factures.nexem.fr Open in urlscan Pro
2001:4b98:dc5:253::8  Public Scan

Form analysis
1 forms found in the DOM

POST #

<form method="post" action="#">
  <input type="hidden" name="envoicontact" value="envoicontact">
  <input type="hidden" name="codeadherent" value="">
  <div class="fields">
    <div class="field half">
      <label for="name">Nom &amp; prénom</label>
      <input type="text" name="name" id="name">
    </div>
    <div class="field half">
      <label for="email">Email</label>
      <input type="text" name="email" id="email">
    </div>
    <div class="field">
      <label for="message">Message</label>
      <textarea name="message" id="message" rows="4"></textarea>
    </div>
  </div>
  <ul class="actions">
    <li><input type="submit" value="Envoyer" class="primary"></li>
    <li><input type="reset" value="Effacer"></li>
  </ul>
</form>

Text Content

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FACTURE

Nous vous remercions de télécharger votre facture de cotisation annuelle 2021.

 * Nous contacter
   


CONTACT

Nom & prénom
Email
Message
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