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54.160.169.151  Public Scan

Submitted URL: https://georigahealthinsurancesolution.com/
Effective URL: https://www.healthsherpa.com/?_agent_id=CHICHING
Submission: On September 25 via api from US — Scanned from US

Form analysis 2 forms found in the DOM

POST /plans-with-contact

<form id="contact-form" data-layer="plans_and_prices_form" action="/plans-with-contact" accept-charset="UTF-8" method="post"><input type="hidden" name="authenticity_token"
    value="5v88ROPHWXKfhz8isiUEP4Z9WwoqBNo1ynVL90eFhYpS9fSTrjEz8f7GPwbdqWV_UBLFZYv3IfyleFDAaq5taw" autocomplete="off">
  <div class="control-group">
    <input type="tel" name="zip_code" id="zip_code" class="form-control input-lg" placeholder="Zip code">
    <p class="help-block"></p>
  </div>
  <div class="control-group">
    <input type="text" name="name" id="name" class="form-control input-lg" placeholder="Name (optional)">
    <p class="help-block"></p>
  </div>
  <div class="control-group">
    <input type="text" name="email" id="email" class="form-control input-lg" placeholder="Email (optional)">
    <p class="help-block"></p>
  </div>
  <div class="control-group">
    <input type="tel" name="phone" id="phone" class="form-control input-lg" placeholder="Phone number (optional)">
    <p class="help-block"></p>
  </div>
  <input type="hidden" name="confirmation_id" value="">
  <div class="form-group submit-wrapper">
    <button type="submit" class="btn btn-md btn-brand-color btn-block branded-color" data-layer="plans_and_prices_form_submit" style="color: rgb(43, 109, 57); background-color: rgb(43, 109, 57);"> See plans and prices </button>
  </div>
  <p class="tcpa-disclaimer"> DISCLAIMER: By submitting your information you agree that <var>Nakkeya King</var> may contact you at the above-listed email or phone number. I understand that consent is not a condition of purchase. </p>
  <input type="hidden" name="locale" value="source">
</form>

POST /plans-with-contact

<form id="contact-form-bottom" data-layer="plans_and_prices_form_bottom" action="/plans-with-contact" accept-charset="UTF-8" method="post"><input type="hidden" name="authenticity_token"
    value="5v88ROPHWXKfhz8isiUEP4Z9WwoqBNo1ynVL90eFhYpS9fSTrjEz8f7GPwbdqWV_UBLFZYv3IfyleFDAaq5taw" autocomplete="off">
  <div class="control-group">
    <input type="tel" name="zip_code" id="zip_code_bottom" class="form-control input-lg" placeholder="Zip code*">
    <p class="help-block"></p>
  </div>
  <div class="control-group">
    <input type="text" name="name" id="name_bottom" class="form-control input-lg" placeholder="Name">
    <p class="help-block"></p>
  </div>
  <div class="control-group">
    <input type="text" name="email" id="email_bottom" class="form-control input-lg" placeholder="Email">
    <p class="help-block"></p>
  </div>
  <div class="control-group">
    <input type="tel" name="phone" id="phone_bottom" class="form-control input-lg" placeholder="Phone number">
    <p class="help-block"></p>
  </div>
  <input type="hidden" name="confirmation_id" value="">
  <div class="form-group submit-wrapper">
    <button type="submit" class="btn btn-md btn-brand-color btn-block branded-color" ,="" data-layer="plans_and_prices_form_bottom_submit" style="color: rgb(43, 109, 57); background-color: rgb(43, 109, 57);"> See plans and prices </button>
    <p class="required" style="margin-top:8px">* Required field</p>
  </div>
  <br>
  <p class="tcpa-disclaimer"> DISCLAIMER: By submitting your information you agree that <var>Nakkeya King</var> may contact you at the above-listed email or phone number. I understand that consent is not a condition of purchase. </p>
  <input type="hidden" name="locale" value="source">
</form>

Text Content

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DISCLAIMER: By submitting your information you agree that Nakkeya King may
contact you at the above-listed email or phone number. I understand that consent
is not a condition of purchase.

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