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Submitted URL: http://www.insuramerica-fl.com/homeowner-quote/
Effective URL: https://entryform.semcat.net/insuramericafl
Submission: On October 03 via api from US — Scanned from DE
Effective URL: https://entryform.semcat.net/insuramericafl
Submission: On October 03 via api from US — Scanned from DE
Form analysis 1 forms found in the DOM
POST /insuramericafl
<form action="/insuramericafl" accept-charset="UTF-8" method="post"><input type="hidden" name="authenticity_token" value="V0pi/JlPrI7FOv/leNKqNNyCrsB5edR/S3PVydgzS519XZgEbrsLNTzO5Q6jSBkQ0+hFsmM7PiY4sTeZ+j38MA==">
<div id="one-third">
<div id="flash">
</div>
<img alt="Security:" src="/assets/padlock-dd47f08beb39bae6efc994d964a469625898210881802dad2dfe4b3e87b5bd4f.png"> We follow strict industry standards to safeguard the confidentiality of your personal information and secure the transmission of your
information from your computer. Filling out this form as completely as possible will result in the most accurate quote.
</div>
<div id="two-thirds">
<table class="form_table">
<tbody class="formatted_body">
<tr class="even_color">
<td>
<br><label for="person_given_name"><span class="required_field">*</span>Name</label>
</td>
<td>
<table class="formatted_subtable">
<tbody>
<tr>
<td>
<label for="person_given_name">First</label>
<input size="14" type="text" name="person[given_name]" id="person_given_name">
</td>
<td>
<label for="person_middle_name">MI</label>
<input size="1" maxlength="1" type="text" name="person[middle_name]" id="person_middle_name">
</td>
</tr>
<tr>
<td>
<label for="person_last_name">Last</label>
<input size="14" type="text" name="person[last_name]" id="person_last_name">
</td>
<td>
<label for="person_suffix">Suffix</label>
<select name="person[suffix]" id="person_suffix">
<option value="" label=" "></option>
<option value="Jr.">Jr.</option>
<option value="Sr.">Sr.</option>
<option value="I">I</option>
<option value="II">II</option>
<option value="III">III</option>
<option value="IV">IV</option>
<option value="DDS">DDS</option>
<option value="MD">MD</option>
<option value="PHD">PHD</option>
</select>
</td>
</tr>
</tbody>
</table>
</td>
</tr>
<tr class="odd_color">
<td>
<label for="lead_email">
<span class="required_field">*</span>E-mail address </label>
</td>
<td>
<input size="28" type="email" name="lead[email]" id="lead_email">
<span class="hint" id="email_hint"> Your e-mail address will be used to contact you about your policy request. It will not be shared with third parties. <span class="hint-pointer"> </span>
</span>
</td>
</tr>
<tr class="even_color">
<td>
<span class="required_field">*</span>Insurance type
</td>
<td>
<table style="font-size: small;">
<tbody>
<tr>
<td colspan="1" style="width: 60px; padding-bottom: 2px;">
<input name="lead[home]" type="hidden" value="0"><input type="checkbox" value="1" name="lead[home]" id="lead_home"><label for="lead_home">Home</label>
</td>
<td colspan="1" style="width: 60px; padding-bottom: 2px;">
<input name="lead[auto]" type="hidden" value="0"><input type="checkbox" value="1" name="lead[auto]" id="lead_auto"><label for="lead_auto">Auto</label>
</td>
<td colspan="1" style="width: 60px; padding-bottom: 2px;">
<input name="lead[life]" type="hidden" value="0"><input type="checkbox" value="1" name="lead[life]" id="lead_life"><label for="lead_life">Life</label>
</td>
<td colspan="1" style="width: 60px; padding-bottom: 2px;">
<input name="lead[health]" type="hidden" value="0"><input type="checkbox" value="1" name="lead[health]" id="lead_health"><label for="lead_health">Health</label>
</td>
</tr>
<tr>
<td colspan="1" style="width: 60px; padding-bottom: 2px;">
<input name="lead[farm]" type="hidden" value="0"><input type="checkbox" value="1" name="lead[farm]" id="lead_farm"><label for="lead_farm">Farm</label>
</td>
<td colspan="1" style="width: 60px; padding-bottom: 2px;">
<input name="lead[boat]" type="hidden" value="0"><input type="checkbox" value="1" name="lead[boat]" id="lead_boat"><label for="lead_boat">Boat</label>
</td>
<td colspan="1" style="width: 60px; padding-bottom: 2px;">
<input name="lead[rv]" type="hidden" value="0"><input type="checkbox" value="1" name="lead[rv]" id="lead_rv"><label for="lead_rv">RV</label>
</td>
</tr>
<tr>
<td colspan="2" style="width: 120px; padding-bottom: 2px;">
<input name="lead[motorcycle]" type="hidden" value="0"><input type="checkbox" value="1" name="lead[motorcycle]" id="lead_motorcycle"><label for="lead_motorcycle">Motorcycle</label>
</td>
</tr>
<tr>
<td colspan="3" style="width: 180px; padding-bottom: 2px;">
<input name="lead[plu]" type="hidden" value="0"><input type="checkbox" value="1" name="lead[plu]" id="lead_plu"><label for="lead_plu">Personal Liability Umbrella</label>
</td>
</tr>
<tr>
<td colspan="2" style="width: 120px; padding-bottom: 2px;">
<input name="lead[disability]" type="hidden" value="0"><input type="checkbox" value="1" name="lead[disability]" id="lead_disability"><label for="lead_disability">Disability</label>
</td>
</tr>
<tr>
<td colspan="4" style="width: 240px; padding-bottom: 2px;">
<a onclick="gn=document.getElementById('person_given_name').value; ln=document.getElementById('person_last_name').value; em=document.getElementById('lead_email').value; window.location = 'https://entryform.semcat.net:443/insuramericafl/commercial/index?first='+gn+'&last='+ln+'&email='+em; return false;" style="text-decoration: underline;" href="/insuramericafl/commercial">or choose Commercial Insurance</a>
</td>
</tr>
</tbody>
</table>
</td>
</tr>
<tr class="odd_color">
<td>
<input type="hidden" name="agent_uid" id="agent_uid">
<input type="hidden" name="api_key" id="api_key" value="ec009730e6c94a96e73cf4fdcc2639575ebd0d1e7c44bc6d360cec5ac639d830">
<input type="hidden" name="from" id="from">
</td>
<td>
<input type="submit" name="commit" value="Get quote" style="font-size: large;" data-disable-with="Get quote">
</td>
</tr>
</tbody>
</table>
</div>
</form>Text Content
We follow strict industry standards to safeguard the confidentiality of your personal information and secure the transmission of your information from your computer. Filling out this form as completely as possible will result in the most accurate quote. *Name First MI Last Suffix Jr. Sr. I II III IV DDS MD PHD *E-mail address Your e-mail address will be used to contact you about your policy request. It will not be shared with third parties. *Insurance type Home Auto Life Health Farm Boat RV Motorcycle Personal Liability Umbrella Disability or choose Commercial Insurance Powered by Applied Systems