tylermsergi.site
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URL:
https://tylermsergi.site/
Submission: On September 28 via api from US — Scanned from DE
Submission: On September 28 via api from US — Scanned from DE
Form analysis
2 forms found in the DOMPOST /create-contact.php
<form id="contact-form" class="contact__form" method="post" action="/create-contact.php">
<input type="hidden" class="form-control" placeholder="First name" name="firstname-empty">
<div class="row">
<div class="col-6 form-group col-md-6 pr-3">
<input type="text" class="form-control" id="Name" name="name" placeholder="Full name" required="">
</div>
<div class="col-6 form-group col-md-6">
<input type="email" class="form-control" id="email" name="email" placeholder="Your Email" required="">
</div>
</div>
<div class="row">
<div class="col-6 form-group col-md-6 pr-3">
<input type="text" class="form-control" id="dob" name="dob" placeholder="Your Date of Birth" required="">
</div>
<div class="col-6 form-group col-md-6">
<input type="text" class="form-control" id="phone" name="phone_number" placeholder="Phone number" required="">
</div>
</div>
<div class="row">
<div class="col-6 form-group col-md-6 pr-3">
<input type="text" class="form-control" id="city" name="city" placeholder="Your City" required="">
</div>
<div class="col-6 form-group col-md-6">
<input type="text" class="form-control" id="state" name="state" placeholder="Your State" required="">
</div>
</div>
<div class="col-12 form-group">
<textarea class="form-control" id="street" name="street" rows="6" placeholder="Your street" required=""></textarea>
</div>
<div class="form-check">
<input type="checkbox" name="agreement" required=""> I agree , By submitting my cell phone number to receive automated sms/mms messages with more information or quote from TYLER M SERGI. 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 & Conditions</a> | <a href="privacy-policy.html">Privacy Policy</a>
</div>
<button type="submit" class="btn btn-primary btn-zoom contact-form-btn" id="contact-form-button" formtarget="_blank">Send Message</button>
</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
100 TYLER M SERGI * Home * Terms Conditions * Privacy Policy TYLER SERGI I'm a committed health plan advisor who loves making the intricate realm of health insurance easier to navigate. Drawing on my in-depth industry expertise. I help clients find health plans tailored to their individual needs and budgets, COMPREHENSIVE SERVICES PERSONALIZED HEALTH PLAN CONSULTING DESIGN Let me use my extensive industry knowledge to help you find the perfect health insurance plan that fits your unique needs and budget. PERSONALIZED HEALTH PLAN CONSULTING I specialize in finding affordable health insurance plans for individuals and families, ensuring quality coverage without breaking the bank. PERSONALIZED HEALTH PLAN CONSULTING As a dedicated health plan advisor, I will simplify the confusing world of insurance and provide personalized recommendations based on your specific situation. 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 TYLER M SERGI. Message frequency may vary. Reply STOP to cancel, Reply HELP for contact information. message and date rates may apply Terms & Conditions | Privacy Policy Send Message UNSUBSCRIBE X Close Submit TYLER M SERGI Unsubscribe ADDRESS * +17722029148 * tylersergi.healthadvisor@gmail.com Copyright © 2024 — TYLER M SERGI All Rights Reserved.