14.stimulusassistance.com
Open in
urlscan Pro
172.67.160.153
Public Scan
Submitted URL: http://www.daviddobler.com/bFb-acid~Tk/C/
Effective URL: https://14.stimulusassistance.com/index.php?pid=1200&utm_source=1200&utm_campaign=1200&chk=1&cid=edbe9e98c40e4ead91d5e63dca1be851&...
Submission: On May 15 via manual from US — Scanned from US
Effective URL: https://14.stimulusassistance.com/index.php?pid=1200&utm_source=1200&utm_campaign=1200&chk=1&cid=edbe9e98c40e4ead91d5e63dca1be851&...
Submission: On May 15 via manual from US — Scanned from US
Form analysis 1 forms found in the DOM
POST handlepost.php
<form action="handlepost.php" method="POST" id="PageForm">
<div id="express-label-container" class="hidden-div">
<li class="user-list ">
<span class="user-left-span ">
<label for="first"> First: </label>
</span>
<span class="user-right-span ">
<label class="user-input-label">
</label>
</span>
</li>
<li class="user-list ">
<span class="user-left-span ">
<label for="last"> Last: </label>
</span>
<span class="user-right-span ">
<label class="user-input-label">
</label>
</span>
</li>
<li class="user-list ">
<span class="user-left-span ">
<label for="address"> Address: </label>
</span>
<span class="user-right-span ">
<label class="user-input-label">
</label>
</span>
</li>
<li class="user-list li-flex zip">
<span class="user-left-span left-span">
<label for="zip"> Zip: </label>
</span>
<span class="user-right-span right-span">
<label class="user-input-label"> 00000 </label>
</span>
</li>
<li class="user-list ">
<span class="user-left-span ">
<label for="email"> Email: </label>
</span>
<span class="user-right-span ">
<label class="user-input-label">
</label>
</span>
</li>
<li class="user-list phone">
<span class="user-left-span ">
<label for="phone"> Phone: </label>
</span>
<span class="user-right-span ">
<label class="user-input-label">
</label>
</span>
</li>
<li class="user-list dob">
<span class="user-left-span ">
<label for="dob"> Birthday: </label>
</span>
<span class="user-right-span ">
<label class="user-input-label">
</label>
</span>
</li>
</div>
<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);
})();
</script>
<input type="hidden" name="page" value="1">
<div id="express-input-container" class="shown-div">
<div class="row">
<div class="col">
<input type="text" class="form-control user-input" id="first" name="first" placeholder="First Name" title="Enter your first name" value="" required="" style="font-size: 16px; padding-top: 20px; padding-bottom: 20px;">
</div>
<div class="col">
<input type="text" class="form-control user-input" id="last" name="last" placeholder="Last Name" title="Enter your last name" value="" required="" style="font-size: 16px; padding-top: 20px; padding-bottom: 20px;">
</div>
</div>
<div class="row">
<div class="col">
<input type="text" class="form-control user-input" id="address" name="address" placeholder="Address" title="Enter your address" value="" required="" style="font-size: 16px; padding-top: 20px; padding-bottom: 20px;">
</div>
<div class="col">
<input type="tel" class="form-control user-input" id="zip" name="zip" minlength="3" maxlength="5" pattern="[0-9]{3,5}" placeholder="ZIP Code" value="" title="Enter your 5-digit ZIP code" onkeypress="return isNumber(event)" required=""
style="font-size: 16px; padding-top: 20px; padding-bottom: 20px;">
</div>
</div>
<div class="row">
<div class="col">
<input type="text" name="emailidaddress" id="emailidaddress" value="" style="display: none;">
<input type="email" class="form-control user-input" id="email" name="email" value="" placeholder="Email" title="Enter your email" required="" style="font-size: 16px; padding-top: 20px; padding-bottom: 20px;">
</div>
<div class="col">
<input type="tel" class="form-control user-input" name="phone" id="phone" placeholder="Phone Number" title="Enter your 10-digit phone number" value="" minlength="10" maxlength="11" onkeypress="return isNumber(event)" required=""
style="font-size: 16px; padding-top: 20px; padding-bottom: 20px;">
</div>
</div>
<div class="row">
<div class="col">
<div class="form-group">
<select id="birth_month" name="dobmonth" value="" class="browser-default custom-select selectpicker select-input" title="Please enter birth month" required="true" style="height: 42px; font-size: 14px;">
<option value="" disabled="" selected="">Birth Month</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
<option value="9">9</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
</select>
</div>
</div>
<div class="col">
<div class="form-group">
<select id="birth_day" name="dobday" value="" class="browser-default custom-select selectpicker select-input" title="Please enter birth day" required="true" style="height: 42px; font-size: 14px;">
<option value="" disabled="" selected="">Birth Day</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
<option value="9">9</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
<option value="13">13</option>
<option value="14">14</option>
<option value="15">15</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
<option value="25">25</option>
<option value="26">26</option>
<option value="27">27</option>
<option value="28">28</option>
<option value="29">29</option>
<option value="30">30</option>
<option value="31">31</option>
</select>
</div>
</div>
<div class="col">
<div class="form-group">
<select id="birth_year" name="dobyear" value="" class="browser-default custom-select selectpicker select-input" title="Please enter birth year" required="true" style="height: 42px; font-size: 14px;">
<option value="" disabled="" selected="">Birth Year</option>
<option value="2006">2006</option>
<option value="2005">2005</option>
<option value="2004">2004</option>
<option value="2003">2003</option>
<option value="2002">2002</option>
<option value="2001">2001</option>
<option value="2000">2000</option>
<option value="1999">1999</option>
<option value="1998">1998</option>
<option value="1997">1997</option>
<option value="1996">1996</option>
<option value="1995">1995</option>
<option value="1994">1994</option>
<option value="1993">1993</option>
<option value="1992">1992</option>
<option value="1991">1991</option>
<option value="1990">1990</option>
<option value="1989">1989</option>
<option value="1988">1988</option>
<option value="1987">1987</option>
<option value="1986">1986</option>
<option value="1985">1985</option>
<option value="1984">1984</option>
<option value="1983">1983</option>
<option value="1982">1982</option>
<option value="1981">1981</option>
<option value="1980">1980</option>
<option value="1979">1979</option>
<option value="1978">1978</option>
<option value="1977">1977</option>
<option value="1976">1976</option>
<option value="1975">1975</option>
<option value="1974">1974</option>
<option value="1973">1973</option>
<option value="1972">1972</option>
<option value="1971">1971</option>
<option value="1970">1970</option>
<option value="1969">1969</option>
<option value="1968">1968</option>
<option value="1967">1967</option>
<option value="1966">1966</option>
<option value="1965">1965</option>
<option value="1964">1964</option>
<option value="1963">1963</option>
<option value="1962">1962</option>
<option value="1961">1961</option>
<option value="1960">1960</option>
<option value="1959">1959</option>
<option value="1958">1958</option>
<option value="1957">1957</option>
<option value="1956">1956</option>
<option value="1955">1955</option>
<option value="1954">1954</option>
<option value="1953">1953</option>
<option value="1952">1952</option>
<option value="1951">1951</option>
<option value="1950">1950</option>
<option value="1949">1949</option>
<option value="1948">1948</option>
<option value="1947">1947</option>
<option value="1946">1946</option>
<option value="1945">1945</option>
<option value="1944">1944</option>
<option value="1943">1943</option>
<option value="1942">1942</option>
<option value="1941">1941</option>
<option value="1940">1940</option>
<option value="1939">1939</option>
<option value="1938">1938</option>
<option value="1937">1937</option>
<option value="1936">1936</option>
<option value="1935">1935</option>
<option value="1934">1934</option>
<option value="1933">1933</option>
<option value="1932">1932</option>
<option value="1931">1931</option>
<option value="1930">1930</option>
<option value="1929">1929</option>
<option value="1928">1928</option>
<option value="1927">1927</option>
<option value="1926">1926</option>
<option value="1925">1925</option>
<option value="1924">1924</option>
<option value="1923">1923</option>
<option value="1922">1922</option>
<option value="1921">1921</option>
<option value="1920">1920</option>
<option value="1919">1919</option>
<option value="1918">1918</option>
<option value="1917">1917</option>
<option value="1916">1916</option>
<option value="1915">1915</option>
<option value="1914">1914</option>
<option value="1913">1913</option>
<option value="1912">1912</option>
<option value="1911">1911</option>
<option value="1910">1910</option>
<option value="1909">1909</option>
<option value="1908">1908</option>
<option value="1907">1907</option>
<option value="1906">1906</option>
<option value="1905">1905</option>
<option value="1904">1904</option>
<option value="1903">1903</option>
<option value="1902">1902</option>
<option value="1901">1901</option>
<option value="1900">1900</option>
</select>
</div>
</div>
</div>
</div> <!-- close #express-input-container -->
<script>
console.log('showing twyne');
</script>
<script>
$(function() {
$("#birth_month, #birth_day, #birth_year").change(function() {
var m = $("#birth_month").val()
var d = $("#birth_day").val()
var y = $("#birth_year").val()
if (m && d && y && window.twyne && window.twyne.form) twyne.form.setValue('dob', m + '/' + d + '/' + y)
})
});
</script>
<div id="embed">
<script type="text/javascript" src="//shift44.api.twyne.io/assets/form.js"></script>
<script type="text/javascript" id="twyne-embed" class="twyne-embed">
(function(global) {
function twyne_load() {
var data = {};
data.pid = '1';
data.sid = '70';
data.first = '';
data.last = '';
data.email = '';
data.address1 = '';
data.address2 = '';
data.city = '';
data.gender = '';
data.state = '';
data.zip = '';
data.country = 'US';
data.phone = '';
data.dob = '';
data.istest = 'N'; //Y - N
data.subid1 = '1200';
data.subid2 = '__embed__control';
// return URL for when a user completes the path
data.rurl = '';
data.embedUrlOverride = 'https://shift44.api.twyne.io';
data.loading = {
enabled: false
};
data.formRegistration = {
binders: {
'first': 'first',
'last': 'last',
'address1': 'address',
'city': 'city',
'gender': 'gender',
'state': 'state',
'zip': 'zip',
'phone': 'phone',
'email': 'email'
},
customFields: ['dob', 'address2'],
percent: 0
}
global.twyne.initEmbed(data);
}
document.addEventListener("DOMContentLoaded", twyne_load);
})(this);
</script>
<script async="" type="text/javascript"
src="https://shift44.api.twyne.io/aserving/index?pid=1&sid=70&first=&last=&email=&address1=&address2=&city=&gender=&state=&zip=&country=US&phone=&dob=&istest=N&subid1=1200&subid2=__embed__control&twid=a81c868f01494b2491082a2d9d581ce0&domainUrl=https%3A%2F%2F14.stimulusassistance.com%2Findex.php%3Fpid%3D1200%26utm_source%3D1200%26utm_campaign%3D1200%26chk%3D1%26cid%3Dedbe9e98c40e4ead91d5e63dca1be851%26oid%3D3668&optout=false">
</script>
<div id="twy-placement-170" class="twyne-path-content"></div>
</div>
<script>
gtag('event', 'embed_twy');
</script>
<div class="tcpadiv grid-container consent-container" name="consent" id="consent" onclick="toggleConsentOnClick()">
<button type="button" style="background: none; font-weight: bolder; border-style: none; grid-template-columns: 1fr;" class="consent-button"
onclick="$(".iagree").prop("checked", !$(".iagree").prop("checked")); toggleConsent(); event.stopPropagation();">
<input type="checkbox" name="iagree" class="iagree" onclick="javascript:event.stopPropagation(); toggleConsent();"></button>
<p class="consent-text" style="color: red; margin-bottom: 0px; font-size: 12px; font-weight: 400; text-align: left; margin-top: 5px;"> <span style="font-weight: 600; font-size: 12px;">I confirm all my information is accurate</span> and consent to
be texted as provided below.</p>
</div>
<div class="row">
<div class="col">
<label>
<input type="hidden" id="leadid_tcpa_disclosure">
<p id="notice" style="font-size: 14px; margin-bottom: 10px; margin-top: 10px;"> By checking the box below I expressly consent to receive marketing and informational phone calls and text messages from StimulusAssistance, Unified Marketing
Partners LLC, and our <a class="housing-links" href="marketing-partners/index.php" style="cursor:pointer;text-decoration:underline;" target="_BLANK">Marketing Partners</a> on the land line and/or mobile number I provided. I confirm that the
phone number set forth above is accurate and I am the regular user of the phone. I understand these calls may be generated using an autodialer and may contain pre-recorded and artificial voice messages and I do not need to check the box to
participate in the deals promoted, offers or to claim a Reward. For SMS message campaigns: Text STOP to stop and HELP for help. Msg & data rates may apply. Periodic messages; max. 30 / month. <br><br> By clicking below, I agree to
receive relevant email from StimulusAssistance & BenefitsBillboard, and other marketing partners, the <a href="tc.php" class="housing-links" target="_blank" id="terms">Terms & Conditions</a> (which include mandatory arbitration),
and the <a href="pp.php" class="housing-links" target="_blank">Privacy Policy</a>. </p>
</label>
</div>
</div>
<div class="row justify-content-center align-items-center">
<div class="col" id="terms-col">
<style>
.tcpadiv {
display: grid;
font-size: 12px;
font-weight: bold;
border: 1px solid #9e9993;
/* Make this 1fr 4fr on anything not small / mobile */
grid-template-columns: 1fr 4fr;
grid-gap: 10px;
padding: 5px;
color: #4b4b4b;
align-items: center;
border: 1px solid #ff5d5d;
border-radius: 6px;
display: flex;
min-height: 55px;
}
.tcpadiv p,
.tcpadiv button {
font-size: 12px;
}
.modal_TCPA_confirmation {
position: fixed;
z-index: 200;
left: 0;
top: 0;
width: 100%;
height: 100%;
background-color: rgba(187, 187, 187, 0.65);
}
.modal_TCPA_container {
font-family: "Lato", sans-serif !important;
background: #fff;
max-width: 500px;
width: 100%;
margin: 15% auto;
border-radius: 8px;
padding: 8px;
}
.modal_TCPA_container .button_action {
display: flex;
justify-content: center;
min-height: 50px;
margin-bottom: 2rem;
}
.modal_TCPA_container .button_action a {
display: flex;
align-items: center;
justify-content: center;
max-width: 300px;
width: 100%;
margin: 0 12px;
border: 1px solid #a6a6a6;
text-decoration: none;
border-radius: 6px;
cursor: pointer;
font-size: 1.25em;
font-weight: 600;
}
.modal_TCPA_container .title {
margin: 3px auto 5% auto;
color: #83d2ff;
width: 100%;
font-size: 24px;
text-align: center;
}
.modal_TCPA_confirmation .modal_TCPA_container .title h1 {
color: #ff5d5d;
}
.modal_TCPA_container .reminder {
margin: 0 0 5% 0;
color: #a6a6a6;
font-size: 1.2em;
text-align: center;
}
.modal_TCPA_container .reminder {
color: #909090;
}
.modal_TCPA_confirmation .modal_TCPA_container .button_action a:first-child {
border: 1px solid #5aa362;
}
.modal_TCPA_container .button_action .confirm {
background: #5aa362;
color: #fff;
}
.modal_TCPA_confirmation .modal_TCPA_container .button_action .disregard {
color: #a6a6a6;
}
@media only screen and (max-width: 420px) {
/* mobile */
.tcpadiv {
grid-template-columns: 1fr 1.5fr;
font-size: 11px;
}
.tcpadiv p,
.tcpadiv button {
font-size: 11px;
}
.modal_TCPA_container .button_action a {
display: flex;
align-items: center;
justify-content: center;
max-width: 300px;
width: 100%;
margin: 0 12px;
border: 1px solid #a6a6a6;
text-decoration: none;
border-radius: 6px;
cursor: pointer;
font-size: 1.25em;
font-weight: 600;
}
.modal_TCPA_confirmation .modal_TCPA_container {
width: 90%;
top: 14%;
position: relative;
}
.modal_TCPA_container .title h1 {
font-size: 1.25em;
line-height: 28px;
}
.modal_TCPA_container .button_action {
display: flex;
justify-content: center;
min-height: 50px;
}
}
@media screen and (max-width: 500px) {
.modal_TCPA_container .button_action a {
height: 50px;
max-width: 300px;
margin-bottom: 15px;
}
.modal_TCPA_container .button_action {
flex-direction: column;
width: 100%;
align-items: center;
margin-bottom: 1rem;
}
}
.iagree {
width: 16px !important;
height: 16px !important;
/*margin-right: 5px !important;*/
margin-top: 0 !important;
background: none;
border: none;
}
</style>
<!-- Section for index page -->
<!--<div class="tcpadiv grid-container">
<button type="button" style="background-color: #54BD6B;color: white;font-weight: bolder;height: 70px;border-style: none; grid-template-columns: 1fr;" onclick="$('.iagree').prop('checked', !$('.iagree').prop('checked')); event.stopPropagation();"><input type="checkbox" name="iagree" class="iagree" onclick="javascript:event.stopPropagation();">I Agree</button>
<p style="color: black; font-size:12px; font-family: 'Mulish','Sans-Serif'">to be called and texted and that all my information is accurate as provided above</p>
</div>-->
<!-- end section for index page -->
<!-- Section for signup page -->
<!--
<div class="row justify-content-center align-items-center">
<div class="col" class="terms-col">
<input type="checkbox" name="agreement1" id="agree1" value="agree1">
<label id="terms-col-label-1" for="agree1" style="max-width: 80%; font-family: 'EB Garamond';">I agree to the <a href="pp.php" target="_blank" id="terms">Privacy Policy</a></label>
</div>
</div>
<div class="row justify-content-center align-items-center">
<div class="col" class="terms-col">
<input type="checkbox" name="agreement2" id="agree2" value="agree2">
<label id="terms-col-label-2" for="agree2" style="max-width: 80%; font-family: 'EB Garamond';">I agree to receive relevant email from StimulusAssistance</label>
</div>
</div>-->
<!-- end section for signup page -->
</div>
</div>
<div class="modal_TCPA_confirmation" id="consent_modal" style="display: none;">
<div class="modal_TCPA_container">
<div class="title">
<h1>Don't Forget To Review & Confirm Your Profile Details</h1>
</div>
<div class="reminder"><span>(Click "Close & Review" Then Check The Red Box)</span></div>
<div class="button_action"><a href="#consent" class="confirm" onclick="close_modal();"><span>Close & Review</span></a><a href="#consent" class="disregard" onclick="formSubmit(); close_modal();"><span>Disregard</span></a></div>
</div>
</div>
<script>
$('#consent_modal').hide();
</script>
<div class="row">
<div class="col">
<input type="submit" id="submit-btn" value="CONTINUE" onclick="">
</div>
</div>
<input type="hidden" id="gender" name="gender" value="">
<input type="hidden" id="city" name="city" value="">
<input type="hidden" id="state" name="state" value="">
<input type="hidden" id="leadid_token" name="universal_leadid" value="724B79FF-1A13-6B7D-842F-D0E8BD764EAB">
<input type="hidden" name="xxTrustedFormCertUrl" value="https://cert.trustedform.com/e204c97a09b624d4568973784fb8f0ad38739291" id="xxTrustedFormCertUrl_0"><input type="hidden" name="xxTrustedFormToken"
value="https://cert.trustedform.com/e204c97a09b624d4568973784fb8f0ad38739291" id="xxTrustedFormToken_0"><input type="hidden" name="xxTrustedFormPingUrl"
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</form>Text Content
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