File: /home/americanadvocateservices/public_html/form-success.php
<?php
//Ip Function
function getClientIp()
{
$ipaddress = '';
if (getenv('HTTP_CLIENT_IP'))
$ipaddress = getenv('HTTP_CLIENT_IP');
else if (getenv('HTTP_X_FORWARDED_FOR'))
$ipaddress = getenv('HTTP_X_FORWARDED_FOR');
else if (getenv('HTTP_X_FORWARDED'))
$ipaddress = getenv('HTTP_X_FORWARDED');
else if (getenv('HTTP_FORWARDED_FOR'))
$ipaddress = getenv('HTTP_FORWARDED_FOR');
else if (getenv('HTTP_FORWARDED'))
$ipaddress = getenv('HTTP_FORWARDED');
else if (getenv('REMOTE_ADDR'))
$ipaddress = getenv('REMOTE_ADDR');
else
$ipaddress = 'UNKNOWN';
return $ipaddress;
}
?>
<head>
<meta charset="utf-8">
<meta content="width=device-width, initial-scale=1.0" name="viewport">
<title>American Advocate Services</title>
<meta name="description" content="">
<meta name="keywords" content="">
<!-- Favicons -->
<link href="assets/img/favicon.png" rel="icon">
<link href="assets/img/apple-touch-icon.png" rel="apple-touch-icon">
<!-- Fonts -->
<link href="https://fonts.googleapis.com" rel="preconnect">
<link href="https://fonts.gstatic.com" rel="preconnect" crossorigin>
<link href="https://fonts.googleapis.com/css2?family=Roboto:ital,wght@0,100;0,300;0,400;0,500;0,700;0,900;1,100;1,300;1,400;1,500;1,700;1,900&family=Inter:wght@100;200;300;400;500;600;700;800;900&family=Nunito:ital,wght@0,200;0,300;0,400;0,500;0,600;0,700;0,800;0,900;1,200;1,300;1,400;1,500;1,600;1,700;1,800;1,900&display=swap" rel="stylesheet">
<!-- Vendor CSS Files -->
<link href="assets/vendor/bootstrap/css/bootstrap.min.css" rel="stylesheet">
<link href="assets/vendor/bootstrap-icons/bootstrap-icons.css" rel="stylesheet">
<link href="assets/vendor/aos/aos.css" rel="stylesheet">
<link href="assets/vendor/glightbox/css/glightbox.min.css" rel="stylesheet">
<link href="assets/vendor/swiper/swiper-bundle.min.css" rel="stylesheet">
<!-- Main CSS File -->
<link href="assets/css/main.css" rel="stylesheet">
<style>
ul {
list-style-type: none;
}
</style>
<script src="https://cdnjs.cloudflare.com/ajax/libs/jquery/3.6.0/jquery.min.js"></script>
<script src="https://cdnjs.cloudflare.com/ajax/libs/jquery-easing/1.4.1/jquery.easing.min.js" integrity="sha512-0QbL0ph8Tc8g5bLhfVzSqxe9GERORsKhIn1IrpxDAgUsbBGz/V7iSav2zzW325XGd1OMLdL4UiqRJj702IeqnQ==" crossorigin="anonymous"></script>
<script src="https://cdnjs.cloudflare.com/ajax/libs/jquery-validate/1.19.5/jquery.validate.min.js"></script>
<script src="https://cdn.jsdelivr.net/jquery.validation/1.16.0/additional-methods.min.js"></script>
<script src="./assets/js/dobpicker.js"></script>
</head>
<body class="index-page">
<header id="header" class="header d-flex align-items-center fixed-top">
<div class="header-container container-fluid container-xl position-relative d-flex align-items-center justify-content-between">
<a href="index.html" class="logo d-flex align-items-center me-auto me-xl-0">
<!-- Uncomment the line below if you also wish to use an image logo -->
<!-- <img src="assets/img/logo.png" alt=""> -->
<h1 class="sitename">American Advocate Services</h1>
</a>
<nav id="navmenu" class="navmenu">
<ul>
<li><a href="/" class="active">Home</a></li>
</li>
</ul>
<i class="mobile-nav-toggle d-xl-none bi bi-list"></i>
</nav>
<a class="btn-getstarted" href="Tel:+18882998146">Call Now: +1 (888) 299-8146</a>
</div>
</header>
<main class="main">
<!-- Hero Section -->
<section id="hero" class="hero section">
<div class="container" data-aos="fade-up" data-aos-delay="100">
<div class="row align-items-center">
<div class="col-lg-12">
<div class="hero-content" data-aos="fade-up" data-aos-delay="200">
<h1 class="mb-4 text-center">
Thank You!
<br>
</h1>
<p class="mb-4 mb-md-5">
<h4 style="color: #343f52; font-size: 1rem; font-weight:600" class="text-center">Your request has been successfully submitted. A licensed agent will be in touch very soon!</h4>
<h1 style="font-style: italic; font-size: 1rem;" class="text-center">If you are in need of immediate assistance you can call us directly at <span><a style="color: #0052D4 !important; text-decoration: none;" href="tel:+18882998146">Call Now: +1 (888) 299-8146</a></span></h4>
</p>
</div>
</div>
</div>
</section><!-- /Hero Section -->
</div>
</div>
</div>
</div>
</section><!-- /Contact Section -->
</main>
<footer id="footer" class="footer">
<div class="container copyright text-center">
© 2025 by American Advocate Services.
</div>
</footer>
<!-- Scroll Top -->
<a href="/" id="scroll-top" class="scroll-top d-flex align-items-center justify-content-center"><i class="bi bi-arrow-up-short"></i></a>
<!-- Vendor JS Files -->
<script src="assets/vendor/bootstrap/js/bootstrap.bundle.min.js"></script>
<script src="assets/vendor/php-email-form/validate.js"></script>
<script src="assets/vendor/aos/aos.js"></script>
<script src="assets/vendor/glightbox/js/glightbox.min.js"></script>
<script src="assets/vendor/swiper/swiper-bundle.min.js"></script>
<script src="assets/vendor/purecounter/purecounter_vanilla.js"></script>
<!-- Main JS File -->
<script src="assets/js/main.js"></script>
<script>
function submitForm()
{
$('#submitButton').prop('disabled', true);
$.ajax({
type: 'post',
dataType:'jsonp',
url: 'https://ushaleads.healthinsuranceguide.org/api/LeadAPI',
data: $('form').serialize(),
success: function () {
console.log('success');
window.location.href = "form-success.php";
},
error:function(){
console.log('Error');
window.location.href = "form-success.php";
}
})
};
$(document).ready(function(){
$('input:checkbox').click(function() {
$('input:checkbox').not(this).prop('checked', false);
});
});
/*-----------------------------------------------------------------------*/
/*----------------------- Phone Number Input Mask -----------------------*/
/*-----------------------------------------------------------------------*/
$(document).ready(function(){
$('#phone').mask('0000000000');
});
/*-----------------------------------------------------------------------*/
/*---------------------------- Zip Code Lookup --------------------------*/
/*-----------------------------------------------------------------------*/
$('#zipCode').on("input",function(){
var zipCode = $('#zipCode').val();
if(zipCode.length == 5)
{
$.ajax({
type: 'GET',
url:'https://ziplookup.visualyzers.com/Ziplookup?zipcode=' + zipCode,
success:function(results){
$('#city').val(results.city);
$('#state').val(results.state);
}
})
}
});
/*-------------------------------------------------------------------------*/
/*---------------------------- Validation Lookup --------------------------*/
/*-------------------------------------------------------------------------*/
$("#valForm").submit(function(e) {
e.preventDefault();
}).validate({
rules:{
phone:{
required:true,
minlength:10,
maxlength:10
},
firstname:{
required:true
},
lastname:{
required:true
},
dateofbirth:{
required:true,
date:true,
},
typeofplan:{
required: true
},
email:{
required:true,
email:true
},
city:{
required:true
},
state:{
required:true
},
zipCode:{
required:true,
minlength:5,
maxlength:5
}
},
messages: {
phone: {
required: "Please enter a valid phone number"
},
},
submitHandler: function(event)
{
submitForm();
}
});
$(function() {
$( "#datepicker" ).datepicker({
dateFormat : 'mm/dd/yy',
changeMonth : true,
changeYear : true,
yearRange: '-100y:c+nn',
maxDate: '-1d'
});
});
/*-----------------------------------------------------------------------*/
/*--------------------------- Date of Birth ----------------------------*/
/*-----------------------------------------------------------------------*/
$(document).ready(function() {
$.getJSON('https://api.ipify.org?format=jsonp&callback=?', function(data) {
$('#IpAddress').val(data.ip);
});
$.dobPicker({
daySelector: '#dobday',
/* Required */
monthSelector: '#dobmonth',
/* Required */
yearSelector: '#dobyear',
/* Required */
dayDefault: 'Day',
/* Optional */
monthDefault: 'Month',
/* Optional */
yearDefault: 'Year',
/* Optional */
minimumAge: 18,
/* Optional */
maximumAge: 100 /* Optional */
});
});
window.dataLayer = window.dataLayer || [];
$.dataLayer.push({
'event':'ec_formsubmit',
'enhanced_conversion_data': {
first_name: $('#firstname').val(),
last_name: $('#lastname').val(),
phone_number: $('#phone').val(),
email_address: $('#email').val(),
street: $('#street').val(),
city: $('#city').val(),
postal_code: $('#zip').val(),
dobday: $('#dobday').val(),
dobmonth: $('#dobmonth').val(),
dobyear: $('#dobyear').val(),
date_of_birth: $('#dob').val(),
plan_condition: $('.planConditions').val(),
plan_option: $('.planOption').val(),
}
})
</script>
</body>
</html>