app.bruin.com Open in urlscan Pro
216.194.28.140  Public Scan

Form analysis
1 forms found in the DOM

POST /User/Verify?request_id=BEE41A1F-13FD-4C6F-A6C3-A2EA6D0B2B1A

<form action="/User/Verify?request_id=BEE41A1F-13FD-4C6F-A6C3-A2EA6D0B2B1A" class="mettel-login-form" id="user_newaccount_setup_form" method="post"><input id="RequestID" name="RequestID" type="hidden"
    value="BEE41A1F-13FD-4C6F-A6C3-A2EA6D0B2B1A"><input id="UserName" name="UserName" type="hidden" value="Helen.Tran@americanfidelity.com">
  <div class="mettel-password-label" style="margin-top:5px;">
    <label style="border-bottom:none;">Minimum of 8 characters in length. At least 1 letter and 1 number, and 1 special character (e.g. "abcdef2!").</label>
  </div>
  <div class="mettel-form-row" style="margin-top:5px;">
    <label class="mettel-label">Email</label>
    <span class="mettel-disabled-text">Helen.Tran@americanfidelity.com</span>
  </div>
  <div class="mettel-form-row">
    <label class="mettel-label">New Password</label>
    <input autocomplete="off" class="mettel-input" data-val="true" data-val-length="New password must be a minimum of 8 characters" data-val-length-max="50" data-val-length-min="8"
      data-val-regex="The password should contain at least 1 letter, 1 number, and 1 special character." data-val-regex-pattern="^(?=.*[0-9])(?=.*[a-zA-Z])(?=.*[!@#$%^&amp;*)(+=._\-?<>{}])([a-zA-Z0-9!@#$%^&amp;*)(+=._\-?<>{}]+)$"
      data-val-required="The New Password field is required." id="NewPassword" name="NewPassword" type="password">
    <span class="field-validation-valid mettel-error-message-verify-form" data-valmsg-for="NewPassword" data-valmsg-replace="true"></span>
  </div>
  <div class="mettel-form-row">
    <label class="mettel-label">Confirm Password</label>
    <input autocomplete="off" class="mettel-input" data-val="true" data-val-equalto="'Confirm Password' and 'New Password' do not match." data-val-equalto-other="*.NewPassword" data-val-required="The Confirm Password field is required."
      id="ConfirmPassword" name="ConfirmPassword" type="password">
    <span class="field-validation-valid mettel-error-message-verify-form" data-valmsg-for="ConfirmPassword" data-valmsg-replace="true"></span>
  </div>
  <div class="mettel-form-row">
    <label class="mettel-label">Hint Questions:</label>
    <select class="mettel-combo-box mettel-input" data-bind="uniform: {  options: {selectClass: 'mettel-combo-box', selectAutoWidth: false } }" data-mettel-class="combo-box" data-val="true" data-val-required="The Hint Question field is required."
      id="PwdHintQuestionID" name="PwdHintQuestionID">
      <option value="">-- Select A Hint Question --</option>
      <option value="354ada38-bfcf-e211-b2a8-005056a30de2">What is the name of the hospital in which you were born?</option>
      <option value="364ada38-bfcf-e211-b2a8-005056a30de2">What is your eldest brother's middle name?</option>
      <option value="374ada38-bfcf-e211-b2a8-005056a30de2">What is your eldest child's middle name?</option>
      <option value="384ada38-bfcf-e211-b2a8-005056a30de2">What is your eldest sister's middle name?</option>
      <option value="394ada38-bfcf-e211-b2a8-005056a30de2">What is your father's middle name?</option>
      <option value="3a4ada38-bfcf-e211-b2a8-005056a30de2">What is your mother's maiden name?</option>
      <option value="3b4ada38-bfcf-e211-b2a8-005056a30de2">What is your mother's middle name?</option>
      <option value="3c4ada38-bfcf-e211-b2a8-005056a30de2">What was the color of your first car?</option>
      <option value="3d4ada38-bfcf-e211-b2a8-005056a30de2">What was your childhood nickname?</option>
      <option value="3e4ada38-bfcf-e211-b2a8-005056a30de2">What was your favorite childhood game?</option>
      <option value="3f4ada38-bfcf-e211-b2a8-005056a30de2">What was your favorite childhood toy?</option>
      <option value="404ada38-bfcf-e211-b2a8-005056a30de2">What was your favorite schoolteacher's name?</option>
      <option value="414ada38-bfcf-e211-b2a8-005056a30de2">What was your favorite subject at school?</option>
      <option value="424ada38-bfcf-e211-b2a8-005056a30de2">What was your first pet's name?</option>
    </select>
    <span class="field-validation-valid mettel-error-message-verify-form" data-valmsg-for="PwdHintQuestionID" data-valmsg-replace="true"></span>
  </div>
  <div class="mettel-form-row mettel-form-lastinput-row">
    <label class="mettel-label">Hint Answer</label>
    <input autocomplete="off" class="mettel-input" data-val="true" data-val-required="The Hint Answer field is required." id="PwdHintAnswer" name="PwdHintAnswer" type="text" value="">
    <span class="field-validation-valid mettel-error-message-verify-form" data-valmsg-for="PwdHintAnswer" data-valmsg-replace="true"></span>
  </div>
  <div class="mettel-form-row">
    <label class="mettel-label"></label>
    <button type="submit" class="mettel-primary-button-login">Submit</button>
  </div>
</form>

Text Content

Minimum of 8 characters in length. At least 1 letter and 1 number, and 1 special
character (e.g. "abcdef2!").
Email Helen.Tran@americanfidelity.com
New Password
Confirm Password
Hint Questions: -- Select A Hint Question -- What is the name of the hospital in
which you were born? What is your eldest brother's middle name? What is your
eldest child's middle name? What is your eldest sister's middle name? What is
your father's middle name? What is your mother's maiden name? What is your
mother's middle name? What was the color of your first car? What was your
childhood nickname? What was your favorite childhood game? What was your
favorite childhood toy? What was your favorite schoolteacher's name? What was
your favorite subject at school? What was your first pet's name?
Hint Answer
Submit

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