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2606:4700:20::ac43:4474  Public Scan

Submitted URL: http://medicaid-now.marshalllawpa.com/
Effective URL: https://app.decisionvault.com/open/marshalllaw/medicaidnow
Submission: On April 04 via api from US — Scanned from DE

Form analysis 1 forms found in the DOM

POST /accounts/signup/

<form class="signup" id="signup_form" method="post" action="/accounts/signup/">
  <input type="hidden" name="csrfmiddlewaretoken" value="k4dLP4duuink3ccM1H26ZO38nmmjpdtpuvUlJC7Z9Ra7BFH31GYZtAFzlR5cubmK">
  <input type="hidden" name="short_name_user_type" value="client">
  <input type="hidden" name="new_user_type" value="C">
  <input type="hidden" name="quest_id" value="643">
  <div class="card bg-primary d-lg-none" style="background-color: #ffffff !important;">
    <div class="card-body">
      <table class="w-100 text-center h-100">
        <tbody>
          <tr>
            <td class="align-middle"><img height="60px" src="https://decisionvault-static.s3.amazonaws.com/logos/784f039d-alllawpa-full.png">
            </td>
          </tr>
        </tbody>
      </table>
    </div>
  </div>
  <div class="card-group">
    <div class="card bg-primary py-5 d-md-down-none" style="width:30%; background-color: #ffffff !important;">
      <div class="card-body">
        <table class="w-100 text-center h-100">
          <tbody>
            <tr>
              <td class="align-middle"><img src="https://decisionvault-static.s3.amazonaws.com/logos/784f039d-alllawpa-full.png" class="img-fluid">
              </td>
            </tr>
          </tbody>
        </table>
      </div>
    </div>
    <div class="card p-3">
      <div class="card-body">
        <h5>Confidential Client Questionnaire</h5>
        <p class="text-muted mb-4">Please create an account to secure your information.</p>
        <div class="input-group mb-3">
          <div class="input-group-prepend"><span class="input-group-text">
              <i class="c-icon cil-user"></i></span></div>
          <input class="form-control" type="email" id="id_email" name="email" placeholder="E-mail address" autofocus="autofocus" autocomplete="username" required="">
        </div>
        <div class="input-group mb-4">
          <div class="input-group-prepend"><span class="input-group-text">
              <i class="c-icon cil-lock-locked"></i>
            </span></div>
          <input class="form-control" type="password" name="password1" autocomplete="new-password" placeholder="Password" required="" id="id_password1">
        </div>
        <div class="row">
          <div class="col">
            <a href="/access/784f039d-1415-4eb4-9e6a-98cc373e7c51" class="btn btn-link">Sign in instead</a>
          </div>
          <div class="col text-right">
            <button type="submit" class="btn btn-success">Create Account »</button>
          </div>
        </div>
      </div>
    </div>
  </div>
  <div class="row mt-2">
    <div class="col text-muted text-center px-5"> By creating an account, you are agreeing to DecisionVault's <a href="https://decisionvault.com/terms-of-service/" target="_BLANK">Terms
                                        of
                                        Service</a> and <a href="https://decisionvault.com/privacy-policy/" target="_BLANK">Privacy
                                        Policy</a>. </div>
  </div>
</form>

Text Content

 

CONFIDENTIAL CLIENT QUESTIONNAIRE

Please create an account to secure your information.



Sign in instead
Create Account »
By creating an account, you are agreeing to DecisionVault's Terms of Service and
Privacy Policy.
All data transmitted & stored securely encrypted. Learn more about our security.
Learn more about our security.
DecisionVault © 2021

SECURITY OVERVIEW

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A bank grade 256 bit encrypted SSL connection keeps your data safe at all times
(even on that open coffee shop wifi).
This application is hosted on cloud servers in the US. The database and any
uploaded files are encrypted and backed up daily.
The information that you share stays between you and your attorney, and is only
used for estate planning purposes.
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