www.ebixcrm.com Open in urlscan Pro
64.238.206.247  Public Scan

Form analysis
3 forms found in the DOM

<form class="d-flex">
  <a href="https://www.ez-data.com/login.shtml" class="btn btn-outline-light">Log In</a>
</form>

Name: Contactusform — POST /Submitdata

<form id="Contactusform" name="Contactusform" action="/Submitdata" method="post" enctype="multipart/form-data">
  <div class="row">
    <div class="col-sm-6">
      <div class="form-group">
        <label class="mandetory"> Title </label>
        <select required="" class="form-control" name="title">
          <option value="Mr." selected="">Mr.</option>
          <option value="Ms.">Ms.</option>
          <option value="Mrs.">Mrs.</option>
        </select>
      </div>
    </div>
    <div class="col-sm-6">
      <div class="form-group">
        <label class="mandetory"> First Name </label>
        <input type="text" name="txtname" id="txtname" required="" class="form-control">
      </div>
    </div>
    <div class="col-sm-6">
      <div class="form-group">
        <label class="mandetory"> Last Name </label>
        <input type="text" name="txtname" id="txtname" required="" class="form-control">
      </div>
    </div>
    <div class="col-sm-6">
      <div class="form-group">
        <label class="mandetory"> Email Address </label>
        <input type="text" name="txtEmail" id="txtEmail" required="" class="form-control" onblur="validatebox(this.parentElement.parentElement,this.id);">
      </div>
    </div>
    <div class="col-sm-6">
      <div class="form-group">
        <label class="mandetory"> Phone </label>
        <input type="text" name="txtphone" id="txtphone" required="" class="form-control numbersOnly" maxlength="10" onblur="validatebox(this.parentElement.parentElement,this.id);">
      </div>
    </div>
    <div class="col-sm-6">
      <div class="form-group">
        <label class="mandetory"> State/Province </label>
        <select required="" class="form-control" name="state" id="state">
          <option value="">[Select State]</option>
          <option value="N/A">N/A</option>
          <option value="AL">Alabama</option>
          <option value="AK">Alaska</option>
          <option value="AS">American Samoa</option>
          <option value="AZ">Arizona</option>
          <option value="AR">Arkansas</option>
          <option value="AA">Armed Forces America</option>
          <option value="AE">Armed Forces Europe</option>
          <option value="AP">Armed Forces Pacific</option>
          <option value="CA">California</option>
          <option value="CZ">Canal Zone</option>
          <option value="CO">Colorado</option>
          <option value="CT">Connecticut</option>
          <option value="DE">Delaware</option>
          <option value="FL">Florida</option>
          <option value="GA">Georgia</option>
          <option value="GU">Guam</option>
          <option value="HI">Hawaii</option>
          <option value="ID">Idaho</option>
          <option value="IL">Illinois</option>
          <option value="IN">Indiana</option>
          <option value="IA">Iowa</option>
          <option value="KS">Kansas</option>
          <option value="KY">Kentucky</option>
          <option value="LA">Louisiana</option>
          <option value="ME">Maine</option>
          <option value="MD">Maryland</option>
          <option value="MA">Massachusetts</option>
          <option value="MI">Michigan</option>
          <option value="MN">Minnesota</option>
          <option value="MS">Mississippi</option>
          <option value="MO">Missouri</option>
          <option value="MT">Montana</option>
          <option value="NE">Nebraska</option>
          <option value="NV">Nevada</option>
          <option value="NH">New Hampshire</option>
          <option value="NJ">New Jersey</option>
          <option value="NM">New Mexico</option>
          <option value="NY">New York</option>
          <option value="NC">North Carolina</option>
          <option value="ND">North Dakota</option>
          <option value="OH">Ohio</option>
          <option value="OK">Oklahoma</option>
          <option value="OR">Oregon</option>
          <option value="PA">Pennsylvania</option>
          <option value="PR">Puerto Rico</option>
          <option value="RI">Rhode Island</option>
          <option value="SC">South Carolina</option>
          <option value="SD">South Dakota</option>
          <option value="TN">Tennessee</option>
          <option value="TX">Texas</option>
          <option value="TT">Trust Territori</option>
          <option value="UT">Utah</option>
          <option value="VT">Vermont</option>
          <option value="VI">Virgin Islands</option>
          <option value="VA">Virginia</option>
          <option value="WA">Washington</option>
          <option value="DC">Washington, DC</option>
          <option value="WV">West Virginia</option>
          <option value="WI">Wisconsin</option>
          <option value="WY">Wyoming</option>
        </select>
      </div>
    </div>
    <div class="col-sm-6">
      <div class="form-group">
        <label class="mandetory"> State/Province </label>
        <select required="" class="form-control" name="country" id="country">
          <option value="">[Select Country]</option>
          <option selected="" value="USA">USA</option>
          <option value="AFGH">Afghanistan</option>
          <option value="ALB">Albania</option>
          <option value="ALGR">Algeria</option>
          <option value="ASMO">American Samoa</option>
          <option value="ANDO">Andorra</option>
          <option value="ANGL">Angola</option>
          <option value="ANGU">Anguilla</option>
          <option value="ANTI">Antigua and Barbuda</option>
          <option value="ARG">Argentina</option>
          <option value="ARM">Armenia</option>
          <option value="ARB">Aruba</option>
          <option value="Australia">Australia</option>
          <option value="AUST">Austria</option>
          <option value="AZR">Azerbaijan</option>
          <option value="BAMA">Bahamas</option>
          <option value="BAHR">Bahrain</option>
          <option value="BANG">Bangladesh</option>
          <option value="BRDO">Barbados</option>
          <option value="BYS">Belarus</option>
          <option value="BELG">Belgium</option>
          <option value="BLZ">Belize</option>
          <option value="BENN">Benin</option>
          <option value="BERM">Bermuda</option>
          <option value="BHU">Bhutan</option>
          <option value="BOL">Bolivia</option>
          <option value="BIH">Bosnia-Herzegovina</option>
          <option value="BOT">Botswana</option>
          <option value="BRZL">Brazil</option>
          <option value="IOT">British Indian Ocean Territory </option>
          <option value="BRVI">British Virgin Islands</option>
          <option value="BRNI">Brunei</option>
          <option value="BULG">Bulgaria</option>
          <option value="BURK">Burkina Faso</option>
          <option value="BURM">Burma</option>
          <option value="BRND">Burundi</option>
          <option value="CBDA">Cambodia</option>
          <option value="CMRN">Cameroon</option>
          <option value="CAN">Canada</option>
          <option value="CAVI">Cape Verde</option>
          <option value="CAYI">Cayman Islands</option>
          <option value="CAFR">Central African Republic </option>
          <option value="CHAD">Chad</option>
          <option value="CHIL">Chile</option>
          <option value="CHIN">China - Mainland</option>
          <option value="CHRI">Christmas Island</option>
          <option value="COCI">Cocos Keeling Islands</option>
          <option value="COL">Colombia</option>
          <option value="COMO">Comoros</option>
          <option value="CONB">Congo (Brazzaville)</option>
          <option value="COD">Congo (Kinshasa)</option>
          <option value="CKIS">Cook Islands</option>
          <option value="CSTR">Costa Rica</option>
          <option value="IVCO">Cote D`Ivoire</option>
          <option value="HRV">Croatia</option>
          <option value="CUBA">Cuba</option>
          <option value="CYPR">Cyprus</option>
          <option value="CZEC">Czech Republic</option>
          <option value="DEN">Denmark, Greenland, and The Faroe Islands</option>
          <option value="DJI">Djibouti</option>
          <option value="DOMN">Dominica</option>
          <option value="DOMR">Dominican Republic</option>
          <option value="TMOR">East Timor</option>
          <option value="ECUA">Ecuador (The Galapagos Islands) </option>
          <option value="EGYP">Egypt</option>
          <option value="ELSL">El Salvador</option>
          <option value="EGN">Equatorial Guinea</option>
          <option value="ERI">Eritrea</option>
          <option value="EST">Estonia</option>
          <option value="ETH">Ethiopia</option>
          <option value="FKLI">Falkland Islands</option>
          <option value="FAER">Faroe Islands</option>
          <option value="FSM">Federated States of Micronesia </option>
          <option value="FIJI">Fiji</option>
          <option value="FIN">Finland</option>
          <option value="FRAN">France</option>
          <option value="FRGN">French Guiana</option>
          <option value="FPOL">French Polynesia (Tahiti) </option>
          <option value="FSAT">French Southern &amp; Antarctic Territories</option>
          <option value="GABN">Gabon</option>
          <option value="GAM">Gambia</option>
          <option value="GRZ">Georgia</option>
          <option value="GER">Germany</option>
          <option value="GHAN">Ghana</option>
          <option value="GIB">Gibraltar</option>
          <option value="GRC">Greece</option>
          <option value="GRLD">Greenland</option>
          <option value="GREN">Grenada</option>
          <option value="GUAD">Guadeloupe</option>
          <option value="GUAM">Guam</option>
          <option value="GUAT">Guatemala</option>
          <option value="GNEA">Guinea</option>
          <option value="GUIB">Guinea - Bissau</option>
          <option value="GUY">Guyana</option>
          <option value="HAT">Haiti</option>
          <option value="HOND">Honduras</option>
          <option value="HNK">Hong Kong SAR (China)</option>
          <option value="HUNG">Hungary</option>
          <option value="ICLD">Iceland</option>
          <option value="IND">India</option>
          <option value="IDSA">Indonesia</option>
          <option value="IRAN">Iran</option>
          <option value="IRAQ">Iraq</option>
          <option value="IRE">Ireland</option>
          <option value="ISRL">Israel, The West Bank, and Gaza </option>
          <option value="ITLY">Italy</option>
          <option value="JAM">Jamaica</option>
          <option value="Japan">Japan</option>
          <option value="JORD">Jordan</option>
          <option value="KAZ">Kazakhstan</option>
          <option value="KENY">Kenya</option>
          <option value="KIRI">Kiribati</option>
          <option value="KUWT">Kuwait</option>
          <option value="KGZ">Kyrgyzstan</option>
          <option value="LAOS">Laos</option>
          <option value="LATV">Latvia</option>
          <option value="LEBN">Lebanon</option>
          <option value="LES">Lesotho</option>
          <option value="LIBR">Liberia</option>
          <option value="LBYA">Libya</option>
          <option value="LCHT">Liechtenstein</option>
          <option value="LITH">Lithuania</option>
          <option value="LXM">Luxembourg</option>
          <option value="MAC">Macau SAR (China)</option>
          <option value="MKD">Macedonia, The Former Yugoslav Republic</option>
          <option value="MADG">Madagascar</option>
          <option value="MALW">Malawi</option>
          <option value="MLAS">Malaysia</option>
          <option value="MLDI">Malden Island</option>
          <option value="MLDV">Maldives</option>
          <option value="MALI">Mali</option>
          <option value="MLTA">Malta</option>
          <option value="MART">Martinique</option>
          <option value="MAUR">Mauritania</option>
          <option value="MRTS">Mauritius</option>
          <option value="MEX">Mexico</option>
          <option value="MDWI">Midway Islands</option>
          <option value="MLD">Moldova</option>
          <option value="MON">Monaco</option>
          <option value="MONG">Mongolia</option>
          <option value="MONT">Montserrat</option>
          <option value="MORO">Morocco</option>
          <option value="MOZ">Mozambique</option>
          <option value="NAMB">Namibia</option>
          <option value="NAU">Nauru</option>
          <option value="NEP">Nepal</option>
          <option value="NETH">Netherlands</option>
          <option value="NETA">Netherlands Antilles</option>
          <option value="NCAL">New Caledonia</option>
          <option value="NZLD">New Zealand</option>
          <option value="NIC">Nicaragua</option>
          <option value="NIR">Niger</option>
          <option value="NRA">Nigeria</option>
          <option value="NIUE">Niue</option>
          <option value="NORW">Norway</option>
          <option value="OMAN">Oman</option>
          <option value="PKST">Pakistan</option>
          <option value="PLMR">Palmyra Atoll</option>
          <option value="PAN">Panama</option>
          <option value="PNG">Papua New Guinea</option>
          <option value="PARA">Paraguay</option>
          <option value="PRK">Peoples Republic of Korea - North Korea</option>
          <option value="PERU">Peru</option>
          <option value="PHIL">Philippines</option>
          <option value="PITC">Pitcairn Islands</option>
          <option value="POL">Poland</option>
          <option value="PORT">Portugal</option>
          <option value="PR">Puerto Rico</option>
          <option value="QTAR">Qatar</option>
          <option value="PALA">Republic of Palau</option>
          <option value="RMI">Republic of the Marshall Islands </option>
          <option value="REUN">Reunion</option>
          <option value="ROM">Romania</option>
          <option value="RUS">Russia</option>
          <option value="RWND">Rwanda</option>
          <option value="SABA">Saba Island</option>
          <option value="WSAM">Samoa</option>
          <option value="SMAR">San Marino</option>
          <option value="STPR">Sao Tome and Principe</option>
          <option value="SARB">Saudi Arabia</option>
          <option value="SENG">Senegal</option>
          <option value="SRM">Serbia and Montenegro</option>
          <option value="SEYC">Seychelles</option>
          <option value="SLEO">Sierra Leone</option>
          <option value="SING">Singapore</option>
          <option value="SVK">Slovakia</option>
          <option value="SVN">Slovenia</option>
          <option value="SLMN">Solomon Islands</option>
          <option value="SOMA">Somalia</option>
          <option value="SAFR">South Africa</option>
          <option value="KOR">South Korea</option>
          <option value="SPN">Spain</option>
          <option value="SRL">Sri Lanka</option>
          <option value="STBR">St. Barthelemy</option>
          <option value="STEU">St. Eustatius</option>
          <option value="SHEL">St. Helena</option>
          <option value="STCN">St. Kitts and Nevis</option>
          <option value="SLCA">St. Lucia</option>
          <option value="STMR">St. Maarten</option>
          <option value="SPMI">St. Pierre &amp; Miquelon</option>
          <option value="STVN">St. Vincent and The Grenadines </option>
          <option value="SUDA">Sudan</option>
          <option value="SURM">Suriname</option>
          <option value="SZLD">Swaziland</option>
          <option value="SWDN">Sweden</option>
          <option value="SWTZ">Switzerland</option>
          <option value="SYR">Syria</option>
          <option value="TWAN">Taiwan</option>
          <option value="TJK">Tajikistan</option>
          <option value="TAZN">Tanzania (Zanzibar)</option>
          <option value="THAI">Thailand</option>
          <option value="TOGO">Togo</option>
          <option value="TONG">Tonga</option>
          <option value="TRIN">Trinidad and Tobago</option>
          <option value="TNSA">Tunisia</option>
          <option value="TRKY">Turkey</option>
          <option value="TKM">Turkmenistan</option>
          <option value="TCIS">Turks and Caicos Islands </option>
          <option value="TUV">Tuvalu</option>
          <option value="UGAN">Uganda</option>
          <option value="UKR">Ukraine</option>
          <option value="UAE">United Arab Emirates</option>
          <option value="GRBR">United Kingdom</option>
          <option value="URU">Uruguay</option>
          <option value="UZB">Uzbekistan</option>
          <option value="VANU">Vanuatu</option>
          <option value="VAT">Vatican City</option>
          <option value="VENZ">Venezuela</option>
          <option value="VTNM">Vietnam</option>
          <option value="VI">Virgin Islands (U.S.)</option>
          <option value="WKI">Wake Island</option>
          <option value="WAFT">Wallis and Futuna Islands </option>
          <option value="SSAH">Western Sahara</option>
          <option value="YEM">Yemen</option>
          <option value="ZAMB">Zambia</option>
          <option value="ZIMB">Zimbabwe</option>
          <option value="">Other Not Shown</option>
        </select>
      </div>
    </div>
    <div class="col-sm-6">
      <div class="form-group">
        <label class="mandetory"> Business Description </label>
        <select required="" class="form-control" name="businessdesc" onchange="showBD(this)">
          <option value="">Please choose one:</option>
          <option value="Financial/Advisor Planner">Financial/Advisor Planner</option>
          <option value="Insurance Agent/Advisor">Insurance Agent/Advisor</option>
          <option value="GA/BGA/MGA">GA/BGA/MGA</option>
          <option value="Broker Dealer">Broker Dealer</option>
          <option value="RIA">RIA</option>
          <option value="Financial Services Wholesaler">Financial Services Wholesaler</option>
          <option value="Banking Institution">Banking Institution</option>
          <option value="Insurance Carrier">Insurance Carrier</option>
          <option value="Other">Other</option>
        </select>
      </div>
    </div>
    <div class="col-sm-6">
      <div class="form-group">
        <label class="mandetory"> How Did You Hear About Us? </label>
        <select required="" class="form-control" name="source" id="source" onchange="enableOther();">
          <option value="">Please choose one:</option>
          <option value="Magazine">Magazine</option>
          <option value="Postcard">Postcard</option>
          <option value="Friend/Colleague">Friend / Colleague</option>
          <option value="Webinar">Webinar</option>
          <option value="Trade Show">Trade Show</option>
          <option value="Email Blast">Email</option>
          <option value="Search Engine">Search Engine</option>
          <option value="My Home Office">My Home Office</option>
          <option value="Other">Other</option>
        </select>
      </div>
    </div>
    <div class="col-sm-6">
      <div class="form-group">
        <label> Receive further information via e-mail? </label>
        <select class="form-control" name="newsletter">
          <option selected="" value="Yes">Yes</option>
          <option value="No">No</option>
        </select>
      </div>
    </div>
    <div class="col-sm-6">
      <div class="form-group">
        <label> How can we help you? </label>
        <textarea class="form-control" name="remark" cols="36" rows="5"></textarea>
      </div>
    </div>
    <div class="col-sm-6">
      <div class="form-group"> Captcha Images and Codes comes here </div>
    </div>
    <div class="clearfix">
    </div>
    <div class="col-lg-12">
      <button type="submit" class="btn btn-info"> Submit </button>
      <button type="reset" class="btn btn-info"> Reset </button>
      <br>
      <br>
    </div>
    <div class="col-lg-12">
      <p> If you are a current SmartOffice user and have a question for our technical team, please e-mail our support group at <a href="mailto:smartofficesupport@ebix.com">smartofficesupport@ebix.com</a> or call us at (626) 585-3515. </p>
      <p> * Required fields. Ebix has strict privacy policies and will not sell, rent, or share the personal information collected to any third parties. </p>
    </div>
  </div>
</form>

<form class="">
  <div class="row">
    <div class="col-sm-6">
      <div class="form-group" id="divEmailsname">
        <input type="text" class="form-control" placeholder="Name" id="txtrecipientname">
      </div>
      <div class="form-group">
        <input type="text" class="form-control" placeholder="Company" id="txtrecipientcompany">
      </div>
    </div>
    <div class="col-sm-6">
      <div class="form-group">
        <input type="email" class="form-control" placeholder="Email Address" id="txtrecipientemail">
      </div>
      <div class="form-group">
        <input type="tel" class="form-control numbersOnly" maxlength="10" placeholder="Phone Number" id="txtrecipientphonenumber">
      </div>
    </div>
  </div>
  <div class="row">
    <div class="col-sm-12">
      <div class="form-group">
        <textarea class="form-control" id="txtrecipientmessage">Messages</textarea>
      </div>
    </div>
  </div>
  <div class="row">
    <div class="col-sm-6">
      <div class="form-group"> Captcha<sup class="mandetory"></sup>
        <div id="divCaptchaPopup"><label>3 + 6 =</label></div>
        <div class="form-group">
          <input type="text" class="form-control" id="txtcaptchaPopup">
        </div>
      </div>
    </div>
    <div class="row">
      <div class="col-sm-12" style="margin-left: 16px;">
        <input type="button" class="btn btn-primary" value="Submit" onclick="return Submitdataforpageemail();">
      </div>
    </div>
    <br>
  </div>
</form>

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SMARTOFFICE HELPS ME SLEEP BETTER AT NIGHT KNOWING THAT EVERY PIECE OF CLIENT
HISTORY IS AT MY FINGERTIPS.

GREG PATTERSON | ADVISORS FINANCIAL GROUP, INC.

SMARTOFFICE HELPS ME SLEEP BETTER AT NIGHT KNOWING THAT EVERY PIECE OF CLIENT
HISTORY IS AT MY FINGERTIPS.

GREG PATTERSON | ADVISORS FINANCIAL GROUP, INC.

SMARTOFFICE HELPS ME SLEEP BETTER AT NIGHT KNOWING THAT EVERY PIECE OF CLIENT
HISTORY IS AT MY FINGERTIPS.

GREG PATTERSON | ADVISORS FINANCIAL GROUP, INC.

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