claims.surewise.com Open in urlscan Pro
2606:4700:3108::ac42:2916  Public Scan

Form analysis
2 forms found in the DOM

<form wire:submit.prevent="authenticate" class="p-8 space-y-8 bg-white/50 backdrop-blur-xl border border-gray-200 shadow-2xl rounded-2xl relative filament-breezy-auth-card">
  <div class="w-full flex justify-center">
    <img src="https://claims.surewise.com/img/logo.png" class="h-8 w-auto">
  </div>
  <div>
    <h2 class="font-bold tracking-tight text-center text-2xl"> Sign in to your account </h2>
  </div>
  <div class="grid grid-cols-1      filament-forms-component-container gap-6">
    <div class="col-span-1" wire:key="GLKQyf1EHslGNleZjrFT.email.Filament\Forms\Components\TextInput">
      <div class="filament-forms-field-wrapper">
        <div class="space-y-2">
          <div class="flex items-center justify-between space-x-2 rtl:space-x-reverse">
            <label class="filament-forms-field-wrapper-label inline-flex items-center space-x-3 rtl:space-x-reverse" for="email">
              <span class="text-sm font-medium leading-4 text-gray-700"> Email address <sup class="font-medium text-danger-700">*</sup>
              </span>
            </label>
          </div>
          <div class="filament-forms-text-input-component flex items-center space-x-2 rtl:space-x-reverse group">
            <div class="flex-1">
              <input x-data="{}" wire:model.defer="email" type="email" dusk="filament.forms.email" autocomplete="on" id="email" required=""
                class="block w-full transition duration-75 rounded-lg shadow-sm outline-none focus:border-primary-500 focus:ring-1 focus:ring-inset focus:ring-primary-500 disabled:opacity-70 border-gray-300" x-bind:class="{
                    'border-gray-300': ! ('email' in $wire.__instance.serverMemo.errors),
                    'dark:border-gray-600': ! ('email' in $wire.__instance.serverMemo.errors) &amp;&amp; false,
                    'border-danger-600 ring-danger-600': ('email' in $wire.__instance.serverMemo.errors),
                    'dark:border-danger-400 dark:ring-danger-400': ('email' in $wire.__instance.serverMemo.errors) &amp;&amp; false,
                }">
            </div>
          </div>
        </div>
      </div>
    </div>
    <div class="col-span-1" wire:key="GLKQyf1EHslGNleZjrFT.password.Filament\Forms\Components\TextInput">
      <div class="filament-forms-field-wrapper">
        <div class="space-y-2">
          <div class="flex items-center justify-between space-x-2 rtl:space-x-reverse">
            <label class="filament-forms-field-wrapper-label inline-flex items-center space-x-3 rtl:space-x-reverse" for="password">
              <span class="text-sm font-medium leading-4 text-gray-700"> Password <sup class="font-medium text-danger-700">*</sup>
              </span>
            </label>
          </div>
          <div class="filament-forms-text-input-component flex items-center space-x-2 rtl:space-x-reverse group">
            <div class="flex-1">
              <input x-data="{}" wire:model.defer="password" type="password" dusk="filament.forms.password" id="password" required=""
                class="block w-full transition duration-75 rounded-lg shadow-sm outline-none focus:border-primary-500 focus:ring-1 focus:ring-inset focus:ring-primary-500 disabled:opacity-70 border-gray-300" x-bind:class="{
                    'border-gray-300': ! ('password' in $wire.__instance.serverMemo.errors),
                    'dark:border-gray-600': ! ('password' in $wire.__instance.serverMemo.errors) &amp;&amp; false,
                    'border-danger-600 ring-danger-600': ('password' in $wire.__instance.serverMemo.errors),
                    'dark:border-danger-400 dark:ring-danger-400': ('password' in $wire.__instance.serverMemo.errors) &amp;&amp; false,
                }">
            </div>
          </div>
        </div>
      </div>
    </div>
    <div class="col-span-1" wire:key="GLKQyf1EHslGNleZjrFT.remember.Filament\Forms\Components\Checkbox">
      <div class="filament-forms-field-wrapper">
        <div class="space-y-2">
          <div class="flex items-center justify-between space-x-2 rtl:space-x-reverse">
            <label class="filament-forms-field-wrapper-label inline-flex items-center space-x-3 rtl:space-x-reverse" for="remember">
              <input wire:loading.attr="disabled" id="remember" type="checkbox" wire:model.defer="remember" dusk="filament.forms.remember"
                class="filament-forms-checkbox-component text-primary-600 transition duration-75 rounded shadow-sm focus:border-primary-500 focus:ring-2 focus:ring-primary-500 disabled:opacity-70 border-gray-300">
              <span class="text-sm font-medium leading-4 text-gray-700"> Remember me </span>
            </label>
          </div>
        </div>
      </div>
    </div>
  </div>
  <button type="submit" wire:loading.attr="disabled" x-data="{
            form: null,
            isUploadingFile: false,
        }" x-bind:class="{ 'opacity-70 cursor-wait': isUploadingFile }" x-bind:disabled="isUploadingFile" x-init="
            form = $el.closest('form')

            form?.addEventListener('file-upload-started', () => {
                isUploadingFile = true
            })

            form?.addEventListener('file-upload-finished', () => {
                isUploadingFile = false
            })
        "
    class="filament-button filament-button-size-md inline-flex items-center justify-center py-1 gap-1 font-medium rounded-lg border transition-colors outline-none focus:ring-offset-2 focus:ring-2 focus:ring-inset min-h-[2.25rem] px-4 text-sm text-white shadow focus:ring-white border-transparent bg-primary-600 hover:bg-primary-500 focus:bg-primary-700 focus:ring-offset-primary-700 w-full">
    <span class="flex items-center gap-1">
      <span class=""> Sign in </span>
    </span>
  </button>
  <div class="text-center">
    <a class="text-primary-600 hover:text-primary-700" href="https://claims.surewise.com/password/reset">Forgot password?</a>
  </div>
</form>

<form wire:submit.prevent="callMountedFormComponentAction">
  <div x-data="{

        isOpen: false,

        livewire: null,

        close: function () {
            this.isOpen = false

            this.$refs.modalContainer.dispatchEvent(new CustomEvent('modal-closed', { id: 'GLKQyf1EHslGNleZjrFT-form-component-action' }))
        },

        open: function () {
            this.isOpen = true

            this.$refs.modalContainer.dispatchEvent(new CustomEvent('modal-opened', { id: 'GLKQyf1EHslGNleZjrFT-form-component-action' }))
        },

    }" x-trap.noscroll="isOpen" x-on:close-modal.window="if ($event.detail.id === 'GLKQyf1EHslGNleZjrFT-form-component-action') close()" x-on:open-modal.window="if ($event.detail.id === 'GLKQyf1EHslGNleZjrFT-form-component-action') open()"
    role="dialog" aria-modal="true" class="filament-modal block" wire:ignore.self="">
    <div x-show="isOpen" x-transition.duration.300ms.opacity="" class="fixed inset-0 z-40 min-h-full overflow-y-auto overflow-x-hidden transition flex items-center" style="display: none;">
      <div x-on:click="$dispatch('close-modal', { id: 'GLKQyf1EHslGNleZjrFT-form-component-action' })" aria-hidden="true" class="filament-modal-close-overlay fixed inset-0 w-full h-full bg-black/50 cursor-pointer"></div>
      <div x-ref="modalContainer" class="relative w-full cursor-pointer pointer-events-none transition my-auto p-4" x-init="livewire = $wire.__instance"
        x-on:modal-closed.stop="if ('mountedFormComponentAction' in livewire?.serverMemo.data) livewire.set('mountedFormComponentAction', null)">
        <div x-data="{ isShown: false }" x-init="$nextTick(()=> {
                    isShown = isOpen
                    $watch('isOpen', () => isShown = isOpen)
                })" x-show="isShown" x-on:keydown.window.escape="$dispatch('close-modal', { id: 'GLKQyf1EHslGNleZjrFT-form-component-action' })" x-transition:enter="ease duration-300" x-transition:leave="ease duration-300"
          x-transition:enter-start="translate-y-8" x-transition:enter-end="translate-y-0" x-transition:leave-start="translate-y-0" x-transition:leave-end="translate-y-8"
          class="filament-modal-window w-full py-2 bg-white cursor-default pointer-events-auto relative rounded-xl mx-auto hidden max-w-sm" style="display: none;">
          <button tabindex="-1" type="button" class="absolute top-2 right-2 rtl:right-auto rtl:left-2" x-on:click="$dispatch('close-modal', { id: 'GLKQyf1EHslGNleZjrFT-form-component-action' })">
            <svg title="Close" tabindex="-1" class="filament-modal-close-button h-4 w-4 cursor-pointer text-gray-400" xmlns="http://www.w3.org/2000/svg" viewBox="0 0 20 20" fill="currentColor" aria-hidden="true">
              <path fill-rule="evenodd" d="M4.293 4.293a1 1 0 011.414 0L10 8.586l4.293-4.293a1 1 0 111.414 1.414L11.414 10l4.293 4.293a1 1 0 01-1.414 1.414L10 11.414l-4.293 4.293a1 1 0 01-1.414-1.414L8.586 10 4.293 5.707a1 1 0 010-1.414z"
                clip-rule="evenodd"></path>
            </svg>
            <span class="sr-only"> Close </span>
          </button>
          <div class="">
            <div class="space-y-2">
            </div>
            <div class="filament-modal-content space-y-2 p-2">
            </div>
            <div class="space-y-2">
            </div>
          </div>
        </div>
      </div>
    </div>
  </div>
</form>

Text Content

SIGN IN TO YOUR ACCOUNT

Email address *

Password *

Remember me
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