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Submitted URL: https://order.weshield.us/e3t/Btc/RI+113/cZZj304/VVCH8S3_7CvXVsRrn75YCh6pW4nNzqf4FfrxJN4313HX3lLBmV1-WJV7CgZRyN2wDbtQQNlCN...
Effective URL: https://share.hsforms.com/1kdDNZHOrTR-ckK9_EJfzdg4vbx3?utm_medium=email&_hsmi=203127482&_hsenc=p2ANqtz-8T8VoRBVEvywZwzrDfi...
Submission: On February 08 via api from US — Scanned from US
Effective URL: https://share.hsforms.com/1kdDNZHOrTR-ckK9_EJfzdg4vbx3?utm_medium=email&_hsmi=203127482&_hsenc=p2ANqtz-8T8VoRBVEvywZwzrDfi...
Submission: On February 08 via api from US — Scanned from US
Form analysis 1 forms found in the DOM
<form id="hs-form-91d0cd64-73ab-4d1f-9c90-af7f1097f376-37d339bc-bbf3-4e21-9c94-77039631a604" class="hs-form-91d0cd64-73ab-4d1f-9c90-af7f1097f376 hs-form hs-form_theme-canvas" data-instance-id="37d339bc-bbf3-4e21-9c94-77039631a604"
data-form-id="91d0cd64-73ab-4d1f-9c90-af7f1097f376" data-portal-id="8180247" lang="en" data-hs-cf-bound="true">
<div class="hs-form__pagination-content-container">
<div class="hs-form__row">
<div class="hs-form__group">
<div class="hs-form__richtext"><img src="https://f.hubspotusercontent40.net/hubfs/8180247/WeShield%20logo%20new%20no%20bkgd.png" style="max-width: 100%; max-height: 100%; display:block; margin-left:auto; margin-right:auto;"
alt="WeShield logo new no bkgd" width="200" data-img-aspect-ratio="1"></div>
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<div class="hs-form__row">
<div class="hs-form__group">
<div class="hs-form__richtext">
<p style="text-align: center;"><span style="font-family: 'Trebuchet MS', Geneva, Tahoma, sans-serif;">Complete the form below to secure lowest pricing </span><span style="font-family: 'Trebuchet MS', Geneva, Tahoma, sans-serif;">on rapid
at-home and</span></p>
<p style="text-align: center;"><span style="font-family: 'Trebuchet MS', Geneva, Tahoma, sans-serif;">point-of-care COVID-19 test kits and to learn about our insurance reimbursement claims processing service.</span></p>
<p style="text-align: center;"><span style="font-family: 'Trebuchet MS', Geneva, Tahoma, sans-serif;">\</span></p>
<p style="text-align: center;"><img src="https://f.hubspotusercontent40.net/hubfs/8180247/iStock-1227389598-1.jpg" alt="iStock-1227389598-1" width="400" loading="lazy"
style="width: 400px; max-width: 400px; margin-left: auto; margin-right: auto; display: block;"></p>
<p> </p>
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<div class="hs-form__row">
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<div class="hs-form__field-row">
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<div class="hs-form__field hs-form__field-email hs-email"><label id="email-label" for="email-input" class="hs-form__field__label hs-form__field__label--required" data-required="true"><span>Email</span></label><input id="email-input"
class="hs-form__field__input" type="email" name="email" required="" autocomplete="email" inputmode="email" aria-invalid="false" aria-required="true" aria-labelledby="email-label" aria-describedby="email-description" value=""></div>
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<div class="hs-form__row">
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<div class="hs-form__field hs-form__field-firstname hs-firstname"><label id="firstname-label" for="firstname-input" class="hs-form__field__label hs-form__field__label--required" data-required="true"><span>First name</span></label><input
id="firstname-input" class="hs-form__field__input" type="string" name="firstname" required="" autocomplete="given-name" inputmode="text" aria-invalid="false" aria-required="true" aria-labelledby="firstname-label"
aria-describedby="firstname-description" value=""></div>
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<div class="hs-form__field-row__column">
<div class="hs-form__field hs-form__field-lastname hs-lastname"><label id="lastname-label" for="lastname-input" class="hs-form__field__label hs-form__field__label--required" data-required="true"><span>Last name</span></label><input
id="lastname-input" class="hs-form__field__input" type="string" name="lastname" required="" autocomplete="family-name" inputmode="text" aria-invalid="false" aria-required="true" aria-labelledby="lastname-label"
aria-describedby="lastname-description" value=""></div>
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<div class="hs-form__row">
<div class="hs-form__group">
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<div class="hs-form__field hs-form__field-company hs-company"><label id="company-label" for="company-input" class="hs-form__field__label" data-required="false"><span>Company name</span></label><input id="company-input"
class="hs-form__field__input" type="string" name="company" autocomplete="organization" inputmode="text" aria-invalid="false" aria-required="false" aria-labelledby="company-label" aria-describedby="company-description" value=""></div>
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<div class="hs-form__row">
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<div class="hs-form__field hs-form__field-phone hs-phone"><label id="phone-label" for="phone-input" class="hs-form__field__label" data-required="false"><span>Phone number</span></label>
<div class="hs-form__field__phone"><input id="phone-input" class="hs-form__field__input" type="tel" name="phone" autocomplete="tel" inputmode="tel" aria-invalid="false" aria-required="false" aria-labelledby="phone-label"
aria-describedby="phone-description" value=""></div>
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<div class="hs-form__row">
<div class="hs-form__actions"><button type="submit" name="Submit" class="hs-form__actions__submit">Submit</button></div>
</div>
</form>Text Content
Skip to form Complete the form below to secure lowest pricing on rapid at-home and point-of-care COVID-19 test kits and to learn about our insurance reimbursement claims processing service. \ Email First name Last name Company name Phone number Submit