www.wawanesa.com Open in urlscan Pro
3.97.75.126  Public Scan

Submitted URL: https://wawanesa.ca/
Effective URL: https://www.wawanesa.com/canada/
Submission: On February 24 via api from US — Scanned from US

Form analysis 2 forms found in the DOM

Name: accountdetails_formPOST https://app.wawanesa.com/form/canada/secure/billing/accountdetails.action

<form id="accountdetails_form" name="accountdetails_form" action="https://app.wawanesa.com/form/canada/secure/billing/accountdetails.action" method="POST" autocomplete="off">
  <input type="hidden" name="region" value="CN" id="accountdetails_form_region" data-di-id="#accountdetails_form_region">
  <input type="hidden" name="language" value="EN" id="accountdetails_form_language" data-di-id="#accountdetails_form_language">
  <input type="hidden" name="target" value="myaccount" id="accountdetails_form_target" data-di-id="#accountdetails_form_target">
  <input type="hidden" name="tracking" value="" id="accountdetails_form_tracking" data-di-id="#accountdetails_form_tracking">
  <div class="field">
    <label class="label" for="inputPolicyNum">Policy number</label>
    <div class="control control-group">
      <input id="inputPolicyNum" aria-describedby="inputPolicyNum-error" aria-required="true" type="text" maxlength="20" name="policyNumber" class="input" data-di-id="#inputPolicyNum">
      <span id="inputPolicyNum-error" class="help-block has-text-danger" data-gtm-vis-polling-id761704_722="357" data-gtm-vis-polling-id761704_554="359" data-gtm-vis-polling-id761704_725="361" data-gtm-vis-polling-id761704_553="363"></span>
    </div>
  </div>
  <div class="field">
    <label class="label" for="inputLastName">Last name or company</label>
    <div class="control control-group">
      <input id="inputLastName" aria-describedby="inputLastName-error" aria-required="true" type="text" maxlength="60" name="insuredLastName" class="input" data-di-id="#inputLastName">
      <span id="inputLastName-error" class="help-block has-text-danger" data-gtm-vis-polling-id761704_722="358" data-gtm-vis-polling-id761704_554="360" data-gtm-vis-polling-id761704_725="362" data-gtm-vis-polling-id761704_553="364"></span>
    </div>
  </div>
  <div id="recaptcha" class="g-recaptcha" data-sitekey="6LdokyQUAAAAAIJ3jP46fxnnTlJe2u_IEnW-3v0g" data-callback="next" data-size="invisible">
    <div class="grecaptcha-badge" data-style="bottomright"
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      <div class="grecaptcha-logo"><iframe title="reCAPTCHA" width="256" height="60" role="presentation" name="a-4v83c28vc3aj" frameborder="0" scrolling="no"
          sandbox="allow-forms allow-popups allow-same-origin allow-scripts allow-top-navigation allow-modals allow-popups-to-escape-sandbox allow-storage-access-by-user-activation"
          src="https://www.google.com/recaptcha/api2/anchor?ar=1&amp;k=6LdokyQUAAAAAIJ3jP46fxnnTlJe2u_IEnW-3v0g&amp;co=aHR0cHM6Ly93d3cud2F3YW5lc2EuY29tOjQ0Mw..&amp;hl=en&amp;v=1kRDYC3bfA-o6-tsWzIBvp7k&amp;size=invisible&amp;cb=pb7e929aru10"></iframe>
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      <div class="grecaptcha-error"></div><textarea id="g-recaptcha-response" name="g-recaptcha-response" class="g-recaptcha-response"
        style="width: 250px; height: 40px; border: 1px solid rgb(193, 193, 193); margin: 10px 25px; padding: 0px; resize: none; display: none;"></textarea>
    </div><iframe style="display: none;"></iframe>
  </div>
  <div class="columns is-vcentered is-desktop">
    <div class="column">
      <div class="ww-policy-help">
        <a href="#" class="ww-policy-help-btn" aria-expanded="false" aria-haspopup="true">Need help?</a>
        <div class="ww-policy-help-content">
          <p class="has-text-right"><button class="delete" aria-label="Close"></button></p>
          <img src="/resources/img/canada/statement-of-account.jpg?language_id=1" alt="Your policy number, last name or company name can be found in the top left corner of your policy documents or invoice.">
          <p><a class="ww-policy-help-link" href="/canada/payments/billing-help.html" data-di-id="di-id-c6a68337-1adae36">More help?</a></p>
        </div>
      </div>
    </div>
    <div class="column has-text-right">
      <button type="submit" class="button is-primary" id="submitBtn" data-di-id="#submitBtn">Continue</button>
    </div>
  </div>
</form>

<form id="ww-pref-select-form">
  <input type="hidden" id="ww-pref-lang" value="1" data-di-id="#ww-pref-lang">
  <input type="hidden" id="ww-pref-persona" value="" data-di-id="#ww-pref-persona">
  <div class="field">
    <label class="label ww-visually-hidden" for="location-select">Choose your location</label>
    <div class="control is-fullwidth">
      <div class="select">
        <select id="location-select" aria-required="true">
          <option value="AB">Alberta</option>
          <option value="BC">British Columbia</option>
          <option value="MB">Manitoba</option>
          <option value="NB">New Brunswick</option>
          <option value="NL">Newfoundland Labrador</option>
          <option value="NT">Northwest Territories</option>
          <option value="NS">Nova Scotia</option>
          <option value="NU">Nunavut</option>
          <option value="ON" selected="">Ontario</option>
          <option value="PE">Prince Edward Island</option>
          <option value="QC">Québec</option>
          <option value="SK">Saskatchewan</option>
          <option value="YT">Yukon</option>
        </select>
      </div>
    </div>
  </div>
</form>

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