第125个样本计划文件| _首页_Welcome var tranzTime = '11/19/2020 12:33:55 PM'; var clTime = '11/19/2020 10:33:55 AM'; form#section125form { max-width: 330px; } form#section125form input { margin-bottom: 15px; } .page_paragraph .raq-form-panel { position: relative; height: auto; } /* HTML5 Placeholder jQuery Plugin - v2.1.0 * Copyright ©2014 Mathias Bynens * 2014-12-29 */ (function(c){c(jQuery)})(function(c){function q(a){var b={},d=/^jQuery\d+$/;c.each(a.attributes,function(a,c){c.specified&&!d.test(c.name)&&(b[c.name]=c.value)});return b}function h(a,b){var d=c(this);if(this.value==d.attr("placeholder")&&d.hasClass(f.customClass))if(d.data("placeholder-password")){d=d.隐藏().nextAll('input[type="password"]:first').show().attr("id",d.removeAttr("id").data("placeholder-id"));if(!0===a)return d[0].value=b;d.focus()}else this.value="",d.removeClass(f.customClass),this== m()&&this.select()}function l(){var a,b=c(this),d=this.id;if(""===this.value){if("password"===this.type){if(!b.data("placeholder-textinput")){try{a=b.clone().attr({type:"text"})}catch(e){a=c("<input>").attr(c.extend(q(this),{type:"text"}))}a.removeAttr("name").data({"placeholder-password":b,"placeholder-id":d}).bind("focus.placeholder",h);b.data({"placeholder-textinput":a,"placeholder-id":d}).before(a)}b=b.removeAttr("id").隐藏().prevAll('input[type="text"]:first').attr("id",d).show()}b.addClass(f.customClass); 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$('form#section125form > input').placeholder(); }); function validateTaxID(inputValue) { // alphanumeric from 1 to 8 chars var r = new RegExp("^([0-9]){9}$"); result = r.test(inputValue); return result; } function validateZip(inputValue) { // alphanumeric 5 chars var r = new RegExp("^([0-9]){5}$"); result = r.test(inputValue); return result; } $('.form125-submit').on('click', function (e) { e.preventDefault(); var _this = $(this); var taxID = $('input#tax_id').val(); var emplZip = $('input#employer_zip').val(); //Form validation if (!validateTaxID(taxID)) { var elemBoundingRect = document.getElementById("tax_id").getBoundingClientRect(); var infoboxPopup = new InfoboxPopup({ title: "Error", message: "The field TaxID must be numeric, 9 digits.", origin: { top: (elemBoundingRect.top + elemBoundingRect.bottom) / 2 + $(window).scrollTop(), left: elemBoundingRect.right + $(window).scrollLeft() }, error: true }); infoboxPopup.show(); return false; } if (!validateZip(emplZip)) { var elemBoundingRect = document.getElementById("employer_zip").getBoundingClientRect(); var infoboxPopup = new InfoboxPopup({ title: "Error", message: "The field ZipCode must be numeric, 5 digits.", origin: { top: (elemBoundingRect.top + elemBoundingRect.bottom) / 2 + $(window).scrollTop(), left: elemBoundingRect.right + $(window).scrollLeft() }, error: true }); infoboxPopup.show(); return false; } $(this).addClass("is_loading"); var urlCheckFile = '/genericbinaryservice/FlexDocuments?force_get=true&check_file_exist=true'; var urliFramePost = '/genericbinaryservice/FlexDocuments?force_get=true'; var urlErrorTrack = '/api/genericservice/FlexDocuments?force_get=true'; var lead = { "taxid": taxID, "zipcode": emplZip }; var leadQS = ""; $.each(lead, function (n, v) { leadQS = leadQS + n + "=" + v + "&"; }); leadQS = leadQS.endsWith("&") ? leadQS.substr(0, leadQS.length -1) : leadQS; $.ajax({ type: 'POST', data: leadQS, contentType: 'application/x-www-form-urlencoded', url: urlCheckFile, error: function(xhr, textStatus, errorThrown){ var elemBoundingRect = document.getElementById("employer_zip").getBoundingClientRect(); var infoboxPopup = new InfoboxPopup({ title: "Error", message: "T这里 was a problem with your request.", origin: { top: elemBoundingRect.top - 5 + $(window).scrollTop(), left: elemBoundingRect.right + $(window).scrollLeft() }, error: true }); infoboxPopup.show(); utag.link({_ga_category: 'site diagnostics',_ga_action: 'section 125 error: web server',_ga_label: 'status code: ' + xhr.status }); }, success: function (data, status, xhr) { contentType = xhr.getResponseHeader('Content-Type'); if (contentType == 'application/pdf'){ postToIframe(lead, '/genericbinaryservice/FlexDocuments?force_get=true', '') } else{ //show error message $.ajax({ type: 'POST', dataType: 'json', data: JSON.stringify(lead), contentType: 'application/json; charset=utf-8', url: urlErrorTrack, success: function (response){ utag.link({_ga_category: 'site diagnostics',_ga_action: 'dental ada error: api',_ga_label: 'status code: ' + response.Status }); } }); var elemBoundingRect = document.getElementById("employer_zip").getBoundingClientRect(); var infoboxPopup = new InfoboxPopup({ title: "Error", message: "No matches were found at this time. Please verify your ID and Zip Code", origin: { top: elemBoundingRect.top - 5 + $(window).scrollTop(), left: elemBoundingRect.right + $(window).scrollLeft() }, error: true }); infoboxPopup.show(); } $(_this).removeClass("is_loading"); } }); }); }); }); }); require.config({waitSeconds: 0}); 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()]); }); }); <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> <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> <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> <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> <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> <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> <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> .test-w_contact-lightbox-individuals { position: fixed; top: 50%; left: 50%; z-index: 99999; -webkit-perspective: 600px; -moz-perspective: 600px; -ms-perspective: 600px; -o-perspective: 600px; perspective: 600px; -webkit-transform: translateZ(0); -moz-transform: translateZ(0); -ms-transform: translateZ(0); -o-transform: translateZ(0); transform: translateZ(0); } .test-w_contact-lightbox-individuals { width: 955px; height: auto; margin-top: -310px; margin-left: -511px; } .form-main-bg { background: #fff; } .sidebar-bg { height: 532px; float: left; background: #00a7e1; min-width: 260px; } .test-w_contact-lightbox-individuals .info-section { position: absolute; top: 0; left: 0; width: 260px; height: 100%; color: white; background: url(//www.360jue.com/_global-assets/images/common/blue_noise.jpg) #00a7e1; } .test-w_contact-lightbox-individuals .required { color: #3b3b3b !important; } .test-w_contact-lightbox-individuals .info-section .top { padding: 85px 30px 0; border-bottom: 1px solid #4db5da; } .test-w_contact-lightbox-individuals .info-section .top h6 { margin-bottom: 10px; line-height: 1; } .test-w_contact-lightbox-individuals .info-section .top p { font-family: 'ProximaNovaLight'; margin-bottom: 20px; } .test-w_contact-lightbox-individuals .info-section .middle { padding: 19px 34px 0; font-family: 'ProximaNovaRegular'; font-size: 18px; line-height: 1.33; text-align: center; } .test-w_contact-lightbox-individuals .info-section .middle em { display: block; margin: 7px 0 8px; font-family: 'ProximaNovaBold'; text-transform: uppercase; color: #007eaf; } .test-w_contact-lightbox-individuals .info-section .middle a { font-family: 'ProximaNovaBold'; text-decoration: none; color: white; } .test-w_contact-lightbox-individuals .info-section .manage-account { position: absolute; bottom: 0; width: 100%; height: 65px; padding-top: 20px; border-top: 1px solid #4db5da; -webkit-box-sizing: border-box; -moz-box-sizing: border-box; box-sizing: border-box; font-family: 'ProximaNovaRegular'; font-size: 18px; line-height: 1.25; text-transform: capitalize; text-decoration: none; text-align: center; color: white; } .form-bg { float: left; min-width: 654px; padding: 0 20px; margin: 27px 0 0px; max-width: 654px; } .eta .value { display: inline; font-family: 'ProximaNovaSemiBold'; color: #f89728; } .form-main-bg .eta { font-family: proximanovasemibold; font-size: 24px; color: #3b3b3b; margin: 20px 0 0; text-align: center; } .form-main-bg p.later-info {font-size: 19px;width: 100%;text-align: center;} .form-main-bg .contact .input-text input[type="text"], .contact textarea, .contact select { color: #3b3b3b !important; } .form-main-bg input::placeholder {color:#3b3b3b} .form-bg .legend { font-family: proximanovasemibold; font-size: 20px; color: #3b3b3b; margin-bottom: 20px; /* text-align: center; */ } .form-bg .divider { width: 45%; border: solid 1px #ccc; vertical-align: middle; position: absolute; top: 50%; } .divider-text { font-size: 22px; font-family: proximanovasemibold; top: 0px; text-transform: uppercase; line-height: 30px; text-align: center; position: absolute; right: 42%; color: #f89728; width: 16%;} .divider-container { height: 30px; position: relative; margin: 10px -21px;} .requirement-info { font-family: proximanovaregular; font-size: 16px; margin: 14px 0 0px 4px; color: #00a7e1; } .form-bg .misc p { margin: 0; } .form-bg ul.misc { padding: 0 20px; display: none; } .form-bg input.textbutton.is-blue.submit { height: 50px; width: 100%; } a.clear-date-time.textlink { margin: 7px 0 0 0; display: inline-block; text-decoration: underline; margin-left: 461px; } .form-main-bg .raq-complete-panel { float: left; width: 694px; } .test-w_contact-lightbox-individuals .input-text { position: relative; display: block; margin: 0 auto; } .test-w_contact-lightbox-individuals .input-text input { width: 90%; height: 40px; padding-left: 20px; display: block; background-image: none; margin: auto; } .close-bg { background: #fff; width: 73px; height: 68px; position: absolute; top: 0px; right: 0px; } .test-w_contact-lightbox-individuals .close { position: absolute; text-indent: -119988px; overflow: hidden; text-align: left; border: none; 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; } .form_progress h4 { font-family: proximanovasemibold; color:#3b3b3b; } @media (max-width: 999px) { html{-webkit-overflow-scrolling: touch;} .form-main-bg { padding-bottom: 20px; } .sidebar-bg { height: auto; float: none; background: #00a7e1; min-width: unset; text-align: center; } .form-bg .legend { display: none; } .test-w_contact-lightbox-individuals .info-section .middle a { color: #00a7e1; font-size: 24px; display: block; } .test-w_contact-lightbox-individuals .info-section .middle em { color: #00a7e1; } .test-w_contact-lightbox-individuals .info-section .middle { background: #fff; color: #3b3b3b; font-family: proximanovasemibold; } .test-w_contact-lightbox-individuals .info-section a.manage-account { display: none; } .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; } } <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, 明确 Link Insurance Agency, LLC or LifeQuotes, Inc. 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>您的确认号码是 <span class="number"></span>.</p> <p>如果您对您的请求有任何疑问，请联系我们 <a class="textlink" href= "mailto:salesinquiry@aflac.com">salesinquiry@aflac.com</a></p> <p>请提供上面列出的确认号码以供参考。</p> </div> <div id="aflac-connect" class="chat-launcher"> <p class="launcher-text">START NOW</p> </div>  </div> <div class="clearfloat"></div> </div> </div> <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>  </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>  </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, 明确 Link Insurance Agency, LLC or LifeQuotes, Inc. 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="#">提交搜索查询</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>您的确认号码是 <span class="number"></span>.</p> <p>如果您对您的请求有任何疑问，请联系我们 <a class="textlink" href="mailto:salesinquiry@aflac.com">salesinquiry@aflac.com</a></p> <p>请提供上面列出的确认号码以供参考。</p> </div> </div>  <div id="aflac-connect" class="chat-launcher"> <p class="launcher-text">START NOW</p> <i class="fas fa-comments"></i> </div>   </div> </div> </div> (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']); }); } })(); <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> <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">了解个人政策。</a> <br>对于员工少于三家的公司，请查看我们的个人和家庭报道。 <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"> 为自己覆盖</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>  </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 id="leadform_employee_count_label_mobile" aria-label="Employee Count">员工数*</p> </div> <select name="employee_count" aria-labelledby="leadform_employee_count_label_mobile"> <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 id="leadform_contact_label_mobile" aria-label="Contact" class="required">Contact</p> </div> <select name="call_time" aria-labelledby="leadform_contact_label_mobile"> <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"> *表示必填字段 </p> <p class="required-legend" style="font-size: 10px; line-height: 12px;"> By hitting "Submit" 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="#">Submit</a> </div> </form> </div> <div class="complete-panel"> <div class="thanks"> <div class="title">谢谢！</div> <p> 立博体育代表将与您联系。 </p> </div>  </div> </div> </div> </div> <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="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"> *表示必填字段 </p> <div class="progress-nav"> <a class="submit" href="#">Submit</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> <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> <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"> 提供有关您公司的以下信息。 </div> <div class="form-fields"> <div id="individualsproductsonly"> <p><a class="textlink" href="/individuals/default.aspx">了解个人政策。</a><br> 对于员工少于三家的公司，请查看我们的个人和家庭报道。 <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"> 为自己覆盖</label> </li> <li> <label class="checkbox" data-manual="1"> <input name="b2b" type="checkbox" value="b2b"> 为我的员工覆盖</label> </li> <input name="findout" type="hidden" value="Find best option" /> </ul>  </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"> 我目前提供立博体育，并希望添加更多政策。</label> </li>  </ul> </div> <p class="required-legend" style="margin-bottom: 10px;"> *表示必填字段 </p> <p class="required-legend" style="font-size: 10px; line-height: 12px;"> 通过点击“提交”，我同意收到立博体育的自动拨款和文本，代表立博体育的独立承包商，以及代表立博体育的第三方，包括但不限于我所提供的号码。消息和数据速率可能适用。我知道我不需要作为访问立博体育网站的条件，以购买任何产品或接收任何立博体育服务的条件。 </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="#">提交搜索查询</a> </div> </div> <div class="complete-panel"> <div class="thanks"> <div class="title">谢谢！</div> <p> 立博体育代表将与您联系。 </p> </div> <div class="info"> <p> 您的确认号码是 <span class="number"></span>. </p> <p> 如果您对您的请求有任何疑问，请联系我们 <a class="textlink" href="mailto:addbenefits@aflac.com">addbenefits@aflac.com.</a></p> <p>请提供上面列出的确认号码以供参考。</p> </div> <div class="progress-nav"> <a href="" class="next">View 制品</a> </div> </div> </div> </div> </div> <div class="w_contact-lightbox-brokers" role="dialog" aria-label="Partner with Aflac"> <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 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>   <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>    <p class="required-legend"> 各个领域都需要。 </p> <div class="progress-nav"> <input class="submit" type="submit" value="Submit" /> </div> <input name="WcoFormId" type="hidden" value="8ba8b49c-29ee-4c3b-af17-362ddb9795cf" /> </div> </form> </div> <div class="complete-panel"> <div class="thanks"> <div class="title">谢谢！</div> <p> Your message has been successfully sent. </p> </div> </div> </div> </div> <div class="w_customer-support-lightbox"> <div class="lightbox-content"> <div class="form-section"> <a class="close is-grey" href="#">close</a> <div class="form-panel"> <h6>Customer Support</h6> <p> Fill out this <strong>联系表</strong> </p> <div class="form-fields"> <form name="custSupportForm" action="" method="post"> <input name="WcoFormId" type="hidden" value="" /> <div class="row two-part"> <span class="input-text" 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 class="row two-part"> <span class="input-text" data-manual="1"> <input name="company_name" type="text" placeholder="Business Name*" title="商业 Name*"> </span> <span class="input-text" data-manual="1"> <input name="account_number" type="text" placeholder="Account Number" title="Account Number"> </span> </div> <div class="row two-part"> <span class="input-text" data-manual="1"> <input name="city" type="text" placeholder="City*" title="City*"> </span> <div class="dropdown-box state-dropdown" data-manual="1" data-scroll-threshold="5"> <div class="dropdown-title"> <p>State*</p> </div> <select name="state"> <option value="AL">AL</option> <option value="AK">AK</option> <option value="AZ">AZ</option> <option value="AR">AR</option> <option value="CA">CA</option> <option value="CO">CO</option> <option value="CT">CT</option> <option value="DE">DE</option> <option value="DC">DC</option> <option value="FL">FL</option> <option value="GA">GA</option> <option value="GU">GU</option> <option value="HI">HI</option> <option value="ID">ID</option> <option value="IL">IL</option> <option value="IN">IN</option> <option value="IA">IA</option> <option value="KS">KS</option> <option value="KY">KY</option> <option value="LA">LA</option> <option value="ME">ME</option> <option value="MD">MD</option> <option value="MA">MA</option> <option value="MI">MI</option> <option value="MN">MN</option> <option value="MS">MS</option> <option value="MO">MO</option> <option value="MT">MT</option> <option value="NE">NE</option> <option value="NV">NV</option> <option value="NH">NH</option> <option value="NJ">NJ</option> <option value="NM">NM</option> <option value="NY">NY</option> <option value="NC">NC</option> <option value="ND">ND</option> <option value="OH">OH</option> <option value="OK">OK</option> <option value="OR">OR</option> <option value="PA">PA</option> <option value="PR">PR</option> <option value="RI">RI</option> <option value="SC">SC</option> <option value="SD">SD</option> <option value="TN">TN</option> <option value="TX">TX</option> <option value="UT">UT</option> <option value="VI">VI</option> <option value="VT">VT</option> <option value="VA">VA</option> <option value="WA">WA</option> <option value="WV">WV</option> <option value="WI">WI</option> <option value="WY">WY</option> </select> </div> <span class="input-text zipcode" data-manual="1"> <input name="zipcode" type="text" placeholder="Zipcode*" title="Zipcode*"> </span> </div> <div class="row two-part"> <span class="input-text" data-manual="1"> <input name="email_address" type="text" placeholder="Email*" title="Email*"> </span> <span class="input-text phone" data-manual="1"> <input name="phone_number" type="text" placeholder="Phone*" title="Phone*"> </span> <span class="input-text ext" data-manual="1"> <input name="phone_number_ext" type="text" placeholder="Ext." title="Ext."> </span> </div> <div class="row"> <span class="textarea"> <textarea name="request_message" placeholder="Request"></textarea> </span> </div> <p class="required-legend"> *表示必填字段 </p> <p> or Call Us at <a href="tel:800.992.3522">800.992.3522</a> </p> <div class="progress-nav"> <a class="back" href="#">背部</a> <a class="submit" href="#">提交搜索查询</a> </div> </form> </div> </div> <div class="complete-panel"> <div class="thanks"> <div class="title">谢谢！</div> <p> Your request has been successfully submitted to Customer Support. </p> </div> </div> </div> </div> </div> <div class="w_error-lightbox"> <div class="lightbox-content"> <header class="orange"> <a href="#" class="close spacebutton" role="button"><span class="icon"></span></a> <h6></h6> </header> <div class="content"> <p></p> <a href="#" class="textbutton is-grey spacebutton" role="button">OK</a> </div> </div> </div>