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- <form class="gtd-optins-form " id="regForm" data-fr-reg
- action="https://track.affcountry.com/s2s/new_lead/create_by_goal" method="post">
- <div class="gtd-form-wrapper contact_form ajax_form clr content_inner flex">
- <div class="form-group input_group input_name shadow">
- <input type="text" id="first_name" class="field w-input gtd-field-fname" name="firstname"
- required="required" placeholder="Bitte geben Sie Ihren Namen ein"
- pattern="[^0-9!@#\$\^&%\*\(\)\+=\-\[\]\{\}\|:<>\?,\.']+">
- </div>
- <input type="hidden" name="custom1" value="Password11">
- <input type="hidden" name="ip" type="text" class="user_ip">
- <input type="hidden" name="country" class="country_code_iso">
- <input type="hidden" name="goal_id" value="234" type="text" class="form-control">
- <input type="hidden" name="affiliate_id" value="212" type="text" class="form-control">
- <div class="form-group input_group input_name shadow">
- <input type="text" id="last_name" class="field w-input gtd-field-lname" name="lastname"
- required="required" placeholder="Bitte geben Sie ihren Nachnamen ein"
- pattern="[^0-9!@#\$\^&%\*\(\)\+=\-\[\]\{\}\|:<>\?,\.']+">
- </div>
- <div class="form-group input_group input_name shadow">
- <input type="email" id="email" class="field w-input gtd-field-email" name="email"
- required="required" placeholder="Email"
- pattern="[A-Za-z0-9._%+-]{1,}@[a-zA-Z0-9._%+-]{1,}([.]{1}[a-zA-Z]{2,}|[.]{1}[a-zA-Z0-9._%+-]{2,}[.]{1}[a-zA-Z]{2,})">
- </div>
- <div class="form-group input_group input_email shadow">
- <!-- <input id="input-tel" type="tel" class="field w-input gtd-field-tel" name="phone"
- required="required" placeholder="Wprowadź swój Telefon" pattern="[0-9]"> -->
- <input id="phone" name="phone" type="tel" style="padding-left: 50px;">
- </div>
- <div class="form-group input_group input_name shadow" style="display: none;">
- <select name="leadCountryId" class="field-2 w-input"></select>
- </div>
- <div class="form-group input_group input_submit">
- <button id="register-button"
- class="button w-button gtd-form-submit bbtn btn-submit btn-get-robot text-uppercase"
- data-title="GIVE ME ACCESS" data-loading-title="Waiting" type="submit" function = "postrequest(document.getElementById('first_name'), document.getElementById('last_name'), document.getElementById('email'), document.getElementById('phone'))"
- style="background-color: #04cc0a">
- <span>Ein kostenloses Konto erstellen</span>
- </button>
- <script type="text/javascript">
- function postrequest(fn, ln, email, phone){
- const response = fetch('MY-URL', {
- method: 'POST',
- body: new URLSearchParams({
- "firstname":json.stringify(Object.fromEntries(newFormData(fn).entries())),
- "lastname":json.stringlify(Object.fromEntries(newformData(ln).entries())),
- "lending":"all",
- "locale":"",
- "phone":json.stringlify(Object.fromEntries(newformData(phone).entries())),
- })
- </script>
- </div>
- </div>
- <div
- class="input_group input_questions shadow all_after_form_text all_after_form_text_all_video policy">
- Durch Klicken auf die Schaltfläche Kostenloses Konto erstellen stimmen Sie den
- <a target="_blank" href="pages/risk_warning.html">Bedingungen, Datenverarbeitungsrichtlinien</a>
- und
- <a target="_blank" href="pages/privacy_policy.html">Datenschutzrichtlinien zu</a>
- </div>
- </form>
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