cloud.lnyfe.com Open in urlscan Pro
13.111.194.210  Public Scan

Form analysis
1 forms found in the DOM

POST https://cloud.lnyfe.com/preference-center?brand=GCS&id=0034W00002TWyxsQAD&update=true

<form action="https://cloud.lnyfe.com/preference-center?brand=GCS&amp;id=0034W00002TWyxsQAD&amp;update=true" method="post" id="OptInForm" onsubmit="return validateForm()">
  <input name="update" type="hidden" value="true">
  <div class="input_wrapper col-left">
    <label for="FirstName">First Name *</label>
    <input type="text" id="FirstName" name="FirstName" value="Misha Bothe" autocomplete="new-password" required="">
  </div>
  <div class="input_wrapper col-left">
    <label for="LastName">Last Name *</label>
    <input type="text" name="LastName" id="LastName" value="Bothe" autocomplete="new-password" required="">
  </div>
  <div style="clear:both"></div>
  <div class="input_wrapper col-left">
    <label for="EmailAddress">Email Address *</label>
    <input type="email" name="EmailAddress" id="EmailAddress" value="misha.bothe@americanfidelity.com" required="">
  </div>
  <div class="input_wrapper col-left">
    <label for="ConfirmEmailAddress">Confirm Email Address *</label>
    <input type="email" name="ConfirmEmailAddress" id="ConfirmEmailAddress" value="misha.bothe@americanfidelity.com" required="">
  </div>
  <div style="clear:both"></div>
  <div class="input_wrapper col-left">
    <label for="Birthday">Birthday * </label>
    <div class="dob-container">
      <input name="dob" id="dobMMDD" type="hidden" value="">
      <select name="month" id="dobMM" required="">
        <option value="">Month</option>
        <option value="01">January</option>
        <option value="02">February</option>
        <option value="03">March</option>
        <option value="04">April</option>
        <option value="05">May</option>
        <option value="06">June</option>
        <option value="07">July</option>
        <option value="08">August</option>
        <option value="09">September</option>
        <option value="10">October</option>
        <option value="11">November</option>
        <option value="12">December</option>
      </select>
      <select name="date" id="dobDD" required="">
        <option value="">Date</option>
        <option value="01">01</option>
        <option value="02">02</option>
        <option value="03">03</option>
        <option value="04">04</option>
        <option value="05">05</option>
        <option value="06">06</option>
        <option value="07">07</option>
        <option value="08">08</option>
        <option value="09">09</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 style="clear:both"></div>
  <div class="input_wrapper">
    <label for="Address">Address</label>
    <input type="text" name="Address" id="Address" value="">
  </div>
  <div class="input_wrapper col-30">
    <label for="City">City</label>
    <input type="text" id="City" name="City" value="">
  </div>
  <div class="input_wrapper col-30">
    <label for="State">State</label>
    <select id="State" name="State">
      <option value="">N/A</option>
      <option value="AK">Alaska</option>
      <option value="AL">Alabama</option>
      <option value="AR">Arkansas</option>
      <option value="AZ">Arizona</option>
      <option value="CA">California</option>
      <option value="CO">Colorado</option>
      <option value="CT">Connecticut</option>
      <option value="DC">District of Columbia</option>
      <option value="DE">Delaware</option>
      <option value="FL">Florida</option>
      <option value="GA">Georgia</option>
      <option value="HI">Hawaii</option>
      <option value="IA">Iowa</option>
      <option value="ID">Idaho</option>
      <option value="IL">Illinois</option>
      <option value="IN">Indiana</option>
      <option value="KS">Kansas</option>
      <option value="KY">Kentucky</option>
      <option value="LA">Louisiana</option>
      <option value="MA">Massachusetts</option>
      <option value="MD">Maryland</option>
      <option value="ME">Maine</option>
      <option value="MI">Michigan</option>
      <option value="MN">Minnesota</option>
      <option value="MO">Missouri</option>
      <option value="MS">Mississippi</option>
      <option value="MT">Montana</option>
      <option value="NC">North Carolina</option>
      <option value="ND">North Dakota</option>
      <option value="NE">Nebraska</option>
      <option value="NH">New Hampshire</option>
      <option value="NJ">New Jersey</option>
      <option value="NM">New Mexico</option>
      <option value="NV">Nevada</option>
      <option value="NY">New York</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="UT">Utah</option>
      <option value="VA">Virginia</option>
      <option value="VT">Vermont</option>
      <option value="WA">Washington</option>
      <option value="WI">Wisconsin</option>
      <option value="WV">West Virginia</option>
      <option value="WY">Wyoming</option>
    </select>
  </div>
  <div class="input_wrapper col-30">
    <label for="ZipCode">Zip Code *</label>
    <input type="text" id="ZipCode" name="ZipCode" value="" minlength="5" required="">
  </div>
  <div style="clear:both"></div>
  <div class="input_wrapper ">
    <h5>Frequency of emails from <span class="brandName"> </span></h5>
    <label for="FrequencyDaily"><input type="radio" id="FrequencyDaily" name="Frequency" value="Daily" required="">Daily</label>
    <label for="FrequencyWeekly"><input type="radio" id="FrequencyWeekly" name="Frequency" value="Weekly" required="" checked="">Weekly</label>
    <label for="FrequencyMonthly"><input type="radio" id="FrequencyMonthly" name="Frequency" value="Monthly" required="">Monthly</label>
  </div>
  <div class="input_wrapper" style="display: none;">
    <h5>Select favorite locations *</h5>
    <div class="fav-locations" id="FavLocations"></div>
  </div>
  <div style="clear:both"></div>
  <p class="error" id="formErrors" style="display:none;text-align:left"></p>
  <div style="clear:both"></div>
  <div class="input_wrapper col-right">
    <button class="btn btn-brand" type="submit">Update</button>
  </div>
  <div class="input_wrapper col-left">
    <!--<button class="btn btn-brand" type="button" onclick="confirmUnsubscribe()">Unsubscribe</button>-->
    <a href="#" onclick="confirmUnsubscribe()">Unsubscribe</a>
  </div>
  <div style="clear:both"></div>
</form>

Text Content

HELLO MISHA BOTHE BOTHE


WELCOME TO YOUR PREFERENCE CENTER! SIMPLY UPDATE YOUR PREFERENCES BELOW AND HIT
"UPDATE". YOUR INFORMATION WILL BE UPDATED.

First Name *
Last Name *

Email Address *
Confirm Email Address *

Birthday *
Month January February March April May June July August September October
November December Date 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19
20 21 22 23 24 25 26 27 28 29 30 31

Address
City
State N/A Alaska Alabama Arkansas Arizona California Colorado Connecticut
District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana
Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota
Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire
New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Puerto
Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia
Vermont Washington Wisconsin West Virginia Wyoming
Zip Code *


FREQUENCY OF EMAILS FROM

Daily Weekly Monthly

SELECT FAVORITE LOCATIONS *







Update
Unsubscribe

 * Accessibility Statement
 * Privacy
 * Website Terms of Use

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Certain activities provided by this website may be covered by U.S. Patent No.
5,930,474