
          <option>2</option>
        </select>
      </div>
    </div>
    <div class="col-sm-6">
      <div class="form-group">
        <label for="exampleInputEmail1">Year Of Purchase</label>
        <select class="form-control">
          <option>select-year</option>
          <option>1999</option>
          <option>2000</option>
          <option>2001</option>
          <option>2002</option>
          <option>2003</option>
        </select>
      </div>
    </div>
  </div>
  <div class="col-sm-12">
    <div class="col-sm-12 form-group">
      <label for="exampleInputEmail1">At the tine of Purchase vehicle was :</label>
      <div class="form-check form-check-inline">
        <input class="form-check-input" type="radio" name="inlineRadioOptions" id="inlineRadio1" value="old">
        <label class="form-check-label" for="inlineRadio1">old</label>
      </div>
      <div class="form-check form-check-inline">
        <input class="form-check-input" type="radio" name="inlineRadioOptions" id="inlineRadio2" value="new">
        <label class="form-check-label" for="inlineRadio2">new</label>
      </div>
    </div>
    <div class="col-sm-12 form-group">
      <label for="exampleInputEmail1">Upload the bluebook image :</label>
      <div class="form-check form-check-inline">
        <input class="form-check-input" type="file" name="photo" value="Upload">
      </div>
    </div>
  </div>
  <div class="col-sm-12" style="text-align: center;">
    <a href="comparison.html"><button type="button" class="submit">Submit</button></a>
  </div>
</form>

Text Content

 * Home
 * About Us
 * Products
   Car Insurance Bike Insurance
 * Contact
 * Login 


PROTECTION THROUGH INSURANCE


Car Insurance

Bike Insurance


ABOUT US




FASTEST & EASY WAY FOR INSURANCE

BeemaBajar is a marketplace to offer wide range of policies with differentiated
price and customized services in insurance while providing a common platform to
compare the benefits to make the decision.

Read More >



HOW IT WORKS?


1.


FILL DETAILS


2.


QUOTE TERMS&CONDITION


3.


PAYMENT & PURCHASE


INSURANCE PARTNER


‹›



PAYMENT PARTNER



BeemaBajar is a marketplace to offer wide range of policies with differentiated
price and customized services in insurance while providing a common platform to
compare the benefits to make the decision.


SUBSCRIBE

By subscribing to our mailing list you will get latest news and updates from us.


 * About Us | 
 * Our Partners | 
 * Careers | 
 * Contact Us | 
 * Terms & conditions | 
 * Privacy Policy

© 2020 MeroBeema. All rights reserved.


FILL IN DETAILS

×
First Name
Last Name
Email
Phone Number
Brand Brand Hero Suzuki
Model Model 1 2
Variant Variant 1 2
Year Of Purchase select-year 1999 2000 2001 2002 2003
At the tine of Purchase vehicle was :
old
new
Upload the bluebook image :

Submit