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Submitted URL: https://www.axxelmarketing.com/sendy/l/VypEIYu763763VnUnhHc0WLZqg/2SuCSCW2nQeENQWdKe9tgQ/avOf5UNJtES2or72dPkIUg
Effective URL: https://form.jotform.me/92893658258476
Submission: On December 22 via manual from IN — Scanned from DE
Effective URL: https://form.jotform.me/92893658258476
Submission: On December 22 via manual from IN — Scanned from DE
Form analysis 1 forms found in the DOM
Name: form_92893658258476 — POST https://submit.jotform.me/submit/92893658258476/
<form class="jotform-form" action="https://submit.jotform.me/submit/92893658258476/" method="post" name="form_92893658258476" id="92893658258476" accept-charset="utf-8" autocomplete="on" novalidate="true">
<input type="hidden" name="formID" value="92893658258476">
<input type="hidden" id="JWTContainer" value="">
<input type="hidden" id="cardinalOrderNumber" value="">
<div role="main" class="form-all">
<link type="text/css" rel="stylesheet" media="all" href="https://cdn.jotfor.ms/wizards/languageWizard/custom-dropdown/css/lang-dd.css?3.3.28153">
<div class="cont">
<input type="text" id="input_language" name="input_language" style="display:none">
<div class="language-dd" id="langDd" style="display:none" tabindex="0" role="combobox" aria-label="Language Selection">
<div class="dd-placeholder en">English (US)</div>
<ul class="lang-list dn light" id="langList" role="combobox" aria-label="Language Selection">
<li data-lang="en" class="en" tabindex="0" role="option"> English (US) </li>
</ul>
</div>
</div>
<script type="text/javascript" src="https://cdn.jotfor.ms/js/formTranslation.v2.js?3.3.28153"></script>
<ul class="form-section page-section">
<li class="form-line" data-type="control_text" id="id_11">
<div id="cid_11" class="form-input-wide">
<div id="text_11" class="form-html" data-component="text">
<h1 style="text-align: center;">
<span style="color: #003366;"> Experience our products and services with a free demo </span>
</h1>
</div>
</div>
</li>
<li class="form-line jf-required" data-type="control_checkbox" id="id_16">
<label class="form-label form-label-top form-label-auto" id="label_16" for="input_16"> Indicate your interest (you may indicate more than one) <span class="form-required"> * </span></label>
<div id="cid_16" class="form-input-wide jf-required">
<div class="form-single-column" role="group" aria-labelledby="label_16" data-component="checkbox">
<span class="form-checkbox-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="checkbox" aria-describedby="label_16" class="form-checkbox validate[required]" id="input_16_0" name="q16_indicateYour16[]" value="I am interested in creating my campaign with Centro" required="">
<label id="label_input_16_0" for="input_16_0"> I am interested in creating my campaign with Centro </label>
</span>
<span class="form-checkbox-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="checkbox" aria-describedby="label_16" class="form-checkbox validate[required]" id="input_16_1" name="q16_indicateYour16[]"
value="I am interested in your services (Sustainbility & Transparency / Redemption platform / ERP integration / Automated re-orders)" required="">
<label id="label_input_16_1" for="input_16_1"> I am interested in your services (Sustainbility & Transparency / Redemption platform / ERP integration / Automated re-orders) </label>
</span>
<span class="form-checkbox-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="checkbox" aria-describedby="label_16" class="form-checkbox validate[required]" id="input_16_2" name="q16_indicateYour16[]" value="I am interested in your products" required="">
<label id="label_input_16_2" for="input_16_2"> I am interested in your products </label>
</span>
<span class="form-checkbox-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="checkbox" aria-describedby="label_16" class="form-checkbox validate[required]" id="input_16_3" name="q16_indicateYour16[]" value="I would like to find out more about Centro" required="">
<label id="label_input_16_3" for="input_16_3"> I would like to find out more about Centro </label>
</span>
<span class="form-checkbox-item" style="clear:left">
<input type="checkbox" class="form-checkbox-other form-checkbox validate[required]" name="q16_indicateYour16[other]" id="other_16" value="other" aria-label="Other">
<label id="label_other_16" style="text-indent:0" for="other_16"> </label>
<input type="text" class="form-checkbox-other-input form-textbox" name="q16_indicateYour16[other]" data-otherhint="Other" size="15" id="input_16" placeholder="Other">
<br>
</span>
</div>
</div>
<div class="form-description" style="display: none;">
<div class="form-description-arrow"></div>
<div class="form-description-arrow-small"></div>
<div class="form-description-content">Feel free to share more about your interest under the Questions/Comments section</div>
</div>
</li>
<li class="form-line jf-required" data-type="control_email" id="id_4">
<label class="form-label form-label-top form-label-auto" id="label_4" for="input_4"> Let us reach out to you <span class="form-required"> * </span></label>
<div id="cid_4" class="form-input-wide jf-required">
<span class="form-sub-label-container" style="vertical-align:top">
<input type="email" id="input_4" name="q4_letUs" class="form-textbox validate[required, Email]" data-defaultvalue="" size="30" value="" data-component="email" aria-labelledby="label_4 sublabel_input_4" required="">
<br>
<label class="form-sub-label" style="border:0;clip:rect(0 0 0 0);height:1px;margin:-1px;overflow:hidden;padding:0;position:absolute;width:1px;white-space:nowrap" for="input_4_confirm" id="label_input_4"> Confirmation Email </label>
<input type="email" id="input_4_confirm" name="q4_letUs" class="form-textbox validate[required, Email, Email_Confirm]" data-defaultvalue="" style="margin-top:8px" size="30" value="" placeholder="example@example.com"
data-component="emailConfirmation" onpaste="return false;">
<label class="form-sub-label" for="input_4" id="sublabel_input_4" style="min-height:13px" aria-hidden="false"> Please enter your email address twice for verification </label>
</span>
</div>
</li>
<li class="form-line always-hidden" data-type="control_textbox" id="id_20">
<label class="form-label form-label-top form-label-auto" id="label_20" for="input_20"> Campaign Code </label>
<div id="cid_20" class="form-input-wide always-hidden">
<input type="text" id="input_20" name="q20_utm_campaign" data-type="input-textbox" class="form-textbox" data-defaultvalue="" size="20" value="" data-component="textbox" aria-labelledby="label_20">
</div>
</li>
<li class="form-line" data-type="control_button" id="id_2">
<div id="cid_2" class="form-input-wide">
<div style="text-align:center" data-align="center" class="form-buttons-wrapper form-buttons-center jsTest-button-wrapperField">
<button id="input_2" type="submit" class="form-submit-button submit-button jf-form-buttons jsTest-submitField" data-component="button" data-content=""> Submit </button>
</div>
</div>
</li>
<li style="display:none"> Should be Empty: <input type="text" name="website" value="">
</li>
</ul>
</div>
<script>
JotForm.showJotFormPowered = "0";
</script>
<script>
JotForm.poweredByText = "Powered by Jotform";
</script>
<input type="hidden" class="simple_spc" id="simple_spc" name="simple_spc" value="92893658258476-92893658258476">
<script type="text/javascript">
var all_spc = document.querySelectorAll("form[id='92893658258476'] .si" + "mple" + "_spc");
for (var i = 0; i < all_spc.length; i++) {
all_spc[i].value = "92893658258476-92893658258476";
}
</script>
<input type="hidden" name="event_id" value="1640174378594_92893658258476_cMUWOxY">
</form>Text Content
English (US) * English (US) * EXPERIENCE OUR PRODUCTS AND SERVICES WITH A FREE DEMO * Indicate your interest (you may indicate more than one) * I am interested in creating my campaign with Centro I am interested in your services (Sustainbility & Transparency / Redemption platform / ERP integration / Automated re-orders) I am interested in your products I would like to find out more about Centro Feel free to share more about your interest under the Questions/Comments section * Let us reach out to you * Confirmation Email Please enter your email address twice for verification * Campaign Code * Submit * Should be Empty: