midwest-alliance.com Open in urlscan Pro
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Form analysis
1 forms found in the DOM

POST email.php

<form method="post" id="contact-form" class="jb-form" action="email.php">
  <p class="note">Fields marked with an asterisk (<abbr title="Required Field">*</abbr>) are required.</p>
  <!-- First Name -->
  <p>
    <label for="firstName">First Name <abbr title="Required Field">*</abbr></label>
    <input type="text" name="firstName" id="firstName" class="req" value="">
  </p>
  <!-- Last Name -->
  <p>
    <label for="lastName">Last Name <abbr title="Required Field">*</abbr></label>
    <input type="text" name="lastName" id="lastName" class="req" value="">
  </p>
  <!-- Company Name -->
  <p>
    <label for="company">Company Name</label>
    <input type="text" name="company" id="company" value="">
  </p>
  <!-- Email Address -->
  <p>
    <label for="email">E-mail Address <abbr title="Required Field">*</abbr></label>
    <input type="email" name="email" id="email" class="req email" value="">
  </p>
  <!-- Phone Number-->
  <p>
    <label for="phone">Phone Number <abbr title="Required Field">*</abbr> </label> Please include area code <input type="tel" name="phone" id="phone" class="req phone" value="">
  </p>
  <!-- Preferred Method of Contact-->
  <p>
    <label for="contactMethod">Contact Method </label> Please choose your preferred method of contact <select name="contactMethod" id="contactMethod">
      <option value="Phone">Phone</option>
      <option value="E-mail">E-mail</option>
    </select>
  </p>
  <!-- Not Sending Sensitive Info -->
  <p>
    <label><abbr title="Required Field">*</abbr></label>
    <input id="noSensitive" class="req chkBox inline-block" type="checkbox" name="noSensitive" value="Yes" title="noSensitive" required=""> I agree to not submit or request account specific or sensitive information via email.
  </p>
  <!-- Feedback-->
  <p>
    <label for="comments">Comments / Requests</label>
    <textarea name="comments" id="comments" rows="6" cols="30"></textarea>
  </p>
  <p class="captcha-container">
    <span class="g-recaptcha" data-sitekey="6Ld9VHAUAAAAANSbrTfgCvyjtMej9PGj01Pt_va_"></span>
  </p>
  <div style="width: 304px; height: 78px;">
    <div><iframe title="reCAPTCHA"
        src="https://www.google.com/recaptcha/api2/anchor?ar=1&amp;k=6Ld9VHAUAAAAANSbrTfgCvyjtMej9PGj01Pt_va_&amp;co=aHR0cHM6Ly9taWR3ZXN0LWFsbGlhbmNlLmNvbTo0NDM.&amp;hl=en&amp;v=wqcyhEwminqmAoT8QO_BkXCr&amp;size=normal&amp;cb=ugelpzfza2bk"
        width="304" height="78" role="presentation" name="a-ttd2ofqono3g" frameborder="0" scrolling="no" sandbox="allow-forms allow-popups allow-same-origin allow-scripts allow-top-navigation allow-modals allow-popups-to-escape-sandbox"></iframe>
    </div><textarea id="g-recaptcha-response" name="g-recaptcha-response" class="g-recaptcha-response" style="width: 250px; height: 40px; border: 1px solid rgb(193, 193, 193); margin: 10px 25px; padding: 0px; resize: none; display: none;"></textarea>
  </div><iframe style="display: none;"></iframe>
  <p></p>
  <!-- Submit -->
  <p class="buttons">
    <input class="btn blue" name="submit" type="submit" value="Submit">
  </p>
</form>

Text Content

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 * Who We Are
 * Our History
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CONTACT US

Please do not send or request confidential or account specific information
through email, as email is not a secure form of communication. In addition, we
cannot provide any account specific information via email.

Address: 12140 W. Lakeshore Drive, Brimley, MI. United States of America.

Telephone: +1 (917) 768-6509

Email: info@midwest-alliance.com


Fields marked with an asterisk (*) are required.

First Name *

Last Name *

Company Name

E-mail Address *

Phone Number * Please include area code

Contact Method Please choose your preferred method of contact Phone E-mail

* I agree to not submit or request account specific or sensitive information via
email.

Comments / Requests






"WORKING TOGETHER FOR YOU"

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Need to dispute a transaction on your debit card? Call +1 (917) 768-6509

Copyright © 2023 Midwest Alliance Bank. all rights reserved. Call toll free: +1
(917) 768-6509

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