unitedstates65.com Open in urlscan Pro
64.20.156.129  Public Scan

Submitted URL: https://www.65wisconsin.com/
Effective URL: https://unitedstates65.com/
Submission: On September 02 via api from US — Scanned from US

Form analysis 1 forms found in the DOM

POST /#wpcf7-f9-o1

<form action="/#wpcf7-f9-o1" method="post" class="wpcf7-form init" aria-label="Contact form" novalidate="novalidate" data-status="init">
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    <input type="hidden" name="_wpcf7_container_post" value="0">
    <input type="hidden" name="_wpcf7_posted_data_hash" value="">
  </div>
  <h2>Compare Medicare Plans </h2>
  <div id="formSection1" class="formSection">
    <p><label for="your-name"></label><span class="wpcf7-form-control-wrap" data-name="your-name"><input size="40" maxlength="80" class="wpcf7-form-control wpcf7-text" id="your-name" aria-invalid="false" placeholder="Name" value="" type="text"
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          name="your-phone"></span><br>
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          type="text" name="your-email"></span><br>
      <label for="your-birth"></label><span class="wpcf7-form-control-wrap" data-name="your-birth"><input size="40" maxlength="80" class="wpcf7-form-control wpcf7-text" id="your-birth" aria-invalid="false" placeholder="Age" value="" type="text"
          name="your-birth"></span><br>
      <input data-open="formSection2" class="openFormSection" value="Start Now" type="button">
    </p>
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  <div id="formSection2" class="formSection" style="display: none;">
    <p><label for="your-zip"></label><span class="wpcf7-form-control-wrap" data-name="your-zip"><input size="40" maxlength="80" class="wpcf7-form-control wpcf7-text" id="your-zip" aria-invalid="false" placeholder="Zip" value="" type="text"
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      <label for="your-address"></label><span class="wpcf7-form-control-wrap" data-name="your-address"><input size="40" maxlength="80" class="wpcf7-form-control wpcf7-text" id="your-address" aria-invalid="false" placeholder="Address" value=""
          type="text" name="your-address"></span><br>
      <label for="your-state"></label><span class="wpcf7-form-control-wrap" data-name="your-state"><select class="wpcf7-form-control wpcf7-select" id="your-state" aria-invalid="false" name="your-state">
          <option value="Alaska">Alaska</option>
          <option value="Alabama">Alabama</option>
          <option value="Arkansas">Arkansas</option>
          <option value="American Samoa">American Samoa</option>
          <option value="Arizona">Arizona</option>
          <option value="California">California</option>
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          <option value="District of Columbia">District of Columbia</option>
          <option value="Delaware">Delaware</option>
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          <option value="Georgia">Georgia</option>
          <option value="Guam">Guam</option>
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          <option value="Idaho">Idaho</option>
          <option value="Illinois">Illinois</option>
          <option value="Indiana">Indiana</option>
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          <option value="New Mexico">New Mexico</option>
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          <option value="Oklahoma">Oklahoma</option>
          <option value="Oregon">Oregon</option>
          <option value="Pennsylvania">Pennsylvania</option>
          <option value="Puerto Rico">Puerto Rico</option>
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          <option value="South Carolina">South Carolina</option>
          <option value="South Dakota">South Dakota</option>
          <option value="Tennessee">Tennessee</option>
          <option value="Texas">Texas</option>
          <option value="United States Minor Outlying Islands">United States Minor Outlying Islands</option>
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          <option value="Virgin Islands, U.S.">Virgin Islands, U.S.</option>
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          <option value="West Virginia">West Virginia</option>
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      <label for="your-county"></label><span class="wpcf7-form-control-wrap" data-name="your-county"><input size="40" maxlength="80" class="wpcf7-form-control wpcf7-text" id="your-county" aria-invalid="false" placeholder="County" value="" type="text"
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      <input class="wpcf7-form-control wpcf7-hidden" id="landing" value="/" type="hidden" name="landing"><br>
      <input class="wpcf7-form-control wpcf7-hidden" id="source" value="" type="hidden" name="source"><br>
      <input class="wpcf7-form-control wpcf7-submit has-spinner" id="submitButton" type="submit" value="Submit"><span class="wpcf7-spinner"></span>
    </p>
  </div>
  <div class="wpcf7-response-output" aria-hidden="true"></div>
</form>

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