www.mybeerrebate.com Open in urlscan Pro
199.73.26.124  Public Scan

Form analysis
1 forms found in the DOM

Name: parentCustomForm —

<form name="parentCustomForm" class="ng-pristine ng-scope ng-invalid ng-invalid-required ng-valid-date">
  <div pccustomform="" customfields="accordion" class="ng-isolate-scope"><ng-form name="customForm" novalidate="" class="ng-pristine ng-invalid ng-invalid-required ng-valid-date"><!-- ngRepeat: field in fields -->
      <div class="form-group ng-scope" ng-repeat="field in fields">
        <div class="input-group dynamic-fields">
          <p class="noMargin ng-hide inactiveFieldLabel" ng-show="customForm[field.fieldName].$viewValue || customForm[field.fieldName].focused" ng-class="(customForm[field.fieldName].focused) ? 'activeFieldLabel' : 'inactiveFieldLabel'"><span
              translate="content.FD_HOME_CUSTOMSEARCH_0_CAMPAIGNCODE" class="ng-scope">Offer Number (AB-XXXX)</span></p><!-- ngIf: (field.type | uppercase) === 'SELECT' --><!-- ngIf: (field.type | uppercase) === 'TEXT' --><input
            ng-if="(field.type | uppercase) === 'TEXT'" border-color="" aria-label="customForm[field.fieldName]" tabindex="0" ng-focus="customForm[field.fieldName].focused = true" ng-blur="customForm[field.fieldName].focused = false"
            name="CampaignCode" class="noBorderTextBox ng-pristine ng-untouched ng-scope ng-invalid ng-invalid-required" type="text" placeholder="Offer Number (AB-XXXX)" ng-model="field.value" ng-required="true"
            pc-field="home-customSearch-CampaignCode" link="" pc-field-type="Text" required="required"><!-- end ngIf: (field.type | uppercase) === 'TEXT' --> <!-- ngIf: (field.type | uppercase) === 'DATE' -->
          <!-- ngIf: (field.type | uppercase) === 'DATE' --> <!-- ngIf: (field.type | uppercase) === 'DATE' --> <!-- ngIf: field.tinyMce_Text && !(field.MODAL) --> <!-- ngIf: field.MODAL && field.tinyMce_Text -->
        </div>
      </div><!-- end ngRepeat: field in fields -->
      <div class="form-group ng-scope" ng-repeat="field in fields">
        <div class="input-group dynamic-fields">
          <p class="noMargin ng-hide inactiveFieldLabel" ng-show="customForm[field.fieldName].$viewValue || customForm[field.fieldName].focused" ng-class="(customForm[field.fieldName].focused) ? 'activeFieldLabel' : 'inactiveFieldLabel'"><span
              translate="content.FD_HOME_CUSTOMSEARCH_0_PURCHASEDATE" class="ng-scope">Purchase Date</span></p><!-- ngIf: (field.type | uppercase) === 'SELECT' --><!-- ngIf: (field.type | uppercase) === 'TEXT' -->
          <!-- ngIf: (field.type | uppercase) === 'DATE' --><input ng-if="(field.type | uppercase) === 'DATE'" id="home-PurchaseDate-text" border-color="" tabindex="0" ng-focus="customForm[field.fieldName].focused = true"
            ng-blur="customFormCtrl.dateTextChange(field.fieldName, true ,this, false)" name="PurchaseDate" class="noBorderTextBox ng-pristine ng-untouched ng-scope ng-invalid ng-invalid-required" type="text" placeholder="Purchase Date"
            ng-model="field.value" is-open="customFormCtrl.dates[field.fieldName]" ng-change="customFormCtrl.dateTextChange(field.fieldName, false ,this, true)" close-text="Close" pc-field="home-customSearch-PurchaseDate" link="" pc-field-type="Date"
            ng-required="true" required="required"><!-- end ngIf: (field.type | uppercase) === 'DATE' --> <!-- ngIf: (field.type | uppercase) === 'DATE' --><input ng-if="(field.type | uppercase) === 'DATE'" id="PurchaseDate-date" tabindex="0"
            name="PurchaseDate1" class="hidden-date-input ng-pristine ng-untouched ng-scope ng-isolate-scope ng-invalid ng-invalid-required ng-valid-date" type="text" uib-datepicker-popup="MM/dd/yyyy" datepicker-options="dateOptions"
            ng-model="field.valueTemp" is-open="customFormCtrl.dates[field.fieldName]" ng-change="customFormCtrl.dateChange(field.fieldName,this)" close-text="Close" ng-required="true" required="required">
          <div uib-datepicker-popup-wrap="" ng-model="date" ng-change="dateSelection(date)" template-url="uib/template/datepickerPopup/popup.html" class="ng-valid">
            <!-- ngIf: isOpen -->
          </div><!-- end ngIf: (field.type | uppercase) === 'DATE' --> <!-- ngIf: (field.type | uppercase) === 'DATE' --><span class="input-group-btn ng-scope" ng-if="(field.type | uppercase) === 'DATE'"><button id="PurchaseDate-searchDate"
              type="button" class="btn form-icon" ng-click="customFormCtrl.toggleDate(field.fieldName)" aria-label="Date Selector" title="Date selector"
              alt="calendar"><i class="fa fa-calendar" aria-hidden="true"></i></button></span><!-- end ngIf: (field.type | uppercase) === 'DATE' --> <!-- ngIf: field.tinyMce_Text && !(field.MODAL) --> <!-- ngIf: field.MODAL && field.tinyMce_Text -->
        </div>
      </div><!-- end ngRepeat: field in fields -->
      <div class="form-group ng-scope" ng-repeat="field in fields">
        <div class="input-group dynamic-fields">
          <p class="noMargin ng-hide inactiveFieldLabel" ng-show="customForm[field.fieldName].$viewValue || customForm[field.fieldName].focused" ng-class="(customForm[field.fieldName].focused) ? 'activeFieldLabel' : 'inactiveFieldLabel'"><span
              translate="content.FD_HOME_CUSTOMSEARCH_0_EMAIL" class="ng-scope">Email Address</span></p><!-- ngIf: (field.type | uppercase) === 'SELECT' --><!-- ngIf: (field.type | uppercase) === 'TEXT' --><input
            ng-if="(field.type | uppercase) === 'TEXT'" border-color="" aria-label="customForm[field.fieldName]" tabindex="0" ng-focus="customForm[field.fieldName].focused = true" ng-blur="customForm[field.fieldName].focused = false" name="Email"
            class="noBorderTextBox ng-pristine ng-untouched ng-scope ng-invalid ng-invalid-required" type="text" placeholder="Email Address" ng-model="field.value" ng-required="true" pc-field="home-customSearch-Email" link="" pc-field-type="Text"
            required="required"><!-- end ngIf: (field.type | uppercase) === 'TEXT' --> <!-- ngIf: (field.type | uppercase) === 'DATE' --> <!-- ngIf: (field.type | uppercase) === 'DATE' --> <!-- ngIf: (field.type | uppercase) === 'DATE' -->
          <!-- ngIf: field.tinyMce_Text && !(field.MODAL) --> <!-- ngIf: field.MODAL && field.tinyMce_Text -->
        </div>
      </div><!-- end ngRepeat: field in fields -->
      <div class="form-group ng-scope" ng-repeat="field in fields">
        <div class="input-group dynamic-fields">
          <p class="noMargin ng-hide inactiveFieldLabel" ng-show="customForm[field.fieldName].$viewValue || customForm[field.fieldName].focused" ng-class="(customForm[field.fieldName].focused) ? 'activeFieldLabel' : 'inactiveFieldLabel'"><span
              translate="content.FD_HOME_CUSTOMSEARCH_0_ZIPCODE" class="ng-scope">Zipcode</span></p><!-- ngIf: (field.type | uppercase) === 'SELECT' --><!-- ngIf: (field.type | uppercase) === 'TEXT' --><input
            ng-if="(field.type | uppercase) === 'TEXT'" border-color="" aria-label="customForm[field.fieldName]" tabindex="0" ng-focus="customForm[field.fieldName].focused = true" ng-blur="customForm[field.fieldName].focused = false" name="Zipcode"
            class="noBorderTextBox ng-pristine ng-untouched ng-scope ng-invalid ng-invalid-required" type="text" placeholder="Zipcode" ng-model="field.value" ng-required="true" pc-field="home-customSearch-Zipcode" link="" pc-field-type="Text"
            required="required"><!-- end ngIf: (field.type | uppercase) === 'TEXT' --> <!-- ngIf: (field.type | uppercase) === 'DATE' --> <!-- ngIf: (field.type | uppercase) === 'DATE' --> <!-- ngIf: (field.type | uppercase) === 'DATE' -->
          <!-- ngIf: field.tinyMce_Text && !(field.MODAL) --> <!-- ngIf: field.MODAL && field.tinyMce_Text -->
        </div>
      </div><!-- end ngRepeat: field in fields -->
    </ng-form></div>
  <div class="row"><!-- ngIf: validationErrors --></div>
  <div class="row"><!-- ngIf: homeCtrl.isBackButtonEnabled -->
    <div class="col-md-6 col-sm-6 col-xs-6 pull-right"><button id="home-customSearch-0-continue" aria-label="Continue" class="btn btn-primary ng-binding" ng-click="homeCtrl.continue()" ng-disabled="parentCustomForm.customForm.$invalid"
        disabled="disabled">Continue <span class="fa fa-chevron-right" aria-hidden="true"></span></button></div>
  </div>
</form>

Text Content

AGE VERIFICATION


YOU MUST BE OF LEGAL DRINKING AGE TO ENTER THIS SITE. PLEASE ENTER YOUR DATE OF
BIRTH.

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Privacy Policy. Do Not Sell My Personal Information.



Birth Date (MM/DD/YYYY)



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YOU'RE JUST A FEW CLICKS AWAY FROM SUBMITTING YOUR REBATE CLAIM. 

TO COMPLETE YOUR ONLINE SUBMISSION, YOU'LL NEED DIGITAL VERSIONS (SCANS OR
PHOTOS) OF YOUR UPC(S) AND PRODUCT RECEIPT(S) TO ATTACH. 

 

ENTER OFFER NUMBER, PURCHASE DATE, EMAIL ADDRESS AND ZIP CODE.

Offer Number (AB-XXXX)

Purchase Date



Email Address

Zipcode


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