think-goodness.myklpages.com Open in urlscan Pro
2606:4700::6812:159b  Public Scan

Form analysis
1 forms found in the DOM

POST

<form action="" id="preferences_form" method="POST" role="form" class="form-horizontal" novalidate="novalidate">
  <input type="hidden" name="$fields" value="EmailInterests,EmailFrequency,EmailProducts">
  <input type="hidden" name="$list_fields" value="EmailInterests">
  <!-- <input type="hidden" name="$unsubscribed_url" value="/p/preferences_updated" /> -->
  <!-- <input type="hidden" name="$updated_profile_url" value="/p/preferences_updated" /> -->
  <!--<p class="required-fields">
               <span>*</span> Required Information
               </p>-->
  <div class="form-group">
    <label for="email" class="col-sm-3 control-label">Email Address<span class="required" aria-required="true">*</span></label>
    <div class="col-sm-9">
      <input type="email" class="form-control" id="email" name="$email" value="tina.smith-ferrell@bcbsnc.com">
    </div>
  </div>
  <div class="form-group">
    <label for="first_name" class="col-sm-3 control-label">First Name</label>
    <div class="col-sm-9">
      <input type="text" class="form-control" id="first_name" name="$first_name" value="">
    </div>
  </div>
  <div class="form-group">
    <label for="last_name" class="col-sm-3 control-label">Last Name</label>
    <div class="col-sm-9">
      <input type="text" class="form-control" id="last_name" name="$last_name" value="">
    </div>
  </div>
  <!-- Interests -->
  <div class="form-group">
    <label for="interests" class="col-sm-3 control-label">Interests</label>
    <div class="col-sm-9">
      <div class="checkbox">
        <label>
          <input type="checkbox" name="EmailInterests" value="New Releases"> New Product Releases </label>
      </div>
      <div class="checkbox">
        <label>
          <input type="checkbox" name="EmailInterests" value="Promotions"> Promotions &amp; Sales </label>
      </div>
      <div class="checkbox">
        <label>
          <input type="checkbox" name="EmailInterests" value="Events"> Events </label>
      </div>
    </div>
  </div>
  <div class="form-group">
    <label for="interests" class="col-sm-3 control-label">Types of Products</label>
    <div class="col-sm-9">
      <div class="checkbox">
        <label>
          <input type="checkbox" name="EmailProducts" value="Jewelry + Accessories"> Jewelry + Accessories </label>
      </div>
      <div class="checkbox">
        <label>
          <input type="checkbox" name="EmailProducts" value="Beauty"> Beauty </label>
      </div>
      <div class="checkbox">
        <label>
          <input type="checkbox" name="EmailProducts" value="Wellness"> Wellness </label>
      </div>
    </div>
  </div>
  <!-- Frequency -->
  <div class="form-group">
    <label for="interests" class="col-sm-3 control-label">How often would you like to hear from us?</label>
    <div class="col-sm-9">
      <div class="radio">
        <label>
          <!-- Default value. -->
          <input type="radio" name="EmailFrequency" id="email_frequency_0" value="All" checked="checked"> As often as you can send! </label>
      </div>
      <div class="radio">
        <label>
          <input type="radio" name="EmailFrequency" id="email_frequency_1" value="Weekly"> Once or twice a week </label>
      </div>
      <div class="radio">
        <label>
          <input type="radio" name="EmailFrequency" id="email_frequency_2" value="Monthly"> Once or twice a month </label>
      </div>
    </div>
  </div>
  <div class="checkbox">
    <label>
      <input type="checkbox" name="$unsubscribe" value="true">
      <span class="text">Unsubscribe me from all emails.</span>
    </label>
  </div>
  <div class="clearfix form-actions">
    <div class="pull-right">
      <button type="submit" class="btn btn-default btn-primary">Update Preferences</button>
    </div>
  </div>
</form>

Text Content

GET THE GOOD NEWS YOU WANT AND NOTHING MORE!

Email Address*

First Name

Last Name

Interests
New Product Releases
Promotions & Sales
Events
Types of Products
Jewelry + Accessories
Beauty
Wellness
How often would you like to hear from us?
As often as you can send!
Once or twice a week
Once or twice a month
Unsubscribe me from all emails.
Update Preferences

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