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document.getElementById('ApplFirstNameLabel').innerHTML = "<span class='requiredMark'>*</span>Applicant's First Name"; document.getElementById('ApplLastNameLabel').innerHTML = "<span class='requiredMark'>*</span>Applicant's Last Name"; document.getElementById('NameRow').className = "fullName highlightMe"; } else { document.getElementById('ApplFirstNameLabel').innerHTML = "<span class='requiredMark'>*</span>Your First Name"; document.getElementById('ApplLastNameLabel').innerHTML = "<span class='requiredMark'>*</span>Your Last Name"; document.getElementById('NameRow').className = "fullName highlightMe hideMe"; } } function showHideExt(cntl) { if(cntl.selectedIndex == 1) { document.getElementById('ExtSpan').className = "showMe"; } else { document.getElementById('ExtSpan').className = "hideMe"; } } function UpdateCompletionMeter(index) { //document.getElementById('meter').className = "step" + index; //alert(document.getElementById('meter').className); } </script> <div class="requiredLabel"><span class="requiredMark">*</span> <span class="requiredFieldText"> Required Field</span></div> <fieldset class="basicInformation"> <ol> <li class="policyFor highlightMe"> <!-- Who is this policy for --><label><span class="requiredMark">*</span> Who is This Policy For?</label> <select name="StartQuoteControl1:PolicyForDDL" id="StartQuoteControl1_PolicyForDDL" onchange="callShowHide(this);UpdateCompletionMeter(1);"> <option selected="selected" value="Self">Myself</option> <option value="Spouse">Spouse</option> <option value="Parent">Parent</option> <option value="Child">Child</option> <option value="Other">Other</option> </select> <LI class="fullName highlightMe hideMe" id="NameRow"> <LABEL>Your Full Name</LABEL> <input name="StartQuoteControl1:ContactFullNameTB" type="text" id="StartQuoteControl1_ContactFullNameTB" /><span id='StartQuoteControl1_ContactNameTextLengthValidator_NEF' style='visibility:hidden;display:none' ><img id='ContactNameTextLengthValidator_NEFImg' src='/DES/Appearance/Validation/checkmarkGreen.gif' alt='' /></span> <li class="highlightMe"> <!-- First name --><label id="ApplFirstNameLabel"><span class="requiredMark">*</span> Your First Name</label><input name="StartQuoteControl1:FirstNameTB" type="text" id="StartQuoteControl1_FirstNameTB" OnBlur="UpdateCompletionMeter(12);" /> <span id='StartQuoteControl1_FirstNameMCV_NEF' style='visibility:hidden;display:none' ><img id='FirstNameMCV_NEFImg' src='/DES/Appearance/Validation/checkmarkGreen.gif' alt='' /></span> <li class="highlightMe"> <!-- Last name --><label id="ApplLastNameLabel"><span class="requiredMark">*</span> Your Last Name</label> <input name="StartQuoteControl1:LastNameTB" type="text" id="StartQuoteControl1_LastNameTB" OnBlur="UpdateCompletionMeter(13);" /><span id='StartQuoteControl1_LastNameMCV_NEF' style='visibility:hidden;display:none' ><img id='LastNameMCV_NEFImg' src='/DES/Appearance/Validation/checkmarkGreen.gif' alt='' /></span> <li class="highlightMe"> <!-- Street address --><label><span class="requiredMark">*</span> Street address</label> <input name="StartQuoteControl1:AddressTB" type="text" id="StartQuoteControl1_AddressTB" OnBlur="UpdateCompletionMeter(9);" /> <span id='StartQuoteControl1_AddressTextLengthValidator_NEF' style='visibility:hidden;display:none' ><img id='AddressTextLengthValidator_NEFImg' src='/DES/Appearance/Validation/checkmarkGreen.gif' alt='' /></span> <li class="highlightMe"> <!-- Zip code --><label><span class="requiredMark">*</span> Zip Code</label> <input name="StartQuoteControl1:ZipCodeTB" type="text" maxlength="5" id="StartQuoteControl1_ZipCodeTB" class="zipCode" OnBlur="UpdateCompletionMeter(8);" /><span id='StartQuoteControl1_ZipCodeMCV_NEF' style='visibility:hidden;display:none' ><img id='ZipCodeMCV_NEFImg' src='/DES/Appearance/Validation/checkmarkGreen.gif' alt='' /></span> <li class="highlightMe"> <!-- Home phone --> <label><span class="requiredMark">*</span> Primary Phone </label> <input name="StartQuoteControl1:HomePhoneTB" type="text" id="StartQuoteControl1_HomePhoneTB" onblur="FormatPhone(this);UpdateCompletionMeter(10);" /> <span id='StartQuoteControl1_HomePhoneMCV_NEF' style='visibility:hidden;display:none' ><img id='HomePhoneMCV_NEFImg' src='/DES/Appearance/Validation/checkmarkGreen.gif' alt='' /></span> <li class="highlightMe work"> <!-- Other phone --><label>Secondary Phone</label> <input name="StartQuoteControl1:AddlPhoneTB" type="text" id="StartQuoteControl1_AddlPhoneTB" class="number" onblur="FormatPhone(this)" /> <span id='StartQuoteControl1_WorkPhoneMCV_NEF' style='visibility:hidden;display:none' ><img id='WorkPhoneMCV_NEFImg' src='/DES/Appearance/Validation/checkmarkGreen.gif' alt='' /></span> <li class="highlightMe"> <!-- Email address --><label><span class="requiredMark">*</span> Your Valid Email Address</label> <input name="StartQuoteControl1:EmailTB" type="text" id="StartQuoteControl1_EmailTB" class="emailAddress" OnBlur="UpdateCompletionMeter(11);" /><span id='StartQuoteControl1_EmailRegexValidator_NEF' style='visibility:hidden;display:none' ><img id='EmailRegexValidator_NEFImg' src='/DES/Appearance/Validation/checkmarkGreen.gif' alt='' /></span><IMG class="note" height="16" alt="A valid address is required so that we can send you a detailed quote analysis via email." src="images/EF/NoJunkMail.gif" width="35"> <li class="highlightMe gender"> <!-- Gender --><label class="legend"><span class="requiredMark">*</span> Gender</label> <span id="StartQuoteControl1_GenderRBL" style="OrigCss: ;"><input id="StartQuoteControl1_GenderRBL_0" type="radio" name="StartQuoteControl1:GenderRBL" value="M" /><label for="StartQuoteControl1_GenderRBL_0"> <span class="rbText">Male</span></label><input id="StartQuoteControl1_GenderRBL_1" type="radio" name="StartQuoteControl1:GenderRBL" value="F" /><label for="StartQuoteControl1_GenderRBL_1"> <span class="rbText">Female</span></label></span><span id='StartQuoteControl1_GenderCountTrueConditionsValidator_NEF' style='visibility:hidden;display:none' ><img id='GenderCountTrueConditionsValidator_NEFImg' src='/DES/Appearance/Validation/checkmarkGreen.gif' alt='' /></span> <li class="highlightMe dob"> <!-- DoB --><label><span class="requiredMark">*</span> Date of Birth</label> <select name="StartQuoteControl1:BirthMonthDDL" id="StartQuoteControl1_BirthMonthDDL" class="month" OnBlur="UpdateCompletionMeter(5);"> <option selected="selected" value="MM">MM</option> <option value="01">Jan</option> <option value="02">Feb</option> <option value="03">Mar</option> <option value="04">Apr</option> <option value="05">May</option> <option value="06">Jun</option> <option value="07">Jul</option> <option value="08">Aug</option> <option value="09">Sep</option> <option value="10">Oct</option> <option value="11">Nov</option> <option value="12">Dec</option> </select><select name="StartQuoteControl1:BirthDayDDL" id="StartQuoteControl1_BirthDayDDL" class="day" OnBlur="UpdateCompletionMeter(6);"> <option selected="selected" value="DD">DD</option> <option value="01">1</option> <option value="02">2</option> <option value="03">3</option> <option value="04">4</option> <option value="05">5</option> <option value="06">6</option> <option value="07">7</option> <option value="08">8</option> <option value="09">9</option> <option value="10">10</option> <option value="11">11</option> <option value="12">12</option> <option value="13">13</option> <option value="14">14</option> <option value="15">15</option> <option value="16">16</option> <option value="17">17</option> <option value="18">18</option> <option value="19">19</option> <option value="20">20</option> <option value="21">21</option> <option value="22">22</option> <option value="23">23</option> <option value="24">24</option> <option value="25">25</option> <option value="26">26</option> <option value="27">27</option> <option value="28">28</option> <option value="29">29</option> <option 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value="1957">1957</option> <option value="1958">1958</option> <option value="1959">1959</option> <option value="1960">1960</option> <option value="1961">1961</option> <option value="1962">1962</option> <option value="1963">1963</option> <option value="1964">1964</option> <option value="1965">1965</option> <option value="1966">1966</option> <option value="1967">1967</option> <option value="1968">1968</option> <option value="1969">1969</option> <option value="1970">1970</option> <option value="1971">1971</option> <option value="1972">1972</option> <option value="1973">1973</option> <option value="1974">1974</option> <option value="1975">1975</option> <option value="1976">1976</option> <option value="1977">1977</option> <option value="1978">1978</option> <option value="1979">1979</option> <option value="1980">1980</option> <option value="1981">1981</option> <option value="1982">1982</option> <option value="1983">1983</option> <option value="1984">1984</option> <option value="1985">1985</option> <option value="1986">1986</option> <option value="1987">1987</option> <option value="1988">1988</option> <option value="1989">1989</option> <option value="1990">1990</option> <option value="1991">1991</option> <option value="1992">1992</option> <option value="1993">1993</option> <option value="1994">1994</option> <option value="1995">1995</option> <option value="1996">1996</option> <option value="1997">1997</option> <option value="1998">1998</option> <option value="1999">1999</option> <option value="2000">2000</option> <option value="2001">2001</option> </select><span id='StartQuoteControl1_DOBMCV_NEF' style='visibility:hidden;display:none' ><img id='DOBMCV_NEFImg' src='/DES/Appearance/Validation/checkmarkGreen.gif' alt='' /></span> <li class="highlightMe heightweight"> <!-- Height/Weight --><label class="heightWeightLabel"><span class="requiredMark">*</span> Height/Weight</label> <select name="StartQuoteControl1:HeightDDL" id="StartQuoteControl1_HeightDDL" class="height noFloat" OnBlur="UpdateCompletionMeter(3);"> <option value="36">3'0</option> <option value="37">3'1</option> <option value="38">3'2</option> <option value="39">3'3</option> <option value="40">3'4</option> <option value="41">3'5</option> <option value="42">3'6</option> <option value="43">3'7</option> <option value="44">3'8</option> <option selected="selected" value="0"></option> <option value="45">3'9</option> <option value="46">3'10</option> <option value="47">3'11</option> <option value="48">4'0</option> <option value="49">4'1</option> <option value="50">4'2</option> <option value="51">4'3</option> <option value="52">4'4</option> <option value="53">4'5</option> <option value="54">4'6</option> <option value="55">4'7</option> <option value="56">4'8</option> <option value="57">4'9</option> <option value="58">4'10</option> <option value="59">4'11</option> <option value="60">5'0</option> <option value="61">5'1</option> <option value="62">5'2</option> <option 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Efinancial, LLC's California license number (d/b/a Efinancial Term Insurance Services) is 0F37537; in Louisiana, 323680 and in Utah, 104501.<br /><br /> American General Life and Accident Insurance Company, Nashville, TN; Banner Life Insurance Company, Urbana, MD, and William Penn Life Insurance Company, Garden City, NY, both Legal & General America companies; Fidelity Life Association, A Legal Reserve Life Insurance Company, Oak Brook, IL; Genworth Life and Annuity Insurance Company, Lynchburg, VA and Genworth Life Insurance Company of New York, New York, NY, member companies of Genworth Financial, Inc.; First MetLife Investors Insurance Company, New York, NY, MetLife Investors USA Insurance Company, Irvine, CA and Metropolitan Life Insurance Company, New York, NY, all three members of the MetLife family; Protective Life and Annuity, Birmingham, AL; Pruco Life Insurance Company, Newark, NJ and Pruco Life Insurance Company of New Jersey, Newark, NJ, member companies of Prudential Financial, Inc., Newark, NJ; Reliastar Life Insurance Company, Minneapolis, MN, Reliastar Life Insurance Company of New York, Woodbury, NY and Security Life of Denver Insurance Company, Denver, CO, member of the ING family of companies; Transamerica Financial Life Insurance Company, Harrison, NY, and Transamerica Life Insurance Company, Cedar Rapids, IA, both AEGON companies; <br /> <br /> Rates and time taken to purchase a policy vary by product. <br /><br /><a href="Privacy-Policy.aspx" id="FooterNavEF1_A1" class="termsOfUse popupbox" name="windowX">Privacy Policy</a> | <a href="Terms-of-Use.aspx" id="FooterNavEF1_A2" class="termsOfUse popupbox" name="windowX">Terms of Use & Legal</a><br /><br /><span class="copyRightWide">Copyright © Efinancial Insurance Services. 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