aerocareusa.hmebillpay.com Open in urlscan Pro
204.193.153.122  Public Scan

Form analysis
1 forms found in the DOM

POST /Account/Register

<form action="/Account/Register" id="RegisterForm" method="post" novalidate="novalidate"> <input type="hidden" name="VmEmailAddress.IsRegisterFlow" value="true">
  <!-- Nav tabs displayed only on Desktop view -->
  <ul class="nav nav-tabs" role="tablist">
    <li class="active   ">
      <a href=" #createprofile" data-toggle="tab">
                    <div class="media">
                        <div class="media-left">
                            <span>1</span>
                        </div>
                        <div class="media-body width-100">
                            Create user <br>profile
                            <div class="required-message">All fields are required</div>
                        </div>
                    </div>
                </a>
    </li>
    <li class=" ">
      <a href="#summary" data-toggle="tab" class="summaryTab">
                    <div class="media">
                        <div class="media-left">
                            <span>2</span>
                        </div>
                        <div class="media-body">
                            Verification
                        </div>
                    </div>
                </a>
    </li>
  </ul>
  <input name="__RequestVerificationToken" type="hidden" value="mHHTL5z72ApX9fEYjKXwX5S4-A8G-eYAMoesynzuAmWGS1uXoEu7Xijhke_5TWTmSRcJgQhz4bP67Gz1Ivg0F3uxafDLMik2tY6xAdL616Q1"> <!-- Tab panes -->
  <div class="tab-content">
    <!-- Step 1 - Create user profile -->
    <div class="tab-pane active" id="createProfile">
      <div class="panel panel-default">
        <!-- panel-heading displayed only on mobile view / Add 'completed' class next to 'panel-heading' once the form is filled and moved to next step -->
        <div class="panel-heading ">
          <div class="panel-title">
            <a data-toggle="collapse" data-parent=".tabs.horizontal .tab-pane" href="#collapseTabContent1">
                                <div class="media">
                                    <div class="media-left">
                                        <span>1</span>
                                    </div>
                                    <div class="media-body">
                                        Create user profile
                                    </div>
                                </div>
                            </a>
          </div>
        </div><!-- ./panel-heading -->
        <!-- panel-collapse content -->
        <div id="collapseTabContent1" class="panel-collapse collapse show">
          <!-- panel-body -->
          <div class="panel-body">
            <div class="required-message hidden-lg">All fields are required</div>
            <div class="clearfix hidden-lg"></div>
            <!--First Name-->
            <div class="form-group">
              <label for="ProfileUserInfo.FirstName"><span>First name</span></label>
              <span class="field-validation-valid" data-valmsg-for="FirstName" data-valmsg-replace="true"></span>
              <input class="form-control" data-val="true" data-val-length="First Name cannot exceed maximum length of 40 characters." data-val-length-max="40" data-val-regex="First Name is invalid." data-val-regex-pattern="^[a-zA-Z .\-']+$"
                data-val-required="Required" id="FirstName" maxlength="40" name="FirstName" type="text" value="">
            </div>
            <!--Last Name-->
            <div class="form-group">
              <label for="ProfileUserInfo.LastName"><span>Last name</span></label>
              <span class="field-validation-valid" data-valmsg-for="LastName" data-valmsg-replace="true"></span>
              <input class="form-control" data-val="true" data-val-length="Last Name cannot exceed maximum length of 40 characters." data-val-length-max="40" data-val-regex="Last Name is invalid." data-val-regex-pattern="^[a-zA-Z- .'_\- 0-9]+$"
                data-val-required="Required" id="LastName" maxlength="40" name="LastName" type="text" value="">
            </div>
            <!--Email address-->
            <div class="form-group">
              <label for="emailAddress"><span>Email address</span></label>
              <input data-val="true" data-val-required="The IsExistsCheck field is required." id="VmEmailAddress_IsExistsCheck" name="VmEmailAddress.IsExistsCheck" type="hidden" value="True">
              <span class="field-validation-valid" data-valmsg-for="VmEmailAddress.EmailAddress" data-valmsg-replace="true" id="emailError"></span>
              <input class="form-control" autocomplete="off" data-val="true" data-val-email="The Email Address field is not a valid e-mail address." data-val-length="Email Address cannot exceed maximum length of 100 characters."
                data-val-length-max="100" data-val-remote="The email address entered is invalid. It has appeared in our system as a bounced email. Please enter a valid email address."
                data-val-remote-additionalfields="*.EmailAddress,*.IsExistsCheck,*.IsRegisterFlow" data-val-remote-type="POST" data-val-remote-url="/Misc/IsValidEmail" data-val-required="Required" id="VmEmailAddress_EmailAddress" maxlength="50"
                name="VmEmailAddress.EmailAddress" oncopy="return false;" oncut="return false;" ondrag="return false;" ondrop="return false;" onpaste="return false;" onselectstart="return false;" type="text" value="">
              <p class="opacity-60 m-t-10"><small><i>You will use this email to sign in to your profile after registration</i></small></p>
            </div>
            <!--Confirm email address-->
            <div class="form-group">
              <label for="confirmEmailAddress"><span>Confirm email address</span></label>
              <span class="field-validation-valid" data-valmsg-for="VmEmailAddress.ConfirmEmail" data-valmsg-replace="true"></span>
              <input class="form-control" autocomplete="off" data-val="true" data-val-email="The Email Address field is not a valid e-mail address." data-val-equalto="Emails do not match." data-val-equalto-other="*.EmailAddress"
                data-val-length="Email Address cannot exceed maximum length of 100 characters." data-val-length-max="100" data-val-required="Required" id="VmEmailAddress_ConfirmEmail" maxlength="50" name="VmEmailAddress.ConfirmEmail"
                oncopy="return false;" oncut="return false;" ondrag="return false;" ondrop="return false;" onpaste="return false;" onselectstart="return false;" type="text" value="">
            </div>
            <p class="m-t-30 "><small>Click to continue to the registration process; an email will be sent to the email address you’ve provided.</small></p>
          </div>
          <button id="btnCreateUserProfile" type="button" class="btn btn-default desk-pull-right center-block width-280 m-t-30 m-t-md-20 m-b-30 disable">Continue Registration Process</button>
        </div>
      </div>
    </div>
    <!-- Step 3 - Summary -->
    <div class="tab-pane " id="summary">
      <div class="panel panel-default">
        <!-- panel-heading displayed only on mobile view / Add 'completed' class next to 'panel-heading' once the form is filled and moved to next step -->
        <div class="panel-heading ">
          <div class="panel-title">
            <a data-toggle="collapse" data-parent=".tabs.horizontal .tab-pane" href="#collapseTabContent1">
                                <div class="media">
                                    <div class="media-left">
                                        <span>2</span>
                                    </div>
                                    <div class="media-body">
                                        Verification
                                    </div>
                                </div>
                            </a>
          </div>
        </div><!-- ./panel-heading -->
        <div id="collapseTabContent1" class="panel-collapse collapse ">
          <div class="panel-body">
            <div class="media  p-b-20 p-l-md-0">
              <div class="media-body">
                <p> Hey , <br>
                  <br> An email has been sent to <b></b>. Open the email and click the link to validate the email address and continue the registration process. <br><br> If you do not receive a verification email, please check your spam/junk folders.
                  If you do not receive the verification email within 24 hours, please register again. If you still do not receive the verification email, please contact our office.
                </p>
              </div>
            </div>
          </div>
        </div>
      </div>
    </div>
  </div><!-- ./tab-content -->
</form>

Text Content

CLOSE

Login
 * Home
 * FAQs
 * Contact
 * Make payment


REGISTER

 * 1
   Create user
   profile
   All fields are required
 * 2
   Verification

1
Create user profile
All fields are required

First name
Last name
Email address

You will use this email to sign in to your profile after registration

Confirm email address

Click to continue to the registration process; an email will be sent to the
email address you’ve provided.

Continue Registration Process
2
Verification

Hey ,

An email has been sent to . Open the email and click the link to validate the
email address and continue the registration process.

If you do not receive a verification email, please check your spam/junk folders.
If you do not receive the verification email within 24 hours, please register
again. If you still do not receive the verification email, please contact our
office.


 * Home
 * FAQ
 * Contact
 * Privacy Policy

© 2018 Brightree, All Rights Reserved.