File: /home/searchmyhealthplan/backup/bu/index.php
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<title>Search My Health Plan</title>
<meta name="description" content="HTML Template for Coming Soon website">
<meta name="author" content="harnishdesign.net">
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$(document).ready(function() {
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<!-- Preloader End -->
<!-- Document Wrapper
=============================== -->
<div id="main-wrapper">
<div class="container-fluid px-0">
<div class="row g-0 min-vh-100">
<!-- Intro
========================= -->
<div class="col-lg-7">
<div class="hero-wrap d-flex align-items-center">
<div id="particles-js" class="hero-particles"></div>
<div class="hero-mask opacity-7 bg-dark"></div>
<div class="hero-bg hero-bg-scroll" style="background-image:url('./images/intro-bg-2.jpg');"></div>
<div class="hero-content w-100 min-vh-100 d-flex flex-column">
<!-- Domain Details -->
<div class="container py-5 px-4 px-lg-5 my-auto">
<div class="row text-center">
<div class="col-12 mx-auto mb-4">
<!-- Logo -->
<a class="logo" href="index.html" title="Zoon"> <img src="images/logo.svg" width="30%" alt="Zoon"/> </a>
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</div>
<div class="col-12 mx-auto">
<h2 class="text-15 fw-600 text-white mb-4">Compare Plans</h2>
</div>
<div class="col-md-9 col-xl-8 mx-auto">
<p class="text-5 text-light mb-3">Find Your Perfect Health Coverage Today!
</p>
<!-- Subscribe Form -->
<button id="submit-btn" class="btn btn-primary" type="submit">Call Now: (855) 599-2128</button>
<!-- Subscribe End -->
</div>
</div>
</div>
<div class="container pb-2 px-3">
<div class="row text-white">
<div class="col-sm-6 col-md-4 d-flex align-items-center justify-content-center justify-content-md-start">
<span class="me-2"><i class="fas fa-info-circle"></i></span><a class="text-white" data-bs-toggle="modal" data-bs-target="#about" href="#">Privacy Policy</a>
</div>
<div class="col-sm-6 col-md-4 d-flex align-items-center justify-content-center mt-2 mt-sm-0">
<span class="me-2"><i class="fas fa-phone-alt"></i></span>(855) 599-2128
</div>
<div class="col-md-4 d-flex align-items-center justify-content-center justify-content-md-end mt-2 mt-md-0">
<span class="me-2"><i class="fas fa-info-circle"></i></span><a class="text-white" data-bs-toggle="modal" data-bs-target="#about" href="#">Terms and Conditions</a>
</div>
</div>
</div>
</div>
</div>
</div>
<!-- Intro End -->
<!-- Contact Us
========================= -->
<div class="col-lg-5 d-flex flex-column bg-light text-center ">
<div class="container my-auto py-5 pt-lg-4 pb-lg-2">
<div class="row mx-0">
<div class="col-11 col-lg-10 mx-auto">
<h3 class="mb-3 fw-600">Get Your Quote Now</h3>
<p class="text-black-50 mb-4">If you are in need of immediate assistance you can call us directly at (855) 599-2128.</p>
<!-- Contact Form -->
<form id="contact-form" action="php/mail.php" method="post">
<div class="row">
<div class="mb-3 col-md-6">
<input id="firstname" name="firstname" type="text" class="form-control border-2 col-6" placeholder="Enter Your First Name" required >
</div>
<div class="mb-3 col-md-6">
<input id="lastname" name="lastname" type="text" class="form-control border-2" placeholder="Enter Your Last Name" required >
</div>
<div class="mb-3 col-md-6">
<input id="phone" name="phone" type="text" class="form-control border-2" placeholder="Enter Your Phone Number" required >
</div>
<div class="mb-3 col-md-6">
<input id="email" name="email" type="text" class="form-control border-2" placeholder="Enter Your Email Address" required >
</div>
<div class="mb-3 col-md-12">
<input id="email" name="email" type="text" class="form-control border-2" placeholder="Enter Your Stree Address" required >
</div>
<div class="mb-3 col-md-4">
<input id="email" name="email" type="text" class="form-control border-2" placeholder="Enter Your City" required >
</div>
<div class="mb-3 col-md-4">
<input id="email" name="email" type="text" class="form-control border-2" placeholder="Enter Your State" required >
</div>
<div class="mb-3 col-md-4">
<input id="email" name="email" type="text" class="form-control border-2" placeholder="Enter Your Zipcode" required >
</div>
<!-- DROPDOWN -->
<div class="col-md-4 col-sm-12">
<label>Month</label>
<select id="dobmonth" class="dobmonth form-select" name="month" required></select>
</div>
<div class="col-md-4 col-sm-12">
<label>Day</label>
<select id="dobday" class="dobday form-select" name="day" required></select>
</div>
<div class="col-md-4 col-sm-12">
<label>Year</label>
<select id="dobyear" class="dobyear form-select" name="year" required></select>
</div>
<!-- DROPDOWN -->
<div class="d-grid mt-4">
<button id="submit-btn" class="btn btn-primary" type="submit">Send Message</button>
</div>
</div>
</form>
</div>
</div>
</div>
<!-- Footer -->
<footer class="container">
<p class="text-2 text-muted mb-2">Copyright © 2022 <a href="#">Search My Health Plan</a>. All Rights Reserved.</p>
</footer>
</div>
<!-- Contact Us End -->
</div>
</div>
</div>
<!-- Document Wrapper End -->
<!--SCRIPTS-->
<!-- TrustedForm -->
<script type="text/javascript">
(function() {
var tf = document.createElement('script');
tf.type = 'text/javascript'; tf.async = true;
tf.src = ("https:" == document.location.protocol ? 'https' : 'http') + "://api.trustedform.com/trustedform.js?field=xxTrustedFormCertUrl&identifier=VHQ&ping_field=xxTrustedFormPingUrl&l=" + new Date().getTime() + Math.random();
var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(tf, s);
})();
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<img src="https://api.trustedform.com/ns.gif" />
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<script>
// When DOM is loaded this
// function will get executed
$(() => {
// function will get executed
// on click of submit button
$("#submitButton").click(function(ev) {
var form = $("#valForm");
var url = form.attr('action');
$.ajax({
type: "POST",
url: url,
data: form.serialize(),
success: function(data) {
// Ajax call completed successfully
alert("Form Submited Successfully");
},
error: function(data) {
// Some error in ajax call
alert("some Error");
}
});
});
});
</script>
<script>
$(document).ready(function(){
setTimeout(function(){
updatedvalue = "xxxxxxx00000";
$("input[name=gclid_field]").val();
value = $('input[name=gclid_field]').val();
console.log(value);
},1000);
});
</script>
<script>
/*-----------------------------------------------------------------------*/
/*--------------------------- 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 */
});
});
</script>
<script>
/*-----------------------------------------------------------------------*/
/*---------------------------- Validation --------------------------*/
/*-----------------------------------------------------------------------*/
var form = $("#valForm");
form.validate({
errorPlacement: function errorPlacement(error, element) {
element.before(error);
},
rules: {
firstname: {
required: true,
maxlength: "30"
},
lastname: {
required: true,
maxlength: "30"
},
dobmonth: {
required: true,
date: true
},
dobday: {
required: true
},
dobyear: {
required: true
},
phone: {
required: true,
minlength: 10,
maxlength: 10,
phoneUS: true
},
email: {
required: true
},
address: {
required: true
},
zipCode: {
required: true,
minlength: 5,
maxlength: 5
},
city: {
required: true
},
state: {
required: true
}
},
messages: {
firstname: {
required: "Please enter a valid First Name"
},
lastname: {
required: "Please enter a valid Last Name"
},
phone: {
required: "Please enter a valid phone number"
},
email: {
required: "Please enter a valid Email Address"
},
address: {
required: "Please enter a valid Street Address",
},
zipCode: {
required: "Please enter a valid Zip Code",
},
city: {
required: "Please enter a valid City",
},
state: {
required: "Please enter a valid State",
}
},
});
</script>
<script>
/*-----------------------------------------------------------------------*/
/*---------------------------- DATA POST --------------------------*/
/*-----------------------------------------------------------------------*/
$("#formStepper").steps({
headerTag: "h4",
bodyTag: "section",
transitionEffect: "slideLeft",
autoFocus: true,
onStepChanging: function(event, currentIndex, newIndex) {
var zipCode = $('#zipCode').val();
if (zipCode.length == 5) {
$.ajax({
type: 'GET',
url: 'https://ziplookup.visualyzers.com/Ziplookup?zipcode=' + zipCode,
success: function(results) {
if (!results) {
$('#errorZip').show();
$('#submitButton').prop("disabled", true);
} else {
$('#city').val(results.city);
$('#state').val(results.state);
$('#errorZip').hide();
$('#submitButton').prop("disabled", false);
}
}
})
}
return form.valid();
},
//Plugin Posting ajax
onFinished: function(event, currentIndex) {
var formValid = form.valid();
if(!formValid)
{
return false;
}
var phoneNumber = $('#phone').val();
$.ajax({
type: 'post',
dataType: 'jsonp',
url: 'https://ushaleads.healthinsuranceguide.org/api/LeadAPI',
data: $('form').serialize(),
success: function() {
console.log('success');
console.log('./form-success.php?phoneNumber=' + phoneNumber);
window.location.href = './form-success.php?phoneNumber=' + phoneNumber;
},
error: function() {
console.log('Error');
console.log('./form-success.php?phoneNumber=' + phoneNumber);
window.location.href = './form-success.php?phoneNumber=' + phoneNumber;
}
});
}
})
</script>
<script>
/*-----------------------------------------------------------------------*/
/*---------------------------- FORM FUNCTION --------------------------*/
/*-----------------------------------------------------------------------*/
$(document).ready(function() {
if ($("#formStepper").steps("getCurrentIndex") == 0 || $("#formStepper").steps("getCurrentIndex") ==
1) {
$('.actions').hide()
} else {
$('.actions').show()
}
$('.planOptions').click(function() {
if ($("#formStepper").steps("getCurrentIndex") == 0) {
$('.actions').hide()
$("#formStepper").steps("setStep", 1);
}
})
$('.planConditions').click(function() {
if ($("#formStepper").steps("getCurrentIndex") == 1) {
$('.actions').show()
$("#formStepper").steps("setStep", 2);
}
})
$('#dobmonth').change(function() {
console.log('month');
$('#dob').val($('#dobmonth').val() + '-' + $('#dobday').val() + '-' + $('#dobyear').val());
});
$('#dobday').change(function() {
console.log('day');
$('#dob').val($('#dobmonth').val() + '-' + $('#dobday').val() + '-' + $('#dobyear').val());
});
$('#dobyear').change(function() {
console.log('year');
$('#dob').val($('#dobmonth').val() + '-' + $('#dobday').val() + '-' + $('#dobyear').val());
});
})
</script>
<script>
/* ZIPCODE */
$('#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) {
if (!results) {
$('#errorZip').show();
$('#submitButton').prop("disabled", true);
} else {
$('#city').val(results.city);
$('#state').val(results.state);
$('#errorZip').hide();
$('#submitButton').prop("disabled", false);
}
}
})
}
});
</script>
<script>
$(document)
.on('keydown', '.alpha', function(e) {
var a = e.key;
if (a.length == 1) return /[a-z]|\$|#|\*/i.test(a);
return true;
})
$(document)
.on('keydown', '.numer', function(e) {
var a = e.key;
if (a.length == 1) return /[0-9]|\$|#|\*/i.test(a);
return true;
})
// now the digit 0 on your mask pattern will be interpreted
// as valid characters like 0,1,2,3,4,5,6,7,8,9 and *
</script>
<script type='text/javascript'>
window.smartlook||(function(d) {
var o=smartlook=function(){ o.api.push(arguments)},h=d.getElementsByTagName('head')[0];
var c=d.createElement('script');o.api=new Array();c.async=true;c.type='text/javascript';
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smartlook('init', '6356ad50b40e20945db3bb7c35b1803dba0d58f3', { region: 'eu' });
</script>
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