thebig-prizes.com Open in urlscan Pro
104.21.64.1  Public Scan

Form analysis
1 forms found in the DOM

POST /flow?uid=c148399a-c6ee-413a-b1de-7168f5f8f4c5

<form id="formSubmit" action="/flow?uid=c148399a-c6ee-413a-b1de-7168f5f8f4c5" method="POST" data-effect="" data-effect-duration="">
  <div id="f1" class="dynamic-form form-step form1 form1-1">
    <div class="row row-spacing" data-row-id="1">
      <div id="col-field-first_name" class="col first-name form-field-col" data-col-id="1" data-autohide="">
        <label class="label">First Name</label>
        <input id="first_name" type="text" name="first_name" class="path-form-field-with-feedback path-dynamic-field required" title="First Name" value="">
        <span id="first_name-error-feedback" class="invalid-feedback hidden path-form-feedback">Please enter your first name.</span>
        <script>
          document.querySelector('#first_name').addEventListener('path-dynamic-field-register', function(evt) {
            var feedbackElem = document.querySelector('#first_name-error-feedback')
            var elem = this
            evt.detail.setControls('eyJwb3B1bGF0ZSI6bnVsbCwidmlzaWJpbGl0eSI6bnVsbCwidmFsaWRhdGlvbnMiOnsiYWN0aW9ucyI6W3sidHlwZSI6ImlzUmVxdWlyZWQiLCJtZXNzYWdlIjoiUGxlYXNlIGVudGVyIHlvdXIgZmlyc3QgbmFtZS4ifV0sInJlcXVpcmVkIjp0cnVlfX0%3D')
            evt.detail.assignToState('first_name')
            evt.detail.render(function(renders) {
              return {
                hide: renders.hideParentFieldForm(elem),
                show: renders.hideParentFieldForm(elem, false),
                populate: {
                  prepopulate_with: renders.fillInput(elem)
                },
                validation: renders.fillFeedbackMessage(feedbackElem)
              }
            })
          })
        </script>
      </div>
      <div id="col-field-last_name" class="col last-name form-field-col" data-col-id="2" data-autohide="">
        <label class="label">Last Name</label>
        <input id="last_name" type="text" name="last_name" class="path-form-field-with-feedback path-dynamic-field required" title="Last Name" value="">
        <span id="last_name-error-feedback" class="invalid-feedback hidden path-form-feedback">Please enter your last name.</span>
        <script>
          document.querySelector('#last_name').addEventListener('path-dynamic-field-register', function(evt) {
            var feedbackElem = document.querySelector('#last_name-error-feedback')
            var elem = this
            evt.detail.setControls('eyJwb3B1bGF0ZSI6bnVsbCwidmlzaWJpbGl0eSI6bnVsbCwidmFsaWRhdGlvbnMiOnsiYWN0aW9ucyI6W3sidHlwZSI6ImlzUmVxdWlyZWQiLCJtZXNzYWdlIjoiUGxlYXNlIGVudGVyIHlvdXIgbGFzdCBuYW1lLiJ9XSwicmVxdWlyZWQiOnRydWV9fQ%3D%3D')
            evt.detail.assignToState('last_name')
            evt.detail.render(function(renders) {
              return {
                hide: renders.hideParentFieldForm(elem),
                show: renders.hideParentFieldForm(elem, false),
                populate: {
                  prepopulate_with: renders.fillInput(elem)
                },
                validation: renders.fillFeedbackMessage(feedbackElem)
              }
            })
          })
        </script>
      </div>
    </div>
    <div class="row row-spacing" data-row-id="2">
      <div id="col-field-email" class="col e-mail-required form-field-col" data-col-id="1" data-autohide="">
        <label class="label">E-mail</label>
        <input id="email" list="email_domains" type="email" name="email" class="path-form-field-with-feedback path-dynamic-field required" title="Email" data-session-verification="-1" value="">
        <span id="emailmessage" class="invalid-feedback hidden path-form-feedback">Please enter a valid email</span>
        <datalist id="email_domains"></datalist>
        <script>
          document.querySelector('#email').addEventListener('path-dynamic-field-register', function(evt) {
            var domains = ["gmail.com", "yahoo.com", "hotmail.com", "aol.com", "hotmail.co.uk", "hotmail.fr", "msn.com", "yahoo.fr", "wanadoo.fr", "orange.fr", "comcast.net", "yahoo.co.uk", "yahoo.co.in", "live.com", "rediffmail.com", "free.fr",
              "gmx.de", "web.de", "yandex.ru", "ymail.com", "libero.it", "outlook.com", "uol.com", "bol.com", "mail.ru", "cox.net", "hotmail.it", "sbcglobal.net", "sfr.fr", "live.fr", "verizon.net", "live.co.uk", "googlemail.com", "yahoo.es",
              "ig.com", "live.nl", "bigpond.com", "terra.com", "yahoo.it", "neuf.fr", "yahoo.de", "alice.it", "rocketmail.com", "att.net", "laposte.net", "facebook.com", "bellsouth.net", "yahoo.in", "hotmail.es", "charter.net", "yahoo.ca",
              "yahoo.com.au", "rambler.ru", "hotmail.de", "tiscali.it", "shaw.ca", "yahoo.co.jp", "sky.com"
            ]
            var feedbackElem = document.querySelector('#emailmessage')
            var emailDomains = document.querySelector('#email_domains')
            var elem = this
            evt.detail.overrideOnChangeListener(function() {
              elem.addEventListener('input', evt.detail.listener(function(evt, setValue) {
                var value = evt.target.value
                setValue(value)
                var split = value.split('@')
                var username = split[0]
                var domain = split[1]
                var regex = domain && new RegExp('@' + domain)
                emailDomains.innerHTML = ''
                domains.forEach(function(domain) {
                  if (regex && regex.test('@' + domain) && username + '@' + domain !== value) {
                    var option = emailDomains.appendChild(document.createElement('option'))
                    option.setAttribute('value', username + '@' + domain)
                  }
                })
              }))
            })
            evt.detail.setControls(
              'eyJwb3B1bGF0ZSI6bnVsbCwidmlzaWJpbGl0eSI6bnVsbCwidmFsaWRhdGlvbnMiOnsiYWN0aW9ucyI6W3sidHlwZSI6ImlzRmFpbGVkVmVyaWZpY2F0aW9uRW1haWwiLCJtZXNzYWdlIjoiUGxlYXNlIGVudGVyIGEgdmFsaWQgZW1haWwifSx7InR5cGUiOiJpc1ZhbGlkRW1haWwiLCJtZXNzYWdlIjoiUGxlYXNlIGVudGVyIGEgdmFsaWQgZW1haWwifSx7InR5cGUiOiJpc1JlcXVpcmVkIiwibWVzc2FnZSI6IlBsZWFzZSBlbnRlciBhIHZhbGlkIGVtYWlsIn1dLCJyZXF1aXJlZCI6dHJ1ZX19'
              )
            evt.detail.assignToState('test')
            evt.detail.assignToState('email', evt.detail.effects.test)
            evt.detail.render(function(renders) {
              return {
                hide: renders.hideParentFieldForm(elem),
                show: renders.hideParentFieldForm(elem, false),
                populate: {
                  prepopulate_with: renders.fillInput(elem)
                },
                validation: renders.fillFeedbackMessage(feedbackElem)
              }
            })
          })
        </script>
      </div>
    </div>
    <div class="row row-spacing" data-row-id="3">
      <div id="col-field-gender" class="col gender form-field-col" data-col-id="1" data-autohide="false">
        <label class="label">Gender</label>
        <select id="gender" data-value="" data-type="gender" name="gender" title="Gender" class="path-form-field-with-feedback path-dynamic-field required">
          <option value=""> Select Gender </option>
          <option value="M">Male</option>
          <option value="F">Female</option>
        </select>
        <span id="gender-error-feedback" class="invalid-feedback hidden path-form-feedback">Please enter your gender</span>
        <script>
          document.querySelector('#gender[data-type=gender]').addEventListener('path-dynamic-field-register', function(evt) {
            var feedbackElem = document.querySelector('#gender-error-feedback')
            var elem = this
            evt.detail.assignToState('gender')
            evt.detail.setControls(
              'eyJwb3B1bGF0ZSI6bnVsbCwidmlzaWJpbGl0eSI6eyJ0eXBlIjoiaGlkZSIsImFjdGlvbnMiOltdLCJhdXRvaGlkZSI6ZmFsc2V9LCJ2YWxpZGF0aW9ucyI6eyJhY3Rpb25zIjpbeyJ0eXBlIjoiaXNSZXF1aXJlZCIsIm1lc3NhZ2UiOiJQbGVhc2UgZW50ZXIgeW91ciBnZW5kZXIifV0sInJlcXVpcmVkIjp0cnVlfX0%3D'
              )
            evt.detail.render(function(renders) {
              return {
                hide: renders.hideParentFieldForm(elem),
                show: renders.hideParentFieldForm(elem, false),
                populate: {
                  populate_options: renders.fillSelectOptions(elem, `
                  Select Gender
            `),
                  prepopulate_with: renders.fillInput(elem)
                },
                validation: renders.fillFeedbackMessage(feedbackElem)
              }
            })
          })
        </script>
      </div>
      <div id="col-field-phone" class="col phone form-field-col" data-col-id="2" data-autohide="">
        <label class="label">Phone</label>
        <input id="phone" type="tel" name="phone" title="Phone" data-session-verification="-1" value="" class="path-dynamic-field path-form-field-with-feedback " pattern="[0-9]*" inputmode="numeric" autocomplete="tel-national">
        <span id="phone-error-feedback" class="invalid-feedback hidden path-form-feedback invalid-phone"></span>
        <script>
          document.querySelector('#phone').addEventListener('path-dynamic-field-register', function(evt) {
            var feedbackElem = document.querySelector('#phone-error-feedback')
            var elem = this
            evt.detail.setControls('eyJwb3B1bGF0ZSI6bnVsbCwidmlzaWJpbGl0eSI6bnVsbCwidmFsaWRhdGlvbnMiOm51bGx9')
            evt.detail.assignToState('phone')
            evt.detail.render(function(renders) {
              return {
                hide: renders.hideParentFieldForm(elem),
                show: renders.hideParentFieldForm(elem, false),
                populate: {
                  prepopulate_with: renders.fillInputPhone(elem)
                },
                validation: renders.fillFeedbackMessage(feedbackElem)
              }
            })
          })
        </script>
      </div>
    </div>
    <div class="row row-spacing" data-row-id="4">
      <div id="col-field-dob" class="col date-of-birth form-field-col" data-col-id="1" data-autohide="">
        <label class="label">Date of Birth</label>
        <div class="row path-form-field-with-feedback-control">
          <div class="col">
            <select id="dob_month" name="dob_month" title="Dob Month" autocomplete="bday-month" class="path-dynamic-field required">
              <option value=""> Month </option>
              <option value="01">Jan</option>
              <option value="02">Feb</option>
              <option value="03">Mar</option>
              <option value="04">Apr</option>
              <option value="05">May</option>
              <option value="06">Jun</option>
              <option value="07">Jul</option>
              <option value="08">Aug</option>
              <option value="09">Sep</option>
              <option value="10">Oct</option>
              <option value="11">Nov</option>
              <option value="12">Dec</option>
            </select>
          </div>
          <div class="col">
            <select id="dob_day" name="dob_day" title="Dob Day" autocomplete="bday-day" class="path-dynamic-field required">
              <option value=""> Day </option>
              <option value="01">01</option>
              <option value="02">02</option>
              <option value="03">03</option>
              <option value="04">04</option>
              <option value="05">05</option>
              <option value="06">06</option>
              <option value="07">07</option>
              <option value="08">08</option>
              <option value="09">09</option>
              <option value="10">10</option>
              <option value="11">11</option>
              <option value="12">12</option>
              <option value="13">13</option>
              <option value="14">14</option>
              <option value="15">15</option>
              <option value="16">16</option>
              <option value="17">17</option>
              <option value="18">18</option>
              <option value="19">19</option>
              <option value="20">20</option>
              <option value="21">21</option>
              <option value="22">22</option>
              <option value="23">23</option>
              <option value="24">24</option>
              <option value="25">25</option>
              <option value="26">26</option>
              <option value="27">27</option>
              <option value="28">28</option>
              <option value="29">29</option>
              <option value="30">30</option>
              <option value="31">31</option>
            </select>
          </div>
          <div class="col">
            <select id="dob_year" name="dob_year" title="Dob Year" autocomplete="bday-year" class="path-dynamic-field required">
              <option value=""> Year </option>
              <option value="2007">2007</option>
              <option value="2006">2006</option>
              <option value="2005">2005</option>
              <option value="2004">2004</option>
              <option value="2003">2003</option>
              <option value="2002">2002</option>
              <option value="2001">2001</option>
              <option value="2000">2000</option>
              <option value="1999">1999</option>
              <option value="1998">1998</option>
              <option value="1997">1997</option>
              <option value="1996">1996</option>
              <option value="1995">1995</option>
              <option value="1994">1994</option>
              <option value="1993">1993</option>
              <option value="1992">1992</option>
              <option value="1991">1991</option>
              <option value="1990">1990</option>
              <option value="1989">1989</option>
              <option value="1988">1988</option>
              <option value="1987">1987</option>
              <option value="1986">1986</option>
              <option value="1985">1985</option>
              <option value="1984">1984</option>
              <option value="1983">1983</option>
              <option value="1982">1982</option>
              <option value="1981">1981</option>
              <option value="1980">1980</option>
              <option value="1979">1979</option>
              <option value="1978">1978</option>
              <option value="1977">1977</option>
              <option value="1976">1976</option>
              <option value="1975">1975</option>
              <option value="1974">1974</option>
              <option value="1973">1973</option>
              <option value="1972">1972</option>
              <option value="1971">1971</option>
              <option value="1970">1970</option>
              <option value="1969">1969</option>
              <option value="1968">1968</option>
              <option value="1967">1967</option>
              <option value="1966">1966</option>
              <option value="1965">1965</option>
              <option value="1964">1964</option>
              <option value="1963">1963</option>
              <option value="1962">1962</option>
              <option value="1961">1961</option>
              <option value="1960">1960</option>
              <option value="1959">1959</option>
              <option value="1958">1958</option>
              <option value="1957">1957</option>
              <option value="1956">1956</option>
              <option value="1955">1955</option>
              <option value="1954">1954</option>
              <option value="1953">1953</option>
              <option value="1952">1952</option>
              <option value="1951">1951</option>
              <option value="1950">1950</option>
              <option value="1949">1949</option>
              <option value="1948">1948</option>
              <option value="1947">1947</option>
              <option value="1946">1946</option>
              <option value="1945">1945</option>
              <option value="1944">1944</option>
              <option value="1943">1943</option>
              <option value="1942">1942</option>
              <option value="1941">1941</option>
              <option value="1940">1940</option>
              <option value="1939">1939</option>
              <option value="1938">1938</option>
              <option value="1937">1937</option>
              <option value="1936">1936</option>
              <option value="1935">1935</option>
              <option value="1934">1934</option>
              <option value="1933">1933</option>
              <option value="1932">1932</option>
              <option value="1931">1931</option>
              <option value="1930">1930</option>
              <option value="1929">1929</option>
              <option value="1928">1928</option>
              <option value="1927">1927</option>
              <option value="1926">1926</option>
              <option value="1925">1925</option>
            </select>
          </div>
        </div>
        <span id="dobmessage" class="invalid-feedback hidden path-form-feedback">Please enter your date of birth.</span>
        <script>
          var feedbackElem = document.querySelector('#dobmessage')
          document.querySelector('#dob_day').addEventListener('path-dynamic-field-register', function(evt) {
            var elem = this
            evt.detail.setControls('eyJwb3B1bGF0ZSI6bnVsbCwidmlzaWJpbGl0eSI6bnVsbCwidmFsaWRhdGlvbnMiOnsiYWN0aW9ucyI6W3sidHlwZSI6ImlzUmVxdWlyZWQiLCJtZXNzYWdlIjoiUGxlYXNlIGVudGVyIHlvdXIgZGF0ZSBvZiBiaXJ0aC4ifV0sInJlcXVpcmVkIjp0cnVlfX0%3D')
            evt.detail.assignToState('dob_day', evt.detail.effects.age)
            evt.detail.render(function(renders) {
              return {
                hide: renders.hideParentFieldForm(elem),
                show: renders.hideParentFieldForm(elem, false),
                populate: {
                  populate_options: renders.fillSelectOptions(elem, `
                Day
          `),
                  prepopulate_with: renders.fillInput(elem)
                },
                validation: renders.fillFeedbackMessage(feedbackElem)
              }
            })
          })
          document.querySelector('#dob_year').addEventListener('path-dynamic-field-register', function(evt) {
            var elem = this
            evt.detail.setControls('eyJwb3B1bGF0ZSI6bnVsbCwidmlzaWJpbGl0eSI6bnVsbCwidmFsaWRhdGlvbnMiOnsiYWN0aW9ucyI6W3sidHlwZSI6ImlzUmVxdWlyZWQiLCJtZXNzYWdlIjoiUGxlYXNlIGVudGVyIHlvdXIgZGF0ZSBvZiBiaXJ0aC4ifV0sInJlcXVpcmVkIjp0cnVlfX0%3D')
            evt.detail.assignToState('age')
            evt.detail.assignToState('dob_year', evt.detail.effects.age)
            evt.detail.render(function(renders) {
              return {
                hide: renders.hideParentFieldForm(elem),
                show: renders.hideParentFieldForm(elem, false),
                populate: {
                  populate_options: renders.fillSelectOptions(elem, `
                Year
          `),
                  prepopulate_with: renders.fillInput(elem)
                },
                validation: renders.fillFeedbackMessage(feedbackElem)
              }
            })
          })
          document.querySelector('#dob_month').addEventListener('path-dynamic-field-register', function(evt) {
            var elem = this
            evt.detail.setControls('eyJwb3B1bGF0ZSI6bnVsbCwidmlzaWJpbGl0eSI6bnVsbCwidmFsaWRhdGlvbnMiOnsiYWN0aW9ucyI6W3sidHlwZSI6ImlzUmVxdWlyZWQiLCJtZXNzYWdlIjoiUGxlYXNlIGVudGVyIHlvdXIgZGF0ZSBvZiBiaXJ0aC4ifV0sInJlcXVpcmVkIjp0cnVlfX0%3D')
            evt.detail.assignToState('dob_month', evt.detail.effects.age)
            evt.detail.render(function(renders) {
              return {
                hide: renders.hideParentFieldForm(elem),
                show: renders.hideParentFieldForm(elem, false),
                populate: {
                  populate_options: renders.fillSelectOptions(elem, `
                Month
          `),
                  prepopulate_with: renders.fillInput(elem)
                },
                validation: renders.fillFeedbackMessage(feedbackElem)
              }
            })
          })
        </script>
      </div>
    </div>
    <div class="row row-spacing" data-row-id="5">
      <div id="col-field-address1" class="col address-1 form-field-col" data-col-id="1" data-autohide="">
        <label class="label">Address 1</label>
        <input id="addressform" type="text" name="addressform" title="Address" value="" class="path-dynamic-field path-form-field-with-feedback required" autocomplete="address-line1">
        <span id="address1-error-feedback" class="invalid-feedback hidden path-form-feedback invalid-postal">Please enter your address.</span>
        <input id="address1" type="hidden" name="address1" title="Address" value="">
        <script>
          document.querySelector('#addressform').addEventListener('path-dynamic-field-register', function(evt) {
            var feedbackElem = document.querySelector('#address1-error-feedback')
            var elem = this
            evt.detail.setControls('eyJwb3B1bGF0ZSI6bnVsbCwidmlzaWJpbGl0eSI6bnVsbCwidmFsaWRhdGlvbnMiOnsiYWN0aW9ucyI6W3sidHlwZSI6ImlzUmVxdWlyZWQiLCJtZXNzYWdlIjoiUGxlYXNlIGVudGVyIHlvdXIgYWRkcmVzcy4ifV0sInJlcXVpcmVkIjp0cnVlfX0%3D')
            evt.detail.assignToState('address1')
            evt.detail.render(function(renders) {
              return {
                hide: renders.hideParentFieldForm(elem),
                show: renders.hideParentFieldForm(elem, false),
                populate: {
                  prepopulate_with: renders.fillInput(elem)
                },
                validation: renders.fillFeedbackMessage(feedbackElem)
              }
            })
          })
        </script>
      </div>
    </div>
    <div class="row row-spacing" data-row-id="6">
      <div id="col-field-city" class="col city form-field-col" data-col-id="1" data-autohide="">
        <label class="label">City</label>
        <input id="city" type="text" name="city" title="City" value="" class="path-form-field-with-feedback path-dynamic-field required" autocomplete="address-level2">
        <span id="city-error-feedback" class="invalid-feedback hidden path-form-feedback">Please enter your city.</span>
        <script>
          document.querySelector('#city').addEventListener('path-dynamic-field-register', function(evt) {
            var feedbackElem = document.querySelector('#city-error-feedback')
            var elem = this
            evt.detail.setControls('eyJwb3B1bGF0ZSI6bnVsbCwidmlzaWJpbGl0eSI6bnVsbCwidmFsaWRhdGlvbnMiOnsiYWN0aW9ucyI6W3sidHlwZSI6ImlzUmVxdWlyZWQiLCJtZXNzYWdlIjoiUGxlYXNlIGVudGVyIHlvdXIgY2l0eS4ifV0sInJlcXVpcmVkIjp0cnVlfX0%3D')
            evt.detail.assignToState('city')
            evt.detail.render(function(renders) {
              return {
                hide: renders.hideParentFieldForm(elem),
                show: renders.hideParentFieldForm(elem, false),
                populate: {
                  prepopulate_with: renders.fillInput(elem)
                },
                validation: renders.fillFeedbackMessage(feedbackElem)
              }
            })
          })
        </script>
      </div>
      <div id="col-field-state" class="col state form-field-col" data-col-id="2" data-autohide="">
        <label class="label">State</label>
        <select id="state" name="state" title="State" class="path-form-field-with-feedback path-dynamic-field required" value="" datavalue="">
          <option value=""> Select State </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>
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By checking this box you consent to receive phone sales calls and/or SMS text
messages - Msg and data rates may apply - for marketing purposes from
TheBigPrizes, DH Insurance Group, Taylored Legacy, Gotham Healthcare, Consumer
Concierge, Financial Relief Center, Your Saving Advisor, GoQuote, Mass Nexus
LLC, Bio Genetics Laboratory, Karma Financial Group, National Consulting
Partners on the landline or mobile number you provided even if you are on the
federal or state do not call registry. You understand these calls and SMS text
messages may be generated using an autodialer and may contain pre-recorded
messages. Consent is not required to participate in the offers promoted. You
understand that you may revoke consent at any time. Text STOP to opt out and
HELP to receive help.
By checking the box, I agree that I am a US resident over the age of 18 and
expressly consent to the Contest Rules, Terms of Service and Privacy Policy and
I agree to receive daily newsletters and promotions via email from TheBigPrizes
and other marketing partners.
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