secure.ngpvan.com Open in urlscan Pro
45.60.33.183  Public Scan

Form analysis
1 forms found in the DOM

POST

<form class="clearfix" method="post" novalidate="" action="" accept-charset="utf-8" autocomplete="on">
  <div class="at-markup FastAction" id="NVSignupForm1549764-FastAction">
    <div class="fastaction-block">
      <div class="fastAction clearfix">
        <p>
          <span class="fa-cta">
            <a href="#fastaction-login" class="profile-link" aria-label="FastAction">
          <img class="profile-link-fa-image" src="//static.everyaction.com/ea-actiontag/assets/images/fast-action.svg"> 
        </a>
            <span><a href="https://fastaction.ngpvan.com##whats-this" class="circle" id="fastaction-whatsthis" data-popup="true" data-popup-width="515" data-popup-height="540" target="_blank">?</a></span>
          </span>
          <span class="fa-lead"> Take future action with a single click.<br>
            <a href="#fastaction-login" class="call-modal" id="fastaction-widget-login">Log in</a>&nbsp;or&nbsp;<a href="#fastaction-signup" class="call-modal" id="fastaction-widget-signup">Sign up</a>&nbsp;for <i>Fast</i><b>Action</b>
          </span>
        </p>
      </div>
    </div>
  </div>
  <div data-name="undefined" data-subview="submit_view" data-subview-index="1"></div>
  <fieldset class="at-fieldset ContactInformation" id="NVSignupForm1549764-ContactInformation">
    <legend class="at-legend">Contact Information</legend>
    <div class="at-fields">
      <div class="at-row FirstName LastName"><label class="at-text   FirstName" id="NVSignupForm1549764-ContactInformation-FirstName">First Name <small>(Optional)</small><input type="text" autocomplete="given-name" x-autocompletetype="given-name"
            false="" title="First Name" name="FirstName" value="" maxlength="20">
        </label><label class="at-text   LastName" id="NVSignupForm1549764-ContactInformation-LastName">Last Name <small>(Optional)</small><input type="text" autocomplete="family-name" x-autocompletetype="surname" false="" title="Last Name"
            name="LastName" value="" maxlength="25">
        </label></div>
      <div class="at-row PostalCode City"><label class="at-text   PostalCode" id="NVSignupForm1549764-ContactInformation-PostalCode">Postal Code <small>(Optional)</small><input type="tel" autocomplete="postal-code" x-autocompletetype="postal-code"
            pattern="^\d{5}([\-]\d{4})?$" false="" title="Postal Code" name="PostalCode" value="" maxlength="10">
        </label><label class="at-text   City" id="NVSignupForm1549764-ContactInformation-City">City <small>(Optional)</small><input type="text" autocomplete="address-level2" x-autocompletetype="locality" false="" title="City" name="City" value=""
            maxlength="25">
        </label></div>
      <div class="at-row EmailAddress MobilePhone"><label class="at-text   EmailAddress" id="NVSignupForm1549764-ContactInformation-EmailAddress">Email<input type="email" autocomplete="email" x-autocompletetype="email"
            pattern="^([\w!#$%&amp;'*+\-\/=?\^`{|}~]+\.)*[\w!#$%&amp;'*+\-\/=?\^`{|}~]+@((((([a-zA-Z0-9]{1}[a-zA-Z0-9\-]{0,62}[a-zA-Z0-9]{1})|[a-zA-Z])\.)+[a-zA-Z]{2,62})|(\d{1,3}\.){3}\d{1,3}(:\d{1,5})?)$" required="" title="Email (required)"
            name="EmailAddress" value="" maxlength="100" placeholder="email@email.com">
        </label><label class="at-text   MobilePhone" id="NVSignupForm1549764-ContactInformation-MobilePhone">Mobile Phone <small>(Optional)</small><input type="tel" autocomplete="mobile tel-national"
            pattern="^(?:\+?1[-. ]?)?(?:\(?([2-9]\d{2})\)?)[-. ]?([2-9]\d{2})[-. ]?(\d{4})(?:\s{0,2}(?:ext(?:ension)?|ex|x)\.?\s?(\d{1,5}))*$" false="" title="Mobile Phone" name="MobilePhone" value="" maxlength="">
        </label></div>
      <div class="at-row at-row-solo SmsSubscribeMobilePhone"><input id="SmsSubscribeMobilePhone_Value" type="hidden" name="SmsSubscribeMobilePhone.Value" value="true"></div>
      <div class="at-row at-row-solo at-row-full SmsLegalDisclaimer">
        <div class="at-markup SmsLegalDisclaimer at-legal" id="NVSignupForm1549764-ContactInformation-SmsLegalDisclaimer">
          <p>By providing your cell phone number, you consent to receive recurring text message updates from Andrei for Arizona, including by automated text message. Text STOP to end. Text HELP for help. Message and Data rates may apply.</p>
        </div>
      </div>
      <div class="at-row at-row-solo YesSignMeUpForUpdatesForBinder"><input id="YesSignMeUpForUpdatesForBinder_Value" type="hidden" name="YesSignMeUpForUpdatesForBinder.Value" value="true"></div>
      <div class="at-row at-row-solo at-row-full UpdateMyProfile at-mode-person-only">
        <div class="at-markup UpdateMyProfile at-mode-person-only" id="NVSignupForm1549764-ContactInformation-UpdateMyProfile">
          <div class="updateMyProfileSection" style=""><label style="display:inline;"><input type="checkbox" name="updateMyProfile" checked="checked"><span><span class="text">Remember me so that I can use <i>Fast</i><b>Action</b> next
                  time.</span></span></label></div>
        </div>
      </div>
      <div class="at-row "><label class="at-text   PersonalUrl" id="NVSignupForm1549764-ContactInformation-PersonalUrl"> <small>(Optional)</small><input type="text" autocomplete="on" false="" title="" name="PersonalUrl" value="" maxlength="">
        </label></div>
      <div class="at-row "><input id="SocialNetworkTrackingId_Value" type="hidden" name="SocialNetworkTrackingId.Value"></div>
      <div class="at-row "><input id="SocialNetwork_Value" type="hidden" name="SocialNetwork.Value"></div>
      <div class="at-row ">
        <div class="at-markup TrackingPixel" id="NVSignupForm1549764-ContactInformation-TrackingPixel" style="display: none;"><img alt=""
            src="https://secure.ngpvan.com/v1/Track/7fW6-1Vpy0OaezC45_uLsQ2?emci=e870536a-c5da-ed11-8e8b-00224832eb73&amp;emdi=4650fa85-d1da-ed11-8e8b-00224832eb73&amp;ceid=9181614&amp;formSessionId=5db62446-e245-4ef5-bba9-517b7732f858&amp;bName=chrome&amp;dType=desktop&amp;formVersion=4/5/2023 4:02:43 PM|&amp;fUrl=aHR0cHM6Ly9zZWN1cmUubmdwdmFuLmNvbS83Zlc2LTFWcHkwT2FlekM0NV91THNRMj9lbWNpPWU4NzA1MzZhLWM1ZGEtZWQxMS04ZThiLTAwMjI0ODMyZWI3MyZlbWRpPTQ2NTBmYTg1LWQxZGEtZWQxMS04ZThiLTAwMjI0ODMyZWI3MyZjZWlkPTkxODE2MTQ%3D&amp;fRef="
            style="display:none"></div>
      </div>
    </div>
  </fieldset>
  <div class="at-form-submit clearfix">
    <input type="submit" value="Submit" class="at-submit btn-at btn-at-primary">
  </div>
</form>

Text Content

Confirm Your Contact Information


? Take future action with a single click.
Log in or Sign up for FastAction


Contact Information
First Name (Optional) Last Name (Optional)
Postal Code (Optional) City (Optional)
Email Mobile Phone (Optional)


By providing your cell phone number, you consent to receive recurring text
message updates from Andrei for Arizona, including by automated text message.
Text STOP to end. Text HELP for help. Message and Data rates may apply.


Remember me so that I can use FastAction next time.
(Optional)









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SHOW YOUR SUPPORT
WITH A SINGLE CLICK

Autofill forms quickly and securely with FastAction
Log in with your email address

Or log in using Facebook or Twitter

Don't have a FastAction account yet? Sign up

By clicking "Sign up," I confirm that I agree with the FastAction terms of
service and privacy policy.

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