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Form analysis
2 forms found in the DOM

POST /create-contact.php

<form id="contact-form" class="contact__form" method="post" action="/create-contact.php">
  <input type="text" id="name" name="name" class="form-control font-weight-normal mb-4 px-2" placeholder="Full name" style="font-weight: 600;">
  <input type="email" id="email" name="email" class="form-control font-weight-normal mb-4 px-2" placeholder="Email address" style="font-weight: 600;">
  <input type="text" id="street" name="street" class="form-control font-weight-normal mb-4 px-2" placeholder="Your street" style="font-weight: 600;">
  <input type="text" id="city" name="city" class="form-control font-weight-normal mb-4 px-2" placeholder="Your City" style="font-weight: 600;">
  <input type="text" id="state" name="state" class="form-control font-weight-normal mb-4 px-2" placeholder="Your State" style="font-weight: 600;">
  <input type="text" id="dob" name="dob" class="form-control font-weight-normal mb-4 px-2" placeholder="Your Date of Birth" style="font-weight: 600;">
  <input type="text" id="phone" name="phone_number" class="form-control font-weight-normal mb-4 px-2" placeholder="Phone number" style="font-weight: 600;">
  <div>
    <input type="checkbox" name="agreement" value="1"> I agree , By submitting my cell phone number to receive automated sms/mms messages with more information or quote from GABRIELLE WILLIAMS. Message frequency may vary. Reply STOP to cancel, Reply
    HELP for contact information. message and date rates may apply <a href="terms-conditions.html">Terms &amp; Conditions</a> | <a href="privacy-policy.html">Privacy Policy</a>
  </div>
  <div class="text-center">
    <button class="btn btn-primary mt-3 rounded" type="submit">Send</button>
  </div>
</form>

POST /opt-contact.php

<form method="POST" action="/opt-contact.php">
  <div class="modal-body"><input type="text" class="form-control" placeholder="Phone" name="ph" required="">
  </div>
  <div class="modal-footer">
    <button type="button" class="btn btn-secondary closeModalButton">Close</button>
    <button type="submit" class="btn btn-primary">Submit</button>
  </div>
</form>

Text Content

GABRIELLE WILLIAMS
 * Home
 * Terms Conditions
 * Privacy Policy


GABRIELLE WILLIAMS


GABRIELLE WILLIAMS

I'm a licensed health insurance advisor, devoted to providing quality assistance
to individuals and families with all their health plan concerns. Making sure all
options are available for them to check and choose from to secure the best
affordable health coverage choice.




PROFESSIONAL SERVICES

COMPREHENSIVE HEALTH PLAN ASSESSMENT

Let us help you navigate the complex world of health insurance by providing a
thorough analysis of all available options to find the best coverage for your
needs and budget.

PERSONALIZED INSURANCE GUIDANCE

With our personalized approach, we will guide you through every step of the
insurance process and assist you in making informed decisions that align with
your unique healthcare goals.

AFFORDABLE COVERAGE SOLUTIONS

We understand the importance of affordable healthcare and strive to offer
cost-effective solutions without compromising on quality. Let us help you secure
the best affordable health coverage choice for you and your family.


REACH OUT TO US


I agree , By submitting my cell phone number to receive automated sms/mms
messages with more information or quote from GABRIELLE WILLIAMS. Message
frequency may vary. Reply STOP to cancel, Reply HELP for contact information.
message and date rates may apply Terms & Conditions | Privacy Policy
Send


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