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167.245.162.31  Public Scan

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Submitted URL: https://americanexpress.myvoluntarybenefit.com/
Effective URL: https://mercervb.com/enrollment?legalEntityId=AECNYO%3AFO&appCode=ppa
Submission Tags: falconsandbox
Submission: On December 07 via api from US — Scanned from US

Form analysis 1 forms found in the DOM

<form class="offset-xl-0  offset-md-2 offset-lg-0 col-md-8 col-lg-11 d-flex flex-column">
  <div class="row pb-3 px-0 ">
    <div class="col-12 pt-0 pb-3 px-0 ">
      <div class="row text-center ">
        <div class="col-12 "><img
            src="data:image/png;base64,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"
            alt="Client Logo" class="img-responsive pt-3 logo-fixed-size" id="client-logo"></div>
        <div class="col-12 px-0 ">
          <div class="devider "></div>
        </div>
      </div>
    </div>
  </div>
  <div class="row">
    <div class="col-12">
      <h1 class="logInTitle  mb-3 mt-4">Log In</h1>
    </div>
    <div class="col-12 ">
      <p class="logInTitleDevider mb-4 "></p>
    </div>
    <div class="col-12 ">
      <div class="text-input"><label for="username">User ID</label><span class="form-mandatory"> * </span><input id="username" name="username" type="text" label="User ID" placeholder="Enter your registered email id" class="" required="" value=""
          style="border-color: rgb(218, 218, 218);"></div>
    </div>
    <div class="col-12" style="margin-top: 15px;">
      <div class="text-input"><label for="password">Password</label><span class="form-mandatory"> * </span><input id="password" name="password" type="password" label="Password" placeholder="Enter password" class="" required="" value=""
          style="border-color: rgb(218, 218, 218);"></div>
    </div>
  </div>
  <div class="row py-2 "><a role="link" class="col-6 link text-left currentLink" href="/retrieveUserID">Forgot User ID?</a><a role="link" class=" col-6 link text-right currentLink" href="/retrievePassword">Forgot Password?</a></div>
  <div class="row ">
    <div class="col-12 "><button type="button" disabled="" class=" btn  btn-primary-contrast btn-block my-3 loginContainerButton inputHeight ">Log In</button></div>
  </div>
  <div class="row">
    <div class="col-lg-8 mx-lg-0 px-xl-3 col-8 col-md-8 col-sm-8 py-3 ">
      <div class=" additionalInfoFirst ">DON’T HAVE AN ACCOUNT ?</div>
      <div class=" additionalInfoSecond ">Register for a new account.</div>
    </div>
    <div class="col-lg-4 col-4 col-md-4 col-sm-3 py-3 "><button type="button" class=" btn  btn-outline-primary primaryOutline registerContainerButton w-100 " data-target="#/userRegistration" data-toggle="/userRegistration">Register</button></div>
  </div>
</form>

Text Content

Welcome to the American Express Voluntary Benefit Enrollment Portal




LOG IN



User ID *
Password *
Forgot User ID?Forgot Password?
Log In
DON’T HAVE AN ACCOUNT ?
Register for a new account.
Register

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