cpa-benefits.com
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165.232.143.119
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Submitted URL: http://url9471.employees-benefits.com/ls/click?upn=u001.vesU9IdG-2FjYCtIHeNTSZSJMoHnO3fy6Q2p3JyNLwxEAnBuroHnR5JZbEqDhqkAccQIglMmkeamfv...
Effective URL: https://cpa-benefits.com/life-insurance-quote/
Submission: On March 07 via manual from US — Scanned from DE
Effective URL: https://cpa-benefits.com/life-insurance-quote/
Submission: On March 07 via manual from US — Scanned from DE
Form analysis 6 forms found in the DOM
GET https://cpa-benefits.com/
<form role="search" action="https://cpa-benefits.com/" method="get">
<div>
<input name="s" type="text" placeholder="Enter Keywords..." class="search-side live-search" autocomplete="off">
<input type="submit" id="searchsubmit" value="Search" class="btn">
</div>
</form>POST /life-insurance-quote/#gf_6
<form method="post" enctype="multipart/form-data" id="gform_6" action="/life-insurance-quote/#gf_6" data-formid="6">
<input type="hidden" class="gforms-pum" value="{"closepopup":false,"closedelay":0,"openpopup":false,"openpopup_id":0}">
<div class="gform-body gform_body">
<div id="gform_page_6_1" class="gform_page " data-js="page-field-id-1">
<div class="gform_page_fields">
<ul id="gform_fields_6" class="gform_fields top_label form_sublabel_below description_below">
<li id="field_6_1"
class="gfield gfield--type-html .gform_wrapper .gf_progressbar_wrapper { display: none; } gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_6_1">
<center>
<font size="5"> <b>Let's get started!</b> </font>
</center>
</li>
<li id="field_6_2" class="gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_6_2"><label
class="gfield_label gform-field-label gfield_label_before_complex">What is your name?<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row" id="input_6_2">
<span id="input_6_2_3_container" class="name_first gform-grid-col gform-grid-col--size-auto">
<input type="text" name="input_2.3" id="input_6_2_3" value="" aria-required="true">
<label for="input_6_2_3" class="gform-field-label gform-field-label--type-sub ">First</label>
</span>
<span id="input_6_2_6_container" class="name_last gform-grid-col gform-grid-col--size-auto">
<input type="text" name="input_2.6" id="input_6_2_6" value="" aria-required="true">
<label for="input_6_2_6" class="gform-field-label gform-field-label--type-sub ">Last</label>
</span>
</div>
</li>
</ul>
</div>
<div class="gform_page_footer top_label">
<input type="button" id="gform_next_button_6_4" class="gform_next_button gform-theme-button button" value="Next"
onclick="jQuery("#gform_target_page_number_6").val("2"); jQuery("#gform_6").trigger("submit",[true]); "
onkeypress="if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_6").val("2"); jQuery("#gform_6").trigger("submit",[true]); } ">
</div>
</div>
<div id="gform_page_6_2" class="gform_page" data-js="page-field-id-4" style="display:none;">
<div class="gform_page_fields">
<ul id="gform_fields_6_2" class="gform_fields top_label form_sublabel_below description_below">
<li id="field_6_5" class="gfield gfield--type-html size =35 gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_6_5">
<b>When were you born?</b></li>
<li id="field_6_6" class="gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible"
data-js-reload="field_6_6"><label class="gfield_label gform-field-label" for="input_6_6">Date of Birth<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_date">
<input name="input_6" id="input_6_6" type="text" value="" class="datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon hasDatepicker initialized" placeholder="mm/dd/yyyy"
aria-describedby="input_6_6_date_format gfield_description_6_6" aria-invalid="false" aria-required="true"><img class="ui-datepicker-trigger"
src="https://cpa-benefits.com/wp-content/plugins/gravityforms/images/datepicker/datepicker.svg" alt="Select date" title="Select date">
<span id="input_6_6_date_format" class="screen-reader-text">MM slash DD slash YYYY</span>
</div>
<input type="hidden" id="gforms_calendar_icon_input_6_6" class="gform_hidden" value="https://cpa-benefits.com/wp-content/plugins/gravityforms/images/datepicker/datepicker.svg">
<div class="gfield_description" id="gfield_description_6_6">Your age determines the rate you pay and is required by all companies.</div>
</li>
</ul>
</div>
<div class="gform_page_footer top_label">
<input type="button" id="gform_previous_button_6_7" class="gform_previous_button gform-theme-button gform-theme-button--secondary button" value="Previous"
onclick="jQuery("#gform_target_page_number_6").val("1"); jQuery("#gform_6").trigger("submit",[true]); "
onkeypress="if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_6").val("1"); jQuery("#gform_6").trigger("submit",[true]); } "> <input type="button" id="gform_next_button_6_7"
class="gform_next_button gform-theme-button button" value="Next" onclick="jQuery("#gform_target_page_number_6").val("3"); jQuery("#gform_6").trigger("submit",[true]); "
onkeypress="if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_6").val("3"); jQuery("#gform_6").trigger("submit",[true]); } ">
</div>
</div>
<div id="gform_page_6_3" class="gform_page" data-js="page-field-id-7" style="display:none;">
<div class="gform_page_fields">
<ul id="gform_fields_6_3" class="gform_fields top_label form_sublabel_below description_below">
<li id="field_6_8" class="gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_6_8"><label
class="gfield_label gform-field-label" for="input_6_8">What is your gender?<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_8" id="input_6_8" class="medium gfield_select" aria-required="true" aria-invalid="false">
<option value="Male">Male</option>
<option value="Female">Female</option>
</select></div>
</li>
</ul>
</div>
<div class="gform_page_footer top_label">
<input type="button" id="gform_previous_button_6_9" class="gform_previous_button gform-theme-button gform-theme-button--secondary button" value="Previous"
onclick="jQuery("#gform_target_page_number_6").val("2"); jQuery("#gform_6").trigger("submit",[true]); "
onkeypress="if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_6").val("2"); jQuery("#gform_6").trigger("submit",[true]); } "> <input type="button" id="gform_next_button_6_9"
class="gform_next_button gform-theme-button button" value="Next" onclick="jQuery("#gform_target_page_number_6").val("4"); jQuery("#gform_6").trigger("submit",[true]); "
onkeypress="if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_6").val("4"); jQuery("#gform_6").trigger("submit",[true]); } ">
</div>
</div>
<div id="gform_page_6_4" class="gform_page" data-js="page-field-id-9" style="display:none;">
<div class="gform_page_fields">
<ul id="gform_fields_6_4" class="gform_fields top_label form_sublabel_below description_below">
<li id="field_6_10" class="gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_6_10"><label
class="gfield_label gform-field-label" for="input_6_10">What state do you live in?<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_10" id="input_6_10" class="medium gfield_select" aria-required="true" aria-invalid="false">
<option value="" selected="selected" class="gf_placeholder">Please Select</option>
<option value="Alabama">Alabama</option>
<option value="Alaska">Alaska</option>
<option value="Arizona">Arizona</option>
<option value="Arkansas">Arkansas</option>
<option value="California">California</option>
<option value="Colorado">Colorado</option>
<option value="Connecticut">Connecticut</option>
<option value="Delaware">Delaware</option>
<option value="District of Columbia">District of Columbia</option>
<option value="Florida">Florida</option>
<option value="Georgia">Georgia</option>
<option value="Guam">Guam</option>
<option value="Hawaii">Hawaii</option>
<option value="Idaho">Idaho</option>
<option value="Illinois">Illinois</option>
<option value="Indiana">Indiana</option>
<option value="Iowa">Iowa</option>
<option value="Kansas">Kansas</option>
<option value="Kentucky">Kentucky</option>
<option value="Louisiana">Louisiana</option>
<option value="Maine">Maine</option>
<option value="Maryland">Maryland</option>
<option value="Massachusetts">Massachusetts</option>
<option value="Michigan">Michigan</option>
<option value="Minnesota">Minnesota</option>
<option value="Mississippi">Mississippi</option>
<option value="Missouri">Missouri</option>
<option value="Montana">Montana</option>
<option value="Nebraska">Nebraska</option>
<option value="Nevada">Nevada</option>
<option value="New Hampshire">New Hampshire</option>
<option value="New Jersey">New Jersey</option>
<option value="New Mexico">New Mexico</option>
<option value="New York">New York</option>
<option value="North Carolina">North Carolina</option>
<option value="North Dakota">North Dakota</option>
<option value="Ohio">Ohio</option>
<option value="Oklahoma">Oklahoma</option>
<option value="Oregon">Oregon</option>
<option value="Pennsylvania">Pennsylvania</option>
<option value="Puerto Rico">Puerto Rico</option>
<option value="Rhode Island">Rhode Island</option>
<option value="South Carolina">South Carolina</option>
<option value="South Dakota">South Dakota</option>
<option value="Tennessee">Tennessee</option>
<option value="Texas">Texas</option>
<option value="Utah">Utah</option>
<option value="Vermont">Vermont</option>
<option value="Virginia">Virginia</option>
<option value="Washington">Washington</option>
<option value="West Virginia">West Virginia</option>
<option value="Wisconsin">Wisconsin</option>
<option value="Wyoming">Wyoming</option>
<option value="Armed Forces Americas">Armed Forces Americas</option>
<option value="Armed Forces Europe">Armed Forces Europe</option>
<option value="Armed Forces Pacific">Armed Forces Pacific</option>
</select></div>
</li>
</ul>
</div>
<div class="gform_page_footer top_label">
<input type="button" id="gform_previous_button_6_11" class="gform_previous_button gform-theme-button gform-theme-button--secondary button" value="Previous"
onclick="jQuery("#gform_target_page_number_6").val("3"); jQuery("#gform_6").trigger("submit",[true]); "
onkeypress="if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_6").val("3"); jQuery("#gform_6").trigger("submit",[true]); } "> <input type="button" id="gform_next_button_6_11"
class="gform_next_button gform-theme-button button" value="Next" onclick="jQuery("#gform_target_page_number_6").val("5"); jQuery("#gform_6").trigger("submit",[true]); "
onkeypress="if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_6").val("5"); jQuery("#gform_6").trigger("submit",[true]); } ">
</div>
</div>
<div id="gform_page_6_5" class="gform_page" data-js="page-field-id-11" style="display:none;">
<div class="gform_page_fields">
<ul id="gform_fields_6_5" class="gform_fields top_label form_sublabel_below description_below">
<li id="field_6_12" class="gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_6_12"><label
class="gfield_label gform-field-label" for="input_6_12">What is your occupation?<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_12" id="input_6_12" class="medium gfield_select" aria-required="true" aria-invalid="false">
<option value="" selected="selected" class="gf_placeholder">Please Select</option>
<option value="CPA">CPA</option>
<option value="Architect">Architect</option>
<option value="Engineer">Engineer</option>
<option value="Real Estate Agent">Real Estate Agent</option>
<option value="Real Estate Broker">Real Estate Broker</option>
<option value="Loan Originator">Loan Originator</option>
<option value="Other">Other</option>
</select></div>
</li>
<li id="field_6_13" class="gfield gfield--type-text field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible" data-js-reload="field_6_13" data-conditional-logic="hidden" style="display: none;"><label
class="gfield_label gform-field-label" for="input_6_13">Occupation: Other</label>
<div class="ginput_container ginput_container_text"><input name="input_13" id="input_6_13" type="text" value="" class="medium" aria-describedby="gfield_description_6_13" aria-invalid="false" disabled="disabled"></div>
<div class="gfield_description" id="gfield_description_6_13">Sorry your occupation was not listed. Please let us know what it is.</div>
</li>
</ul>
</div>
<div class="gform_page_footer top_label">
<input type="button" id="gform_previous_button_6_14" class="gform_previous_button gform-theme-button gform-theme-button--secondary button" value="Previous"
onclick="jQuery("#gform_target_page_number_6").val("4"); jQuery("#gform_6").trigger("submit",[true]); "
onkeypress="if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_6").val("4"); jQuery("#gform_6").trigger("submit",[true]); } "> <input type="button" id="gform_next_button_6_14"
class="gform_next_button gform-theme-button button" value="Next" onclick="jQuery("#gform_target_page_number_6").val("6"); jQuery("#gform_6").trigger("submit",[true]); "
onkeypress="if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_6").val("6"); jQuery("#gform_6").trigger("submit",[true]); } ">
</div>
</div>
<div id="gform_page_6_6" class="gform_page" data-js="page-field-id-14" style="display:none;">
<div class="gform_page_fields">
<ul id="gform_fields_6_6" class="gform_fields top_label form_sublabel_below description_below">
<li id="field_6_15" class="gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_6_15"><label
class="gfield_label gform-field-label" for="input_6_15">What is your employment status?<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_15" id="input_6_15" class="medium gfield_select" aria-required="true" aria-invalid="false">
<option value="Employee">Employee</option>
<option value="Independent Contractor">Independent Contractor</option>
<option value="Partner of a Group">Partner of a Group</option>
<option value="Solo Practice/ Business Owner">Solo Practice/ Business Owner</option>
<option value="Government Employee">Government Employee</option>
<option value="Other">Other</option>
</select></div>
</li>
<li id="field_6_16" class="gfield gfield--type-text field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible" data-js-reload="field_6_16" data-conditional-logic="hidden" style="display: none;"><label
class="gfield_label gform-field-label" for="input_6_16">Employment: Other</label>
<div class="ginput_container ginput_container_text"><input name="input_16" id="input_6_16" type="text" value="" class="medium" aria-describedby="gfield_description_6_16" aria-invalid="false" disabled="disabled"></div>
<div class="gfield_description" id="gfield_description_6_16">Please tell us your employment status.</div>
</li>
<li id="field_6_17" class="gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_6_17" data-conditional-logic="visible"><label
class="gfield_label gform-field-label" for="input_6_17">Please enter the name of your employer (discounts may apply)</label>
<div class="ginput_container ginput_container_text"><input name="input_17" id="input_6_17" type="text" value="" class="medium" aria-invalid="false" data-conditional-logic="visible"></div>
</li>
<li id="field_6_28" class="gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_hidden" data-js-reload="field_6_28">
<div class="admin-hidden-markup"><i class="gform-icon gform-icon--hidden"></i><span>Hidden</span></div><label class="gfield_label gform-field-label" for="input_6_28">Please enter the name of your program (discounts may apply)</label>
<div class="ginput_container ginput_container_text"><input name="input_28" id="input_6_28" type="text" value="" class="medium" aria-invalid="false"></div>
</li>
<li id="field_6_29" class="gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_hidden" data-js-reload="field_6_29">
<div class="admin-hidden-markup"><i class="gform-icon gform-icon--hidden"></i><span>Hidden</span></div><label class="gfield_label gform-field-label" for="input_6_29">What year will you finish all training?</label>
<div class="ginput_container ginput_container_text"><input name="input_29" id="input_6_29" type="text" value="" class="medium" aria-invalid="false"></div>
</li>
</ul>
</div>
<div class="gform_page_footer top_label">
<input type="button" id="gform_previous_button_6_30" class="gform_previous_button gform-theme-button gform-theme-button--secondary button" value="Previous"
onclick="jQuery("#gform_target_page_number_6").val("5"); jQuery("#gform_6").trigger("submit",[true]); "
onkeypress="if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_6").val("5"); jQuery("#gform_6").trigger("submit",[true]); } "> <input type="button" id="gform_next_button_6_30"
class="gform_next_button gform-theme-button button" value="Next" onclick="jQuery("#gform_target_page_number_6").val("7"); jQuery("#gform_6").trigger("submit",[true]); "
onkeypress="if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_6").val("7"); jQuery("#gform_6").trigger("submit",[true]); } ">
</div>
</div>
<div id="gform_page_6_7" class="gform_page" data-js="page-field-id-30" style="display:none;">
<div class="gform_page_fields">
<ul id="gform_fields_6_7" class="gform_fields top_label form_sublabel_below description_below">
<li id="field_6_31" class="gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_6_31"><label
class="gfield_label gform-field-label" for="input_6_31">What is your annual income.<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_31" id="input_6_31" class="medium gfield_select" aria-required="true" aria-invalid="false">
<option value="<$50,000"><$50,000</option>
<option value="$50,000 - $99,999">$50,000 - $99,999</option>
<option value="$100,000 - $149,999">$100,000 - $149,999</option>
<option value="$150,000 - $199,999">$150,000 - $199,999</option>
<option value="$200,000 - $249,999">$200,000 - $249,999</option>
<option value="$250,000 - $299,999">$250,000 - $299,999</option>
<option value="$300,000 - $349,999">$300,000 - $349,999</option>
<option value="$350,000 - $399,999">$350,000 - $399,999</option>
<option value="$400,000 - $449,999">$400,000 - $449,999</option>
<option value="$450,000 - $499,999">$450,000 - $499,999</option>
<option value="$500,000 - $549,999">$500,000 - $549,999</option>
<option value="$550,000 - $599,999">$550,000 - $599,999</option>
<option value="$600,000 - $649,999">$600,000 - $649,999</option>
<option value="$650,000 - $699,999">$650,000 - $699,999</option>
<option value="$700,000 - $749,999">$700,000 - $749,999</option>
<option value="$750,000 - $799,999">$750,000 - $799,999</option>
<option value="$800,000 - $849,999">$800,000 - $849,999</option>
<option value="$850,000 - $899,999">$850,000 - $899,999</option>
<option value="$900,000 - $949,999">$900,000 - $949,999</option>
<option value="$950,000 - $999,999">$950,000 - $999,999</option>
<option value="$1,000,000 & Over">$1,000,000 & Over</option>
</select></div>
</li>
</ul>
</div>
<div class="gform_page_footer top_label">
<input type="button" id="gform_previous_button_6_18" class="gform_previous_button gform-theme-button gform-theme-button--secondary button" value="Previous"
onclick="jQuery("#gform_target_page_number_6").val("6"); jQuery("#gform_6").trigger("submit",[true]); "
onkeypress="if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_6").val("6"); jQuery("#gform_6").trigger("submit",[true]); } "> <input type="button" id="gform_next_button_6_18"
class="gform_next_button gform-theme-button button" value="Next" onclick="jQuery("#gform_target_page_number_6").val("8"); jQuery("#gform_6").trigger("submit",[true]); "
onkeypress="if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_6").val("8"); jQuery("#gform_6").trigger("submit",[true]); } ">
</div>
</div>
<div id="gform_page_6_8" class="gform_page" data-js="page-field-id-18" style="display:none;">
<div class="gform_page_fields">
<ul id="gform_fields_6_8" class="gform_fields top_label form_sublabel_below description_below">
<li id="field_6_19" class="gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_6_19"><label
class="gfield_label gform-field-label" for="input_6_19">In the past 12 months, have you used any tobacco products?<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_19" id="input_6_19" class="medium gfield_select" aria-required="true" aria-invalid="false">
<option value="NO">NO</option>
<option value="YES">YES</option>
</select></div>
</li>
</ul>
</div>
<div class="gform_page_footer top_label">
<input type="button" id="gform_previous_button_6_20" class="gform_previous_button gform-theme-button gform-theme-button--secondary button" value="Previous"
onclick="jQuery("#gform_target_page_number_6").val("7"); jQuery("#gform_6").trigger("submit",[true]); "
onkeypress="if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_6").val("7"); jQuery("#gform_6").trigger("submit",[true]); } "> <input type="button" id="gform_next_button_6_20"
class="gform_next_button gform-theme-button button" value="Next" onclick="jQuery("#gform_target_page_number_6").val("9"); jQuery("#gform_6").trigger("submit",[true]); "
onkeypress="if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_6").val("9"); jQuery("#gform_6").trigger("submit",[true]); } ">
</div>
</div>
<div id="gform_page_6_9" class="gform_page" data-js="page-field-id-20" style="display:none;">
<div class="gform_page_fields">
<ul id="gform_fields_6_9" class="gform_fields top_label form_sublabel_below description_below">
<li id="field_6_21" class="gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_6_21"><label
class="gfield_label gform-field-label" for="input_6_21">Would you also like life insurance quotes?<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_21" id="input_6_21" class="medium gfield_select" aria-required="true" aria-invalid="false">
<option value="YES">YES</option>
<option value="NO">NO</option>
</select></div>
</li>
</ul>
</div>
<div class="gform_page_footer top_label">
<input type="button" id="gform_previous_button_6_22" class="gform_previous_button gform-theme-button gform-theme-button--secondary button" value="Previous"
onclick="jQuery("#gform_target_page_number_6").val("8"); jQuery("#gform_6").trigger("submit",[true]); "
onkeypress="if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_6").val("8"); jQuery("#gform_6").trigger("submit",[true]); } "> <input type="button" id="gform_next_button_6_22"
class="gform_next_button gform-theme-button button" value="Next" onclick="jQuery("#gform_target_page_number_6").val("10"); jQuery("#gform_6").trigger("submit",[true]); "
onkeypress="if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_6").val("10"); jQuery("#gform_6").trigger("submit",[true]); } ">
</div>
</div>
<div id="gform_page_6_10" class="gform_page" data-js="page-field-id-22" style="display:none;">
<div class="gform_page_fields">
<ul id="gform_fields_6_10" class="gform_fields top_label form_sublabel_below description_below">
<li id="field_6_23" class="gfield gfield--type-html size =35 gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_6_23"><b> Contact Information</b></li>
<li id="field_6_25" class="gfield gfield--type-phone gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_6_25"><label
class="gfield_label gform-field-label" for="input_6_25">Mobile Number<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_phone"><input name="input_25" id="input_6_25" type="text" value="" class="medium" aria-required="true" aria-invalid="false"></div>
</li>
<li id="field_6_26" class="gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible" data-js-reload="field_6_26"><label
class="gfield_label gform-field-label" for="input_6_26">Email<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_email">
<input name="input_26" id="input_6_26" type="text" value="" class="medium" aria-required="true" aria-invalid="false" aria-describedby="gfield_description_6_26">
</div>
<div class="gfield_description" id="gfield_description_6_26">Your information is confidential and will be used solely for providing a quote.</div>
</li>
</ul>
</div>
<div class="gform_page_footer top_label"><input type="submit" id="gform_previous_button_6" class="gform_previous_button gform-theme-button gform-theme-button--secondary button" value="Previous"
onclick="if(window["gf_submitting_6"]){return false;} window["gf_submitting_6"]=true; "
onkeypress="if( event.keyCode == 13 ){ if(window["gf_submitting_6"]){return false;} window["gf_submitting_6"]=true; jQuery("#gform_6").trigger("submit",[true]); }"> <input type="submit"
id="gform_submit_button_6" class="gform_button button" value="Submit" onclick="if(window["gf_submitting_6"]){return false;} window["gf_submitting_6"]=true; "
onkeypress="if( event.keyCode == 13 ){ if(window["gf_submitting_6"]){return false;} window["gf_submitting_6"]=true; jQuery("#gform_6").trigger("submit",[true]); }">
<input type="hidden" class="gform_hidden" name="is_submit_6" value="1">
<input type="hidden" class="gform_hidden" name="gform_submit" value="6">
<input type="hidden" class="gform_hidden" name="gform_unique_id" value="">
<input type="hidden" class="gform_hidden" name="state_6" value="WyJbXSIsImNhMTE5MGVlZjNhOGM2OTk3ZDAzNzhkZTkzYmY3MWQ2Il0=">
<input type="hidden" class="gform_hidden" name="gform_target_page_number_6" id="gform_target_page_number_6" value="2">
<input type="hidden" class="gform_hidden" name="gform_source_page_number_6" id="gform_source_page_number_6" value="1">
<input type="hidden" name="gform_field_values" value="">
</div>
</div>
</div><input type="hidden" name="pum_form_popup_id" value="10946">
</form>POST /life-insurance-quote/
<form method="post" enctype="multipart/form-data" id="gform_6" action="/life-insurance-quote/" data-formid="6">
<input type="hidden" class="gforms-pum" value="{"closepopup":false,"closedelay":0,"openpopup":false,"openpopup_id":0}">
<div class="gform-body gform_body">
<div id="gform_page_6_1" class="gform_page " data-js="page-field-id-1">
<div class="gform_page_fields">
<ul id="gform_fields_6" class="gform_fields top_label form_sublabel_below description_below">
<li id="field_6_1"
class="gfield gfield--type-html .gform_wrapper .gf_progressbar_wrapper { display: none; } gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_6_1">
<center>
<font size="5"> <b>Let's get started!</b> </font>
</center>
</li>
<li id="field_6_2" class="gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_6_2"><label
class="gfield_label gform-field-label gfield_label_before_complex">What is your name?<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row" id="input_6_2">
<span id="input_6_2_3_container" class="name_first gform-grid-col gform-grid-col--size-auto">
<input type="text" name="input_2.3" id="input_6_2_3" value="" aria-required="true">
<label for="input_6_2_3" class="gform-field-label gform-field-label--type-sub ">First</label>
</span>
<span id="input_6_2_6_container" class="name_last gform-grid-col gform-grid-col--size-auto">
<input type="text" name="input_2.6" id="input_6_2_6" value="" aria-required="true">
<label for="input_6_2_6" class="gform-field-label gform-field-label--type-sub ">Last</label>
</span>
</div>
</li>
</ul>
</div>
<div class="gform_page_footer top_label">
<input type="button" id="gform_next_button_6_4" class="gform_next_button gform-theme-button button" value="Next"
onclick="jQuery("#gform_target_page_number_6").val("2"); jQuery("#gform_6").trigger("submit",[true]); "
onkeypress="if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_6").val("2"); jQuery("#gform_6").trigger("submit",[true]); } ">
</div>
</div>
<div id="gform_page_6_2" class="gform_page" data-js="page-field-id-4" style="display:none;">
<div class="gform_page_fields">
<ul id="gform_fields_6_2" class="gform_fields top_label form_sublabel_below description_below">
<li id="field_6_5" class="gfield gfield--type-html size =35 gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_6_5">
<b>When were you born?</b></li>
<li id="field_6_6" class="gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible"
data-js-reload="field_6_6"><label class="gfield_label gform-field-label" for="input_6_6">Date of Birth<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_date">
<input name="input_6" id="input_6_6" type="text" value="" class="datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon hasDatepicker initialized" placeholder="mm/dd/yyyy"
aria-describedby="input_6_6_date_format gfield_description_6_6" aria-invalid="false" aria-required="true"><img class="ui-datepicker-trigger"
src="https://cpa-benefits.com/wp-content/plugins/gravityforms/images/datepicker/datepicker.svg" alt="Select date" title="Select date">
<span id="input_6_6_date_format" class="screen-reader-text">MM slash DD slash YYYY</span>
</div>
<input type="hidden" id="gforms_calendar_icon_input_6_6" class="gform_hidden" value="https://cpa-benefits.com/wp-content/plugins/gravityforms/images/datepicker/datepicker.svg">
<div class="gfield_description" id="gfield_description_6_6">Your age determines the rate you pay and is required by all companies.</div>
</li>
</ul>
</div>
<div class="gform_page_footer top_label">
<input type="button" id="gform_previous_button_6_7" class="gform_previous_button gform-theme-button gform-theme-button--secondary button" value="Previous"
onclick="jQuery("#gform_target_page_number_6").val("1"); jQuery("#gform_6").trigger("submit",[true]); "
onkeypress="if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_6").val("1"); jQuery("#gform_6").trigger("submit",[true]); } "> <input type="button" id="gform_next_button_6_7"
class="gform_next_button gform-theme-button button" value="Next" onclick="jQuery("#gform_target_page_number_6").val("3"); jQuery("#gform_6").trigger("submit",[true]); "
onkeypress="if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_6").val("3"); jQuery("#gform_6").trigger("submit",[true]); } ">
</div>
</div>
<div id="gform_page_6_3" class="gform_page" data-js="page-field-id-7" style="display:none;">
<div class="gform_page_fields">
<ul id="gform_fields_6_3" class="gform_fields top_label form_sublabel_below description_below">
<li id="field_6_8" class="gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_6_8"><label
class="gfield_label gform-field-label" for="input_6_8">What is your gender?<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_8" id="input_6_8" class="medium gfield_select" aria-required="true" aria-invalid="false">
<option value="Male">Male</option>
<option value="Female">Female</option>
</select></div>
</li>
</ul>
</div>
<div class="gform_page_footer top_label">
<input type="button" id="gform_previous_button_6_9" class="gform_previous_button gform-theme-button gform-theme-button--secondary button" value="Previous"
onclick="jQuery("#gform_target_page_number_6").val("2"); jQuery("#gform_6").trigger("submit",[true]); "
onkeypress="if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_6").val("2"); jQuery("#gform_6").trigger("submit",[true]); } "> <input type="button" id="gform_next_button_6_9"
class="gform_next_button gform-theme-button button" value="Next" onclick="jQuery("#gform_target_page_number_6").val("4"); jQuery("#gform_6").trigger("submit",[true]); "
onkeypress="if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_6").val("4"); jQuery("#gform_6").trigger("submit",[true]); } ">
</div>
</div>
<div id="gform_page_6_4" class="gform_page" data-js="page-field-id-9" style="display:none;">
<div class="gform_page_fields">
<ul id="gform_fields_6_4" class="gform_fields top_label form_sublabel_below description_below">
<li id="field_6_10" class="gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_6_10"><label
class="gfield_label gform-field-label" for="input_6_10">What state do you live in?<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_10" id="input_6_10" class="medium gfield_select" aria-required="true" aria-invalid="false">
<option value="" selected="selected" class="gf_placeholder">Please Select</option>
<option value="Alabama">Alabama</option>
<option value="Alaska">Alaska</option>
<option value="Arizona">Arizona</option>
<option value="Arkansas">Arkansas</option>
<option value="California">California</option>
<option value="Colorado">Colorado</option>
<option value="Connecticut">Connecticut</option>
<option value="Delaware">Delaware</option>
<option value="District of Columbia">District of Columbia</option>
<option value="Florida">Florida</option>
<option value="Georgia">Georgia</option>
<option value="Guam">Guam</option>
<option value="Hawaii">Hawaii</option>
<option value="Idaho">Idaho</option>
<option value="Illinois">Illinois</option>
<option value="Indiana">Indiana</option>
<option value="Iowa">Iowa</option>
<option value="Kansas">Kansas</option>
<option value="Kentucky">Kentucky</option>
<option value="Louisiana">Louisiana</option>
<option value="Maine">Maine</option>
<option value="Maryland">Maryland</option>
<option value="Massachusetts">Massachusetts</option>
<option value="Michigan">Michigan</option>
<option value="Minnesota">Minnesota</option>
<option value="Mississippi">Mississippi</option>
<option value="Missouri">Missouri</option>
<option value="Montana">Montana</option>
<option value="Nebraska">Nebraska</option>
<option value="Nevada">Nevada</option>
<option value="New Hampshire">New Hampshire</option>
<option value="New Jersey">New Jersey</option>
<option value="New Mexico">New Mexico</option>
<option value="New York">New York</option>
<option value="North Carolina">North Carolina</option>
<option value="North Dakota">North Dakota</option>
<option value="Ohio">Ohio</option>
<option value="Oklahoma">Oklahoma</option>
<option value="Oregon">Oregon</option>
<option value="Pennsylvania">Pennsylvania</option>
<option value="Puerto Rico">Puerto Rico</option>
<option value="Rhode Island">Rhode Island</option>
<option value="South Carolina">South Carolina</option>
<option value="South Dakota">South Dakota</option>
<option value="Tennessee">Tennessee</option>
<option value="Texas">Texas</option>
<option value="Utah">Utah</option>
<option value="Vermont">Vermont</option>
<option value="Virginia">Virginia</option>
<option value="Washington">Washington</option>
<option value="West Virginia">West Virginia</option>
<option value="Wisconsin">Wisconsin</option>
<option value="Wyoming">Wyoming</option>
<option value="Armed Forces Americas">Armed Forces Americas</option>
<option value="Armed Forces Europe">Armed Forces Europe</option>
<option value="Armed Forces Pacific">Armed Forces Pacific</option>
</select></div>
</li>
</ul>
</div>
<div class="gform_page_footer top_label">
<input type="button" id="gform_previous_button_6_11" class="gform_previous_button gform-theme-button gform-theme-button--secondary button" value="Previous"
onclick="jQuery("#gform_target_page_number_6").val("3"); jQuery("#gform_6").trigger("submit",[true]); "
onkeypress="if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_6").val("3"); jQuery("#gform_6").trigger("submit",[true]); } "> <input type="button" id="gform_next_button_6_11"
class="gform_next_button gform-theme-button button" value="Next" onclick="jQuery("#gform_target_page_number_6").val("5"); jQuery("#gform_6").trigger("submit",[true]); "
onkeypress="if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_6").val("5"); jQuery("#gform_6").trigger("submit",[true]); } ">
</div>
</div>
<div id="gform_page_6_5" class="gform_page" data-js="page-field-id-11" style="display:none;">
<div class="gform_page_fields">
<ul id="gform_fields_6_5" class="gform_fields top_label form_sublabel_below description_below">
<li id="field_6_12" class="gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_6_12"><label
class="gfield_label gform-field-label" for="input_6_12">What is your occupation?<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_12" id="input_6_12" class="medium gfield_select" aria-required="true" aria-invalid="false">
<option value="" selected="selected" class="gf_placeholder">Please Select</option>
<option value="CPA">CPA</option>
<option value="Architect">Architect</option>
<option value="Engineer">Engineer</option>
<option value="Real Estate Agent">Real Estate Agent</option>
<option value="Real Estate Broker">Real Estate Broker</option>
<option value="Loan Originator">Loan Originator</option>
<option value="Other">Other</option>
</select></div>
</li>
<li id="field_6_13" class="gfield gfield--type-text field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible" data-js-reload="field_6_13"><label class="gfield_label gform-field-label"
for="input_6_13">Occupation: Other</label>
<div class="ginput_container ginput_container_text"><input name="input_13" id="input_6_13" type="text" value="" class="medium" aria-describedby="gfield_description_6_13" aria-invalid="false"></div>
<div class="gfield_description" id="gfield_description_6_13">Sorry your occupation was not listed. Please let us know what it is.</div>
</li>
</ul>
</div>
<div class="gform_page_footer top_label">
<input type="button" id="gform_previous_button_6_14" class="gform_previous_button gform-theme-button gform-theme-button--secondary button" value="Previous"
onclick="jQuery("#gform_target_page_number_6").val("4"); jQuery("#gform_6").trigger("submit",[true]); "
onkeypress="if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_6").val("4"); jQuery("#gform_6").trigger("submit",[true]); } "> <input type="button" id="gform_next_button_6_14"
class="gform_next_button gform-theme-button button" value="Next" onclick="jQuery("#gform_target_page_number_6").val("6"); jQuery("#gform_6").trigger("submit",[true]); "
onkeypress="if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_6").val("6"); jQuery("#gform_6").trigger("submit",[true]); } ">
</div>
</div>
<div id="gform_page_6_6" class="gform_page" data-js="page-field-id-14" style="display:none;">
<div class="gform_page_fields">
<ul id="gform_fields_6_6" class="gform_fields top_label form_sublabel_below description_below">
<li id="field_6_15" class="gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_6_15"><label
class="gfield_label gform-field-label" for="input_6_15">What is your employment status?<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_15" id="input_6_15" class="medium gfield_select" aria-required="true" aria-invalid="false">
<option value="Employee">Employee</option>
<option value="Independent Contractor">Independent Contractor</option>
<option value="Partner of a Group">Partner of a Group</option>
<option value="Solo Practice/ Business Owner">Solo Practice/ Business Owner</option>
<option value="Government Employee">Government Employee</option>
<option value="Other">Other</option>
</select></div>
</li>
<li id="field_6_16" class="gfield gfield--type-text field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible" data-js-reload="field_6_16"><label class="gfield_label gform-field-label"
for="input_6_16">Employment: Other</label>
<div class="ginput_container ginput_container_text"><input name="input_16" id="input_6_16" type="text" value="" class="medium" aria-describedby="gfield_description_6_16" aria-invalid="false"></div>
<div class="gfield_description" id="gfield_description_6_16">Please tell us your employment status.</div>
</li>
<li id="field_6_17" class="gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_6_17"><label class="gfield_label gform-field-label"
for="input_6_17">Please enter the name of your employer (discounts may apply)</label>
<div class="ginput_container ginput_container_text"><input name="input_17" id="input_6_17" type="text" value="" class="medium" aria-invalid="false"></div>
</li>
<li id="field_6_28" class="gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_hidden" data-js-reload="field_6_28">
<div class="admin-hidden-markup"><i class="gform-icon gform-icon--hidden"></i><span>Hidden</span></div><label class="gfield_label gform-field-label" for="input_6_28">Please enter the name of your program (discounts may apply)</label>
<div class="ginput_container ginput_container_text"><input name="input_28" id="input_6_28" type="text" value="" class="medium" aria-invalid="false"></div>
</li>
<li id="field_6_29" class="gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_hidden" data-js-reload="field_6_29">
<div class="admin-hidden-markup"><i class="gform-icon gform-icon--hidden"></i><span>Hidden</span></div><label class="gfield_label gform-field-label" for="input_6_29">What year will you finish all training?</label>
<div class="ginput_container ginput_container_text"><input name="input_29" id="input_6_29" type="text" value="" class="medium" aria-invalid="false"></div>
</li>
</ul>
</div>
<div class="gform_page_footer top_label">
<input type="button" id="gform_previous_button_6_30" class="gform_previous_button gform-theme-button gform-theme-button--secondary button" value="Previous"
onclick="jQuery("#gform_target_page_number_6").val("5"); jQuery("#gform_6").trigger("submit",[true]); "
onkeypress="if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_6").val("5"); jQuery("#gform_6").trigger("submit",[true]); } "> <input type="button" id="gform_next_button_6_30"
class="gform_next_button gform-theme-button button" value="Next" onclick="jQuery("#gform_target_page_number_6").val("7"); jQuery("#gform_6").trigger("submit",[true]); "
onkeypress="if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_6").val("7"); jQuery("#gform_6").trigger("submit",[true]); } ">
</div>
</div>
<div id="gform_page_6_7" class="gform_page" data-js="page-field-id-30" style="display:none;">
<div class="gform_page_fields">
<ul id="gform_fields_6_7" class="gform_fields top_label form_sublabel_below description_below">
<li id="field_6_31" class="gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_6_31"><label
class="gfield_label gform-field-label" for="input_6_31">What is your annual income.<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_31" id="input_6_31" class="medium gfield_select" aria-required="true" aria-invalid="false">
<option value="<$50,000"><$50,000</option>
<option value="$50,000 - $99,999">$50,000 - $99,999</option>
<option value="$100,000 - $149,999">$100,000 - $149,999</option>
<option value="$150,000 - $199,999">$150,000 - $199,999</option>
<option value="$200,000 - $249,999">$200,000 - $249,999</option>
<option value="$250,000 - $299,999">$250,000 - $299,999</option>
<option value="$300,000 - $349,999">$300,000 - $349,999</option>
<option value="$350,000 - $399,999">$350,000 - $399,999</option>
<option value="$400,000 - $449,999">$400,000 - $449,999</option>
<option value="$450,000 - $499,999">$450,000 - $499,999</option>
<option value="$500,000 - $549,999">$500,000 - $549,999</option>
<option value="$550,000 - $599,999">$550,000 - $599,999</option>
<option value="$600,000 - $649,999">$600,000 - $649,999</option>
<option value="$650,000 - $699,999">$650,000 - $699,999</option>
<option value="$700,000 - $749,999">$700,000 - $749,999</option>
<option value="$750,000 - $799,999">$750,000 - $799,999</option>
<option value="$800,000 - $849,999">$800,000 - $849,999</option>
<option value="$850,000 - $899,999">$850,000 - $899,999</option>
<option value="$900,000 - $949,999">$900,000 - $949,999</option>
<option value="$950,000 - $999,999">$950,000 - $999,999</option>
<option value="$1,000,000 & Over">$1,000,000 & Over</option>
</select></div>
</li>
</ul>
</div>
<div class="gform_page_footer top_label">
<input type="button" id="gform_previous_button_6_18" class="gform_previous_button gform-theme-button gform-theme-button--secondary button" value="Previous"
onclick="jQuery("#gform_target_page_number_6").val("6"); jQuery("#gform_6").trigger("submit",[true]); "
onkeypress="if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_6").val("6"); jQuery("#gform_6").trigger("submit",[true]); } "> <input type="button" id="gform_next_button_6_18"
class="gform_next_button gform-theme-button button" value="Next" onclick="jQuery("#gform_target_page_number_6").val("8"); jQuery("#gform_6").trigger("submit",[true]); "
onkeypress="if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_6").val("8"); jQuery("#gform_6").trigger("submit",[true]); } ">
</div>
</div>
<div id="gform_page_6_8" class="gform_page" data-js="page-field-id-18" style="display:none;">
<div class="gform_page_fields">
<ul id="gform_fields_6_8" class="gform_fields top_label form_sublabel_below description_below">
<li id="field_6_19" class="gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_6_19"><label
class="gfield_label gform-field-label" for="input_6_19">In the past 12 months, have you used any tobacco products?<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_19" id="input_6_19" class="medium gfield_select" aria-required="true" aria-invalid="false">
<option value="NO">NO</option>
<option value="YES">YES</option>
</select></div>
</li>
</ul>
</div>
<div class="gform_page_footer top_label">
<input type="button" id="gform_previous_button_6_20" class="gform_previous_button gform-theme-button gform-theme-button--secondary button" value="Previous"
onclick="jQuery("#gform_target_page_number_6").val("7"); jQuery("#gform_6").trigger("submit",[true]); "
onkeypress="if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_6").val("7"); jQuery("#gform_6").trigger("submit",[true]); } "> <input type="button" id="gform_next_button_6_20"
class="gform_next_button gform-theme-button button" value="Next" onclick="jQuery("#gform_target_page_number_6").val("9"); jQuery("#gform_6").trigger("submit",[true]); "
onkeypress="if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_6").val("9"); jQuery("#gform_6").trigger("submit",[true]); } ">
</div>
</div>
<div id="gform_page_6_9" class="gform_page" data-js="page-field-id-20" style="display:none;">
<div class="gform_page_fields">
<ul id="gform_fields_6_9" class="gform_fields top_label form_sublabel_below description_below">
<li id="field_6_21" class="gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_6_21"><label
class="gfield_label gform-field-label" for="input_6_21">Would you also like life insurance quotes?<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_21" id="input_6_21" class="medium gfield_select" aria-required="true" aria-invalid="false">
<option value="YES">YES</option>
<option value="NO">NO</option>
</select></div>
</li>
</ul>
</div>
<div class="gform_page_footer top_label">
<input type="button" id="gform_previous_button_6_22" class="gform_previous_button gform-theme-button gform-theme-button--secondary button" value="Previous"
onclick="jQuery("#gform_target_page_number_6").val("8"); jQuery("#gform_6").trigger("submit",[true]); "
onkeypress="if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_6").val("8"); jQuery("#gform_6").trigger("submit",[true]); } "> <input type="button" id="gform_next_button_6_22"
class="gform_next_button gform-theme-button button" value="Next" onclick="jQuery("#gform_target_page_number_6").val("10"); jQuery("#gform_6").trigger("submit",[true]); "
onkeypress="if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_6").val("10"); jQuery("#gform_6").trigger("submit",[true]); } ">
</div>
</div>
<div id="gform_page_6_10" class="gform_page" data-js="page-field-id-22" style="display:none;">
<div class="gform_page_fields">
<ul id="gform_fields_6_10" class="gform_fields top_label form_sublabel_below description_below">
<li id="field_6_23" class="gfield gfield--type-html size =35 gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_6_23"><b> Contact Information</b></li>
<li id="field_6_25" class="gfield gfield--type-phone gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_6_25"><label
class="gfield_label gform-field-label" for="input_6_25">Mobile Number<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_phone"><input name="input_25" id="input_6_25" type="text" value="" class="medium" aria-required="true" aria-invalid="false"></div>
</li>
<li id="field_6_26" class="gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible" data-js-reload="field_6_26"><label
class="gfield_label gform-field-label" for="input_6_26">Email<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_email">
<input name="input_26" id="input_6_26" type="text" value="" class="medium" aria-required="true" aria-invalid="false" aria-describedby="gfield_description_6_26">
</div>
<div class="gfield_description" id="gfield_description_6_26">Your information is confidential and will be used solely for providing a quote.</div>
</li>
</ul>
</div>
<div class="gform_page_footer top_label"><input type="submit" id="gform_previous_button_6" class="gform_previous_button gform-theme-button gform-theme-button--secondary button" value="Previous"
onclick="if(window["gf_submitting_6"]){return false;} window["gf_submitting_6"]=true; "
onkeypress="if( event.keyCode == 13 ){ if(window["gf_submitting_6"]){return false;} window["gf_submitting_6"]=true; jQuery("#gform_6").trigger("submit",[true]); }"> <input type="submit"
id="gform_submit_button_6" class="gform_button button" value="Submit" onclick="if(window["gf_submitting_6"]){return false;} window["gf_submitting_6"]=true; "
onkeypress="if( event.keyCode == 13 ){ if(window["gf_submitting_6"]){return false;} window["gf_submitting_6"]=true; jQuery("#gform_6").trigger("submit",[true]); }">
<input type="hidden" class="gform_hidden" name="is_submit_6" value="1">
<input type="hidden" class="gform_hidden" name="gform_submit" value="6">
<input type="hidden" class="gform_hidden" name="gform_unique_id" value="">
<input type="hidden" class="gform_hidden" name="state_6" value="WyJbXSIsImNhMTE5MGVlZjNhOGM2OTk3ZDAzNzhkZTkzYmY3MWQ2Il0=">
<input type="hidden" class="gform_hidden" name="gform_target_page_number_6" id="gform_target_page_number_6" value="2">
<input type="hidden" class="gform_hidden" name="gform_source_page_number_6" id="gform_source_page_number_6" value="1">
<input type="hidden" name="gform_field_values" value="">
</div>
</div>
</div><input type="hidden" name="pum_form_popup_id" value="11075">
</form>POST /life-insurance-quote/
<form method="post" enctype="multipart/form-data" id="gform_3" action="/life-insurance-quote/" data-formid="3">
<input type="hidden" class="gforms-pum" value="{"closepopup":false,"closedelay":0,"openpopup":false,"openpopup_id":0}">
<div class="gform-body gform_body">
<ul id="gform_fields_3" class="gform_fields top_label form_sublabel_below description_below">
<li id="field_3_1" class="gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_3_1"><label
class="gfield_label gform-field-label gfield_label_before_complex">Name<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row" id="input_3_1">
<span id="input_3_1_3_container" class="name_first gform-grid-col gform-grid-col--size-auto">
<input type="text" name="input_1.3" id="input_3_1_3" value="" aria-required="true">
<label for="input_3_1_3" class="gform-field-label gform-field-label--type-sub ">First</label>
</span>
<span id="input_3_1_6_container" class="name_last gform-grid-col gform-grid-col--size-auto">
<input type="text" name="input_1.6" id="input_3_1_6" value="" aria-required="true">
<label for="input_3_1_6" class="gform-field-label gform-field-label--type-sub ">Last</label>
</span>
</div>
</li>
<li id="field_3_2" class="gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_3_2"><label class="gfield_label gform-field-label"
for="input_3_2">Email<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_email">
<input name="input_2" id="input_3_2" type="text" value="" class="medium" aria-required="true" aria-invalid="false">
</div>
</li>
<li id="field_3_3" class="gfield gfield--type-phone gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_3_3"><label class="gfield_label gform-field-label"
for="input_3_3">Phone<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_phone"><input name="input_3" id="input_3_3" type="text" value="" class="medium" aria-required="true" aria-invalid="false"></div>
</li>
<li id="field_3_4" class="gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_3_4"><label class="gfield_label gform-field-label"
for="input_3_4">Message</label>
<div class="ginput_container ginput_container_textarea"><textarea name="input_4" id="input_3_4" class="textarea medium" aria-invalid="false" rows="10" cols="50"></textarea></div>
</li>
<li id="field_3_5" class="gfield gfield--type-captcha field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_3_5"><label class="gfield_label gform-field-label"
for="input_3_5">CAPTCHA</label>
<div id="input_3_5" class="ginput_container ginput_recaptcha" data-sitekey="" data-theme="light" data-tabindex="-1" data-size="invisible" data-badge="bottomright"></div>
</li>
</ul>
</div>
<div class="gform_footer top_label"> <input type="submit" id="gform_submit_button_3" class="gform_button button" value="Submit" onclick="if(window["gf_submitting_3"]){return false;} window["gf_submitting_3"]=true; "
onkeypress="if( event.keyCode == 13 ){ if(window["gf_submitting_3"]){return false;} window["gf_submitting_3"]=true; jQuery("#gform_3").trigger("submit",[true]); }">
<input type="hidden" class="gform_hidden" name="is_submit_3" value="1">
<input type="hidden" class="gform_hidden" name="gform_submit" value="3">
<input type="hidden" class="gform_hidden" name="gform_unique_id" value="">
<input type="hidden" class="gform_hidden" name="state_3" value="WyJbXSIsImNhMTE5MGVlZjNhOGM2OTk3ZDAzNzhkZTkzYmY3MWQ2Il0=">
<input type="hidden" class="gform_hidden" name="gform_target_page_number_3" id="gform_target_page_number_3" value="0">
<input type="hidden" class="gform_hidden" name="gform_source_page_number_3" id="gform_source_page_number_3" value="1">
<input type="hidden" name="gform_field_values" value="">
</div><input type="hidden" name="pum_form_popup_id" value="10437">
</form>POST /life-insurance-quote/
<form method="post" enctype="multipart/form-data" id="gform_4" action="/life-insurance-quote/" data-formid="4">
<input type="hidden" class="gforms-pum" value="{"closepopup":false,"closedelay":0,"openpopup":false,"openpopup_id":0}">
<div class="gform-body gform_body">
<ul id="gform_fields_4" class="gform_fields top_label form_sublabel_below description_below">
<li id="field_4_1" class="gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_4_1"><label
class="gfield_label gform-field-label gfield_label_before_complex">Name<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row" id="input_4_1">
<span id="input_4_1_3_container" class="name_first gform-grid-col gform-grid-col--size-auto">
<input type="text" name="input_1.3" id="input_4_1_3" value="" aria-required="true">
<label for="input_4_1_3" class="gform-field-label gform-field-label--type-sub ">First</label>
</span>
<span id="input_4_1_6_container" class="name_last gform-grid-col gform-grid-col--size-auto">
<input type="text" name="input_1.6" id="input_4_1_6" value="" aria-required="true">
<label for="input_4_1_6" class="gform-field-label gform-field-label--type-sub ">Last</label>
</span>
</div>
</li>
<li id="field_4_2" class="gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_4_2"><label class="gfield_label gform-field-label"
for="input_4_2">Email<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_email">
<input name="input_2" id="input_4_2" type="text" value="" class="medium" aria-required="true" aria-invalid="false">
</div>
</li>
<li id="field_4_3" class="gfield gfield--type-phone gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_4_3"><label class="gfield_label gform-field-label"
for="input_4_3">Phone<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_phone"><input name="input_3" id="input_4_3" type="text" value="" class="medium" aria-required="true" aria-invalid="false"></div>
</li>
<li id="field_4_4" class="gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_4_4"><label class="gfield_label gform-field-label"
for="input_4_4">Message</label>
<div class="ginput_container ginput_container_textarea"><textarea name="input_4" id="input_4_4" class="textarea medium" aria-invalid="false" rows="10" cols="50"></textarea></div>
</li>
<li id="field_4_5" class="gfield gfield--type-captcha field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_4_5"><label class="gfield_label gform-field-label"
for="input_4_5">CAPTCHA</label>
<div id="input_4_5" class="ginput_container ginput_recaptcha" data-sitekey="" data-theme="light" data-tabindex="-1" data-size="invisible" data-badge="bottomright"></div>
</li>
</ul>
</div>
<div class="gform_footer top_label"> <input type="submit" id="gform_submit_button_4" class="gform_button button" value="Submit" onclick="if(window["gf_submitting_4"]){return false;} window["gf_submitting_4"]=true; "
onkeypress="if( event.keyCode == 13 ){ if(window["gf_submitting_4"]){return false;} window["gf_submitting_4"]=true; jQuery("#gform_4").trigger("submit",[true]); }">
<input type="hidden" class="gform_hidden" name="is_submit_4" value="1">
<input type="hidden" class="gform_hidden" name="gform_submit" value="4">
<input type="hidden" class="gform_hidden" name="gform_unique_id" value="">
<input type="hidden" class="gform_hidden" name="state_4" value="WyJbXSIsImNhMTE5MGVlZjNhOGM2OTk3ZDAzNzhkZTkzYmY3MWQ2Il0=">
<input type="hidden" class="gform_hidden" name="gform_target_page_number_4" id="gform_target_page_number_4" value="0">
<input type="hidden" class="gform_hidden" name="gform_source_page_number_4" id="gform_source_page_number_4" value="1">
<input type="hidden" name="gform_field_values" value="">
</div><input type="hidden" name="pum_form_popup_id" value="10485">
</form>POST /life-insurance-quote/
<form method="post" enctype="multipart/form-data" id="gform_2" action="/life-insurance-quote/" data-formid="2">
<input type="hidden" class="gforms-pum" value="{"closepopup":false,"closedelay":0,"openpopup":false,"openpopup_id":0}">
<div class="gform-body gform_body">
<ul id="gform_fields_2" class="gform_fields top_label form_sublabel_below description_below">
<li id="field_2_1" class="gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_2_1"><label
class="gfield_label gform-field-label gfield_label_before_complex">Name<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row" id="input_2_1">
<span id="input_2_1_3_container" class="name_first gform-grid-col gform-grid-col--size-auto">
<input type="text" name="input_1.3" id="input_2_1_3" value="" aria-required="true">
<label for="input_2_1_3" class="gform-field-label gform-field-label--type-sub ">First</label>
</span>
<span id="input_2_1_6_container" class="name_last gform-grid-col gform-grid-col--size-auto">
<input type="text" name="input_1.6" id="input_2_1_6" value="" aria-required="true">
<label for="input_2_1_6" class="gform-field-label gform-field-label--type-sub ">Last</label>
</span>
</div>
</li>
<li id="field_2_2" class="gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_2_2"><label class="gfield_label gform-field-label"
for="input_2_2">Email<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_email">
<input name="input_2" id="input_2_2" type="text" value="" class="medium" aria-required="true" aria-invalid="false">
</div>
</li>
<li id="field_2_3" class="gfield gfield--type-phone gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_2_3"><label class="gfield_label gform-field-label"
for="input_2_3">Phone<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_phone"><input name="input_3" id="input_2_3" type="text" value="" class="medium" aria-required="true" aria-invalid="false"></div>
</li>
<li id="field_2_4" class="gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_2_4"><label class="gfield_label gform-field-label"
for="input_2_4">Message</label>
<div class="ginput_container ginput_container_textarea"><textarea name="input_4" id="input_2_4" class="textarea medium" aria-invalid="false" rows="10" cols="50"></textarea></div>
</li>
<li id="field_2_5" class="gfield gfield--type-captcha field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_2_5"><label class="gfield_label gform-field-label"
for="input_2_5">CAPTCHA</label>
<div id="input_2_5" class="ginput_container ginput_recaptcha" data-sitekey="" data-theme="light" data-tabindex="-1" data-size="invisible" data-badge="bottomright"></div>
</li>
</ul>
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-------------------------------------------------------------------------------- INFO@CPA-BENEFITS.COM 561-570-6240 FAX: 954-790-6754 4611 S UNIVERSITY DR SUITE 475 DAVIE, FL 33328 Menu - Navigation * Home * About us * Services * Life Insurance for CPAs and Accountants * Specialty Disability Insurance for CPAs and Accountants * Retirement Strategies * Other Services * Business Partners * Quotes * Term Life Insurance Quote * Disability Quote * Contact Us * Home * About us * Services * Life Insurance for CPAs and Accountants * Specialty Disability Insurance for CPAs and Accountants * Retirement Strategies * Other Services * Business Partners * Quotes * Term Life Insurance Quote * Disability Quote * Contact Us INSTANT LIFE INSURANCE QUOTES CPAS | ACCOUNTANTS | FINANCIAL PROFESSIONALS Your Information Hide State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshal IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming* Date of Birth JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember 12345678910111213141516171819202122232425262728293031 1904190519061907190819091910191119121913191419151916191719181919192019211922192319241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024 * Gender MaleFemale* Tobacco User? NoYes* Your Health Preferred PlusPreferredStandard PlusStandard* Length of Coverage 10 Year Term15 Year Term20 Year Term25 Year Term30 Year Term35 Year Term15 Year Term ROP20 Year Term ROP30 Year Term ROPTo age 121 (No Lapse U/L)* Coverage Amount * First Name * Last Name * Cell Phone * Email * View Quotes Terms of ServicePrivacy Policy powered by IXN OUR AUTOMATED UNDERWRITING SYSTEM UTILIZES AN E-APPLICATION TO PROVIDE AN UNDERWRITING DECISION MUCH QUICKER THAN THE TRADITIONAL UNDERWRITING PROCESS. ALTHOUGH NO EXAM IS REQUIRED, MEDICAL HISTORY IS REVIEWED. WE CAN TELL YOU UPFRONT IF THIS PROGRAM IS A FIT OR IF COMPLETING AN EXAM IS A BETTER OPTION. WE OFFER OVER 50 ALTERNATIVE OPTIONS FOR TERM AND PERMANENT COVERAGE FROM FULLY UNDERWRITTEN TO GUARANTEED ISSUE POLICIES UP TO $10,000,000. Please contact our office at 561-570-6240 to discuss specific coverage details and your insurance and planning needs. In order to protect your privacy, please do not send us your confidential personal information, such as your Social Security number, via email. Instead, discuss that personal information with us by phone or send by fax. SEARCH CONTACT US Tel 561-570-6240 Fax 954-790-6754 4611 S University Dr Suite 475 Davie, FL 33328 © 2020 All Rights Reserved. CPA Benefits Alexander Symanski - Licensed Insurance Professional Alexander is a licensed insurance professional who resides in Cape May County New Jersey. Through his experience as an active trader, he has learned that wealth protection is the first step to sustainable wealth creation. Alexander specializes in Life Insurance products that can help his clients achieve financial flexibility and protection for their family. He will work with you and help you understand which types of products best apply to your financial and life goals. Alexander lives with his wife Ashlee, their sons Owen & Ethan and two dogs, Finnegan & Sawyer. When he’s not working, he enjoys the simple things in life like a morning coffee, splitting firewood, and working in his yard. CLOSE Emmanuel Butmankiewicz, MBA - Co-Founder Emmanuel’s goal is to help his clients navigate the confusing path toward financial stability. He and his team strive to understand each client’s unique financial situation from every angle. This enables him to provide the best possible services, information, and products necessary to meet the client’s specific goals. Emmanuel was born in Brooklyn, but has spent most of his life in beautiful South Florida. He attended college in Grove City, Pennsylvania, where he met his wife. Emmanuel earned his MBA at the Wayne Huizenga School of Business in Davie, Florida. He enjoys spending time with his wife, Laurel, his daughter, Eloise, and his son, Wolfe. He also enjoys helping his clients protect their retirement funds and hard-earned savings. CLOSE Brian Symanski - Co-Founder Preparing for that next step in life isn’t always easy. Brian has a combination of experience, professionalism, and access to a wide variety of products and services; together, these can help you meet your financial goals, estate strategies and insurance needs. Whether your goals are to prepare for milestone life events like retirement or simply to find life insurance, disability income, or long-term care insurance protection, he’ll provide the highest level of attention, insight and capability. Brian holds a Bachelor’s Degree in Business Administration from the Wayne Huizenga School of Business at Nova Southeastern University. He served 8 years in the U.S. Coast Guard prior to entering the financial services industry. Brian is married to his wife Cecilia and has two sons; Domenick and Benjamin. CLOSE Laurel Butmankiewicz, CPA - Founder Laurel brings her experience in corporate accounting to the CPA Benefits team. She is a Certified Public Accountant and a licensed insurance agent. She was born and raised in the beautiful state of New Jersey, then attended Grove City College in Pennsylvania where she met her husband, Emmanuel. Laurel loves to travel, cook, craft, and spend time with her children Eloise & Wolfe. CLOSE Jared Henig - Licensed Insurance Professional Jared Henig is a licensed insurance professional with Doctors Benefits based out of Ft. Lauderdale, FL. Jared has many years of experience with helping clients through life’s transitions, planning for the future, and navigating unexpected events. His clients include physicians, attorneys, business owners and retirees. His objective is to develop strategies to protect and maximize his client’s wealth. Based on the client’s needs and long-term planning, Jared is able to offer a wide range of products from an assortment of options in the marketplace. When Jared is not developing a plan for his clients, he enjoys life at home with his wife and two sons. As a family, they enjoy traveling, sports and most outdoor activities. CLOSE Cecilia Symanski, MBA - Chief Technology Officer Cecilia spent over 15 years supporting the Subway Restaurant chain with a focus on logistics, supply chain optimization, analytics, and automation. Cecilia hold a Masters Degree in Management Information Science from the University of Florida, a Six Sigma Black Belt, and a certificate for data science and big data analytics from MIT. Cecilia utilizes the latest technology so that CPA Benefits can operate 100% virtually saving our clients the time of in person meetings. The systems that Cecilia has built and continues to maintain has grown CPA Benefits into a leader in the industry. CLOSE Seth Crews - Licensed Insurance Professional Originally from Colorado and Arkansas, Seth graduated from Lipscomb University with a degree in Business Administration, specializing in corporate finance. Outside the realm of business, he finds solace and excitement in the great outdoors, particularly through activities like hiking, rock climbing, and mountain biking. He values quality time with loved ones and believes in striking a balance between professional pursuits and personal fulfillment, striving to make a positive impact in all aspects of his life. CLOSE Have questions? Speak to an agent (561)570-6240 * Let's get started! * What is your name?* First Last * When were you born? * Date of Birth* MM slash DD slash YYYY Your age determines the rate you pay and is required by all companies. * What is your gender?* MaleFemale * What state do you live in?* Please SelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific * What is your occupation?* Please SelectCPAArchitectEngineerReal Estate AgentReal Estate BrokerLoan OriginatorOther * Occupation: Other Sorry your occupation was not listed. Please let us know what it is. * What is your employment status?* EmployeeIndependent ContractorPartner of a GroupSolo Practice/ Business OwnerGovernment EmployeeOther * Employment: Other Please tell us your employment status. * Please enter the name of your employer (discounts may apply) * Hidden Please enter the name of your program (discounts may apply) * Hidden What year will you finish all training? * What is your annual income.* <$50,000$50,000 - $99,999$100,000 - $149,999$150,000 - $199,999$200,000 - $249,999$250,000 - $299,999$300,000 - $349,999$350,000 - $399,999$400,000 - $449,999$450,000 - $499,999$500,000 - $549,999$550,000 - $599,999$600,000 - $649,999$650,000 - $699,999$700,000 - $749,999$750,000 - $799,999$800,000 - $849,999$850,000 - $899,999$900,000 - $949,999$950,000 - $999,999$1,000,000 & Over * In the past 12 months, have you used any tobacco products?* NOYES * Would you also like life insurance quotes?* YESNO * Contact Information * Mobile Number* * Email* Your information is confidential and will be used solely for providing a quote. × Have questions? Speak to an agent (561)570-6240 * Let's get started! * What is your name?* First Last * When were you born? * Date of Birth* MM slash DD slash YYYY Your age determines the rate you pay and is required by all companies. * What is your gender?* MaleFemale * What state do you live in?* Please SelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific * What is your occupation?* Please SelectCPAArchitectEngineerReal Estate AgentReal Estate BrokerLoan OriginatorOther * Occupation: Other Sorry your occupation was not listed. Please let us know what it is. * What is your employment status?* EmployeeIndependent ContractorPartner of a GroupSolo Practice/ Business OwnerGovernment EmployeeOther * Employment: Other Please tell us your employment status. * Please enter the name of your employer (discounts may apply) * Hidden Please enter the name of your program (discounts may apply) * Hidden What year will you finish all training? * What is your annual income.* <$50,000$50,000 - $99,999$100,000 - $149,999$150,000 - $199,999$200,000 - $249,999$250,000 - $299,999$300,000 - $349,999$350,000 - $399,999$400,000 - $449,999$450,000 - $499,999$500,000 - $549,999$550,000 - $599,999$600,000 - $649,999$650,000 - $699,999$700,000 - $749,999$750,000 - $799,999$800,000 - $849,999$850,000 - $899,999$900,000 - $949,999$950,000 - $999,999$1,000,000 & Over * In the past 12 months, have you used any tobacco products?* NOYES * Would you also like life insurance quotes?* YESNO * Contact Information * Mobile Number* * Email* Your information is confidential and will be used solely for providing a quote. × FILL OUT THE FORM BELOW TO CLAIM YOUR COMPLIMENTARY DISABILITY INSURANCE GUIDE FOR ACCOUNTANTS * Name* First Last * Email* * Phone* * Message * CAPTCHA × FILL OUT THE FORM BELOW TO CLAIM YOUR COMPLIMENTARY WEALTH ACCUMULATION GUIDE FOR ACCOUNTANTS * Name* First Last * Email* * Phone* * Message * CAPTCHA × FILL OUT THE FORM BELOW TO CLAIM YOUR COMPLIMENTARY LIFE INSURANCE GUIDE FOR ACCOUNTANTS * Name* First Last * Email* * Phone* * Message * CAPTCHA × Notifications