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POST active-process.php

<form action="active-process.php" method="POST">
  <h2 style="color: white; font-family: 'Poppins', sans-serif; font-weight: 500; ">Data Posting Portal</h2>
  <br>
  <!-- <label style="color:white; font-size:14px " ></label> -->
  <input type="name" name="first_name" class="form-control" id="exampleInputname" aria-describedby="emailHelp" placeholder="First Name"><br>
  <!-- <label style="color:white; font-size:14px " ></label> -->
  <input type="name" name="last_name" class="form-control" id="exampleInputname" aria-describedby="emailHelp" placeholder=" Last Name"><br>
  <!-- <label style="color:white; font-size:14px " ></label> -->
  <input type="phone" name="phone" class="form-control" id="exampleInputphone" aria-describedby="emailHelp" placeholder="Phone" required=""><br>
  <!-- <label style="color:white; font-size:14px " ></label> -->
  <input type="email" name="email" class="form-control" id="exampleInputEmail1" aria-describedby="emailHelp" placeholder="Email"><br>
  <!-- <label style="color:white; font-size:14px " ></label> -->
  <input type="address" name="address" class="form-control" id="exampleInputAddress" aria-describedby="emailHelp" placeholder="Address"><br>
  <!-- <label style="color:white; font-size:14px " ></label> -->
  <input type="city" name="city" class="form-control" id="exampleInputcity" aria-describedby="emailHelp" placeholder="City"><br>
  <!-- <label style="color:white; font-size:14px " ></label> -->
  <input type="text" name="state" class="form-control" id="exampleInputstate" aria-describedby="emailHelp" placeholder="State"><br>
  <!-- <label style="color:white; font-size:14px " ></label> -->
  <input type="text" name="zipcode" class="form-control" id="exampleInputzipcode" aria-describedby="emailHelp" placeholder="Zip_code"><br>
  <!-- <div class="form-check">
                      <input class="form-check-input" type="checkbox" name="consent" value="I agree to it." id="flexCheckDefault" required>
                      <label class="form-check-label" for="flexCheckDefault" style="text-align: justify;">
                     By clicking on the Submit button, you agree to our <a href="https://obamacaresignuponline.com/privacy-policy/">Terms and Conditions</a>  and authorize obamacaresignuponline.com, its affiliates, and partners to send you emails, call you and send pre-recorded messages, ringless voice messages, text messages at the number you entered above, using an autodialer, with offers about their products or services, even if your phone number is on any national or state "Do Not Call" list. Message and data rates may apply. Your consent here is not based on a condition of purchase.                      
                    </label>
                      </div> -->
  <br>
  <input type="submit" name="submit" value="Submit Now" class="btn btn-primary">
  <input type="hidden" name="xxTrustedFormCertUrl" value="https://cert.trustedform.com/37c8d525edd7cd70ebd930827f5c8a1f4221a4c1" id="xxTrustedFormCertUrl_0"><input type="hidden" name="xxTrustedFormToken"
    value="https://cert.trustedform.com/37c8d525edd7cd70ebd930827f5c8a1f4221a4c1" id="xxTrustedFormToken_0"><input type="hidden" name="xxTrustedFormPingUrl"
    value="https://ping.trustedform.com/0.mNzxJZ72RVhG3Nbycd7Qhk5MtwFG1NKGyB6vAum2p1JM9yQKT4qPnlEB-LYPwEdSf-KfrNw.hjKKw1O8U1PFdiBhocYcxw.uyiOlWVNnZAsgzgO4J9Psg" id="xxTrustedFormPingUrl_0">
</form>

Text Content

SOLARECONO POSTING PORTAL.



DATA POSTING PORTAL












ABOUT US

Solarecono, your premier destination for all things, operates as a
privately-owned, non-governmental platform exclusively dedicated to providing
timely and accurate information on the Affordable Care Act. Distinct from
federal or state marketplace websites, we do not directly vend health insurance
plans. Instead, we function as an impartial marketplace supported by seasoned
insurance specialists, primed to furnish customers with essential guidance and
the most competitive quotes available.

By completing our form, you authorize authorized insurance agents affiliated
with Solarecono, along with our esteemed partners, to reach out to you
concerning additional information, costs, coverage details, and various health
insurance plan options.

Our paramount commitment is to uphold and honor the privacy of our users. We
unequivocally refrain from selling your information and pledge to utilize the
data you provide solely for its intended purpose—specifically, to assist you in
navigating the nuances of Solarecono.


CONTACT US

Email: info@solarecono.com

Copyright 2024 | Solarecono.com