withgrayce53177.activehosted.com Open in urlscan Pro
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Form analysis
1 forms found in the DOM

POST https://withgrayce53177.activehosted.com/proc.php

<form method="POST" action="https://withgrayce53177.activehosted.com/proc.php" id="_form_1_" class="_form _form_1 _inline-form  _dark" novalidate="">
  <input type="hidden" name="u" value="1" data-name="u">
  <input type="hidden" name="f" value="1" data-name="f">
  <input type="hidden" name="s" data-name="s">
  <input type="hidden" name="c" value="0" data-name="c">
  <input type="hidden" name="m" value="0" data-name="m">
  <input type="hidden" name="act" value="sub" data-name="act">
  <input type="hidden" name="v" value="2" data-name="v">
  <input type="hidden" name="or" value="61c78fd99299aa5814f09bc2c74050cc" data-name="or">
  <div class="_form-content">
    <div class="_form_element _x82619753 _full_width _clear">
      <div class="_form-title"> Communication Preferences </div>
    </div>
    <div class="_form_element _x96852629 _full_width _clear">
      <div class="_html-code">
      </div>
    </div>
    <div class="_form_element _x94879475 _full_width ">
      <label for="email" class="_form-label"> Work Email* </label>
      <div class="_field-wrapper">
        <input type="text" id="email" name="email" placeholder="Type your email" required="" data-name="email">
      </div>
    </div>
    <div class="_form_element _x71907938 _full_width ">
      <fieldset class="_form-fieldset">
        <div class="_row">
          <legend for="field[15][]" class="_form-label"> As your employee benefit, we'll only send you what you're interested in. What would be valuable to hear from Grayce about? </legend>
        </div>
        <input data-autofill="false" type="hidden" id="field[15][]" name="field[15][]" value="~|" data-name="communicationpreferences">
        <div class="_row _checkbox-radio">
          <input id="field_15Quarterly live events" type="checkbox" name="field[15][]" value="Quarterly live events" data-name="communicationpreferences">
          <span>
            <label for="field_15Quarterly live events"> Quarterly live events </label>
          </span>
        </div>
        <div class="_row _checkbox-radio">
          <input id="field_15Quarterly updates to your benefit" type="checkbox" name="field[15][]" value="Quarterly updates to your benefit" data-name="communicationpreferences">
          <span>
            <label for="field_15Quarterly updates to your benefit"> Quarterly updates to your benefit </label>
          </span>
        </div>
        <div class="_row _checkbox-radio">
          <input id="field_15None, I don't want any information about my benefit" type="checkbox" name="field[15][]" value="None, I don't want any information about my benefit" data-name="communicationpreferences">
          <span>
            <label for="field_15None, I don't want any information about my benefit"> None, I don't want any information about my benefit </label>
          </span>
        </div>
      </fieldset>
    </div>
    <div class="_button-wrapper _full_width">
      <button id="_form_1_submit" class="_submit" type="submit"> Submit </button>
    </div>
    <div class="_clear-element">
    </div>
  </div>
  <div class="_form-thank-you" style="display:none;">
  </div>
</form>

Text Content

Communication Preferences

Work Email*

As your employee benefit, we'll only send you what you're interested in. What
would be valuable to hear from Grayce about?
Quarterly live events
Quarterly updates to your benefit
None, I don't want any information about my benefit
Submit