www.mt-ins.com Open in urlscan Pro
2606:4700:3031::6815:4c23  Public Scan

Form analysis
1 forms found in the DOM

Name: frmCaptcha — POST UnSub_R_Proc.php

<form action="UnSub_R_Proc.php" method="POST" id="frmCaptcha" name="frmCaptcha" class="form" onsubmit="return getParam(this)">
  <input type="hidden" name="CampaignID" id="CampaignID" value="6887">
  <input type="hidden" name="queryid" id="queryid" value="2">
  <table border="0" cellpadding="2" id="tbl_frmMain">
    <tbody>
      <tr valign="top">
        <td width="30%" align="right" valign="top">
          <strong>
            <font face="Verdana" size="2" class="required">*</font>
            <font face="Verdana" size="2">Email Address: &nbsp;</font>
          </strong>
        </td>
        <td align="left" valign="top"> &nbsp; <font face="Verdana" size="1"><textarea name="email" id="email" rows="5" cols="30" tabindex="1">warren.laird@vsp.com</textarea></font>
        </td>
      </tr>
      <tr>
        <td align="right">
          <font face="Verdana" size="2" class="required">*</font>
          <font face="Verdana" size="2"><strong>Unsubscribe Reason: &nbsp;</strong></font>
        </td>
        <td> &nbsp; <select id="reason" name="reason">
            <option value="">--Please Select--</option>
            <option value="Too many email">Too many email</option>
            <option value="Not relevant">Not relevant</option>
            <option value="Not interesting">Not interesting</option>
            <option value="No longer there">No longer there</option>
            <option value="None of the above">None of the above</option>
          </select>
        </td>
      </tr>
      <tr valign="top">
        <td width="30%" valign="top" align="right">
          <font face="Verdana" size="2"><strong>Comments: &nbsp;</strong></font>
        </td>
        <td align="left" valign="top"> &nbsp; <font face="Verdana" size="2"><textarea id="comment" name="comment" cols="30" rows="5" tabindex="2"></textarea></font>
        </td>
      </tr>
      <tr valign="top">
        <td valign="top" align="center" colspan="2">
          <!--   <p><font face="Verdana" size="2"><input type="checkbox" checked="checked" name="email_confirmation" value="yes"/> Please send me an email confirmation that I have been unsubscribed</font></p> -->
        </td>
      </tr>
      <tr>
        <td align="center" colspan="2">
          <font face="Verdana" size="2">
            <div id="imgCaptcha" width="5">
              <h2>45617</h2>
            </div>
            <div id="captcha_status"></div> <br>
            <label for="captcha">Please enter the text as you see it in the image above:</label>
          </font>
        </td>
      </tr>
      <tr>
        <td></td>
        <td><input id="txtCaptcha" type="text" name="txtCaptcha" value="" maxlength="10" size="32"></td>
      </tr>
      <tr valign="top">
        <td></td>
        <td>
          <input type="submit" value="Submit" class="btn tertiary" tabindex="3">
        </td>
      </tr>
    </tbody>
  </table>
</form>

Text Content

 

 

--------------------------------------------------------------------------------

  

We wish to communicate special offers and promotions to you via email but only
if you enjoy receiving them. If you would like to be removed from all emails in
the future please click here.

You can unsubscribe yourself below. We do not always read the comments.

You are now being removed for Health products from Brokerage 1.

You will be receiving more product information from other companies and
products.

Please Report Any Abuse to 702-458-9833

* Required Field

--------------------------------------------------------------------------------

*Email Address:     warren.laird@vsp.com *Unsubscribe Reason:     --Please
Select-- Too many email Not relevant Not interesting No longer there None of the
above Comments:    


45617



Please enter the text as you see it in the image above:

All data gathered from this page is being recorded. This includes the IP
address, email address that is entered, and any other data that may be collected
from your internet connection that uniquely identifies the unsubscriber.

Please allow 72 hours to be completely removed from our system.

Regards, Technology Department
Thank You In Advance - Ultimate Insurance Resource
Please Report Any Abuse to 702-458-9833