ay.os33.com Open in urlscan Pro
142.147.8.8  Public Scan

Form analysis
2 forms found in the DOM

<form role="form">
  <div class="input-fields">
    <div class="form-group"><input id="user_name" class="form-control" required="" type="text" placeholder="Username"></div>
  </div>
  <div class="form-submit-section"><a tabindex="0" id="login-btn" class="button button-prime signInBtn ">Next</a>
    <div class="remember-me">
      <div class="checkbox-wrapper">
        <div class="checkbox-icon"><img src="d3fc9c84aba07e87d78c9a61960340d0.png" srcset="b6e077c1d91feb5afba6424b24e5d533.png 2x, 12d40b200dcdd375c456ecfd353e76a1.png 3x" alt="checkbox" class="hidden"></div><label>Remember username</label>
      </div>
    </div>
    <div class="form-submit d-flex justify-content-between align-items-center"><a class="get-help-link ">Get help<span class="">&nbsp;from The Guardian Life Insurance Company of America</span></a></div>
  </div><input type="submit" class="hidden-submit-input">
</form>

<form class="row no-gutters">
  <div class="user-info col p-0 col-6 pr-3">
    <div class="form-group"><label for="userName">Your name</label><input class="form-control " id="userName" name="userName" type="text"></div>
    <div class="form-group"><label for="email">Work email</label><input class="form-control " id="email" name="email" type="email"></div>
  </div>
  <div class="user-info col p-0 col-6 pl-3">
    <div class="form-group "><label for="company">Company</label><input class="form-control" id="company" name="company" type="text"></div>
    <div class="form-group"><label>Phone</label>
      <div class="react-tel-input" data-test-id="src_reacttelephoneinput_test_id_4">
        <div class="flag-dropdown" data-test-id="src_reacttelephoneinput_test_id_6" tabindex="0"><button class="selected-flag" title="United States: + 1" data-test-id="src_reacttelephoneinput_test_id_7" type="button">
            <div class="flag us" data-test-id="src_reacttelephoneinput_test_id_8" style="background-image: url(&quot;img/flags.png&quot;);">
              <div class="arrow" data-test-id="src_reacttelephoneinput_test_id_9"></div>
            </div>
          </button></div><input type="tel" class="form-control" autocomplete="tel" placeholder="+1 (702) 123-4567" data-test-id="src_reacttelephoneinput_test_id_5">
      </div>
    </div>
  </div>
  <div class="ticket-content col col-12">
    <div class="form-group"><label for="ticketContent">How can we help you?</label><textarea class="form-control " id="ticketContent" name="ticketContent" cols="30" rows="10" maxlength="512"></textarea></div>
  </div><input type="submit" class="hidden">
</form>

Text Content

Next

Remember username
Get help from The Guardian Life Insurance Company of America


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