unitedstates65.com
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Submitted URL: https://65wisconsin.com/
Effective URL: https://unitedstates65.com/
Submission: On September 01 via api from US — Scanned from US
Effective URL: https://unitedstates65.com/
Submission: On September 01 via api from US — Scanned from US
Form analysis
1 forms found in the DOMPOST /#wpcf7-f9-o1
<form action="/#wpcf7-f9-o1" method="post" class="wpcf7-form init" aria-label="Contact form" novalidate="novalidate" data-status="init">
<div style="display: none;">
<input type="hidden" name="_wpcf7" value="9">
<input type="hidden" name="_wpcf7_version" value="5.9.6">
<input type="hidden" name="_wpcf7_locale" value="en_US">
<input type="hidden" name="_wpcf7_unit_tag" value="wpcf7-f9-o1">
<input type="hidden" name="_wpcf7_container_post" value="0">
<input type="hidden" name="_wpcf7_posted_data_hash" value="">
</div>
<h2>Compare Medicare Plans </h2>
<div id="formSection1" class="formSection">
<p><label for="your-name"></label><span class="wpcf7-form-control-wrap" data-name="your-name"><input size="40" maxlength="80" class="wpcf7-form-control wpcf7-text" id="your-name" aria-invalid="false" placeholder="Name" value="" type="text"
name="your-name"></span><br>
<label for="your-phone"></label><span class="wpcf7-form-control-wrap" data-name="your-phone"><input size="40" maxlength="80" class="wpcf7-form-control wpcf7-text" id="your-phone" aria-invalid="false" placeholder="Phone" value="" type="text"
name="your-phone"></span><br>
<label for="your-email"></label><span class="wpcf7-form-control-wrap" data-name="your-email"><input size="40" maxlength="80" class="wpcf7-form-control wpcf7-text" id="your-email" aria-invalid="false" placeholder="Email Address" value=""
type="text" name="your-email"></span><br>
<label for="your-birth"></label><span class="wpcf7-form-control-wrap" data-name="your-birth"><input size="40" maxlength="80" class="wpcf7-form-control wpcf7-text" id="your-birth" aria-invalid="false" placeholder="Age" value="" type="text"
name="your-birth"></span><br>
<input data-open="formSection2" class="openFormSection" value="Start Now" type="button">
</p>
</div>
<div id="formSection2" class="formSection" style="display: none;">
<p><label for="your-zip"></label><span class="wpcf7-form-control-wrap" data-name="your-zip"><input size="40" maxlength="80" class="wpcf7-form-control wpcf7-text" id="your-zip" aria-invalid="false" placeholder="Zip" value="" type="text"
name="your-zip"></span><br>
<label for="your-address"></label><span class="wpcf7-form-control-wrap" data-name="your-address"><input size="40" maxlength="80" class="wpcf7-form-control wpcf7-text" id="your-address" aria-invalid="false" placeholder="Address" value=""
type="text" name="your-address"></span><br>
<label for="your-state"></label><span class="wpcf7-form-control-wrap" data-name="your-state"><select class="wpcf7-form-control wpcf7-select" id="your-state" aria-invalid="false" name="your-state">
<option value="Alaska">Alaska</option>
<option value="Alabama">Alabama</option>
<option value="Arkansas">Arkansas</option>
<option value="American Samoa">American Samoa</option>
<option value="Arizona">Arizona</option>
<option value="California">California</option>
<option value="Colorado">Colorado</option>
<option value="Connecticut">Connecticut</option>
<option value="District of Columbia">District of Columbia</option>
<option value="Delaware">Delaware</option>
<option value="Florida">Florida</option>
<option value="Georgia">Georgia</option>
<option value="Guam">Guam</option>
<option value="Hawaii">Hawaii</option>
<option value="Iowa">Iowa</option>
<option value="Idaho">Idaho</option>
<option value="Illinois">Illinois</option>
<option value="Indiana">Indiana</option>
<option value="Kansas">Kansas</option>
<option value="Kentucky">Kentucky</option>
<option value="Louisiana">Louisiana</option>
<option value="Massachusetts">Massachusetts</option>
<option value="Maryland">Maryland</option>
<option value="Maine">Maine</option>
<option value="Michigan">Michigan</option>
<option value="Minnesota">Minnesota</option>
<option value="Missouri">Missouri</option>
<option value="Northern Mariana Islands">Northern Mariana Islands</option>
<option value="Mississippi">Mississippi</option>
<option value="Montana">Montana</option>
<option value="North Carolina">North Carolina</option>
<option value="North Dakota">North Dakota</option>
<option value="Nebraska">Nebraska</option>
<option value="New Hampshire">New Hampshire</option>
<option value="New Jersey">New Jersey</option>
<option value="New Mexico">New Mexico</option>
<option value="Nevada">Nevada</option>
<option value="New York">New York</option>
<option value="Ohio">Ohio</option>
<option value="Oklahoma">Oklahoma</option>
<option value="Oregon">Oregon</option>
<option value="Pennsylvania">Pennsylvania</option>
<option value="Puerto Rico">Puerto Rico</option>
<option value="Rhode Island">Rhode Island</option>
<option value="South Carolina">South Carolina</option>
<option value="South Dakota">South Dakota</option>
<option value="Tennessee">Tennessee</option>
<option value="Texas">Texas</option>
<option value="United States Minor Outlying Islands">United States Minor Outlying Islands</option>
<option value="Utah">Utah</option>
<option value="Virginia">Virginia</option>
<option value="Virgin Islands, U.S.">Virgin Islands, U.S.</option>
<option value="Vermont">Vermont</option>
<option value="Washington">Washington</option>
<option value="Wisconsin">Wisconsin</option>
<option value="West Virginia">West Virginia</option>
<option value="Wyoming">Wyoming</option>
</select></span><br>
<label for="your-county"></label><span class="wpcf7-form-control-wrap" data-name="your-county"><input size="40" maxlength="80" class="wpcf7-form-control wpcf7-text" id="your-county" aria-invalid="false" placeholder="County" value="" type="text"
name="your-county"></span><br>
<input class="wpcf7-form-control wpcf7-hidden" id="qualifyingCode" value="" type="hidden" name="qualifyingCode"><br>
<input class="wpcf7-form-control wpcf7-hidden" id="landing" value="/" type="hidden" name="landing"><br>
<input class="wpcf7-form-control wpcf7-hidden" id="source" value="" type="hidden" name="source"><br>
<input class="wpcf7-form-control wpcf7-submit has-spinner" id="submitButton" type="submit" value="Submit"><span class="wpcf7-spinner"></span>
</p>
</div>
<div class="wpcf7-response-output" aria-hidden="true"></div>
</form>
Text Content
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