lifeplans.co Open in urlscan Pro
54.196.166.150  Public Scan

Form analysis
1 forms found in the DOM

POST submit.php?aff_unique1=%7Baff_unique1%7D

<form id="captureForm" class="form-horizontal" onsubmit="
            document.getElementById('mfSubmitId').value = mfSession.generateSessionId();
            document.getElementById('mfSessionId').value = mfSession.getSessionId();
            SDSS.aff = '';
            SDSS.aff_unique3 = '';
            SDSS.aff_unique5 = '';
            SDSS.sendFormData('captureForm'); window.onbeforeunload = null;
            return true;
            " method="POST" action="submit.php?aff_unique1=%7Baff_unique1%7D">
  <input type="hidden" id="form_version" name="form_version" value="index">
  <input type="hidden" name="vertical" value="US-LIFE">
  <input type="hidden" name="offer_id" value="">
  <input type="hidden" name="goal_id" value="">
  <input type="hidden" id="sub" name="sub" value="">
  <input type="hidden" id="transaction_id" name="transaction_id" value="">
  <input type="hidden" id="affiliate_id" name="affiliate_id" value="">
  <input type="hidden" id="aff_sub2" name="aff_sub2" value="">
  <input type="hidden" id="aff_sub3" name="aff_sub3" value="">
  <input type="hidden" id="aff_sub4" name="aff_sub4" value="">
  <input type="hidden" id="aff_sub5" name="aff_sub5" value="">
  <input type="hidden" id="aff_unique3" name="aff_unique3" value="">
  <input type="hidden" id="aff_unique5" name="aff_unique5" value="">
  <input type="hidden" id="tune_event_id" name="tune_event_id" value="">
  <input type="hidden" id="affiliate_ref" name="affiliate_ref" value="">
  <input type="hidden" id="mfSubmitId" name="mfSubmitId" value="">
  <input type="hidden" id="mfSessionId" name="mfSessionId" value="">
  <input type="hidden" id="ip_address" name="ip_address" value="80.255.7.118">
  <script>
    if (typeof qualifyEmail !== 'function') {
      var qualifyEmail = function() {
        return true;
      }
    }
  </script>
  <input type="hidden" id="city" value="" name="city"><input type="hidden" id="state" value="" name="state">
  <script>
    function updateVehicleRemoveList(vehicles) {
      var vehicleCount = 0;
      for (var k in vehicles) {
        if (vehicles.hasOwnProperty(k)) {
          ++vehicleCount;
        }
      }
      var vehicle_listHtml = "";
      $('#vehicleRemoveList').html(vehicle_listHtml);
      for (var key in vehicles) {
        var entry = vehicles[key];
        vehicle_listHtml = vehicle_listHtml + '<div class="well well-sm wellCustom">' + entry.year + ' ' + entry.make + ' ' + entry.model + '<a id="remove_vehicle_' + entry.id + '" onclick="removeVehicle(' + entry.id +
          ');" class="glyphicon glyphicon-remove-circle glyphClose" style="float:right;" aria-hidden="true"></a></div>' + "\n";
      }
      if (0 === vehicleCount) {
        // Must add another vehicle.
        mfSlides.gotoSlideByChildSelector('#vehicleYear');
      }
      if (1 == vehicleCount) {
        $('#addVehicleLabel').html('Add Second Vehicle? (Save&nbsp;additional&nbsp;20%)');
      } else {
        $('#addVehicleLabel').html('Add Another Vehicle?');
      }
      if (vehicleCount >= 4) {
        $('#addVehicleLabel').html('4 Vehicle Maximum Reached');
        $('#addVehicle_Yes').hide();
        $('#addVehicle_No').html('Continue');
      } else {
        $('#addVehicle_Yes').fadeIn();
        $('#addVehicle_No').html('NO');
      }
      $('#vehicleRemoveList').html(vehicle_listHtml);
    }

    function removeVehicle(id) {
      var vehicleString = $('#vehicle_list').val();
      var updatedVehicles = {};
      var vIndex = 0;
      if (vehicleString) {
        vsJSON = JSON.parse(vehicleString);
        for (var key in vsJSON) {
          var entry = vsJSON[key];
          if (id !== entry.id) {
            updatedVehicles[vIndex] = entry;
            vIndex = vIndex + 1;
          }
        }
      }
      $('#vehicle_list').val(JSON.stringify(updatedVehicles));
      updateVehicleRemoveList(updatedVehicles);
    }

    function addVehicle() {
      var vehicleString = $('#vehicle_list').val();
      var vehicles = {};
      var vehicle = {};
      var vIndex = 0;
      if (vehicleString) {
        vsJSON = JSON.parse(vehicleString);
        for (var key in vsJSON) {
          vehicles[vIndex] = vsJSON[key];
          vIndex = vIndex + 1;
        }
      } else {
        vehicles = {};
      }
      // Turn JSON into Array as we can push onto it...
      // vehicles = Object.keys(vehicles).map(function(k) { return obj[k] });
      vehicle['id'] = new Date().getTime(); // Unique identifier
      vehicle['year'] = $('#vehicleYear').val();
      vehicle['make'] = $('#vehicleMake').val();
      vehicle['model'] = $('#vehicleModel').val();
      vehicle['submodel'] = $('#vehicleSubModel').val();
      $.ajax({
        dataType: "json",
        url: '//common.comparisons.org/auto/getVinFromIdModel.php',
        data: {
          idModel: $('#vehicleIdModel').val()
        },
        success: function(obj) {
          vehicle['vinStub'] = obj.vinStub;
          vehicles[vIndex] = vehicle;
          updateVehicleRemoveList(vehicles);
          $('#vehicle_list').val(JSON.stringify(vehicles));
        },
        error: function(jqXHR, textStatus, errorThrown) {
          $('<input>').attr({
            type: 'hidden',
            name: 'error_on_get_vin',
            value: jqXHR.responseText
          }).appendTo('form#captureForm');
        }
      });
    }

    function vehicleCount() {
      var vehicleString = $('#vehicle_list').val();
      var vehicles = JSON.parse(vehicleString);
      return Object.keys(vehicles).length;
    }

    function updateMakes() {
      // vehicleYear vehicleMake vehicleModel vehicle_list
      var year = $('#vehicleYear').val();
      $.getJSON("//common.comparisons.org/auto/getMakesFromYear.php?year=" + year).done(function(data) {
        var prefMakes = ['GMC', 'FORD', 'TOYOTA', 'CHEVROLET', 'HONDA', 'NISSAN', 'CHRYSLER', 'DODGE', 'SUBARU', 'CADILLAC'];
        var buttonHtml = "";
        var selectHtml = "<option disabled=\"disabled\" selected=\"selected\">Other Makes</option>\n";
        $('#vehicleMake_buttons').html(buttonHtml);
        $('#vehicleMake_select').html(selectHtml);
        var col = 0;
        var foundCount = 0;
        var maxPrefs = 10;
        $.each(data, function(i, obj) {
          if (foundCount < maxPrefs && prefMakes.indexOf(obj.name) !== -1) {
            // Populate buttons
            foundCount = foundCount + 1;
            col = col + 1;
            if (1 === col) {
              buttonHtml = buttonHtml + "<div class=\"row\">\n";
              buttonHtml = buttonHtml + "<div class=\"col-md-2 col-sm-1 hidden-xs\"></div>\n";
            }
            buttonHtml = buttonHtml + "<div class=\"col-md-4 col-sm-5 col-xs-6\">\n";
            buttonHtml = buttonHtml + "<button type=\"button\" class=\"textBtn\" onclick=\"debounceAllButtonOnclicksIn($('#vehicleMake').parents('.orderedSlide'));  $('#vehicleMake').val('" + obj.name +
              "'); updateModels(); mfSlides.nextSlide();\">" + obj.name + "</button>\n";
            buttonHtml = buttonHtml + "</div>\n";
            if (2 === col) {
              buttonHtml = buttonHtml + "<div class=\"col-md-2 col-sm-1 hidden-xs\"></div>\n";
              buttonHtml = buttonHtml + "</div>\n";
              col = 0;
            }
          } else {
            // Populate select options
            selectHtml = selectHtml + "<option value=\"" + obj.makeId + "\">" + obj.name + "</option>\n";
          }
        });
        $('#vehicleMake_buttons').html(buttonHtml);
        $('#vehicleMake_select').html(selectHtml);
      });
    }

    function updateModels() {
      // vehicleYear vehicleMake vehicleModel vehicle_list
      var year = $('#vehicleYear').val();
      var make = $('#vehicleMake').val();
      $.getJSON("//common.comparisons.org/auto/getModelsFromYearMake.php?year=" + year + "&make=" + make).done(function(data) {
        var buttonHtml = "";
        $('#vehicleModel_buttons').html(buttonHtml);
        var col = 0;
        var modelsFound = [];
        buttonHtml = buttonHtml + "<div class=\"form-group\">\n";
        $.each(data, function(i, obj) {
          // Only permit one of each base-class.
          if (modelsFound.indexOf(obj.name) != -1) {
            return true; // Same as continue
          }
          modelsFound.push(obj.name);
          // Populate buttons
          col = col + 1;
          if (1 === col) {
            buttonHtml = buttonHtml + "<div class=\"row\">\n";
            buttonHtml = buttonHtml + "<div class=\"col-sm-1\"></div>\n";
          }
          buttonHtml = buttonHtml + "<div class=\"col-sm-5\">\n";
          buttonHtml = buttonHtml + "<button type=\"button\" class=\"textBtn autoModelButton\" " + " onclick=\"debounceAllButtonOnclicksIn($('#vehicleModel_buttons').parents('.orderedSlide')); " + " $('#vehicleModel').val('" + obj.name +
            "'); $('#vehicleSubModel').val('" + obj.sub + "'); " + "$('#vehicleIdModel').val('" + obj.idModel + "'); " + "addVehicle(); " + "setVehicleNameInAnnualMileage(); " + "mfSlides.nextSlide();\">" + obj.name + ' ' + obj.sub +
            "</button>\n";
          buttonHtml = buttonHtml + "</div>\n";
          if (2 === col) {
            buttonHtml = buttonHtml + "<div class=\"col-sm-1\"></div>\n";
            buttonHtml = buttonHtml + "</div>\n";
            col = 0;
          }
        });
        buttonHtml = buttonHtml + "</div>\n";
        $('#vehicleModel_buttons').html(buttonHtml);
      });
    }

    function setVehicleNameInAnnualMileage() {
      $("#vehicleMakeModelName").html($("#vehicleMake").val() + " " + $("#vehicleModel").val());
    }

    function updateLastVehicleAnnualMileage() {
      var vehicleList = JSON.parse($("#vehicle_list").val());
      var lastVehicleKey = Object.keys(vehicleList).pop();
      vehicleList[lastVehicleKey]['annual_mileage'] = $("#vehicleAnnualMileage").val();
      $('#vehicle_list').val(JSON.stringify(vehicleList));
    }

    function validateZipAndUpdateCity() {
      disableAllButtonOnclicksIn($('#postal_code').parents('.orderedSlide'));
      window.console && console.log('Validating Zip...');
      $.ajax({
        async: true,
        url: '//insurance.comparisons.org/geo-location/usZipToCityState.php',
        type: 'POST',
        headers: {
          'Origin': 'http://insurance.comparisons.org'
        },
        dataType: 'json',
        data: {
          'zip': $('#postal_code').val(),
          'fullStateName': true
        },
        timeout: 10000,
        success: function(i, desc) {
          if (i !== null && i.hasOwnProperty('city')) {
            window.console && console.log('Valid!');
            $('#postal_code').parent().removeClass('has-error');
            $('#city').val(i.city);
            $('#state').val(i.state);
            enableAllButtonOnclicksIn($('#postal_code').parents('.orderedSlide'));
            mfSlides.nextSlide();
          } else {
            window.console && console.log('Invalid...');
            $('#postal_code').parent().addClass('has-error');
            $('#postal_code').focus();
            enableAllButtonOnclicksIn($('#postal_code').parents('.orderedSlide'));
          }
        },
        error: function(obj, error) {
          console.log('local error: ' + error);
          console.log(obj);
          // TODO: Log / Alert on this event!
        }
      });
    }
  </script>
  <div class="orderedSlide" id="slide_1">
    <div class="form-horizontal">
      <div class="form-group">
        <input type="hidden" name="currently-have-insurance" id="currently-have-insurance" data-dimension="data-dimension">
        <label for="currently-have-insurance" class="labelHeadline control-label">Do You Currently Have Life Insurance?</label>
      </div>
      <div class="form-group thinBottom">
        <div class="row">
          <div class="hidden-sm col-xs-1"></div>
          <div class="col-sm-12 col-xs-5"> <button class="btn btn-default currently-have-insuranceButton0"
              onclick="debounceAllButtonOnclicksIn($('#currently-have-insurance').parents('.orderedSlide'));  $('#currently-have-insurance').val('Y'); mfSlides.nextSlide();" type="button"> YES </button>
          </div>
          <div class="col-sm-12 col-xs-5"> <button class="btn btn-default currently-have-insuranceButton1"
              onclick="debounceAllButtonOnclicksIn($('#currently-have-insurance').parents('.orderedSlide'));  $('#currently-have-insurance').val('N'); mfSlides.nextSlide();" type="button"> NO </button>
          </div>
          <div class="hidden-sm col-xs-1"></div>
        </div>
      </div>
    </div>
  </div>
  <div class="orderedSlide" id="slide_2">
    <label for="fmvTemp" class="labelHeadline control-label">Select Your Desired Coverage Amount</label>
    <div class="form-group thinBottom">
      <div class="sliderInput">
        <div class="row">
          <div id="fmvTemp_leftFlank" class="hidden-xs col-sm-2"></div>
          <div class="col-xs-12 col-sm-8">
            <span class="sliderValue" id="fmvTemp_value">$400,000</span>
          </div>
          <div id="fmvTemp_rightFlank" class="hidden-xs col-sm-2"></div>
        </div>
        <div class="row">
          <div class="col-xs-1 col-sm-2"></div>
          <div class="col-xs-10 col-sm-8">
            <div class="slider slider-horizontal" id="fmvTemp">
              <div class="slider-track">
                <div class="slider-track-low" style="left: 0px; width: 0%;"></div>
                <div class="slider-selection tick-slider-selection" style="left: 0%; width: 50%;"></div>
                <div class="slider-track-high" style="right: 0px; width: 50%;"></div>
              </div>
              <div class="tooltip tooltip-main top hide" role="presentation" style="left: 50%; margin-left: 0px;">
                <div class="tooltip-arrow"></div>
                <div class="tooltip-inner">6</div>
              </div>
              <div class="tooltip tooltip-min top hide" role="presentation">
                <div class="tooltip-arrow"></div>
                <div class="tooltip-inner"></div>
              </div>
              <div class="tooltip tooltip-max top hide" role="presentation">
                <div class="tooltip-arrow"></div>
                <div class="tooltip-inner"></div>
              </div>
              <div class="slider-handle min-slider-handle round" role="slider" aria-valuemin="0" aria-valuemax="12" aria-valuenow="6" tabindex="0" style="left: 50%;"></div>
              <div class="slider-handle max-slider-handle round hide" role="slider" aria-valuemin="0" aria-valuemax="12" aria-valuenow="0" tabindex="0" style="left: 0%;"></div>
            </div><input id="fmvTemp" name="fmvTemp" data-slider-id="fmvTemp" type="text" data-slider-value="6" value="6" data-dimension="data-dimension" data-slider-ticks="[0,1,2,3,4,5,6,7,8,9,10,11,12]"
              data-slider-ticks-list="[&quot;$10,000&quot;,&quot;$25,000&quot;,&quot;$50,000&quot;,&quot;$100,000&quot;,&quot;$200,000&quot;,&quot;$300,000&quot;,&quot;$400,000&quot;,&quot;$500,000&quot;,&quot;$600,000&quot;,&quot;$700,000&quot;,&quot;$800,000&quot;,&quot;$900,000&quot;,&quot;$1,000,000&quot;]"
              data-value="6" style="display: none;">
          </div>
          <div class="col-xs-1 col-sm-2"></div>
        </div>
      </div>
      <div class="col-sm-1"></div>
      <div class="col-sm-10">
        <button type="button" class="btn btn-default buttonRightArrow" onclick="debounceAllButtonOnclicksIn($(this).parents('.orderedSlide')); if (true) { mfSlides.nextSlide(); } else {  }">Continue</button>
      </div>
      <div class=" col-sm-1
        ">
      </div>
    </div>
  </div>
  <script>
    $(function() {
      mf_fmvTemp_slider = $("#fmvTemp").bootstrapSlider({
        step: 1,
        min: 0,
        max: 12,
        scale: 'linear',
        tooltip: 'hide'
      });
      $("#fmvTemp").on("slide", function(slideEvt) {
        var valueText = slideEvt.value;
        $("#fmvTemp_value").html('' + valueText + '');
        if ($('input#fmvTemp').val() == 0) {
          $('#fmvTemp_value').html('$10,000');
          $('#coverage_amount').val(10000);
        }
        if ($('input#fmvTemp').val() == 1) {
          $('#fmvTemp_value').html('$25,000');
          $('#coverage_amount').val(25000);
        }
        if ($('input#fmvTemp').val() == 2) {
          $('#fmvTemp_value').html('$50,000');
          $('#coverage_amount').val(50000);
        }
        if ($('input#fmvTemp').val() == 3) {
          $('#fmvTemp_value').html('$100,000');
          $('#coverage_amount').val(100000);
        }
        if ($('input#fmvTemp').val() == 4) {
          $('#fmvTemp_value').html('$200,000');
          $('#coverage_amount').val(200000);
        }
        if ($('input#fmvTemp').val() == 5) {
          $('#fmvTemp_value').html('$300,000');
          $('#coverage_amount').val(300000);
        }
        if ($('input#fmvTemp').val() == 6) {
          $('#fmvTemp_value').html('$400,000');
          $('#coverage_amount').val(400000);
        }
        if ($('input#fmvTemp').val() == 7) {
          $('#fmvTemp_value').html('$500,000');
          $('#coverage_amount').val(500000);
        }
        if ($('input#fmvTemp').val() == 8) {
          $('#fmvTemp_value').html('$600,000');
          $('#coverage_amount').val(600000);
        }
        if ($('input#fmvTemp').val() == 9) {
          $('#fmvTemp_value').html('$700,000');
          $('#coverage_amount').val(700000);
        }
        if ($('input#fmvTemp').val() == 10) {
          $('#fmvTemp_value').html('$800,000');
          $('#coverage_amount').val(800000);
        }
        if ($('input#fmvTemp').val() == 11) {
          $('#fmvTemp_value').html('$900,000');
          $('#coverage_amount').val(900000);
        }
        if ($('input#fmvTemp').val() == 12) {
          $('#fmvTemp_value').html('$1,000,000');
          $('#coverage_amount').val(1000000);
        }
      });
      $("#fmvTemp").on("slideStop", function(slideStopEvent) {
        var valueText = slideStopEvent.value;
        $("#fmvTemp_value").html('' + valueText + '');
        if ($('input#fmvTemp').val() == 0) {
          $('#fmvTemp_value').html('$10,000');
          $('#coverage_amount').val(10000);
        }
        if ($('input#fmvTemp').val() == 1) {
          $('#fmvTemp_value').html('$25,000');
          $('#coverage_amount').val(25000);
        }
        if ($('input#fmvTemp').val() == 2) {
          $('#fmvTemp_value').html('$50,000');
          $('#coverage_amount').val(50000);
        }
        if ($('input#fmvTemp').val() == 3) {
          $('#fmvTemp_value').html('$100,000');
          $('#coverage_amount').val(100000);
        }
        if ($('input#fmvTemp').val() == 4) {
          $('#fmvTemp_value').html('$200,000');
          $('#coverage_amount').val(200000);
        }
        if ($('input#fmvTemp').val() == 5) {
          $('#fmvTemp_value').html('$300,000');
          $('#coverage_amount').val(300000);
        }
        if ($('input#fmvTemp').val() == 6) {
          $('#fmvTemp_value').html('$400,000');
          $('#coverage_amount').val(400000);
        }
        if ($('input#fmvTemp').val() == 7) {
          $('#fmvTemp_value').html('$500,000');
          $('#coverage_amount').val(500000);
        }
        if ($('input#fmvTemp').val() == 8) {
          $('#fmvTemp_value').html('$600,000');
          $('#coverage_amount').val(600000);
        }
        if ($('input#fmvTemp').val() == 9) {
          $('#fmvTemp_value').html('$700,000');
          $('#coverage_amount').val(700000);
        }
        if ($('input#fmvTemp').val() == 10) {
          $('#fmvTemp_value').html('$800,000');
          $('#coverage_amount').val(800000);
        }
        if ($('input#fmvTemp').val() == 11) {
          $('#fmvTemp_value').html('$900,000');
          $('#coverage_amount').val(900000);
        }
        if ($('input#fmvTemp').val() == 12) {
          $('#fmvTemp_value').html('$1,000,000');
          $('#coverage_amount').val(1000000);
        }
      });
      mf_fmvTemp_slider.bootstrapSlider('setValue', 6, true, true);
    });
  </script>
  <input type="hidden" id="coverage_amount" name="coverage_amount" value="400000">
  <script>
    $(function() {
      $('#fmvTemp').find('.slider-tick-container').remove();
    });
  </script>
  <script>
    //Validation of slides to go to next slide:
    function validate_slide_1() {
      //Why Are You Looking For Life Insurance?
      if ($("input[name='why[money-for-family]']").is(":checked") || $("input[name='why[protect-debt]']").is(":checked") || $("input[name='why[end-of-life]']").is(":checked") || $("input[name='why[income-replacement]']").is(":checked") || $(
          "input[name='why[money-to-organization]']").is(":checked") || $("input[name='why[other]").is(":checked")) return true;
      else return false;
    }
  </script>
  <div class="orderedSlide" id="slide_3">
    <div class="row form-group">
      <div class="col-xs-12">
        <label for="major_illness" class="control-label labelHeadline">Why are you looking for Life Insurance?</label>
        <div class="instruction">Please select all that apply</div>
      </div>
    </div>
    <div class="row form-group">
      <div class="col-xs-1"></div>
      <div class="col-xs-10">
        <div class="details">
          <div class="container-fluid">
            <div class="row">
              <div class="col-xs-12">
                <div class="checkbox">
                  <input class="checkCustom" type="hidden" name="why[money-for-family]" value="N">
                  <label><input type="checkbox" class="checkCustom" value="Y" name="why[money-for-family]">Leave money for my family</label>
                </div>
                <div class="checkbox">
                  <input class="checkCustom" type="hidden" name="why[protect-debt]" value="N">
                  <label><input type="checkbox" class="checkCustom" value="Y" name="why[protect-debt]">Protect Debt (ie. mortgage or medical bills)</label>
                </div>
                <div class="checkbox">
                  <input class="checkCustom" type="hidden" name="why[end-of-life]" value="N">
                  <label><input type="checkbox" class="checkCustom" value="Y" name="why[end-of-life]">Cover end of life expenses such as funeral costs</label>
                </div>
                <div class="checkbox">
                  <input class="checkCustom" type="hidden" name="why[income-replacement]" value="N">
                  <label><input type="checkbox" class="checkCustom" value="Y" name="why[income-replacement]">As income replacement</label>
                </div>
                <div class="checkbox">
                  <input class="checkCustom" type="hidden" name="why[money-to-organization]" value="N">
                  <label><input type="checkbox" class="checkCustom" value="Y" name="why[money-to-organization]">Leave money to an organization, such as a personal business or charity</label>
                </div>
                <div class="checkbox">
                  <input class="checkCustom" type="hidden" name="why[other]" value="N">
                  <label><input type="checkbox" class="checkCustom" value="Y" name="why[other]">Other</label>
                </div>
              </div>
            </div>
          </div>
        </div>
      </div>
      <div class="col-xs-1"></div>
    </div>
    <div class="row">
      <div class="col-xs-1"></div>
      <div class="col-xs-10">
        <button onclick="debounceAllButtonOnclicksIn($('#why').parents('.orderedSlide')); $('why').val('Why'); if (validate_slide_1()) {mfSlides.nextSlide();}" type="button"> Continue </button>
      </div>
      <div class="col-xs-1"></div>
    </div>
  </div>
  <div class="orderedSlide" id="slide_4">
    <div class="form-horizontal">
      <div class="form-group">
        <input type="hidden" name="gender" id="gender" data-dimension="data-dimension">
        <label for="gender" class="labelHeadline control-label">Gender</label>
      </div>
      <div class="form-group thinBottom">
        <div class="row">
          <div class="hidden-sm col-xs-1"></div>
          <div class="col-sm-12 col-xs-5"> <button class="btn btn-default genderButton0" onclick="debounceAllButtonOnclicksIn($('#gender').parents('.orderedSlide'));  $('#gender').val('M'); mfSlides.nextSlide();" type="button"> MALE </button>
          </div>
          <div class="col-sm-12 col-xs-5"> <button class="btn btn-default genderButton1" onclick="debounceAllButtonOnclicksIn($('#gender').parents('.orderedSlide'));  $('#gender').val('F'); mfSlides.nextSlide();" type="button"> FEMALE </button>
          </div>
          <div class="hidden-sm col-xs-1"></div>
        </div>
      </div>
    </div>
  </div>
  <div class="orderedSlide" id="slide_5">
    <div class="form-horizontal">
      <div class="form-group">
        <input type="hidden" name="married" id="married" data-dimension="data-dimension">
        <label for="married" class="labelHeadline control-label">Are You Married?</label>
      </div>
      <div class="form-group thinBottom">
        <div class="row">
          <div class="hidden-sm col-xs-1"></div>
          <div class="col-sm-12 col-xs-5"> <button class="btn btn-default marriedButton0" onclick="debounceAllButtonOnclicksIn($('#married').parents('.orderedSlide'));  $('#married').val('Y'); mfSlides.nextSlide();" type="button"> YES </button>
          </div>
          <div class="col-sm-12 col-xs-5"> <button class="btn btn-default marriedButton1" onclick="debounceAllButtonOnclicksIn($('#married').parents('.orderedSlide'));  $('#married').val('N'); mfSlides.nextSlide();" type="button"> NO </button>
          </div>
          <div class="hidden-sm col-xs-1"></div>
        </div>
      </div>
    </div>
  </div>
  <div class="orderedSlide" id="slide_6">
    <div class="form-horizontal">
      <div class="form-group">
        <input type="hidden" name="child-status" id="child-status" data-dimension="data-dimension">
        <label for="child-status" class="labelHeadline control-label">Do You Have Children?</label>
      </div>
      <div class="form-group thinBottom">
        <div class="row">
          <div class="hidden-sm col-xs-1"></div>
          <div class="col-sm-12 col-xs-5"> <button class="btn btn-default child-statusButton0" onclick="debounceAllButtonOnclicksIn($('#child-status').parents('.orderedSlide'));  $('#child-status').val('Y'); mfSlides.nextSlide();" type="button"> Yes
            </button>
          </div>
          <div class="col-sm-12 col-xs-5"> <button class="btn btn-default child-statusButton1" onclick="debounceAllButtonOnclicksIn($('#child-status').parents('.orderedSlide'));  $('#child-status').val('N'); mfSlides.nextSlide();" type="button"> No
            </button>
          </div>
          <div class="hidden-sm col-xs-1"></div>
        </div>
      </div>
    </div>
  </div>
  <div class="orderedSlide row" id="slide_7">
    <div class="col-xs-12">
      <div class="row form-group">
        <div class="col-sm-12">
          <div id="#" class="row">
            <div class="col-sm-12">
              <label for="#" class="labelHeadline control-label">What Is Your Date of Birth?</label>
            </div>
          </div>
          <div class="row">
            <div class="col-md-2 hidden-xs"></div>
            <div class="col-md-4 col-xs-5">
              <select name="dob_month" id="dob_month" class="form-control">
                <option value="1">January</option>
                <option value="2">February</option>
                <option value="3">March</option>
                <option value="4">April</option>
                <option value="5">May</option>
                <option value="6">June</option>
                <option value="7">July</option>
                <option value="8">August</option>
                <option value="9">September</option>
                <option value="10">October</option>
                <option value="11">November</option>
                <option value="12">December</option>
              </select>
            </div>
            <div class="col-md-2 col-xs-3">
              <select name="dob_date" id="dob_date" class="form-control">
                <option value="1">1</option>
                <option value="2">2</option>
                <option value="3">3</option>
                <option value="4">4</option>
                <option value="5">5</option>
                <option value="6">6</option>
                <option value="7">7</option>
                <option value="8">8</option>
                <option value="9">9</option>
                <option value="10">10</option>
                <option value="11">11</option>
                <option value="12">12</option>
                <option value="13">13</option>
                <option value="14">14</option>
                <option value="15">15</option>
                <option value="16">16</option>
                <option value="17">17</option>
                <option value="18">18</option>
                <option value="19">19</option>
                <option value="20">20</option>
                <option value="21">21</option>
                <option value="22">22</option>
                <option value="23">23</option>
                <option value="24">24</option>
                <option value="25">25</option>
                <option value="26">26</option>
                <option value="27">27</option>
                <option value="28">28</option>
                <option value="29">29</option>
                <option value="30">30</option>
                <option value="31">31</option>
              </select>
            </div>
            <div class="col-md-2 col-xs-4">
              <select name="dob_year" id="dob_year" class="form-control">
                <option value="2006">2006</option>
                <option value="2005">2005</option>
                <option value="2004">2004</option>
                <option value="2003">2003</option>
                <option value="2002">2002</option>
                <option value="2001">2001</option>
                <option value="2000">2000</option>
                <option value="1999">1999</option>
                <option value="1998">1998</option>
                <option value="1997">1997</option>
                <option value="1996">1996</option>
                <option value="1995">1995</option>
                <option value="1994">1994</option>
                <option value="1993">1993</option>
                <option value="1992">1992</option>
                <option value="1991">1991</option>
                <option value="1990">1990</option>
                <option value="1989">1989</option>
                <option value="1988">1988</option>
                <option value="1987">1987</option>
                <option value="1986">1986</option>
                <option value="1985">1985</option>
                <option value="1984">1984</option>
                <option value="1983">1983</option>
                <option value="1982">1982</option>
                <option value="1981">1981</option>
                <option value="1980">1980</option>
                <option value="1979">1979</option>
                <option value="1978">1978</option>
                <option value="1977">1977</option>
                <option value="1976">1976</option>
                <option value="1975">1975</option>
                <option value="1974">1974</option>
                <option value="1973">1973</option>
                <option value="1972">1972</option>
                <option value="1971">1971</option>
                <option value="1970">1970</option>
                <option value="1969">1969</option>
                <option value="1968">1968</option>
                <option value="1967">1967</option>
                <option value="1966">1966</option>
                <option value="1965">1965</option>
                <option value="1964">1964</option>
                <option value="1963">1963</option>
                <option value="1962">1962</option>
                <option value="1961">1961</option>
                <option value="1960">1960</option>
                <option value="1959">1959</option>
                <option value="1958">1958</option>
                <option value="1957">1957</option>
                <option value="1956">1956</option>
                <option value="1955">1955</option>
                <option value="1954">1954</option>
                <option value="1953">1953</option>
                <option value="1952">1952</option>
                <option value="1951">1951</option>
                <option value="1950">1950</option>
                <option value="1949">1949</option>
                <option value="1948">1948</option>
                <option value="1947">1947</option>
                <option value="1946">1946</option>
                <option value="1945">1945</option>
                <option value="1944">1944</option>
                <option value="1943">1943</option>
                <option value="1942">1942</option>
                <option value="1941">1941</option>
                <option value="1940">1940</option>
                <option value="1939">1939</option>
                <option value="1938">1938</option>
                <option value="1937">1937</option>
                <option value="1936">1936</option>
                <option value="1935">1935</option>
                <option value="1934">1934</option>
                <option value="1933">1933</option>
                <option value="1932">1932</option>
                <option value="1931">1931</option>
                <option value="1930">1930</option>
                <option value="1929">1929</option>
                <option value="1928">1928</option>
                <option value="1927">1927</option>
                <option value="1926">1926</option>
                <option value="1925">1925</option>
                <option value="1924">1924</option>
              </select>
            </div>
            <div class="col-md-2 hidden-xs"></div>
          </div>
        </div>
      </div>
      <div class="row text-center">
        <div class="col-sm-1"></div>
        <div class="col-sm-10">
          <button type="button" class="buttonRightArrow" onclick="{ mfSlides.nextSlide(); }">Continue</button>
        </div>
        <div class="col-sm-1"></div>
      </div>
    </div>
  </div>
  <style>
    .slidecontainer {
      width: 100%;
    }

    .sliderBar {
      -webkit-appearance: none;
      width: 100%;
      height: 15px !important;
      border-radius: 5px;
      background: #d3d3d3;
      outline: none;
      opacity: 0.7;
      -webkit-transition: .2s;
      transition: opacity .2s;
    }

    .sliderBar:hover {
      opacity: 1;
    }

    .sliderBar::-webkit-slider-thumb {
      -webkit-appearance: none;
      appearance: none;
      width: 25px;
      height: 25px;
      border-radius: 50%;
      background: #04AA6D;
      cursor: pointer;
    }

    .sliderBar::-moz-range-thumb {
      width: 25px;
      height: 25px;
      border-radius: 50%;
      background: #04AA6D;
      cursor: pointer;
    }
  </style>
  <script>
    function validateHeightWeight() {
      var isValid = true;
      var weight_lbs = Number.parseInt($('#weight_lbs').val());
      if (Number.isInteger(weight_lbs) && weight_lbs >= 60 && weight_lbs <= 999) {
        $('#weight_lbs').parent().removeClass('has-error');
      } else {
        $('#weight_lbs').parent().addClass('has-error');
        isValid = false;
      }
      return isValid;
    }
  </script>
  <div class="orderedSlide row" id="slide_8">
    <div class="col-xs-12">
      <div class="row form-group">
        <div class="col-sm-12">
          <div id="" class="row">
            <div class="col-sm-12">
              <label for="height_ft" class="labelHeadline control-label">What is your height?</label>
            </div>
          </div>
          <div class="row">
            <div class="col-xs-4"></div>
            <div class="col-xs-4">
              <input name="height_non_formatted" placeholder="Feet &amp; Inches" id="total_height" value="5′10″" class="form-control" type="tel" disabled="">
              <input type="hidden" name="height" id="formattedHeight" value="5.10">
            </div>
            <div class="col-xs-4"></div>
          </div>
          <div class="row">
            <div class="col-sm-12">
              <div class="slidecontainer">
                <input type="range" min="0" max="34" value="22" class="sliderBar" id="heightRange">
              </div>
            </div>
          </div>
        </div>
      </div>
      <div class="row form-group">
        <div class="col-sm-12">
          <div id="last_name_label_row" class="row">
            <div class="col-sm-12">
              <label for="weight_lbs" class="labelHeadline control-label">What is your weight?</label>
            </div>
          </div>
          <div class="row">
            <div class="col-xs-4"></div>
            <div class="col-xs-4">
              <input name="weight_lbs" placeholder="180" value="180" id="weight_lbs" class="form-control" type="tel">
              <span class="weight_units">lbs.</span>
            </div>
            <div class="col-xs-4"></div>
          </div>
          <div class="row">
            <div class="col-sm-12">
              <div class="slidecontainer">
                <input type="range" min="88" max="441" value="180" class="sliderBar" id="weightRange">
              </div>
            </div>
          </div>
        </div>
      </div>
      <div class="row text-center" style="margin-top: 10px;">
        <div class="col-sm-1"></div>
        <div class="col-sm-10">
          <button type="button" class="btn btn-default buttonRightArrow" onclick="debounceAllButtonOnclicksIn($(this).parents('.orderedSlide')); if (validateHeightWeight()) { mfSlides.nextSlide(); } else {  }"> Continue </button>
        </div>
        <div class="col-sm-1"></div>
      </div>
    </div>
  </div>
  <script>
    var sliderHeight = document.getElementById("heightRange");
    var sliderWeight = document.getElementById("weightRange");
    var all_heights = ["4′0″", "4′1″", "4′2″", "4′3″", "4′4″", "4′5″", "4′6″", "4′7″", "4′8″", "4′9″", "4′10″", "4′11″", "5′0″", "5′1″", "5′2″", "5′3″", "5′4″", "5′5″", "5′6″", "5′7″", "5′8″", "5′9″", "5′10″", "5′11″", "6′0″", "6′1″", "6′2″", "6′3″",
      "6′4″", "6′5″", "6′6″", "6′7″", "6′8″", "6′9″", "7′0″"
    ];
    var all_heights_formatted = ["4.0", "4.1", "4.2", "4.3", "4.4", "4.5", "4.6", "4.7", "4.8", "4.9", "4.10", "4.11", "5.0", "5.1", "5.2", "5.3", "5.4", "5.5", "5.6", "5.7", "5.8", "5.9", "5.10", "5.11", "6.0", "6.1", "6.2", "6.3", "6.4", "6.5",
      "6.6", "6.7", "6.8", "6.9", "7.0"
    ];

    function setSliderHeightValue(i) {
      sliderHeight.value = i;
      $("#total_height").val(all_heights[i]);
      $("#formattedHeight").val(all_heights_formatted[i]);
    }
    sliderHeight.oninput = function() {
      $("#total_height").val(all_heights[sliderHeight.value]);
      $("#formattedHeight").val(all_heights_formatted[sliderHeight.value]);
    }

    function setSliderWeightValue(weight) {
      sliderWeight.value = weight;
      $("#weight_lbs").val(weight);
    }
    sliderWeight.oninput = function() {
      $("#weight_lbs").val(sliderWeight.value);
    }
    $("#weight_lbs").keyup(function() {
      $("#weightRange").val($(this).val())
    });
  </script>
  <div class="orderedSlide" id="slide_9">
    <div class="form-horizontal">
      <div class="form-group">
        <input type="hidden" name="used-tobacco-lately" id="used-tobacco-lately" data-dimension="data-dimension">
        <label for="used-tobacco-lately" class="labelHeadline control-label">Have You Used Tobacco Products Within The Last 12 Months?</label>
      </div>
      <div class="form-group thinBottom">
        <div class="row">
          <div class="hidden-sm col-xs-1"></div>
          <div class="col-sm-12 col-xs-5"> <button class="btn btn-default used-tobacco-latelyButton0"
              onclick="debounceAllButtonOnclicksIn($('#used-tobacco-lately').parents('.orderedSlide'));  $('#used-tobacco-lately').val('Y'); mfSlides.nextSlide();" type="button"> YES </button>
          </div>
          <div class="col-sm-12 col-xs-5"> <button class="btn btn-default used-tobacco-latelyButton1"
              onclick="debounceAllButtonOnclicksIn($('#used-tobacco-lately').parents('.orderedSlide'));  $('#used-tobacco-lately').val('N'); mfSlides.nextSlide();" type="button"> NO </button>
          </div>
          <div class="hidden-sm col-xs-1"></div>
        </div>
      </div>
    </div>
  </div>
  <script>
    function noneOfTheseChanged(caller) {
      var conditions = $(caller).closest('.orderedSlide').find('.conditions');
      if ($(caller).prop("checked") == true) {
        conditions.prop('checked', false);
        conditions.prop('disabled', true);
        conditions.attr('readonly', true);
      } else {
        conditions.prop('disabled', false);
        conditions.attr('readonly', false);
      }
    }
  </script>
  <div class="orderedSlide" id="slide_10">
    <div class="row form-group">
      <div class="col-xs-12">
        <div class="row">
          <div class="col-xs-12">
            <label for="major_illness" class="control-label labelHeadline">In The Past 5 Years Have You Been Treated Or Prescribed Medication For Any Of The Following Conditions?</label>
            <div class="instruction">Please select all that apply</div>
            <div class="details">
              <div class="container-fluid">
                <div class="row">
                  <div class="col-sm-6">
                    <div class="checkbox">
                      <input type="hidden" name="conditions[cancer]" value="N">
                      <label><input type="checkbox" class="conditions checkCustom" value="Y" name="conditions[cancer]">Cancer</label>
                    </div>
                    <div class="checkbox">
                      <input type="hidden" name="conditions[chronic-pain]" value="N">
                      <label><input type="checkbox" class="conditions checkCustom" value="Y" name="conditions[chronic-pain]">Chronic Pain</label>
                    </div>
                    <div class="checkbox">
                      <input type="hidden" name="conditions[diabetes]" value="N">
                      <label><input type="checkbox" class="conditions checkCustom" value="Y" name="conditions[diabetes]">Diabetes</label>
                    </div>
                    <div class="checkbox">
                      <input type="hidden" name="conditions[heart]" value="N">
                      <label><input type="checkbox" class="conditions checkCustom" value="Y" name="conditions[heart]">Heart or Circulatory Disorder</label>
                    </div>
                  </div>
                  <div class="col-sm-6">
                    <div class="checkbox">
                      <input type="hidden" name="conditions[respiratory]" value="N">
                      <label><input type="checkbox" class="conditions checkCustom" value="Y" name="conditions[respiratory]">Respiratory Disorder</label>
                    </div>
                    <div class="checkbox">
                      <input type="hidden" name="conditions[anxiety-depression-bipolar]" value="N">
                      <label><input type="checkbox" class="conditions checkCustom" value="Y" name="conditions[anxiety-depression-bipolar]">Anxiety - Depression - Bipolar</label>
                    </div>
                    <div class="checkbox">
                      <input type="hidden" name="conditions[other]" value="N">
                      <label><input type="checkbox" class="conditions checkCustom" value="Y" name="conditions[other]">Other medical conditions</label>
                    </div>
                  </div>
                  <div class="col-xs-12 text-center" style="margin-top:15px;">
                    <div class="checkbox">
                      <label><input type="checkbox" value="" name="" onchange="noneOfTheseChanged(this)" class="checkCustom"><strong>I have no medical conditions</strong></label>
                    </div>
                  </div>
                </div>
              </div>
            </div>
          </div>
        </div>
        <div class="row">
          <div class="col-xs-12">
            <div class="row">
              <div class="col-xs-12">
                <button class="btnDefault" onclick="debounceAllButtonOnclicksIn($('#conditions').parents('.orderedSlide')); $('conditions').val('Continue'); mfSlides.nextSlide();" type="button"> Continue </button>
              </div>
            </div>
          </div>
        </div>
      </div>
    </div>
  </div>
  <div class="orderedSlide" id="slide_11">
    <div class="form-horizontal">
      <div class="form-group">
        <input type="hidden" name="currently_employed" id="currently_employed" data-dimension="data-dimension">
        <label for="currently_employed" class="labelHeadline control-label">Are You Currently Employed?</label>
      </div>
      <div class="form-group thinBottom">
        <div class="row">
          <div class="hidden-sm col-xs-1"></div>
          <div class="col-sm-12 col-xs-10"> <button class="btn btn-default currently_employedButton0" onclick="debounceAllButtonOnclicksIn($('#currently_employed').parents('.orderedSlide'));  $('#currently_employed').val('Y'); mfSlides.nextSlide();"
              type="button"> YES </button>
          </div>
          <div class="hidden-sm col-xs-1"></div>
        </div>
        <div class="row">
          <div class="hidden-sm col-xs-1"></div>
          <div class="col-sm-12 col-xs-10"> <button class="btn btn-default currently_employedButton1" onclick="debounceAllButtonOnclicksIn($('#currently_employed').parents('.orderedSlide'));  $('#currently_employed').val('N'); mfSlides.nextSlide();"
              type="button"> NO </button>
          </div>
          <div class="hidden-sm col-xs-1"></div>
        </div>
      </div>
    </div>
  </div>
  <script>
    function validate41817180() {
      mfSlideIsValid = true;
      if (mfStdValidation.isStreetAddress($('#address').val()) == false) {
        mfSlideIsValid = false;
        $('#address').focus().closest('.row .form-group').addClass('has-error');
        return mfSlideIsValid;
      } else {
        $('#address').focus().closest('.row .form-group').removeClass('has-error');
      }
      if (!(mfStdValidation.isUSZip($('#postal_code').val()))) {
        mfSlideIsValid = false;
        $('#postal_code').focus().closest('.row .form-group').addClass('has-error');
        return mfSlideIsValid;
      } else {
        $('#postal_code').closest('.row .form-group').removeClass('has-error');
      }
      return mfSlideIsValid;
    }
  </script>
  <div class="orderedSlide row" id="slide_12">
    <div class="row form-group">
      <div class="col-sm-12">
        <div id="address_label_row" class="row">
          <div class="col-sm-12">
            <label for="address" class="labelHeadline control-label">What is your street address?</label>
          </div>
        </div>
        <div class="row">
          <div class="hidden-xs"></div>
          <div class="col-xs-12">
            <input name="address" id="address" type="text" placeholder="Street Address" class="form-control" data-dimension="data-dimension">
          </div>
          <div class="col-sm-3 hidden-xs"></div>
        </div>
      </div>
    </div>
    <div class="col-xs-12">
      <div class="row form-group" style="">
        <div class="col-sm-12">
          <div id="postal_code_label_row" class="row">
            <div class="col-sm-12">
              <label for="postal_code" class="labelHeadline control-label">What is your zip code?</label>
            </div>
          </div>
          <div class="row">
            <div class="hidden-xs"></div>
            <div class="col-xs-12">
              <input name="postal_code" id="postal_code" type="tel" placeholder="Zip Code" class="form-control" data-dimension="data-dimension">
            </div>
            <div class="col-sm-3 hidden-xs"></div>
          </div>
        </div>
      </div>
      <div class="row text-center" style="margin-top: 30px;">
        <div class="col-sm-1"></div>
        <div class="col-sm-10">
          <button id="continueButtonpostal_code" type="button" class="btn btn-default btnDefault"
            onclick="debounceAllButtonOnclicksIn($(this).parents('.orderedSlide')); if (validate41817180() )  {  ajaxGetJSON('/geo-location/usZipToCityState.php?zip=' + $('#postal_code').val(),  function(data){ console.info(data); $('#city').val(data['city']); $('#state').val(data['state']); }); $('#headline').fadeOut(); mfSlides.nextSlide(); } else {  }">Continue</button>
        </div>
        <div class=" col-sm-1
        ">
        </div>
      </div>
    </div>
  </div>
  <script type="text/javascript">
    $(function() {
      $("#postal_code").mask("00000");
    });
  </script>
  <script>
    function validate811039() {
      mfSlideIsValid = true;
      if (!(true)) {
        mfSlideIsValid = false;
        $('#email-quality[UUID]').focus().closest('.row .form-group').addClass('has-error');
      } else {
        $('#email-quality[UUID]').closest('.row .form-group').removeClass('has-error');
      }
      if (!(true)) {
        mfSlideIsValid = false;
        $('#email-quality[ERROR]').focus().closest('.row .form-group').addClass('has-error');
      } else {
        $('#email-quality[ERROR]').closest('.row .form-group').removeClass('has-error');
      }
      if (!(true)) {
        mfSlideIsValid = false;
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          <button id="continueButtonaddress" type="button" class="btn btn-default buttonRightArrow" onclick="debounceAllButtonOnclicksIn($(this).parents('.orderedSlide')); if (validate51354151()) { submitPage() } else {  }">Get My Life
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email or text (including through automated and artificial voice means; e.g. automated telephone dialing system, text and pre-recorded messaging) 
about insurance products, services and marketing/telemarketing offers. I understand standard message &amp; data rates may apply.
My signature authorizes these parties to contact me even if my telephone number is currently listed on any state, federal, local or corporate 
Do Not Call lists and registries.  I further authorize these entities to confirm my information through the use of consumer reports, including my credit score 
and driving record. I acknowledge that my consent to this agreement is not required to purchase products or services and I may revoke my consent at any time. 
By clicking 'GET MY LIFEQUOTES', I affirm that I have read and agree to this website's 
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Text Content

SPEAK TO A LICENSED INSURANCE AGENT
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Do You Currently Have Life Insurance?
YES
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Select Your Desired Coverage Amount
$400,000

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Why are you looking for Life Insurance?
Please select all that apply
Leave money for my family
Protect Debt (ie. mortgage or medical bills)
Cover end of life expenses such as funeral costs
As income replacement
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Gender
MALE
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Do You Have Children?
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What Is Your Date of Birth?
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In The Past 5 Years Have You Been Treated Or Prescribed Medication For Any Of
The Following Conditions?
Please select all that apply
Cancer
Chronic Pain
Diabetes
Heart or Circulatory Disorder
Respiratory Disorder
Anxiety - Depression - Bipolar
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*We would like to send you our quote and other information about your insurance
needs
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NAME, your results are ready.
What is your phone number?


Get My Life Quotes


By clicking 'GET MY LIFE QUOTES', I am providing my electronic signature,
providing express written consent for MyLifePolicy.co, up to eight (8) insurance
carriers, and authorized marketing associates to contact me at the number
provided above via telephone, email or text (including through automated and
artificial voice means; e.g. automated telephone dialing system, text and
pre-recorded messaging) about insurance products, services and
marketing/telemarketing offers. I understand standard message & data rates may
apply. My signature authorizes these parties to contact me even if my telephone
number is currently listed on any state, federal, local or corporate Do Not Call
lists and registries. I further authorize these entities to confirm my
information through the use of consumer reports, including my credit score and
driving record. I acknowledge that my consent to this agreement is not required
to purchase products or services and I may revoke my consent at any time. By
clicking 'GET MY LIFEQUOTES', I affirm that I have read and agree to this
website's Privacy Policy and Terms of Use.

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