rewardzinga.com Open in urlscan Pro
188.114.96.3  Public Scan

Form analysis
1 forms found in the DOM

POST /flow?uid=23617a1e-83a1-4534-a1e7-14a0968af3f2

<form id="formSubmit" action="/flow?uid=23617a1e-83a1-4534-a1e7-14a0968af3f2" 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-html" class="col html form-field-col-ignored" data-col-id="1" data-autohide="">
        <div id="path-field-html-1-1-1" class="path-dynamic-field">
          <style>
            .global-consent {
              font-size: 11px;
              line-height: 1.1;
            }
          </style>
        </div>
        <script>
          document.querySelector('#path-field-html-1-1-1').addEventListener('path-dynamic-field-register', function(evt) {
            var elem = this
            elem.fieldContent = elem.innerHTML
            evt.detail.setControls('eyJwb3B1bGF0ZSI6bnVsbCwidmlzaWJpbGl0eSI6bnVsbCwidmFsaWRhdGlvbnMiOm51bGx9')
            evt.detail.render(function(renders) {
              return {
                hide: renders.hideParentFieldForm(elem),
                show: renders.hideParentFieldForm(elem, false),
                populate: {
                  prepopulate_with: renders.fillMergetagsHTML(elem)
                },
              }
            })
          })
        </script>
      </div>
    </div>
    <div class="row row-spacing" data-row-id="2">
      <div id="col-field-html" class="col html form-field-col-ignored" data-col-id="1" data-autohide="">
        <div id="path-field-html-1-2-1" class="path-dynamic-field">
          <div id="form-progress-bar-container" style="
    display: flex;
    flex-direction: column;
    align-items: center;
    padding: 0 0 10px 0;
  ">
            <span id="form-progress-bar-text" style="color: #5a5a5a; font-size: 16px; padding: 0 0 8px 0">Confirming entry to win</span>
            <svg xmlns="http://www.w3.org/2000/svg" width="210px" height="7" viewBox="0 0 210 7" fill="none">
              <rect x="0.233337" y="0.11908" width="209" height="7" rx="3.19169" fill="#E4E4E4"></rect>
              <rect x="0.233337" y="0.11908" width="157.5" height="7" rx="3.19169" fill="#10B210"></rect>
            </svg>
          </div>
        </div>
        <script>
          document.querySelector('#path-field-html-1-2-1').addEventListener('path-dynamic-field-register', function(evt) {
            var elem = this
            elem.fieldContent = elem.innerHTML
            evt.detail.setControls('eyJwb3B1bGF0ZSI6bnVsbCwidmlzaWJpbGl0eSI6bnVsbCwidmFsaWRhdGlvbnMiOm51bGx9')
            evt.detail.render(function(renders) {
              return {
                hide: renders.hideParentFieldForm(elem),
                show: renders.hideParentFieldForm(elem, false),
                populate: {
                  prepopulate_with: renders.fillMergetagsHTML(elem)
                },
              }
            })
          })
        </script>
      </div>
    </div>
    <div class="row row-spacing" data-row-id="3">
      <div id="col-field-html" class="col html form-field-col-ignored" data-col-id="1" data-autohide="">
        <div id="path-field-html-1-3-1" class="path-dynamic-field">
          <div class="headertext">Continue below to proceed</div>
        </div>
        <script>
          document.querySelector('#path-field-html-1-3-1').addEventListener('path-dynamic-field-register', function(evt) {
            var elem = this
            elem.fieldContent = elem.innerHTML
            evt.detail.setControls('eyJwb3B1bGF0ZSI6bnVsbCwidmlzaWJpbGl0eSI6bnVsbCwidmFsaWRhdGlvbnMiOm51bGx9')
            evt.detail.render(function(renders) {
              return {
                hide: renders.hideParentFieldForm(elem),
                show: renders.hideParentFieldForm(elem, false),
                populate: {
                  prepopulate_with: renders.fillMergetagsHTML(elem)
                },
              }
            })
          })
        </script>
      </div>
    </div>
    <div class="row row-spacing" data-row-id="4">
      <div id="col-field-first_name" class="col first-name form-field-col" data-col-id="1" data-autohide="true">
        <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"></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('eyJwb3B1bGF0ZSI6bnVsbCwidmlzaWJpbGl0eSI6eyJ0eXBlIjoiaGlkZSIsImFjdGlvbnMiOltdLCJhdXRvaGlkZSI6dHJ1ZX0sInZhbGlkYXRpb25zIjp7ImFjdGlvbnMiOltdLCJyZXF1aXJlZCI6dHJ1ZX19')
            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>
    <div class="row row-spacing" data-row-id="5">
      <div id="col-field-last_name" class="col last-name form-field-col" data-col-id="1" data-autohide="true">
        <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"></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('eyJwb3B1bGF0ZSI6bnVsbCwidmlzaWJpbGl0eSI6eyJ0eXBlIjoiaGlkZSIsImFjdGlvbnMiOltdLCJhdXRvaGlkZSI6dHJ1ZX0sInZhbGlkYXRpb25zIjp7ImFjdGlvbnMiOltdLCJyZXF1aXJlZCI6dHJ1ZX19')
            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="6">
      <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"></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('eyJwb3B1bGF0ZSI6bnVsbCwidmlzaWJpbGl0eSI6bnVsbCwidmFsaWRhdGlvbnMiOnsiYWN0aW9ucyI6W10sInJlcXVpcmVkIjp0cnVlfX0%3D')
            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="7">
      <div id="col-field-address1" class="col address-1 form-field-col" data-col-id="1" data-autohide="true">
        <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"></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('eyJwb3B1bGF0ZSI6bnVsbCwidmlzaWJpbGl0eSI6eyJ0eXBlIjoiaGlkZSIsImFjdGlvbnMiOltdLCJhdXRvaGlkZSI6dHJ1ZX0sInZhbGlkYXRpb25zIjp7ImFjdGlvbnMiOltdLCJyZXF1aXJlZCI6dHJ1ZX19')
            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="8">
      <div id="col-field-zip" class="col zip-code form-field-col" data-col-id="1" data-autohide="true">
        <label class="label">Zip Code</label>
        <input id="zip" type="text" name="zip" title="Zipcode" maxlength="5" data-session-verification="-1" value="" class="path-form-field-with-feedback required path-dynamic-field" pattern="[0-9]*" inputmode="numeric" autocomplete="postal-code">
        <span id="zip-error-feedback" class="invalid-feedback hidden path-form-feedback"></span>
        <script>
          document.querySelector('#zip').addEventListener('path-dynamic-field-register', function(evt) {
            var feedbackElem = document.querySelector('#zip-error-feedback')
            var elem = this
            evt.detail.setControls('eyJwb3B1bGF0ZSI6bnVsbCwidmlzaWJpbGl0eSI6eyJ0eXBlIjoiaGlkZSIsImFjdGlvbnMiOltdLCJhdXRvaGlkZSI6dHJ1ZX0sInZhbGlkYXRpb25zIjp7ImFjdGlvbnMiOltdLCJyZXF1aXJlZCI6dHJ1ZX19')
            evt.detail.assignToState('zip')
            evt.detail.render(function(renders) {
              return {
                hide: renders.hideParentFieldForm(elem),
                show: renders.hideParentFieldForm(elem, false),
                populate: {
                  prepopulate_with: renders.fillZip(elem)
                },
                validation: renders.fillFeedbackMessage(feedbackElem)
              }
            })
            $(elem).change()
          })
        </script>
      </div>
    </div>
    <div class="row row-spacing" data-row-id="9">
      <div id="col-field-city" class="col city form-field-col" data-col-id="1" data-autohide="true">
        <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"></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('eyJwb3B1bGF0ZSI6bnVsbCwidmlzaWJpbGl0eSI6eyJ0eXBlIjoiaGlkZSIsImFjdGlvbnMiOltdLCJhdXRvaGlkZSI6dHJ1ZX0sInZhbGlkYXRpb25zIjp7ImFjdGlvbnMiOltdLCJyZXF1aXJlZCI6dHJ1ZX19')
            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="true">
        <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>
          <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>
        <span id="state-error-feedback" class="invalid-feedback hidden path-form-feedback"></span>
        <script>
          document.querySelector('#state').addEventListener('path-dynamic-field-register', function(evt) {
            var feedbackElem = document.querySelector('#state-error-feedback')
            var elem = this
            evt.detail.setControls('eyJwb3B1bGF0ZSI6bnVsbCwidmlzaWJpbGl0eSI6eyJ0eXBlIjoiaGlkZSIsImFjdGlvbnMiOltdLCJhdXRvaGlkZSI6dHJ1ZX0sInZhbGlkYXRpb25zIjp7ImFjdGlvbnMiOltdLCJyZXF1aXJlZCI6dHJ1ZX19')
            evt.detail.assignToState('state')
            evt.detail.render(function(renders) {
              return {
                hide: renders.hideParentFieldForm(elem),
                show: renders.hideParentFieldForm(elem, false),
                populate: {
                  populate_options: renders.fillSelectOptions(elem, `
                Select State
          `),
                  prepopulate_with: renders.fillInput(elem)
                },
                validation: renders.fillFeedbackMessage(feedbackElem)
              }
            })
          })
        </script>
      </div>
    </div>
    <div class="row row-spacing" data-row-id="10">
      <div id="col-field-dob" class="col date-of-birth form-field-col" data-col-id="1" data-autohide="true">
        <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="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>
              <option value="1924">1924</option>
            </select>
          </div>
        </div>
        <span id="dobmessage" class="invalid-feedback hidden path-form-feedback"></span>
        <script>
          var feedbackElem = document.querySelector('#dobmessage')
          document.querySelector('#dob_day').addEventListener('path-dynamic-field-register', function(evt) {
            var elem = this
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                validation: renders.fillFeedbackMessage(feedbackElem)
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                  populate_options: renders.fillSelectOptions(elem, `
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                validation: renders.fillFeedbackMessage(feedbackElem)
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    </div>
    <div class="row row-spacing" data-row-id="12">
      <div id="col-field-submit" class="col custom-submit-button form-field-col-ignored" data-col-id="1" data-autohide="">
        <button class="btn form-button submitbutton form-submit-button" type="button" id="submitbutton">
          <span>Continue</span>
          <i class="fa fa-spinner fa-spin"></i>
        </button>
      </div>
    </div>
    <div class="row row-spacing" data-row-id="13">
      <div id="col-field-registration_consent" class="col registration-consent form-field-col" data-col-id="1" data-autohide="false">
        <div class="terms termschk">
          <input type="hidden" class="chkbox path-dynamic-field" id="chkterms" name="chkterms" checked="" value="on">
          <label class="term-label terms-label--text">
            <div class="global-consent">By clicking Continue, I agree to receive email from RewardZinga and affiliated brands that may be of interest to me. I also agree to the
              <a href="/rewards-terms-and-conditions" target="_blank" style="color:#5e8bb8;">Terms &amp; Conditions</a> (including mandatory arbitration), <a href="/rewards-privacy-policy" target="_blank" style="color:#5e8bb8;">Privacy Policy</a>,
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          </label>
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                return elem.checked
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        </div>
      </div>
    </div>
  </div>
  <div id="f2" class="dynamic-form form-step form2 form1-2 hidden">
    <div class="row row-spacing" data-row-id="1">
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        <div id="path-field-html-2-1-1" class="path-dynamic-field">
          <div id="form-progress-bar-container" style="
    display: flex;
    flex-direction: column;
    align-items: center;
    padding: 0 0 10px 0;
  ">
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          </div>
        </div>
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                hide: renders.hideParentFieldForm(elem),
                show: renders.hideParentFieldForm(elem, false),
                populate: {
                  prepopulate_with: renders.fillMergetagsHTML(elem)
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            })
          })
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      </div>
    </div>
    <div class="row row-spacing" data-row-id="2">
      <div id="col-field-html" class="col html form-field-col-ignored" data-col-id="1" data-autohide="">
        <div id="path-field-html-2-2-1" class="path-dynamic-field">
          <div class="headertext">Thanks! Please confirm your number</div>
        </div>
        <script>
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            var elem = this
            elem.fieldContent = elem.innerHTML
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        </script>
      </div>
    </div>
    <div class="row row-spacing" data-row-id="3">
      <div id="col-field-phone" class="col phone form-field-col" data-col-id="1" 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 required" pattern="[0-9]*" inputmode="numeric" autocomplete="tel-national">
        <span id="phone-error-feedback" class="invalid-feedback hidden path-form-feedback invalid-phone"></span>
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                hide: renders.hideParentFieldForm(elem),
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                validation: renders.fillFeedbackMessage(feedbackElem)
              }
            })
          })
        </script>
      </div>
    </div>
    <div class="row row-spacing" data-row-id="4">
      <div id="col-field-tcpa_consent" class="col tcpa-consent form-field-col" data-col-id="1" data-autohide="false">
        <div class="tcpa-terms">
          <input type="hidden" class="chkbox path-dynamic-field" id="leadid_tcpa_disclosure" name="chktcpa" checked="">
          <label class="term-label p-0" for="leadid_tcpa_disclosure">
            <div class="global-consent">By clicking the “Continue” button, I give my affirmative express consent authorizing RewardZinga, Support First, Unified Marketing Partner LLC, JobblyPro, American Benefits Zone, Aid4Families and
              <a href="/marketing-partners-r" target="_blank" style="color:#5e8bb8;">Marketing Partners</a> to contact me by text messages or telephone including the use of an autodialer. I confirm the number I provided above is accurate and I am the
              regular user. I am willing to incur charges from my phone company for these contacts. This consent applies even if my number is on a Federal or State Do-Not-Call List. I also agree to the
              <a href="/rewards-terms-and-conditions" target="_blank" style="color:#5e8bb8;">Terms &amp; Conditions</a> (including mandatory arbitration) and <a href="/rewards-privacy-policy" target="_blank" style="color:#5e8bb8;">Privacy Policy</a>.
              I understand that consent isn’t required to participate and that I can revoke my consent for calls by any reasonable means. <a notcpaconsent="" style="color:#5e8bb8;" href="javascript:void(0)">Click here</a> to continue without
              providing consent.</div>
          </label>
          <script>
            document.querySelector('#leadid_tcpa_disclosure').addEventListener('path-dynamic-field-register', function(evt) {
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              evt.detail.assignToState('tcpaConsent', function(value) {
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          <span>Continue</span>
          <i class="fa fa-spinner fa-spin"></i>
        </button>
      </div>
    </div>
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  <div class="form-row">
    <div class="x-12 col-mobile center">
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    <input type="hidden" id="haddress2" value="">
    <input type="hidden" id="hcity" value="">
    <input type="hidden" id="hstate" value="">
    <input type="hidden" id="hzipcode" value="">
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    <script type="text/javascript">
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        tf.async = true;
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</form>

Text Content

Confirming entry to win
Continue below to proceed
First Name
Last Name
E-mail
Address 1
Zip Code
City
State Select State Alabama Alaska Arizona Arkansas California Colorado
Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois
Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan
Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey
New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon
Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah
Vermont Virginia Washington West Virginia Wisconsin Wyoming
Date of Birth
Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
26 27 28 29 30 31
Year
20062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924
Gender Select Gender Male Female
Continue
By clicking Continue, I agree to receive email from RewardZinga and affiliated
brands that may be of interest to me. I also agree to the Terms & Conditions
(including mandatory arbitration), Privacy Policy, and site visit recordation by
TrustedForm and Jornaya.
Confirming entry to win
Thanks! Please confirm your number
Phone
By clicking the “Continue” button, I give my affirmative express consent
authorizing RewardZinga, Support First, Unified Marketing Partner LLC,
JobblyPro, American Benefits Zone, Aid4Families and Marketing Partners to
contact me by text messages or telephone including the use of an autodialer. I
confirm the number I provided above is accurate and I am the regular user. I am
willing to incur charges from my phone company for these contacts. This consent
applies even if my number is on a Federal or State Do-Not-Call List. I also
agree to the Terms & Conditions (including mandatory arbitration) and Privacy
Policy. I understand that consent isn’t required to participate and that I can
revoke my consent for calls by any reasonable means. Click here to continue
without providing consent.
Continue



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