e.srgllc.com
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44.239.89.235
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URL:
http://e.srgllc.com/prefs/9z4zn21vb4v7sica34uksqsidjjbvjjf5g9bctqj4s0
Submission Tags: falconsandbox
Submission: On June 08 via api from US — Scanned from DE
Submission Tags: falconsandbox
Submission: On June 08 via api from US — Scanned from DE
Form analysis
1 forms found in the DOMGET /prefs/9z4zn21vb4v7sica34uksqsidjjbvjjf5g9bctqj4s0
<form action="/prefs/9z4zn21vb4v7sica34uksqsidjjbvjjf5g9bctqj4s0" method="get" role="form">
<div id="updates_div">
<h4>Your email address: <span style="font-size:15px; font-weight:bold;"> pattersona@grangeinsurance.com <input type="hidden" name="email_addr" value="pattersona@grangeinsurance.com">
</span>
</h4>
<div class="email_confirm_msg" style="padding-bottom:10px;"> (A confirmation email will be sent to this address) </div>
<div id="refresh_form_msg">
<a href="/kccsrg/prefs">Please click here if
pattersona@grangeinsurance.com is not your email address.</a>
</div>
<div class="radio">
<label>
<input type="radio" value="optin" name="subscribe" checked=""> Yes, please send email from <span class="client_name"> KCC/SRG</span> to the address above. </label>
</div>
<div class="radio">
<label>
<input type="radio" name="subscribe" value="optout"> No, please stop sending email from <span class="client_name"> KCC/SRG</span> to the address above. </label>
</div>
<div class="radio">
<label>
<input type="radio" value="change" name="subscribe"> Please change my email address from the address above to: <input type="text" tabindex="2" name="new_addr" size="30" class="form-control" style="margin-top:10px;">
</label>
</div>
<div id="change_email">
<div class="email_confirm_msg"> (new email address) </div>
</div>
</div>
<!--
<hr>
<div id="freq_div" class="form-group">
<h4>How often would you like to hear from us:</h4>
<label class="checkbox-inline no_indent">
<select name="email_frequency_limit"><option selected value="0">Include me on all mailings<option value="7">No more than once a week<option value="30">No more than once a month</select>
</label>
</div>
-->
<hr>
<div id="sms_div" class="form-group">
<div> Mobile Phone (optional): </div>
<div class="mobile_field">
<input type="text" name="mobile_phone" tabindex="2" size="30" value="" style="margin-top:10px;" class="form-control">
</div>
</div>
<div class="row" align="left" style="padding-bottom:50px;">
<div class="col-xs-6 col-sm-8 col-md-10">
<input tabindex="7" class="btn btn-primary " type="submit" value="Change Subscription" name="submit" id="submit">
</div>
</div>
</form>
Text Content
KCC/SRG Subscription Form SUBSCRIPTION CENTER We want you to enjoy receiving email from KCC/SRG. To modify your subscription, change your settings below and click Change Subscription. You will receive an email confirming your changes have taken effect. -------------------------------------------------------------------------------- YOUR EMAIL ADDRESS: PATTERSONA@GRANGEINSURANCE.COM (A confirmation email will be sent to this address) Please click here if pattersona@grangeinsurance.com is not your email address. Yes, please send email from KCC/SRG to the address above. No, please stop sending email from KCC/SRG to the address above. Please change my email address from the address above to: (new email address) -------------------------------------------------------------------------------- Mobile Phone (optional):