I am trying to get a landing page grab the URL parameters. I have two hidden fields in the form that match the parameter names, but I can't seem to get this to work.
I need to grab the URL Parameters, and have them send with the rest of the form. The form's method="POST">
I need to do this with JavaScript, not PHP.
THANKS!
For instance, a URL will look like this:
http://mywebsite.com/qualify/new/?AFFILIATE_ID=-1&SUB_1=Test#
Here is my form code:
<html>
<head>
<script>
function getParameterByName(name) {
var match = RegExp('[?&]' + name + '=([^&]*)').exec(window.location.search);
return match && decodeURIComponent(match[1].replace(/\+/g, ' '));
}
</script>
Please Choose an Insurance Type Private / Group Insurance Medicare / Medicaid Secondary Insurance
<input type="text" name="phone" placeholder="Phone Number" required="required">
<select value="State" name="state" style="width:100%;height: 35px!important; margin-top: 10px!important;">
<option value="">Please Choose a State:</option>
<option value="Alabama">Alabama</option>
<option value="Arizona">Arizona</option>
<option value="California">California</option>
<option value="Colorado">Colorado</option>
<option value="Connecticut">Connecticut</option>
<option value="Delaware">Delaware</option>
<option value="District Of Columbia">District Of Columbia</option>
<option value="Florida">Florida</option>
<option value="Georgia">Georgia</option>
<option value="Illinois">Illinois</option>
<option value="Indiana">Indiana</option>
<option value="Iowa">Iowa</option>
<option value="Kentucky">Kentucky</option>
<option value="Maine">Maine</option>
<option value="Maryland">Maryland</option>
<option value="Massachusetts">Massachusetts</option>
<option value="Michigan">Michigan</option>
<option value="Minnesota">Minnesota</option>
<option value="Missouri">Missouri</option>
<option value="Montana">Montana</option>
<option value="Nebraska">Nebraska</option>
<option value="New Hampshire">New Hampshire</option>
<option value="New Jersey">New Jersey</option>
<option value="New Mexico">New Mexico</option>
<option value="New York">New York</option>
<option value="North Carolina">North Carolina</option>
<option value="North Dakota">North Dakota</option>
<option value="Ohio">Ohio</option>
<option value="Oklahoma">Oklahoma</option>
<option value="Pennsylvania">Pennsylvania</option>
<option value="Rhode Island">Rhode Island</option>
<option value="South Carolina">South Carolina</option>
<option value="Tennessee">Tennessee</option>
<option value="Texas">Texas</option>
<option value="Utah">Utah</option>
<option value="Virginia">Virginia</option>
<option value="Washington">Washington</option>
<option value="West Virginia">West Virginia</option>
<option value="Wisconsin">Wisconsin</option>
</select>
<input type="number" min="18" max="64" step="1" name="birthdate" placeholder="Age" required="required" style="margin-bottom: 8px!important;">
<input type="text" name="insuranceComp" placeholder="Insurance Company" required="required">
<input type="text" name="memberID" placeholder="Member ID or Group Policy" required="required">
<input type="text" name="RxBin" placeholder="Rx Bin Number" required="required">
<input type="text" name="PcnNumber" placeholder="PCN Number" required="required">
<input type="text" name="groupID" placeholder="Rx Group ID" required="required">
<input type="hidden" name="SUB_1" value="">
<input type="hidden" name="AFFILIATE_ID" value="">
<button class="submit" style="width: 100%;">Submit Now</button>
</form>
</body>
</html>