File: /home/sreyam/form.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;
}
?>
<!doctype html>
<html lang="en">
<head>
<!-- Google Tag Manager -->
<script>(function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':
new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],
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<meta charset="utf-8">
<meta name="viewport" content="width=device-width, initial-scale=1, shrink-to-fit=no">
<link rel="stylesheet" href="https://stackpath.bootstrapcdn.com/bootstrap/4.3.1/css/bootstrap.min.css" integrity="sha384-ggOyR0iXCbMQv3Xipma34MD+dH/1fQ784/j6cY/iJTQUOhcWr7x9JvoRxT2MZw1T" crossorigin="anonymous">
<link rel="stylesheet" type="text/css" href="css/styles.css">
<link rel="stylesheet" href="//code.jquery.com/ui/1.12.1/themes/base/jquery-ui.css">
<link rel="stylesheet" href="/resources/demos/style.css">
<link rel="style" href="https://cdnjs.cloudflare.com/ajax/libs/jqueryui/1.12.1/jquery-ui.css">
<script src="https://ajax.googleapis.com/ajax/libs/jquery/3.5.1/jquery.min.js"></script>
<script src="https://code.jquery.com/ui/1.12.1/jquery-ui.js"></script>
<script src="https://cdnjs.cloudflare.com/ajax/libs/jquery.mask/1.14.16/jquery.mask.min.js"></script>
<link rel="apple-touch-icon" sizes="180x180" href="images/apple-touch-icon.png">
<link rel="icon" type="image/png" sizes="32x32" href="images/favicon-32x32.png">
<link rel="icon" type="image/png" sizes="16x16" href="images/favicon-16x16.png">
<link rel="manifest" href="images/site.webmanifest">
<title>Getting Started - ValueHealth Quotes</title>
<style>
a {
color:#0000ff;
}
.error{
color:red;
@import url(http://fonts.googleapis.com/css?family=Source+Code+Pro:400|Roboto+Condensed:400,700);
/* Body - remove browser margin & set padding to accommodate for the fixed header bar */
body {
margin: 0;
/*padding-top: 89px;*/
background: #FEFEFE;
}
.wrapper {
margin: 0 auto;
width: 95%;
text-align: center;
}
/* Plugin Example Container */
.example {
width: 33%;
min-width: 400px;
padding: 15px;
display: inline-block;
box-sizing: border-box;
text-align: center;
}
.example:first-of-type {
position: relative;
bottom: 35px;
}
/* Example Heading */
.example h2 {
font-family: "Poppins", helvetica, arial, sans-serif;
font-weight:300;
font-size: 1.3em;
margin: 15px 0;
color: #4F5462;
}
.example input {
display: block;
margin: 0 auto 20px auto;
width: 150px;
padding: 8px 10px;
border: 1px solid #CCCCCC;
border-radius: 3px;
background: #F2F2F2;
text-align: center;
font-size: 1em;
letter-spacing: 0.02em;
font-family: "Poppins", helvetica, arial, sans-serif;
}
.example select {
padding: 10px;
background: #ffffff;
border: 1px solid #CCCCCC;
border-radius: 3px;
margin: 0 3px;
}
.example select.invalid {
color: #E9403C;
}
.example input[type="submit"] {
margin-top: 10px;
}
.example input[type="submit"]:hover {
cursor: pointer;
background-color: #e5e5e5;
}
/* Code Blocks */
pre.code-wrapper {
padding: 15px 30px;
margin-top: 20px;
background: #F4F6F4;
color: #393D3F;
text-align: left;
border: 1px solid #DCDFDC;
border-radius: 3px;
}
pre code {
font-family: 'Poppins', monospace, monospace;
font-weight: 400;
font-size: 14px;
}
/* Highlighted Code Blocks */
pre code span.highlight {
color: #EF6F6C;
}
div#speedbump {
display: none;
z-index: 9999;
position: fixed;
top: 0;
width: 100%;
background: #eeeeee;
}
#speedbump h4.modal-title {
text-align: center;
text-transform: uppercase;
color: #004795;
font-size:2.5em;
}
.modal-body p {
text-align:center;
font-size: 1em;
}
button.btn-modal:hover {
cursor: pointer;
}
button.btn-modal.btn-continue {
background-color: #8bc63e;
border: 0px;
margin: 1% 0;
}
button.btn-modal.btn-close {
background-color: inherit;
border: 1px solid #030000;
color: #030000;
font-weight: 400;
}
.modal-header .close {
font-size: 3.5em;
}
/* Media */
@media(max-width: 847px) {
.header-bar h1 {
text-align: center !important;
width: 100%;
}
.header-bar nav {
display: none;
}
.example:first-of-type {
bottom: 0;
}
}
@media(min-width: 848px) {
.header-bar nav {
display: block;
}
}
</style>
<!-- Navigation -->
<nav class="navbar navbar-expand-lg navbar-dark fixed-top">
<div class="container">
<a class="navbar-brand" href="index.html"><img height="30px;" src="images/logo.svg"></a>
<div>
<span class="navbar-text navbar-contact navbar-toggle collapsed"><a href="tel:+18559181595"> Call Now: (855) 918-1595 </a></span>
<span><a class="navbar-contact-logo" href="tel:+18559181595"><i class="fas fa-phone"></i> (855) 918-1595</a></span>
</div>
</div>
</nav>
<!-- Start VWO Async SmartCode -->
<script type='text/javascript'>
window._vwo_code = window._vwo_code || (function(){
var account_id=541992,
settings_tolerance=2000,
library_tolerance=2500,
use_existing_jquery=false,
is_spa=1,
hide_element='body',
/* DO NOT EDIT BELOW THIS LINE */
f=false,d=document,code={use_existing_jquery:function(){return use_existing_jquery;},library_tolerance:function(){return library_tolerance;},finish:function(){if(!f){f=true;var a=d.getElementById('_vis_opt_path_hides');if(a)a.parentNode.removeChild(a);}},finished:function(){return f;},load:function(a){var b=d.createElement('script');b.src=a;b.type='text/javascript';b.innerText;b.onerror=function(){_vwo_code.finish();};d.getElementsByTagName('head')[0].appendChild(b);},init:function(){
window.settings_timer=setTimeout('_vwo_code.finish()',settings_tolerance);var a=d.createElement('style'),b=hide_element?hide_element+'{opacity:0 !important;filter:alpha(opacity=0) !important;background:none !important;}':'',h=d.getElementsByTagName('head')[0];a.setAttribute('id','_vis_opt_path_hides');a.setAttribute('type','text/css');if(a.styleSheet)a.styleSheet.cssText=b;else a.appendChild(d.createTextNode(b));h.appendChild(a);this.load('https://dev.visualwebsiteoptimizer.com/j.php?a='+account_id+'&u='+encodeURIComponent(d.URL)+'&f='+(+is_spa)+'&r='+Math.random());return settings_timer; }};window._vwo_settings_timer = code.init(); return code; }());
</script>
<!-- End VWO Async SmartCode -->
</head>
<body>
<!-- Google Tag Manager (noscript) -->
<noscript><iframe src="https://www.googletagmanager.com/ns.html?id=GTM-MWH78H7"
height="0" width="0" style="display:none;visibility:hidden"></iframe></noscript>
<!-- End Google Tag Manager (noscript) -->
<!-- Page Content -->
<section class="py-5" id="about">
<div class="container">
<div class="row">
<div class="col">
<br>
<div class="wrap-box">
<div class="form-header">
<h3>Find Your Perfect Plan</h3>
<div class="row align-items-center">
<div class="col-md">
<h4><i class="far fa-check-square"></i> Zero Obligation</h4>
</div>
<div class="col-md">
<h4><i class="far fa-check-square"></i> Affordable Prices</h4>
</div>
<div class="col-md">
<h4><i class="far fa-check-square"></i> Trusted Providers</h4>
</div>
</div>
</div>
<form id="quoteWizard" name="quoteWizard" method="get" class="p-4" >
<div class="col-md pb-4">
<h4 class="text-left"> Cotact Information</h4>
</div>
<!--Get Client IP -->
<?php
$ip = getClientIp();
echo '<input name="IPAddress" type="hidden" value="' . $ip . '" />';
?>
<input type="hidden" name="CompanyId" id="CompanyId" value="16">
<div class="form-row">
<div class="form-group col-sm">
<input type="text" class="form-control" name="firstname" id="firstname" placeholder="First Name" required>
</div>
<div class="form-group col-sm">
<input type="text" class="form-control" name="lastname" id="lastname" placeholder="Last Name" required>
</div>
</div>
<br>
<div class="form-row">
<div class="form-group col-sm">
<input type="text" class="form-control" name="dateofbirth" id="datepicker" placeholder="Date of Birth" required>
</div>
<div class="form-group col-sm">
<select class="form-control" name="typeofplan" value="ind" required>
<option selected disabled hidden>Who Are We Looking For?</option>
<option value="ind">Just For Me</option>
<option value="ind1">Myself & Spouse/Child</option>
<option value="family">The Whole Family</option>
</select>
</div>
</div>
<br>
<div class="form-row">
<div class="form-group col-sm">
<input type="text" class="form-control bfh-phone" id="phone" name="phone" minlength="10" maxlength="10" placeholder="Phone Number" required>
</div>
<div class="form-group col-sm">
<input type="email" class="form-control" id="email" name="email" placeholder="Email Address" required>
</div>
</div>
<div class="col-md py-4">
<h4 class="text-left"> Address</h4>
</div>
<div class="form-group">
<input type="text" class="form-control" id="address" name="address" placeholder="Street Address" required>
</div>
<div class="form-row">
<div class="form-group col-sm">
<input type="text" class="form-control" id="zipCode" name="zip" onkeyup="zipCodeLookup(1);" placeholder="Zip" maxlength="5" required>
</div>
<div class="form-group col-sm">
<input type="text" class="form-control-plaintext city" name="city" id="city" placeholder="City" readonly required>
</div>
<div class="form-group col-sm">
<input type="text" class="form-control-plaintext state" name="state" id="state" placeholder="State" readonly required>
</div>
<!--
<div class="form-group form-check col-sm-12 mt-2">
<hr>
<p>After clicking submit and Opting-In to Value Health Quotes terms and conditions and privacy
policy you are agreeing to receive an immediate text message containing the contact information
and process of Value Health Quotes services.</p>
<hr>
<p><b>The first message after initial Opt-In and content will be as follows:</b></p>
<p>Thanks for contacting Value Health Quotes. We aim to streamline the healthcare enrollment
process by connecting consumers to valuable health information and options that fit your needs.
If you need immediate assistance please call (855) 918-1595 to speak to a live representative.
You can reply STOP to Opt-Out. </p>
<p class="form-check-label">You can reply <b>STOP</b> to opt out or <b>HELP</b> for additional information. Message alerts may vary. </p>
</div>
<div class="col-md-12 text-center" style="margin-bottom: 13px !important;"><a href="/terms.html">Terms and Conditions </a>|
<a href="privacy-policy.html"> Privacy Policy</a></div>
<hr style="margin-top: 13px !important; margin-bottom: 13px !important;">
<div class="form-group form-check col-sm-12 mt-3">
<p>Would you like to receive text messages regarding healthcare information and updates?</p>
<div class="col-sm-12 mt-3">
<div class="form-check form-check-inline">
<input class="form-check-input" type="checkbox" name="PreExisting" id="inlineCheckbox1" value="option1">
<label class="form-check-label" for="inlineCheckbox1" ><b>Yes</b></label>
</div>
<div class="form-check form-check-inline">
<input class="form-check-input" type="checkbox" id="inlineCheckbox2" value="option2">
<label class="form-check-label" for="inlineCheckbox2"><b>No</b></label>
</div>
</div>
</div>
<div class="form-group form-check col-sm-12 mt-4">
<p>Would you like to receive communication from live operators by telephone, text messages and/or emails regarding healthcare information and updates?</p>
<div class="col-sm-12 mt-3">
<div class="form-check form-check-inline">
<input class="form-check-input" type="checkbox" name="PreExisting" id="inlineCheckbox1" value="option1">
<label class="form-check-label" for="inlineCheckbox1" ><b>Yes</b></label>
</div>
<div class="form-check form-check-inline">
<input class="form-check-input" type="checkbox" id="inlineCheckbox2" value="option2">
<label class="form-check-label" for="inlineCheckbox2"><b>No</b></label>
</div>
</div>
</div>
-->
<div class="form-group col-sm-12 pt-4">
<!-- Button trigger modal -->
<button type="submit" id="submitButton" class="modalButton" data-toggle="modal" data-target="#myModal"><i class="fas fa-lock"></i> Submit</button>
</div>
</div>
</div>
<br>
<div class="modal" id="loadingModal">
<div class="modal-dialog" role="document">
<div class="modal-content">
<div class="modal-header">
<h5 class="modal-title">Successs</h5>
<button type="button" class="close" data-dismiss="modal" aria-label="Close">
<span aria-hidden="true">×</span>
</button>
</div>
<div class="modal-body">
<div class="thank-you-pop">
<img src="images/check-green-lime.png" alt="">
<h1>Thank You!</h1>
<p>Your submission is received and we will contact you soon</p>
</div> </div>
<div class="modal-footer">
<button type="button" class="btn btn-secondary" data-dismiss="modal">Close</button>
</div>
</div>
</div>
</div>
</form>
<div class="appFooter">
<p>By entering a phone number and email address and submitting this form, you represent that you are at least 18 years old and agree to our
Privacy Policy and Terms of Use. You also authorize valuehealthquotes.com and/or its marketing partners to contact you for marketing/telemarketing
purposes at the number and address provided above, including your wireless number if provided, using live operators, automated telephone dialing systems,
re-recorded messages, text messages and/or emails, even if the number you provide is on a state or Federal Do Not Call registry. You are not required to
consent as a condition of purchasing goods or services and may revoke consent at anytime. Value Health Quotes has the option to send communication such as
texting via a short code and will not allow third parties to send messages or communications on their behalf.</p>
<p>Value Health Quotes is an independent website and is not a federal or state Marketplace website. Value Health Quotes 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>
</div>
</section>
<footer>
<section>
<div class="container-fluid text-center">
<div class="row footer-bg">
<div class="col-sm">
<p>© Value Health Quotes 2019-2020 All Rights Reserved | <span><a href="privacy-policy.html" style="text-decoration: none;"><b>Privacy Policy</b></a> | <span><a href="terms.html" style="text-decoration: none;"><b>Terms of Service</b></a></span></span></p>
</div>
</div>
</div>
</section>
</footer>
<script src="https://cdnjs.cloudflare.com/ajax/libs/jqueryui/1.12.1/jquery-ui.min.js"></script>
<script src="https://cdnjs.cloudflare.com/ajax/libs/select2/4.0.6-rc.1/js/select2.js"></script>
<script src="https://cdnjs.cloudflare.com/ajax/libs/popper.js/1.14.7/umd/popper.min.js" integrity="sha384-UO2eT0CpHqdSJQ6hJty5KVphtPhzWj9WO1clHTMGa3JDZwrnQq4sF86dIHNDz0W1" crossorigin="anonymous"></script>
<script src="https://stackpath.bootstrapcdn.com/bootstrap/4.3.1/js/bootstrap.min.js" integrity="sha384-JjSmVgyd0p3pXB1rRibZUAYoIIy6OrQ6VrjIEaFf/nJGzIxFDsf4x0xIM+B07jRM" crossorigin="anonymous"></script>
<script src="https://cdnjs.cloudflare.com/ajax/libs/jquery-validate/1.19.1/jquery.validate.min.js"></script>
<script src="https://cdnjs.cloudflare.com/ajax/libs/jquery-validate/1.19.1/additional-methods.min.js" integrity="sha256-vb+6VObiUIaoRuSusdLRWtXs/ewuz62LgVXg2f1ZXGo=" crossorigin="anonymous"></script>
<script src="https://kit.fontawesome.com/69fd8ad995.js" crossorigin="anonymous"></script>
<script type="text/javascript" src="js/main.js"></script>
<!-- SELECTION OPT INT -->
<script>
$(document).ready(function(){
$('input:checkbox').click(function() {
$('input:checkbox').not(this).prop('checked', false);
});
});
</script>
<!--Form posting -->
<script>
$('#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);
}
}
})
}
});
function submitForm()
{
$('#submitButton').prop('disabled', true);
$('#loadingModal').modal('show');
$.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.html";
},
error:function(){
console.log('Error');
window.location.href = "form-success.html";
}
})
};
$.validator.addMethod("dateRange", function(value, element, params) {
try {
var date = new Date(value);
if (date >= params.from && date <= params.to) {
return true;
}
} catch (e) {}
return false;
}, 'Invalid Date of Birth');
var fromDate = new Date("1900-01-01");
var toDate = new Date("2003-01-01");
$("#quoteWizard").submit(function(e) {
e.preventDefault();
}).validate({
rules:{
phone:{
required:true,
phoneUS:true,
minlength:10,
maxlength:10
},
firstname:{
required:true
},
lastname:{
required:true
},
dateofbirth:{
required:true,
date:true,
dateRange:{
from:fromDate,
to: toDate
}
},
typeofplan:{
required: true
},
email:{
required:true,
email:true
},
city:{
required:true
},
state:{
required:true
},
zip:{
required:true
}
},
messages: {
phone: {
required: "Please enter a valid phone number"
},
},
submitHandler: function(event)
{
submitForm();
}
});
</script>
<script>
function getParameterByName(name, url) {
if (!url) url = window.location.href;
name = name.replace(/[\[\]]/g, '\\$&');
var regex = new RegExp('[?&]' + name + '(=([^&#]*)|&|#|$)'),
results = regex.exec(url);
if (!results) return null;
if (!results[2]) return '';
return decodeURIComponent(results[2].replace(/\+/g, ' '));
}
$('#city').val(getParameterByName('city'));
$('#state').val(getParameterByName('state'));
$('#zipCode').val(getParameterByName('zipCode'));
/*
* jQuery Date Dropdowns - v1.0.0
* A simple, customisable date select plugin
* https://github.com/IckleChris/jquery-date-dropdowns
* Made by Chris Brown
* Under MIT License
*/
!function(a,b,c,d){"use strict";function e(b,c){return this.element=b,this.$element=a(b),this.config=a.extend({},g,c),this.internals={objectRefs:{}},this.init(),this}var f="dateDropdowns",g={defaultDate:null,defaultDateFormat:"yyyy-mm-dd",displayFormat:"dmy",submitFormat:"yyyy-mm-dd",minAge:0,maxAge:120,minYear:null,maxYear:null,submitFieldName:"date",wrapperClass:"date-dropdowns",dropdownClass:null,daySuffixes:!0,monthSuffixes:!0,monthFormat:"long",required:!1,dayLabel:"Day",monthLabel:"Month",yearLabel:"Year",monthLongValues:["January","February","March","April","May","June","July","August","September","October","November","December"],monthShortValues:["Jan","Feb","Mar","Apr","May","Jun","Jul","Aug","Sep","Oct","Nov","Dec"],initialDayMonthYearValues:["Day","Month","Year"],daySuffixValues:["st","nd","rd","th"]};a.extend(e.prototype,{init:function(){this.checkForDuplicateElement(),this.setInternalVariables(),this.setupMarkup(),this.buildDropdowns(),this.attachDropdowns(),this.bindChangeEvent(),this.config.defaultDate&&this.populateDefaultDate()},checkForDuplicateElement:function(){return!a('input[name="'+this.config.submitFieldName+'"]').length||(a.error("Duplicate element found"),!1)},setInternalVariables:function(){var a=new Date;this.internals.currentDay=a.getDate(),this.internals.currentMonth=a.getMonth()+1,this.internals.currentYear=a.getFullYear()},setupMarkup:function(){var b,c;if("input"===this.element.tagName.toLowerCase()){this.config.defaultDate||(this.config.defaultDate=this.element.value),c=this.$element.attr("type","hidden").wrap('<div class="'+this.config.wrapperClass+'"></div>');var d=this.config.submitFieldName!==g.submitFieldName,e=this.element.hasAttribute("name");e||d?d&&this.$element.attr("name",this.config.submitFieldName):this.$element.attr("name",g.submitFieldName),b=this.$element.parent()}else c=a("<input/>",{type:"hidden",name:this.config.submitFieldName}),this.$element.append(c).addClass(this.config.wrapperClass),b=this.$element;return this.internals.objectRefs.pluginWrapper=b,this.internals.objectRefs.hiddenField=c,!0},buildDropdowns:function(){var a,b,c;return e.message={day:this.config.initialDayMonthYearValues[0],month:this.config.initialDayMonthYearValues[1],year:this.config.initialDayMonthYearValues[2]},a=this.buildDayDropdown(),this.internals.objectRefs.dayDropdown=a,b=this.buildMonthDropdown(),this.internals.objectRefs.monthDropdown=b,c=this.buildYearDropdown(),this.internals.objectRefs.yearDropdown=c,!0},attachDropdowns:function(){var a=this.internals.objectRefs.pluginWrapper,b=this.internals.objectRefs.dayDropdown,c=this.internals.objectRefs.monthDropdown,d=this.internals.objectRefs.yearDropdown;switch(this.config.displayFormat){case"mdy":a.append(c,b,d);break;case"ymd":a.append(d,c,b);break;case"dmy":default:a.append(b,c,d)}return!0},bindChangeEvent:function(){var a=this.internals.objectRefs.dayDropdown,b=this.internals.objectRefs.monthDropdown,c=this.internals.objectRefs.yearDropdown,d=this,e=this.internals.objectRefs;e.pluginWrapper.on("change","select",function(){var f,g,h=a.val(),i=b.val(),j=c.val();return(f=d.checkDate(h,i,j))?(e.dayDropdown.addClass("invalid"),!1):("00"!==e.dayDropdown.val()&&e.dayDropdown.removeClass("invalid"),e.hiddenField.val(""),f||h*i*j===0||(g=d.formatSubmitDate(h,i,j),e.hiddenField.val(g)),void e.hiddenField.change())})},populateDefaultDate:function(){var a=this.config.defaultDate,b=[],c="",d="",e="";switch(this.config.defaultDateFormat){case"yyyy-mm-dd":default:b=a.split("-"),c=b[2],d=b[1],e=b[0];break;case"dd/mm/yyyy":b=a.split("/"),c=b[0],d=b[1],e=b[2];break;case"mm/dd/yyyy":b=a.split("/"),c=b[1],d=b[0],e=b[2];break;case"unix":b=new Date,b.setTime(1e3*a),c=b.getDate()+"",d=b.getMonth()+1+"",e=b.getFullYear(),c.length<2&&(c="0"+c),d.length<2&&(d="0"+d)}return this.internals.objectRefs.dayDropdown.val(c),this.internals.objectRefs.monthDropdown.val(d),this.internals.objectRefs.yearDropdown.val(e),this.internals.objectRefs.hiddenField.val(a),!0===this.checkDate(c,d,e)&&this.internals.objectRefs.dayDropdown.addClass("invalid"),!0},buildBaseDropdown:function(b){var c=b;return this.config.dropdownClass&&(c+=" "+this.config.dropdownClass),a("<select></select>",{class:c,name:this.config.submitFieldName+"_["+b+"]",required:this.config.required})},buildDayDropdown:function(){var a,b=this.buildBaseDropdown("day"),d=c.createElement("option");d.setAttribute("value",""),d.appendChild(c.createTextNode(this.config.dayLabel)),b.append(d);for(var e=1;e<10;e++)a=this.config.daySuffixes?e+this.getSuffix(e):"0"+e,d=c.createElement("option"),d.setAttribute("value","0"+e),d.appendChild(c.createTextNode(a)),b.append(d);for(var f=10;f<=31;f++)a=f,this.config.daySuffixes&&(a=f+this.getSuffix(f)),d=c.createElement("option"),d.setAttribute("value",f),d.appendChild(c.createTextNode(a)),b.append(d);return b},buildMonthDropdown:function(){var a=this.buildBaseDropdown("month"),b=c.createElement("option");b.setAttribute("value",""),b.appendChild(c.createTextNode(this.config.monthLabel)),a.append(b);for(var d=1;d<=12;d++){var e;switch(this.config.monthFormat){case"short":e=this.config.monthShortValues[d-1];break;case"long":e=this.config.monthLongValues[d-1];break;case"numeric":e=d,this.config.monthSuffixes&&(e+=this.getSuffix(d))}d<10&&(d="0"+d),b=c.createElement("option"),b.setAttribute("value",d),b.appendChild(c.createTextNode(e)),a.append(b)}return a},buildYearDropdown:function(){var a=this.config.minYear,b=this.config.maxYear,d=this.buildBaseDropdown("year"),e=c.createElement("option");e.setAttribute("value",""),e.appendChild(c.createTextNode(this.config.yearLabel)),d.append(e),a||(a=this.internals.currentYear-(this.config.maxAge+1)),b||(b=this.internals.currentYear-this.config.minAge);for(var f=b;f>=a;f--)e=c.createElement("option"),e.setAttribute("value",f),e.appendChild(c.createTextNode(f)),d.append(e);return d},getSuffix:function(a){var b="",c=this.config.daySuffixValues[0],d=this.config.daySuffixValues[1],e=this.config.daySuffixValues[2],f=this.config.daySuffixValues[3];switch(a%10){case 1:b=a%100===11?f:c;break;case 2:b=a%100===12?f:d;break;case 3:b=a%100===13?f:e;break;default:b="th"}return b},checkDate:function(a,b,c){var d;if("00"!==b){var e=new Date(c,b,0).getDate(),f=parseInt(a,10);d=this.updateDayOptions(e,f),d&&this.internals.objectRefs.hiddenField.val("")}return d},updateDayOptions:function(a,b){var d=parseInt(this.internals.objectRefs.dayDropdown.children(":last").val(),10),e="",f="",g=!1;if(d>a){for(;d>a;)this.internals.objectRefs.dayDropdown.children(":last").remove(),d--;b>a&&(g=!0)}else if(d<a)for(;d<a;){e=++d,f=e,this.config.daySuffixes&&(f+=this.getSuffix(d));var h=c.createElement("option");h.setAttribute("value",e),h.appendChild(c.createTextNode(f)),this.internals.objectRefs.dayDropdown.append(h)}return g},formatSubmitDate:function(a,b,c){var d,e;switch(this.config.submitFormat){case"unix":e=new Date,e.setDate(a),e.setMonth(b-1),e.setYear(c),d=Math.round(e.getTime()/1e3);break;default:d=this.config.submitFormat.replace("dd",a).replace("mm",b).replace("yyyy",c)}return d},destroy:function(){var a=this.config.wrapperClass;if(this.$element.hasClass(a))this.$element.empty();else{var b=this.$element.parent(),c=b.find("select");this.$element.unwrap(),c.remove()}}}),a.fn[f]=function(b){return this.each(function(){if("string"==typeof b){var c=Array.prototype.slice.call(arguments,1),d=a.data(this,"plugin_"+f);if("undefined"==typeof d)return a.error("Please initialize the plugin before calling this method."),!1;d[b].apply(d,c)}else a.data(this,"plugin_"+f)||a.data(this,"plugin_"+f,new e(this,b))}),this}}(jQuery,window,document);
/*inicializar*/
$(document).ready(function() {
$("#example1").dateDropdowns(
//$("#example1 select").select2()
);
$("#example2").dateDropdowns({
submitFieldName: 'example2',
submitFormat: "dd/mm/yyyy"
});
});
</script>
</body>
</html>