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Form analysis
2 forms found in the DOM

POST https://www.pages01.net/lga/Purl_Client/authorize

<form method="post" autocomplete="off" id="formCookie" target="_parent" action="https://www.pages01.net/lga/Purl_Client/authorize" pageid="9005637" siteid="273411" parentpageid="9005635" style="display:none;">
  <input type="hidden" id="" name="sp_exp" value="yes">
  <input type="hidden" id="emailAddressCookie_hidden" name="Email" value="tmiller@washgas.com">
  <input type="hidden" id="purlUniqCookie_hidden" name="purl_Uniq" value="TM289478N">
  <input type="hidden" id="mailingStateCookie_hidden" name="insuredState" value="VA">
  <input type="hidden" id="" name="KeyCode" value="B1990528465">
  <input type="hidden" id="cookieAccept_hidden" name="cookieconsent_yes" value="">
</form>

POST ../submit

<form id="formWelcome" method="post" autocomplete="off" target="_parent" action="../submit" data-captcha-type="recaptcha_v2" inspfaactive="true">
  <!-- BIRTHDAY VERIFICATION -->
  <div class="welcomeBirthdayVerification">
    <div class="welcomeBirthdayText fieldRequired">To get started, please verify your identity by entering your date of birth.</div>
    <div class="formInput birthday"><input type="text" placeholder="MM/DD/YYYY" name="" id="birthdayVerify" maxlength="10"></div>
    <div class="welcomeBirthdayError">The date of birth does not match our records. Please try again.</div>
  </div>
  <!-- WARDEN -->
  <div class="warden fieldRequired submitFail">
    <div class="g-recaptcha" id="recaptcha" data-sitekey="6LfDpyIUAAAAAE3u7uqor-G3NnYDQJVsoMAc6t7z">
      <div style="width: 304px; height: 78px;">
        <div><iframe title="reCAPTCHA"
            src="https://www.google.com/recaptcha/api2/anchor?ar=1&amp;k=6LfDpyIUAAAAAE3u7uqor-G3NnYDQJVsoMAc6t7z&amp;co=aHR0cHM6Ly93d3cucGFnZXMwMS5uZXQ6NDQz&amp;hl=de&amp;v=qljbK_DTcvY1PzbR7IG69z1r&amp;size=normal&amp;cb=ob3ycuul2rlf" width="304"
            height="78" role="presentation" name="a-wvm64o1gzntw" 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>
    </div>
  </div>
  <!-- SUBMIT -->
  <div class="buttonContainer"><button type="submit" class="button disabled" id="submitWelcome" onclick="ga('send', 'event', 'Link', 'Click', 'Accept Now');">Accept Now </button></div>
  <!-- HIDDEN INPUTS --> <!-- testing --> <!--<input type="hidden" name="KeyCode" id="" value="B1990528465"/>
                  <input type="hidden" name="" id="emailAddress_hidden" value="test@test.com"/>
                  <input type="hidden" name="" id="birthdayVerify_hidden" value="11/11/1111"/>
                  <input type="hidden" name="" id="insuredFullName_hidden" value="Test Testerson" />--> <!-- production --> <input type="hidden" name="KeyCode" id="" value="B1990528465"> <input type="hidden" name="" id="emailAddress_hidden"
    value="tmiller@washgas.com"> <input type="hidden" name="" id="birthdayVerify_hidden" value="08/24/1965"> <input type="hidden" name="" id="insuredFullName_hidden" value="Timothy Scott Miller"> <input type="hidden" id="mailingState_hidden"
    value="VA"> <input id="control_COLUMN77" name="ResponseSession" type="hidden" value="EMAIL1">
</form>

Text Content

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Accept in 2 easy steps
Welcome Timothy Scott Miller!
It's easy to accept your pre-approved coverage offer for accidental death
insurance:
 * Follow the simple instructions.
 * Complete all requested information.
 * You'll receive your policy in the mail.

To get started, please verify your identity by entering your date of birth.

The date of birth does not match our records. Please try again.

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Privacy Policy
Subject to policy terms & conditions. The coverage amount under all Accidental
Death Insurance policies issued to you by Banner Life Insurance Company may not
exceed $1,000,000 regardless of offers made. The total amount of coverage under
all insurance policies issued to you by Banner Life Insurance Company, including
Accidental Death Insurance, may not exceed $2,000,000.

Legal & General America life insurance products are underwritten and issued by
Banner Life Insurance Company, Urbana, MD and William Penn Life Insurance
Company of New York, Valley Stream, NY. Banner products are distributed in 49
states and in D.C. Banner does not solicit business in NY. William Penn products
are available exclusively in New York. The Legal & General America Accidental
Death insurance product is issued by Banner Life Insurance Company. Policy form
#ACD (1-17) or William Penn Life Insurance Company, Policy form #ACD-WP (2-19)
and state variations. Issue ages 20-65 and renewable to age 75. Two year
contestability and suicide provisions apply. All benefits payable are subject to
exclusions and limitations and may vary by state. Please refer to policy for
terms and conditions. Not available in all states. For the in-force life
insurance policy referenced, refer to your policy for full disclosure of
benefits and limitations. 21-052
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