windows.roiverifyhub.com Open in urlscan Pro
34.120.230.5  Public Scan

Form analysis
1 forms found in the DOM

POST /free_answer

<form class="edit_survey" id="edit_survey_8086206" data-type="free_answer" action="/free_answer" accept-charset="UTF-8" data-remote="true" method="post">
  <div class="card border-0 shadow-custom free-answer-card">
    <div class="card-body p-5 ">
      <div class="form-row">
        <input value="6380" type="hidden" name="survey[page_id]" id="survey_page_id">
        <div class="form-group col-sm-8 offset-sm-2 px-3">
          <label class="label-custom label-custom-sm"> Enter your zip code </label>
          <input type="text" name="survey[results][0][value]" id="postal_code" class="form-control form-control-lg question_input_12889" placeholder="Postal Code" required="required" pattern="\d{5}">
          <input type="hidden" name="survey[results][0][question_id]" id="survey_results_0_question_id" value="12889">
          <small>
          </small>
        </div>
        <input type="text" name="survey[results][1][value]" id="leadid_token" class="form-control form-control-lg question_input_12890" placeholder="" hidden="hidden">
        <input type="hidden" name="survey[results][1][question_id]" id="survey_results_1_question_id" value="12890">
        <input type="text" name="survey[results][2][value]" id="ip_address" class="form-control form-control-lg question_input_12891" placeholder="" hidden="hidden">
        <input type="hidden" name="survey[results][2][question_id]" id="survey_results_2_question_id" value="12891">
        <input type="text" name="survey[results][3][value]" id="xxTrustedFormCertUrl" class="form-control form-control-lg question_input_12892" placeholder="" hidden="hidden">
        <input type="hidden" name="survey[results][3][question_id]" id="survey_results_3_question_id" value="12892">
        <input type="text" name="survey[results][4][value]" id="" class="form-control form-control-lg question_input_12893" placeholder="" hidden="hidden">
        <input type="hidden" name="survey[results][4][question_id]" id="survey_results_4_question_id" value="12893">
        <input type="text" name="survey[results][5][value]" id="" class="form-control form-control-lg question_input_12894" placeholder="" hidden="hidden">
        <input type="hidden" name="survey[results][5][question_id]" id="survey_results_5_question_id" value="12894">
        <input type="text" name="survey[results][6][value]" id="" class="form-control form-control-lg question_input_12895" placeholder="" hidden="hidden">
        <input type="hidden" name="survey[results][6][question_id]" id="survey_results_6_question_id" value="12895">
        <input type="text" name="survey[results][7][value]" id="" class="form-control form-control-lg question_input_12896" placeholder="" hidden="hidden">
        <input type="hidden" name="survey[results][7][question_id]" id="survey_results_7_question_id" value="12896">
        <input type="text" name="survey[results][8][value]" id="" class="form-control form-control-lg question_input_12897" placeholder="" hidden="hidden">
        <input type="hidden" name="survey[results][8][question_id]" id="survey_results_8_question_id" value="12897">
        <input type="text" name="survey[results][9][value]" id="" class="form-control form-control-lg question_input_12898" placeholder="" hidden="hidden">
        <input type="hidden" name="survey[results][9][question_id]" id="survey_results_9_question_id" value="12898">
        <input type="text" name="survey[results][10][value]" id="" class="form-control form-control-lg question_input_12899" placeholder="" hidden="hidden">
        <input type="hidden" name="survey[results][10][question_id]" id="survey_results_10_question_id" value="12899">
        <input type="text" name="survey[results][11][value]" id="" class="form-control form-control-lg question_input_12900" placeholder="" hidden="hidden">
        <input type="hidden" name="survey[results][11][question_id]" id="survey_results_11_question_id" value="12900">
        <input type="text" name="survey[results][12][value]" id="" class="form-control form-control-lg question_input_12901" placeholder="" hidden="hidden">
        <input type="hidden" name="survey[results][12][question_id]" id="survey_results_12_question_id" value="12901">
        <input type="text" name="survey[results][13][value]" id="" class="form-control form-control-lg question_input_12902" placeholder="" hidden="hidden">
        <input type="hidden" name="survey[results][13][question_id]" id="survey_results_13_question_id" value="12902">
        <input type="text" name="survey[results][14][value]" id="" class="form-control form-control-lg question_input_12903" placeholder="" hidden="hidden">
        <input type="hidden" name="survey[results][14][question_id]" id="survey_results_14_question_id" value="12903">
        <input type="text" name="survey[results][15][value]" id="" class="form-control form-control-lg question_input_12904" placeholder="" hidden="hidden">
        <input type="hidden" name="survey[results][15][question_id]" id="survey_results_15_question_id" value="12904">
        <input type="text" name="survey[results][16][value]" id="" class="form-control form-control-lg question_input_12905" placeholder="" hidden="hidden">
        <input type="hidden" name="survey[results][16][question_id]" id="survey_results_16_question_id" value="12905">
        <input type="text" name="survey[results][17][value]" id="" class="form-control form-control-lg question_input_12906" placeholder="" hidden="hidden">
        <input type="hidden" name="survey[results][17][question_id]" id="survey_results_17_question_id" value="12906">
        <input type="text" name="survey[results][18][value]" id="" class="form-control form-control-lg question_input_12907" placeholder="" hidden="hidden">
        <input type="hidden" name="survey[results][18][question_id]" id="survey_results_18_question_id" value="12907">
        <input type="text" name="survey[results][19][value]" id="" class="form-control form-control-lg question_input_12908" placeholder="" hidden="hidden">
        <input type="hidden" name="survey[results][19][question_id]" id="survey_results_19_question_id" value="12908">
        <input type="text" name="survey[results][20][value]" id="" class="form-control form-control-lg question_input_12909" placeholder="" hidden="hidden">
        <input type="hidden" name="survey[results][20][question_id]" id="survey_results_20_question_id" value="12909">
        <input type="text" name="survey[results][21][value]" id="" class="form-control form-control-lg question_input_12910" placeholder="" hidden="hidden">
        <input type="hidden" name="survey[results][21][question_id]" id="survey_results_21_question_id" value="12910">
        <input type="text" name="survey[results][22][value]" id="" class="form-control form-control-lg question_input_12911" placeholder="" hidden="hidden">
        <input type="hidden" name="survey[results][22][question_id]" id="survey_results_22_question_id" value="12911">
        <input type="text" name="survey[results][23][value]" id="request_sig" class="form-control form-control-lg question_input_12912" placeholder="" hidden="hidden">
        <input type="hidden" name="survey[results][23][question_id]" id="survey_results_23_question_id" value="12912">
        <input type="text" name="survey[results][24][value]" id="" class="form-control form-control-lg question_input_12913" placeholder="" hidden="hidden">
        <input type="hidden" name="survey[results][24][question_id]" id="survey_results_24_question_id" value="12913">
        <div class="form-row">
          <div class="col-12">
            <!-- Start LeadID Code -->
            <script id="LeadiDscript_campaign" type="text/javascript" async="" src="//create.lidstatic.com/campaign/af5ee6e1-073e-f239-0d14-b1007da075f4.js?snippet_version=2"></script>
            <script id="LeadiDscript" type="text/javascript">
              (function() {
                var s = document.createElement('script');
                s.id = 'LeadiDscript_campaign';
                s.type = 'text/javascript';
                s.async = true;
                s.src = '//create.lidstatic.com/campaign/af5ee6e1-073e-f239-0d14-b1007da075f4.js?snippet_version=2';
                var LeadiDscript = document.getElementById('LeadiDscript');
                LeadiDscript.parentNode.insertBefore(s, LeadiDscript);
              })();
            </script>
            <noscript><img src="//create.leadid.com/noscript.gif?lac=ff5884e6-790e-0e5b-578f-d2502bc2c800&amp;lck=af5ee6e1-073e-f239-0d14-b1007da075f4&amp;snippet_version=2"></noscript>
            <!-- End LeadID Code -->
            <!-- Start TrustedForm Code -->
            <script type="text/javascript">
              (function() {
                var field = 'xxTrustedFormCertUrl';
                var provideReferrer = false;
                var invertFieldSensitivity = false;
                var tf = document.createElement('script');
                tf.type = 'text/javascript';
                tf.async = true;
                tf.src = 'http' + ('https:' == document.location.protocol ? 's' : '') + '://api.trustedform.com/trustedform.js?provide_referrer=' + escape(provideReferrer) + '&field=' + escape(field) + '&l=' + new Date().getTime() + Math.random() +
                  '&invert_field_sensitivity=' + invertFieldSensitivity;
                var s = document.getElementsByTagName('script')[0];
                s.parentNode.insertBefore(tf, s);
              })();

              function trustedFormCertUrlCallback(certificateUrl) {
                document.getElementsByName('survey[results][3][value]')[0].value = certificateUrl;
                document.getElementsByName('survey[results][3][value]')[0].dispatchEvent(new Event("input"));
              }
            </script>
            <noscript>
              <img src="http://api.trustedform.com/ns.gif">
            </noscript>
            <!-- End TrustedForm Code -->
            <!-- Meta Pixel Code -->
            <script>
              ! function(f, b, e, v, n, t, s) {
                if (f.fbq) return;
                n = f.fbq = function() {
                  n.callMethod ? n.callMethod.apply(n, arguments) : n.queue.push(arguments)
                };
                if (!f._fbq) f._fbq = n;
                n.push = n;
                n.loaded = !0;
                n.version = '2.0';
                n.queue = [];
                t = b.createElement(e);
                t.async = !0;
                t.src = v;
                s = b.getElementsByTagName(e)[0];
                s.parentNode.insertBefore(t, s)
              }(window, document, 'script', 'https://connect.facebook.net/en_US/fbevents.js');
              fbq('init', '1115942002528141');
              fbq('track', 'PageView');
            </script>
            <noscript><img height="1" width="1" style="display:none" src="https://www.facebook.com/tr?id=1115942002528141&amp;ev=PageView&amp;noscript=1"></noscript>
            <!-- End Meta Pixel Code -->
            <!-- Start Validation Zip Code -->
            <script type="text/javascript" src="https://jqueryjs.googlecode.com/files/jquery-1.3.2.min.js"></script>
            <script type="text/javascript">
              $(document).ready(function() {
                $('#postal_code').keyup(function() {
                  var len = this.value.length;
                  if (len >= 5) {
                    this.value = this.value.substring(0, 5);
                  }
                  $('#charLeft').text(5 - len);
                });
              });
            </script>
            <script type="text/javascript">
              document.getElementById('postal_code').setAttribute('Pattern', "\\d{5}");
            </script>
            <script type="text/javascript">
              let date1 = new Date();
              let date2 = date1.toISOString()
              document.getElementsByName('survey[results][12][value]')[0].value = date2;
              document.getElementsByName('survey[results][12][value]')[0].dispatchEvent(new Event("input"));
            </script>
            <!-- End Validation Zip Code -->
            <!-- Request Sig Code -->
            <script type="text/javascript" src="https://cdnjs.cloudflare.com/ajax/libs/crypto-js/3.1.2/rollups/hmac-sha1.js"></script>
            <script type="text/javascript" src="https://cdnjs.cloudflare.com/ajax/libs/crypto-js/3.1.2/components/enc-base64.js"></script>
            <script type="text/javascript">
              var date = new Date();
              var timestamp = Math.floor(date.getTime() / 1000.0);
              var encodedStringBtoA = btoa(timestamp);
              var message = (encodedStringBtoA);
              var secret = 'Ad5lluNAFz-0zB-UlavsUwz_4AgoqfZEu7k7DObQ9TI';
              var encrypted = CryptoJS.HmacSHA1(message, secret);
              var request_sig = message + "--" + encrypted;
              $('#message').text(message);
              $('#encrypted').text(encrypted);
              $('#request_sig').text(message + "--" + encrypted);
              document.getElementsByName('survey[results][23][value]')[0].value = request_sig;
              document.getElementsByName('survey[results][23][value]')[0].dispatchEvent(new Event("input"));
            </script>
            <!--End Request Sig Code -->
          </div>
        </div>
        <script>
          var emailValid = false;
          var phoneValid = false;
          $("#phone_number").mask('000-000-0000', {
            placeholder: "___-___-____"
          });
          $("#ssn").mask('000-00-0000', {
            placeholder: "__-__-____"
          });
          $("#zip_code").mask('00000', {
            placeholder: "_____"
          });
          // months
          $("#months").mask('00', {
            placeholder: "__"
          });
          $("form").submit(function(e) {
            if ($("#months").length > 0) {
              return validateMonths($("#months"))
            }
          });
          $("#months").keyup(function() {
            validateMonths(this)
            removeLeadingZero(this, 2)
          })

          function validateMonths(input) {
            var val = $(input).val()
            $(".invalid-text").remove()
            if (val <= 12) {
              console.log("valid months")
            } else {
              $(input).parent().append("<label class='help-text invalid-text'>Months must be between 0 and 12</label>")
              return false
            }
          }

          function removeLeadingZero(input, length) {
            var val = $(input).val();
            if (val.length == length && val[0] == "0") {
              $(input).val(val[1]);
            }
          }
          // Date Validations using Domain's date format
          var dateFormat = "mm/dd/yyyy";
          var mask = dateFormat.replace(/\w/gi, '0');
          $(".date-field").mask(mask, {
            placeholder: dateFormat
          });
          $("#birth_date").mask(mask, {
            placeholder: dateFormat
          });
          $("form").submit(function(e) {
            if ($("#birth_date").length > 0) {
              return validateDateField($("#birth_date"))
            }
          });
          $("#birth_date").keyup(function() {
            validateDateField(this)
          })
          $(".date-field").keyup(function() {
            validateDateField(this)
          });

          function validateDateField(input) {
            var val = $(input).val()
            $(".invalid-text").remove()
            if (val.length == 10) {
              if (moment(val, dateFormat.toUpperCase()).isSameOrAfter('1910-01-01')) {
                console.log("valid date")
              } else {
                $(input).parent().append("<label class='help-text invalid-text'>Invalid Date</label>")
                $(input).val("")
                return false
              }
            } else {
              $(input).parent().append("<label class='help-text invalid-text'>Date too short</label>")
              return false
            }
          }
          // if type is tel - only allow numbers
          $('input[type=tel]').keyup(function() {
            this.value = this.value.replace(/[^0-9-/\.]/g, '');
          });
          if ($("#date-selectors").length > 0) {
            var html = "<select class='' id='date-months'><option>1</option></select>"
            $("form").prepend(html);
          }
          // fill ip_address id with value of user's ip address
          if ($("#ip_address").length > 0) {
            fetch('https://jsonip.com', {
              mode: 'cors'
            }).then((resp) => resp.json()).then((data) => {
              $("#ip_address").val(data.ip);
            })
          }

          function validateEmailAddress(emailAddress) {
            var pattern = /^(([^<>()\[\]\\.,;:\s@"]+(\.[^<>()\[\]\\.,;:\s@"]+)*)|(".+"))@((\[[0-9]{1,3}\.[0-9]{1,3}\.[0-9]{1,3}\.[0-9]{1,3}])|(([a-zA-Z\-0-9]+\.)+[a-zA-Z]{2,}))$/;
            return pattern.test(emailAddress);
          }

          function addErrorText(input, text) {
            $(input).parent().append("<label class='help-text invalid-text'>Invalid " + text + "</label>")
            $(input).addClass("invalid-input")
          }

          function removeErrorText(input) {
            var el = $(input).siblings(".invalid-text")[0]
            $(el).remove()
            $(input).removeClass("invalid-input")
          }

          function addVerifyingText(input) {
            $(input).parent().append("<label class='help-text verifying'>Verifying...</label>")
          }

          function removeVerifyingText(input) {
            var el = $(input).siblings(".verifying")[0]
            $(el).remove()
          }

          function checkTwilio(input, phoneNumber) {
            var areaCode = phoneNumber.substr(0, 3)
            var badAreaCodes = ["800", "833", "844", "855", "866", "877", "888"]
            removeVerifyingText(input);
            if (badAreaCodes.indexOf(areaCode) >= 0) {
              addErrorText(input, "Phone Number")
              phoneValid = false;
              console.log("bad area code")
            } else {
              addVerifyingText(input);
              $.ajax({
                url: "/check-phone",
                method: "POST",
                dataType: "script",
                data: {
                  area_code: areaCode
                },
              }).complete(function(data) {
                removeErrorText(input);
                removeVerifyingText(input);
                if (data.responseText == "success") {
                  phoneValid = true;
                } else {
                  addErrorText(input, "Phone Number")
                  phoneValid = false;
                }
              });
            }
          };

          function validateEmail(input) {
            $.ajax({
              url: "/validation-count",
              method: "POST",
              dataType: "script",
              data: {
                validation_type: 'E'
              },
            }).complete(function(data) {
              if (data.responseText == "success") {
                console.log("Email Success")
              } else {
                console.log("Email Failed")
              }
            });
            var address = $(input).val();
            var group = $(input).parents(".form-group")[0]
            $(group).find("label").remove(".invalid-text");
            $(group).find("input").removeClass("invalid-input");
            if ($(input).length > 0) {
              if (!validateEmailAddress(address)) {
                // alert("Invalid Email Address!");
                addErrorText(input, "Email Address")
                emailValid = false;
              } else {
                $(input).mailcheck({
                  suggested: function(element, suggestion) {
                    // console.log(suggestion)
                    $(element).parent().append("<label class='help-text invalid-text'>Did you mean <u id='suggestion'>" + suggestion.full + "</u>?</label>")
                    $(element).addClass("invalid-input")
                    suggestionText();
                    emailValid = true;
                  },
                  empty: function(element) {
                    // console.log(element);
                    emailValid = true;
                  }
                })
              }
            } else {
              emailValid = false;
            }
          }

          function validatePhone(phoneInput) {
            $.ajax({
              url: "/validation-count",
              method: "POST",
              dataType: "script",
              data: {
                validation_type: 'P'
              },
            }).complete(function(data) {
              if (data.responseText == "success") {
                console.log("Phone Success")
              } else {
                console.log("Phone Failed")
              }
            });
            var group = $(phoneInput).parents(".form-group")[0]
            $(group).find("label").remove(".invalid-text");
            $(group).find("input").removeClass("invalid-input");
            var phoneNumber = $(phoneInput).val().replace(/-/g, "");
            if ($(phoneInput).val().length > 1) {
              removeErrorText(phoneInput);
              checkTwilio(phoneInput, phoneNumber);
            } else {
              console.log("number no length")
              addErrorText(phoneInput, "Phone Number")
            }
          }
          suggestionText = function() {
            $("#suggestion").click(function() {
              var group = $(this).parents(".form-group")[0]
              var input = $(group).find("input");
              input.val($(this).text())
              $("label").remove(".invalid-text");
              $("input").removeClass("invalid-input");
            })
          }
          $("#email_address").change(function() {
            validateEmail(this);
          })
          // $("#phone_number").change(function() {
          //     validatePhone(this);
          // })
          var previousValue;
          $("#phone_number").keyup(function() {
            var currentValue = $(this).val().replace(/-/g, "")
            //  console.log(previousValue, currentValue)
            if (previousValue != currentValue && currentValue.length > 9) {
              validatePhone(this);
              previousValue = currentValue
            }
          });
          $("#phone_number").change(function() {
            var currentValue = $(this).val().replace(/-/g, "")
            if (currentValue.length < 10) {
              removeErrorText(this);
              addErrorText(this, "Phone Number")
            }
          })

          function validateForm(emailInput, phoneInput) {
            // validatePhone(phoneInput);
            // validateEmail(emailInput);
            // console.log("email " + emailValid)
            // console.log("phone " + phoneValid)
            if (emailInput.length > 0 && !emailValid) {
              toastr.error('Email Address Invalid')
              return false;
            }
            if (phoneInput.length > 0 && !phoneValid) {
              toastr.error('Phone Number Invalid')
              return false;
            }
          }
          $("form").submit(function(e) {
            var emailInput = $(this).find("#email_address");
            var phoneInput = $(this).find("#phone_number");
            return validateForm(emailInput, phoneInput);
          });
        </script>
      </div>
    </div>
    <div class="form-row next-button ">
      <div class="col-md-6 offset-md-3 px-3 next-container">
        <div class="form-row">
        </div>
        <button class="mx-auto btn-custom " type="submit"> NEXT </button>
      </div>
      <div class="col-md-10 offset-md-1 px-3">
        <div class="form-row">
        </div>
      </div>
    </div>
  </div><input type="hidden" name="xxTrustedFormToken" id="xxTrustedFormToken_0" value="https://cert.trustedform.com/ec280833d201e443a20510d5e3a21a01cd2f53a1"><input type="hidden" name="xxTrustedFormCertUrl" id="xxTrustedFormCertUrl_0"
    value="https://cert.trustedform.com/ec280833d201e443a20510d5e3a21a01cd2f53a1"><input type="hidden" name="xxTrustedFormPingUrl" id="xxTrustedFormPingUrl_0"
    value="https://ping.trustedform.com/0.knrhM-4qy38NMws6lISNXxCZosxqxNymVuWSIA5LPFSL-Mt_P5HHC0moDpTQhmso3i6gTp7s.OR41nraFBaLE8ThJBsATRA.uwnTf09jd_1_LT_qqG_bUw">
</form>

Text Content

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