File: /home/searchmyhealthplan/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;
}
?>
<?php
$actual_link = "http://$_SERVER[HTTP_HOST]$_SERVER[REQUEST_URI]";
?>
<script src="https://ajax.googleapis.com/ajax/libs/jquery/3.6.1/jquery.min.js"></script>
<script>
$(document).ready(function() {
$("submit").click(function() {
var pageURL = $(location).attr("href");
alert(pageURL);
});
});
</script>
<head>
<script>
!function(a, b, c, d, e, f, g)
{if(a.ctrk)return;e=a.ctrk=function(){e.runner?
e.runner.apply(e,arguments):e.q.push(arguments)};
e.q=[];f=b.createElement(c);f.async=true;
f.src=d+'?d='+a.location.hostname;g=b.getElementsByTagName(c)[0];
g.parentNode.insertBefore(f,g);}
(window, document,'script','https://c.pmsrv.co/v1/analytics.js');
ctrk('boot', '2e090405-6df4-4c96-a491-823f33d81a37');
ctrk('record', 'page-land', {dnt: false})
</script>
<script>
ctrk('record', 'Lead', { dnt: false })
</script>
<meta charset="utf-8">
<meta http-equiv="X-UA-Compatible" content="IE=edge"/>
<meta name="author" content="Search Health Plans"/>
<meta name="description" content="Search My Health Plan"/>
<meta name="keywords" content="Responsive">
<meta name="viewport" content="width=device-width, initial-scale=1.0"/>
<!-- SITE TITLE -->
<title>Search My Health Plan</title>
<!-- FAVICON AND TOUCH ICONS -->
<link rel="shortcut icon" href="images/favicon.ico" type="image/x-icon">
<link rel="icon" href="images/favicon.ico" type="image/x-icon">
<link rel="apple-touch-icon" sizes="152x152" href="images/apple-touch-icon-152x152.png">
<link rel="apple-touch-icon" sizes="120x120" href="images/apple-touch-icon-120x120.png">
<link rel="apple-touch-icon" sizes="76x76" href="images/apple-touch-icon-76x76.png">
<link rel="apple-touch-icon" href="images/apple-touch-icon.png">
<link rel="icon" href="images/apple-touch-icon.png" type="image/x-icon">
<!-- GOOGLE FONTS -->
<link href="https://fonts.googleapis.com/css?family=Roboto:300,400,500,700&display=swap" rel="stylesheet">
<link href="https://fonts.googleapis.com/css?family=Noto+Sans+TC:300,400,500,700,900" rel="stylesheet">
<!-- BOOTSTRAP CSS -->
<link href="css/bootstrap.min.css" rel="stylesheet">
<!-- FONT ICONS -->
<link href="https://use.fontawesome.com/releases/v5.11.0/css/all.css" rel="stylesheet" crossorigin="anonymous">
<link href="css/flaticon.css" rel="stylesheet">
<!-- PLUGINS STYLESHEET -->
<link rel="stylesheet" href="css/jquerySteps.css">
<link href="css/menu.css" rel="stylesheet">
<link id="effect" href="css/dropdown-effects/fade-down.css" media="all" rel="stylesheet">
<link href="css/magnific-popup.css" rel="stylesheet">
<!-- ON SCROLL ANIMATION -->
<link href="css/animate.css" rel="stylesheet">
<!-- TEMPLATE CSS -->
<link href="css/skyblue-theme.css" rel="stylesheet">
<!-- RESPONSIVE CSS -->
<link href="css/responsive.css" rel="stylesheet">
<script src="https://cdnjs.cloudflare.com/ajax/libs/jquery-validate/1.19.3/jquery.validate.min.js" integrity="sha512-37T7leoNS06R80c8Ulq7cdCDU5MNQBwlYoy1TX/WUsLFC2eYNqtKlV0QjH7r8JpG/S0GUMZwebnVFLPd6SU5yg==" crossorigin="anonymous" referrerpolicy="no-referrer"></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://cdn.jsdelivr.net/jquery.validation/1.16.0/additional-methods.min.js"></script>
<script src="js/jquery.steps.js"></script>
<script src="js/dobpicker.js"></script>
<script>
dataLayer.push({
'event':'ec_formsubmit',
'enhanced_conversion_data': {
"email": 'yourEmailVariable',
"phone_number": 'yourPhoneVariable',
"first_name": 'yourFirstNameVariable',
"last_name": 'yourLastNameVariable',
"street": 'yourStreetAddressVariable',
"city": 'yourCityVariable',
"region": 'yourRegionVariable',
"postal_code": 'yourPostalCodeVariable',
"country": 'yourCountryVariable'
}
})
</script>
</head>
<style>
#msform fieldset:not(:first-of-type) {
display: none;
}
#mybutton {
position: fixed;
bottom: -4px;
right: 10px;
z-index: 1;
}
/*progressbar*/
#progressbar {
margin-bottom: 30px;
overflow: hidden;
/*CSS counters to number the steps*/
counter-reset: step;
}
#progressbar li {
list-style-type: none;
color: #2C3E50;
font-size: 9px;
float: left;
position: relative;
letter-spacing: 1px;
}
#progressbar li:before {
content: counter(step);
counter-increment: step;
line-height: 26px;
display: block;
font-size: 24px;
color: #333;
border-radius: 25px;
}
/*progressbar connectors*/
#progressbar li:after {
content: '';
width: 100%;
height: 2px;
background: white;
position: absolute;
left: -50%;
top: 9px;
z-index: -1;
/*put it behind the numbers*/
}
#progressbar li:first-child:after {
/*connector not needed before the first step*/
content: none;
}
/*marking active/completed steps green*/
/*The number of the step and the connector before it = green*/
#progressbar li.active:before,
#progressbar li.active:after {
background: #4fb01d;
color: white;
padding: 0;
border-radius: 100% !important;
width: 2.2rem;
height: 2.2rem;
display: inline-flex;
align-items: center;
justify-content: center;
font-size: 1rem;
line-height: 1;
-webkit-backface-visibility: hidden;
backface-visibility: hidden;
}
/* Not relevant to this form */
.dme_link {
margin-top: 30px;
text-align: center;
}
.dme_link a {
background: #FFF;
font-weight: bold;
color: #4fb01d;
border: 0 none;
border-radius: 25px;
cursor: pointer;
padding: 5px 25px;
font-size: 12px;
}
.dme_link a:hover,
.dme_link a:focus {
background: #C5C5F1;
text-decoration: none;
}
.question {
background: #d1e5ff !important;
border: 2px solid #d1e5ff !important;
color: #072b5a;
height: 55px;
font-size: 25px;
font-weight: 600;
border-radius: 7px !important;
width: 100%;
}
.btn-next {
color: #fff;
background-color: #256ac3;
border-color: #256ac3;
border-radius: 4px !important;
width: 60% !important;
}
/*-- FORM --*/
</style>
<body>
<!-- PAGE CONTENT
============================================= -->
<div id="page" class="page">
<!-- HEADER
============================================= -->
<header id="header" class="header tra-menu navbar-dark">
<script src="https://c.pmsrv.co/v2/
conversion/src?a=28e696d8-a753-4e49-827d-
6de2fc71a03e" type="text/javascript">
</script>
<noscript>
<img height="0" width="0" alt=""
style="display:none"
src="https://c.pmsrv.co/v2/acvr?akey=bf2aa4ba-5532-
4221-85d2-fb6f9c11bd0f&noscript=1&ord=0" />
</noscript>
<div class="header-wrapper">
<!-- MOBILE HEADER -->
<div class="wsmobileheader clearfix">
<span class="smllogo"><img src="images/logo.svg" width="255" height="32" alt="mobile-logo"/></span>
<a id="wsnavtoggle" class="wsanimated-arrow"><span></span></a>
</div>
<!-- NAVIGATION MENU -->
<div class="wsmainfull menu clearfix">
<div class="wsmainwp clearfix">
<!-- LOGO IMAGE -->
<!-- For Retina Ready displays take a image with double the amount of pixels that your image will be displayed (e.g 310 x 72 pixels) -->
<div class="desktoplogo"><a href="/" class="logo-black"><img src="images/logo.svg" width="255" height="72" alt="header-logo"></a></div>
<div class="desktoplogo"><a href="/" class="logo-white"><img src="images/logo.svg" width="255" height="72" alt="header-logo"></a></div>
<!-- MAIN MENU -->
<nav class="wsmenu clearfix">
<ul class="wsmenu-list">
<!-- HEADER BUTTON -->
<li class="nl-simple" aria-haspopup="true">
<a href="#Tel:+18884833475" class="btn btn-tra-primary primary-hover last-link">Get Quotes: (888) 483-3475</a>
</li>
</ul>
</nav> <!-- END MAIN MENU -->
</div>
</div> <!-- END NAVIGATION MENU -->
</div> <!-- End header-wrapper -->
</header> <!-- END HEADER -->
<!-- HERO-11
============================================= -->
<section id="hero-11" class="bg-lightgrey hero-section division" style="padding-bottom: 300px">
<!-- HERO TEXT -->
<div class="container">
<div class="row">
<div class="col-lg-12">
<div class="hero-11-txt text-center">
<h1 class="display-vhq text-center pb-4" style="color: #0052D4; font-size: 2.5rem; font-weight:600">
Thank You!
</h1>
<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:+18884833475">(888) 483-3475</a></span></h4>
</div>
</div>
</div> <!-- End row -->
</div> <!-- END HERO TEXT -->
<!-- HERO IMAGE -->
</section> <!-- END HERO-11 -->
<!-- CALL TO ACTION-1
============================================= -->
<section id="cta-1" class="cta-1 bg-01 cta-section division">
<div class="container white-color">
<div class="row d-flex align-items-center">
<!-- CALL TO ACTION TEXT -->
<div class="col-lg-12 text-center">
<div class="cta-1-txt pr-25">
<!-- Title -->
<!-- Text -->
<p class="p-md" style="font-size: 12px">Search My Health Plan is an independent website and is not a federal or state Marketplace website. Search My Health Plan does not provide quotes or sell insurance directly to consumers, is not affiliated with any exchange, and is not a licensed insurance agent or broker. Accordingly, you should not send us (via mail or email) any sensitive information, including personal health information or applications. Any such communications will not be treated as confidential and will be discarded, as, in offering this website, we are required to comply with the standards established under 45 CFR 155.260 to protect the privacy and security of personally identifiable information.
</p>
</div>
</div>
</div> <!-- End row -->
</div> <!-- End container -->
</section> <!-- END CALL TO ACTION-1 -->
<!-- FOOTER-3
============================================= -->
<footer id="footer-3" class="pt-20 pb-20 text-center">
<div class="container">
<!-- BOTTOM FOOTER -->
<div class="grey-color">
<div class="row d-flex align-items-center">
<!-- FOOTER COPYRIGHT -->
<div class="col-md-12">
<div class="footer-copyright">
<p>© Search My Health Plan 2019-2022 All Rights Reserved <a href="/privacy.php">Privacy Policy</a> | <a href="/terms.php">Terms of Service</a></p>
</div>
</div>
</div> <!-- End row -->
</div> <!-- END BOTTOM FOOTER -->
</div> <!-- End container -->
<!-- EXTERNAL SCRIPTS
============================================= -->
<script src="js/bootstrap.min.js"></script>
<script src="js/modernizr.custom.js"></script>
<!-- Custom Script -->
<script src="js/custom.js"></script>
<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>
/*-----------------------------------------------------------------------*/
/*---------------------------- 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>
</footer> <!-- END FOOTER-3 -->
</div> <!-- END PAGE CONTENT -->
</body>
</html>