www5.benefitsolver.com Open in urlscan Pro
23.7.197.234  Public Scan

Form analysis
2 forms found in the DOM

Name: signonForm — POST ./BenefitSolverView

<form name="signonForm" action="./BenefitSolverView" method="POST" onsubmit="isValidBrowser(); return submitForm(this)" novalidate="novalidate">
  <input type="hidden" name="fingerprint" value="UNKNOWN"><input type="hidden" name="isSignonPage" value="t"><input autocorrect="off" autocapitalize="off" type="hidden" name="BrowserName" value="Edge"><input autocorrect="off" autocapitalize="off"
    type="hidden" name="BrowserVersion" value="92"><input autocorrect="off" autocapitalize="off" type="hidden" name="CURRENT_LANGUAGE" value="en"><input autocorrect="off" autocapitalize="off" type="hidden"
    name="org.springframework.web.servlet.HandlerMapping.bestMatchingPattern" value="/{_:^(?!swagger).*$}/**"><input autocorrect="off" autocapitalize="off" type="hidden" name="signonurl"
    value="http://www5.benefitsolver.com/benefits/BenefitSolverView"><input autocorrect="off" autocapitalize="off" type="hidden" name="org.springframework.web.util.UrlPathHelper.path" value="/BenefitSolverView"><input autocorrect="off"
    autocapitalize="off" type="hidden" name="displayMessage" value=""><input autocorrect="off" autocapitalize="off" type="hidden" name="org.springframework.web.servlet.HandlerMapping.pathWithinHandlerMapping" value="/BenefitSolverView"><input
    type="hidden" name="co_num" value="">
  <div id="checkJS" class="no-margin-top" style="display: none;">
    <div class="alert alert-danger" role="alert">
      <table cellpadding="3" cellspacing="0" width="100%" role="presentation">
        <tbody>
          <tr>
            <td align="" valign="top" class="text-danger"><i class="icon-warning-sign pull-left icon-warning-sign-padding"></i><b>Warning&nbsp;-&nbsp;</b><span class="normalFont">It appears that you have JavaScript disabled. Please enable JavaScript
                in your browser and refresh this page to log in.</span></td>
          </tr>
        </tbody>
      </table>
    </div>
  </div>
  <script type="text/javascript">
    document.getElementById("checkJS").style.display = "none";
  </script><input type="hidden" name="USERID" value=""><input type="hidden" name="PASSWORD" value="">
  <div class="panel" widget-type="signon">
    <div class="panel-heading">
      <h2 class="panel-title">Welcome</h2>
    </div>
    <div class="panel-body">
      <div class="row">
        <div class="col-xs-12 col-sm-6">
          <div class="form-group required">
            <label for="USERID1" id="label_USERID1" class="control-label">User Name</label><span class="input-group"><span class="input-group-addon" id="USERID1_addon_before"><span class="icon icon-user icon-lg"> </span></span><input id="USERID1"
                name="USERID1" value="" class="form-control input-lg" type="text" required="required" aria-required="true" autocorrect="off" autocapitalize="off" aria-describedby="USERID1_helptext USERID1_addon_before"></span>
            <div class="help-block" id="USERID1_helptext">case sensitive</div>
          </div>
          <div class="form-group required">
            <label for="PASSWORD1" id="label_PASSWORD1" class="control-label">Password</label><span class="input-group"><span class="input-group-addon" id="PASSWORD1_addon_before"><span class="icon icon-lock icon-lg"> </span></span><input
                id="PASSWORD1" name="PASSWORD1" value="" class="form-control input-lg" type="password" required="required" aria-required="true" autocomplete="off" aria-describedby="PASSWORD1_helptext PASSWORD1_addon_before"></span>
            <div class="help-block" id="PASSWORD1_helptext">case sensitive</div>
          </div>
          <button id="button_4d8eaefd-752a-456f-91b5-3f7ec0504b87" value="Login" class="loginButton btn btn-lg btn-primary btn-block index_next m-bottom-sm" type="submit">Login <span class="icon icon-chevron-right"></span></button>
          <div class="text-center m-bottom-sm">
            <a href="javascript:gotoPage(null, 'signup/pwdverify', false, false, { formActionURL: './BenefitSolverView', co_num: '', co_affid: '', RelayState: '' });" onclick="return handleClick('forgotpwd')">Forgot your user name or password?</a>
          </div>
        </div>
        <div class="col-xs-12 col-sm-5 pull-right">
          <div style="overflow-y:auto;max-height:300px;">
            <h4>First time here?</h4>Register to create your<br>user name and password.
          </div>
          <br>
          <button id="button_b3cfae49-9a6a-4018-8505-1dc7d54cbd55" value="Register" onclick="gotoPage(null, 'signup/verify', false, false, { formActionURL: './BenefitSolverView', co_num: '', gd_num: '', co_affid: '', RelayState: '' })"
            class="btn btn-default btn-block" type="button"><span class="icon icon-user"></span> Register</button>
        </div>
      </div>
    </div>
  </div>
  <input type="hidden" name="CSRF" value=""><input type="hidden" name="requestUUID" value="096150f6-bf37-420b-ac57-d0eeee63bc62">
</form>

<form onsubmit="return false;" id="loginForm">
  <div class="form-group">
    <label for="loginModalUsername" class="control-label">User Name</label>
    <div class="input-group">
      <span class="input-group-addon"><i class="icon icon-user icon-large"></i></span><input type="text" class="form-control input-lg" id="loginModalUsername" name="loginModalUsername" value="" autocorrect="off" autocapitalize="off">
    </div>
  </div>
  <div class="form-group">
    <label for="loginModalPassword" class="control-label">Password</label>
    <div class="input-group">
      <span class="input-group-addon"><i class="icon icon-lock icon-large"></i></span><input type="password" class="form-control input-lg" id="loginModalPassword" name="loginModalPassword" value="" autocomplete="off">
    </div>
  </div>
  <input type="hidden" name="CSRF" value=""><input type="hidden" name="requestUUID" value="3987e033-e836-44d9-b962-216e1247cfcf">
</form>

Text Content

Error

The following error(s) have occurred.

Warning

The following warning(s) have occurred.

Information

The following action(s) have occurred.

Warning - It appears that you have JavaScript disabled. Please enable JavaScript
in your browser and refresh this page to log in.


WELCOME

User Name
case sensitive
Password
case sensitive
Login
Forgot your user name or password?

FIRST TIME HERE?

Register to create your
user name and password.

Register
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