mykey.com Open in urlscan Pro
138.197.165.104  Public Scan

Form analysis
1 forms found in the DOM

POST /insurance-inquiry

<form action="/insurance-inquiry" accept-charset="UTF-8" method="post"><input type="hidden" name="authenticity_token" value="NqBqc68U1Qhqk3C56PKmAnPcU8oTrLp6xTbS/g8Pu/bfR9I11dPYwi1A6T05KLu4FbNzFMGJ1lVRP3Wn/SWNWQ==">
  <input class="location_latitude" type="hidden" name="housing_lead[latitude]">
  <input class="location_longitude" type="hidden" name="housing_lead[longitude]">
  <div class="flat-card page-form">
    <div class="card-body">
      <h3 class="text-center"><img src="/assets/icons/housing_leads/claim-info-d833ff7d8b6a2033a0dbea74a29db1ca86d26467d6e605bfeef47a90940edf19.png">Claim Info</h3>
      <div class="row">
        <div class="form-group col-md-4">
          <input class="form-control" placeholder="Claim Number *" required="required" type="text" name="housing_lead[file_number]">
        </div>
        <div class="form-group col-md-4">
          <div class="input-group">
            <div class="input-group-prepend"><span class="input-group-text">$</span></div>
            <input value="" class="form-control" placeholder="ALE Limit" min="0" step="any" type="number" name="housing_lead[budget]">
          </div>
        </div>
        <div class="form-group col-md-4">
          <div class="input-group">
            <div class="input-group-prepend"><span class="input-group-text">$</span></div>
            <input value="" class="form-control" placeholder="Budget per Night" min="0" step="any" type="number" name="housing_lead[nightly_rate]">
          </div>
        </div>
      </div>
      <div class="row">
        <div class="form-group col-md-6">
          <div class="split-daterange-picker  daterange-picker" id="">
            <input class="start-date form-control" placeholder="Requested Dates *" type="text" name="housing_lead[start_date]">
            <input class="end-date form-control" type="text" name="housing_lead[end_date]">
            <div class="caleran-container caleran-popup" style="display: none;">
              <div class="caleran-box-arrow-top"></div>
              <div class="caleran-input" style="width: 460px;">
                <div class="caleran-header" style="display: none;">
                  <div class="caleran-header-start">
                    <div class="caleran-header-start-day"></div>
                    <div class="caleran-header-start-date"></div>
                    <div class="caleran-header-start-weekday"></div>
                  </div>
                  <div class="caleran-header-separator"><i class="fa fa-chevron-right"></i></div>
                  <div class="caleran-header-end">
                    <div class="caleran-header-end-day"></div>
                    <div class="caleran-header-end-date"></div>
                    <div class="caleran-header-end-weekday"></div>
                  </div>
                </div>
                <div class="caleran-calendars">
                  <div class="caleran-calendar" data-month="8">
                    <div class="caleran-title">
                      <div class="caleran-prev"><i class="fa fa-arrow-left"></i></div><b class="caleran-month-switch">September</b>&nbsp;<span class="caleran-year-switch">2022</span>
                    </div>
                    <div class="caleran-days-container">
                      <div class="caleran-dayofweek">Sun</div>
                      <div class="caleran-dayofweek">Mon</div>
                      <div class="caleran-dayofweek">Tue</div>
                      <div class="caleran-dayofweek">Wed</div>
                      <div class="caleran-dayofweek">Thu</div>
                      <div class="caleran-dayofweek">Fri</div>
                      <div class="caleran-dayofweek">Sat</div>
                      <div class="caleran-day caleran-disabled caleran-not-in-month" data-value="1661688000"><span>28</span></div>
                      <div class="caleran-day caleran-disabled caleran-not-in-month" data-value="1661774400"><span>29</span></div>
                      <div class="caleran-day caleran-disabled caleran-not-in-month" data-value="1661860800"><span>30</span></div>
                      <div class="caleran-day caleran-disabled caleran-not-in-month" data-value="1661947200"><span>31</span></div>
                      <div class="caleran-day" data-value="1662033600"><span>1</span></div>
                      <div class="caleran-day" data-value="1662120000"><span>2</span></div>
                      <div class="caleran-day caleran-weekend" data-value="1662206400"><span>3</span></div>
                      <div class="caleran-day caleran-weekend" data-value="1662292800"><span>4</span></div>
                      <div class="caleran-day" data-value="1662379200"><span>5</span></div>
                      <div class="caleran-day" data-value="1662465600"><span>6</span></div>
                      <div class="caleran-day" data-value="1662552000"><span>7</span></div>
                      <div class="caleran-day" data-value="1662638400"><span>8</span></div>
                      <div class="caleran-day" data-value="1662724800"><span>9</span></div>
                      <div class="caleran-day caleran-weekend" data-value="1662811200"><span>10</span></div>
                      <div class="caleran-day caleran-weekend" data-value="1662897600"><span>11</span></div>
                      <div class="caleran-day" data-value="1662984000"><span>12</span></div>
                      <div class="caleran-day" data-value="1663070400"><span>13</span></div>
                      <div class="caleran-day" data-value="1663156800"><span>14</span></div>
                      <div class="caleran-day" data-value="1663243200"><span>15</span></div>
                      <div class="caleran-day" data-value="1663329600"><span>16</span></div>
                      <div class="caleran-day caleran-weekend" data-value="1663416000"><span>17</span></div>
                      <div class="caleran-day caleran-weekend" data-value="1663502400"><span>18</span></div>
                      <div class="caleran-day" data-value="1663588800"><span>19</span></div>
                      <div class="caleran-day" data-value="1663675200"><span>20</span></div>
                      <div class="caleran-day" data-value="1663761600"><span>21</span></div>
                      <div class="caleran-day caleran-today" data-value="1663848000"><span>22</span></div>
                      <div class="caleran-day" data-value="1663934400"><span>23</span></div>
                      <div class="caleran-day caleran-weekend" data-value="1664020800"><span>24</span></div>
                      <div class="caleran-day caleran-weekend" data-value="1664107200"><span>25</span></div>
                      <div class="caleran-day" data-value="1664193600"><span>26</span></div>
                      <div class="caleran-day" data-value="1664280000"><span>27</span></div>
                      <div class="caleran-day" data-value="1664366400"><span>28</span></div>
                      <div class="caleran-day" data-value="1664452800"><span>29</span></div>
                      <div class="caleran-day" data-value="1664539200"><span>30</span></div>
                      <div class="caleran-day caleran-disabled caleran-not-in-month" data-value="1664625600"><span>1</span></div>
                      <div class="caleran-day caleran-disabled caleran-not-in-month" data-value="1664712000"><span>2</span></div>
                      <div class="caleran-day caleran-disabled caleran-not-in-month" data-value="1664798400"><span>3</span></div>
                      <div class="caleran-day caleran-disabled caleran-not-in-month" data-value="1664884800"><span>4</span></div>
                      <div class="caleran-day caleran-disabled caleran-not-in-month" data-value="1664971200"><span>5</span></div>
                      <div class="caleran-day caleran-disabled caleran-not-in-month" data-value="1665057600"><span>6</span></div>
                      <div class="caleran-day caleran-disabled caleran-not-in-month" data-value="1665144000"><span>7</span></div>
                      <div class="caleran-day caleran-disabled caleran-not-in-month" data-value="1665230400"><span>8</span></div>
                    </div>
                  </div>
                  <div class="caleran-calendar no-border-right" data-month="9">
                    <div class="caleran-title"><b class="caleran-month-switch">October</b>&nbsp;<span class="caleran-year-switch">2022</span>
                      <div class="caleran-next"><i class="fa fa-arrow-right"></i></div>
                    </div>
                    <div class="caleran-days-container">
                      <div class="caleran-dayofweek">Sun</div>
                      <div class="caleran-dayofweek">Mon</div>
                      <div class="caleran-dayofweek">Tue</div>
                      <div class="caleran-dayofweek">Wed</div>
                      <div class="caleran-dayofweek">Thu</div>
                      <div class="caleran-dayofweek">Fri</div>
                      <div class="caleran-dayofweek">Sat</div>
                      <div class="caleran-day caleran-disabled caleran-not-in-month" data-value="1664107200"><span>25</span></div>
                      <div class="caleran-day caleran-disabled caleran-not-in-month" data-value="1664193600"><span>26</span></div>
                      <div class="caleran-day caleran-disabled caleran-not-in-month" data-value="1664280000"><span>27</span></div>
                      <div class="caleran-day caleran-disabled caleran-not-in-month" data-value="1664366400"><span>28</span></div>
                      <div class="caleran-day caleran-disabled caleran-not-in-month" data-value="1664452800"><span>29</span></div>
                      <div class="caleran-day caleran-disabled caleran-not-in-month" data-value="1664539200"><span>30</span></div>
                      <div class="caleran-day caleran-weekend" data-value="1664625600"><span>1</span></div>
                      <div class="caleran-day caleran-weekend" data-value="1664712000"><span>2</span></div>
                      <div class="caleran-day" data-value="1664798400"><span>3</span></div>
                      <div class="caleran-day" data-value="1664884800"><span>4</span></div>
                      <div class="caleran-day" data-value="1664971200"><span>5</span></div>
                      <div class="caleran-day" data-value="1665057600"><span>6</span></div>
                      <div class="caleran-day" data-value="1665144000"><span>7</span></div>
                      <div class="caleran-day caleran-weekend" data-value="1665230400"><span>8</span></div>
                      <div class="caleran-day caleran-weekend" data-value="1665316800"><span>9</span></div>
                      <div class="caleran-day" data-value="1665403200"><span>10</span></div>
                      <div class="caleran-day" data-value="1665489600"><span>11</span></div>
                      <div class="caleran-day" data-value="1665576000"><span>12</span></div>
                      <div class="caleran-day" data-value="1665662400"><span>13</span></div>
                      <div class="caleran-day" data-value="1665748800"><span>14</span></div>
                      <div class="caleran-day caleran-weekend" data-value="1665835200"><span>15</span></div>
                      <div class="caleran-day caleran-weekend" data-value="1665921600"><span>16</span></div>
                      <div class="caleran-day" data-value="1666008000"><span>17</span></div>
                      <div class="caleran-day" data-value="1666094400"><span>18</span></div>
                      <div class="caleran-day" data-value="1666180800"><span>19</span></div>
                      <div class="caleran-day" data-value="1666267200"><span>20</span></div>
                      <div class="caleran-day" data-value="1666353600"><span>21</span></div>
                      <div class="caleran-day caleran-weekend" data-value="1666440000"><span>22</span></div>
                      <div class="caleran-day caleran-weekend" data-value="1666526400"><span>23</span></div>
                      <div class="caleran-day" data-value="1666612800"><span>24</span></div>
                      <div class="caleran-day" data-value="1666699200"><span>25</span></div>
                      <div class="caleran-day" data-value="1666785600"><span>26</span></div>
                      <div class="caleran-day" data-value="1666872000"><span>27</span></div>
                      <div class="caleran-day" data-value="1666958400"><span>28</span></div>
                      <div class="caleran-day caleran-weekend" data-value="1667044800"><span>29</span></div>
                      <div class="caleran-day caleran-weekend" data-value="1667131200"><span>30</span></div>
                      <div class="caleran-day" data-value="1667217600"><span>31</span></div>
                      <div class="caleran-day caleran-disabled caleran-not-in-month" data-value="1667304000"><span>1</span></div>
                      <div class="caleran-day caleran-disabled caleran-not-in-month" data-value="1667390400"><span>2</span></div>
                      <div class="caleran-day caleran-disabled caleran-not-in-month" data-value="1667476800"><span>3</span></div>
                      <div class="caleran-day caleran-disabled caleran-not-in-month" data-value="1667563200"><span>4</span></div>
                      <div class="caleran-day caleran-disabled caleran-not-in-month" data-value="1667649600"><span>5</span></div>
                    </div>
                  </div>
                </div>
              </div>
            </div>
            <div class="caleran-container caleran-popup" style="display: none;">
              <div class="caleran-box-arrow-top"></div>
              <div class="caleran-input" style="width: 460px;">
                <div class="caleran-header" style="display: none;">
                  <div class="caleran-header-start">
                    <div class="caleran-header-start-day"></div>
                    <div class="caleran-header-start-date"></div>
                    <div class="caleran-header-start-weekday"></div>
                  </div>
                  <div class="caleran-header-separator"><i class="fa fa-chevron-right"></i></div>
                  <div class="caleran-header-end">
                    <div class="caleran-header-end-day"></div>
                    <div class="caleran-header-end-date"></div>
                    <div class="caleran-header-end-weekday"></div>
                  </div>
                </div>
                <div class="caleran-calendars">
                  <div class="caleran-calendar" data-month="8">
                    <div class="caleran-title">
                      <div class="caleran-prev"><i class="fa fa-arrow-left"></i></div><b class="caleran-month-switch">September</b>&nbsp;<span class="caleran-year-switch">2022</span>
                    </div>
                    <div class="caleran-days-container">
                      <div class="caleran-dayofweek">Sun</div>
                      <div class="caleran-dayofweek">Mon</div>
                      <div class="caleran-dayofweek">Tue</div>
                      <div class="caleran-dayofweek">Wed</div>
                      <div class="caleran-dayofweek">Thu</div>
                      <div class="caleran-dayofweek">Fri</div>
                      <div class="caleran-dayofweek">Sat</div>
                      <div class="caleran-day caleran-disabled caleran-not-in-month" data-value="1661688000"><span>28</span></div>
                      <div class="caleran-day caleran-disabled caleran-not-in-month" data-value="1661774400"><span>29</span></div>
                      <div class="caleran-day caleran-disabled caleran-not-in-month" data-value="1661860800"><span>30</span></div>
                      <div class="caleran-day caleran-disabled caleran-not-in-month" data-value="1661947200"><span>31</span></div>
                      <div class="caleran-day" data-value="1662033600"><span>1</span></div>
                      <div class="caleran-day" data-value="1662120000"><span>2</span></div>
                      <div class="caleran-day caleran-weekend" data-value="1662206400"><span>3</span></div>
                      <div class="caleran-day caleran-weekend" data-value="1662292800"><span>4</span></div>
                      <div class="caleran-day" data-value="1662379200"><span>5</span></div>
                      <div class="caleran-day" data-value="1662465600"><span>6</span></div>
                      <div class="caleran-day" data-value="1662552000"><span>7</span></div>
                      <div class="caleran-day" data-value="1662638400"><span>8</span></div>
                      <div class="caleran-day" data-value="1662724800"><span>9</span></div>
                      <div class="caleran-day caleran-weekend" data-value="1662811200"><span>10</span></div>
                      <div class="caleran-day caleran-weekend" data-value="1662897600"><span>11</span></div>
                      <div class="caleran-day" data-value="1662984000"><span>12</span></div>
                      <div class="caleran-day" data-value="1663070400"><span>13</span></div>
                      <div class="caleran-day" data-value="1663156800"><span>14</span></div>
                      <div class="caleran-day" data-value="1663243200"><span>15</span></div>
                      <div class="caleran-day" data-value="1663329600"><span>16</span></div>
                      <div class="caleran-day caleran-weekend" data-value="1663416000"><span>17</span></div>
                      <div class="caleran-day caleran-weekend" data-value="1663502400"><span>18</span></div>
                      <div class="caleran-day" data-value="1663588800"><span>19</span></div>
                      <div class="caleran-day" data-value="1663675200"><span>20</span></div>
                      <div class="caleran-day" data-value="1663761600"><span>21</span></div>
                      <div class="caleran-day caleran-today" data-value="1663848000"><span>22</span></div>
                      <div class="caleran-day" data-value="1663934400"><span>23</span></div>
                      <div class="caleran-day caleran-weekend" data-value="1664020800"><span>24</span></div>
                      <div class="caleran-day caleran-weekend" data-value="1664107200"><span>25</span></div>
                      <div class="caleran-day" data-value="1664193600"><span>26</span></div>
                      <div class="caleran-day" data-value="1664280000"><span>27</span></div>
                      <div class="caleran-day" data-value="1664366400"><span>28</span></div>
                      <div class="caleran-day" data-value="1664452800"><span>29</span></div>
                      <div class="caleran-day" data-value="1664539200"><span>30</span></div>
                      <div class="caleran-day caleran-disabled caleran-not-in-month" data-value="1664625600"><span>1</span></div>
                      <div class="caleran-day caleran-disabled caleran-not-in-month" data-value="1664712000"><span>2</span></div>
                      <div class="caleran-day caleran-disabled caleran-not-in-month" data-value="1664798400"><span>3</span></div>
                      <div class="caleran-day caleran-disabled caleran-not-in-month" data-value="1664884800"><span>4</span></div>
                      <div class="caleran-day caleran-disabled caleran-not-in-month" data-value="1664971200"><span>5</span></div>
                      <div class="caleran-day caleran-disabled caleran-not-in-month" data-value="1665057600"><span>6</span></div>
                      <div class="caleran-day caleran-disabled caleran-not-in-month" data-value="1665144000"><span>7</span></div>
                      <div class="caleran-day caleran-disabled caleran-not-in-month" data-value="1665230400"><span>8</span></div>
                    </div>
                  </div>
                  <div class="caleran-calendar no-border-right" data-month="9">
                    <div class="caleran-title"><b class="caleran-month-switch">October</b>&nbsp;<span class="caleran-year-switch">2022</span>
                      <div class="caleran-next"><i class="fa fa-arrow-right"></i></div>
                    </div>
                    <div class="caleran-days-container">
                      <div class="caleran-dayofweek">Sun</div>
                      <div class="caleran-dayofweek">Mon</div>
                      <div class="caleran-dayofweek">Tue</div>
                      <div class="caleran-dayofweek">Wed</div>
                      <div class="caleran-dayofweek">Thu</div>
                      <div class="caleran-dayofweek">Fri</div>
                      <div class="caleran-dayofweek">Sat</div>
                      <div class="caleran-day caleran-disabled caleran-not-in-month" data-value="1664107200"><span>25</span></div>
                      <div class="caleran-day caleran-disabled caleran-not-in-month" data-value="1664193600"><span>26</span></div>
                      <div class="caleran-day caleran-disabled caleran-not-in-month" data-value="1664280000"><span>27</span></div>
                      <div class="caleran-day caleran-disabled caleran-not-in-month" data-value="1664366400"><span>28</span></div>
                      <div class="caleran-day caleran-disabled caleran-not-in-month" data-value="1664452800"><span>29</span></div>
                      <div class="caleran-day caleran-disabled caleran-not-in-month" data-value="1664539200"><span>30</span></div>
                      <div class="caleran-day caleran-weekend" data-value="1664625600"><span>1</span></div>
                      <div class="caleran-day caleran-weekend" data-value="1664712000"><span>2</span></div>
                      <div class="caleran-day" data-value="1664798400"><span>3</span></div>
                      <div class="caleran-day" data-value="1664884800"><span>4</span></div>
                      <div class="caleran-day" data-value="1664971200"><span>5</span></div>
                      <div class="caleran-day" data-value="1665057600"><span>6</span></div>
                      <div class="caleran-day" data-value="1665144000"><span>7</span></div>
                      <div class="caleran-day caleran-weekend" data-value="1665230400"><span>8</span></div>
                      <div class="caleran-day caleran-weekend" data-value="1665316800"><span>9</span></div>
                      <div class="caleran-day" data-value="1665403200"><span>10</span></div>
                      <div class="caleran-day" data-value="1665489600"><span>11</span></div>
                      <div class="caleran-day" data-value="1665576000"><span>12</span></div>
                      <div class="caleran-day" data-value="1665662400"><span>13</span></div>
                      <div class="caleran-day" data-value="1665748800"><span>14</span></div>
                      <div class="caleran-day caleran-weekend" data-value="1665835200"><span>15</span></div>
                      <div class="caleran-day caleran-weekend" data-value="1665921600"><span>16</span></div>
                      <div class="caleran-day" data-value="1666008000"><span>17</span></div>
                      <div class="caleran-day" data-value="1666094400"><span>18</span></div>
                      <div class="caleran-day" data-value="1666180800"><span>19</span></div>
                      <div class="caleran-day" data-value="1666267200"><span>20</span></div>
                      <div class="caleran-day" data-value="1666353600"><span>21</span></div>
                      <div class="caleran-day caleran-weekend" data-value="1666440000"><span>22</span></div>
                      <div class="caleran-day caleran-weekend" data-value="1666526400"><span>23</span></div>
                      <div class="caleran-day" data-value="1666612800"><span>24</span></div>
                      <div class="caleran-day" data-value="1666699200"><span>25</span></div>
                      <div class="caleran-day" data-value="1666785600"><span>26</span></div>
                      <div class="caleran-day" data-value="1666872000"><span>27</span></div>
                      <div class="caleran-day" data-value="1666958400"><span>28</span></div>
                      <div class="caleran-day caleran-weekend" data-value="1667044800"><span>29</span></div>
                      <div class="caleran-day caleran-weekend" data-value="1667131200"><span>30</span></div>
                      <div class="caleran-day" data-value="1667217600"><span>31</span></div>
                      <div class="caleran-day caleran-disabled caleran-not-in-month" data-value="1667304000"><span>1</span></div>
                      <div class="caleran-day caleran-disabled caleran-not-in-month" data-value="1667390400"><span>2</span></div>
                      <div class="caleran-day caleran-disabled caleran-not-in-month" data-value="1667476800"><span>3</span></div>
                      <div class="caleran-day caleran-disabled caleran-not-in-month" data-value="1667563200"><span>4</span></div>
                      <div class="caleran-day caleran-disabled caleran-not-in-month" data-value="1667649600"><span>5</span></div>
                    </div>
                  </div>
                </div>
              </div>
            </div>
          </div>
        </div>
        <div class="form-group col-md-6">
          <label class="sr-only">Desired location</label>
          <div class="input-group">
            <input class="form-control location_address pac-target-input" placeholder="Desired Address (or Location) *" required="required" type="text" name="housing_lead[location]" autocomplete="off">
            <a id="hidden-location-field-toggle" class="collapsed " data-toggle="collapse" href=".hidden-location-fields">
  <div class="input-group-append h-100">
    <span class="input-group-text">
      <svg xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink" width="13px" height="8px" viewBox="0 0 13 8" version="1.1">
    <!-- Generator: Sketch 49.3 (51167) - http://www.bohemiancoding.com/sketch -->
    <title>dropdown-icon-dark</title>
    <desc>Created with Sketch.</desc>
    <defs></defs>
    <g id="Symbols" stroke="none" stroke-width="1" fill="none" fill-rule="evenodd">
        <g id="Button-(Edit--Dropdown)" transform="translate(-86.000000, -18.000000)" fill="#25323D">
            <g id="Button">
                <path d="M92.5,23.3686292 L96.9343146,18.9343146 L97.5,18.3686292 L98.6313708,19.5 L98.0656854,20.0656854 L93.6313708,24.5 L92.5,25.6313708 L91.9343146,25.0656854 L86.9343146,20.0656854 L86.3686292,19.5 L87.5,18.3686292 L88.0656854,18.9343146 L92.5,23.3686292 Z" id="dropdown-icon-dark"></path>
            </g>
        </g>
    </g>
</svg>

    </span>
  </div>
</a>
          </div>
        </div>
      </div>
      <div class="collapse hidden-location-fields row" id="">
        <div class="form-group col-md-6">
          <label class="sr-only">Street Address</label>
          <input class="form-control location_street_address" placeholder="Street Address" type="text" name="housing_lead[address]">
        </div>
        <div class="form-group col-md-6">
          <label class="sr-only">City</label>
          <input class="form-control location_city" placeholder="City" type="text" name="housing_lead[city]">
        </div>
        <div class="form-group col-md-6">
          <label class="sr-only">State / Province</label>
          <input class="form-control location_province" placeholder="State / Province" type="text" name="housing_lead[province]">
        </div>
        <div class="form-group col-md-6">
          <label class="sr-only">Zip Code / Postal Code</label>
          <input class="form-control location_postal_code" placeholder="Zip Code / Postal Code" type="text" name="housing_lead[postal_code]">
        </div>
        <div class="form-group col-md-12">
          <label class="sr-only">Country</label>
          <input class="form-control location_country" placeholder="Country" type="text" name="housing_lead[country]">
        </div>
      </div>
      <div class="row">
        <div class="form-group col-md-6">
          <label class="sr-only">Accommodations Required</label>
          <select class="select2-mykey select2-hidden-accessible" data-placeholder="Accommodations Required" data-key="name" name="housing_lead[accommodations_required]" data-select2-id="1" tabindex="-1" aria-hidden="true">
            <option value="" data-select2-id="3"></option>
            <option value="housing">Housing</option>
            <option value="hotel">Hotel</option>
            <option value="both">Both Hotel &amp; Housing</option>
            <option value="frv_only">Fair Rental Value Only</option>
            <option value="travel_trailer">Travel Trailer</option>
            <option value="both_hotel_and_travel_trailer">Both Hotel &amp; Travel Trailer</option>
          </select><span class="select2 select2-container select2-container--default" dir="ltr" data-select2-id="2" style="width: 100%;"><span class="selection"><span class="select2-selection select2-selection--single" role="combobox"
                aria-haspopup="true" aria-expanded="false" tabindex="0" aria-labelledby="select2-housing_leadaccommodations_required-7n-container"><span class="select2-selection__rendered" id="select2-housing_leadaccommodations_required-7n-container"
                  role="textbox" aria-readonly="true"><span class="select2-selection__placeholder">Accommodations Required</span></span><span class="select2-selection__arrow" role="presentation"><b role="presentation"></b></span></span></span><span
              class="dropdown-wrapper" aria-hidden="true"></span></span>
        </div>
        <div class="form-group col-md-6">
          <label class="sr-only">Policy Type</label>
          <select class="select2-mykey select2-hidden-accessible" data-placeholder="Policy Type" data-key="name" name="housing_lead[policy_type]" data-select2-id="4" tabindex="-1" aria-hidden="true">
            <option value="" data-select2-id="6"></option>
            <option value="owner">Owner</option>
            <option value="renter">Renter</option>
            <option value="landlord">Landlord</option>
            <option value="condominium">Condominium</option>
          </select><span class="select2 select2-container select2-container--default" dir="ltr" data-select2-id="5" style="width: 100%;"><span class="selection"><span class="select2-selection select2-selection--single" role="combobox"
                aria-haspopup="true" aria-expanded="false" tabindex="0" aria-labelledby="select2-housing_leadpolicy_type-xb-container"><span class="select2-selection__rendered" id="select2-housing_leadpolicy_type-xb-container" role="textbox"
                  aria-readonly="true"><span class="select2-selection__placeholder">Policy Type</span></span><span class="select2-selection__arrow" role="presentation"><b role="presentation"></b></span></span></span><span class="dropdown-wrapper"
              aria-hidden="true"></span></span>
        </div>
      </div>
      <div class="row">
        <div class="form-group col-md-6 styled-checkbox">
          <div class="input-group">
            <label class="form-check-label" for="chk_hotel_required">
              <input name="housing_lead[hotel_required]" type="hidden" value="0"><input id="chk_hotel_required" class="checkbox-inline" type="checkbox" value="yes" name="housing_lead[hotel_required]">
              <span class="checkmark"></span> Emergency Hotel Required? </label>
          </div>
        </div>
      </div>
    </div>
    <div class="card-body">
      <h3 class="text-center"><img src="/assets/icons/housing_leads/adjuster-info-5005fdd2dfb404a84dfda0b8e07093bb8ce1688458fff6fef6ee1f438bdcd952.png">Adjuster Info</h3>
      <div class="row">
        <div class="form-group col-md-6">
          <input class="form-control" placeholder="Name *" required="required" type="text" name="housing_lead[contact_name]">
        </div>
        <div class="form-group col-md-6">
          <input class="form-control" placeholder="Email Address *" required="required" type="email" name="housing_lead[contact_email]">
        </div>
      </div>
      <div class="row">
        <div class="form-group col-md-6">
          <input class="form-control" placeholder="Company Name" type="text" name="housing_lead[company_name]">
        </div>
        <div class="form-group col-md-6">
          <input class="form-control" placeholder="Phone Number *" required="required" type="text" name="housing_lead[contact_phone]">
        </div>
      </div>
    </div>
    <div class="card-body">
      <div class="row">
        <div class="col-md-6">
          <h3><img src="/assets/icons/housing_leads/policyholder-info-763aa07d0e141921487fdde213637211e5bceddee115b675d01a17768407e20f.png">Policyholder Info</h3>
          <div class="form-group">
            <input class="form-control" placeholder="Guest Name *" required="required" type="text" name="housing_lead[guest_name]">
          </div>
          <div class="row">
            <div class="form-group col-md-6">
              <input class="form-control" placeholder="Email Address *" required="required" type="email" name="housing_lead[guest_email]">
            </div>
            <div class="form-group col-md-6">
              <input class="form-control" placeholder="Secondary Email Address" type="email" name="housing_lead[guest_secondary_email]">
            </div>
          </div>
          <div class="form-group">
            <input class="form-control" placeholder="Phone Number *" required="required" type="text" name="housing_lead[guest_phone]">
          </div>
          <div class="form-group styled-checkbox">
            <div class="input-group">
              <label class="form-check-label" for="chk_vip_policyholder">
                <input name="housing_lead[vip_policyholder]" type="hidden" value="0"><input id="chk_vip_policyholder" class="checkbox-inline" type="checkbox" value="yes" name="housing_lead[vip_policyholder]">
                <span class="checkmark"></span> VIP Policyholder? </label>
            </div>
          </div>
        </div>
        <div class="col-md-6">
          <h3><img src="/assets/icons/housing_leads/loss-info-ba537e987f74d2abf34e04126f1ae82bb1cce0b2dce49143332798a1365a0c86.png">Loss Info</h3>
          <div class="form-group">
            <input class="form-control past-date-picker" placeholder="Date of Loss" type="text" name="housing_lead[date_of_loss]">
          </div>
          <div class="form-group">
            <select class="select2-mykey select2-hidden-accessible" data-placeholder="Loss Type" data-key="name" name="housing_lead[loss_type]" data-select2-id="7" tabindex="-1" aria-hidden="true">
              <option value="" data-select2-id="9"></option>
              <option value="fire">Fire/Smoke</option>
              <option value="water">Flood/Water</option>
              <option value="wind">Wind</option>
              <option value="storm">Storm</option>
              <option value="hail">Hail</option>
              <option value="theft">Theft/Vandalism</option>
              <option value="falling_objects">Falling Objects</option>
              <option value="other">Other</option>
            </select><span class="select2 select2-container select2-container--default" dir="ltr" data-select2-id="8" style="width: 100%;"><span class="selection"><span class="select2-selection select2-selection--single" role="combobox"
                  aria-haspopup="true" aria-expanded="false" tabindex="0" aria-labelledby="select2-housing_leadloss_type-t8-container"><span class="select2-selection__rendered" id="select2-housing_leadloss_type-t8-container" role="textbox"
                    aria-readonly="true"><span class="select2-selection__placeholder">Loss Type</span></span><span class="select2-selection__arrow" role="presentation"><b role="presentation"></b></span></span></span><span class="dropdown-wrapper"
                aria-hidden="true"></span></span>
          </div>
          <div class="form-group">
            <input class="form-control location-autocomplete loss_location pac-target-input" placeholder="Loss Address (or Location)" type="text" name="housing_lead[loss_location]" autocomplete="off">
          </div>
          <div class="form-group styled-checkbox">
            <div class="input-group">
              <label class="form-check-label" for="chk_catastrophe">
                <input name="housing_lead[catastrophe]" type="hidden" value="0"><input id="chk_catastrophe" class="checkbox-inline" type="checkbox" value="yes" name="housing_lead[catastrophe]">
                <span class="checkmark"></span> Claim is Due to a Catastrophic Event? </label>
            </div>
          </div>
        </div>
      </div>
    </div>
    <div class="card-body">
      <h3 class="text-center"><img src="/assets/icons/housing_leads/other-info-5fe16da0db26f1d9c50dcfea0743f0db3c5ed72ff67055e358c475f8208a26ac.png">Other Info</h3>
      <div class="row">
        <div class="form-group col-sm-6 col-md-3 styled-checkbox">
          <label class="form-check-label" for="chk_room_and_taxes_covered">
            <input name="housing_lead[room_and_taxes_covered]" type="hidden" value="0"><input id="chk_room_and_taxes_covered" class="form-check" type="checkbox" value="yes" checked="checked" name="housing_lead[room_and_taxes_covered]">
            <span class="checkmark"></span> Room and tax covered? </label>
        </div>
        <div class="form-group col-sm-6 col-md-3 styled-checkbox">
          <label class="form-check-label" for="chk_parking_covered">
            <input name="housing_lead[parking_covered]" type="hidden" value="0"><input id="chk_parking_covered" class="form-check" type="checkbox" value="1" name="housing_lead[parking_covered]">
            <span class="checkmark"></span> Parking fees covered? </label>
        </div>
        <div class="form-group col-sm-6 col-md-3 styled-checkbox">
          <label class="form-check-label" for="chk_pet_fee_covered">
            <input name="housing_lead[pet_fee_covered]" type="hidden" value="0"><input id="chk_pet_fee_covered" class="form-check" type="checkbox" value="1" name="housing_lead[pet_fee_covered]">
            <span class="checkmark"></span> Pet fees covered? </label>
        </div>
        <div class="form-group col-sm-6 col-md-3 styled-checkbox">
          <label class="form-check-label" for="chk_incidentals_covered">
            <input name="housing_lead[incidentals_covered]" type="hidden" value="0"><input id="chk_incidentals_covered" class="form-check" type="checkbox" value="1" name="housing_lead[incidentals_covered]">
            <span class="checkmark"></span> Incidental fees covered? </label>
        </div>
      </div>
      <div class="row">
        <div class="form-group col-sm-6">
          <select class="select2-mykey select2-hidden-accessible" data-placeholder="Adult" data-key="name" name="housing_lead[adults]" data-select2-id="10" tabindex="-1" aria-hidden="true">
            <option value=""></option>
            <option selected="selected" value="1" data-select2-id="12">1 Adult</option>
            <option value="2">2 Adults</option>
            <option value="3">3 Adults</option>
            <option value="4">4 Adults</option>
            <option value="5">5 Adults</option>
            <option value="6">6 Adults</option>
            <option value="7">7 Adults</option>
            <option value="8">8 Adults</option>
            <option value="9">9 Adults</option>
          </select><span class="select2 select2-container select2-container--default" dir="ltr" data-select2-id="11" style="width: 100%;"><span class="selection"><span class="select2-selection select2-selection--single" role="combobox"
                aria-haspopup="true" aria-expanded="false" tabindex="0" aria-labelledby="select2-housing_leadadults-hj-container"><span class="select2-selection__rendered" id="select2-housing_leadadults-hj-container" role="textbox"
                  aria-readonly="true" title="1 Adult"><span class="select2-selection__clear" data-select2-id="13">×</span>1 Adult</span><span class="select2-selection__arrow" role="presentation"><b role="presentation"></b></span></span></span><span
              class="dropdown-wrapper" aria-hidden="true"></span></span>
        </div>
        <div class="form-group col-sm-6">
          <select class="select2-mykey select2-hidden-accessible" data-placeholder="Child" data-key="name" name="housing_lead[children]" data-select2-id="14" tabindex="-1" aria-hidden="true">
            <option value="" data-select2-id="16"></option>
            <option value="1">1 Child</option>
            <option value="2">2 Children</option>
            <option value="3">3 Children</option>
            <option value="4">4 Children</option>
            <option value="5">5 Children</option>
            <option value="6">6 Children</option>
            <option value="7">7 Children</option>
            <option value="8">8 Children</option>
            <option value="9">9 Children</option>
          </select><span class="select2 select2-container select2-container--default" dir="ltr" data-select2-id="15" style="width: 100%;"><span class="selection"><span class="select2-selection select2-selection--single" role="combobox"
                aria-haspopup="true" aria-expanded="false" tabindex="0" aria-labelledby="select2-housing_leadchildren-gr-container"><span class="select2-selection__rendered" id="select2-housing_leadchildren-gr-container" role="textbox"
                  aria-readonly="true"><span class="select2-selection__placeholder">Child</span></span><span class="select2-selection__arrow" role="presentation"><b role="presentation"></b></span></span></span><span class="dropdown-wrapper"
              aria-hidden="true"></span></span>
        </div>
        <div class="form-group col-sm-6">
          <select class="select2-mykey select2-hidden-accessible" data-placeholder="Bedroom" data-key="name" name="housing_lead[bedrooms]" data-select2-id="17" tabindex="-1" aria-hidden="true">
            <option value=""></option>
            <option selected="selected" value="1" data-select2-id="19">1 Bedroom</option>
            <option value="2">2 Bedrooms</option>
            <option value="3">3 Bedrooms</option>
            <option value="4">4 Bedrooms</option>
            <option value="5">5 Bedrooms</option>
            <option value="6">6 Bedrooms</option>
            <option value="7">7 Bedrooms</option>
            <option value="8">8 Bedrooms</option>
            <option value="9">9 Bedrooms</option>
          </select><span class="select2 select2-container select2-container--default" dir="ltr" data-select2-id="18" style="width: 100%;"><span class="selection"><span class="select2-selection select2-selection--single" role="combobox"
                aria-haspopup="true" aria-expanded="false" tabindex="0" aria-labelledby="select2-housing_leadbedrooms-u2-container"><span class="select2-selection__rendered" id="select2-housing_leadbedrooms-u2-container" role="textbox"
                  aria-readonly="true" title="1 Bedroom"><span class="select2-selection__clear" data-select2-id="20">×</span>1 Bedroom</span><span class="select2-selection__arrow"
                  role="presentation"><b role="presentation"></b></span></span></span><span class="dropdown-wrapper" aria-hidden="true"></span></span>
        </div>
        <div class="form-group col-sm-6">
          <select class="select2-mykey select2-hidden-accessible" data-placeholder="Parking Spot" data-key="name" name="housing_lead[parking]" data-select2-id="21" tabindex="-1" aria-hidden="true">
            <option value="" data-select2-id="23"></option>
            <option value="1">1 Parking Spot</option>
            <option value="2">2 Parking Spots</option>
            <option value="3">3 Parking Spots</option>
            <option value="4">4 Parking Spots</option>
            <option value="5">5 Parking Spots</option>
            <option value="6">6 Parking Spots</option>
            <option value="7">7 Parking Spots</option>
            <option value="8">8 Parking Spots</option>
            <option value="9">9 Parking Spots</option>
          </select><span class="select2 select2-container select2-container--default" dir="ltr" data-select2-id="22" style="width: 100%;"><span class="selection"><span class="select2-selection select2-selection--single" role="combobox"
                aria-haspopup="true" aria-expanded="false" tabindex="0" aria-labelledby="select2-housing_leadparking-u3-container"><span class="select2-selection__rendered" id="select2-housing_leadparking-u3-container" role="textbox"
                  aria-readonly="true"><span class="select2-selection__placeholder">Parking Spot</span></span><span class="select2-selection__arrow" role="presentation"><b role="presentation"></b></span></span></span><span class="dropdown-wrapper"
              aria-hidden="true"></span></span>
        </div>
      </div>
      <div class="row">
        <div class="form-group col-md-6">
          <textarea class="form-control" placeholder="Pet Information" rows="4" name="housing_lead[pets]"></textarea>
        </div>
        <div class="form-group col-md-6">
          <textarea class="form-control" placeholder="Additional Needs" rows="4" name="housing_lead[notes]"></textarea>
        </div>
      </div>
    </div>
    <div class="card-body">
      <div class="row">
        <div class="col-12 buttons text-center">
          <input type="submit" name="commit" value="Send" class="btn btn-mykey" data-disable-with="Send">
        </div>
      </div>
    </div>
  </div>
</form>

Text Content

Insurance Inquiry


FROM SINGLE RESIDENTS TO THOSE WITH CHILDREN AND EVEN EXTENDED FAMILIES,

MyKey provides the most comprehensive access to safe and secure temporary
accommodations.
You have enough to worry about, let a MyKey Insurance Housing Specialist find
the right accommodations in the right neighborhood for your policyholder.
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CLAIM INFO

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Desired location
dropdown-icon-dark Created with Sketch.
Street Address
City
State / Province
Zip Code / Postal Code
Country
Accommodations Required Housing Hotel Both Hotel & Housing Fair Rental Value
Only Travel Trailer Both Hotel & Travel TrailerAccommodations Required
Policy Type Owner Renter Landlord CondominiumPolicy Type
Emergency Hotel Required?


ADJUSTER INFO





POLICYHOLDER INFO




VIP Policyholder?


LOSS INFO


Fire/Smoke Flood/Water Wind Storm Hail Theft/Vandalism Falling Objects OtherLoss
Type

Claim is Due to a Catastrophic Event?


OTHER INFO

Room and tax covered?
Parking fees covered?
Pet fees covered?
Incidental fees covered?
1 Adult 2 Adults 3 Adults 4 Adults 5 Adults 6 Adults 7 Adults 8 Adults 9
Adults×1 Adult
1 Child 2 Children 3 Children 4 Children 5 Children 6 Children 7 Children 8
Children 9 ChildrenChild
1 Bedroom 2 Bedrooms 3 Bedrooms 4 Bedrooms 5 Bedrooms 6 Bedrooms 7 Bedrooms 8
Bedrooms 9 Bedrooms×1 Bedroom
1 Parking Spot 2 Parking Spots 3 Parking Spots 4 Parking Spots 5 Parking Spots 6
Parking Spots 7 Parking Spots 8 Parking Spots 9 Parking SpotsParking Spot



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Submit ALE Housing Claim Temporary Housing Inquiry

Copyright @ 2022 MyKey Global Accommodations, Inc.

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