www.infragard.org Open in urlscan Pro
15.200.79.243  Public Scan

Form analysis
1 forms found in the DOM

POST /Application/Account/Recertification

<form area="Application" action="/Application/Account/Recertification" method="post">
  <div class="row">
    <div class="text col-sm-12">
      <div class="radio row panel panel-default">
        <div class="panel-heading">
          <h3 class="panel-title">InfraGard Recertification</h3>
        </div>
        <div class="panel-body">
        </div>
      </div>
      <div class="row">
        <div class="col-sm-2">
          <label class="control-label required-label" for="SSN4"> Last 4 digits of SSN:</label>
        </div>
        <div class="col-sm-4">
          <input class="form-control" id="SSN4" maxlength="4" name="SSN4" pattern="(\d{4})" required="required" size="4" title="Invalid last 4 digit of SSN" type="text" value="">
          <span class="errorMsg"></span>
        </div>
      </div>
      <br>
      <div class="row">
        <div class="col-sm-2">
          <style type="text/css">
            .red-background {
              background-color: #e32
            }

            .white {
              color: azure
            }
          </style>
          <input id="InvitationToken" name="InvitationToken" type="hidden" value="BAFADA08-A640-492D-BA51-2759E6AA65EB">
          <input type="submit" value="Send Activation Code" class="btn btn-primary red-background white">
        </div>
        <div class="col-sm-4"> &nbsp; </div>
      </div>
      <div>
        <br><br><br><br>
      </div>
    </div>
  </div>
  <script type="text/javascript">
    $(document).ready(function() {
      $(".calDate").mask("99/99/9999");
      $(".ssn-ctrl").mask("999-99-9999");
      //MaskItems();
    });
  </script>
  <style type="text/css">
    .row {
      margin-left: 0px;
      margin-right: 0px;
    }

    .required-label:after {
      color: #e32;
      content: ' *';
      display: inline;
    }
  </style>
</form>

Text Content

a


INFRAGARD RECERTIFICATION


Last 4 digits of SSN:


 








× Close

MODAL TITLE

...
Save changes Close