m.medicare.ameriquote.com
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206.189.189.20
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Submitted URL: http://m.medicare.ameriquote.com/
Effective URL: https://m.medicare.ameriquote.com/
Submission: On December 31 via api from US — Scanned from DE
Effective URL: https://m.medicare.ameriquote.com/
Submission: On December 31 via api from US — Scanned from DE
Form analysis 1 forms found in the DOM
medicare/thank-you
<form id="msform" class="form" action="medicare/thank-you" novalidate="novalidate">
<input type="hidden" id="post_url" value="/api/lead">
<input id="leadid_token" name="universal_leadid" type="hidden" value="4DEF2D6F-C9D1-1B84-4F04-FAC5491B26BF">
<input type="hidden" id="session_id" name="session_id" value="">
<input type="hidden" id="completed" name="completed" value="0">
<input type="hidden" id="token" name="token" value="">
<input type="hidden" id="aff_id" name="aff_id" value="">
<input type="hidden" id="transaction_id" name="transaction_id" value="">
<input type="hidden" id="sub_id" name="sub_id" value="">
<input type="hidden" id="s2" name="s2" value="">
<input type="hidden" id="s3" name="s3" value="">
<input type="hidden" id="s4" name="s4" value="">
<input type="hidden" id="s5" name="s5" value="">
<input type="hidden" id="dob" name="dob" value="">
<input type="hidden" id="tcpa_text" name="tcpa_text" value="
By clicking the "View Quotes" button above, I give my express
written consent by electronic signature to receive telephone calls, text messages and/or emails for the
purposes of solicitation from or on behalf of one or more of the companies listed here regarding their products and services
(Including Medicare Advantage plans, Medicare Part D Prescription Drug Plans or Medicare Supplement Insurance
Plans using an automated telephone dialing system and/or pre-recorded voice at the telephone number provided
above, including any mobile number. I understand my consent, which may be revoked at any time, is not a
condition to receive goods/services. I also have read and agree to the Terms and Conditions and Privacy Policy of this website.">
<input type="hidden" id="lotame_profile_data" name="lotame_profile_data" value="">
<input type="hidden" id="time_spent_on_page" name="time_spent_on_page" value="0">
<input type="hidden" id="address_short" value="">
<div id="hero-header-progress-wrapper">
<div data-hk="s00-1-1-1" class="w-full bg-gray-200 rounded-full h-1.5">
<div class="bg-primary-400 h-1.5 rounded-full transition-width duration-600" id="showProgress">
</div>
</div>
<!-- <div id="hero-header-progress">
<div class="circle-progress" data-progress="0"><span class="progress-left"><span class="progress-bar"></span></span><span class="progress-right"><span class="progress-bar"></span></span>
<div class="progress-value">
<div class="progress-content"><span class="percent">Start</span>
<br><span class="complete"><i class="arrowdown"></i></span>
</div>
</div>
</div>
</div>
</div>-->
<div class="container-fluid">
<fieldset id="zip-container" data-bar="0" class="fadeIn" data-step="1">
<legend style="visibility: hidden; position: absolute;">Zip Code</legend>
<h3 class="step-title">What <b>Area</b> Are You Located In?</h3>
<p class="step-desc">Enter your zip code and we will help you compare free quotes!</p>
<div class="container" style="max-width:500px;">
<div class="form-group"><label style="visibility: hidden; position: absolute;" for="zip">Zip Code</label>
<input id="zip" class="form-control zipcode" type="tel" name="zip_code" maxlength="5" placeholder="Enter your zip code" required="">
<div class="zip-error form-error-message">Please enter valid US zip code.</div>
</div>
<div class="form-btns">
<button class="btn btn-primary btn-next" type="button" id="btn-zip"><span class="btn-text">View Quotes</span></button>
</div>
</div>
</fieldset>
<fieldset data-bar="10" class=" gender" data-step="2">
<legend style="visibility: hidden; position: absolute;">roof shade</legend>
<h3 class="step-title">Are you looking for <b>individual</b> or <b>family</b> coverage?</h3>
<div class="container" style="max-width:500px;">
<div class="form-group">
<ul class="step__options step__options-vertical step__options-vertical--amount row" style="list-style: none;">
<li class="col-6">
<input id="individual" class="img-radio" type="radio" name="coverage" value="individual">
<label class="radio-label" for="individual"><span>INDIVIDUAL</span></label>
</li>
<li class="col-6">
<input id="family" class="img-radio" type="radio" name="coverage" value="family">
<label class="radio-label" for="family"><span>FAMILY</span></label>
</li>
</ul>
</div>
<div class="form-btns">
<button class="btn btn-primary btn-next" type="button" id="coveragebtn" disabled=""><span class="btn-text">Next</span></button>
</div>
<div class="form-btns" style="margin-top:15px">
<button class="btn btn-primary btn-back" type="button" onclick="goBack()"><span class="btn-back">Back</span></button>
</div>
</div>
</fieldset>
<fieldset data-bar="20" class=" gender" data-step="3">
<legend style="visibility: hidden; position: absolute;">roof shade</legend>
<h3 class="step-title"> What is your <b>household</b> size? </h3>
<div class="container" style="max-width:500px;">
<div class="form-group">
<ul class="step__options step__options-vertical step__options-vertical--amount row input-group" style="list-style: none; ">
<li class="col-6">
<input id="household1" class="img-radio" type="radio" name="household" value="1">
<label class="radio-label" for="household1"><span>1</span></label>
</li>
<li class="col-6">
<input id="household2" class="img-radio" type="radio" name="household" value="2">
<label class="radio-label" for="household2"><span>2</span></label>
</li>
<li class="col-6">
<input id="household3" class="img-radio" type="radio" name="household" value="3">
<label class="radio-label" for="household3"><span>3</span></label>
</li>
<li class="col-6">
<input id="household4" class="img-radio" type="radio" name="household" value="4">
<label class="radio-label" for="household4"><span>4</span></label>
</li>
<li class="col-6">
<input id="household5" class="img-radio" type="radio" name="household" value="5">
<label class="radio-label" for="household5"><span>5</span></label>
</li>
<li class="col-6">
<input id="household6" class="img-radio" type="radio" name="household" value="6">
<label class="radio-label" for="household6"><span>6+</span></label>
</li>
</ul>
</div>
<div class="form-btns" style="margin-bottom:15px">
<button id="householdbtn" class="btn btn-primary btn-next" disabled="" type="button"><span class="btn-text">Next</span></button>
</div>
<div class="form-btns">
<button class="btn btn-primary btn-back" type="button" onclick="goBack()"><span class="btn-back">Back</span></button>
</div>
</div>
</fieldset>
<fieldset data-bar="30" class="" data-step="4">
<legend style="visibility: hidden; position: absolute;">roof shade</legend>
<h3 class="step-title">
<span class="xs-break">What is your <b>household</b> income?</span>
</h3>
<div class="container" style="max-width:500px;">
<div class="form-group" style=" position: relative;">
<ul class="step__options step__options-vertical step__options-vertical--amount row input-group" style="list-style: none; ">
<li class="col-6">
<input id="household-income1" class="img-radio" type="radio" name="income" value="Below $23000">
<label class="radio-label" for="household-income1"><span>Below $23,000</span></label>
</li>
<li class="col-6">
<input id="household-income2" class="img-radio" type="radio" name="income" value="$23000 - $30000">
<label class="radio-label" for="household-income2"><span>$23,000 - $30,000</span></label>
</li>
<li class="col-6">
<input id="household-income3" class="img-radio" type="radio" name="income" value="$30000-$40000">
<label class="radio-label" for="household-income3"><span>$30,000-$40,000</span></label>
</li>
<li class="col-6">
<input id="household-income4" class="img-radio" type="radio" name="income" value="$40000-$50000">
<label class="radio-label" for="household-income4"><span>$40,000-$50,000</span></label>
</li>
<li class="col-6">
<input id="household-income5" class="img-radio" type="radio" name="income" value="$50000-$60000">
<label class="radio-label" for="household-income5"><span>$50,000-$60,000</span></label>
</li>
<li class="col-6">
<input id="household-income6" class="img-radio" type="radio" name="income" value="Over $70000">
<label class="radio-label" for="household-income6"><span>Over $70,000</span></label>
</li>
</ul>
</div>
<div class="form-btns" style="margin-bottom:15px;">
<button id="householdIncomebtn" class="btn btn-primary btn-next" disabled="" type="button"><span class="btn-text">Next</span></button>
</div>
<div class="form-btns">
<button class="btn btn-primary btn-back" type="button" onclick="goBack()"><span class="btn-back">Back</span></button>
</div>
</div>
</fieldset>
<fieldset data-bar="40" class=" gender" data-step="5">
<legend style="visibility: hidden; position: absolute;">roof shade</legend>
<h3 class="step-title">What is your <b>gender?</b></h3>
<div class="container" style="max-width:500px;">
<div class="form-group">
<ul class="step__options step__options-vertical step__options-vertical--amount row" style="list-style: none;">
<li class="col-6">
<input id="gendermale" class="img-radio" type="radio" name="gender" value="Male">
<label class="radio-label" for="gendermale"><span>Male</span></label>
</li>
<li class="col-6">
<input id="genderfemale" class="img-radio" type="radio" name="gender" value="Female">
<label class="radio-label" for="genderfemale"><span>Female</span></label>
</li>
</ul>
<div class="form-error-message">Don't forget to tell us your gender.</div>
</div>
<div class="form-btns">
<button id="genderbtn" class="btn btn-primary btn-next" disabled="" type="button" style="margin-bottom:15px"><span class="btn-text">Next</span></button>
</div>
<div class="form-btns">
<button class="btn btn-primary btn-back" type="button" onclick="goBack()"><span class="btn-back">Back</span></button>
</div>
</div>
</fieldset>
<fieldset data-bar="50" class="" id="birthdayfieldset" data-step="6">
<legend style="visibility: hidden; position: absolute;">electric bill</legend>
<h3 class="step-title">What is your birthday?</h3>
<div class="container" style="max-width:600px;">
<div class="row ">
<div class="col-5">
<div class="form-group parent-error">
<label for="birth_month" style="visibility: hidden; position: absolute;">month</label>
<select name="birth_month" id="bday-month" type="text" class="form-control">
<option value="" selected="">Month</option>
<option value="01">January</option>
<option value="02">February</option>
<option value="03">March</option>
<option value="04">April</option>
<option value="05">May</option>
<option value="06">June</option>
<option value="07">July</option>
<option value="08">August</option>
<option value="09">September</option>
<option value="10">October</option>
<option value="11">November</option>
<option value="12">December</option>
</select>
<div class="form-error-message">This Field is Required</div>
</div>
</div>
<div class="col-3">
<div class="form-group parent-error">
<label for="birth_day" style="visibility: hidden; position: absolute;">Day</label>
<select name="birth_day" class="form-control" id="bday-day">
<option value="" selected="">Day</option>
<option value="01">1</option>
<option value="02">2</option>
<option value="03">3</option>
<option value="04">4</option>
<option value="05">5</option>
<option value="06">6</option>
<option value="07">7</option>
<option value="08">8</option>
<option value="09">9</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 class="form-error-message">This Field is Required</div>
</div>
</div>
<div class="col-4">
<div class="form-group parent-error">
<label for="birth_year" style="visibility: hidden; position: absolute;">Year</label>
<select name="birth_year" id="bday-year" class="form-control">
<option value="" selected="">Year</option>
<script language="javascript">
for (var i = 1921; i <= 2003; i++) {
document.write("<option value=\"" + i + "\">" + i + "</option>\n");
}
</script>
<option value="1921">1921</option>
<option value="1922">1922</option>
<option value="1923">1923</option>
<option value="1924">1924</option>
<option value="1925">1925</option>
<option value="1926">1926</option>
<option value="1927">1927</option>
<option value="1928">1928</option>
<option value="1929">1929</option>
<option value="1930">1930</option>
<option value="1931">1931</option>
<option value="1932">1932</option>
<option value="1933">1933</option>
<option value="1934">1934</option>
<option value="1935">1935</option>
<option value="1936">1936</option>
<option value="1937">1937</option>
<option value="1938">1938</option>
<option value="1939">1939</option>
<option value="1940">1940</option>
<option value="1941">1941</option>
<option value="1942">1942</option>
<option value="1943">1943</option>
<option value="1944">1944</option>
<option value="1945">1945</option>
<option value="1946">1946</option>
<option value="1947">1947</option>
<option value="1948">1948</option>
<option value="1949">1949</option>
<option value="1950">1950</option>
<option value="1951">1951</option>
<option value="1952">1952</option>
<option value="1953">1953</option>
<option value="1954">1954</option>
<option value="1955">1955</option>
<option value="1956">1956</option>
<option value="1957">1957</option>
<option value="1958">1958</option>
<option value="1959">1959</option>
<option value="1960">1960</option>
<option value="1961">1961</option>
<option value="1962">1962</option>
<option value="1963">1963</option>
<option value="1964">1964</option>
<option value="1965">1965</option>
<option value="1966">1966</option>
<option value="1967">1967</option>
<option value="1968">1968</option>
<option value="1969">1969</option>
<option value="1970">1970</option>
<option value="1971">1971</option>
<option value="1972">1972</option>
<option value="1973">1973</option>
<option value="1974">1974</option>
<option value="1975">1975</option>
<option value="1976">1976</option>
<option value="1977">1977</option>
<option value="1978">1978</option>
<option value="1979">1979</option>
<option value="1980">1980</option>
<option value="1981">1981</option>
<option value="1982">1982</option>
<option value="1983">1983</option>
<option value="1984">1984</option>
<option value="1985">1985</option>
<option value="1986">1986</option>
<option value="1987">1987</option>
<option value="1988">1988</option>
<option value="1989">1989</option>
<option value="1990">1990</option>
<option value="1991">1991</option>
<option value="1992">1992</option>
<option value="1993">1993</option>
<option value="1994">1994</option>
<option value="1995">1995</option>
<option value="1996">1996</option>
<option value="1997">1997</option>
<option value="1998">1998</option>
<option value="1999">1999</option>
<option value="2000">2000</option>
<option value="2001">2001</option>
<option value="2002">2002</option>
<option value="2003">2003</option>
</select>
<div class="form-error-message">This Field is Required</div>
</div>
</div>
</div>
<div class="form-btns d-flex justify-content-between">
<button class="btn btn-primary btn-back" type="button" onclick="goBack()"><span class="btn-back">Back</span></button>
<button class="btn btn-primary btn-next" type="button"><span class="btn-text">Next</span></button>
</div>
</div>
</fieldset>
<fieldset data-bar="60" class="" data-step="7">
<legend style="visibility: hidden; position: absolute;">address</legend>
<h3 class="step-title">What is your <b>home address</b>?</h3>
<p class="step-desc">We verify your location to provide local quotes in your area. </p>
<div class="container" style="max-width:640px;">
<div class="form-group">
<label style="visibility: hidden; position: absolute;" for="address">Street Address</label>
<input id="address" class="form-control pac-target-input" type="text" name="address" placeholder="Street Address" required="" autocomplete="off">
<!--<div class="step__city-state"><span id="city2">City</span>, <span id="state2">State</span></div> -->
<div class="form-error-message">Please enter your address.</div>
</div>
<div class="form-btns d-flex justify-content-between">
<button class="btn btn-primary btn-back" type="button" onclick="goBack()"><span class="btn-back">Back</span></button>
<button class="btn btn-primary btn-next" type="button"><span class="btn-text">Next</span></button>
</div>
</div>
</fieldset>
<fieldset data-bar="70" class="" data-step="8">
<legend style="visibility: hidden; position: absolute;">full name</legend>
<h3 class="step-title mb-3"> What is your <b>full name</b>?</h3>
<div class="container" style="max-width:500px;">
<div class="form-group">
<label style="visibility: hidden; position: absolute;" for="firstName">FirstName</label>
<input id="firstName" pattern="[a-zA-Z0-9]+" minlength="3" class="form-control" type="text" name="first_name" placeholder="First Name" required="" autofocus="" tabindex="1">
<div class="form-error-message">Don't forget to tell us your name.</div>
</div>
<div class="form-group">
<label style="visibility: hidden; position: absolute;" for="lastName">Last Name</label>
<input id="lastName" pattern="[a-zA-Z0-9]+" minlength="3" class="form-control" type="text" name="last_name" placeholder="Last Name" required="" tabindex="2">
<div class="form-error-message">Don't forget to tell us your last name.</div>
</div>
<div class="form-btns d-flex justify-content-between">
<button class="btn btn-primary btn-back" type="button" onclick="goBack()"><span class="btn-back">Back</span></button>
<button class="btn btn-primary btn-next" type="button"><span class="btn-text">Next</span></button>
</div>
</div>
</fieldset>
<fieldset data-bar="80" class="" style="min-height: 238px;" data-step="9">
<legend style="visibility: hidden; position: absolute;">Email</legend>
<h3 class="step-title mb-3">Thanks <span id="username"></span>, Next let’s compare your quotes!</h3>
<div class="container">
<div class="container" style="max-width:500px;">
<div class="form-group parent-error">
<label style="visibility: hidden; position: absolute;" for="email">Email Address</label>
<input id="email" class="form-control" type="email" name="email_address" placeholder="Email Address" required="" pattern="[A-Za-z0-9._%+-]+@[A-Za-z0-9.-]+\.[A-Za-z]{1,63}$">
<div class="form-error-message">Please enter your email address.</div>
</div>
<div class="form-group parent-error">
<label style="visibility: hidden; position: absolute;" for="homePhone">Phone Number</label>
<input id="homePhone" class="form-control" type="tel" pattern="[\(]\d{3}[\)][\-]\d{3}[\-]\d{4}" name="phone_home" placeholder="(XXX) XXX-XXXX" required="">
<div class="phone-valid-error form-error-message">Please enter a valid phone number</div>
</div>
<div class="form-btns d-flex justify-content-between">
<button class="btn btn-primary btn-back" type="button" onclick="goBack()"><span class="btn-back">Back</span></button>
<button class="btn btn-primary btn-next" type="button"><span class="btn-text">View Quotes</span></button>
</div>
<p class="form-tcpa" style="margin-top:20px">
<label id="tcpa_label">
<input type="hidden" id="leadid_tcpa_disclosure">By clicking the "View Quotes" button above, I give my express written consent by electronic signature to receive telephone calls, text messages and/or emails for the purposes of
solicitation from or on behalf of one or more of the companies <a href="https://ameriquote.com/partners" target="_blank">listed here</a> regarding their products and services (Including Medicare Advantage plans, Medicare Part D
Prescription Drug Plans or Medicare Supplement Insurance Plans using an automated telephone dialing system and/or pre-recorded voice at the telephone number provided above, including any mobile number. I understand my consent, which
may be revoked at any time, is not a condition to receive goods/services. I also have read and agree to the <a href="https://ameriquote.com/terms-and-conditions" target="_blank">Terms and Conditions</a> and
<a href="https://ameriquote.com/privacy-policy" target="_blank">Privacy Policy</a> of this website.</label>
</p>
</div>
</div>
</fieldset>
<fieldset data-bar="100" class="text-center" data-step="10">
<legend style="visibility: hidden; position: absolute;">Success</legend>
<img src="/themes/survey-theme/partials/surveys/quotev1/images/thankyou-img_03.png" alt="success" class="img-fluid">
</fieldset>
<center><img src="https://m.medicare.ameriquote.com/themes/survey-theme/partials/surveys/quotev1/fonts/trusted.svg?v=1234" alt="trusted site" class="mt-4 trusted"></center>
</div>
<template id="thankyoufrm">
<div class="container main">
<div class="inner-container">
<div class="loadingMessageConatinerWrapper text-center" style="display: none;">
<div class="counter">
<div class="counterbg">
<p class="step1" style="font-weight: bold; display: none;">Reviewing your details..</p>
<p style="font-weight: bold; display: none;" class="step2">Searching <i id="lcity"></i> <i id="lstate"></i>... </p>
<p style="font-weight: bold; display: none;" class="step3">Matching you with different options...</p>
<p style="font-weight: bold; display: none;" class="step4">Checking plan availability...</p>
<p style="font-weight: bold;" class="step5"><b>Congratulations!</b><br>We hacityve found matches in your area!</p>
</div>
</div>
<div class="loading-icons">
<div class="loading-icon licon1" style="opacity: 0.25;"></div>
<div class="loading-icon licon2" style="opacity: 0.25;"></div>
<div class="loading-icon licon3" style="opacity: 0.25;"></div>
<div class="loading-icon licon4" style="opacity: 0.25;"></div>
<div class="loading-icon licon5" style="opacity: 1;"></div>
</div>
<div class="clearfix"></div>
</div>
<div class="next-block infoblock">
<div class="info-img"><svg xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink" width="40px" height="45px">
<path fill-rule="evenodd" fill="rgb(140, 197, 67)"
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</path>
</svg></div>
<h2 class="title text-center">Agents Are Standing By</h2>
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<p>Select <u>at least</u> 3 quotes below for the best rates!</p>
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<script>
cInsstate = rsp.state || 'FL'; //State ID For Example: AL
cInszip = rsp.zipcode || '33166'; // Z
cInsmaxads = "3"; //Max ads the affiliate want to display
cInspublisher_id = "277"; // Publisher Unique ID
cInssub_id = "medicare"; //Sub ID
cInspub_id = ""; //Pub ID
cInsinsurancetype = "medicare";
! function(e, f, u) {
e.async = 1;
e.src = u;
f.parentNode.insertBefore(e, f);
}(document.createElement('script'), document.getElementsByTagName('script')[0], 'https://www.insuranceclicks.com/iClickListing/RenderListing.js');
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<p class="footer-terms">DISCLOSURES - This is an advertising referral and comparison service that matches consumers with prospective insurance agents and companies depending upon your information. The operator of this website is not an
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contact your third-party provider or agent, directly. We do not endorse or charge you for any product or service. Any compensation received is paid by participating providers and only for advertising services provided. This service is void
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<script src="//insurance.mediaalpha.com/js/serve.js"></script>
<script>
google.maps.event.addDomListener(window, 'load', initialize);
function initialize() {
var input = document.getElementById('address');
var autocomplete = new google.maps.places.Autocomplete(input);
google.maps.event.addListener(autocomplete, 'place_changed', function() {
var place = autocomplete.getPlace();
var formattedAddress = place.formatted_address;
console.log(formattedAddress);
});
}
</script>
<script>
$('input[name="gender"]').click(function() {
$('#genderbtn').removeAttr('disabled');
//$(this).closest("fieldset").find(".btn-next").trigger("click");
});
$('input[name="coverage"]').click(function() {
$("#coveragebtn").prop('disabled', false);
});
// $('input[name="medicalcontition"]').click(function() {
// $(this).closest("fieldset").find(".btn-next").trigger("click");
// });
$('input[name="income"]').click(function() {
$('#householdIncomebtn').removeAttr('disabled');
$("#householdIncomebtn").prop('disabled', false);
// $(this).closest("fieldset").find(".btn-next").trigger("click");
});
$('input[name="household"]').click(function() {
console.log('household')
$('#householdbtn').removeAttr('disabled');
$("#householdbtn").prop('disabled', false);
// $(this).closest("fieldset").find(".btn-next").trigger("click");
});
$('input[name="life_event"]').click(function() {
console.log('life_event_btn')
$('#life_event_btn').removeAttr('disabled');
$("#life_event_btn").prop('disabled', false);
// $(this).closest("fieldset").find(".btn-next").trigger("click");
});
$("#zip").keydown(function(event) {
if (event.keyCode === 13) { // 13 is the key code for Enter
$(this).closest("fieldset").find(".btn-next").trigger("click");
}
});
</script>
<script>
var getUrlParameter = function getUrlParameter(sParam) {
var sPageURL = window.location.search.substring(1),
sURLVariables = sPageURL.split('&'),
sParameterName,
i;
for (i = 0; i < sURLVariables.length; i++) {
sParameterName = sURLVariables[i].split('=');
if (sParameterName[0] === sParam) {
return sParameterName[1] === undefined ? true : decodeURIComponent(sParameterName[1]);
}
}
};
function is_int(value) {
if ((parseFloat(value) == parseInt(value)) && !isNaN(value)) {
return true;
} else {
return false;
}
}
$.fn.serializeObject = function() {
var o = {};
var a = this.serializeArray();
$.each(a, function() {
if (o[this.name]) {
if (!o[this.name].push) {
o[this.name] = [o[this.name]];
}
o[this.name].push(this.value || '');
} else {
o[this.name] = this.value || '';
}
});
return o;
};
function getLocationPathName(href) {
var l = document.createElement("a");
l.href = href;
return l.pathname ? l.pathname.replace('/', '') : "";
}
function saveLeadInSession() {
var formData = $("#msform").serializeObject();
var leadData = {};
for (var key in formData) {
if (formData.hasOwnProperty(key)) {
switch (key) {
case 'street_adderss':
leadData['address'] = formData[key];
break;
case 'state':
leadData['county'] = formData[key];
break;
case 'zip_code':
case 'zip':
leadData['zip'] = formData['zip_code'];
break;
case 'first_name':
leadData['contact'] = formData[key] + ' ' + formData['last_name'];
break;
case 'last_name':
break;
case 'email_address':
leadData['email'] = formData[key];
break;
case 'gender':
leadData[key] = formData[key] === 'genderfemale' ? 'F' : 'M';
break;
case 'medicalcontition':
leadData[key] = formData[key]
break;
case 'cancer':
leadData['major_condition_cancer'] = formData[key];
break;
case 'heart_disease':
leadData['major_condition_heart_disease'] = formData[key];
break;
case 'phone_home':
leadData['phone'] = formData[key];
break;
case 'tobacco_use':
leadData['tobacco'] = formData[key];
break;
case 'universal_leadid':
leadData['leadid_id'] = formData[key];
break;
case 'xxTrustedFormToken':
leadData['trusted_form_certificate_id'] = getLocationPathName(formData[key]);
break;
case 'dob': {
leadData['birth_date'] = formData[key];
break;
}
default:
leadData[key] = formData[key];
}
}
}
localStorage.leadData = JSON.stringify(leadData);
}
//timer functions
var startTime, endTime;
function startTimeCounter() {
startTime = new Date();
}
function endTimeCounter() {
endTime = new Date();
var timeDiff = endTime - startTime; //in ms
// strip the ms
timeDiff /= 1000;
// return seconds
return Math.round(timeDiff);
}
//get the client ip address
function getClientIpAddress() {
var ipv4 = '';
$.getJSON("https://api.ipify.org?format=jsonp&callback=?", function(json) {
ipv4 = json.ip;
$('<input>', {
type: 'hidden',
id: 'ip_address',
name: 'ip_address',
value: json.ip
}).appendTo('form');
});
$.getJSON("https://api6.ipify.org?format=jsonp&callback=?", function(json) {
if (ipv4 != json.ip) {
$('<input>', {
type: 'hidden',
id: 'ip_address_v6',
name: 'ip_address_v6',
value: json.ip
}).appendTo('form');
}
});
}
//generate token
function generateToken() {
/*
var token = getUrlParameter('token');
if (token) {
$("#token").val(token);
$("#token").trigger("change");
} else {
$.getJSON("https://leadgen.pushint.com/api/token", function (result) {
if (result && result.success) {
$("#token").val(result.token);
$("#token").trigger("change");
} else {
alert('Server Error! Please reload the page and try again!')
}
});
}*/
}
//autocomplete data from thank you page
function autocompleteForm() {
var orig_token = '';
if (orig_token) {
$.ajax({
type: "GET",
url: "https://leadgen.pushint.com/api/lead/data?token=" + orig_token,
success: function(result) {
if (result.success && result.lead) {
var lead = result.lead;
for (var field_name in lead) {
var field_value = lead[field_name];
var field = $('[name="' + field_name + '"]');
if (field) {
var input_type = false;
if (field.is('input')) {
input_type = field.attr('type');
}
if (field.is('select')) {
input_type = 'select';
}
//console.log(field_name + ' ' + input_type + ' ' + field_value);
if (input_type == 'text' || input_type == 'number' || input_type == 'email' || input_type == 'tel' || input_type == 'select') {
field.val(field_value);
field.trigger('change');
}
}
}
}
}
});
}
}
//autocomplete form from URL parameters
function autocompleteFormFromUrl() {}
//process url parameters
function processUrlParameters() {
$("#aff_id").val(getUrlParameter('aff_id'));
$("#sub_id").val(getUrlParameter('sub_id'));
$("#transaction_id").val(getUrlParameter('transaction_id'));
//$("#source").val(getUrlParameter('source'));
var s_params = ["s2", "s3", "s4", "s5"];
//check for both S2 and s2, S3 and s3 etc
s_params.forEach(function(item, index) {
var param_val = getUrlParameter(item);
if (param_val) $("#" + item).val(param_val);
else {
param_val = getUrlParameter(item.toUpperCase());
if (param_val) {
$("#" + item).val(param_val);
}
}
});
if (!$("#aff_id").val()) {
$("#aff_id").val(getUrlParameter('AFFID'));
}
if (!$("#sub_id").val()) {
$("#sub_id").val(getUrlParameter('SUBID'));
}
if (!$("#transaction_id").val()) {
$("#transaction_id").val(getUrlParameter('TRANSACTIONID'));
}
}
$(document).on("click", '#email-suggestion', function() {
$("input[name='email_address']").val($(this).text());
$("input[name='email_address']").css('border-color', 'green');
$("#email-error").remove();
return false;
});
jQuery.validator.addMethod("emailfull", function(value, element) {
return this.optional(element) ||
/^([a-z\d!#$%&'*+\-\/=?^_`{|}~\u00A0-\uD7FF\uF900-\uFDCF\uFDF0-\uFFEF]+(\.[a-z\d!#$%&'*+\-\/=?^_`{|}~\u00A0-\uD7FF\uF900-\uFDCF\uFDF0-\uFFEF]+)*|"((([ \t]*\r\n)?[ \t]+)?([\x01-\x08\x0b\x0c\x0e-\x1f\x7f\x21\x23-\x5b\x5d-\x7e\u00A0-\uD7FF\uF900-\uFDCF\uFDF0-\uFFEF]|\\[\x01-\x09\x0b\x0c\x0d-\x7f\u00A0-\uD7FF\uF900-\uFDCF\uFDF0-\uFFEF]))*(([ \t]*\r\n)?[ \t]+)?")@(([a-z\d\u00A0-\uD7FF\uF900-\uFDCF\uFDF0-\uFFEF]|[a-z\d\u00A0-\uD7FF\uF900-\uFDCF\uFDF0-\uFFEF][a-z\d\-._~\u00A0-\uD7FF\uF900-\uFDCF\uFDF0-\uFFEF]*[a-z\d\u00A0-\uD7FF\uF900-\uFDCF\uFDF0-\uFFEF])\.)+([a-z\u00A0-\uD7FF\uF900-\uFDCF\uFDF0-\uFFEF]|[a-z\u00A0-\uD7FF\uF900-\uFDCF\uFDF0-\uFFEF][a-z\d\-._~\u00A0-\uD7FF\uF900-\uFDCF\uFDF0-\uFFEF]*[a-z\u00A0-\uD7FF\uF900-\uFDCF\uFDF0-\uFFEF])\.?$/i
.test(value);
}, "Please enter valid email address!");
jQuery.validator.addMethod("boolean", function(value, element) {
if (value == 1 || value == 0) return true;
else return false;
}, "Please enter valid value!");
jQuery.validator.addMethod("date_new", function(value, element) {
var day = parseInt($("#bday-day").val());
var month = parseInt($("#bday-month").val());
var year = parseInt($("#bday-year").val());
if (!day || !year || !month) return false;
// Check the ranges of month and year
if (year < 1000 || year > 3000 || month == 0 || month > 12) return false;
var monthLength = [31, 28, 31, 30, 31, 30, 31, 31, 30, 31, 30, 31];
// Adjust for leap years
if (year % 400 == 0 || (year % 100 != 0 && year % 4 == 0)) monthLength[1] = 29;
// Check the range of the day
return day > 0 && day <= monthLength[month - 1];
}, "Please enter a valid date!");
jQuery.validator.addMethod("minLenghNoSpaces", function(value, element, len) {
var trimmedValue = value.replace(/\s/g, "");
return trimmedValue == "" || trimmedValue.length >= len;
});
jQuery.validator.addMethod("hasNumber", function(value, element) {
return value.match(".*\\d.*");
}, "Your address must include the house/unit number.");
var in_click = false;
$(document).ready(function() {
$.ajaxSetup({
//timeout: 20000, //Time in milliseconds
cache: false
});
$.get('https://ipapi.co/json/', function(data) {
console.log(999, data)
clientip = data;
$('#zip').val(data.postal)
});
//start time counter
startTimeCounter();
processUrlParameters();
generateToken();
getClientIpAddress();
autocompleteForm();
autocompleteFormFromUrl();
$('#tcpa_text').val($('#leadid_tcpa_disclosure').parent().text());
var phoneValid = false;
$('#income').on('input', (ev) => {
let w = new Intl.NumberFormat().format(ev.target.value)
let display = $('#fweight');
display.text(`$${w}`);
})
$("#bday-day").change(function() {
if ($("#bday-month").val() && $("#bday-year").val()) {
$("#msform").valid();
}
});
$("#bday-month").change(function() {
if ($("#bday-day").val() && $("#bday-year").val()) {
$("#msform").valid();
}
});
var phoneSelector = $('input[name="phone_home"]');
var maskOptions = {
onKeyPress: function(cep, e, field, options) {
var masks = ['(000)-000-0000', '(000)-000-0000'];
var mask = (cep.length > 14) ? masks[1] : masks[0];
$('input[name="phone_home"]').mask(mask, options);
},
translation: {
'Z': {
pattern: /[0-9]/,
optional: true
}
}
};
phoneSelector.mask('(000)-000-0000', maskOptions);
//disable copy/paste
});
/**
* We inject an iFrame with the Leadspedia Click Tracking link for the (Affiliate, Vertical) pair
* This tracking link is configured within LP to redirect to submit.pushint.com (or local if set to)
* which then stores the lp_click_id with the passed session_id
* We take that session_id when the lead gets sold and check if it indeed sold, then fire a conversion with that
* lp_click_id
*
* @param vertical - defined in the submit.pushint.com database e.g. "solar"
*/
function lptrk(vertical) {
var affId = $.urlParam('aff_id');
var s2 = $("#s2").val();
var subId = $.urlParam('sub_id');
if (!affId) {
affId = $.urlParam('AFFID');
}
if (!s2) {
s2 = $.urlParam('S2') || "";
}
var token = $("#token").val();
var lptrkUrl = 'https://leadgen.pushint.com/api/getLpTrackingLink?affId=' + affId + '&vertical=' + vertical
if (subId) {
lptrkUrl += '&sub_id=' + subId;
}
if (typeof affId !== 'undefined' && affId > 0) {
/* $.ajax({
'url': lptrkUrl,
'type': 'GET',
async: false,
'success': function (data) {
if (data.lpTrackingLink) {
var iFrameLink = data.lpTrackingLink + "&session_id=" + data.sessionId + '&s2=' + s2 + '&s5=' +
token;
document.getElementById('session_id').value = data.sessionId;
injectIframe(iFrameLink);
}
},
'error': function (jqxhr, textStatus, error) {
var err = textStatus + ", " + error;
Rollbar.critical("Error getting the lp tracking link, error: " + err);
}
});
*/
}
}
/**
* Parses for given url parameter
* @param name
* @returns {(string | number)|null}
*/
$.urlParam = function(name) {
var results = new RegExp('[\?&]' + name + '=([^&#]*)').exec(window.location.href);
if (results == null) {
return null;
} else {
return decodeURI(results[1]) || 0;
}
};
/**
* Injects invisible iframe into page
* @param src
*/
function injectIframe(src) {
var iframe = document.createElement('iframe');
iframe.style.display = 'none';
iframe.src = src;
document.body.appendChild(iframe);
}
function getAge(dateString) {
var today = new Date();
var birthDate = new Date(dateString);
var age = today.getFullYear() - birthDate.getFullYear();
var m = today.getMonth() - birthDate.getMonth();
if (m < 0 || (m === 0 && today.getDate() < birthDate.getDate())) {
age--;
}
return age;
}
$("#dob").change(function() {
/*
var dob = $("#dob").val();
var age = parseInt(getAge(dob));
if (age >= 65) {
var script = document.createElement('script');
script.onload = function () {
_cc14683.add("dem", "Age - 65 +");
_cc14683.bcp();
console.log('Age 65+ triggered');
};
script.src = 'https://tags.crwdcntrl.net/c/14683/cc.js?ns=_cc14683';
script.id = "LOTCC_14683";
document.head.appendChild(script);
}
*/
});
</script>
<script>
var inClick = false;
var phoneValid = false;
var phoneSelector = $('input[name="phone_home"]');
var form = $("#msform");
var postUrl = $("#post_url").val();
var clientip;
var heights = [];
//lead submit function
function setCookie(name, value, days) {
var expires = "";
if (days) {
var date = new Date();
date.setTime(date.getTime() + (days * 24 * 60 * 60 * 1000));
expires = "; expires=" + date.toUTCString();
}
document.cookie = name + "=" + (value || "") + expires + "; path=/";
}
function getCustomDate() {
let date;
let d = new Date();
date = [
d.getFullYear(),
('0' + (d.getMonth() + 1)).slice(-2),
('0' + d.getDate()).slice(-2)
].join('-');
return date;
}
function getIp(cb) {
$.get('https://www.cloudflare.com/cdn-cgi/trace', function(data) {
let fullrs = data.split('\n');
clientip = fullrs[2].replace('ip=', '');
});
}
$('#ffeet').on('input', (ev) => {
$('#ffeetlbl').text(heights[ev.target.value]);
});
function validateEm(em) {
return /^[^\s@]+@[^\s@]+\.[^\s@]+$/.test(em)
}
window.validatePhone = async function({
telephone_ac,
telephone_pf,
telephone_sf
}) {
const ETAKA = `f39a34c48c2340f698af18b0bce3d53e`;
const ENDPOINT = `https://api.ekata.com/3.1/phone`;
const phone = `${telephone_ac}${telephone_pf}${telephone_sf}`
if (phone.length < 10) return {};
return (await fetch(`${ENDPOINT}?api_key=${ETAKA}&phone=${phone}`)).json()
}
async function submitLead() {
console.log('submitLead')
$("#time_spent_on_page").val(endTimeCounter());
let {
dob,
state,
gender,
coverage,
first_name: fname,
last_name: lname,
address,
zip_code: zipcode,
phone_home: phone,
email_address: email,
household,
life_event,
income,
...rest
} = $("#msform").serializeObject();
let cip = ''
if (clientip) {
cip = clientip.ip
}
let apiData = {
"email": email,
"name": fname,
"surname": lname,
"dob": dob,
"phone": phone,
"survey_id": 1,
"zipcode": zipcode,
"address": address,
"state": state || clientip.region_code,
"date": getCustomDate(),
"clientip": cip,
"urlorigin": document.location.href,
"leadid": LeadiD.token || 'NA',
"gender": gender,
coverage,
life_event,
household,
income,
};
rsp = {
state: apiData.state,
zipcode: apiData.zipcode
}
setCookie('lstate', rsp.state);
setCookie('lzip', rsp.zipcode);
// let verifiedPhone = await validatePhone(rest);
$.post('/api/leads', apiData).done(function(data) {
$('#sbbtn').attr('disabled', true)
$('#endbtn').text('Loading...')
$('#mheader, #msform').hide()
const saved = JSON.parse(data)
document.location.href = `/thankyou?id=${saved.id}&zip=` + zipcode;
// window.location.href = '/';
});
function changeTmpl(plchldr, tmpl) {
let oldTmpl = plchldr.innerHTML;
let template = document.querySelector(tmpl);
let cln = template.content.cloneNode(true);
plchldr.innerHTML = '';
plchldr.appendChild(cln);
return cln;
}
}
//show phone error
function displayPhoneError(currentFieldset, prevFeildset, phoneSelector) {
currentFieldset.hide().promise().done(function() {
prevFeildset.fadeIn().promise().done(function() {
$('.phone-valid-error').show();
phoneSelector.attr('style', 'border: 1px solid red');
//prevFeildset.removeClass('fadeOutLeft');
});
});
}
$(document).ready(function() {
getIp();
});
$("#msform").submit(function(e) {
e.preventDefault();
//$('button[type="submit"]').trigger('click');
return false;
});
</script>
<script>
$(document).ready(function() {
$("#msform").validate({
rules: {
zip_code: {
required: true,
digits: true,
minlength: 5,
maxlength: 5
},
email_address: {
required: true,
emailfull: true,
},
first_name: {
required: true,
minLenghNoSpaces: 3
},
last_name: {
required: true,
minLenghNoSpaces: 3
},
address: {
required: true,
hasNumber: true
},
phone_home: {
required: true,
minlength: 10,
remote: async function() {
let phone = $('#homePhone').val();
let verified = await validatePhone(phone);
return verified.is_valid;
}
},
height_in_feet: {
required: true,
number: true
},
height_in_inches: {
required: true,
number: true
},
weight_in_pounds: {
required: true,
number: true,
min: 50,
max: 500
},
birth_year: {
date_new: true
},
gender: {
required: true
},
medicalcontition: {
required: true
},
household: {
required: true
}
},
messages: {
zip_code: 'Enter a valid ZIP',
email_address: 'Enter a valid email address.',
first_name: "Enter a valid First Name.",
last_name: "Enter a valid Last Name.",
address: {
required: 'Enter a valid Address.',
hasNumber: 'Your address must include the house/unit number. ',
},
gender: 'Please select your gender.',
medicalcontition: 'Please select your medical condition.',
phone_home: 'Enter a valid Phone Number',
weight_in_pounds: {
required: 'Enter your weight.',
number: 'Please enter a value between 50 and 500.',
min: 'Please enter a value between 50 and 500.',
max: 'Please enter a value between 50 and 500.'
}
},
errorElement: 'div',
errorPlacement: function(error, element) {
if ($(element).attr('id') == 'bday-year' || $(element).attr('id') == 'bday-day' || $(element).attr('id') == 'bday-month') {
if ($(element).attr('id') == 'bday-year') {
$(element).parent().parent().after(error);
}
} else {
$(element).next().after(error);
}
},
showErrors: function(errorMap, errorList) {
this.defaultShowErrors();
if (errorMap.birth_year) {
$("#bday-day").addClass('error');
$("#bday-month").addClass('error');
} else {
$("#bday-day").removeClass('error');
$("#bday-month").removeClass('error');
}
}
});
});
</script>
<script>
var md = new MobileDetect(window.navigator.userAgent);
var rates_redirect = false;
if (!md.mobile() && !md.tablet()) {
rates_redirect = true;
}
rates_redirect = false;
function zipValidationSuccess(button_click) {
if (rates_redirect && button_click) {
var el = $('#zip');
var current_url = window.location.href;
var final_url = '';
if (current_url.includes('?')) final_url = current_url + '&zip_code=' + el.val() + "&token=" + $("#token").val();
else final_url = current_url + '?zip_code=' + el.val() + "&token=" + $("#token").val();
var new_window = window.open(final_url);
if (new_window) {
new_window.focus();
$(window).attr('location', 'medicare/rates/?zip_code=' + el.val() + '&' + window.location.search.substr(1));
}
} else {
$("#zip").blur();
$('#btnzip').removeAttr('disabled');
$('#btn-zip').removeAttr('disabled');;
var zipcode = getUrlParameter('zip_code');
if (!isNaN(zipcode)) {
$('#zip-container').trigger('step-redirect');
$('#zip-container').hide();
$('#zip-container').next().show();
}
}
}
function zipValidationError() {
$(".zip-error").show();
$('#btnzip').attr('disabled', 'disabled');
$('#btn-zip').attr('disabled', 'disabled');
}
function zipValidate(button_click) {
// Cache
var el = $('#zip');
// Did they type five integers?
if ((el.val().length == 5) && (is_int(el.val())) && !zip_inclick) {
zip_inclick = true;
$("#btn-zip").prop('disabled', false);
$("#btnzip").prop('disabled', false);
zipValidationSuccess(button_click);
} else if (el.val().length < 5) {
$(".zip-error").hide();
}
}
var zip_inclick = false;
var button_click = false;
//zip validation
$("#zip").on('keyup change', function(e) {
button_click = false;
zipValidate(button_click);
});
$("#token").change(function() {
var zipcode = getUrlParameter('zip_code');
if (!isNaN(zipcode)) {
button_click = false;
$("#zip").val(zipcode);
zipValidate(button_click);
}
});
$(document).ready(function() {
if (rates_redirect) {
$("#btn-zip").unbind('click');
$('#btn-zip').click(function() {
button_click = true;
zipValidationSuccess(button_click);
});
}
});
</script>
<script type="text/javascript" src="js/everflow.js"></script>
<script type="text/javascript">
$(document).ready(function() {
var efClickPromise = EF.click({
offer_id: EF.urlParameter('oid'),
affiliate_id: EF.urlParameter('aff_id'),
sub1: EF.urlParameter('sub_id'),
sub2: EF.urlParameter('s2'),
sub3: EF.urlParameter('s3'),
sub4: EF.urlParameter('s4'),
sub5: EF.urlParameter('s5'),
uid: EF.urlParameter('uid')
});
efClickPromise.then(function() {
var oid = EF.urlParameter('oid');
if (oid) {
var transactionId = EF.getTransactionId(oid);
if (transactionId) {
$("#s2").val(transactionId);
$("#transaction_id").val(transactionId);
}
}
// lptrk("medicare");
});
});
</script>
<script>
function stateHandler(state) {
// This script needs to wait a second to make sure the ringpool number gets populated
window.history.pushState(null, null, '?step=' + state);
};
stateHandler(1)
window.onpopstate = function(event) {
if (!getUrlParameter('step')) return;
let slide = Number(getUrlParameter('step') || 1);
let parent_fieldset = $('fieldset.active');
let next = $(`[data-step="${slide}"]`);
let progwidth = next.attr('data-bar');
if (parent_fieldset.attr('id') == 'birthdayfieldset') {
var date = $('#bday-year').val() + '-' + $('#bday-month').val() + '-' + $('#bday-day').val();
$('#dob').val(date);
}
//parent_fieldset.removeClass('fadeOutLeft');
parent_fieldset.removeClass('active');
//parent_fieldset.addClass('fadeInRight');
parent_fieldset.fadeOut(function() {
$(this).find('.form-group').children('.form-error-message').hide();
window.top.scrollTo(0, 0)
next.fadeIn(function() {
//stateHandler($(this).data('step'));
// next.removeClass('fadeOutLeft')
//next.addClass('fadeInRight');
next.addClass('active');
$(this).find('input,select').first().focus();
//$(".circle-progress").attr('data-progress', progwidth);
$('#showProgress').width(progwidth + '%');
// $(".percent").html(progwidth + '%');
$(".complete").html('completed')
if ($('#phoneContainer').is(':visible')) {
$('.trusted').hide();
}
});
})
}
if (window.location.href.indexOf('lp3') > -1) {
$(".featured").show();
}
$(".btn-next").click(function() {
var parent_fieldset = $(this).parents('fieldset');
var next_step = true;
var next_fs = $(this).parent().next();
var progwidth = $(this).parents('fieldset').next().attr('data-bar');
var stepNumber = $(this).parents('fieldset').next().attr('data-step');
console.log('stepNumber', stepNumber);
var result = $("#msform").valid();
console.log('result', result);
if (!result) {
next_step = false;
}
const firstName = $('#firstName').val()
console.log('firstName', firstName);
$('#username').text(firstName);
console.log('step number', stepNumber)
if (stepNumber === '10') {
setTimeout(() => {
return submitLead()
}, 2500)
}
if (next_step) {
if (parent_fieldset.attr('id') == 'birthdayfieldset') {
var date = $('#bday-year').val() + '-' + $('#bday-month').val() + '-' + $('#bday-day').val();
$('#dob').val(date);
$('#dob').trigger('change');
}
//////////////////// HOTJAR FUNNEL START ////////////////////
//We use this to track the step so we know what virtual page to trigger when because it's not explicitly defined in the btn-next click handler
if (typeof window.stepNumberForHotjar === "undefined") {
//On page load, HotJar starts at step 0, and we track that event
window.stepNumberForHotjar = 0;
}
//Each subsequent event is tracked after it happens, so after the monthly bill is selected, then that event is triggered
window.stepNumberForHotjar = window.stepNumberForHotjar + 1;
// parent_fieldset.removeClass('fadeInRight');
// parent_fieldset.toggleClass('fadeOutLeft');
parent_fieldset.removeClass('active');
parent_fieldset.fadeOut(function() {
$(this).find('.form-group').children('.form-error-message').hide();
$("body").animate({
scrollTop: 0
}, '500');
window.top.scrollTo(0, 0)
$(this).next().fadeIn(function() {
stateHandler($(this).data('step'));
$(this).addClass('active');
$(this).find('input,select').first().focus();
$('#showProgress').width(progwidth + '%');
// $(".circle-progress").attr('data-progress', progwidth);
// $(".percent").html(progwidth + '%');
$(".complete").html('completed');
if ($('#phoneContainer').is(':visible')) {
$('.trusted').hide();
}
});
})
}
});
function goBack() {
window.history.back();
}
</script>
<script src="js_1" async="" defer=""></script>
<script type="text/javascript">
(function() {
var field = 'xxTrustedFormCertUrl';
var provideReferrer = false;
var invertFieldSensitivity = false;
var tf = document.createElement('script');
tf.type = 'text/javascript';
tf.async = true;
tf.src = 'http' + ('https:' == document.location.protocol ? 's' : '') + '://api.trustedform.com/trustedform.js?provide_referrer=' + escape(provideReferrer) + '&field=' + escape(field) + '&l=' + new Date().getTime() + Math.random() +
'&invert_field_sensitivity=' + invertFieldSensitivity;
var s = document.getElementsByTagName('script')[0];
s.parentNode.insertBefore(tf, s);
})();
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LeadiDscript.parentNode.insertBefore(s, LeadiDscript);
})();
</script>
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</div><input type="hidden" id="ip_address" name="ip_address" value="78.159.108.10"><input type="hidden" id="ip_address_v6" name="ip_address_v6" value="2a00:c98:2f00:20:a::5"><input type="hidden" name="xxTrustedFormCertUrl"
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Need a quote? Call toll free: 1-833-258-48891-833-258-4889 A licensed insurance agent will answer your call 1-833-258-4889 AFFORDABLE CARE ACT OPTIONS Calculate savings, compare free quotes, and check incentives! Zip Code WHAT AREA ARE YOU LOCATED IN? Enter your zip code and we will help you compare free quotes! Zip Code Please enter valid US zip code. View Quotes roof shade ARE YOU LOOKING FOR INDIVIDUAL OR FAMILY COVERAGE? * INDIVIDUAL * FAMILY Next Back roof shade WHAT IS YOUR HOUSEHOLD SIZE? * 1 * 2 * 3 * 4 * 5 * 6+ Next Back roof shade WHAT IS YOUR HOUSEHOLD INCOME? * Below $23,000 * $23,000 - $30,000 * $30,000-$40,000 * $40,000-$50,000 * $50,000-$60,000 * Over $70,000 Next Back roof shade WHAT IS YOUR GENDER? * Male * Female Don't forget to tell us your gender. Next Back electric bill WHAT IS YOUR BIRTHDAY? month Month January February March April May June July August September October November December This Field is Required Day Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 This Field is Required Year Year 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 This Field is Required Back Next address WHAT IS YOUR HOME ADDRESS? We verify your location to provide local quotes in your area. Street Address Please enter your address. Back Next full name WHAT IS YOUR FULL NAME? FirstName Don't forget to tell us your name. Last Name Don't forget to tell us your last name. Back Next Email THANKS , NEXT LET’S COMPARE YOUR QUOTES! Email Address Please enter your email address. Phone Number Please enter a valid phone number Back View Quotes By clicking the "View Quotes" button above, I give my express written consent by electronic signature to receive telephone calls, text messages and/or emails for the purposes of solicitation from or on behalf of one or more of the companies listed here regarding their products and services (Including Medicare Advantage plans, Medicare Part D Prescription Drug Plans or Medicare Supplement Insurance Plans using an automated telephone dialing system and/or pre-recorded voice at the telephone number provided above, including any mobile number. I understand my consent, which may be revoked at any time, is not a condition to receive goods/services. I also have read and agree to the Terms and Conditions and Privacy Policy of this website. Success Reviewing your details.. Searching ... Matching you with different options... Checking plan availability... Congratulations! We hacityve found matches in your area! AGENTS ARE STANDING BY Select at least 3 quotes below for the best rates! -------------------------------------------------------------------------------- Copyright © 2020 ameriquote.com * Privacy Policy * Contact * Terms of Use * Do Not Sell MyInformation DISCLOSURES - This is an advertising referral and comparison service that matches consumers with prospective insurance agents and companies depending upon your information. The operator of this website is not an insurance company, an agent, a provider, a broker, a representative, a bank, or a financial or lending institution. We do not represent any specific insurance provider and do not provide insurance or financial quotes, or policies. The service is not used for insurance or credit decisions. Quotes are provided by independent participating insurance agents and companies that participate in network. Lowest advertised rates may vary and are not necessarily available from all participating service providers. By submitting your information, you expressly consent to be contacted by a representative, an insurance agent or insurance company. Providing your information does not guarantee that you will be accepted by a participating provider. We do not have access to the terms of your insurance plan and disclaim liability for, without limitation, any product, service, plan or provider. For details, questions or concerns regarding your plan, please contact your third-party provider or agent, directly. We do not endorse or charge you for any product or service. Any compensation received is paid by participating providers and only for advertising services provided. This service is void where prohibited. We are not connected with or endorsed by the U.S. government or any federal insurance program. This service does not constitute an offer to sell or a solicitation in connection with any product or service. This service and these disclosures are provided to you for information purposes only and should not be used as a substitute for informed professional advice.