ca.norcal.wfgfetch.com
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urlscan Pro
52.20.78.240
Public Scan
Submitted URL: https://ca.norcal.wfgfetch.com/#!/sign-up
Effective URL: https://ca.norcal.wfgfetch.com/
Submission: On March 11 via manual from US — Scanned from DE
Effective URL: https://ca.norcal.wfgfetch.com/
Submission: On March 11 via manual from US — Scanned from DE
Form analysis 1 forms found in the DOM
Name: form —
<form name="form" data-ng-submit="submitForm()" class="validate-form ng-pristine ng-invalid ng-invalid-required ng-valid-minlength ng-valid-maxlength ng-valid-date ng-valid-email ng-valid-pattern" data-ng-class="{'form-loading': status.sending}"
novalidate="">
<fieldset data-ng-hide="status.type === 'success'"><!-- ngIf: ::config.associationObj && config.hideControls.indexOf('associateToRep') === -1 --><!-- ngIf: ::config.page !== 'profile' -->
<div class="row ng-scope" data-ng-if="::config.page !== 'profile'">
<div class="col-md-6">
<div class="form-group"><i class="fa fa-asterisk asterisk-icon" data-ng-show="!config.noRequired && !otherConfigs.grayOutUserPrimaryFields"></i> <label>Email Address (Username):</label><input type="email" name="username"
class="form-control ng-pristine ng-untouched ng-valid-email ng-invalid ng-invalid-required ng-valid-pattern" placeholder="E.g. name@company.com" data-ng-model="userObj.TbUser.username"
data-ng-change="resetFieldCustomValidators(form.username)" data-ng-disabled="status.sending || otherConfigs.grayOutUserPrimaryFields" data-ng-readonly="config.readonlyFields || config.hideControls.indexOf('username') >= 0"
data-ng-required="::!config.noRequired" data-ng-focus="hideAvailableErrorBox()" data-ng-pattern="/^([A-Za-z0-9_\-\.]){1,40}\@([A-Za-z0-9_\-\.]){1,40}\.([A-Za-z0-9]{1,40})$/"
data-ng-blur="!config.noRequired && checkUserExits(form.username)" required="required"><!-- ngIf: form.username.$invalid && (form.username.$touched || form.$submitted) --><!-- ngIf: checkUserExitsObj.emailAvailabilityBox --></div>
</div>
<div class="col-md-6"><!-- ngIf: config.hideControls.indexOf('userType') === -1 --></div>
</div><!-- end ngIf: ::config.page !== 'profile' --><!-- ngIf: ::config.page == 'profile' -->
<div class="row">
<div class="col-md-6">
<div class="form-group"><label>First Name:</label> <i class="fa fa-asterisk asterisk-icon" data-ng-show="::!config.noRequired"></i> <input type="text" name="first_name"
class="form-control ng-pristine ng-untouched ng-invalid ng-invalid-required" data-ng-model="userObj.TbUser.first_name" data-ng-disabled="status.sending" data-ng-readonly="config.readonlyFields" data-ng-required="::!config.noRequired"
required="required"><!-- ngIf: form.first_name.$error && (form.first_name.$touched || form.first_name.$dirty || form.$submitted) --></div>
</div>
<div class="col-md-6">
<div class="form-group"><label>Last Name:</label> <i class="fa fa-asterisk asterisk-icon" data-ng-show="::!config.noRequired"></i> <input type="text" name="last_name"
class="form-control ng-pristine ng-untouched ng-invalid ng-invalid-required" data-ng-model="userObj.TbUser.last_name" data-ng-disabled="status.sending" data-ng-readonly="config.readonlyFields" data-ng-required="::!config.noRequired"
required="required"><!-- ngIf: form.last_name.$error && (form.last_name.$touched || form.last_name.$dirty || form.$submitted) --></div>
</div>
</div><!-- ngIf: ::config.hideControls.indexOf('reps') === -1 -->
<div class="row ng-scope" data-ng-if="::config.hideControls.indexOf('reps') === -1">
<div class="col-md-12">
<div class="form-group" data-ng-class="{'fetching-list': repsDropDown.fetching}"><label>Associated Rep:</label> <i class="fa fa-asterisk asterisk-icon" data-ng-show="::!config.noRequired"></i>
<div class="ui-select-container ui-select-bootstrap dropdown ng-invalid ng-invalid-required" ng-class="{open: $select.open}" data-ui-select="" name="parent_user" data-theme="bootstrap" data-search-enabled="true"
data-ng-model="userObj.TbAssociation.parent_user_id" data-on-select="onAssocRepChange($item)" data-ng-disabled="config.readonlyFields || status.sending || repsDropDown.fetching" data-ng-required="::!config.noRequired" required="required">
<div class="ui-select-match" ng-hide="$select.open && $select.searchEnabled" ng-disabled="$select.disabled" ng-class="{'btn-default-focus':$select.focus}" data-placeholder="Click to select"><span tabindex="-1"
class="btn btn-default form-control ui-select-toggle" aria-label="Select box activate" ng-disabled="$select.disabled" ng-click="$select.activate()" style="outline: 0;"><span ng-show="$select.isEmpty()"
class="ui-select-placeholder text-muted ng-binding">Click to select</span> <span ng-hide="$select.isEmpty()" class="ui-select-match-text pull-left ng-hide"
ng-class="{'ui-select-allow-clear': $select.allowClear && !$select.isEmpty()}" ng-transclude=""><span class="ng-binding ng-scope"></span></span> <i class="caret pull-right" ng-click="$select.toggle($event)"></i>
<a ng-show="$select.allowClear && !$select.isEmpty() && ($select.disabled !== true)" aria-label="Select box clear" style="margin-right: 10px" ng-click="$select.clear($event)" class="btn btn-xs btn-link pull-right ng-hide"><i class="glyphicon glyphicon-remove" aria-hidden="true"></i></a></span>
</div><span ng-show="$select.open && $select.refreshing && $select.spinnerEnabled" class="ui-select-refreshing glyphicon glyphicon-refresh ui-select-spin ng-hide"></span> <input type="search" autocomplete="off"
tabindex="-1" aria-expanded="true" aria-label="Select box" aria-owns="ui-select-choices-1" class="form-control ui-select-search ng-pristine ng-untouched ng-valid ng-hide" ng-class="{ 'ui-select-search-hidden' : !$select.searchEnabled }"
placeholder="Click to select" ng-model="$select.search" ng-show="$select.open">
<ul class="ui-select-choices ui-select-choices-content ui-select-dropdown dropdown-menu ng-hide" ng-show="$select.open && $select.items.length > 0" data-group-by=""
data-repeat="rep.TbUser.users_id as rep in repsDropDown.reps | filter: $select.search track by $index">
<li class="ui-select-choices-group" id="ui-select-choices-1">
<div class="divider ng-hide" ng-show="$select.isGrouped && $index > 0"></div>
<div ng-show="$select.isGrouped" class="ui-select-choices-group-label dropdown-header ng-binding ng-hide" ng-bind="$group.name"></div>
<!-- ngRepeat: rep in $select.items track by $index --><!-- ngIf: $select.open --><!-- end ngRepeat: rep in $select.items track by $index --><!-- ngIf: $select.open --><!-- end ngRepeat: rep in $select.items track by $index --><!-- ngIf: $select.open --><!-- end ngRepeat: rep in $select.items track by $index --><!-- ngIf: $select.open --><!-- end ngRepeat: rep in $select.items track by $index --><!-- ngIf: $select.open --><!-- end ngRepeat: rep in $select.items track by $index --><!-- ngIf: $select.open --><!-- end ngRepeat: rep in $select.items track by $index --><!-- ngIf: $select.open --><!-- end ngRepeat: rep in $select.items track by $index --><!-- ngIf: $select.open --><!-- end ngRepeat: rep in $select.items track by $index --><!-- ngIf: $select.open --><!-- end ngRepeat: rep in $select.items track by $index --><!-- ngIf: $select.open --><!-- end ngRepeat: rep in $select.items track by $index --><!-- ngIf: $select.open --><!-- end ngRepeat: rep in $select.items track by $index --><!-- ngIf: $select.open --><!-- end ngRepeat: rep in $select.items track by $index --><!-- ngIf: $select.open --><!-- end ngRepeat: rep in $select.items track by $index --><!-- ngIf: $select.open --><!-- end ngRepeat: rep in $select.items track by $index --><!-- ngIf: $select.open --><!-- end ngRepeat: rep in $select.items track by $index --><!-- ngIf: $select.open --><!-- end ngRepeat: rep in $select.items track by $index --><!-- ngIf: $select.open --><!-- end ngRepeat: rep in $select.items track by $index --><!-- ngIf: $select.open --><!-- end ngRepeat: rep in $select.items track by $index --><!-- ngIf: $select.open --><!-- end ngRepeat: rep in $select.items track by $index --><!-- ngIf: $select.open --><!-- end ngRepeat: rep in $select.items track by $index --><!-- ngIf: $select.open --><!-- end ngRepeat: rep in $select.items track by $index --><!-- ngIf: $select.open --><!-- end ngRepeat: rep in $select.items track by $index --><!-- ngIf: $select.open --><!-- end ngRepeat: rep in $select.items track by $index --><!-- ngIf: $select.open --><!-- end ngRepeat: rep in $select.items track by $index --><!-- ngIf: $select.open --><!-- end ngRepeat: rep in $select.items track by $index --><!-- ngIf: $select.open --><!-- end ngRepeat: rep in $select.items track by $index --><!-- ngIf: $select.open --><!-- end ngRepeat: rep in $select.items track by $index --><!-- ngIf: $select.open --><!-- end ngRepeat: rep in $select.items track by $index -->
</li>
</ul>
<div class="ui-select-no-choice"></div><ui-select-single></ui-select-single><input ng-disabled="$select.disabled" class="ui-select-focusser ui-select-offscreen ng-scope" type="text" id="focusser-1" aria-label="Select box focus"
aria-haspopup="true" role="button">
</div><!-- ngIf: form.parent_user.$error && (form.parent_user.$touched || form.parent_user.$dirty || form.$submitted) -->
</div>
</div>
</div><!-- end ngIf: ::config.hideControls.indexOf('reps') === -1 --><!-- ngIf: ::config.hideControls.indexOf('offices') === -1 -->
<div class="row">
<div class="col-md-6">
<div class="form-group"><label data-ng-bind="::($root.content.custom_content.user_manage.account_company_placeholder || 'Company Name') + ':'" class="ng-binding">Company Name:</label> <input type="text" name="company_name"
class="form-control ng-pristine ng-untouched ng-valid" data-ng-model="userObj.TbUser.company_name" data-ng-readonly="config.readonlyFields" data-ng-disabled="status.sending"></div>
</div>
<div class="col-md-6">
<div class="form-group"><label>Phone:</label> <i class="fa fa-asterisk asterisk-icon" data-ng-show="::!config.noRequired"></i> <input type="text" name="phone"
class="form-control ng-pristine ng-untouched ng-invalid ng-invalid-required ng-valid-minlength ng-valid-maxlength" placeholder="E.g. 8668123123" data-ng-model="userObj.TbPhone[0].phone" data-ng-disabled="status.sending"
data-ng-readonly="config.readonlyFields" data-ng-minlength="10" data-ng-maxlength="10" data-ng-required="::!config.noRequired"
required="required"><!-- ngIf: form.phone.$error && (form.phone.$dirty || form.phone.$touched || form.$submitted) --></div>
</div>
</div>
<div class="row">
<div class="col-md-6">
<div class="form-group"><label data-ng-bind="::($root.content.custom_content.user_manage.account_license_placeholder || 'License Number') + ':'" class="ng-binding">License Number:</label> <input type="text" name="license_number"
class="form-control ng-pristine ng-untouched ng-valid" data-ng-model="userObj.TbLicense.license_number" data-ng-readonly="config.readonlyFields" data-ng-disabled="status.sending"></div>
</div>
<div class="col-md-6"><label>Expiration Date:</label>
<div class="input-group date-picker expiration-date-edit-user"><input type="text" class="form-control ng-pristine ng-untouched ng-valid ng-isolate-scope ng-valid-date" name="expiration_date" title="Click to specify" placeholder="MM/DD/YYYY"
data-ng-click="!config.readonlyFields && (datePickerObj.isOpened = true)" date-picker-field-formatter="" datepicker-popup="MM/dd/yyyy" data-ng-model="userObj.TbLicense.expiration_date" data-ng-disabled="status.sending"
data-ng-readonly="config.readonlyFields" is-open="datePickerObj.isOpened"><!-- ngIf: isOpen --> <span class="input-group-btn"><button type="button" class="btn btn-primary"
data-ng-click="!config.readonlyFields && (datePickerObj.isOpened = true)"><span class="fa fa-calendar"></span></button></span></div>
</div>
</div>
<div class="row">
<div class="col-md-12">
<div class="form-group"><label>Address:</label> <i class="fa fa-asterisk asterisk-icon" data-ng-show="::!config.noRequired"></i> <input type="text" name="address" class="form-control ng-pristine ng-untouched ng-invalid ng-invalid-required"
placeholder="E.g. 123 Baker St" data-ng-model="userObj.TbAddress[0].address" data-ng-disabled="status.sending" data-ng-readonly="config.readonlyFields" data-ng-required="::!config.noRequired"
required="required"><!-- ngIf: form.address.$error && (form.address.$touched || form.address.$dirty || form.$submitted) --></div>
</div>
</div>
<div class="row">
<div class="col-md-6">
<div class="form-group"><label>Address 2:</label> <input type="text" class="form-control ng-pristine ng-untouched ng-valid" data-ng-model="userObj.TbAddress[0].address_2" data-ng-readonly="config.readonlyFields"
data-ng-disabled="status.sending"></div>
</div>
<div class="col-md-6">
<div class="form-group"><label>City:</label> <i class="fa fa-asterisk asterisk-icon" data-ng-show="::!config.noRequired"></i> <input type="text" name="city" class="form-control ng-pristine ng-untouched ng-invalid ng-invalid-required"
placeholder="E.g. Costa Mesa" data-ng-model="userObj.TbAddress[0].city" data-ng-disabled="status.sending" data-ng-readonly="config.readonlyFields" data-ng-required="::!config.noRequired"
required="required"><!-- ngIf: form.city.$error && (form.city.$touched || form.city.$dirty || form.$submitted) --></div>
</div>
</div>
<div class="row">
<div class="col-xs-6">
<div class="form-group" data-ng-class="{'fetching-list': statesDropDown.fetching}"><label>State:</label> <i class="fa fa-asterisk asterisk-icon" data-ng-show="::!config.noRequired"></i>
<div class="ui-select-container ui-select-bootstrap dropdown ng-invalid ng-invalid-required" ng-class="{open: $select.open}" data-ui-select="" name="state" data-ng-model="userObj.TbAddress[0].state" data-theme="bootstrap"
data-search-enabled="true" data-ng-disabled="config.readonlyFields || status.sending || statesDropDown.fetching" data-ng-required="::!config.noRequired" required="required">
<div class="ui-select-match" ng-hide="$select.open && $select.searchEnabled" ng-disabled="$select.disabled" ng-class="{'btn-default-focus':$select.focus}" data-placeholder="Click to select"><span tabindex="-1"
class="btn btn-default form-control ui-select-toggle" aria-label="Select box activate" ng-disabled="$select.disabled" ng-click="$select.activate()" style="outline: 0;"><span ng-show="$select.isEmpty()"
class="ui-select-placeholder text-muted ng-binding">Click to select</span> <span ng-hide="$select.isEmpty()" class="ui-select-match-text pull-left ng-hide"
ng-class="{'ui-select-allow-clear': $select.allowClear && !$select.isEmpty()}" ng-transclude=""><span class="ng-binding ng-scope"></span></span> <i class="caret pull-right" ng-click="$select.toggle($event)"></i>
<a ng-show="$select.allowClear && !$select.isEmpty() && ($select.disabled !== true)" aria-label="Select box clear" style="margin-right: 10px" ng-click="$select.clear($event)" class="btn btn-xs btn-link pull-right ng-hide"><i class="glyphicon glyphicon-remove" aria-hidden="true"></i></a></span>
</div><span ng-show="$select.open && $select.refreshing && $select.spinnerEnabled" class="ui-select-refreshing glyphicon glyphicon-refresh ui-select-spin ng-hide"></span> <input type="search" autocomplete="off"
tabindex="-1" aria-expanded="true" aria-label="Select box" aria-owns="ui-select-choices-0" class="form-control ui-select-search ng-pristine ng-untouched ng-valid ng-hide" ng-class="{ 'ui-select-search-hidden' : !$select.searchEnabled }"
placeholder="Click to select" ng-model="$select.search" ng-show="$select.open">
<ul class="ui-select-choices ui-select-choices-content ui-select-dropdown dropdown-menu ng-hide" ng-show="$select.open && $select.items.length > 0" data-group-by=""
data-repeat="state.value as state in statesDropDown.states | filter: $select.search">
<li class="ui-select-choices-group" id="ui-select-choices-0">
<div class="divider ng-hide" ng-show="$select.isGrouped && $index > 0"></div>
<div ng-show="$select.isGrouped" class="ui-select-choices-group-label dropdown-header ng-binding ng-hide" ng-bind="$group.name"></div>
<!-- ngRepeat: state in $select.items --><!-- ngIf: $select.open --><!-- end ngRepeat: state in $select.items --><!-- ngIf: $select.open --><!-- end ngRepeat: state in $select.items --><!-- ngIf: $select.open --><!-- end ngRepeat: state in $select.items --><!-- ngIf: $select.open --><!-- end ngRepeat: state in $select.items --><!-- ngIf: $select.open --><!-- end ngRepeat: state in $select.items --><!-- ngIf: $select.open --><!-- end ngRepeat: state in $select.items --><!-- ngIf: $select.open --><!-- end ngRepeat: state in $select.items --><!-- ngIf: $select.open --><!-- end ngRepeat: state in $select.items --><!-- ngIf: $select.open --><!-- end ngRepeat: state in $select.items --><!-- ngIf: $select.open --><!-- end ngRepeat: state in $select.items --><!-- ngIf: $select.open --><!-- end ngRepeat: state in $select.items --><!-- ngIf: $select.open --><!-- end ngRepeat: state in $select.items --><!-- ngIf: $select.open --><!-- end ngRepeat: state in $select.items --><!-- ngIf: $select.open --><!-- end ngRepeat: state in $select.items --><!-- ngIf: $select.open --><!-- end ngRepeat: state in $select.items --><!-- ngIf: $select.open --><!-- end ngRepeat: state in $select.items --><!-- ngIf: $select.open --><!-- end ngRepeat: state in $select.items --><!-- ngIf: $select.open --><!-- end ngRepeat: state in $select.items --><!-- ngIf: $select.open --><!-- end ngRepeat: state in $select.items --><!-- ngIf: $select.open --><!-- end ngRepeat: state in $select.items --><!-- ngIf: $select.open --><!-- end ngRepeat: state in $select.items --><!-- ngIf: $select.open --><!-- end ngRepeat: state in $select.items --><!-- ngIf: $select.open --><!-- end ngRepeat: state in $select.items --><!-- ngIf: $select.open --><!-- end ngRepeat: state in $select.items --><!-- ngIf: $select.open --><!-- end ngRepeat: state in $select.items --><!-- ngIf: $select.open --><!-- end ngRepeat: state in $select.items --><!-- ngIf: $select.open --><!-- end ngRepeat: state in $select.items --><!-- ngIf: $select.open --><!-- end ngRepeat: state in $select.items --><!-- ngIf: $select.open --><!-- end ngRepeat: state in $select.items --><!-- ngIf: $select.open --><!-- end ngRepeat: state in $select.items --><!-- ngIf: $select.open --><!-- end ngRepeat: state in $select.items --><!-- ngIf: $select.open --><!-- end ngRepeat: state in $select.items --><!-- ngIf: $select.open --><!-- end ngRepeat: state in $select.items --><!-- ngIf: $select.open --><!-- end ngRepeat: state in $select.items --><!-- ngIf: $select.open --><!-- end ngRepeat: state in $select.items --><!-- ngIf: $select.open --><!-- end ngRepeat: state in $select.items --><!-- ngIf: $select.open --><!-- end ngRepeat: state in $select.items --><!-- ngIf: $select.open --><!-- end ngRepeat: state in $select.items --><!-- ngIf: $select.open --><!-- end ngRepeat: state in $select.items --><!-- ngIf: $select.open --><!-- end ngRepeat: state in $select.items --><!-- ngIf: $select.open --><!-- end ngRepeat: state in $select.items --><!-- ngIf: $select.open --><!-- end ngRepeat: state in $select.items --><!-- ngIf: $select.open --><!-- end ngRepeat: state in $select.items --><!-- ngIf: $select.open --><!-- end ngRepeat: state in $select.items --><!-- ngIf: $select.open --><!-- end ngRepeat: state in $select.items --><!-- ngIf: $select.open --><!-- end ngRepeat: state in $select.items --><!-- ngIf: $select.open --><!-- end ngRepeat: state in $select.items --><!-- ngIf: $select.open --><!-- end ngRepeat: state in $select.items --><!-- ngIf: $select.open --><!-- end ngRepeat: state in $select.items --><!-- ngIf: $select.open --><!-- end ngRepeat: state in $select.items --><!-- ngIf: $select.open --><!-- end ngRepeat: state in $select.items -->
</li>
</ul>
<div class="ui-select-no-choice"></div><ui-select-single></ui-select-single><input ng-disabled="$select.disabled" class="ui-select-focusser ui-select-offscreen ng-scope" type="text" id="focusser-0" aria-label="Select box focus"
aria-haspopup="true" role="button">
</div><!-- ngIf: form.state.$error && (form.state.$touched || form.state.$dirty || form.$submitted) -->
</div>
</div>
<div class="col-xs-6">
<div class="form-group"><label>Zip Code:</label> <i class="fa fa-asterisk asterisk-icon" data-ng-show="::!config.noRequired"></i> <input type="text" name="zip_code" class="form-control ng-pristine ng-untouched ng-invalid ng-invalid-required"
placeholder="E.g. 92612" data-ng-model="userObj.TbAddress[0].zip" data-ng-disabled="status.sending" data-ng-readonly="config.readonlyFields" data-ng-required="::!config.noRequired"
required="required"><!-- ngIf: form.zip_code.$error && (form.zip_code.$touched || form.zip_code.$dirty || form.$submitted) --></div>
</div>
</div><!-- ngIf: config.hideControls.indexOf('password') === -1 -->
<div class="row ng-scope" data-ng-if="config.hideControls.indexOf('password') === -1">
<div class="col-md-6">
<div class="form-group"><label>Password:</label> <i class="fa fa-asterisk asterisk-icon" data-ng-show="!config.noRequired && !config.passwordOptional"></i> <input type="password" name="password"
class="form-control ng-pristine ng-untouched ng-invalid ng-invalid-required ng-valid-minlength" minlength="7" data-ng-model="userObj.TbUser.password" data-ng-disabled="status.sending || otherConfigs.grayOutUserPrimaryFields"
data-ng-readonly="config.readonlyFields" data-ng-required="!config.noRequired && !config.passwordOptional"
required="required"><!-- ngIf: form.password.$error && (form.password.$touched || form.password.$dirty || form.$submitted) --></div>
</div>
<div class="col-md-6">
<div class="form-group"><label>Confirm Password:</label> <i class="fa fa-asterisk asterisk-icon" data-ng-show="!config.noRequired && !config.passwordOptional"></i> <input type="password" name="confirm_password"
class="form-control ng-pristine ng-untouched ng-invalid ng-invalid-required ng-valid-minlength" data-ng-model="userObj.TbUser.confirm_password" minlength="7" data-ng-disabled="status.sending || otherConfigs.grayOutUserPrimaryFields"
data-ng-readonly="config.readonlyFields" data-ng-required="!config.noRequired && !config.passwordOptional || !!userObj.TbUser.password" confirm-password="userObj.TbUser.password"
required="required"><!-- ngIf: form.confirm_password.$error && (form.confirm_password.$touched || form.confirm_password.$dirty || form.$submitted) --></div>
</div>
</div><!-- end ngIf: config.hideControls.indexOf('password') === -1 -->
<div data-ng-transclude=""></div><!-- ngIf: ::config.hideControls.indexOf('agreeCheck') === -1 -->
<div class="row ng-scope" data-ng-if="::config.hideControls.indexOf('agreeCheck') === -1">
<div class="col-xs-12"><i class="fa fa-asterisk asterisk-icon check"></i>
<div class="checkbox" data-ng-class="{'has-error': form.agree_terms_check.$error.required && (form.agree_terms_check.$touched || form.agree_terms_check.$dirty || form.$submitted)}"><input type="checkbox" name="agree_terms_check"
data-ng-model="agreeChecks.terms" id="agree_terms" data-ng-disabled="status.sending" required="" class="ng-pristine ng-untouched ng-invalid ng-invalid-required"> <label for="agree_terms">I agree to the
<a data-ng-show="::$root.content.custom_content.common.terms_and_conditions.link" data-ng-href="" target="_blank" class="ng-hide">terms</a> <span
data-ng-hide="::$root.content.custom_content.common.terms_and_conditions.link">terms</span></label></div>
</div><!-- ngIf: $root.content.custom_content.signup.contact_me_agree_checkbox !== false -->
<div class="col-xs-12 ng-scope" ng-if="$root.content.custom_content.signup.contact_me_agree_checkbox !== false"><i class="fa fa-asterisk asterisk-icon check"></i>
<div class="checkbox" data-ng-class="{'has-error': form.agree_contact_check.$error.required && (form.agree_contact_check.$touched || form.agree_contact_check.$dirty || form.$submitted)}"><input type="checkbox"
name="agree_contact_check" data-ng-model="agreeChecks.contact" id="agree_contact" data-ng-disabled="status.sending" data-ng-readonly="config.readonlyFields" required="" class="ng-pristine ng-untouched ng-invalid ng-invalid-required">
<label for="agree_contact">I agree that a representative can contact me about my account</label></div>
</div><!-- end ngIf: $root.content.custom_content.signup.contact_me_agree_checkbox !== false -->
<div class="col-xs-12">
<hr>
</div>
</div><!-- end ngIf: ::config.hideControls.indexOf('agreeCheck') === -1 -->
<div class="row">
<div class="col-xs-12">
<div data-ng-class="{'alert alert-success' : status.type === 'success', 'alert alert-danger' : status.type === 'error'}"><span data-ng-bind="status.message" class="ng-binding"></span></div>
</div>
</div>
<div class="row">
<div class="col-xs-12 text-right" data-ng-class="::{'text-right': config.controlsOnRight}"><button type="button" class="btn btn-danger" data-ng-disabled="status.sending || config.readonlyFields" data-ng-click="resetForm()">Reset</button>
<button type="submit" class="btn btn-success" data-ng-class="{'loading' : status.sending}" data-ng-disabled="config.readonlyFields || status.sending || repsDropDown.fetching || officeDropDown.fetching"><span data-ng-bind="config.submitText"
class="ng-binding">Create my account</span> <i class="fa fa-spinner fa-pulse"></i></button></div>
</div>
</fieldset><!-- ngIf: status.type === 'success' -->
</form>Text Content
WFG NORTHERN CALIFORNIA Toggle navigation * Home * About Us * Contact * Login * Sign up Call us toll free 866.887.0206 CREATE YOUR ACCOUNT New here ? Apply for an account and get access to our data and tools. PLEASE COMPLETE ALL THE FIELDS TO GET STARTED After you have filled out this form, a representative will get in touch with you to finish setting up your account. Email Address (Username): First Name: Last Name: Associated Rep: Click to select * Company Name: Phone: License Number: Expiration Date: Address: Address 2: City: State: Click to select * Zip Code: Password: Confirm Password: I agree to the terms terms I agree that a representative can contact me about my account -------------------------------------------------------------------------------- Reset Create my account Continue Contact us Our team is here to help. Don't hesitate to contact us! * Street * Physical * Satellite * Hybrid Select Map Type Street WFG NORTHERN CALIFORNIA 790 San Ramon Valley Blvd #100 Danville, CA 94526 ⇧ › * © OpenStreetMap contributors. Contact us Our team is here to help. Don't hesitate to contact us! * Home * About Us * Contact Terms of Use Privacy Policy Copyright © 2024 Benutech Inc. All rights reserved