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require(['/_Global-Assets/js/common.js'], function (common) { require(['main-require']); }); $('document').ready(function() { aflac.modules = aflac.modules || {}; var module = aflac.modules; module.rcc = function (){ if($("div[class*='rcc']").length > 0 && $("div[class*='step--customize']").length > 0){ return 'rcc-require'; } else{ return ''; } }; module.agentLocator = function (){ if($("div[class*='aal']").length > 0){ return 'agentlocator-require'; } else{ return ''; } }; return module; }(window.aflac = window.aflac || {} )); $('document').ready(function() { require(['/_Global-Assets/js/common.js'], function (common) { require([aflac.modules.agentLocator(), aflac.modules.rcc()]); }); }); </script> <script src="//www.youtube.com/player_api"></script> <!-- B2C Section General --> <script id="individuals-mobile-contact-cta-tpl" type="text/html"> <div class="contact-wrapper"> <div class="contact-trigger contact-button bottom-button"> <div class="cta-wrapper" style="max-width: 175px;"> 请求报价 </div> <div class="scroll-icon"></div> </div> <div class="call-us-button bottom-button"> <a href="tel:855-782-5850"> <div class="call-us-p">Call Us<div class="call-us-logo"> </div> </div> </a> </div> </div> </script> <!-- B2C Ecomm Section General --> <script id="ecomm-individuals-mobile-contact-cta-tpl" type="text/html"> <div class="contact-wrapper"> <div class="ecomm-lightbox contact-button bottom-button" data-lightbox="#home_quote_popup"> <div class="cta-wrapper" style="max-width: 130px;"> 请求报价 </div> <div class="scroll-icon"></div> </div> <div class="call-us-button bottom-button"> <a href="tel:855-782-5850"> <div class="call-us-p">Call Us<div class="call-us-logo"> </div> </div> </a> </div> </div> </script> <!-- Prospecting Section General --> <script id="prospecting-mobile-contact-cta-tpl" type="text/html"> <div class="prospecting-sticky-footer" href="#"> <div class="header-text"> <p>I would like coverage for:</p> </div> <a class="myself bottom-button individuals-cta"> <div class="cta-wrapper"> <span>Myself</span> <div class="user-icon"></div> </div> </a> <a class="employees bottom-button employers-cta"> <div class="cta-wrapper"> <span>My Employees</span> <div class="employees-icon"></div> </div> </a> </div> </script> <!-- Ecomm Prospecting Section --> <script id="ecomm-prospecting-mobile-contact-cta-tpl" type="text/html"> <div class="prospecting-sticky-footer" href="#"> <div class="header-text"> <p>I would like coverage for:</p> </div> <a class="myself bottom-button ecomm-lightbox" data-lightbox="#home_quote_popup"> <div class="cta-wrapper"> <span>Myself</span> <div class="user-icon"></div> </div> </a> <a class="employees bottom-button employers-cta"> <div class="cta-wrapper"> <span>My Employees</span> <div class="employees-icon"></div> </div> </a> </div> </script> <!-- B2B Section General --> <script id="business-mobile-contact-cta-tpl" type="text/html"> <div class="contact-wrapper"> <div class="contact-trigger contact-button bottom-button"> <div class="cta-wrapper" style="max-width: 130px;"> 请求信息 </div> <div class="scroll-icon"></div> </div> <div class="call-us-button bottom-button"> <a href="tel:855-604-8436"> <div class="call-us-p">Call Us<div class="call-us-logo"></div> </div> </a> </div> </div> </script> <!-- Broker Section General --> <script id="broker-mobile-contact-cta-tpl" type="text/html"> <div class="contact-wrapper"> <div class="contact-trigger contact-button bottom-button" style="width: 100.3%;"> <div class="cta-wrapper"> Partner with Aflac <div class="scroll-icon"></div> </div> </div> </div> </script> <!-- Agent Section General --> <script id="agent-mobile-contact-cta-tpl" type="text/html"> <div class="contact-wrapper"> <div class="contact-trigger contact-button bottom-button" style="width: 100.3%;"> <div class="cta-wrapper"> Become an Agent <div class="scroll-icon"></div> </div> </div> </div> </script> <style> .test-w_contact-lightbox-individuals { position: fixed; 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} .test-w_contact-lightbox-individuals .info-section { position: initial; width: auto; } .test-w_contact-lightbox-individuals .info-section .top { padding: 38px 21px 0px; } .test-w_contact-lightbox-individuals { width: 100%; height: 100%; margin-top: auto; margin-left: auto; position: fixed; top: 0; left: 0; overflow-y: scroll; -webkit-overflow-scrolling: touch; } .form-bg { float: none; min-width: auto; padding: 0 20px; margin: 20px 0 0px; max-width: unset; text-align: center; } a.clear-date-time.textlink { margin: 30px 0 30px 0; display: inline-block; text-decoration: underline; margin-left: auto; } /*mobile */ .close-bg { width: 57px; height: 54px; position: absolute; top: 0px; right: 0px; background: none; } .test-w_contact-lightbox-individuals .close::after { content: ""; width: 30px; height: 30px; background: url(//www.360jue.com/_global-assets/images/icons/close-3b.png) 0px 0px no-repeat; cursor: pointer; display: block; width: 28px; height: 24px; position: relative; top: -11px; left: 11px; background: url(//www.360jue.com/_global-assets/images/sprites/layout/sprites-sfd5c0480fb.png) 6px -622px no-repeat; } .test-w_contact-lightbox-individuals .close { background: none; width: 100%; height: 100%; } .test-w_contact-lightbox-individuals .dropdown-box, .test-w_contact-lightbox-individuals .time-dropdown { margin-bottom: 10px; width: 97%; } .form-main-bg .raq-complete-panel { float: left; width: 100%; } .test-w_contact-lightbox-individuals .close:active:after { content: ""; filter: invert(1); } .close-bg:active { background: #fff; } } </style> <script id="test-contact-lightbox-individuals-tpl" type="text/html"> <div class="test-w_contact-lightbox-individuals"> <div class="form-main-bg"> <div class="close-bg"><button type="button" class="close">close</button></div> <div class="sidebar-bg"> <div class="info-section"> <div class="top"> <h6>请求报价</h6> <p>Aflac is insurance that pays cash benefits, to help pay for things that major medical may not cover.</p> </div> <div class="middle"> Fill out our <strong>Contact Form</strong> and we'll call you <em>or</em> Call Us now at <a href="tel:800.992.3522">800.992.3522</a> </div><a class="manage-account" href="//my.aflac.com/portal/server.pt?open=512&objID=639&mode=2" target= "_blank">Manage My Policy</a> </div> </div> <div class="form-bg"> <div class="legend"> Provide your information so an Aflac agent can reach you. </div> <form method="post"> <input name="offering" type="hidden" value="Individual"> <input name="language" type="hidden" value="English" /> <div class="contact-fields"> <div class="flex_columns"> <div class="flex_2col"> <span class="input-text firstname" data-manual="1"><input name="firstname" title="First Name" class="required" id= "firstname" type="text" maxlength="150" placeholder="First Name *"></span> </div> <div class="flex_2col"> <span class="input-text lastname" data-manual="1"><input name="lastname" title="Last Name" class="required" id= "lastname" type="text" maxlength="150" placeholder="Last Name *"></span> </div> <div class="clearfloat"></div> </div> <div class="flex_columns"> <div class="flex_2col"> <span class="input-text phone" data-manual="1"><input name="phone" title="Phone Number" class="required" id= "phone" type="tel" maxlength="12" placeholder="Phone Number *"></span> </div> <div class="flex_2col"> <span class="input-text zipcode" data-manual="1"><input name="zipcode" title="Zip Code" class="required" id= "zipcode" type="tel" maxlength="5" placeholder="Zip Code *"></span> </div> <div class="clearfloat"></div> </div> <div class="flex_columns"> <div class="flex_2col"> <span class="input-text email" data-manual="1"><input name="email" title="Email" class="required" id="email" type= "email" maxlength="255" placeholder="Email *"></span> </div> <div class="flex_2col"> <div class="requirement-info"> * fields are required </div> <ul class="misc"> <li> <p>Would you like an Aflac agent to call asap?</p><label class="checkbox"><input name="yesmeet" type= "checkbox"> Yes</label> <label class="checkbox"><input name="nomeet" type="checkbox"> No</label> </li> </ul> </div> <div class="clearfloat"></div> </div> </div> <div class="form_progress"></div> <div class="contact-time-selection" style="display: none;"> <div class="tabs"> <div class="flex_columns"> <div class="tab"> <input class="now-date" name="date" type="hidden"> <input class="now-time" name="time" type="hidden"> <input class="now-contact-me-type" name="contactMeType" type="hidden"> <div class="eta"> Press submit for an Aflac agent to call you <span class="value">within 15 minutes</span> </div> </div> <div class="tab"> <div class="divider-container"> <div class="divider"></div> <div class="divider-text"> or </div> <div class="divider" style="right: 0%;"></div> </div> <input class="now-contact-me-type" name="contactMeType" type="hidden"> <p class="later-info">If you need to schedule another time for a call, <span>select a date and time that works with your schedule below:</span></p> <div class="dropdown-row"> <div class="dropdown-box date-dropdown" data-manual="1" data-scroll-threshold="4"> <div class="dropdown-title"> <p>Select a Day</p> </div><select name="date"> </select> </div> <div class="time-dropdown-box time-dropdown" data-manual="1"> <div class="dropdown-title"> <p>Select Time</p> </div><select name="time"> </select> </div> </div><a href="#" class="clear-date-time textlink">Reset Date & Time Selection</a> </div> </div> </div> </div> <div class="flex_columns" style=" /* display: none; */"> <input class="textbutton is-blue submit" type="submit" value="Submit"> <div class="clearfloat"></div> </div> <p style="font-size: 13px;line-height: 100%;margin: 15px 0 14px;">By hitting submit, I agree to receive autodialed calls, to include scheduling reminders, and texts from Aflac, an independent contractor Aflac associate, and an Aflac Partner, such as Sutherland Global 服务 or 明确 Link Insurance Agency, LLC working at Aflac's request, at the number provided. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. I understand I may also receive text messages about the status of my Aflac application and am not required to provide my consent as a condition of accessing Aflac's website or purchasing Aflac's products.</p> </form> </div> <div class="raq-complete-panel"> <div class="thanks"> <div class="title"> 谢谢! </div> <p>An Aflac agent will call you<br> <span class="eta">within 15 minutes.</span></p> </div> <div class="info"> <p>你确认号码 <span class="number"></span>.</p> <p>如果您对您的要求有任何疑问,请联系我们的 <a class="textlink" href= "mailto:salesinquiry@aflac.com">salesinquiry@aflac.com</a></p> <p>请提供参考上面列出您的确认号。</p> </div><!-- START OF SUTHERLAND CHANGES --> <div id="aflac-connect" class="chat-launcher"> <p class="launcher-text">START NOW</p> </div><!--<div id="locl-messenger"></div>--> <!-- END OF SUTHERLAND CHANGES --> </div> <div class="clearfloat"></div> </div> </div> </script> <script id="contact-lightbox-individuals-tpl" type="text/html"> <div class="w_contact-lightbox-individuals"> <div class="lightbox-content"> <div class="info-section"> <div class="top"> <h6>请求报价</h6> <p>Aflac is insurance that pays cash benefits, to help pay for things that major medical may not cover.</p> </div> <div class="middle"> Fill out our <strong>Contact Form</strong> and we'll call you <em>or</em> Call Us now at <a href="tel:800.992.3522">800.992.3522</a> </div> <a class="manage-account" href="//my.aflac.com/portal/server.pt?open=512&objID=639&mode=2" target="_blank">Manage My Policy</a> </div> <div class="form-section"> <ol class="progress-indicator"> <li class="is-current">1. Contact Information</li> <li>2. Call time</li> </ol> <a class="close" href="#">关</a> <div class="raq-form-panel"> <div class="form-steps"> <form action="#" method="POST"> <input name="offering" type="hidden" value="Individual"> <input name="language" type="hidden" value="English" /> <fieldset class="form-step interests"> <div class="legend">Please select at least one Aflac insurance product.</div> <p>我感兴趣的是:</p> <ul class="interest-list"> <li> <div class="checkbox-holder"> <label class="checkbox has-orange-fg" data-manual="1"> <input name="offering_1" type="checkbox" value="Accident"> Accident</label> </div> </li> <li> <div class="checkbox-holder"> <label class="checkbox has-orange-fg" data-manual="1"> <input name="offering_2" type="checkbox" value="Cancer/Specified-Disease"> Cancer/Specified-Disease</label> </div> </li> <li> <div class="checkbox-holder"> <label class="checkbox has-orange-fg" data-manual="1"> <input name="offering_3" type="checkbox" value="Critical Care and Recovery"> Critical Illness</label> </div> </li> <li> <div class="checkbox-holder"> <label class="checkbox has-orange-fg" data-manual="1"> <input name="offering_4" type="checkbox" value="Dental"> Dental</label> </div> </li> <li> <div class="checkbox-holder"> <label class="checkbox has-orange-fg" data-manual="1"> <input name="offering_5" type="checkbox" value="Juvenile Life"> Juvenile Life</label> </div> </li> </ul> </fieldset> <fieldset class="form-step contact-info" data-di-form-track data-di-form-id="individuals-form-contact-info"> <div class="legend">Provide your information so an Aflac agent can reach you.</div> <div class="form-fields"> <div class="row"> <span class="input-text firstname" data-manual="1"> <input name="firstname" type="text" placeholder="First Name" title="First Name"> </span> <span class="input-text lastname" data-manual="1"> <input name="lastname" type="text" placeholder="Last Name" title="Last Name"> </span> </div> <div class="row"> <span class="input-text phone" data-manual="1"> <input name="phone" type="tel" placeholder="Phone" title="Phone"> </span> <span class="input-text zipcode" data-manual="1"> <input name="zipcode" type="tel" placeholder="ZIP Code" title="ZIP Code"> </span> </div> <div class="row"> <span class="input-text email" data-manual="1"> <input name="email" type="email" placeholder="Email" title="Email"> </span> </div> </div> <p style="margin-bottom: 10px">各个领域都需要。</p> <!--<p style="font-size: 10px; line-height: 12px;">By hitting submit, I agree to receive autodialed calls, to include scheduling reminders, and texts from Aflac, an independent contractor Aflac associate, and an Aflac Partner, such as Sutherland Global 服务 or 明确 Link Insurance Agency, LLC working at Aflac’s request, at the number provided. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. I understand I may also receive text messages about the status of my Aflac application and am not required to provide my consent as a condition of accessing Aflac’s website or purchasing Aflac’s products.</p>--> </fieldset> <fieldset class="form-step call-time" data-di-form-track data-di-form-id="individuals-form-call-time"> <div class="legend">Your preferred call time</div> <p class="available"> Monday - Friday <strong id="mf-start-time">8:00 AM</strong> to <strong id="mf-end-time">11:00 PM</strong> ET<br> Saturday & Sunday <strong id="sat-start-time">10:00 AM</strong> to <strong id="sat-end-time">6:00 PM</strong> ET<br> <!--Aflac will be open on January 21, 2019 from 8:00 AM - 8:30 PM.--> </p> <div class="call-options"> <ul class="tab-nav"> <li><a href="#">Call me now</a></li> <li><a href="#">Call me later</a></li> </ul> <div class="tabs"> <div class="tab"> <input class="now-date" name="date" type="hidden"> <input class="now-time" name="time" type="hidden"> <input class="now-contact-me-type" name="contactMeType" type="hidden"> <div class="current-time"> Current time: <span class="value"></span> </div> <div class="eta"> An Aflac agent will call you <span class="value">within 15 minutes</span> </div> </div> <div class="tab"> <input class="now-contact-me-type" name="contactMeType" type="hidden"> <p class="later-info"> Select a date and time you'd like to be<br> contacted by an Aflac agent. </p> <div class="dropdown-row"> <div class="dropdown-box date-dropdown" data-manual="1" data-scroll-threshold="4"> <div class="dropdown-title"> <p>Select a Day</p> </div> <select name="date"> </select> </div> <div class="time-dropdown-box time-dropdown" data-manual="1"> <div class="dropdown-title"> <p>Select Time</p> </div> <select name="time"> </select> </div> <div class="requirement-info">各个领域都需要。</div> </div> </div> </div> </div> <div class="form-disclaimer"> <p>By hitting submit, I agree to receive autodialed calls, to include scheduling reminders, and texts from Aflac, an independent contractor Aflac associate, and an Aflac Partner, such as Sutherland Global 服务 or 明确 Link Insurance Agency, LLC working at Aflac’s request, at the number provided. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. I understand I may also receive text messages about the status of my Aflac application and am not required to provide my consent as a condition of accessing Aflac’s website or purchasing Aflac’s products.</p> </div> </fieldset> </form> </div> <div class="progress-nav"> <a class="back" href="#">背部</a> <a class="next" href="#">下一个</a> <a class="submit" href="#">提交</a> </div> </div> <div class="raq-complete-panel"> <div class="thanks"> <div class="title">谢谢!</div> <p> An Aflac agent will call you<br> <span class="eta">within 15 minutes.</span> </p> </div> <div class="info"> <p>你确认号码 <span class="number"></span>.</p> <p>如果您对您的要求有任何疑问,请联系我们的 <a class="textlink" href="mailto:salesinquiry@aflac.com">salesinquiry@aflac.com</a></p> <p>请提供参考上面列出您的确认号。</p> </div> </div> <!-- START OF SUTHERLAND CHANGES --> <div id="aflac-connect" class="chat-launcher"> <p class="launcher-text">START NOW</p> <i class="fas fa-comments"></i> </div> <!--<div id="locl-messenger"></div>--> <!-- END OF SUTHERLAND CHANGES --> </div> </div> </div> </script> <script> (function(){ //start anon var allowed = false; var allowedPages = ["agents"]; for(var i=0; i < location.pathname.split("/").length; i++){ for (var x=0; x < allowedPages.length; x++){ if(location.pathname.split("/")[i] === allowedPages[x] && i < 2){ allowed = true; } } } if(allowed){ require(['/_global-assets/js/common.js'], function(common) { require(['local-agent-require']); }); } })(); </script> <script id="contact-lightbox-local-agents-tpl" type="text/html"> <div class="w_contact-lightbox-local-agents"> <div class="lightbox-content"> <div class="info-section"> <div class="top header-only"> <h6>Local 代理 Form</h6> </div> <!-- <div class="middle bottom-aligned"> Fill out the form and we’ll contact you. <a href="tel:800.992.3522">800.992.3522</a> </div>--> </div> <div class="form-section"> <a class="close is-grey" href="#">关</a> <div class="form-panel"> <form method="POST"> <div class="form-steps"> <div class="form-step getting-started" style="display: block;"> <form action="" method="POST"> <div class="legend"> Please select at least one of the options below to continue: </div> <div class="form-fields"> <div id="individualsproductsonly"> <p><a class="textlink" href="/individuals/default.aspx">了解更多关于个别政策。</a> <br>随着公司比三个少的员工,请看看我们的个人和家庭的覆盖面。 <a class="textlink" href="/individuals/default.aspx">学到更多。</a> </p> </div> <div class="captioned-list"> <p>我感兴趣的是:</p> <ul> <li> <label class="checkbox" data-manual="1"><input name="b2c" type="checkbox" value="individual"> 覆盖率为自己</label> </li> <li> <label class="checkbox" data-manual="1"><input name="b2b" type="checkbox" value="business"> Coverage for Employees</label> </li> <li> <label class="checkbox" data-manual="1"><input name="agents" type="checkbox" value="agent"> Become an Agent</label> </li> </ul> </div> <!-----END PREQUAL-----> </div> <p class="required-legend"> 各个领域都需要。 </p> </form> </div> <div class="form-step contact-info"> <form action="/url_to_post_to" method="POST"> <input type="hidden" name="language" value="EN"> <input type="hidden" name="marketing_program_id" value=""> <div class="form-fields"> <div id="name" class="row two-part"> <span class="input-text name" data-manual="1"><input name="first_name" type="text" placeholder="First Name*" title="First Name*"> </span> <span class="input-text" data-manual="1"><input name="last_name" type="text" placeholder="Last Name*" title="Last Name*"> </span> </div> <div id="address" class="row two-part"> <span class="input-text address" data-manual="1"> <input style="width: 423px" name="address" type="text" placeholder="Address*" title="Address*"> </span> </div> <div class="row three-part"> <span class="input-text zipcode" data-manual="1"><input name="zipcode" type="tel" placeholder="ZIP Code*" title="ZIP Code*"> </span> <span class="input-text phone" data-manual="1"><input name="phone" type="tel" placeholder="Phone*" title="Phone*"> </span> <span class="input-text email" data-manual="1"><input name="email" type="email" placeholder="Email*" title="Email*"> </span> </div> <div id="count" class="row two-part"> <span class="input-text company" data-manual="1"><input name="company" type="text" placeholder="Company Name*" title="Company Name*"> </span> <div class="dropdown-container"> <div class="dropdown-box" data-char-limit="30" data-scroll-threshold="6" data-highlight-submit=""> <div class="dropdown-title"> <p>员工数*</p> </div> <select name="employee_count"> <option value="2">少于3</option> <option value="24">3 - 24</option> <option value="99">25-99</option> <option value="499">100-499</option> <option value="999">500-999</option> <option value="1000">1000+</option> </select> </div> </div> </div> <div id="contact" class="row"> <div class="dropdown-container style=" width: 423px ""> <div class="dropdown-box" data-char-limit="30" data-scroll-threshold="2" data-highlight-submit=""> <div class="dropdown-title"> <p>Contact</p> </div> <select name="call_time"> <option value="daytime">Daytime</option> <option value="nighttime">Nighttime</option> </select> </div> </div> </div> <ul id="spanish" class="misc"> <li> <label class="checkbox has-orange-fg"> <input type="checkbox" name="spanish">I'm proficient in Spanish</label> </li> </ul> <div id="interested" class="captioned-list"> <p>我感兴趣的是:</p> <span style=" font-size: 12px; font-family: proximanovaregular; display: block; margin: 10px 0 7px 0; ">选择所有符合条件的</span> <ul> <li> <div class="checkbox-holder"><label class="checkbox" data-manual="1"><input name="w_option_1" type="checkbox" value="Accident"> Accident</label> </div> </li> <li> <div class="checkbox-holder"><label class="checkbox" data-manual="1"><input name="w_option_2" type="checkbox" value="Cancer"> Cancer</label> </div> </li> <li> <div class="checkbox-holder"><label class="checkbox" data-manual="1"><input name="w_option_3" type="checkbox" value="Dental"> Dental</label> </div> </li> </ul> </div> <p class="required-legend"> *必须填写 </p> <p class="required-legend" style="font-size: 10px; line-height: 12px;"> By hitting "提交" Button I agree to receive autodialed calls and texts from Aflac, independent contractors acting on Aflac’s behalf, and third parties acting on Aflac’s behalf, including but not limited to Five9 at the number I have provided. Messages and data rates may apply. I understand that I am not required to provide my consent as a condition of accessing Aflac’s website, purchasing any product or receiving any Aflac services. </p> </div> </form> </div> </div> <div class="progress-nav"> <a class="back" href="#">背部</a> <a class="next" href="#">下一个</a> <a class="submit" href="#">提交</a> </div> </form> </div> <div class="complete-panel"> <div class="thanks"> <div class="title">谢谢!</div> <p> 一个立博体育代表将与您联系。 </p> </div> <!-- <div class="info"> <!-- <p> 你确认号码 <span class="number"></span>. </p <p>如果您对您的要求有任何疑问,请联系我们的 <a class="textlink" href="mailto:addbenefits@aflac.com">addbenefits@aflac.com</a></p> <p>请提供参考上面列出您的确认号。</p> </div> <div class="progress-nav"> <a href="" class="next">View 制品</a> </div> --> </div> </div> </div> </div> </script> <script id="contact-lightbox-agents-tpl" type="text/html"> <div class="w_contact-lightbox-agents"> <div class="lightbox-content"> <div class="info-section"> <div class="top header-only"> <h6>Apply Now</h6> </div> <div class="middle bottom-aligned"> </div> </div> <div class="form-section"> <a class="close is-grey" href="#">关</a> <div class="form-panel"> <form method="POST"> <div class="form-fields"> <div class="row two-part"> <span class="input-text" data-manual="1"> <input name="firstname" type="text" placeholder="First Name*" title="First Name*"> </span> <span class="input-text" data-manual="1"> <input name="lastname" type="text" placeholder="Last Name*" title="Last Name*"> </span> </div> <div class="row three-part"> <span class="input-text zipcode" data-manual="1"> <input name="zipcode" type="tel" placeholder="ZIP Code*" title="ZIP Code*"> </span> <span class="input-text phone" data-manual="1"> <input name="phone" type="tel" placeholder="Phone*" title="Phone*"> </span> <span class="input-text" data-manual="1"> <input name="email" type="email" placeholder="Email*" title="Email*"> </span> </div> <div class="row"> <div class="dropdown-box date-dropdown" data-manual="1" data-scroll-threshold="5"> <div class="dropdown-title"> <p>How did you hear about us?*</p> </div> <select name="referer" id="referer"> <option value="V">Aflac.com</option> <option value="M">Career Builder</option> <option value="F">Career Fair</option> <option value="G">College Campus Recruiting</option> <option value="1">CareerCo</option> <option value="JB">Glassdoor</option> <option value="K">Google</option> <option value="X">Indeed</option> <option value="5">Monster</option> <option value="P">Online Advertisement </option> <option value="R">Print Advertisement </option> <option value="A">Referral/Nomination</option> <option value="2">Simply Hired</option> <option value="8">Social Media</option> <option value="C">TV Ad</option> </select> <input type="hidden" name="subscriberIdList" value="*=15584|NY=16082"></input> </div> </div> <div class="row"> <span class="input-text" data-manual="1"> <input name="agentnumber" type="text" placeholder="Referring Agent's Number" title="Referring Agent's Number"> </span> </div> <div class="row two-part resume_section"> <!-- <input type="button" class="textbutton is-orange resume upload_resume" value="Upload Resume" />--> <input type="hidden" class="filename" name="filename"/> <input type="hidden" class="fileextension" name="fileextension"/> <input type="hidden" class="filedata" name="filedata"/> <label class="resume_button main_form_resume"> UPLOAD RESUME <input type="file" class="resume_file hidden" accept=".doc,.docx,.txt,.pdf,.rtf,.odt,.wps"/> </label> <label class="resume_label main_form_resume"> No file selected </label> </div> <ul class="misc"> <li> <label class="checkbox has-orange-fg"><input type="checkbox" name="spanish"/> I'm proficient in Spanish</label> </li> <li> I'm over 18 <label class="checkbox"><input type="checkbox" name="over18"/> Yes<span class="ipad-hitfield"></span></label> <label class="checkbox"><input type="checkbox" name="notover18"/> No<span class="ipad-hitfield"></span></label> </li> </ul> </div> <p class="required-legend"> *必须填写 </p> <div class="progress-nav"> <a class="submit" href="#">提交</a> </div> </form> </div> <div class="complete-panel"> <div class="thanks"> <div class="title">谢谢!</div> <p> You will be contacted soon by one of our Aflac coordinators. </p> </div> <div class="info"> <p> Questions? Email us at <a class="textlink" href="mailto:whyaflac@aflac.com">whyaflac@aflac.com</a> </p> </div> </div> </div> </div> </div> </script> <script id="contact-lightbox-employers-tpl" type="text/html"> <div class="w_contact-lightbox-employers"> <div class="lightbox-content"> <div class="info-section"> <div class="top"> <h6 class="has-subtitle">Offer Aflac <br> <span class="is-smaller">to your employees</span></h6> <p><strong>Aflac policies are 100% employee-paid.</strong> </p> <p>Companies choose to make Aflac policies available to increase benefits options without impacting their bottom line. </p> </div> <div class="middle"> <p>Fill out our <strong>Contact Form</strong> and we'll call you <em>or</em> Call Us now at <a href="tel:855.502.3522">855.502.3522</a></p> </div> <!--<div class="bottom"> <a class="customer-support" href="#">Customer support <br><span class="is-smaller">for existing customers</span></a> </div>--> </div> <div class="form-section"> <ol class="progress-indicator"> <li class="is-current">1. Getting Started</li> <li>2. Contact Information</li> </ol> <a class="close" href="#">关</a> <div class="form-panel"> <div class="form-steps"> <div class="form-step getting-started" data-di-form-track data-di-form-id="business-form-prequalification"> <form action="" method="POST"> <div class="legend"> 请提供以下信息,关于你的公司。 </div> <div class="form-fields"> <div id="individualsproductsonly"> <p><a class="textlink" href="/individuals/default.aspx">了解更多关于个别政策。</a><br> 随着公司比三个少的员工,请看看我们的个人和家庭的覆盖面。 <a class="textlink" href="/individuals/default.aspx">学到更多。</a></p> </div> <div class="row two-part"> <div class="dropdown-box" data-manual="1" data-scroll-threshold="5"> <div class="dropdown-title"> <p>员工数</p> </div> <select name="employeecount"> <option value="2">少于3</option> <option value="24">3 - 24</option> <option value="99">25-99</option> <option value="499">100-499</option> <option value="999">500-999</option> <option value="1000">1000+</option> </select> </div> <span class="input-text" data-manual="1"> <input name="business" type="text" placeholder="Business Name" title="商业 Name"> </span> </div> <div class="captioned-list"> <p>我感兴趣的是:</p> <span style="font-size: 12px; font-family: proximanovaregular; display: block; margin: 10px 0 7px 0;">选择所有符合条件的</span> <ul> <li> <label class="checkbox" data-manual="1"> <input name="b2c" type="checkbox" value="b2c"> 覆盖率为自己</label> </li> <li> <label class="checkbox" data-manual="1"> <input name="b2b" type="checkbox" value="b2b"> 米覆盖率为员工</label> </li> <input name="findout" type="hidden" value="Find best option" /> </ul> <!-----END PREQUAL-----> </div> </div> <p class="required-legend"> 各个领域都需要。 </p> </form> </div> <div class="form-step contact-info" data-di-form-track data-di-form-id="business-form-contact-info"> <form action="/url_to_post_to" method="POST"> <input type="hidden" name="language" value="EN"> <input type="hidden" name="marketing_program_id" value=""> <div class="legend"> Please provide us with your direct business contact information. </div> <div class="form-fields"> <div class="row two-part"> <span class="input-text" data-manual="1"> <input name="firstname" type="text" placeholder="First Name*" title="First Name*"> </span> <span class="input-text" data-manual="1"> <input name="lastname" type="text" placeholder="Last Name*" title="Last Name*"> </span> </div> <div class="row two-part"> <span class="input-text phone" data-manual="1"> <input name="phone" type="tel" placeholder="Phone*" title="Phone*"> </span> <span class="input-text ext" data-manual="1"> <input name="ext" type="tel" placeholder="Ext." title="Ext."> </span> <span class="input-text zipcode" data-manual="1"> <input name="zipcode" type="tel" placeholder="ZIP Code*" title="ZIP Code*"> </span> </div> <div class="row"> <span class="input-text" data-manual="1"> <input name="email" type="email" placeholder="Email*" title="Email*"> </span> </div> <ul class="misc"> <li> <label class="checkbox" data-manual="1"> <input name="add" type="checkbox"> 目前我提供立博体育,并希望增加更多的政策。</label> </li> <!--<li> <label class="checkbox" data-manual="1"><input name="news" type="checkbox"> I'd like to receive the latest Aflac new and insights.</label> </li>--> </ul> </div> <p class="required-legend" style="margin-bottom: 10px;"> *必须填写 </p> <p class="required-legend" style="font-size: 10px; line-height: 12px;"> 通过点击“提交”我同意接收来自立博体育 autodialed电话和短信,立博体育独立承包商代表行事上的,以及代表立博体育的第三方合作伙伴,但在我所提供的数量不限,包括Five9。消息和数据传输费用五月。我明白,我不需要为访问立博体育网站的条件提供本人的同意,在购买任何产品或接受任何立博体育服务。 </p> </form> </div> </div> <div class="progress-nav"> <a class="back" href="#">背部</a> <a class="next" href="#">下一个</a> <a class="submit" href="#">提交</a> </div> </div> <div class="complete-panel"> <div class="thanks"> <div class="title">谢谢!</div> <p> 一个立博体育代表将与您联系。 </p> </div> <div class="info"> <p> 你确认号码 <span class="number"></span>. </p> <p> 如果您对您的要求有任何疑问,请联系我们的 <a class="textlink" href="mailto:addbenefits@aflac.com">addbenefits@aflac.com</a></p> <p>请提供参考上面列出您的确认号。</p> </div> <div class="progress-nav"> <a href="" class="next">View 制品</a> </div> </div> </div> </div> </div> </script> <script id="contact-lightbox-brokers-tpl" type="text/html"> <div class="w_contact-lightbox-brokers"> <div class="lightbox-content"> <div class="info-section"> <div class="top header-only"> <h6>Partner with Aflac</h6> </div> <div class="middle bottom-aligned"> Fill out the form and we’ll contact you. <a href="tel:800.992.3522">800.992.3522</a> </div> </div> <div class="form-section"> <a class="close is-grey" href="#">关</a> <div class="form-panel"> <form method="post"> <div class="form-fields"> <div class="row two-part"> <span class="input-text" data-manual="1"> <input name="full_name" type="text" placeholder="Your Name" title="Your Name*"> </span> <span class="input-text" data-manual="1"> <input name="company_name" type="text" placeholder="Broker/Company" title="Broker/Company*"> </span> </div> <div class="row"> <span class="input-text" data-manual="1"> <input name="email_address" type="email" placeholder="Email" title="Email*"> </span> </div> <!-- <div class="row"> <span class="input-text" data-manual="1"> <input name="address_line_1" type="text" placeholder="Address" title="Address*"> </span> </div> --> <div class="row two-part"> <span class="input-text zipcode" data-manual="1"> <input name="zipcode" type="tel" placeholder="ZIP Code" title="ZIP Code*"> </span> <span class="input-text phone" data-manual="1"> <input name="phone_number" type="tel" placeholder="Phone" title="Phone*"> </span> </div> <!-- Original location of email --> <!-- <div class="row"> <span class="input-text" data-manual="1"> <input name="email_address" type="text" placeholder="Email" title="Email*"> </span> </div> <div class="row"> <span class="textarea"> <textarea name="email_message" placeholder="Email Message"></textarea> </span> </div> </div>--> <p>我感兴趣的是:</p> <ul class="interest-list"> <li> <div class="checkbox-holder"> <label class="checkbox" data-manual="1"> <input name="w_option_1" value="Expanding my current voluntary portfolio" type="checkbox"> Expanding my current voluntary portfolio</label> </div> </li> <li> <div class="checkbox-holder"> <label class="checkbox" data-manual="1"> <input name="w_option_2" value="Offering voluntary policies" type="checkbox"> Offering voluntary policies</label> </div> </li> <li> <div class="checkbox-holder"> <label class="checkbox on-lightbox" data-manual="1"> <input name="w_option_3" value="Getting a Wingman in my office" type="checkbox" id="wingman_tip"> Getting a Wingman in my office</label> </div> </li> </ul> <!-- <div style="display: none" class="w_infobox-popup tool-tip lightbox"><div class="box"><div class="title">What is a Wingman?</div><div class="message">An experienced voluntary expert right in your office – at no cost to you.</div></div></div> --> <!-- <p class="required-legend"> //* Indicates required field </p>--> <!-- <label class="checkbox has-orange-fg" data-manual="1"><input name="optin" type="checkbox"> Opt-in to the latest news and 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