{"id":480,"date":"2026-06-04T16:09:29","date_gmt":"2026-06-04T20:09:29","guid":{"rendered":"https:\/\/webdirectms.com\/bquoted\/?page_id=480"},"modified":"2026-06-29T04:29:52","modified_gmt":"2026-06-29T08:29:52","slug":"life","status":"publish","type":"page","link":"https:\/\/webdirectms.com\/bquoted\/life\/","title":{"rendered":"Life"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"480\" class=\"elementor elementor-480\" 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#112337;--gf-ctrl-label-color-secondary: #112337;--gf-ctrl-choice-size: var(--gf-ctrl-choice-size-md);--gf-ctrl-checkbox-check-size: var(--gf-ctrl-checkbox-check-size-md);--gf-ctrl-radio-check-size: var(--gf-ctrl-radio-check-size-md);--gf-ctrl-btn-font-size: var(--gf-ctrl-btn-font-size-md);--gf-ctrl-btn-padding-x: var(--gf-ctrl-btn-padding-x-md);--gf-ctrl-btn-size: var(--gf-ctrl-btn-size-md);--gf-ctrl-btn-border-color-secondary: #686e77;--gf-ctrl-file-btn-bg-color-hover: #EBEBEB;--gf-field-img-choice-size: var(--gf-field-img-choice-size-md);--gf-field-img-choice-card-space: var(--gf-field-img-choice-card-space-md);--gf-field-img-choice-check-ind-size: var(--gf-field-img-choice-check-ind-size-md);--gf-field-img-choice-check-ind-icon-size: var(--gf-field-img-choice-check-ind-icon-size-md);--gf-field-pg-steps-number-color: rgba(17, 35, 55, 0.8);}<\/style><div id='gf_2' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_2' id='gform_2'  action='\/bquoted\/wp-json\/wp\/v2\/pages\/480#gf_2' data-formid='2' novalidate>\n        <div id='gf_progressbar_wrapper_2' class='gf_progressbar_wrapper' data-start-at-zero=''>\n        \t<p class=\"gf_progressbar_title\">Step <span class='gf_step_current_page'>1<\/span> of <span class='gf_step_page_count'>23<\/span><span class='gf_step_page_name'> -  <\/span>\n        \t<\/p>\n            <div class='gf_progressbar gf_progressbar_red' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_red percentbar_4' style='width:4%;'><span>4%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_2_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><div id='gform_fields_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_2_1\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h1>When were you born?<\/h1><\/div><div id=\"field_2_12\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_12'>Date<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_12' id='input_2_12' type='text' value='' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_2_12_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_2_12_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_2_12' class='gform_hidden' value='https:\/\/webdirectms.com\/bquoted\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_2_16\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_16'>Zip Code<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_16' id='input_2_16' type='text' value='' class='large'    placeholder='Enter Zip Code' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_100\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full form-question-below-text gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><h3 class=\"h3-heading font-semibold text-foreground mb-2\">Why We Request Your Age<\/h3><p class=\"p-text text-sm text-muted-foreground leading-relaxed\">Your age helps us match you with the most suitable life insurance options. No matter your stage in life, coverage can provide reassurance and financial protection for those who matter most.<\/p><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_2_3' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_2' class='gform_page q2-con' data-js='page-field-id-3' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_2_14\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h1>Please select your gender<\/h1><\/div><fieldset id=\"field_2_21\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Gender<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_21'>\n\t\t\t<div class='gchoice gchoice_2_21_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_21' type='radio' value='\u2642 Male'  id='choice_2_21_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_21_0' id='label_2_21_0' class='gform-field-label gform-field-label--type-inline'>\u2642 Male<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_21_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_21' type='radio' value='\u2640 Female'  id='choice_2_21_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_21_1' id='label_2_21_1' class='gform-field-label gform-field-label--type-inline'>\u2640 Female<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_124\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full form-question-below-text gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><h3 class=\"h3-heading font-semibold text-foreground mb-2\">Why We Request Your Gender<\/h3><p class=\"p-text text-sm text-muted-foreground leading-relaxed\">Your gender can impact life expectancy, helping us match you with life insurance options that better fit your needs.<\/p><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_22' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_2_22' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_3' class='gform_page' data-js='page-field-id-22' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_2_27\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h1>How would you describe your overall health?<\/h1><\/div><fieldset id=\"field_2_23\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio life-q1 gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >How would you describe your overall health?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_23'>\n\t\t\t<div class='gchoice gchoice_2_23_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_23' type='radio' value='Excellent'  id='choice_2_23_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_23_0' id='label_2_23_0' class='gform-field-label gform-field-label--type-inline'><span class=\"font-semibold text-foreground block mb-1\">Excellent<\/span><span class=\"text-sm text-muted-foreground leading-relaxed\">You're in excellent overall health, maintain a healthy weight, and do not use tobacco. You have no known medical conditions, with cholesterol and blood pressure within normal ranges, and you typically only visit your doctor for routine checkups. There is no history of heart disease or cancer in your immediate family before age 60.<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_23_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_23' type='radio' value='Above Average'  id='choice_2_23_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_23_1' id='label_2_23_1' class='gform-field-label gform-field-label--type-inline'><span class=\"font-semibold text-foreground block mb-1\">Above Average<\/span><span class=\"text-sm text-muted-foreground leading-relaxed\">You're in solid overall health and within a healthy weight range, with perhaps a minor concern like slightly elevated blood pressure or borderline cholesterol. Medical visits are infrequent and typically limited to routine checkups.<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_23_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_23' type='radio' value='Average'  id='choice_2_23_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_23_2' id='label_2_23_2' class='gform-field-label gform-field-label--type-inline'><span class=\"font-semibold text-foreground block mb-1\">Average<\/span><span class=\"text-sm text-muted-foreground leading-relaxed\">You may have a few health conditions, but they are well-managed. You could be slightly above your ideal weight and have elevated cholesterol or blood pressure that is kept under control with medication. You maintain regular checkups to monitor your health.<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_23_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_23' type='radio' value='Below Average'  id='choice_2_23_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_23_3' id='label_2_23_3' class='gform-field-label gform-field-label--type-inline'><span class=\"font-semibold text-foreground block mb-1\">Below Average<\/span><span class=\"text-sm text-muted-foreground leading-relaxed\">You are dealing with major health conditions that require ongoing treatment and regular medical care, such as obesity, diabetes, or cancer.<\/span><\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_101\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full form-question-below-text gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><h3 class=\"h3-heading font-semibold text-foreground mb-2\">Why We Ask About Your Health<\/h3><p class=\"p-text text-sm text-muted-foreground leading-relaxed\">No matter your age or current health status, we use this information to connect you with coverage options that fit your needs.<\/p><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_24' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_2_24' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_4' class='gform_page' data-js='page-field-id-24' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_4' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_2_26\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>Please provide your height and weight<\/h3><\/div><fieldset id=\"field_2_30\" class=\"gfield gfield--type-list gfield--input-type-list gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Current Height<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_list ginput_list ginput_container_list--columns'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_header gform-grid-row\"><div class=\"gform-field-label gfield_header_item gform-grid-col\">ft<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">in<\/div><\/div><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_30_cell1 gform-grid-col' data-label='ft'><input aria-invalid='false' aria-required=\"true\"  aria-label='ft, Row 1' data-aria-label-template='ft, Row {0}' type='text' name='input_30[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_30_cell2 gform-grid-col' data-label='in'><input aria-invalid='false' aria-required=\"true\"  aria-label='in, Row 1' data-aria-label-template='in, Row {0}' type='text' name='input_30[]' value=''   \/><\/div><\/div><\/div><\/div><\/div><\/fieldset><div id=\"field_2_31\" class=\"gfield gfield--type-number gfield--input-type-number gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_31'>Current Weight<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_31' id='input_2_31' type='number' step='any'   value='' class='large'    placeholder='lbs' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_2_102\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full form-question-below-text gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><h3 class=\"h3-heading font-semibold text-foreground mb-2\">Why We Ask About Your Height and Weight<\/h3><p class=\"p-text text-sm text-muted-foreground leading-relaxed\">Height and weight are part of how we understand your health profile and identify coverage that fits. Wherever you are today, we focus on finding options that move you forward.<\/p><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_32' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_2_32' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_5' class='gform_page' data-js='page-field-id-32' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_5' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_2_33\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>Where are you located?<\/h3><\/div><div id=\"field_2_34\" class=\"gfield gfield--type-text gfield--input-type-text zip-code-two gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_34'>Zip Code<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_34' id='input_2_34' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_36\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_36'>State<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_36' id='input_2_36' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select<\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/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='Northern Mariana Islands' >Northern Mariana Islands<\/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='U.S. Virgin Islands' >U.S. Virgin Islands<\/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><\/div><div id=\"field_2_105\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full form-question-below-text gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><h3 class=\"h3-heading font-semibold text-foreground mb-2\">Why We Ask About Your Location<\/h3><p class=\"p-text text-sm text-muted-foreground leading-relaxed\">Your location helps us identify which life insurance options are available in your state.<\/p><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_37' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_2_37' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_6' class='gform_page' data-js='page-field-id-37' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_6' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_2_38\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>Do you currently have life insurance overage?<\/h3><\/div><fieldset id=\"field_2_39\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Do you currently have life insurance overage?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_39'>\n\t\t\t<div class='gchoice gchoice_2_39_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_39' type='radio' value='Yes'  id='choice_2_39_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_39_0' id='label_2_39_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_39_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_39' type='radio' value='No'  id='choice_2_39_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_39_1' id='label_2_39_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_41\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_41'>Current Coverage Amount<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_41' id='input_2_41' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_106\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full form-question-below-text gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><h3 class=\"h3-heading font-semibold text-foreground mb-2\">Why We Ask About Your Current Coverage<\/h3><p class=\"p-text text-sm text-muted-foreground leading-relaxed\">Knowing what coverage you already have helps us identify any gaps and recommend options that build on or improve your protection.<\/p><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_40' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_2_40' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_7' class='gform_page' data-js='page-field-id-40' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_7' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_2_42\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>What type of insurance are you interested in?<\/h3><\/div><fieldset id=\"field_2_43\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >What type of insurance are you interested in?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_43'>\n\t\t\t<div class='gchoice gchoice_2_43_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_43' type='radio' value='Term'  id='choice_2_43_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_43_0' id='label_2_43_0' class='gform-field-label gform-field-label--type-inline'><span class=\"font-semibold text-foreground block mb-1\">Term<\/span><span class=\"text-sm text-muted-foreground leading-relaxed\">You select the policy duration, with terms commonly ranging from 10 to 30 years. It's often one of the most cost-effective life insurance options.<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_43_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_43' type='radio' value='I&#039;m not sure'  id='choice_2_43_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_43_1' id='label_2_43_1' class='gform-field-label gform-field-label--type-inline'><span class=\"font-semibold text-foreground block mb-1\">I'm not sure<\/span><span class=\"text-sm text-muted-foreground leading-relaxed\">With so many life insurance options available, the process can feel overwhelming. We take the time to understand your needs and help you find coverage that fits both your goals and your budget.<\/span><\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_107\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full form-question-below-text gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><h3 class=\"h3-heading font-semibold text-foreground mb-2\">Why We Ask About Your Preferred Type of Life Insurance<\/h3><p class=\"p-text text-sm text-muted-foreground leading-relaxed\">Your selection helps us connect you with the most suitable options from the insurance providers we work with.<\/p><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_44' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_2_44' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_8' class='gform_page' data-js='page-field-id-44' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_8' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_2_46\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>What is your individual annual income from salary and wages?<\/h3><\/div><fieldset id=\"field_2_47\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >What is your individual annual income from salary and wages?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_47'>\n\t\t\t<div class='gchoice gchoice_2_47_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_47' type='radio' value='Less than $50,000'  id='choice_2_47_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_47_0' id='label_2_47_0' class='gform-field-label gform-field-label--type-inline'>Less than $50,000<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_47_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_47' type='radio' value='$50,000 - $99,999'  id='choice_2_47_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_47_1' id='label_2_47_1' class='gform-field-label gform-field-label--type-inline'>$50,000 - $99,999<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_47_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_47' type='radio' value='$100,000 - $149,999'  id='choice_2_47_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_47_2' id='label_2_47_2' class='gform-field-label gform-field-label--type-inline'>$100,000 - $149,999<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_47_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_47' type='radio' value='$150,000 - $199,999'  id='choice_2_47_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_47_3' id='label_2_47_3' class='gform-field-label gform-field-label--type-inline'>$150,000 - $199,999<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_47_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_47' type='radio' value='$200,000 - $249,999'  id='choice_2_47_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_47_4' id='label_2_47_4' class='gform-field-label gform-field-label--type-inline'>$200,000 - $249,999<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_47_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_47' type='radio' value='$250,000 - $299,999'  id='choice_2_47_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_47_5' id='label_2_47_5' class='gform-field-label gform-field-label--type-inline'>$250,000 - $299,999<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_47_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_47' type='radio' value='$300,000 - $399,999'  id='choice_2_47_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_47_6' id='label_2_47_6' class='gform-field-label gform-field-label--type-inline'>$300,000 - $399,999<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_47_7'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_47' type='radio' value='$400,000 - $499,999'  id='choice_2_47_7' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_47_7' id='label_2_47_7' class='gform-field-label gform-field-label--type-inline'>$400,000 - $499,999<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_47_8'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_47' type='radio' value='Over $500,000'  id='choice_2_47_8' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_47_8' id='label_2_47_8' class='gform-field-label gform-field-label--type-inline'>Over $500,000<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_47_9'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_47' type='radio' value='N\/A: On Disability Income'  id='choice_2_47_9' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_47_9' id='label_2_47_9' class='gform-field-label gform-field-label--type-inline'>N\/A: On Disability Income<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_108\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full form-question-below-text gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><h3 class=\"h3-heading font-semibold text-foreground mb-2\">Why We Ask About Your Income<\/h3><p class=\"p-text text-sm text-muted-foreground leading-relaxed\">This refers to your total yearly earnings before taxes from salary or wages. Be sure to include bonuses, commissions, freelance income, or other variable pay to reflect your full annual income.<\/p><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_45' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_2_45' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_9' class='gform_page' data-js='page-field-id-45' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_9' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_2_49\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>How much coverage do you need?<\/h3><\/div><div id=\"field_2_50\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_50'>Coverage Amount<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_50' id='input_2_50' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please Select<\/option><option value='$50,000 - $99,999' >$50,000 - $99,999<\/option><option value='$100,000 - $199,999' >$100,000 - $199,999<\/option><option value='$200,000 - $299,999' >$200,000 - $299,999<\/option><option value='$300,000 - $399,999' >$300,000 - $399,999<\/option><option value='$400,000 - $499,999' >$400,000 - $499,999<\/option><option value='$500,000 - $599,999' >$500,000 - $599,999<\/option><option value='$600,000 - $699,999' >$600,000 - $699,999<\/option><option value='$700,000 - $799,999' >$700,000 - $799,999<\/option><option value='$800,000 - $899,999' >$800,000 - $899,999<\/option><option value='$900,000 - $999,999' >$900,000 - $999,999<\/option><option value='$1,000,000 - $1,499,999' >$1,000,000 - $1,499,999<\/option><option value='$1,500,000 - $1,999,999' >$1,500,000 - $1,999,999<\/option><option value='$2,000,000 - $4,999,999' >$2,000,000 - $4,999,999<\/option><option value='$5,000,000 or greater' >$5,000,000 or greater<\/option><\/select><\/div><\/div><div id=\"field_2_51\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_51'>Length of Term<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_51' id='input_2_51' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please Select<\/option><option value='10 Years' >10 Years<\/option><option value='15 Years' >15 Years<\/option><option value='20 Years' >20 Years<\/option><option value='30 Years' >30 Years<\/option><\/select><\/div><\/div><div id=\"field_2_109\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full form-question-below-text gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><h3 class=\"h3-heading font-semibold text-foreground mb-2\">Why We Ask About Coverage Amount<\/h3><p class=\"p-text text-sm text-muted-foreground leading-relaxed\">Understanding how much coverage you need helps us recommend policies that adequately protect your family and fit your budget.<\/p><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_48' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_2_48' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_10' class='gform_page' data-js='page-field-id-48' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_10' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_2_52\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>Have you ever used Tobacco or Nicotine products?<\/h3><\/div><fieldset id=\"field_2_53\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Have you ever used Tobacco or Nicotine products?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_53'>\n\t\t\t<div class='gchoice gchoice_2_53_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_53' type='radio' value='Yes'  id='choice_2_53_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_53_0' id='label_2_53_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_53_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_53' type='radio' value='No'  id='choice_2_53_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_53_1' id='label_2_53_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_110\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full form-question-below-text gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><h3 class=\"h3-heading font-semibold text-foreground mb-2\">Understanding Your Tobacco Use<\/h3><p class=\"p-text text-sm text-muted-foreground leading-relaxed\">Being upfront about your tobacco and nicotine use allows us to provide the most accurate quotes possible. We partner with a wide range of carriers who offer competitive rates for all applicants, including those who smoke.<\/p><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_55' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_2_55' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_11' class='gform_page' data-js='page-field-id-55' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_11' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_2_54\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>Check all conditions for which you've been treated:<\/h3><\/div><fieldset id=\"field_2_56\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Check all conditions for which you&#039;ve been treated:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_56'>\n\t\t\t<div class='gchoice gchoice_2_56_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_56' type='radio' value='Alcohol or Substance Abuse'  id='choice_2_56_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_56_0' id='label_2_56_0' class='gform-field-label gform-field-label--type-inline'><span class=\"text\">Alcohol or Substance Abuse<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_56_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_56' type='radio' value='Asthma'  id='choice_2_56_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_56_1' id='label_2_56_1' class='gform-field-label gform-field-label--type-inline'><span class=\"text\">Asthma<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_56_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_56' type='radio' value='Blood Clot'  id='choice_2_56_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_56_2' id='label_2_56_2' class='gform-field-label gform-field-label--type-inline'><span class=\"text\">Blood Clot<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_56_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_56' type='radio' value='Blood Pressure'  id='choice_2_56_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_56_3' id='label_2_56_3' class='gform-field-label gform-field-label--type-inline'><span class=\"text\">Blood Pressure<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_56_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_56' type='radio' value='Cancer'  id='choice_2_56_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_56_4' id='label_2_56_4' class='gform-field-label gform-field-label--type-inline'><span class=\"text\">Cancer<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_56_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_56' type='radio' value='Cholesterol'  id='choice_2_56_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_56_5' id='label_2_56_5' class='gform-field-label gform-field-label--type-inline'><span class=\"text\">Cholesterol<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_56_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_56' type='radio' value='Depression or Anxiety'  id='choice_2_56_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_56_6' id='label_2_56_6' class='gform-field-label gform-field-label--type-inline'><span class=\"text\">Depression or Anxiety<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_56_7'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_56' type='radio' value='Diabetes'  id='choice_2_56_7' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_56_7' id='label_2_56_7' class='gform-field-label gform-field-label--type-inline'><span class=\"text\">Diabetes<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_56_8'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_56' type='radio' value='Heart Issue'  id='choice_2_56_8' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_56_8' id='label_2_56_8' class='gform-field-label gform-field-label--type-inline'><span class=\"Heart Issue\">Heart Issue<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_56_9'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_56' type='radio' value='HIV\/AIDS'  id='choice_2_56_9' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_56_9' id='label_2_56_9' class='gform-field-label gform-field-label--type-inline'><span class=\"text\">HIV\/AIDS<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_56_10'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_56' type='radio' value='Sleep Apnea'  id='choice_2_56_10' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_56_10' id='label_2_56_10' class='gform-field-label gform-field-label--type-inline'><span class=\"text\">Sleep Apnea<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_56_11'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_56' type='radio' value='Stroke'  id='choice_2_56_11' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_56_11' id='label_2_56_11' class='gform-field-label gform-field-label--type-inline'><span class=\"text\">Stroke<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_56_12'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_56' type='radio' value='None of these'  id='choice_2_56_12' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_56_12' id='label_2_56_12' class='gform-field-label gform-field-label--type-inline'><span class=\"text\">None of these<\/span><\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_111\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full form-question-below-text gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><h3 class=\"h3-heading font-semibold text-foreground mb-2\">Understanding Your Health Background<\/h3><p class=\"p-text text-sm text-muted-foreground leading-relaxed\">Your personal health history allows us to connect you with the most relevant coverage options. We partner with carriers who offer competitive rates for a wide range of health profiles, including those with pre-existing conditions.<\/p><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_57' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_2_57' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_12' class='gform_page' data-js='page-field-id-57' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_12' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_2_58\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>Have you been cited for impaired driving or had more than 3 driving violations in the past 5 years?<\/h3><\/div><fieldset id=\"field_2_59\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Do you currently engage in any of these sports or activities?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_59'>\n\t\t\t<div class='gchoice gchoice_2_59_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_59' type='radio' value='Yes'  id='choice_2_59_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_59_0' id='label_2_59_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_59_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_59' type='radio' value='No'  id='choice_2_59_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_59_1' id='label_2_59_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_112\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full form-question-below-text gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><h3 class=\"h3-heading font-semibold text-foreground mb-2\">Understanding Your Driving History<\/h3><p class=\"p-text text-sm text-muted-foreground leading-relaxed\">Your driving history is one factor insurers use to evaluate overall risk. Regardless of your record, we work with a variety of carriers to help identify coverage that fits your individual situation.<\/p><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_60' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_2_60' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_13' class='gform_page' data-js='page-field-id-60' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_13' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_2_61\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>Do you currently engage in any of these sports or activities?<\/h3><\/div><fieldset id=\"field_2_62\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Do you currently engage in any of these sports or activities?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_2_62'>Piloting aircraft, Bungee jumping, Mountain & rock climbing, Hang gliding, Scuba diving, Skydiving<\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_62'>\n\t\t\t<div class='gchoice gchoice_2_62_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_62' type='radio' value='Yes'  id='choice_2_62_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_2_62\"   \/>\n\t\t\t\t\t<label for='choice_2_62_0' id='label_2_62_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_62_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_62' type='radio' value='No'  id='choice_2_62_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_62_1' id='label_2_62_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_113\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full form-question-below-text gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><h3 class=\"h3-heading font-semibold text-foreground mb-2\">Understanding Your Activity Profile<\/h3><p class=\"p-text text-sm text-muted-foreground leading-relaxed\">Participation in certain activities is a factor carriers consider when determining coverage. Whatever your lifestyle, our goal is to find a policy that gives you the protection you deserve.<\/p><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_63' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_2_63' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_14' class='gform_page' data-js='page-field-id-63' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_14' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_2_64\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>Did your parents or siblings have heart disease, cancer, stroke, or diabetes before age 65?<\/h3><\/div><fieldset id=\"field_2_65\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Did your parents or siblings have heart disease, cancer, stroke, or diabetes before age 65?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_65'>\n\t\t\t<div class='gchoice gchoice_2_65_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_65' type='radio' value='Yes'  id='choice_2_65_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_65_0' id='label_2_65_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_65_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_65' type='radio' value='No'  id='choice_2_65_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_65_1' id='label_2_65_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_114\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full form-question-below-text gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><h3 class=\"h3-heading font-semibold text-foreground mb-2\">Understanding Your Family Health Background<\/h3><p class=\"p-text text-sm text-muted-foreground leading-relaxed\">A family history of certain conditions gives insurers context about potential inherited health risks. This information helps us identify policies that account for your full picture and are the right fit for you.<\/p><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_66' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_2_66' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_15' class='gform_page' data-js='page-field-id-66' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_15' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_2_67\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>Have you been declined for life insurance in the past year?<\/h3><\/div><fieldset id=\"field_2_68\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Have you been declined for life insurance in the past year?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_68'>\n\t\t\t<div class='gchoice gchoice_2_68_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_68' type='radio' value='Yes'  id='choice_2_68_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_68_0' id='label_2_68_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_68_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_68' type='radio' value='No'  id='choice_2_68_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_68_1' id='label_2_68_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_115\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full form-question-below-text gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><h3 class=\"h3-heading font-semibold text-foreground mb-2\">Understanding Prior Coverage Decisions<\/h3><p class=\"p-text text-sm text-muted-foreground leading-relaxed\">A previous denial can affect the quoting process, so knowing this upfront helps us set realistic expectations and direct you toward carriers best suited to your circumstances.<\/p><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_69' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_2_69' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_16' class='gform_page' data-js='page-field-id-69' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_16' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_2_75\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>Do you consume more than 4 alcoholic beverages per day?<\/h3><\/div><fieldset id=\"field_2_79\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Do you consume more than 4 alcoholic beverages per day?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_79'>\n\t\t\t<div class='gchoice gchoice_2_79_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_79' type='radio' value='Yes'  id='choice_2_79_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_79_0' id='label_2_79_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_79_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_79' type='radio' value='No'  id='choice_2_79_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_79_1' id='label_2_79_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_73\" class=\"gfield gfield--type-email gfield--input-type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_73'>Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_73' id='input_2_73' type='email' value='' class='large'   placeholder='Enter Here' aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_2_116\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full form-question-below-text gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><h3 class=\"h3-heading font-semibold text-foreground mb-2\">Understanding Your Lifestyle Choices<\/h3><p class=\"p-text text-sm text-muted-foreground leading-relaxed\">Information about alcohol consumption helps us identify the coverage options that best align with your overall lifestyle and individual profile.<\/p><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_74' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_2_74' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_17' class='gform_page' data-js='page-field-id-74' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_17' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_2_78\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>Do you use marijuana daily?<\/h3><\/div><fieldset id=\"field_2_76\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Do you use marijuana daily?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_76'>\n\t\t\t<div class='gchoice gchoice_2_76_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_76' type='radio' value='Yes'  id='choice_2_76_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_76_0' id='label_2_76_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_76_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_76' type='radio' value='No'  id='choice_2_76_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_76_1' id='label_2_76_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_117\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full form-question-below-text gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><h3 class=\"h3-heading font-semibold text-foreground mb-2\">Understanding Your Lifestyle Choices<\/h3><p class=\"p-text text-sm text-muted-foreground leading-relaxed\">Information about marijuana use helps us identify the coverage options that best align with your overall lifestyle and individual profile.<\/p><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_77' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_2_77' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_18' class='gform_page' data-js='page-field-id-77' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_18' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_2_81\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>Are you currently using narcotics or opioids for pain?<\/h3><\/div><fieldset id=\"field_2_82\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Are you currently using narcotics or opioids for pain?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_82'>\n\t\t\t<div class='gchoice gchoice_2_82_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_82' type='radio' value='Yes'  id='choice_2_82_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_82_0' id='label_2_82_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_82_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_82' type='radio' value='No'  id='choice_2_82_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_82_1' id='label_2_82_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_118\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full form-question-below-text gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><h3 class=\"h3-heading font-semibold text-foreground mb-2\">Understanding Your Pain Management<\/h3><p class=\"p-text text-sm text-muted-foreground leading-relaxed\">Knowing whether you currently use prescription pain medication allows us to match you with a carrier whose products are designed to accommodate your specific health needs.<\/p><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_80' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_2_80' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_19' class='gform_page' data-js='page-field-id-80' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_19' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_2_84\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>Have you been convicted of a felony in the past 10 years?<\/h3><\/div><fieldset id=\"field_2_85\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Have you been convicted of a felony in the past 10 years?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_85'>\n\t\t\t<div class='gchoice gchoice_2_85_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_85' type='radio' value='Yes'  id='choice_2_85_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_85_0' id='label_2_85_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_85_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_85' type='radio' value='No'  id='choice_2_85_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_85_1' id='label_2_85_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_119\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full form-question-below-text gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><h3 class=\"h3-heading font-semibold text-foreground mb-2\">Understanding Your Legal Background<\/h3><p class=\"p-text text-sm text-muted-foreground leading-relaxed\">Your criminal history is one of many factors insurers consider when evaluating coverage eligibility. Whatever your background, we'll work to connect you with the right options for your situation.<\/p><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_83' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_2_83' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_20' class='gform_page' data-js='page-field-id-83' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_20' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_2_70\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>Who are we preparing this quote for?<\/h3><\/div><fieldset id=\"field_2_72\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><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_72'>\n                            \n                            <span id='input_2_72_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_2_72_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                    <input type='text' name='input_72.3' id='input_2_72_3' value=''   aria-required='true'   placeholder='Enter Here'  \/>\n                                                <\/span>\n                            \n                            <span id='input_2_72_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_2_72_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                            <input type='text' name='input_72.6' id='input_2_72_6' value=''   aria-required='true'   placeholder='Enter Here'  \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_2_120\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full form-question-below-text gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><h3 class=\"h3-heading font-semibold text-foreground mb-2\">Why We Need Your Address<\/h3><p class=\"p-text text-sm text-muted-foreground leading-relaxed\">Your home address helps finalize your application details and may factor into your premium calculation. We use this information solely to help secure the best possible coverage for you.<\/p><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_86' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_2_86' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_21' class='gform_page' data-js='page-field-id-86' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_21' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_2_87\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>Where do you live?<\/h3><\/div><div id=\"field_2_88\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_88'>Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_88' id='input_2_88' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_89\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_89'>City<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_89' id='input_2_89' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_90\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_90'>State<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_90' id='input_2_90' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_91\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_91'>ZIP<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_91' id='input_2_91' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_121\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full form-question-below-text gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><h3 class=\"h3-heading font-semibold text-foreground mb-2\">Why We Need Your Address<\/h3><p class=\"p-text text-sm text-muted-foreground leading-relaxed\">Your home address helps finalize your application details and may factor into your premium calculation. We use this information solely to help secure the best possible coverage for you.<\/p><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_92' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_2_92' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_22' class='gform_page' data-js='page-field-id-92' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_22' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_2_93\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>What's the best number to reach you at if we have any questions about your request?<\/h3><\/div><div id=\"field_2_94\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_94'>Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_94' id='input_2_94' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_95\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p class=\"small-text-last\">By submitting your quote request, you provide your electronic signature and express written consent for B-QUOTED and its insurance partners to contact you by phone, text, or email using the number provided, including automated systems. Your consent is not required to receive a quote. Message and data rates may apply. Text STOP to cancel. You agree to our Privacy <a href=\"#\" class=\"text-secondary hover:underline\">Privacy Policy<\/a> and <a href=\"#\" class=\"text-secondary hover:underline\">Terms and Conditions<\/a>.<\/p><\/div><div id=\"field_2_122\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full form-question-below-text gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><h3 class=\"h3-heading font-semibold text-foreground mb-2\">Why We Need Your Phone Number<\/h3><p class=\"p-text text-sm text-muted-foreground leading-relaxed\">Having a valid phone number on file means we can reach you quickly with quote details, policy options, or answers to any questions you may have along the way.<\/p><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_96' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_2_96' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_23' class='gform_page' data-js='page-field-id-96' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_23' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_2_97\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>How did you hear about us? (Optional)<\/h3><\/div><div id=\"field_2_98\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_98'>Options<\/label><div class='ginput_container ginput_container_select'><select name='input_98' id='input_2_98' class='large gfield_select'     aria-invalid=\"false\" ><option value='Please select' >Please select<\/option><option value='Search Engine (Google, Bing, etc.)' >Search Engine (Google, Bing, etc.)<\/option><option value='Social Media (Facebook, Instagram, etc.)' >Social Media (Facebook, Instagram, etc.)<\/option><option value='Television' >Television<\/option><option value='Radio' >Radio<\/option><option value='Friend or Family Referral' >Friend or Family Referral<\/option><option value='Email' >Email<\/option><option value='Online Advertisement' >Online Advertisement<\/option><option value='Direct Mail' >Direct Mail<\/option><option value='Other' >Other<\/option><\/select><\/div><\/div><div id=\"field_2_123\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full form-question-below-text gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><h3 class=\"h3-heading font-semibold text-foreground mb-2\">How You Found Us<\/h3><p class=\"p-text text-sm text-muted-foreground leading-relaxed\">Learning how you came across B-QUOTED helps us refine how we share our services and reach more people who could benefit from better coverage options.<\/p><\/div><\/div><\/div>\n        <div class='gform-page-footer gform_page_footer top_label'><input type='submit' id='gform_previous_button_2' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='submit' id='gform_submit_button_2' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Submit'  \/> <input type='hidden' name='gform_ajax' value='form_id=2&amp;title=&amp;description=&amp;tabindex=0&amp;theme=orbital&amp;hash=18eab37819c7171bff3b3a11717aa9be' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_2' value='iframe' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_2' id='gform_theme_2' value='orbital' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_2' id='gform_style_settings_2' value='' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_2' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='2' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='USD' value='0ddCPqsUZtpe81kfbabh76BVPKFoLaaSbtofRUo8ZwLfUbFZ9ZqxvaGXTZ+OCzIAuFVcT8NO1opowINMGgrJuCxcNDsx4GRhQcV0HMWja7d77es=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_2' 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data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-far-question-circle\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M256 8C119.043 8 8 119.083 8 256c0 136.997 111.043 248 248 248s248-111.003 248-248C504 119.083 392.957 8 256 8zm0 448c-110.532 0-200-89.431-200-200 0-110.495 89.472-200 200-200 110.491 0 200 89.471 200 200 0 110.53-89.431 200-200 200zm107.244-255.2c0 67.052-72.421 68.084-72.421 92.863V300c0 6.627-5.373 12-12 12h-45.647c-6.627 0-12-5.373-12-12v-8.659c0-35.745 27.1-50.034 47.579-61.516 17.561-9.845 28.324-16.541 28.324-29.579 0-17.246-21.999-28.693-39.784-28.693-23.189 0-33.894 10.977-48.942 29.969-4.057 5.12-11.46 6.071-16.666 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class=\"elementor-icon-box-description\">\n\t\t\t\t\t\tYour age helps us match you with the most suitable life insurance options. No matter your stage in life, coverage can provide reassurance and financial protection for those who matter most.\t\t\t\t\t<\/p>\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Step 1 of 23 &#8211; 4% When were you born? 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