webapp10622.activehosted.com Open in urlscan Pro
2606:4700::6811:596d  Public Scan

Form analysis
1 forms found in the DOM

POST https://webapp10622.activehosted.com/proc.php

<form method="POST" action="https://webapp10622.activehosted.com/proc.php" id="_form_105_" class="_form _form_105 _inline-form  _dark" novalidate="">
  <input type="hidden" name="u" value="105" data-name="u">
  <input type="hidden" name="f" value="105" data-name="f">
  <input type="hidden" name="s" data-name="s">
  <input type="hidden" name="c" value="0" data-name="c">
  <input type="hidden" name="m" value="0" data-name="m">
  <input type="hidden" name="act" value="sub" data-name="act">
  <input type="hidden" name="v" value="2" data-name="v">
  <input type="hidden" name="or" value="cb231b70bf083e7cc00a21827603d11e" data-name="or">
  <div class="_form-content">
    <div class="_form_element _x49091126 _full_width _clear">
      <img class="_form-image" src="//webapp10622.img-us3.com/admin/download_2.png?r=0.7847314281415618" style="">
    </div>
    <div class="_form_element _x21909390 _full_width _clear">
      <div class="_form-title"> Richiesta consulente commerciale vivawallet </div>
    </div>
    <div class="_form_element _x86978995 _full_width _clear">
      <div class="_html-code">
        <p> Compila il form e sarai contattato dal responsabile commerciale, nostro partner VIVAWALLET, che ti informerà su come implementare questa modalità di pagamento all'interno della tua APP </p>
      </div>
    </div>
    <div class="_form_element _x68872449 _full_width ">
      <label for="firstname" class="_form-label"> Nome* </label>
      <div class="_field-wrapper">
        <input type="text" id="firstname" name="firstname" placeholder="Digita il nome" required="" data-name="firstname">
      </div>
    </div>
    <div class="_form_element _x84338863 _full_width ">
      <label for="lastname" class="_form-label"> Cognome* </label>
      <div class="_field-wrapper">
        <input type="text" id="lastname" name="lastname" placeholder="Digita il cognome" required="" data-name="lastname">
      </div>
    </div>
    <div class="_form_element _x82029629 _full_width ">
      <label for="phone" class="_form-label"> Telefono* </label>
      <div class="_field-wrapper">
        <input type="text" id="phone" name="phone" placeholder="Digita il numero di telefono" required="" data-name="phone">
      </div>
    </div>
    <div class="_form_element _x00929753 _full_width ">
      <label for="customer_account" class="_form-label"> nome azienda* </label>
      <div class="_field-wrapper">
        <input type="text" id="customer_account" name="customer_account" placeholder="Digita il nome della tua azienda" required="" data-name="customer_account">
      </div>
    </div>
    <div class="_form_element _field7 _full_width ">
      <label for="field[7]" class="_form-label"> Città* </label>
      <div class="_field-wrapper">
        <input type="text" id="field[7]" name="field[7]" value="" placeholder="Digita la tua città" required="" data-name="google_spreadsheets-citta">
      </div>
    </div>
    <div class="_form_element _x44147090 _full_width ">
      <label for="email" class="_form-label"> Email* </label>
      <div class="_field-wrapper">
        <input type="text" id="email" name="email" placeholder="Digita l'email" required="" data-name="email">
      </div>
    </div>
    <div class="_form_element _x42141855 _full_width ">
      <label for="ls" class="_form-label"> Verifica la richiesta* </label>
      <div class="g-recaptcha" data-sitekey="6LcwIw8TAAAAACP1ysM08EhCgzd6q5JAOUR1a0Go" id="recaptcha_0">
        <div style="width: 304px; height: 78px;">
          <div><iframe title="reCAPTCHA"
              src="https://www.google.com/recaptcha/api2/anchor?ar=1&amp;k=6LcwIw8TAAAAACP1ysM08EhCgzd6q5JAOUR1a0Go&amp;co=aHR0cHM6Ly93ZWJhcHAxMDYyMi5hY3RpdmVob3N0ZWQuY29tOjQ0Mw..&amp;hl=it&amp;v=tNAc29ZZrpcOCErva2nr4BS9&amp;size=normal&amp;cb=2you1snydts2"
              width="304" height="78" role="presentation" name="a-tjhw8oek6qvc" frameborder="0" scrolling="no"
              sandbox="allow-forms allow-popups allow-same-origin allow-scripts allow-top-navigation allow-modals allow-popups-to-escape-sandbox"></iframe></div><textarea id="g-recaptcha-response" name="g-recaptcha-response"
            class="g-recaptcha-response" style="width: 250px; height: 40px; border: 1px solid rgb(193, 193, 193); margin: 10px 25px; padding: 0px; resize: none; display: none;"></textarea>
        </div><iframe style="display: none;"></iframe>
      </div>
    </div>
    <div class="_button-wrapper _full_width">
      <button id="_form_105_submit" class="_submit" type="submit"> Richiedi Consulenza </button>
    </div>
    <div class="_clear-element">
    </div>
  </div>
  <div class="_form-thank-you" style="display:none;">
  </div>
</form>

Text Content

Richiesta consulente commerciale vivawallet

Compila il form e sarai contattato dal responsabile commerciale, nostro partner
VIVAWALLET, che ti informerà su come implementare questa modalità di pagamento
all'interno della tua APP

Nome*

Cognome*

Telefono*

nome azienda*

Città*

Email*

Verifica la richiesta*

Richiedi Consulenza