ashleymstauffer.site Open in urlscan Pro
188.114.96.9  Public Scan

Form analysis
2 forms found in the DOM

POST /create-contact.php

<form id="contact-form" class="contact__form" method="post" action="/create-contact.php">
  <div class="row">
    <div class="col-md-6 form-group mb-3">
      <input name="name" id="name" type="text" class="form-control" placeholder="Full name">
    </div>
    <div class="col-md-6 form-group mb-3">
      <input name="email" id="email" type="email" class="form-control" placeholder="Email address">
    </div>
    <div class="col-md-6 form-group mb-3">
      <input id="dob" name="dob" type="text" class="form-control" placeholder="Your Date of Birth">
    </div>
    <div class="col-md-6 form-group mb-3">
      <input id="phone" name="phone_number" type="text" class="form-control" placeholder="Phone number">
    </div>
    <div class="col-md-6 form-group mb-3">
      <input id="city" name="city" type="text" class="form-control" placeholder="Your City">
    </div>
    <div class="col-md-6 form-group mb-3">
      <input id="state" name="state" type="text" class="form-control" placeholder="Your State">
    </div>
    <div class="col-12 form-group mb-3">
      <textarea name="street" id="street" class="form-control" rows="6" placeholder="Your street"></textarea>
    </div>
    <div>
      <input type="checkbox" name="agreement" value="1"> I agree , By submitting my cell phone number to receive automated sms/mms messages with more information or quote from ASHLEY M STAUFFER. Message frequency may vary. Reply STOP to cancel, Reply
      HELP for contact information. message and date rates may apply <a href="terms-conditions.html">Terms &amp; Conditions</a> | <a href="privacy-policy.html">Privacy Policy</a>
    </div>
    <div class="col-12 mt-4 text-center">
      <button type="submit" value="send" class="btn btn-hero btn-circled">Send</button>
    </div>
  </div>
</form>

POST /opt-contact.php

<form method="POST" action="/opt-contact.php">
  <div class="modal-body"><input type="text" class="form-control" placeholder="Phone" name="ph" required="">
  </div>
  <div class="modal-footer">
    <button type="button" class="btn btn-secondary closeModalButton">Close</button>
    <button type="submit" class="btn btn-primary">Submit</button>
  </div>
</form>

Text Content

ASHLEY M STAUFFER
 * Home
 * Terms Conditions
 * Privacy Policy


ASHLEY M STAUFFER

Ashley Stauffer

I'm a licensed health plan advisor that helps families and individuals be
covered with the best affordable health insurance coverage option possible that
is a right match to their health needs and easy on their budget.

EXPLORE OUR OFFERINGS

PERSONALIZED HEALTH INSURANCE PLANS



Let me help you find the perfect health insurance coverage for your unique needs
and budget.

FAMILY HEALTH INSURANCE PACKAGES



Protect your loved ones with comprehensive health insurance plans tailored to
fit your family's specific healthcare requirements.

AFFORDABLE HEALTH INSURANCE OPTIONS



Get the best value for your money with my expertise in finding affordable health
insurance plans that still provide quality coverage.


WE'RE HERE TO HELP

I agree , By submitting my cell phone number to receive automated sms/mms
messages with more information or quote from ASHLEY M STAUFFER. Message
frequency may vary. Reply STOP to cancel, Reply HELP for contact information.
message and date rates may apply Terms & Conditions | Privacy Policy
Send

CONTACT INFO

+12602559180

CONTACT MAIL

healthwithash71@gmail.com

UNSUBSCRIBE

X
Close Submit
Copyright © 2024 — ASHLEY M STAUFFER All Rights Reserved.
Unsubscribe