francktshiz27.github.io
185.199.110.153 

Submitted URL: https://francktshiz27.github.io/tp_formulaire
Effective URL: https://francktshiz27.github.io/tp_formulaire/
Submission: On February 23 via api from US

Form analysis 1 forms found in the DOM

<form action="">
  <fieldset class="fieldset--left">
    <label class="label--blue"> General Information </label>
    <div>
      <select>
        <option value="">Title</option>
        <option value="">Directeur</option>
        <option value="">Caissier</option>
        <option value="">Conseiller</option>
      </select>
    </div>
    <div>
      <input type="text" class="input--min" placeholder="First Name">
      <input type="text" class="input--min" placeholder="Last Name">
    </div>
    <div>
      <select>
        <option value="">Position</option>
        <option value="">Premiere</option>
        <option value="">Deuxieme</option>
      </select>
    </div>
    <div>
      <input type="text" name="" id="" placeholder="Company">
    </div>
    <div>
      <input type="text" class="input--average" placeholder="First Name">
      <select class="select--min">
        <option value="">Employees</option>
        <option value="">Francois</option>
        <option value="">Christian</option>
      </select>
    </div>
  </fieldset>
  <fieldset class="fieldset--right">
    <label class="label--white"> Contact Details </label>
    <div>
      <input type="text" placeholder="Strit+Nr">
    </div>
    <div>
      <select>
        <option value="">Additional information</option>
        <option value="">Adress</option>
        <option value="">Anniversary</option>
      </select>
    </div>
    <div>
      <input type="text" class="input--very_min" placeholder="Zip code">
      <select class="select--average">
        <option> Place </option>
        <option value=""> Premiere </option>
        <option value=""> Deuxieme </option>
      </select>
    </div>
    <div>
      <select>
        <option value="">Country</option>
        <option value="">Republique Democratique du Congo</option>
        <option value="">Irlande</option>
      </select>
    </div>
    <div>
      <input type="email" placeholder="Your Email">
    </div>
    <div>
      <input type="text" class="input--very_min" placeholder="Code+">
      <input class="select--average" type="text" placeholder="Phone number">
    </div>
    <div class="div--min">
      <input type="radio" id="rd">
      <label for=""> I do accept </label>
      <a href="#">The terms and conditions</a>
    </div>
    <div class="div--self">
      <label for="">of your site.</label>
    </div>
    <div>
      <input type="submit" value="Register badge">
    </div>
  </fieldset>
</form>

Text Content

Document
General Information
Title
Directeur
Caissier
Conseiller
Position
Premiere
Deuxieme
Employees
Francois
Christian
Contact Details
Additional information
Adress
Anniversary
Place 
Premiere 
Deuxieme 
Country
Republique Democratique du Congo
Irlande
I do accept 
The terms and conditions 
of your site.