mypensionassistance.com
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Submitted URL: http://email.mypensionassistance.com/c/eJx1jk0OgyAQRk-DSzIOP8KCRZPGe4wDVhtFI7SJty8XaPJt3rd4eTHMpAGHbg0IiDCA6x1YUDJ5gyYarbBPFLUXGvb7TL...
Effective URL: https://mypensionassistance.com/?cnt=575565&c2c=1328202
Submission: On July 25 via manual from US — Scanned from DE
Effective URL: https://mypensionassistance.com/?cnt=575565&c2c=1328202
Submission: On July 25 via manual from US — Scanned from DE
Form analysis 1 forms found in the DOM
Name: form_makeappointment — POST /index.php
<form class="bg-primary" id="main" action="/index.php" method="post" name="form_makeappointment" accept-charset="utf-8" onsubmit="return validateForm(this)">
<!-- Contact -->
<section class="container bg-light pt-4">
<!--Contact heading-->
<h2 class="p-4 text-center">Annual Pension Review</h2>
<div class="row">
<!--Grid column-->
<div class="col-lg-7">
<!--Google map-->
<div class="mb-2">
<div class="p-2">
<p> Each year, we provide a one-on-one complimentary consultation regarding your specific state, federal, and individual retirement benefit questions. </p>
<p> During your meeting, you will receive advice on the best ways to utilize your <b>specific pension</b> options with your state administered pension and/or Social Security benefits. You will also be provided with information that will
tell you what your expected income will be from your state pension when you retire and how much longer you will have to work. </p>
<p> Please be sure to indicate which type of appointment you prefer (phone call, or teleconference) in the notes section while scheduling. Please also include your direct cell phone number. </p>
<p> All licensed representatives are not employees of the school, state or federal pension program. </p>
</div>
</div>
</div>
<!--Grid column-->
<!--Grid column-->
<div class="col-lg-5 mb-4">
<!--Form with header-->
<div class="card border-secondary rounded-4">
<div class="card-header p-0">
<div class="bg-secondary text-white text-center py-2 px-4">
<h3><i class="fa fa-envelope"></i> Contact Us:</h3>
<p class="m-0">Complete the form to get answers to your specific state, federal and individual retirement benefit questions.</p>
</div>
</div>
<div class="card-body p-3">
<!--Body-->
<div class="form-group">
<i class="fa fa-user text-secondary pt-2"></i> <label>Full Name*</label>
<div class="input-group">
<div class="input-group-addon bg-light"></div>
<input name="name" type="text" class="form-control rounded" id="inlineFormInputGroupUsername" value="Carmelita James" placeholder="Your Full Name" required="">
</div>
</div>
<div class="form-group">
<i class="fa fa-envelope text-secondary pt-2"></i> <label>Work Email*</label>
<div class="input-group mb-2 mb-sm-0">
<div class="input-group-addon bg-light"></div>
<input name="work_email" type="email" class="form-control rounded" id="inlineFormInputGroupWorkEmail" value="carmelita.james@sdcounty.ca.gov" placeholder="Your Work Email" required="">
</div>
</div>
<div class="form-group">
<i class="fa fa-envelope text-secondary pt-2"></i> <label>Personal Email</label>
<div class="input-group mb-2 mb-sm-0">
<div class="input-group-addon bg-light"></div>
<input name="personal_email" type="email" class="form-control rounded" id="inlineFormInputGroupPersoanlEmail" value="" placeholder="Your Personal Email">
</div>
</div>
<div class="form-group">
<i class="fa fa-phone text-secondary pt-2"></i> <label>Mobile Number*</label>
<div class="input-group mb-2 mb-sm-0">
<div class="input-group-addon bg-light"></div>
<input name="phone" type="tel" class="form-control rounded" id="inlineFormInputGroupPhone" value="" placeholder="Your Mobile Number" required="">
</div>
</div>
<div class="form-group">
<i class="fa fa-building text-secondary pt-2"></i> <label>Employer/District*</label>
<div class="input-group">
<div class="input-group-addon bg-light"></div>
<input name="organization" type="text" class="form-control rounded" id="inlineFormInputGroupOrganization" value="San Diego County" placeholder="Your Employer/District" required="" readonly="">
</div>
</div>
<div class="form-group">
<i class="fa fa-sitemap text-secondary pt-2"></i> <label>Department/School*</label>
<div class="input-group">
<div class="input-group-addon bg-light"></div>
<input name="department" type="text" class="form-control rounded" id="inlineFormInputGroupDepartment" value="Health and Human Services Agency" placeholder="Your Department/School" required="">
</div>
</div>
<div class="form-group">
<i class="fa fa-briefcase text-secondary pt-2"></i> <label>Job Title</label>
<div class="input-group">
<div class="input-group-addon bg-light"></div>
<input name="title" type="text" class="form-control rounded" id="inlineFormInputGroupTitle" value="Human Services Specialist" placeholder="Your Job Title">
</div>
</div>
<div class="form-group" style="border:solid #D0D0D0 1px; border-radius:5px;padding:10px;background:#F0F0F0;text-align:center !important;">
<div class="input-groupq mb-2 mb-sm-0 text-center">
<span style="font-weight:600;text-align:center !important;">Please select from an available appointment time below.</span>
</div>
</div>
<div class="form-group">
<i class="fa fa-clock-o text-secondary pt-2"></i> <label>Timezone - Select this first</label>
<div class="input-group mb-2 mb-sm-0">
<div class="input-group-addon bg-light"></div>
<select name="timezone" id="timezone" data-component="time" class="form-control rounded" required="">
<option selected="selected" value=""> Select Your Timezone </option>
<option value="Eastern">Eastern</option>
<option value="Central">Central</option>
<option value="Mountain">Mountain</option>
<option value="Mountain - Phoenix">Mountain - Phoenix</option>
<option value="Pacific">Pacific</option>
</select>
</div>
</div>
<div class="row form-group">
<div class="col-sm-6">
<i class="fa fa-calendar text-secondary pt-2"></i> <label>Meeting Day</label>
<div class="input-group mb-2 mb-sm-0">
<div class="input-group-addon bg-light"></div>
<select name="day" id="day" data-component="date" class="form-control rounded" required="">
<option selected="selected" value=""> Select Day </option>
</select>
<!-- <input id="date" name="date" type="date" value="--><!--" class="form-control rounded" id="inlineFormInputGroupEmail" >-->
</div>
</div>
<div class="col-sm-6">
<i class="fa fa-clock-o text-secondary pt-2"></i> <label>Meeting Time</label>
<div class="input-group mb-2 mb-sm-0">
<div class="input-group-addon bg-light"></div>
<select name="time" id="time" data-component="time" class="form-control rounded" required="">
<option selected="selected" value=""> Select Time </option>
</select>
</div>
</div>
</div>
<div class="form-group">
<i class="fa fa-pencil text-secondary pt-2"></i> <label>Message - (optional)</label>
<div class="input-group mb-2 mb-sm-0">
<div class="input-group-addon bg-light"></div>
<textarea name="message" class="form-control rounded" maxlength="500"></textarea>
</div>
</div>
<div class="text-center">
<!--The below two hidden fields store IDs
-->
<input type="hidden" name="campaign_id" value="445">
<input type="hidden" name="organization_id" value="126">
<input type="hidden" name="contact_id" value="575565">
<input type="hidden" name="c2c_id" value="1328202">
<!-- <button id="contact-submit" class="btn btn-secondary btn-block rounded-0 py-2">Submit</button>-->
<input type="submit" class="btn btn-secondary btn-block rounded-0 py-2" name="btnsubmit" value="Submit">
</div>
</div>
</div>
<!--Form with header-->
</div>
<!--Grid column-->
</div>
<div class="row spacer pt-4"> </div>
</section>
<!-- Contact -->
</form>Text Content
MY PENSION ASSISTANCE * Contact ANNUAL PENSION REVIEW Each year, we provide a one-on-one complimentary consultation regarding your specific state, federal, and individual retirement benefit questions. During your meeting, you will receive advice on the best ways to utilize your specific pension options with your state administered pension and/or Social Security benefits. You will also be provided with information that will tell you what your expected income will be from your state pension when you retire and how much longer you will have to work. Please be sure to indicate which type of appointment you prefer (phone call, or teleconference) in the notes section while scheduling. Please also include your direct cell phone number. All licensed representatives are not employees of the school, state or federal pension program. CONTACT US: Complete the form to get answers to your specific state, federal and individual retirement benefit questions. Full Name* Work Email* Personal Email Mobile Number* Employer/District* Department/School* Job Title Please select from an available appointment time below. Timezone - Select this first Select Your Timezone EasternCentralMountainMountain - PhoenixPacific Meeting Day Select Day Meeting Time Select Time Message - (optional) ©2022 Copyright My Pension Assistance All Rights Reserved Privacy Policy