withgrayce53177.activehosted.com
Open in
urlscan Pro
2606:4700::6811:586d
Public Scan
Submitted URL: https://withgrayce53177.lt.acemlna.com/Prod/link-tracker?redirectUrl=aHR0cHMlM0ElMkYlMkZ3aXRoZ3JheWNlNTMxNzcuYWN0aXZlaG9zdGVkLmNvbSUyRm...
Effective URL: https://withgrayce53177.activehosted.com/f/1?email=Tiffany.Tuck@bcbsnc.com&utm_source=Newsletter&utm_medium=email&utm_content=Introducing...
Submission: On July 11 via api from US — Scanned from DE
Effective URL: https://withgrayce53177.activehosted.com/f/1?email=Tiffany.Tuck@bcbsnc.com&utm_source=Newsletter&utm_medium=email&utm_content=Introducing...
Submission: On July 11 via api from US — Scanned from DE
Form analysis
1 forms found in the DOMPOST https://withgrayce53177.activehosted.com/proc.php
<form method="POST" action="https://withgrayce53177.activehosted.com/proc.php" id="_form_1_" class="_form _form_1 _inline-form _dark" novalidate="" data-styles-version="0">
<input type="hidden" name="u" value="1" data-name="u">
<input type="hidden" name="f" value="1" data-name="f">
<input type="hidden" name="s" data-name="s">
<input type="hidden" name="c" value="0" data-name="c">
<input type="hidden" name="m" value="0" data-name="m">
<input type="hidden" name="act" value="sub" data-name="act">
<input type="hidden" name="v" value="2" data-name="v">
<input type="hidden" name="or" value="45d544aa8e9063f56970fb3867b63010" data-name="or">
<div class="_form-content">
<div class="_form_element _x82619753 _full_width _clear">
<div class="_form-title"> Communication Preferences </div>
</div>
<div class="_form_element _x96852629 _full_width _clear">
<div class="_html-code">
</div>
</div>
<div class="_form_element _x94879475 _full_width ">
<label for="email" class="_form-label"> Work Email* </label>
<div class="_field-wrapper">
<input type="text" id="email" name="email" placeholder="Type your email" required="" data-name="email">
</div>
</div>
<div class="_form_element _x71907938 _full_width ">
<fieldset class="_form-fieldset">
<div class="_row">
<legend for="field[15][]" class="_form-label"> As your employee benefit, we'll only send you what you're interested in. What would be valuable to hear from Grayce about? </legend>
</div>
<input data-autofill="false" type="hidden" id="field[15][]" name="field[15][]" value="~|" data-name="communicationpreferences">
<div class="_row _checkbox-radio">
<input id="field_15Quarterly live events" type="checkbox" name="field[15][]" value="Quarterly live events" data-name="communicationpreferences">
<span>
<label for="field_15Quarterly live events"> Quarterly live events </label>
</span>
</div>
<div class="_row _checkbox-radio">
<input id="field_15Quarterly updates to your benefit" type="checkbox" name="field[15][]" value="Quarterly updates to your benefit" data-name="communicationpreferences">
<span>
<label for="field_15Quarterly updates to your benefit"> Quarterly updates to your benefit </label>
</span>
</div>
<div class="_row _checkbox-radio">
<input id="field_15None, I don't want any information about my benefit" type="checkbox" name="field[15][]" value="None, I don't want any information about my benefit" data-name="communicationpreferences">
<span>
<label for="field_15None, I don't want any information about my benefit"> None, I don't want any information about my benefit </label>
</span>
</div>
</fieldset>
</div>
<div class="_button-wrapper _full_width">
<button id="_form_1_submit" class="_submit" type="submit"> Submit </button>
</div>
<div class="_clear-element">
</div>
</div>
<div class="_form-thank-you" style="display:none;">
</div>
</form>
Text Content
Communication Preferences Work Email* As your employee benefit, we'll only send you what you're interested in. What would be valuable to hear from Grayce about? Quarterly live events Quarterly updates to your benefit None, I don't want any information about my benefit Submit