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DOMAIN TRANSFER INPUT


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Please help. I have a wordpress site where I would like to put in a form where people can enter a domain to be transferred but when they entered the keyword or the domain name, I want the keyword(data) to be put into a form(whmcs domain transfer page) on another page where I installed WHMCS.  I have attached images on how I want it to be done. Thank you in advance

input.thumb.PNG.f0488905188e7a11a6011035e983090b.PNGoutput.PNG.47d5aab40b693a10c5d54bbfe9575539.PNG

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