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Submission: On March 24 via api from US — Scanned from US
Submission: On March 24 via api from US — Scanned from US
Form analysis 1 forms found in the DOM
<form class="flex flex-col gap-8 sm:gap-10">
<div>
<div style="opacity: 1; transform: none;">
<div class="flex flex-col gap-4">
<header class="flex flex-row items-center">
<h1 class="h4 font-semibold">Enter Pet Info</h1>
</header>
<div class="flex flex-1 flex-col gap-4">
<div style="opacity: 1; transform: none;">
<div class="flex flex-row">
<div class="flex flex-col rounded-md border border-stroke-weaker p-4 flex-1 gap-5 bg-surface-weakest">
<div class="flex flex-col gap-5 lg:flex-row">
<div class="relative flex flex-col w-full lg:w-1/3 lg:max-w-[365px]">
<div class="relative flex items-center rounded-md border border-none bg-surface-weakest shadow-faux-border"><input
class="px-4 h-11 w-full bg-surface-weakest rounded-md text-type-primary text-base appearance-none focus:outline-none peer placeholder:opacity-0 focus:placeholder:opacity-100 placeholder:text-type-hint input-value-false"
placeholder="" id="policies.0.name" value="" name="policies.0.name"><label class="font-medium text-type-hint peer-disabled:cursor-not-allowed peer-disabled:opacity-70 label--floating text-base bg-surface-weakest"
for="policies.0.name">Your dog's name</label></div>
</div>
<div class="flex w-full flex-row justify-center gap-5 max-[380px]:flex-col sm:w-auto lg:w-2/3">
<div class="relative flex flex-col w-full">
<div role="group" dir="ltr" class="flex h-11 flex-row rounded-md text-xs font-extrabold text-type-primary disabled:cursor-wait" tabindex="0" style="outline: none;"><button type="button" data-state="on" role="radio"
aria-checked="true"
class="flex w-full cursor-pointer flex-col items-center justify-center whitespace-nowrap px-2 text-center shadow-faux-border focus:rounded-none first:focus:rounded-l-md first:focus:rounded-r-none last:focus:rounded-l-none last:focus:rounded-r-md disabled:cursor-wait bg-surface-strong rounded-l-md"
tabindex="-1" data-radix-collection-item=""><svg aria-hidden="true" focusable="false" data-prefix="fas" data-icon="dog" class="svg-inline--fa fa-dog fa-lg " role="img" xmlns="http://www.w3.org/2000/svg"
viewBox="0 0 576 512">
<path fill="currentColor"
d="M309.6 158.5L332.7 19.8C334.6 8.4 344.5 0 356.1 0c7.5 0 14.5 3.5 19 9.5L392 32h52.1c12.7 0 24.9 5.1 33.9 14.1L496 64h56c13.3 0 24 10.7 24 24v24c0 44.2-35.8 80-80 80H464 448 426.7l-5.1 30.5-112-64zM416 256.1L416 480c0 17.7-14.3 32-32 32H352c-17.7 0-32-14.3-32-32V364.8c-24 12.3-51.2 19.2-80 19.2s-56-6.9-80-19.2V480c0 17.7-14.3 32-32 32H96c-17.7 0-32-14.3-32-32V249.8c-28.8-10.9-51.4-35.3-59.2-66.5L1 167.8c-4.3-17.1 6.1-34.5 23.3-38.8s34.5 6.1 38.8 23.3l3.9 15.5C70.5 182 83.3 192 98 192h30 16H303.8L416 256.1zM464 80a16 16 0 1 0 -32 0 16 16 0 1 0 32 0z">
</path>
</svg><label aria-disabled="false" class="text-sm font-medium cursor-pointer">Dog</label></button><button type="button" data-state="off" role="radio" aria-checked="false"
class="flex w-full cursor-pointer flex-col items-center justify-center whitespace-nowrap px-2 text-center shadow-faux-border focus:rounded-none first:focus:rounded-l-md first:focus:rounded-r-none last:focus:rounded-l-none last:focus:rounded-r-md disabled:cursor-wait bg-surface-weakest hover:bg-surface-weaker rounded-r-md"
tabindex="-1" data-radix-collection-item=""><svg aria-hidden="true" focusable="false" data-prefix="fas" data-icon="cat" class="svg-inline--fa fa-cat fa-lg " role="img" xmlns="http://www.w3.org/2000/svg"
viewBox="0 0 576 512">
<path fill="currentColor"
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</path>
</svg><label aria-disabled="false" class="text-sm font-medium cursor-pointer">Cat</label></button></div>
</div>
<div class="relative flex flex-col w-full">
<div role="group" dir="ltr" class="flex h-11 flex-row rounded-md text-xs font-extrabold text-type-primary disabled:cursor-wait" tabindex="0" style="outline: none;"><button type="button" data-state="on" role="radio"
aria-checked="true"
class="flex w-full cursor-pointer flex-col items-center justify-center whitespace-nowrap px-2 text-center shadow-faux-border focus:rounded-none first:focus:rounded-l-md first:focus:rounded-r-none last:focus:rounded-l-none last:focus:rounded-r-md disabled:cursor-wait bg-surface-strong rounded-l-md"
tabindex="-1" data-radix-collection-item=""><svg aria-hidden="true" focusable="false" data-prefix="fas" data-icon="venus" class="svg-inline--fa fa-venus fa-lg " role="img" xmlns="http://www.w3.org/2000/svg"
viewBox="0 0 384 512">
<path fill="currentColor"
d="M80 176a112 112 0 1 1 224 0A112 112 0 1 1 80 176zM224 349.1c81.9-15 144-86.8 144-173.1C368 78.8 289.2 0 192 0S16 78.8 16 176c0 86.3 62.1 158.1 144 173.1V384H128c-17.7 0-32 14.3-32 32s14.3 32 32 32h32v32c0 17.7 14.3 32 32 32s32-14.3 32-32V448h32c17.7 0 32-14.3 32-32s-14.3-32-32-32H224V349.1z">
</path>
</svg><label aria-disabled="false" class="text-sm font-medium cursor-pointer">Female</label></button><button type="button" data-state="off" role="radio" aria-checked="false"
class="flex w-full cursor-pointer flex-col items-center justify-center whitespace-nowrap px-2 text-center shadow-faux-border focus:rounded-none first:focus:rounded-l-md first:focus:rounded-r-none last:focus:rounded-l-none last:focus:rounded-r-md disabled:cursor-wait bg-surface-weakest hover:bg-surface-weaker rounded-r-md"
tabindex="-1" data-radix-collection-item=""><svg aria-hidden="true" focusable="false" data-prefix="fas" data-icon="mars" class="svg-inline--fa fa-mars fa-lg " role="img" xmlns="http://www.w3.org/2000/svg"
viewBox="0 0 448 512">
<path fill="currentColor"
d="M289.8 46.8c3.7-9 12.5-14.8 22.2-14.8H424c13.3 0 24 10.7 24 24V168c0 9.7-5.8 18.5-14.8 22.2s-19.3 1.7-26.2-5.2l-33.4-33.4L321 204.2c19.5 28.4 31 62.7 31 99.8c0 97.2-78.8 176-176 176S0 401.2 0 304s78.8-176 176-176c37 0 71.4 11.4 99.8 31l52.6-52.6L295 73c-6.9-6.9-8.9-17.2-5.2-26.2zM400 80l0 0h0v0zM176 416a112 112 0 1 0 0-224 112 112 0 1 0 0 224z">
</path>
</svg><label aria-disabled="false" class="text-sm font-medium cursor-pointer">Male</label></button></div>
</div>
</div>
</div>
<div class="flex flex-col gap-5 lg:flex-row">
<div class="relative flex flex-col w-full lg:w-1/2"><label class="font-medium text-type-hint peer-disabled:cursor-not-allowed peer-disabled:opacity-70 label--floating text-xs bg-surface-weakest">Your dog's age</label>
<div tabindex="-1" class="size-[1px] pointer-events-none absolute left-0 top-0 opacity-0"></div><button type="button" role="combobox" aria-controls="radix-:r1u:" aria-expanded="false" aria-autocomplete="none" dir="ltr"
data-state="closed" data-placeholder=""
class="flex max-h-11 w-full items-center justify-between rounded-md bg-surface-weakest px-4 py-2 text-left text-base font-medium text-type-hint shadow-faux-border disabled:cursor-not-allowed disabled:opacity-50 relative h-11 min-w-[200px] flex-1"><span
class="truncate"><span style="pointer-events: none;">Pet's age</span></span><svg xmlns="http://www.w3.org/2000/svg" width="24" height="24" viewBox="0 0 24 24" fill="none" stroke="currentColor" stroke-width="2"
stroke-linecap="round" stroke-linejoin="round" class="size-4 opacity-50" aria-hidden="true">
<path d="m6 9 6 6 6-6"></path>
</svg></button><select aria-hidden="true" tabindex="-1"
style="position: absolute; border: 0px; width: 1px; height: 1px; padding: 0px; margin: -1px; overflow: hidden; clip: rect(0px, 0px, 0px, 0px); white-space: nowrap; overflow-wrap: normal;">
<option value=""></option>
<option value="0">8 weeks to 11 months</option>
<option value="1">1 year</option>
<option value="2">2 years</option>
<option value="3">3 years</option>
<option value="4">4 years</option>
<option value="5">5 years</option>
<option value="6">6 years</option>
<option value="7">7 years</option>
<option value="8">8 years</option>
<option value="9">9 years</option>
<option value="10">10 years</option>
<option value="11">11 years</option>
<option value="12">12 years</option>
<option value="13">13 years</option>
<option value="14">14 years</option>
<option value="15">15 years</option>
<option value="16">16 years</option>
<option value="17">17 years</option>
<option value="18">18 years</option>
<option value="19">19 years</option>
<option value="20">20 years</option>
</select>
</div>
<div class="relative flex flex-col w-full lg:w-1/2"><label class="font-medium text-type-hint peer-disabled:cursor-not-allowed peer-disabled:opacity-70 label--floating text-xs bg-surface-weakest">Your dog's breed</label>
<div tabindex="-1" class="size-[1px] pointer-events-none absolute left-0 top-0 opacity-0"></div><button
class="inline-flex items-center text-base font-medium transition-colors disabled:pointer-events-none disabled:opacity-50 rounded-md border border-stroke-weaker bg-surface-weakest text-type-hint h-11 px-4 py-3 relative w-full min-w-[200px] justify-between border-none shadow-faux-border"
type="button" role="combobox" aria-expanded="false" aria-haspopup="dialog" aria-controls="radix-:r1v:" data-state="closed"><span class="absolute max-w-[80%] truncate sm:max-w-[85%]">Select a breed</span><svg
xmlns="http://www.w3.org/2000/svg" width="24" height="24" viewBox="0 0 24 24" fill="none" stroke="currentColor" stroke-width="2" stroke-linecap="round" stroke-linejoin="round" class="size-4 absolute right-4 opacity-50">
<path d="m7 15 5 5 5-5"></path>
<path d="m7 9 5-5 5 5"></path>
</svg></button>
</div>
</div>
</div>
</div>
</div>
<div class="flex flex-row"><button class="inline-flex items-center justify-center text-base font-medium transition-colors disabled:pointer-events-none disabled:opacity-50 rounded-md text-type-primary hover:bg-surface-weak h-11 px-4 py-3"
type="button" title="Add a Pet"><span class="mr-2 flex"><svg aria-hidden="true" focusable="false" data-prefix="fas" data-icon="circle-plus" class="svg-inline--fa fa-circle-plus fa-lg " role="img" xmlns="http://www.w3.org/2000/svg"
viewBox="0 0 512 512">
<path fill="currentColor"
d="M256 512A256 256 0 1 0 256 0a256 256 0 1 0 0 512zM232 344V280H168c-13.3 0-24-10.7-24-24s10.7-24 24-24h64V168c0-13.3 10.7-24 24-24s24 10.7 24 24v64h64c13.3 0 24 10.7 24 24s-10.7 24-24 24H280v64c0 13.3-10.7 24-24 24s-24-10.7-24-24z">
</path>
</svg></span>Add a Pet<span class="ml-2 flex">
<div class="inline-flex items-center rounded-full px-2 text-xs leading-5 transition-colors focus:outline-none bg-surface-success-weaker text-type-success ml-1">10% multi-pet discount on all additional pets</div>
</span></button></div>
</div>
<div class="flex flex-col rounded-md border border-stroke-weaker p-4 flex-1 gap-5 bg-surface-weakest">
<div class="grid grid-cols-1 gap-5 lg:grid-cols-2">
<div class="relative flex flex-col flex-1">
<div class="relative flex items-center rounded-md border border-none bg-surface-weakest shadow-faux-border"><input
class="px-4 h-11 w-full bg-surface-weakest rounded-md text-type-primary text-base appearance-none focus:outline-none peer placeholder:opacity-0 focus:placeholder:opacity-100 placeholder:text-type-hint input-value-false"
placeholder="" id="first-name" autocomplete="given-name" value="" name="firstName"><label class="font-medium text-type-hint peer-disabled:cursor-not-allowed peer-disabled:opacity-70 label--floating text-base bg-surface-weakest"
for="first-name">First name</label></div>
</div>
<div class="relative flex flex-col flex-1">
<div class="relative flex items-center rounded-md border border-none bg-surface-weakest shadow-faux-border"><input
class="px-4 h-11 w-full bg-surface-weakest rounded-md text-type-primary text-base appearance-none focus:outline-none peer placeholder:opacity-0 focus:placeholder:opacity-100 placeholder:text-type-hint input-value-false"
placeholder="" id="last-name" autocomplete="family-name" value="" name="lastName"><label class="font-medium text-type-hint peer-disabled:cursor-not-allowed peer-disabled:opacity-70 label--floating text-base bg-surface-weakest"
for="last-name">Last name</label></div>
</div>
</div>
<div class="grid grid-cols-1 gap-5 lg:grid-cols-3">
<div class="relative flex flex-col flex-1">
<div class="relative flex items-center rounded-md border border-none bg-surface-weakest shadow-faux-border"><input
class="px-4 h-11 w-full bg-surface-weakest rounded-md text-type-primary text-base appearance-none focus:outline-none peer placeholder:opacity-0 focus:placeholder:opacity-100 placeholder:text-type-hint input-value-false"
placeholder="my@email.com" id="email-address" autocomplete="email" type="email" value="" name="email"><label
class="font-medium text-type-hint peer-disabled:cursor-not-allowed peer-disabled:opacity-70 label--floating text-base bg-surface-weakest" for="email-address">Email address</label></div>
</div>
<div class="-m-2 rounded-lg p-2 bg-surface-brand-secondary-weakest">
<div class="relative flex flex-col flex-1">
<div class="relative flex items-center rounded-md border border-none bg-surface-weakest shadow-faux-border"><input
class="px-4 h-11 w-full bg-surface-weakest rounded-md text-type-primary text-base appearance-none focus:outline-none peer placeholder:opacity-0 focus:placeholder:opacity-100 placeholder:text-type-hint input-value-false"
placeholder="" id="zip-code" autocomplete="postal-code" value="" name="ratingZipcode"><label class="font-medium text-type-hint peer-disabled:cursor-not-allowed peer-disabled:opacity-70 label--floating text-base bg-surface-weakest"
for="zip-code">Zip code</label></div>
</div><span class="mt-2 block text-center text-xs"><span>See if you qualify for a <strong>$25 Amazon Gift Card!*</strong></span></span>
</div>
<div class="relative flex flex-col mt-1 flex-1 lg:mt-0">
<div class="relative flex items-center rounded-md border border-none bg-surface-weakest shadow-faux-border"><input
class="px-4 h-11 w-full bg-surface-weakest rounded-md text-type-primary text-base appearance-none focus:outline-none peer placeholder:opacity-0 focus:placeholder:opacity-100 placeholder:text-type-hint input-value-false"
placeholder="(555) 555-5555" id="mobile-number-(optional)" autocomplete="tel-national" type="tel" value="" name="phone"><label
class="font-medium text-type-hint peer-disabled:cursor-not-allowed peer-disabled:opacity-70 label--floating text-base bg-surface-weakest" for="mobile-number-(optional)">Mobile number (optional)</label></div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="flex flex-col gap-8 sm:gap-10">
<div class="relative flex justify-center"><button
class="inline-flex items-center justify-center text-base font-medium transition-colors disabled:pointer-events-none disabled:opacity-50 rounded-full bg-surface-brand-strong text-type-invert hover:bg-surface-brand-stronger focus:rounded-full h-11 px-4 py-3"
type="button">
<div class="flex items-center gap-2">Select Coverage</div><span class="ml-2 flex"><svg aria-hidden="true" focusable="false" data-prefix="fas" data-icon="chevron-right" class="svg-inline--fa fa-chevron-right " role="img"
xmlns="http://www.w3.org/2000/svg" viewBox="0 0 320 512">
<path fill="currentColor" d="M310.6 233.4c12.5 12.5 12.5 32.8 0 45.3l-192 192c-12.5 12.5-32.8 12.5-45.3 0s-12.5-32.8 0-45.3L242.7 256 73.4 86.6c-12.5-12.5-12.5-32.8 0-45.3s32.8-12.5 45.3 0l192 192z"></path>
</svg></span>
</button></div>
<div class="flex flex-col gap-4 text-xs text-type-hint">
<p>By clicking "Select Coverage" above, you agree that Spot Pet Insurance and its affiliates may communicate with you via email, text, or phone through the email and/or phone numbers provided to Spot. Spot may use automated technology (e.g.,
prerecorded messages, autodialers) to contact you. You are not required to provide your phone number to Spot Pet Insurance. Your consent to these terms is not a condition of being able to purchase pet insurance. Your information is collected
and used in accordance with Spot Pet Insurance <a href="https://spotpetins.com/privacy" target="_blank" class="underline">Privacy Policy</a>. Text messages are subject to the Spot Pet Insurance
<a href="https://spotpetins.com/privacy#texting-terms" target="_blank" class="underline">Texting Terms</a>. Opt out any time.</p>
<div class="mx-auto max-w-[976px] text-xs text-type-hint">Amazon.com Gift Card* is subject to eligibility, not available in all states. <a href="https://spotpetins.com/amz-terms" class="underline">Eligibility terms</a>.</div>
</div>
</div>
</form>Text Content
1-800-905-1595 ENTER PET INFO Your dog's name DogCat FemaleMale Your dog's age Pet's age8 weeks to 11 months1 year2 years3 years4 years5 years6 years7 years8 years9 years10 years11 years12 years13 years14 years15 years16 years17 years18 years19 years20 years Your dog's breed Select a breed Add a Pet 10% multi-pet discount on all additional pets First name Last name Email address Zip code See if you qualify for a $25 Amazon Gift Card!* Mobile number (optional) Select Coverage By clicking "Select Coverage" above, you agree that Spot Pet Insurance and its affiliates may communicate with you via email, text, or phone through the email and/or phone numbers provided to Spot. Spot may use automated technology (e.g., prerecorded messages, autodialers) to contact you. You are not required to provide your phone number to Spot Pet Insurance. Your consent to these terms is not a condition of being able to purchase pet insurance. Your information is collected and used in accordance with Spot Pet Insurance Privacy Policy. Text messages are subject to the Spot Pet Insurance Texting Terms. Opt out any time. Amazon.com Gift Card* is subject to eligibility, not available in all states. Eligibility terms. Terms & ConditionsPrivacySources & CitationsAgency InformationSample PolicyADA NoticeSitemap Spot NOTICE TO CALIFORNIA RESIDENTSSpot NOTICE TO MAINE RESIDENTS Pre-existing conditions are not covered. Waiting periods, annual deductible, co-insurance, benefit limits, and exclusions may apply. For all terms and conditions visit spotpetins.com/sample-policy. Preventive Care reimbursements are based on a schedule. Accident & Illness coverage reimbursements are based on the invoice. Products, schedules, discounts, and rates may vary and are subject to change. More information is available at checkout. Insurance products are underwritten by either Independence American Insurance Company (NAIC #26581. A Delaware insurance company located at 11333 N. Scottsdale Rd, Ste. 160, Scottsdale, AZ 85254), or United States Fire Insurance Company (NAIC #21113. Morristown, NJ). Please refer to your policy forms to determine the underwriter for your policy. Insurance is produced by Spot Pet Insurance Services, LLC. (NPN # 19246385. 990 Biscayne Blvd Suite 603, Miami, FL 33132). CA License #6000188. PTZ Insurance Agency Ltd. (NPN: 5328528. domiciled in Illinois with offices at 1208 Massillon Road, Suite G200, Akron, Ohio 44306) is responsible for administration and claims adjudication. (California residents only: PTZ Insurance Agency Ltd., d.b.a PIA Insurance Agency Ltd. CA license #0E36937). © 2024 United States Fire Insurance Company. Spot Pet Insurance Logo, Copyright 2024, Spot Pet Insurance. All Rights Reserved.