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POST https://secure.velocify.com/Import.aspx?Provider=HughHewittLandingPage&Client=31961&CampaignId=11&URL=https://www.andrewandtodd.com/thanks

<form action="https://secure.velocify.com/Import.aspx?Provider=HughHewittLandingPage&amp;Client=31961&amp;CampaignId=11&amp;URL=https://www.andrewandtodd.com/thanks" autocomplete="off" id="mainForm" method="POST" role="form" novalidate="novalidate">
  <input name="contact_form" type="hidden" value="Landing Form">
  <div class="form_content">
    <div class="form_field_wrap"><label for="firstName">First Name</label> <input autocomplete="both" class="form-control" id="firstName" name="fname" type="text"></div>
    <div class="form_field_wrap"><label for="lastName">Last Name</label> <input autocomplete="both" class="form-control" id="lastName" name="lname" type="text"></div>
    <div class="form_field_wrap"><label for="email">Email Address</label> <input autocomplete="both" class="form-control" id="email" name="email" type="email"></div>
    <div class="form_field_wrap"><label for="phone">Phone Number</label> <input autocomplete="both" class="form-control" id="phone" name="phone" type="tel"></div>
    <div class="form_field_wrap"><label for="state">State in which the property is located</label> <select class="form-control" id="inputState" name="state">
        <option value=""></option>
        <option value="AL">Alabama</option>
        <option value="AK">Alaska</option>
        <option value="AZ">Arizona</option>
        <option value="AR">Arkansas</option>
        <option value="CA">California</option>
        <option value="CO">Colorado</option>
        <option value="CT">Connecticut</option>
        <option value="DE">Delaware</option>
        <option value="DC">District Of Columbia</option>
        <option value="FL">Florida</option>
        <option value="GA">Georgia</option>
        <option value="HI">Hawaii</option>
        <option value="ID">Idaho</option>
        <option value="IL">Illinois</option>
        <option value="IN">Indiana</option>
        <option value="IA">Iowa</option>
        <option value="KS">Kansas</option>
        <option value="KY">Kentucky</option>
        <option value="LA">Louisiana</option>
        <option value="ME">Maine</option>
        <option value="MD">Maryland</option>
        <option value="MA">Massachusetts</option>
        <option value="MI">Michigan</option>
        <option value="MN">Minnesota</option>
        <option value="MS">Mississippi</option>
        <option value="MO">Missouri</option>
        <option value="MT">Montana</option>
        <option value="NE">Nebraska</option>
        <option value="NV">Nevada</option>
        <option value="NH">New Hampshire</option>
        <option value="NJ">New Jersey</option>
        <option value="NM">New Mexico</option>
        <option value="NY">New York</option>
        <option value="NC">North Carolina</option>
        <option value="ND">North Dakota</option>
        <option value="OH">Ohio</option>
        <option value="OK">Oklahoma</option>
        <option value="OR">Oregon</option>
        <option value="PA">Pennsylvania</option>
        <option value="RI">Rhode Island</option>
        <option value="SC">South Carolina</option>
        <option value="SD">South Dakota</option>
        <option value="TN">Tennessee</option>
        <option value="TX">Texas</option>
        <option value="UT">Utah</option>
        <option value="VT">Vermont</option>
        <option value="VA">Virginia</option>
        <option value="WA">Washington</option>
        <option value="WV">West Virginia</option>
        <option value="WI">Wisconsin</option>
        <option value="WY">Wyoming</option>
      </select></div>
    <div class="form_field_wrap"><label for="typeofLoan">Type of loan requested</label> <select class="form-control" id="typeOfLoan" name="purpose">
        <option value=""></option>
        <option value="purchase">Purchase</option>
        <option value="refinance">Refinance</option>
        <option value="reverse">Reverse</option>
      </select></div>
    <div class="form_field_wrap"><label for="loanAmount">Loan Amount</label> <input autocomplete="both" class="form-control" id="loanAmount" name="loan_amount" type="text"></div>
    <div class="form_field_wrap"><label for="homeValue">Home Value</label> <input autocomplete="both" class="form-control" id="homeValue" name="home_value" type="text"></div>
    <div class="form_field_wrap"><label for="hearAbout">How did you hear about us?</label> <select class="form-control" id="hearAbout" name="hear_about">
        <option value=""></option>
        <option value="Charlie Kirk">Charlie Kirk</option>
        <option value="Dennis Prager">Dennis Prager</option>
        <option value="Hugh Hewitt">Hugh Hewitt</option>
        <option value="Alfonso y Hector">Alfonso y Hector</option>
        <option value="Other">Other</option>
      </select></div>
    <div class="form_field_wrap form_btn_wrap"><button class="btn btn-primary btn-block form_btn" type="submit">Submit</button></div>
  </div>
</form>

Text Content

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First Name
Last Name
Email Address
Phone Number
State in which the property is located
AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of
ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew
HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth
DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth
DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
Type of loan requested PurchaseRefinanceReverse
Loan Amount
Home Value
How did you hear about us? Charlie KirkDennis PragerHugh HewittAlfonso y
HectorOther
Submit
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NMLS#: 1788
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Lender. 950 Glenn Drive, Suite 150, Folsom, CA 95630 (Tel. 800-447-3386).

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