custombenefitplans.com
Open in
urlscan Pro
66.228.55.71
Public Scan
Submitted URL: http://custombenefitplans.com/
Effective URL: https://custombenefitplans.com/
Submission: On November 24 via api from US — Scanned from DE
Effective URL: https://custombenefitplans.com/
Submission: On November 24 via api from US — Scanned from DE
Form analysis
1 forms found in the DOMName: New Form — POST
<form class="elementor-form" method="post" name="New Form">
<input type="hidden" name="post_id" value="8062">
<input type="hidden" name="form_id" value="3b2f7811">
<input type="hidden" name="referer_title" value="Home - Custom Benefit Plans, Inc.">
<input type="hidden" name="queried_id" value="746">
<div class="elementor-form-fields-wrapper elementor-labels-">
<div class="elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_e72e70f elementor-col-100 elementor-field-required">
<label for="form-field-field_e72e70f" class="elementor-field-label elementor-screen-only"> First and Last name </label>
<input size="1" type="text" name="form_fields[field_e72e70f]" id="form-field-field_e72e70f" class="elementor-field elementor-size-sm elementor-field-textual" placeholder="First and Last Name" required="required" aria-required="true">
</div>
<div class="elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_58538aa elementor-col-100">
<label for="form-field-field_58538aa" class="elementor-field-label elementor-screen-only"> Agency Name </label>
<input size="1" type="text" name="form_fields[field_58538aa]" id="form-field-field_58538aa" class="elementor-field elementor-size-sm elementor-field-textual" placeholder="Agency Name">
</div>
<div class="elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_29b0752 elementor-col-100 elementor-field-required">
<label for="form-field-field_29b0752" class="elementor-field-label elementor-screen-only"> National Producer Number </label>
<input size="1" type="text" name="form_fields[field_29b0752]" id="form-field-field_29b0752" class="elementor-field elementor-size-sm elementor-field-textual" placeholder="National Producer Number" required="required" aria-required="true">
</div>
<div class="elementor-field-type-email elementor-field-group elementor-column elementor-field-group-email elementor-col-100 elementor-field-required">
<label for="form-field-email" class="elementor-field-label elementor-screen-only"> Email </label>
<input size="1" type="email" name="form_fields[email]" id="form-field-email" class="elementor-field elementor-size-sm elementor-field-textual" placeholder="Email" required="required" aria-required="true">
</div>
<div class="elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_6ec206a elementor-col-100 elementor-field-required">
<label for="form-field-field_6ec206a" class="elementor-field-label elementor-screen-only"> Telephone </label>
<input size="1" type="tel" name="form_fields[field_6ec206a]" id="form-field-field_6ec206a" class="elementor-field elementor-size-sm elementor-field-textual" placeholder="Telephone" required="required" aria-required="true"
pattern="[0-9()#&+*-=.]+" title="Only numbers and phone characters (#, -, *, etc) are accepted.">
</div>
<div class="elementor-field-type-recaptcha elementor-field-group elementor-column elementor-field-group-field_fd89f87 elementor-col-100">
<div class="elementor-field" id="form-field-field_fd89f87">
<div class="elementor-g-recaptcha" data-sitekey="6LdB7ewZAAAAAG3joi1M2KtvQ2wUoUVLtdW8Qq5K" data-type="v2_checkbox" data-theme="light" data-size="normal">
<div style="width: 304px; height: 78px;">
<div><iframe title="reCAPTCHA" width="304" height="78" role="presentation" name="a-biwam3ew9xwk" frameborder="0" scrolling="no"
sandbox="allow-forms allow-popups allow-same-origin allow-scripts allow-top-navigation allow-modals allow-popups-to-escape-sandbox allow-storage-access-by-user-activation"
src="https://www.google.com/recaptcha/api2/anchor?ar=1&k=6LdB7ewZAAAAAG3joi1M2KtvQ2wUoUVLtdW8Qq5K&co=aHR0cHM6Ly9jdXN0b21iZW5lZml0cGxhbnMuY29tOjQ0Mw..&hl=de&type=v2_checkbox&v=-QbJqHfGOUB8nuVRLvzFLVed&theme=light&size=normal&cb=wcqfv5n4ycwj"></iframe>
</div><textarea id="g-recaptcha-response" name="g-recaptcha-response" class="g-recaptcha-response"
style="width: 250px; height: 40px; border: 1px solid rgb(193, 193, 193); margin: 10px 25px; padding: 0px; resize: none; display: none;"></textarea>
</div><iframe style="display: none;"></iframe>
</div>
</div>
</div>
<div class="elementor-field-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons">
<button type="submit" class="elementor-button elementor-size-sm">
<span>
<span class=" elementor-button-icon">
</span>
<span class="elementor-button-text">SUBMIT</span>
</span>
</button>
</div>
</div>
</form>
Text Content
Skip to content * About * Get Covered * Individual and Family Coverage * Medicare Plans * Employer Benefits * Life Insurance * Annuities * Agents * Contact Menu * About * Get Covered * Individual and Family Coverage * Medicare Plans * Employer Benefits * Life Insurance * Annuities * Agents * Contact * 1-866-422-9188 HELPING YOU MAKE INFORMED DECISIONS ABOUT HEALTHCARE COVERAGE LIFE INSURANCE ANNUITIES Rely on one of the country’s most trusted sources for services and information on health insurance, life insurance, and annuities. Are You an Agent? START USING OUR RESOURCES JOIN OUR MAILING LIST FOR BENEFIT UPDATES HELPING YOU MAKE INFORMED DECISIONS ABOUT HEALTHCARE COVERAGE LIFE INSURANCE ANNUITIES Rely on one of the country’s most trusted sources for services and information on health insurance, life insurance, and annuities. Are You an Agent? START USING OUR RESOURCES JOIN OUR MAILING LIST FOR BENEFIT UPDATES WE REPRESENT ALL MAJOR CARRIERS SEE FULL LIST OF CARRIERS © 2023 Custom Benefit Plans Privacy Policy Facebook Linkedin 616 Easton Rd, Willow Grove PA, 19090 616 Easton Rd, Willow Grove PA, 19090 Facebook Linkedin © 2023 Custom Benefit Plans Privacy Policy NEW! ATTENTION AGENTS ACA CONTRACTING AVAILABLE 7 plans being offered in the following counties: Philadelphia, Bucks, and Montgomery * $0 Medical deductible plans available in all tiers. * No referrals required. * Free virtual visits via JeffConnect, available 24/7 * Competitive commission Please enter your information below and we will contact you shortly. First and Last name Agency Name National Producer Number Email Telephone SUBMIT