www.bcbsal.org Open in urlscan Pro
216.104.80.113  Public Scan

Form analysis
1 forms found in the DOM

Name: login — POST /webapps/customeraccess/Dispatch?application=org.bcbsal.inet.customermgmt.CustomerAppListApplication

<form action="/webapps/customeraccess/Dispatch?application=org.bcbsal.inet.customermgmt.CustomerAppListApplication" method="post" name="login" id="login" autocomplete="OFF" onsubmit="return rememberMeFunction()">
  <input type="hidden" name="action" value="login"> <input type="hidden" name="pagetype" value="login"> <input type="hidden" name="loginType" value="direct">
  <input type="hidden" name="targetUrl" value="%2Fwebapps%2Fcustomeraccess%2FDispatch%3Fapplication%3Dorg.bcbsal.inet.customermgmt.CustomerAppListApplication">
  <input type="hidden" name="skipSelectContract" value="true"> <input type="hidden" name="nvap" value="">
  <div class="form-row">
    <label class="form-label mobileInputLabel" for="userName">Username</label> <input style="margin-bottom: 0;" class="input-block-level login-input form-control" autocomplete="off" onchange="return trim(this)" autocorrect="off" type="text"
      id="userName" name="userName" aria-label="Username" maxlength="15" size="15" data-id="userName" title="Please enter your username." value="">
  </div>
  <br>
  <div class="form-row">
    <label class="form-label mobileInputLabel" for="password">Password<span class="secure-site">secure site <i class="icon-lock"></i></span></label>
    <div style="position: relative;">
      <input style="margin-bottom: 0;" class="form-control" tabindex="0" name="password" id="password" size="15" maxlength="100" type="password">
      <div id="showPassContainer">
        <img id="showpassword" src="/mp-images/svg-icons/show-password.svg" style="cursor: pointer; height: 20px;" alt="Show or Hide password visiblility">
      </div>
    </div>
  </div>
  <br>
  <div class="form-row">
    <label class="rememberMeSwitch" for="rememberMeCheckBox"> <input type="checkbox" class="form-check-input" id="rememberMeCheckBox" onclick="ntptEventTag('ev=signin&amp;evdetail=Saved User ID');">
      <span class="rememberMeSlider round"></span>
    </label> <label class="form-label"><span class="mobileRememberUsername">Remember Username</span></label>
  </div>
  <div class="form-row">
    <button type="submit" class="btn loginButton btn-block">
      <strong>LOG IN</strong>
    </button>
  </div>
  <br>
  <div class="form-row">
    <span class="forgotUserPass">
      <p class="forgotUserPassText"> Forgot <a id="<portlet:namespace/>forgotUserName-mobile" href="/webapps/customeraccess/Dispatch?application=org.bcbsal.inet.customermgmt.CustomerForgotUserIdApplication&amp;responsive=true" class="forgotUserName loginLinkText forgotUserName-mobile">
										username</a> or
        <a id="<portlet:namespace/>forgotPassword-mobile" href="/webapps/customeraccess/Dispatch?application=org.bcbsal.inet.customermgmt.CustomerForgottenPasswordApplication&amp;responsive=true" class="forgotPassword loginLinkText forgotPassword-mobile">password</a>?
      </p>
    </span>
  </div>
</form>

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