insurancedirectcanada.com
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urlscan Pro
104.21.75.93
Public Scan
Submitted URL: http://www.insurancedirectcanada.ca/wp-content/plugins/formcraft/file-upload/server/content/files/160702eb5e8acd---45076519714.pdf
Effective URL: https://insurancedirectcanada.com/show-quotes/
Submission: On March 10 via api from FR — Scanned from CA
Effective URL: https://insurancedirectcanada.com/show-quotes/
Submission: On March 10 via api from FR — Scanned from CA
Form analysis 8 forms found in the DOM
<form id="fc69255_63" class="a_12363 nform no_submit_hidden save_form placeholder noframe ltr none spin check_conflict allow_multi three block_label star_true vertical fc-common"
ng-style="{background: con[0].bg_image, width: con[0].fw, borderRadius: con[0].fr+"px", MozBorderRadius: con[0].fr+"px", WebkitBorderRadius: con[0].fr+"px", fontFamily: con[0].formfamily}"
style="background: blue; width: 480px; border-radius: 0px; font-family: "Helvetica Neue", Arial;"><input type="hidden" class="form_id ng-pristine ng-valid" val="63" ng-model="con[0].form_main_id"><input type="hidden" class="getlocation"
val="" name="location_hidden__0_0_1000_" value="https://www.insurancedirectcanada.com/wp-admin/admin.php?page=formcraft_admin&id=63"><a id="anchor_12905_anchor"></a><a href="#anchor_12905_anchor" class="anchor_trigger"></a>
<div id="fe_title" class="nform_li form_title none"
ng-style="{fontSize: con[0].ft_px+"px", borderTopLeftRadius: con[0].fr+"px", MozBorderTopLeftRadius: con[0].fr+"px", WebkitBorderTopLeftRadius: con[0].fr+"px", borderTopRightRadius: con[0].fr+"px", MozBorderTopRightRadius: con[0].fr+"px", WebkitBorderTopRightRadius: con[0].fr+"px", color: con[0].ft_co, backgroundColor: con[0].ft_bg, fontFamily: con[0].tfamily, fontWeight: con[0].tbold, backgroundImage: con[0].bg_image, textAlign: con[0].ftalign}"
style="font-size: 18px; border-top-left-radius: 0px; border-top-right-radius: 0px; color: rgb(255, 255, 255); background-color: rgb(0, 0, 255); font-weight: bold; text-align: left;">Request a call back</div>
<ul class="form_ul none" id="form_ul" style="height: auto; opacity: 1;">
<li ng-repeat="el in build" ng-style="{paddingBottom: con[0].space+"px", paddingTop: con[0].space+"px"}" id="fe_0_12363" class="nform_li ng-scope inline2 left fe_0 required-1"
ng-class="[el.default, el.inline, con[0].field_align, el.li_class, "fe_"+$index, "required-"+el.req]" scale="" style="padding-bottom: 8px; padding-top: 8px;">
<div compile="el.el_f" ng-style="{marginBottom: el.divspa, marginTop: el.divspa}"><input type="hidden" class="name_holder ng-scope" value="First name"><span class="cap_cover relative"><span class="cap1 "
ng-style="{ fontSize: con[0].lfs, color: con[0].lfc}" style="font-size: 13px;">First name<span class="show_1">*</span></span><span class="cap2 " ng-bind="el.cap2" ng-style="{ fontSize: con[0].slfs, color: con[0].slfc }"
style="font-size: 11px;"></span></span><span class="input_cover text_cover ng-scope"><input type="text" ng-style="{width: el.wid, fontSize: con[0].field_font, color: con[0].input_color}" placeholder="First name" has_p="placeholder"
name="First name_text_alphabets_1_2_30_field0_txtfirstname" class="field_class" do_what="[]" style="width: 100%; font-size: 15px;"><span class="q_cover" style="display: none;"><span class="inst ttip"
ng-style="{ fontSize: con[0].ifs, color: con[0].lfc }" data-original-title="" style="position: absolute;"><i class="formcraft-help-circled"></i></span></span><span class="field0 valid_show" style="display: none;"></span></span></div>
<span class="element_id ng-binding">0</span>
</li>
<li ng-repeat="el in build" ng-style="{paddingBottom: con[0].space+"px", paddingTop: con[0].space+"px"}" id="fe_1_12363" class="nform_li ng-scope inline2 left fe_1 required-1"
ng-class="[el.default, el.inline, con[0].field_align, el.li_class, "fe_"+$index, "required-"+el.req]" scale="" style="padding-bottom: 8px; padding-top: 8px;">
<div compile="el.el_f" ng-style="{marginBottom: el.divspa, marginTop: el.divspa}"><input type="hidden" class="name_holder ng-scope" value="Last name"><span class="cap_cover relative"><span class="cap1 "
ng-style="{ fontSize: con[0].lfs, color: con[0].lfc}" style="font-size: 13px;">Last name<span class="show_1">*</span></span><span class="cap2 " ng-bind="el.cap2" ng-style="{ fontSize: con[0].slfs, color: con[0].slfc }"
style="font-size: 11px;"></span></span><span class="input_cover text_cover ng-scope"><input type="text" ng-style="{width: el.wid, fontSize: con[0].field_font, color: con[0].input_color}" placeholder="Last name" has_p="placeholder"
name="Last name_text_alphabets_1_2_30_field1_txtlastname" class="field_class" do_what="[]" style="width: 100%; font-size: 15px;"><span class="q_cover" style="display: none;"><span class="inst ttip"
ng-style="{ fontSize: con[0].ifs, color: con[0].lfc }" data-original-title="" style="position: absolute;"><i class="formcraft-help-circled"></i></span></span><span class="field1 valid_show" style="display: none;"></span></span></div>
<span class="element_id ng-binding">1</span>
</li>
<li ng-repeat="el in build" ng-style="{paddingBottom: con[0].space+"px", paddingTop: con[0].space+"px"}" id="fe_2_12363" class="nform_li ng-scope inline1 left fe_2 required-1"
ng-class="[el.default, el.inline, con[0].field_align, el.li_class, "fe_"+$index, "required-"+el.req]" scale="" style="padding-bottom: 8px; padding-top: 8px;">
<div compile="el.el_f" ng-style="{marginBottom: el.divspa, marginTop: el.divspa}"><input type="hidden" class="name_holder ng-scope" value="Mobile number"><span class="cap_cover relative"><span class="cap1 "
ng-style="{ fontSize: con[0].lfs, color: con[0].lfc}" style="font-size: 13px;">Mobile number<span class="show_1">*</span></span><span class="cap2 " ng-bind="el.cap2" ng-style="{ fontSize: con[0].slfs, color: con[0].slfc }"
style="font-size: 11px;"></span></span><span class="input_cover text_cover ng-scope"><input type="text" ng-style="{width: el.wid, fontSize: con[0].field_font, color: con[0].input_color}" placeholder="Mobile number" has_p="placeholder"
name="Mobile number_text_alphabets_1_10__field2_txtphone_valid" class="field_class" do_what="[]" style="width: 100%; font-size: 15px;"><span class="q_cover" style="display: none;"><span class="inst ttip"
ng-style="{ fontSize: con[0].ifs, color: con[0].lfc }" data-original-title="" style="position: absolute;"><i class="formcraft-help-circled"></i></span></span><span class="field2 valid_show" style="display: none;"></span></span></div>
<span class="element_id ng-binding">2</span>
</li>
<li ng-repeat="el in build" ng-style="{paddingBottom: con[0].space+"px", paddingTop: con[0].space+"px"}" id="fe_3_12363" class="nform_li ng-scope inline1 left fe_3 required-1"
ng-class="[el.default, el.inline, con[0].field_align, el.li_class, "fe_"+$index, "required-"+el.req]" scale="" style="padding-bottom: 8px; padding-top: 8px;">
<div compile="el.el_f" ng-style="{marginBottom: el.divspa, marginTop: el.divspa}"><input type="hidden" class="name_holder ng-scope" value="Email address"><span class="cap_cover relative"><span class="cap1 "
ng-style="{ fontSize: con[0].lfs, color: con[0].lfc }" style="font-size: 13px;">Email address<span class="show_1">*</span></span><span class="cap2 " ng-bind="el.cap2" ng-style="{fontSize: con[0].slfs, color: con[0].slfc }"
style="font-size: 11px;"></span></span><span class="input_cover text_cover ng-scope"><span class="emailfield-cover" ng-style="{ width: el.wid, fontSize: con[0].field_font }" style="width: 100%; font-size: 15px;"><input type="email"
ng-style="{fontSize: con[0].field_font, color: con[0].input_color}" placeholder="Email address" has_p="placeholder" style="width: 100%; font-size: 15px;" name="Email address_email_email_1___field3_____" do_what="[]"
class="field_class"></span><span class="q_cover" style="display: none;"><span class="inst ttip" ng-style="{ fontSize: con[0].ifs, color: con[0].lfc }" data-original-title=""
style="position: absolute;"><i class="formcraft-help-circled"></i></span></span><span class="field3 valid_show" style="display: none;"></span></span></div><span class="element_id ng-binding">3</span>
</li>
<li ng-repeat="el in build" ng-style="{paddingBottom: con[0].space+"px", paddingTop: con[0].space+"px"}" id="fe_4_12363" class="nform_li ng-scope inline1 left fe_4 required-1"
ng-class="[el.default, el.inline, con[0].field_align, el.li_class, "fe_"+$index, "required-"+el.req]" scale="" style="padding-bottom: 8px; padding-top: 8px;">
<div compile="el.el_f" ng-style="{marginBottom: el.divspa, marginTop: el.divspa}"><input type="hidden" class="name_holder ng-scope" value="Type your message..."><span class="cap_cover relative"><span class="cap1 "
ng-style="{ fontSize: con[0].lfs, color: con[0].lfc }" style="font-size: 13px;">Type your message...<span class="show_1">*</span></span><span class="cap2 " ng-bind="el.cap2" ng-style="{ fontSize: con[0].slfs, color: con[0].slfc }"
style="font-size: 11px;"></span></span><span class="input_cover text_cover ng-scope"><textarea rows="2" ng-style="{width: el.wid, fontSize: con[0].field_font, color: con[0].input_color}" placeholder="Type your message..."
has_p="placeholder" name="Type your message..._para__1__300_field4_" class="field_class" do_what="[]" style="width: 100%; font-size: 15px;"></textarea><span class="q_cover" style="display: none;"><span class="inst ttip"
ng-style="{ fontSize: con[0].ifs, color: con[0].lfc }" data-original-title="" style="position: absolute;"><i class="formcraft-help-circled"></i></span></span><span class="field4 valid_show" style="display: none;"></span></span></div>
<span class="element_id ng-binding">4</span>
</li>
<li ng-repeat="el in build" ng-style="{paddingBottom: con[0].space+"px", paddingTop: con[0].space+"px"}" id="fe_5_12363" class="nform_li ng-scope inline2 left fe_5 required-1"
ng-class="[el.default, el.inline, con[0].field_align, el.li_class, "fe_"+$index, "required-"+el.req]" scale="" style="padding-bottom: 8px; padding-top: 8px;">
<div compile="el.el_f" ng-style="{marginBottom: el.divspa, marginTop: el.divspa}"><input type="hidden" class="name_holder ng-scope" value="When"><span class="cap_cover relative"><span class="cap1 "
ng-style="{ fontSize: con[0].lfs, color: con[0].lfc }" style="font-size: 13px;">When<span class="show_1">*</span></span><span class="cap2 " ng-bind="el.cap2" ng-style="{ fontSize: con[0].slfs, color: con[0].slfc }"
style="font-size: 11px;"></span></span><span class="input_cover text_cover ng-scope">
<div class="select-cover no-ar" ng-style="{width: el.wid}" style="width: 100%;"><select class="field_class" do_what="[]" ng-style="{fontSize: con[0].field_font, color: con[0].input_color}" name="When_dropdown__1___field5_"
style="font-size: 15px;">
<option ng-repeat="opt in el.options_final" value="0" class="ng-scope ng-binding">Best time to call...</option>
<option ng-repeat="opt in el.options_final" value="Call me now" class="ng-scope ng-binding">Call me now</option>
<option ng-repeat="opt in el.options_final" value="Weekdays Morning" class="ng-scope ng-binding">Weekdays Morning</option>
<option ng-repeat="opt in el.options_final" value="Weekdays Afternoon" class="ng-scope ng-binding">Weekdays Afternoon</option>
<option ng-repeat="opt in el.options_final" value="Weekdays Evening" class="ng-scope ng-binding">Weekdays Evening</option>
<option ng-repeat="opt in el.options_final" value="Saturdays Morning" class="ng-scope ng-binding">Saturdays Morning</option>
<option ng-repeat="opt in el.options_final" value="Saturdays Afternoon" class="ng-scope ng-binding">Saturdays Afternoon</option>
</select></div><span class="q_cover" style="display: none;"><span class="inst ttip" ng-style="{ fontSize: con[0].ifs, color: con[0].lfc }" data-original-title=""
style="position: absolute;"><i class="formcraft-help-circled"></i></span></span><span class="field5 valid_show" style="display: none;"></span>
</span></div><span class="element_id ng-binding">5</span>
</li>
<li ng-repeat="el in build" ng-style="{paddingBottom: con[0].space+"px", paddingTop: con[0].space+"px"}" id="fe_6_12363" class="nform_li ng-scope inline2 left fe_6 required-0"
ng-class="[el.default, el.inline, con[0].field_align, el.li_class, "fe_"+$index, "required-"+el.req]" scale="" style="padding-bottom: 8px; padding-top: 8px;">
<div compile="el.el_f" ng-style="{marginBottom: el.divspa, marginTop: el.divspa}"><input type="hidden" class="name_holder ng-scope" value="Call me back"><button type="submit" class="submit_button nform_btn boots"
ng-style="{backgroundColor: el.sco, fontSize: el.sfs, left: el.lp, marginTop: el.tp, marginBottom: el.bp, marginRight: el.rp, height: el.spad1, width: el.spad2, borderRadius: el.curve, MozBorderRadius: el.curve, WebkitBorderRadius: el.curve, fontFamily: el.sfamily, fontWeight: el.sbold, color: el.sbfco}"
style="background-color: rgb(255, 165, 0); font-size: 18px; height: 38px; width: 100%; border-radius: 2px; font-weight: bold; color: rgb(255, 255, 255);">Call me back</button></div><span class="element_id ng-binding">6</span>
</li>
</ul>
<div id="fe_submit" class="form_submit" style="position: relative">
<div class="res_div"><span class="nform_res"></span></div><span
style="text-align: center; display: inline; padding-top: 8px; padding-bottom: 4px"><a class="ref_link" ng-href="" compile="con[0].rlink" target="_blank" title="Opens in a new tab" href=""></a></span>
</div><input type="text" name="name" id="waspnet" value="">
</form><form id="fc16843_36" class="a_12336 nform no_submit_hidden save_form placeholder noframe ltr none spin check_conflict allow_multi three block_label star_true horizontal fc-common"
ng-style="{background: con[0].bg_image, width: con[0].fw, borderRadius: con[0].fr+"px", MozBorderRadius: con[0].fr+"px", WebkitBorderRadius: con[0].fr+"px", fontFamily: con[0].formfamily}"
style="background: blue; width: 100%; border-radius: 0px; font-family: "Helvetica Neue", Arial;"><input type="hidden" class="form_id ng-pristine ng-valid" val="36" ng-model="con[0].form_main_id"><input type="hidden" class="getlocation"
val="" name="location_hidden__0_0_1000_" value="https://www.insurancedirectcanada.com/wp-admin/admin.php?page=formcraft_admin&id=36"><a id="anchor_21440_anchor"></a><a href="#anchor_21440_anchor" class="anchor_trigger"></a>
<div id="fe_title" class="nform_li form_title none"
ng-style="{fontSize: con[0].ft_px+"px", borderTopLeftRadius: con[0].fr+"px", MozBorderTopLeftRadius: con[0].fr+"px", WebkitBorderTopLeftRadius: con[0].fr+"px", borderTopRightRadius: con[0].fr+"px", MozBorderTopRightRadius: con[0].fr+"px", WebkitBorderTopRightRadius: con[0].fr+"px", color: con[0].ft_co, backgroundColor: con[0].ft_bg, fontFamily: con[0].tfamily, fontWeight: con[0].tbold, backgroundImage: con[0].bg_image, textAlign: con[0].ftalign}"
style="font-size: 18px; border-top-left-radius: 0px; border-top-right-radius: 0px; color: rgb(255, 255, 255); background-color: rgb(0, 0, 255); font-weight: bold; text-align: left;">Search for more quotes</div>
<ul class="form_ul none" id="form_ul" style="height: auto; opacity: 1;">
<li ng-repeat="el in build" ng-style="{paddingBottom: con[0].space+"px", paddingTop: con[0].space+"px"}" id="fe_0_12336" class="nform_li ng-scope inline2 left fe_0 required-1"
ng-class="[el.default, el.inline, con[0].field_align, el.li_class, "fe_"+$index, "required-"+el.req]" scale="" style="padding-bottom: 8px; padding-top: 8px;">
<div compile="el.el_f" ng-style="{marginBottom: el.divspa, marginTop: el.divspa}"><input type="hidden" class="name_holder ng-scope" value="TYPE OF INSURANCE"><span class="cap_cover relative"><span class="cap1 subl"
ng-style="{ fontSize: con[0].lfs, color: con[0].lfc }" style="font-size: 13px; color: rgb(255, 252, 252);">TYPE OF INSURANCE<span class="show_1">*</span></span><span class="cap2 subl" ng-bind="el.cap2"
ng-style="{ fontSize: con[0].slfs, color: con[0].slfc }" style="font-size: 11px; color: rgb(255, 255, 255);"></span></span><span class="input_cover text_cover ng-scope">
<div class="select-cover no-ar" ng-style="{width: el.wid}" style="width: 100%;"><select class="field_class" do_what="[]" ng-style="{fontSize: con[0].field_font, color: con[0].input_color}"
name="TYPE OF INSURANCE_dropdown__1___field0_seltype_of_insurance" style="font-size: 15px; color: rgb(0, 0, 0);">
<option ng-repeat="opt in el.options_final" value="0" class="ng-scope ng-binding">Type of life insurance...</option>
<option ng-repeat="opt in el.options_final" value="0" class="ng-scope ng-binding">---Term Life Insurance---</option>
<option ng-repeat="opt in el.options_final" value="TL10" class="ng-scope ng-binding">Term Life 10-year</option>
<option ng-repeat="opt in el.options_final" value="TL15" class="ng-scope ng-binding">Term Life 15-year</option>
<option ng-repeat="opt in el.options_final" value="TL20" class="ng-scope ng-binding">Term Life 20-year</option>
<option ng-repeat="opt in el.options_final" value="TL25" class="ng-scope ng-binding">Term Life 25-year</option>
<option ng-repeat="opt in el.options_final" value="TL30" class="ng-scope ng-binding">Term Life 30-year</option>
<option ng-repeat="opt in el.options_final" value="TL35" class="ng-scope ng-binding">Term Life 35-year</option>
<option ng-repeat="opt in el.options_final" value="TL40" class="ng-scope ng-binding">Term Life 40-year</option>
<option ng-repeat="opt in el.options_final" value="TL65" class="ng-scope ng-binding">Term Life - Pay to Age 65</option>
<option ng-repeat="opt in el.options_final" value="T100" class="ng-scope ng-binding">Term 100 - Pay Lifetime</option>
<option ng-repeat="opt in el.options_final" value="0" class="ng-scope ng-binding">---Whole Life Insurance---</option>
<option ng-repeat="opt in el.options_final" value="WLLP" class="ng-scope ng-binding">Whole Life - Pay Lifetime</option>
<option ng-repeat="opt in el.options_final" value="WL65" class="ng-scope ng-binding">Whole Life - Pay to Age 65</option>
<option ng-repeat="opt in el.options_final" value="WL20" class="ng-scope ng-binding">Whole Life - Pay 20-year</option>
<option ng-repeat="opt in el.options_final" value="WL15" class="ng-scope ng-binding">Whole Life - Pay 15-year</option>
<option ng-repeat="opt in el.options_final" value="WL10" class="ng-scope ng-binding">Whole Life - Pay 10-year</option>
<option ng-repeat="opt in el.options_final" value="0" class="ng-scope ng-binding">---Universal Life Insurance---</option>
<option ng-repeat="opt in el.options_final" value="ULMP" class="ng-scope ng-binding">Universal Life - Pay Minimum</option>
<option ng-repeat="opt in el.options_final" value="UL20" class="ng-scope ng-binding">Universal Life - Pay 20-year</option>
<option ng-repeat="opt in el.options_final" value="UL15" class="ng-scope ng-binding">Universal Life - Pay 15-year</option>
<option ng-repeat="opt in el.options_final" value="UL10" class="ng-scope ng-binding">Universal Life - Pay 10-year</option>
</select></div><span class="q_cover" style="display: none;"><span class="inst ttip" ng-style="{ fontSize: con[0].ifs, color: con[0].lfc }" data-original-title=""
style="color: rgb(255, 252, 252); position: absolute;"><i class="formcraft-help-circled"></i></span></span><span class="field0 valid_show" style="display: none;"></span>
</span></div><span class="element_id ng-binding">0</span>
</li>
<li ng-repeat="el in build" ng-style="{paddingBottom: con[0].space+"px", paddingTop: con[0].space+"px"}" id="fe_1_12336" class="nform_li ng-scope inline2 left fe_1 required-1"
ng-class="[el.default, el.inline, con[0].field_align, el.li_class, "fe_"+$index, "required-"+el.req]" scale="" style="padding-bottom: 8px; padding-top: 8px;">
<div compile="el.el_f" ng-style="{marginBottom: el.divspa, marginTop: el.divspa}"><input type="hidden" class="name_holder ng-scope" value="FACE AMOUNT"><span class="cap_cover relative"><span class="cap1 subl"
ng-style="{ fontSize: con[0].lfs, color: con[0].lfc }" style="font-size: 13px; color: rgb(255, 252, 252);">FACE AMOUNT<span class="show_1">*</span></span><span class="cap2 subl" ng-bind="el.cap2"
ng-style="{ fontSize: con[0].slfs, color: con[0].slfc }" style="font-size: 11px; color: rgb(255, 255, 255);"></span></span><span class="input_cover text_cover ng-scope">
<div class="select-cover no-ar" ng-style="{width: el.wid}" style="width: 100%;"><select class="field_class" do_what="[]" ng-style="{fontSize: con[0].field_font, color: con[0].input_color}" name="FACE AMOUNT_dropdown__1___field1_"
style="font-size: 15px; color: rgb(0, 0, 0);">
<option ng-repeat="opt in el.options_final" value="0" class="ng-scope ng-binding">Face amount...</option>
<option ng-repeat="opt in el.options_final" value="D_10000" class="ng-scope ng-binding">$10,000</option>
<option ng-repeat="opt in el.options_final" value="D_25000" class="ng-scope ng-binding">$25,000</option>
<option ng-repeat="opt in el.options_final" value="D_50000" class="ng-scope ng-binding">$50,000</option>
<option ng-repeat="opt in el.options_final" value="D_75000" class="ng-scope ng-binding">$75,000</option>
<option ng-repeat="opt in el.options_final" value="D_100000" class="ng-scope ng-binding">$100,000</option>
<option ng-repeat="opt in el.options_final" value="D_125000" class="ng-scope ng-binding">$125,000</option>
<option ng-repeat="opt in el.options_final" value="D_150000" class="ng-scope ng-binding">$150,000</option>
<option ng-repeat="opt in el.options_final" value="D_175000" class="ng-scope ng-binding">$175,000</option>
<option ng-repeat="opt in el.options_final" value="D_200000" class="ng-scope ng-binding">$200,000</option>
<option ng-repeat="opt in el.options_final" value="D_225000" class="ng-scope ng-binding">$225,000</option>
<option ng-repeat="opt in el.options_final" value="D_250000" class="ng-scope ng-binding">$250,000</option>
<option ng-repeat="opt in el.options_final" value="D_300000" class="ng-scope ng-binding">$300,000</option>
<option ng-repeat="opt in el.options_final" value="D_350000" class="ng-scope ng-binding">$350,000</option>
<option ng-repeat="opt in el.options_final" value="D_400000" class="ng-scope ng-binding">$400,000</option>
<option ng-repeat="opt in el.options_final" value="D_450000" class="ng-scope ng-binding">$450,000</option>
<option ng-repeat="opt in el.options_final" value="D_500000" class="ng-scope ng-binding">$500,000</option>
<option ng-repeat="opt in el.options_final" value="D_550000" class="ng-scope ng-binding">$550,000</option>
<option ng-repeat="opt in el.options_final" value="D_600000" class="ng-scope ng-binding">$600,000</option>
<option ng-repeat="opt in el.options_final" value="D_650000" class="ng-scope ng-binding">$650,000</option>
<option ng-repeat="opt in el.options_final" value="D_700000" class="ng-scope ng-binding">$700,000</option>
<option ng-repeat="opt in el.options_final" value="D_750000" class="ng-scope ng-binding">$750,000</option>
<option ng-repeat="opt in el.options_final" value="D_800000" class="ng-scope ng-binding">$800,000</option>
<option ng-repeat="opt in el.options_final" value="D_900000" class="ng-scope ng-binding">$900,000</option>
<option ng-repeat="opt in el.options_final" value="D_1000000" class="ng-scope ng-binding">$1,000,000</option>
<option ng-repeat="opt in el.options_final" value="D_1100000" class="ng-scope ng-binding">$1,100,000</option>
<option ng-repeat="opt in el.options_final" value="D_1250000" class="ng-scope ng-binding">$1,250,000</option>
<option ng-repeat="opt in el.options_final" value="D_1500000" class="ng-scope ng-binding">$1,500,000</option>
<option ng-repeat="opt in el.options_final" value="D_1750000" class="ng-scope ng-binding">$1,750,000</option>
<option ng-repeat="opt in el.options_final" value="D_2000000" class="ng-scope ng-binding">$2,000,000</option>
<option ng-repeat="opt in el.options_final" value="D_2500000" class="ng-scope ng-binding">$2,500,000</option>
<option ng-repeat="opt in el.options_final" value="D_3000000" class="ng-scope ng-binding">$3,000,000</option>
<option ng-repeat="opt in el.options_final" value="D_4000000" class="ng-scope ng-binding">$4,000,000</option>
<option ng-repeat="opt in el.options_final" value="D_5000000" class="ng-scope ng-binding">$5,000,000</option>
<option ng-repeat="opt in el.options_final" value="D_6000000" class="ng-scope ng-binding">$6,000,000</option>
<option ng-repeat="opt in el.options_final" value="D_7000000" class="ng-scope ng-binding">$7,000,000</option>
<option ng-repeat="opt in el.options_final" value="D_8000000" class="ng-scope ng-binding">$8,000,000</option>
<option ng-repeat="opt in el.options_final" value="D_9000000" class="ng-scope ng-binding">$9,000,000</option>
<option ng-repeat="opt in el.options_final" value="D_10000000" class="ng-scope ng-binding">$10,000,000</option>
</select></div><span class="q_cover" style="display: none;"><span class="inst ttip" ng-style="{ fontSize: con[0].ifs, color: con[0].lfc }" data-original-title=""
style="color: rgb(255, 252, 252); position: absolute;"><i class="formcraft-help-circled"></i></span></span><span class="field1 valid_show" style="display: none;"></span>
</span></div><span class="element_id ng-binding">1</span>
</li>
<li ng-repeat="el in build" ng-style="{paddingBottom: con[0].space+"px", paddingTop: con[0].space+"px"}" id="fe_2_12336" class="nform_li ng-scope inline2 left fe_2 required-1"
ng-class="[el.default, el.inline, con[0].field_align, el.li_class, "fe_"+$index, "required-"+el.req]" scale="" style="padding-bottom: 8px; padding-top: 8px;">
<div compile="el.el_f" ng-style="{marginBottom: el.divspa, marginTop: el.divspa}"><input type="hidden" class="name_holder ng-scope" value="TOBACCO/NICOTINE USE"><span class="cap_cover relative"><span class="cap1 subl"
ng-style="{ fontSize: con[0].lfs, color: con[0].lfc }" style="font-size: 13px; color: rgb(255, 252, 252);">TOBACCO/NICOTINE USE<span class="show_1">*</span></span><span class="cap2 subl" ng-bind="el.cap2"
ng-style="{ fontSize: con[0].slfs, color: con[0].slfc }" style="font-size: 11px; color: rgb(255, 255, 255);"></span></span><span class="input_cover text_cover ng-scope">
<div class="select-cover no-ar" ng-style="{width: el.wid}" style="width: 100%;"><select class="field_class" do_what="[]" ng-style="{fontSize: con[0].field_font, color: con[0].input_color}" name="TOBACCO/NICOTINE USE_dropdown__1___field2_"
style="font-size: 15px; color: rgb(0, 0, 0);">
<option ng-repeat="opt in el.options_final" value="0" class="ng-scope ng-binding">Smoking...</option>
<option ng-repeat="opt in el.options_final" value="SN" class="ng-scope ng-binding">No, I do not smoke</option>
<option ng-repeat="opt in el.options_final" value="SY" class="ng-scope ng-binding">Yes, I am a smoker</option>
</select></div><span class="q_cover" style="display: none;"><span class="inst ttip" ng-style="{ fontSize: con[0].ifs, color: con[0].lfc }" data-original-title=""
style="color: rgb(255, 252, 252); position: absolute;"><i class="formcraft-help-circled"></i></span></span><span class="field2 valid_show" style="display: none;"></span>
</span></div><span class="element_id ng-binding">2</span>
</li>
<li ng-repeat="el in build" ng-style="{paddingBottom: con[0].space+"px", paddingTop: con[0].space+"px"}" id="fe_3_12336" class="nform_li ng-scope inline2 left fe_3 required-1"
ng-class="[el.default, el.inline, con[0].field_align, el.li_class, "fe_"+$index, "required-"+el.req]" scale="" style="padding-bottom: 8px; padding-top: 8px;">
<div compile="el.el_f" ng-style="{marginBottom: el.divspa, marginTop: el.divspa}"><input type="hidden" class="name_holder ng-scope" value="HEALTH CLASS"><span class="cap_cover relative"><span class="cap1 subl"
ng-style="{ fontSize: con[0].lfs, color: con[0].lfc }" style="font-size: 13px; color: rgb(255, 252, 252);">HEALTH CLASS<span class="show_1">*</span></span><span class="cap2 subl" ng-bind="el.cap2"
ng-style="{ fontSize: con[0].slfs, color: con[0].slfc }" style="font-size: 11px; color: rgb(255, 255, 255);"></span></span><span class="input_cover text_cover ng-scope">
<div class="select-cover no-ar" ng-style="{width: el.wid}" style="width: 100%;"><select class="field_class" do_what="[]" ng-style="{fontSize: con[0].field_font, color: con[0].input_color}" name="HEALTH CLASS_dropdown__1___field3_"
style="font-size: 15px; color: rgb(0, 0, 0);">
<option ng-repeat="opt in el.options_final" value="0" class="ng-scope ng-binding">Health class...</option>
<option ng-repeat="opt in el.options_final" value="HS" class="ng-scope ng-binding">Average</option>
<option ng-repeat="opt in el.options_final" value="HP" class="ng-scope ng-binding">Good</option>
<option ng-repeat="opt in el.options_final" value="HPP" class="ng-scope ng-binding">Excellent</option>
</select></div><span class="q_cover" style="display: none;"><span class="inst ttip" ng-style="{ fontSize: con[0].ifs, color: con[0].lfc }" data-original-title=""
style="color: rgb(255, 252, 252); position: absolute;"><i class="formcraft-help-circled"></i></span></span><span class="field3 valid_show" style="display: none;"></span>
</span></div><span class="element_id ng-binding">3</span>
</li>
<li ng-repeat="el in build" ng-style="{paddingBottom: con[0].space+"px", paddingTop: con[0].space+"px"}" id="fe_4_12336" class="nform_li ng-scope inline2 left fe_4 required-0 nform_li_before"
ng-class="[el.default, el.inline, con[0].field_align, el.li_class, "fe_"+$index, "required-"+el.req]" scale="" style="padding-bottom: 8px; padding-top: 8px;">
<div compile="el.el_f" ng-style="{marginBottom: el.divspa, marginTop: el.divspa}"><input type="hidden" class="name_holder ng-scope" value="New quotes"><span class="cap_cover relative"><span class="cap1 subl"
ng-style="{ fontSize: con[0].lfs, color: con[0].lfc }" style="font-size: 13px; color: rgb(255, 252, 252);">New quotes<span class="show_0">*</span></span><span class="cap2 subl" ng-bind="el.cap2"
ng-style="{ fontSize: con[0].slfs, color: con[0].slfc }" style="font-size: 11px; color: rgb(255, 255, 255);"></span></span><span class="input_cover ng-scope" style="display: inline-block"><span class="box_cover ">
<div class="new_ldiv ng-scope" ng-repeat="opt in el.options_final" ng-style="{color: el.ocolor, width: el.wid, fontSize: con[0].field_font}" for="check70"
style="display: inline-block; color: rgb(255, 255, 255); width: 100%; font-size: 15px;"><label class="label_check circle-ticked c_on" ng-class="el.tick_type" style="height: 20px; width: 0px"><input class="field_class_checkbox"
do_what="[{"equals":"SQ","do":"","to":"5,6,7,8,9,10","emails":"","redirect":"","law":"=","doit":"show"}]"
type="checkbox" value="SQ" id="check70" name="New quotes_check__0___field4_"></label>
<div class="label_div ng-binding">Get a new quote</div>
</div><span class="q_cover" style="display: none;"><span class="inst ttip" ng-style="{ fontSize: con[0].ifs, color: con[0].lfc }" data-original-title=""
style="color: rgb(255, 252, 252); position: absolute;"><i class="formcraft-help-circled"></i></span></span><span class="field4 valid_show" style="display: none;"></span>
</span></span></div><span class="element_id ng-binding">4</span>
</li>
<li ng-repeat="el in build" ng-style="{paddingBottom: con[0].space+"px", paddingTop: con[0].space+"px"}" id="fe_5_12336" class="nform_li ng-scope is_hidden inline2 left fe_5 required-1"
ng-class="[el.default, el.inline, con[0].field_align, el.li_class, "fe_"+$index, "required-"+el.req]" scale="" style="padding-bottom: 8px; padding-top: 8px;">
<div compile="el.el_f" ng-style="{marginBottom: el.divspa, marginTop: el.divspa}"><input type="hidden" class="name_holder ng-scope no_show" value="Related"><span class="cap_cover relative"><span class="cap1 subl"
ng-style="{ fontSize: con[0].lfs, color: con[0].lfc }" style="font-size: 13px; color: rgb(255, 252, 252);">Related<span class="show_1">*</span></span><span class="cap2 subl" ng-bind="el.cap2"
ng-style="{ fontSize: con[0].slfs, color: con[0].slfc }" style="font-size: 11px; color: rgb(255, 255, 255);"></span></span><span class="input_cover text_cover ng-scope">
<div class="select-cover no-ar" ng-style="{width: el.wid}" style="width: 100%;"><select class="field_class no_show" do_what="[]" ng-style="{fontSize: con[0].field_font, color: con[0].input_color}" name="Related_dropdown__1___field5_"
style="font-size: 15px; color: rgb(0, 0, 0);">
<option ng-repeat="opt in el.options_final" value="0" class="ng-scope ng-binding">Who is the quote for...</option>
<option ng-repeat="opt in el.options_final" value="RT01" class="ng-scope ng-binding">Just for me</option>
<option ng-repeat="opt in el.options_final" value="RT02" class="ng-scope ng-binding">Spouse/Partner</option>
<option ng-repeat="opt in el.options_final" value="RT03" class="ng-scope ng-binding">Child/Grandchild</option>
<option ng-repeat="opt in el.options_final" value="RT04" class="ng-scope ng-binding">Parent/Grandparent</option>
<option ng-repeat="opt in el.options_final" value="RT05" class="ng-scope ng-binding">Friend/Relative</option>
<option ng-repeat="opt in el.options_final" value="RT06" class="ng-scope ng-binding">Partner/Shareholder</option>
<option ng-repeat="opt in el.options_final" value="RT07" class="ng-scope ng-binding">Key-Person/Employee</option>
</select></div><span class="q_cover" style="display: none;"><span class="inst ttip" ng-style="{ fontSize: con[0].ifs, color: con[0].lfc }" data-original-title=""
style="color: rgb(255, 252, 252); position: absolute;"><i class="formcraft-help-circled"></i></span></span><span class="field5 valid_show" style="display: none;"></span>
</span></div><span class="element_id ng-binding">5</span>
</li>
<li ng-repeat="el in build" ng-style="{paddingBottom: con[0].space+"px", paddingTop: con[0].space+"px"}" id="fe_6_12336" class="nform_li ng-scope is_hidden inline2 left fe_6 required-1"
ng-class="[el.default, el.inline, con[0].field_align, el.li_class, "fe_"+$index, "required-"+el.req]" scale="" style="padding-bottom: 8px; padding-top: 8px;">
<div compile="el.el_f" ng-style="{marginBottom: el.divspa, marginTop: el.divspa}"><input type="hidden" class="name_holder ng-scope no_show" value="PROVINCE"><span class="cap_cover relative"><span class="cap1 subl"
ng-style="{ fontSize: con[0].lfs, color: con[0].lfc }" style="font-size: 13px; color: rgb(255, 252, 252);">PROVINCE<span class="show_1">*</span></span><span class="cap2 subl" ng-bind="el.cap2"
ng-style="{ fontSize: con[0].slfs, color: con[0].slfc }" style="font-size: 11px; color: rgb(255, 255, 255);"></span></span><span class="input_cover text_cover ng-scope">
<div class="select-cover no-ar" ng-style="{width: el.wid}" style="width: 100%;"><select class="field_class no_show" do_what="[]" ng-style="{fontSize: con[0].field_font, color: con[0].input_color}" name="PROVINCE_dropdown__1___field6_"
style="font-size: 15px; color: rgb(0, 0, 0);">
<option ng-repeat="opt in el.options_final" value="0" class="ng-scope ng-binding">Province/Territory...</option>
<option ng-repeat="opt in el.options_final" value="P02" class="ng-scope ng-binding">British Columbia</option>
<option ng-repeat="opt in el.options_final" value="P01" class="ng-scope ng-binding">Alberta</option>
<option ng-repeat="opt in el.options_final" value="P12" class="ng-scope ng-binding">Saskatchewan</option>
<option ng-repeat="opt in el.options_final" value="P03" class="ng-scope ng-binding">Manitoba</option>
<option ng-repeat="opt in el.options_final" value="P09" class="ng-scope ng-binding">Ontario</option>
<option ng-repeat="opt in el.options_final" value="P11" class="ng-scope ng-binding">Quebec</option>
<option ng-repeat="opt in el.options_final" value="P04" class="ng-scope ng-binding">New Brunswick</option>
<option ng-repeat="opt in el.options_final" value="P05" class="ng-scope ng-binding">Newfoundland</option>
<option ng-repeat="opt in el.options_final" value="P06" class="ng-scope ng-binding">Nova Scotia</option>
<option ng-repeat="opt in el.options_final" value="P10" class="ng-scope ng-binding">Prince Edward Island</option>
<option ng-repeat="opt in el.options_final" value="P13" class="ng-scope ng-binding">Yukon</option>
<option ng-repeat="opt in el.options_final" value="P07" class="ng-scope ng-binding">Northwest Territories</option>
<option ng-repeat="opt in el.options_final" value="P08" class="ng-scope ng-binding">Nunavut</option>
</select></div><span class="q_cover" style="display: none;"><span class="inst ttip" ng-style="{ fontSize: con[0].ifs, color: con[0].lfc }" data-original-title=""
style="color: rgb(255, 252, 252); position: absolute;"><i class="formcraft-help-circled"></i></span></span><span class="field6 valid_show" style="display: none;"></span>
</span></div><span class="element_id ng-binding">6</span>
</li>
<li ng-repeat="el in build" ng-style="{paddingBottom: con[0].space+"px", paddingTop: con[0].space+"px"}" id="fe_7_12336" class="nform_li ng-scope is_hidden inline2 left fe_7 required-1"
ng-class="[el.default, el.inline, con[0].field_align, el.li_class, "fe_"+$index, "required-"+el.req]" scale="" style="padding-bottom: 8px; padding-top: 8px;">
<div compile="el.el_f" ng-style="{marginBottom: el.divspa, marginTop: el.divspa}"><input type="hidden" class="name_holder ng-scope no_show" value="GENDER"><span class="cap_cover relative"><span class="cap1 subl"
ng-style="{ fontSize: con[0].lfs, color: con[0].lfc }" style="font-size: 13px; color: rgb(255, 252, 252);">GENDER<span class="show_1">*</span></span><span class="cap2 subl" ng-bind="el.cap2"
ng-style="{ fontSize: con[0].slfs, color: con[0].slfc }" style="font-size: 11px; color: rgb(255, 255, 255);"></span></span><span class="input_cover text_cover ng-scope">
<div class="select-cover no-ar" ng-style="{width: el.wid}" style="width: 100%;"><select class="field_class no_show" do_what="[]" ng-style="{fontSize: con[0].field_font, color: con[0].input_color}" name="GENDER_dropdown__1___field7_"
style="font-size: 15px; color: rgb(0, 0, 0);">
<option ng-repeat="opt in el.options_final" value="0" class="ng-scope ng-binding">Gender...</option>
<option ng-repeat="opt in el.options_final" value="GF" class="ng-scope ng-binding">Female</option>
<option ng-repeat="opt in el.options_final" value="GM" class="ng-scope ng-binding">Male</option>
</select></div><span class="q_cover" style="display: none;"><span class="inst ttip" ng-style="{ fontSize: con[0].ifs, color: con[0].lfc }" data-original-title=""
style="color: rgb(255, 252, 252); position: absolute;"><i class="formcraft-help-circled"></i></span></span><span class="field7 valid_show" style="display: none;"></span>
</span></div><span class="element_id ng-binding">7</span>
</li>
<li ng-repeat="el in build" ng-style="{paddingBottom: con[0].space+"px", paddingTop: con[0].space+"px"}" id="fe_8_12336" class="nform_li ng-scope is_hidden inline3 left fe_8 required-1"
ng-class="[el.default, el.inline, con[0].field_align, el.li_class, "fe_"+$index, "required-"+el.req]" scale="" style="padding-bottom: 8px; padding-top: 8px;">
<div compile="el.el_f" ng-style="{marginBottom: el.divspa, marginTop: el.divspa}"><input type="hidden" class="name_holder ng-scope no_show" value="MONTH"><span class="cap_cover relative"><span class="cap1 subl"
ng-style="{ fontSize: con[0].lfs, color: con[0].lfc }" style="font-size: 13px; color: rgb(255, 252, 252);">MONTH<span class="show_1">*</span></span><span class="cap2 subl" ng-bind="el.cap2"
ng-style="{ fontSize: con[0].slfs, color: con[0].slfc }" style="font-size: 11px; color: rgb(255, 255, 255);"></span></span><span class="input_cover text_cover ng-scope">
<div class="select-cover no-ar" ng-style="{width: el.wid}" style="width: 100%;"><select class="field_class no_show" do_what="[]" ng-style="{fontSize: con[0].field_font, color: con[0].input_color}" name="MONTH_dropdown__1___field8_"
style="font-size: 15px; color: rgb(0, 0, 0);">
<option ng-repeat="opt in el.options_final" value="0" class="ng-scope ng-binding">Birth month...</option>
<option ng-repeat="opt in el.options_final" value="M01" class="ng-scope ng-binding">January</option>
<option ng-repeat="opt in el.options_final" value="M02" class="ng-scope ng-binding">February</option>
<option ng-repeat="opt in el.options_final" value="M03" class="ng-scope ng-binding">March</option>
<option ng-repeat="opt in el.options_final" value="M04" class="ng-scope ng-binding">April</option>
<option ng-repeat="opt in el.options_final" value="M05" class="ng-scope ng-binding">May</option>
<option ng-repeat="opt in el.options_final" value="M06" class="ng-scope ng-binding">June</option>
<option ng-repeat="opt in el.options_final" value="M07" class="ng-scope ng-binding">July</option>
<option ng-repeat="opt in el.options_final" value="M08" class="ng-scope ng-binding">August</option>
<option ng-repeat="opt in el.options_final" value="M09" class="ng-scope ng-binding">September</option>
<option ng-repeat="opt in el.options_final" value="M10" class="ng-scope ng-binding">October</option>
<option ng-repeat="opt in el.options_final" value="M11" class="ng-scope ng-binding">November</option>
<option ng-repeat="opt in el.options_final" value="M12" class="ng-scope ng-binding">December</option>
</select></div><span class="q_cover" style="display: none;"><span class="inst ttip" ng-style="{ fontSize: con[0].ifs, color: con[0].lfc }" data-original-title=""
style="color: rgb(255, 252, 252); position: absolute;"><i class="formcraft-help-circled"></i></span></span><span class="field8 valid_show" style="display: none;"></span>
</span></div><span class="element_id ng-binding">8</span>
</li>
<li ng-repeat="el in build" ng-style="{paddingBottom: con[0].space+"px", paddingTop: con[0].space+"px"}" id="fe_9_12336" class="nform_li ng-scope is_hidden inline3 left fe_9 required-1"
ng-class="[el.default, el.inline, con[0].field_align, el.li_class, "fe_"+$index, "required-"+el.req]" scale="" style="padding-bottom: 8px; padding-top: 8px;">
<div compile="el.el_f" ng-style="{marginBottom: el.divspa, marginTop: el.divspa}"><input type="hidden" class="name_holder ng-scope no_show" value="DATE"><span class="cap_cover relative"><span class="cap1 subl"
ng-style="{ fontSize: con[0].lfs, color: con[0].lfc }" style="font-size: 13px; color: rgb(255, 252, 252);">DATE<span class="show_1">*</span></span><span class="cap2 subl" ng-bind="el.cap2"
ng-style="{ fontSize: con[0].slfs, color: con[0].slfc }" style="font-size: 11px; color: rgb(255, 255, 255);"></span></span><span class="input_cover text_cover ng-scope">
<div class="select-cover no-ar" ng-style="{width: el.wid}" style="width: 100%;"><select class="field_class no_show" do_what="[]" ng-style="{fontSize: con[0].field_font, color: con[0].input_color}" name="DATE_dropdown__1___field9_"
style="font-size: 15px; color: rgb(0, 0, 0);">
<option ng-repeat="opt in el.options_final" value="0" class="ng-scope ng-binding"> Birth date...</option>
<option ng-repeat="opt in el.options_final" value="D01" class="ng-scope ng-binding">1</option>
<option ng-repeat="opt in el.options_final" value="D02" class="ng-scope ng-binding">2</option>
<option ng-repeat="opt in el.options_final" value="D03" class="ng-scope ng-binding">3</option>
<option ng-repeat="opt in el.options_final" value="D04" class="ng-scope ng-binding">4</option>
<option ng-repeat="opt in el.options_final" value="D05" class="ng-scope ng-binding">5</option>
<option ng-repeat="opt in el.options_final" value="D06" class="ng-scope ng-binding">6</option>
<option ng-repeat="opt in el.options_final" value="D07" class="ng-scope ng-binding">7</option>
<option ng-repeat="opt in el.options_final" value="D08" class="ng-scope ng-binding">8</option>
<option ng-repeat="opt in el.options_final" value="D09" class="ng-scope ng-binding">9</option>
<option ng-repeat="opt in el.options_final" value="D10" class="ng-scope ng-binding">10</option>
<option ng-repeat="opt in el.options_final" value="D11" class="ng-scope ng-binding">11</option>
<option ng-repeat="opt in el.options_final" value="D12" class="ng-scope ng-binding">12</option>
<option ng-repeat="opt in el.options_final" value="D13" class="ng-scope ng-binding">13</option>
<option ng-repeat="opt in el.options_final" value="D14" class="ng-scope ng-binding">14</option>
<option ng-repeat="opt in el.options_final" value="D15" class="ng-scope ng-binding">15</option>
<option ng-repeat="opt in el.options_final" value="D16" class="ng-scope ng-binding">16</option>
<option ng-repeat="opt in el.options_final" value="D17" class="ng-scope ng-binding">17</option>
<option ng-repeat="opt in el.options_final" value="D18" class="ng-scope ng-binding">18</option>
<option ng-repeat="opt in el.options_final" value="D19" class="ng-scope ng-binding">19</option>
<option ng-repeat="opt in el.options_final" value="D20" class="ng-scope ng-binding">20</option>
<option ng-repeat="opt in el.options_final" value="D21" class="ng-scope ng-binding">21</option>
<option ng-repeat="opt in el.options_final" value="D22" class="ng-scope ng-binding">22</option>
<option ng-repeat="opt in el.options_final" value="D23" class="ng-scope ng-binding">23</option>
<option ng-repeat="opt in el.options_final" value="D24" class="ng-scope ng-binding">24</option>
<option ng-repeat="opt in el.options_final" value="D25" class="ng-scope ng-binding">25</option>
<option ng-repeat="opt in el.options_final" value="D26" class="ng-scope ng-binding">26</option>
<option ng-repeat="opt in el.options_final" value="D27" class="ng-scope ng-binding">27</option>
<option ng-repeat="opt in el.options_final" value="D28" class="ng-scope ng-binding">28</option>
<option ng-repeat="opt in el.options_final" value="D29" class="ng-scope ng-binding">29</option>
<option ng-repeat="opt in el.options_final" value="D30" class="ng-scope ng-binding">30</option>
<option ng-repeat="opt in el.options_final" value="D31" class="ng-scope ng-binding">31</option>
</select></div><span class="q_cover" style="display: none;"><span class="inst ttip" ng-style="{ fontSize: con[0].ifs, color: con[0].lfc }" data-original-title=""
style="color: rgb(255, 252, 252); position: absolute;"><i class="formcraft-help-circled"></i></span></span><span class="field9 valid_show" style="display: none;"></span>
</span></div><span class="element_id ng-binding">9</span>
</li>
<li ng-repeat="el in build" ng-style="{paddingBottom: con[0].space+"px", paddingTop: con[0].space+"px"}" id="fe_10_12336" class="nform_li ng-scope is_hidden inline3 left fe_10 required-1"
ng-class="[el.default, el.inline, con[0].field_align, el.li_class, "fe_"+$index, "required-"+el.req]" scale="" style="padding-bottom: 8px; padding-top: 8px;">
<div compile="el.el_f" ng-style="{marginBottom: el.divspa, marginTop: el.divspa}"><input type="hidden" class="name_holder ng-scope no_show" value="YEAR"><span class="cap_cover relative"><span class="cap1 subl"
ng-style="{ fontSize: con[0].lfs, color: con[0].lfc }" style="font-size: 13px; color: rgb(255, 252, 252);">YEAR<span class="show_1">*</span></span><span class="cap2 subl" ng-bind="el.cap2"
ng-style="{ fontSize: con[0].slfs, color: con[0].slfc }" style="font-size: 11px; color: rgb(255, 255, 255);"></span></span><span class="input_cover text_cover ng-scope">
<div class="select-cover no-ar" ng-style="{width: el.wid}" style="width: 100%;"><select class="field_class no_show" do_what="[]" ng-style="{fontSize: con[0].field_font, color: con[0].input_color}" name="YEAR_dropdown__1___field10_"
style="font-size: 15px; color: rgb(0, 0, 0);">
<option ng-repeat="opt in el.options_final" value="0" class="ng-scope ng-binding">Birth year...</option>
<option ng-repeat="opt in el.options_final" value="Y1937" class="ng-scope ng-binding">1937</option>
<option ng-repeat="opt in el.options_final" value="Y1938" class="ng-scope ng-binding">1938</option>
<option ng-repeat="opt in el.options_final" value="Y1939" class="ng-scope ng-binding">1939</option>
<option ng-repeat="opt in el.options_final" value="Y1940" class="ng-scope ng-binding">1940</option>
<option ng-repeat="opt in el.options_final" value="Y1941" class="ng-scope ng-binding">1941</option>
<option ng-repeat="opt in el.options_final" value="Y1942" class="ng-scope ng-binding">1942</option>
<option ng-repeat="opt in el.options_final" value="Y1943" class="ng-scope ng-binding">1943</option>
<option ng-repeat="opt in el.options_final" value="Y1944" class="ng-scope ng-binding">1944</option>
<option ng-repeat="opt in el.options_final" value="Y1945" class="ng-scope ng-binding">1945</option>
<option ng-repeat="opt in el.options_final" value="Y1946" class="ng-scope ng-binding">1946</option>
<option ng-repeat="opt in el.options_final" value="Y1947" class="ng-scope ng-binding">1947</option>
<option ng-repeat="opt in el.options_final" value="Y1948" class="ng-scope ng-binding">1948</option>
<option ng-repeat="opt in el.options_final" value="Y1949" class="ng-scope ng-binding">1949</option>
<option ng-repeat="opt in el.options_final" value="Y1950" class="ng-scope ng-binding">1950</option>
<option ng-repeat="opt in el.options_final" value="Y1951" class="ng-scope ng-binding">1951</option>
<option ng-repeat="opt in el.options_final" value="Y1952" class="ng-scope ng-binding">1952</option>
<option ng-repeat="opt in el.options_final" value="Y1953" class="ng-scope ng-binding">1953</option>
<option ng-repeat="opt in el.options_final" value="Y1954" class="ng-scope ng-binding">1954</option>
<option ng-repeat="opt in el.options_final" value="Y1955" class="ng-scope ng-binding">1955</option>
<option ng-repeat="opt in el.options_final" value="Y1956" class="ng-scope ng-binding">1956</option>
<option ng-repeat="opt in el.options_final" value="Y1957" class="ng-scope ng-binding">1957</option>
<option ng-repeat="opt in el.options_final" value="Y1958" class="ng-scope ng-binding">1958</option>
<option ng-repeat="opt in el.options_final" value="Y1959" class="ng-scope ng-binding">1959</option>
<option ng-repeat="opt in el.options_final" value="Y1960" class="ng-scope ng-binding">1960</option>
<option ng-repeat="opt in el.options_final" value="Y1961" class="ng-scope ng-binding">1961</option>
<option ng-repeat="opt in el.options_final" value="Y1962" class="ng-scope ng-binding">1962</option>
<option ng-repeat="opt in el.options_final" value="Y1963" class="ng-scope ng-binding">1963</option>
<option ng-repeat="opt in el.options_final" value="Y1964" class="ng-scope ng-binding">1964</option>
<option ng-repeat="opt in el.options_final" value="Y1965" class="ng-scope ng-binding">1965</option>
<option ng-repeat="opt in el.options_final" value="Y1966" class="ng-scope ng-binding">1966</option>
<option ng-repeat="opt in el.options_final" value="Y1967" class="ng-scope ng-binding">1967</option>
<option ng-repeat="opt in el.options_final" value="Y1968" class="ng-scope ng-binding">1968</option>
<option ng-repeat="opt in el.options_final" value="Y1969" class="ng-scope ng-binding">1969</option>
<option ng-repeat="opt in el.options_final" value="Y1970" class="ng-scope ng-binding">1970</option>
<option ng-repeat="opt in el.options_final" value="Y1971" class="ng-scope ng-binding">1971</option>
<option ng-repeat="opt in el.options_final" value="Y1972" class="ng-scope ng-binding">1972</option>
<option ng-repeat="opt in el.options_final" value="Y1973" class="ng-scope ng-binding">1973</option>
<option ng-repeat="opt in el.options_final" value="Y1974" class="ng-scope ng-binding">1974</option>
<option ng-repeat="opt in el.options_final" value="Y1975" class="ng-scope ng-binding">1975</option>
<option ng-repeat="opt in el.options_final" value="Y1976" class="ng-scope ng-binding">1976</option>
<option ng-repeat="opt in el.options_final" value="Y1977" class="ng-scope ng-binding">1977</option>
<option ng-repeat="opt in el.options_final" value="Y1978" class="ng-scope ng-binding">1978</option>
<option ng-repeat="opt in el.options_final" value="Y1979" class="ng-scope ng-binding">1979</option>
<option ng-repeat="opt in el.options_final" value="Y1980" class="ng-scope ng-binding">1980</option>
<option ng-repeat="opt in el.options_final" value="Y1981" class="ng-scope ng-binding">1981</option>
<option ng-repeat="opt in el.options_final" value="Y1982" class="ng-scope ng-binding">1982</option>
<option ng-repeat="opt in el.options_final" value="Y1983" class="ng-scope ng-binding">1983</option>
<option ng-repeat="opt in el.options_final" value="Y1984" class="ng-scope ng-binding">1984</option>
<option ng-repeat="opt in el.options_final" value="Y1985" class="ng-scope ng-binding">1985</option>
<option ng-repeat="opt in el.options_final" value="Y1986" class="ng-scope ng-binding">1986</option>
<option ng-repeat="opt in el.options_final" value="Y1987" class="ng-scope ng-binding">1987</option>
<option ng-repeat="opt in el.options_final" value="Y1988" class="ng-scope ng-binding">1988</option>
<option ng-repeat="opt in el.options_final" value="Y1989" class="ng-scope ng-binding">1989</option>
<option ng-repeat="opt in el.options_final" value="Y1990" class="ng-scope ng-binding">1990</option>
<option ng-repeat="opt in el.options_final" value="Y1991" class="ng-scope ng-binding">1991</option>
<option ng-repeat="opt in el.options_final" value="Y1992" class="ng-scope ng-binding">1992</option>
<option ng-repeat="opt in el.options_final" value="Y1993" class="ng-scope ng-binding">1993</option>
<option ng-repeat="opt in el.options_final" value="Y1994" class="ng-scope ng-binding">1994</option>
<option ng-repeat="opt in el.options_final" value="Y1995" class="ng-scope ng-binding">1995</option>
<option ng-repeat="opt in el.options_final" value="Y1996" class="ng-scope ng-binding">1996</option>
<option ng-repeat="opt in el.options_final" value="Y1997" class="ng-scope ng-binding">1997</option>
<option ng-repeat="opt in el.options_final" value="Y1998" class="ng-scope ng-binding">1998</option>
<option ng-repeat="opt in el.options_final" value="Y1999" class="ng-scope ng-binding">1999</option>
<option ng-repeat="opt in el.options_final" value="Y2000" class="ng-scope ng-binding">2000</option>
<option ng-repeat="opt in el.options_final" value="Y2001" class="ng-scope ng-binding">2001</option>
<option ng-repeat="opt in el.options_final" value="Y2002" class="ng-scope ng-binding">2002</option>
<option ng-repeat="opt in el.options_final" value="Y2003" class="ng-scope ng-binding">2003</option>
<option ng-repeat="opt in el.options_final" value="Y2004" class="ng-scope ng-binding">2004</option>
<option ng-repeat="opt in el.options_final" value="Y2005" class="ng-scope ng-binding">2005</option>
<option ng-repeat="opt in el.options_final" value="Y2006" class="ng-scope ng-binding">2006</option>
<option ng-repeat="opt in el.options_final" value="Y2007" class="ng-scope ng-binding">2007</option>
<option ng-repeat="opt in el.options_final" value="Y2008" class="ng-scope ng-binding">2008</option>
<option ng-repeat="opt in el.options_final" value="Y2009" class="ng-scope ng-binding">2009</option>
<option ng-repeat="opt in el.options_final" value="Y2010" class="ng-scope ng-binding">2010</option>
<option ng-repeat="opt in el.options_final" value="Y2011" class="ng-scope ng-binding">2011</option>
<option ng-repeat="opt in el.options_final" value="Y2012" class="ng-scope ng-binding">2012</option>
<option ng-repeat="opt in el.options_final" value="Y2013" class="ng-scope ng-binding">2013</option>
<option ng-repeat="opt in el.options_final" value="Y2014" class="ng-scope ng-binding">2014</option>
<option ng-repeat="opt in el.options_final" value="Y2015" class="ng-scope ng-binding">2015</option>
<option ng-repeat="opt in el.options_final" value="Y2016" class="ng-scope ng-binding">2016</option>
<option ng-repeat="opt in el.options_final" value="Y2017" class="ng-scope ng-binding">2017</option>
<option ng-repeat="opt in el.options_final" value="Y2018" class="ng-scope ng-binding">2018</option>
<option ng-repeat="opt in el.options_final" value="Y2019" class="ng-scope ng-binding">2019</option>
<option ng-repeat="opt in el.options_final" value="Y2020" class="ng-scope ng-binding">2020</option>
<option ng-repeat="opt in el.options_final" value="Y2021" class="ng-scope ng-binding">2021</option>
<option ng-repeat="opt in el.options_final" value="Y2022" class="ng-scope ng-binding">2022</option>
</select></div><span class="q_cover" style="display: none;"><span class="inst ttip" ng-style="{ fontSize: con[0].ifs, color: con[0].lfc }" data-original-title=""
style="color: rgb(255, 252, 252); position: absolute;"><i class="formcraft-help-circled"></i></span></span><span class="field10 valid_show" style="display: none;"></span>
</span></div><span class="element_id ng-binding">10</span>
</li>
<li ng-repeat="el in build" ng-style="{paddingBottom: con[0].space+"px", paddingTop: con[0].space+"px"}" id="fe_11_12336" class="nform_li ng-scope inline1 left fe_11 required-0"
ng-class="[el.default, el.inline, con[0].field_align, el.li_class, "fe_"+$index, "required-"+el.req]" scale="" style="padding-bottom: 8px; padding-top: 8px;">
<div compile="el.el_f" ng-style="{marginBottom: el.divspa, marginTop: el.divspa}"><input type="hidden" class="name_holder ng-scope" value="Get Quotes"><button type="submit" class="submit_button nform_btn boots"
ng-style="{backgroundColor: el.sco, fontSize: el.sfs, left: el.lp, marginTop: el.tp, marginBottom: el.bp, marginRight: el.rp, height: el.spad1, width: el.spad2, borderRadius: el.curve, MozBorderRadius: el.curve, WebkitBorderRadius: el.curve, fontFamily: el.sfamily, fontWeight: el.sbold, color: el.sbfco}"
style="background-color: rgb(255, 165, 0); font-size: 18px; height: 38px; width: 100%; border-radius: 2px; font-weight: bold; color: rgb(255, 255, 255);">Get Quotes</button></div><span class="element_id ng-binding">11</span>
</li>
</ul>
<div id="fe_submit" class="form_submit" style="position: relative">
<div class="res_div"><span class="nform_res"></span></div><span
style="text-align: center; display: inline; padding-top: 8px; padding-bottom: 4px"><a class="ref_link" ng-href="" compile="con[0].rlink" target="_blank" title="Opens in a new tab" href=""></a></span>
</div><input type="text" name="name" id="waspnet" value="">
</form><form id="fc19302_63" class="a_12363 nform no_submit_hidden save_form placeholder noframe ltr none spin check_conflict allow_multi three block_label star_true vertical fc-common"
ng-style="{background: con[0].bg_image, width: con[0].fw, borderRadius: con[0].fr+"px", MozBorderRadius: con[0].fr+"px", WebkitBorderRadius: con[0].fr+"px", fontFamily: con[0].formfamily}"
style="background: blue; width: 480px; border-radius: 0px; font-family: "Helvetica Neue", Arial;"><input type="hidden" class="form_id ng-pristine ng-valid" val="63" ng-model="con[0].form_main_id"><input type="hidden" class="getlocation"
val="" name="location_hidden__0_0_1000_" value="https://www.insurancedirectcanada.com/wp-admin/admin.php?page=formcraft_admin&id=63"><a id="anchor_12905_anchor"></a><a href="#anchor_12905_anchor" class="anchor_trigger"></a>
<div id="fe_title" class="nform_li form_title none"
ng-style="{fontSize: con[0].ft_px+"px", borderTopLeftRadius: con[0].fr+"px", MozBorderTopLeftRadius: con[0].fr+"px", WebkitBorderTopLeftRadius: con[0].fr+"px", borderTopRightRadius: con[0].fr+"px", MozBorderTopRightRadius: con[0].fr+"px", WebkitBorderTopRightRadius: con[0].fr+"px", color: con[0].ft_co, backgroundColor: con[0].ft_bg, fontFamily: con[0].tfamily, fontWeight: con[0].tbold, backgroundImage: con[0].bg_image, textAlign: con[0].ftalign}"
style="font-size: 18px; border-top-left-radius: 0px; border-top-right-radius: 0px; color: rgb(255, 255, 255); background-color: rgb(0, 0, 255); font-weight: bold; text-align: left;">Request a call back</div>
<ul class="form_ul none" id="form_ul" style="height: auto; opacity: 1;">
<li ng-repeat="el in build" ng-style="{paddingBottom: con[0].space+"px", paddingTop: con[0].space+"px"}" id="fe_0_12363" class="nform_li ng-scope inline2 left fe_0 required-1"
ng-class="[el.default, el.inline, con[0].field_align, el.li_class, "fe_"+$index, "required-"+el.req]" scale="" style="padding-bottom: 8px; padding-top: 8px;">
<div compile="el.el_f" ng-style="{marginBottom: el.divspa, marginTop: el.divspa}"><input type="hidden" class="name_holder ng-scope" value="First name"><span class="cap_cover relative"><span class="cap1 "
ng-style="{ fontSize: con[0].lfs, color: con[0].lfc}" style="font-size: 13px;">First name<span class="show_1">*</span></span><span class="cap2 " ng-bind="el.cap2" ng-style="{ fontSize: con[0].slfs, color: con[0].slfc }"
style="font-size: 11px;"></span></span><span class="input_cover text_cover ng-scope"><input type="text" ng-style="{width: el.wid, fontSize: con[0].field_font, color: con[0].input_color}" placeholder="First name" has_p="placeholder"
name="First name_text_alphabets_1_2_30_field0_txtfirstname" class="field_class" do_what="[]" style="width: 100%; font-size: 15px;"><span class="q_cover" style="display: none;"><span class="inst ttip"
ng-style="{ fontSize: con[0].ifs, color: con[0].lfc }" data-original-title="" style="position: absolute;"><i class="formcraft-help-circled"></i></span></span><span class="field0 valid_show" style="display: none;"></span></span></div>
<span class="element_id ng-binding">0</span>
</li>
<li ng-repeat="el in build" ng-style="{paddingBottom: con[0].space+"px", paddingTop: con[0].space+"px"}" id="fe_1_12363" class="nform_li ng-scope inline2 left fe_1 required-1"
ng-class="[el.default, el.inline, con[0].field_align, el.li_class, "fe_"+$index, "required-"+el.req]" scale="" style="padding-bottom: 8px; padding-top: 8px;">
<div compile="el.el_f" ng-style="{marginBottom: el.divspa, marginTop: el.divspa}"><input type="hidden" class="name_holder ng-scope" value="Last name"><span class="cap_cover relative"><span class="cap1 "
ng-style="{ fontSize: con[0].lfs, color: con[0].lfc}" style="font-size: 13px;">Last name<span class="show_1">*</span></span><span class="cap2 " ng-bind="el.cap2" ng-style="{ fontSize: con[0].slfs, color: con[0].slfc }"
style="font-size: 11px;"></span></span><span class="input_cover text_cover ng-scope"><input type="text" ng-style="{width: el.wid, fontSize: con[0].field_font, color: con[0].input_color}" placeholder="Last name" has_p="placeholder"
name="Last name_text_alphabets_1_2_30_field1_txtlastname" class="field_class" do_what="[]" style="width: 100%; font-size: 15px;"><span class="q_cover" style="display: none;"><span class="inst ttip"
ng-style="{ fontSize: con[0].ifs, color: con[0].lfc }" data-original-title="" style="position: absolute;"><i class="formcraft-help-circled"></i></span></span><span class="field1 valid_show" style="display: none;"></span></span></div>
<span class="element_id ng-binding">1</span>
</li>
<li ng-repeat="el in build" ng-style="{paddingBottom: con[0].space+"px", paddingTop: con[0].space+"px"}" id="fe_2_12363" class="nform_li ng-scope inline1 left fe_2 required-1"
ng-class="[el.default, el.inline, con[0].field_align, el.li_class, "fe_"+$index, "required-"+el.req]" scale="" style="padding-bottom: 8px; padding-top: 8px;">
<div compile="el.el_f" ng-style="{marginBottom: el.divspa, marginTop: el.divspa}"><input type="hidden" class="name_holder ng-scope" value="Mobile number"><span class="cap_cover relative"><span class="cap1 "
ng-style="{ fontSize: con[0].lfs, color: con[0].lfc}" style="font-size: 13px;">Mobile number<span class="show_1">*</span></span><span class="cap2 " ng-bind="el.cap2" ng-style="{ fontSize: con[0].slfs, color: con[0].slfc }"
style="font-size: 11px;"></span></span><span class="input_cover text_cover ng-scope"><input type="text" ng-style="{width: el.wid, fontSize: con[0].field_font, color: con[0].input_color}" placeholder="Mobile number" has_p="placeholder"
name="Mobile number_text_alphabets_1_10__field2_txtphone_valid" class="field_class" do_what="[]" style="width: 100%; font-size: 15px;"><span class="q_cover" style="display: none;"><span class="inst ttip"
ng-style="{ fontSize: con[0].ifs, color: con[0].lfc }" data-original-title="" style="position: absolute;"><i class="formcraft-help-circled"></i></span></span><span class="field2 valid_show" style="display: none;"></span></span></div>
<span class="element_id ng-binding">2</span>
</li>
<li ng-repeat="el in build" ng-style="{paddingBottom: con[0].space+"px", paddingTop: con[0].space+"px"}" id="fe_3_12363" class="nform_li ng-scope inline1 left fe_3 required-1"
ng-class="[el.default, el.inline, con[0].field_align, el.li_class, "fe_"+$index, "required-"+el.req]" scale="" style="padding-bottom: 8px; padding-top: 8px;">
<div compile="el.el_f" ng-style="{marginBottom: el.divspa, marginTop: el.divspa}"><input type="hidden" class="name_holder ng-scope" value="Email address"><span class="cap_cover relative"><span class="cap1 "
ng-style="{ fontSize: con[0].lfs, color: con[0].lfc }" style="font-size: 13px;">Email address<span class="show_1">*</span></span><span class="cap2 " ng-bind="el.cap2" ng-style="{fontSize: con[0].slfs, color: con[0].slfc }"
style="font-size: 11px;"></span></span><span class="input_cover text_cover ng-scope"><span class="emailfield-cover" ng-style="{ width: el.wid, fontSize: con[0].field_font }" style="width: 100%; font-size: 15px;"><input type="email"
ng-style="{fontSize: con[0].field_font, color: con[0].input_color}" placeholder="Email address" has_p="placeholder" style="width: 100%; font-size: 15px;" name="Email address_email_email_1___field3_____" do_what="[]"
class="field_class"></span><span class="q_cover" style="display: none;"><span class="inst ttip" ng-style="{ fontSize: con[0].ifs, color: con[0].lfc }" data-original-title=""
style="position: absolute;"><i class="formcraft-help-circled"></i></span></span><span class="field3 valid_show" style="display: none;"></span></span></div><span class="element_id ng-binding">3</span>
</li>
<li ng-repeat="el in build" ng-style="{paddingBottom: con[0].space+"px", paddingTop: con[0].space+"px"}" id="fe_4_12363" class="nform_li ng-scope inline1 left fe_4 required-1"
ng-class="[el.default, el.inline, con[0].field_align, el.li_class, "fe_"+$index, "required-"+el.req]" scale="" style="padding-bottom: 8px; padding-top: 8px;">
<div compile="el.el_f" ng-style="{marginBottom: el.divspa, marginTop: el.divspa}"><input type="hidden" class="name_holder ng-scope" value="Type your message..."><span class="cap_cover relative"><span class="cap1 "
ng-style="{ fontSize: con[0].lfs, color: con[0].lfc }" style="font-size: 13px;">Type your message...<span class="show_1">*</span></span><span class="cap2 " ng-bind="el.cap2" ng-style="{ fontSize: con[0].slfs, color: con[0].slfc }"
style="font-size: 11px;"></span></span><span class="input_cover text_cover ng-scope"><textarea rows="2" ng-style="{width: el.wid, fontSize: con[0].field_font, color: con[0].input_color}" placeholder="Type your message..."
has_p="placeholder" name="Type your message..._para__1__300_field4_" class="field_class" do_what="[]" style="width: 100%; font-size: 15px;"></textarea><span class="q_cover" style="display: none;"><span class="inst ttip"
ng-style="{ fontSize: con[0].ifs, color: con[0].lfc }" data-original-title="" style="position: absolute;"><i class="formcraft-help-circled"></i></span></span><span class="field4 valid_show" style="display: none;"></span></span></div>
<span class="element_id ng-binding">4</span>
</li>
<li ng-repeat="el in build" ng-style="{paddingBottom: con[0].space+"px", paddingTop: con[0].space+"px"}" id="fe_5_12363" class="nform_li ng-scope inline2 left fe_5 required-1"
ng-class="[el.default, el.inline, con[0].field_align, el.li_class, "fe_"+$index, "required-"+el.req]" scale="" style="padding-bottom: 8px; padding-top: 8px;">
<div compile="el.el_f" ng-style="{marginBottom: el.divspa, marginTop: el.divspa}"><input type="hidden" class="name_holder ng-scope" value="When"><span class="cap_cover relative"><span class="cap1 "
ng-style="{ fontSize: con[0].lfs, color: con[0].lfc }" style="font-size: 13px;">When<span class="show_1">*</span></span><span class="cap2 " ng-bind="el.cap2" ng-style="{ fontSize: con[0].slfs, color: con[0].slfc }"
style="font-size: 11px;"></span></span><span class="input_cover text_cover ng-scope">
<div class="select-cover no-ar" ng-style="{width: el.wid}" style="width: 100%;"><select class="field_class" do_what="[]" ng-style="{fontSize: con[0].field_font, color: con[0].input_color}" name="When_dropdown__1___field5_"
style="font-size: 15px;">
<option ng-repeat="opt in el.options_final" value="0" class="ng-scope ng-binding">Best time to call...</option>
<option ng-repeat="opt in el.options_final" value="Call me now" class="ng-scope ng-binding">Call me now</option>
<option ng-repeat="opt in el.options_final" value="Weekdays Morning" class="ng-scope ng-binding">Weekdays Morning</option>
<option ng-repeat="opt in el.options_final" value="Weekdays Afternoon" class="ng-scope ng-binding">Weekdays Afternoon</option>
<option ng-repeat="opt in el.options_final" value="Weekdays Evening" class="ng-scope ng-binding">Weekdays Evening</option>
<option ng-repeat="opt in el.options_final" value="Saturdays Morning" class="ng-scope ng-binding">Saturdays Morning</option>
<option ng-repeat="opt in el.options_final" value="Saturdays Afternoon" class="ng-scope ng-binding">Saturdays Afternoon</option>
</select></div><span class="q_cover" style="display: none;"><span class="inst ttip" ng-style="{ fontSize: con[0].ifs, color: con[0].lfc }" data-original-title=""
style="position: absolute;"><i class="formcraft-help-circled"></i></span></span><span class="field5 valid_show" style="display: none;"></span>
</span></div><span class="element_id ng-binding">5</span>
</li>
<li ng-repeat="el in build" ng-style="{paddingBottom: con[0].space+"px", paddingTop: con[0].space+"px"}" id="fe_6_12363" class="nform_li ng-scope inline2 left fe_6 required-0"
ng-class="[el.default, el.inline, con[0].field_align, el.li_class, "fe_"+$index, "required-"+el.req]" scale="" style="padding-bottom: 8px; padding-top: 8px;">
<div compile="el.el_f" ng-style="{marginBottom: el.divspa, marginTop: el.divspa}"><input type="hidden" class="name_holder ng-scope" value="Call me back"><button type="submit" class="submit_button nform_btn boots"
ng-style="{backgroundColor: el.sco, fontSize: el.sfs, left: el.lp, marginTop: el.tp, marginBottom: el.bp, marginRight: el.rp, height: el.spad1, width: el.spad2, borderRadius: el.curve, MozBorderRadius: el.curve, WebkitBorderRadius: el.curve, fontFamily: el.sfamily, fontWeight: el.sbold, color: el.sbfco}"
style="background-color: rgb(255, 165, 0); font-size: 18px; height: 38px; width: 100%; border-radius: 2px; font-weight: bold; color: rgb(255, 255, 255);">Call me back</button></div><span class="element_id ng-binding">6</span>
</li>
</ul>
<div id="fe_submit" class="form_submit" style="position: relative">
<div class="res_div"><span class="nform_res"></span></div><span
style="text-align: center; display: inline; padding-top: 8px; padding-bottom: 4px"><a class="ref_link" ng-href="" compile="con[0].rlink" target="_blank" title="Opens in a new tab" href=""></a></span>
</div><input type="text" name="name" id="waspnet" value="">
</form><form id="fc72098_45" class="a_12345 nform no_submit_hidden save_form placeholder false ltr none spin check_conflict allow_multi three block_label star_true vertical fc-common"
ng-style="{background: con[0].bg_image, width: con[0].fw, borderRadius: con[0].fr+"px", MozBorderRadius: con[0].fr+"px", WebkitBorderRadius: con[0].fr+"px", fontFamily: con[0].formfamily}"
style="width: 480px; border-radius: 0px; font-family: "Helvetica Neue", Arial;"><input type="hidden" class="form_id ng-pristine ng-valid" val="45" ng-model="con[0].form_main_id"><input type="hidden" class="getlocation" val=""
name="location_hidden__0_0_1000_" value="https://www.insurancedirectcanada.com/wp-admin/admin.php?page=formcraft_admin&id=45"><a id="anchor_10604_anchor"></a><a href="#anchor_10604_anchor" class="anchor_trigger"></a>
<div id="fe_title" class="nform_li form_title none"
ng-style="{fontSize: con[0].ft_px+"px", borderTopLeftRadius: con[0].fr+"px", MozBorderTopLeftRadius: con[0].fr+"px", WebkitBorderTopLeftRadius: con[0].fr+"px", borderTopRightRadius: con[0].fr+"px", MozBorderTopRightRadius: con[0].fr+"px", WebkitBorderTopRightRadius: con[0].fr+"px", color: con[0].ft_co, backgroundColor: con[0].ft_bg, fontFamily: con[0].tfamily, fontWeight: con[0].tbold, backgroundImage: con[0].bg_image, textAlign: con[0].ftalign}"
style="font-size: 18px; border-top-left-radius: 0px; border-top-right-radius: 0px; color: rgb(255, 255, 255); background-color: rgb(0, 0, 255); font-weight: bold; text-align: left;">Request a call back</div>
<ul class="form_ul none" id="form_ul" style="height: auto; opacity: 1;">
<li ng-repeat="el in build" ng-style="{paddingBottom: con[0].space+"px", paddingTop: con[0].space+"px"}" id="fe_0_12345" class="nform_li ng-scope inline2 left fe_0 required-1"
ng-class="[el.default, el.inline, con[0].field_align, el.li_class, "fe_"+$index, "required-"+el.req]" scale="" style="padding-bottom: 8px; padding-top: 8px;">
<div compile="el.el_f" ng-style="{marginBottom: el.divspa, marginTop: el.divspa}"><input type="hidden" class="name_holder ng-scope" value="First name"><span class="cap_cover relative"><span class="cap1 "
ng-style="{ fontSize: con[0].lfs, color: con[0].lfc}" style="font-size: 13px;">First name<span class="show_1">*</span></span><span class="cap2 " ng-bind="el.cap2" ng-style="{ fontSize: con[0].slfs, color: con[0].slfc }"
style="font-size: 11px;"></span></span><span class="input_cover text_cover ng-scope"><input type="text" ng-style="{width: el.wid, fontSize: con[0].field_font, color: con[0].input_color}" placeholder="First name" has_p="placeholder"
name="First name_text__1_2_30_field0_txtfirstname" class="field_class" do_what="[]" style="width: 100%; font-size: 15px;"><span class="q_cover" style="display: none;"><span class="inst ttip"
ng-style="{ fontSize: con[0].ifs, color: con[0].lfc }" data-original-title="" style="position: absolute;"><i class="formcraft-help-circled"></i></span></span><span class="field0 valid_show" style="display: none;"></span></span></div>
<span class="element_id ng-binding">0</span>
</li>
<li ng-repeat="el in build" ng-style="{paddingBottom: con[0].space+"px", paddingTop: con[0].space+"px"}" id="fe_1_12345" class="nform_li ng-scope inline2 left fe_1 required-1"
ng-class="[el.default, el.inline, con[0].field_align, el.li_class, "fe_"+$index, "required-"+el.req]" scale="" style="padding-bottom: 8px; padding-top: 8px;">
<div compile="el.el_f" ng-style="{marginBottom: el.divspa, marginTop: el.divspa}"><input type="hidden" class="name_holder ng-scope" value="Last name"><span class="cap_cover relative"><span class="cap1 "
ng-style="{ fontSize: con[0].lfs, color: con[0].lfc}" style="font-size: 13px;">Last name<span class="show_1">*</span></span><span class="cap2 " ng-bind="el.cap2" ng-style="{ fontSize: con[0].slfs, color: con[0].slfc }"
style="font-size: 11px;"></span></span><span class="input_cover text_cover ng-scope"><input type="text" ng-style="{width: el.wid, fontSize: con[0].field_font, color: con[0].input_color}" placeholder="Last name" has_p="placeholder"
name="Last name_text__1_2_30_field1_txtlastname" class="field_class" do_what="[]" style="width: 100%; font-size: 15px;"><span class="q_cover" style="display: none;"><span class="inst ttip"
ng-style="{ fontSize: con[0].ifs, color: con[0].lfc }" data-original-title="" style="position: absolute;"><i class="formcraft-help-circled"></i></span></span><span class="field1 valid_show" style="display: none;"></span></span></div>
<span class="element_id ng-binding">1</span>
</li>
<li ng-repeat="el in build" ng-style="{paddingBottom: con[0].space+"px", paddingTop: con[0].space+"px"}" id="fe_2_12345" class="nform_li ng-scope inline1 left fe_2 required-1"
ng-class="[el.default, el.inline, con[0].field_align, el.li_class, "fe_"+$index, "required-"+el.req]" scale="" style="padding-bottom: 8px; padding-top: 8px;">
<div compile="el.el_f" ng-style="{marginBottom: el.divspa, marginTop: el.divspa}"><input type="hidden" class="name_holder ng-scope" value="Mobile number"><span class="cap_cover relative"><span class="cap1 "
ng-style="{ fontSize: con[0].lfs, color: con[0].lfc}" style="font-size: 13px;">Mobile number<span class="show_1">*</span></span><span class="cap2 " ng-bind="el.cap2" ng-style="{ fontSize: con[0].slfs, color: con[0].slfc }"
style="font-size: 11px;"></span></span><span class="input_cover text_cover ng-scope"><input type="text" ng-style="{width: el.wid, fontSize: con[0].field_font, color: con[0].input_color}" placeholder="Mobile number" has_p="placeholder"
name="Mobile number_text_alphabets_1_10__field2_txtphone_valid" class="field_class" do_what="[]" style="width: 100%; font-size: 15px;"><span class="q_cover" style="display: none;"><span class="inst ttip"
ng-style="{ fontSize: con[0].ifs, color: con[0].lfc }" data-original-title="" style="position: absolute;"><i class="formcraft-help-circled"></i></span></span><span class="field2 valid_show" style="display: none;"></span></span></div>
<span class="element_id ng-binding">2</span>
</li>
<li ng-repeat="el in build" ng-style="{paddingBottom: con[0].space+"px", paddingTop: con[0].space+"px"}" id="fe_3_12345" class="nform_li ng-scope inline1 left fe_3 required-1"
ng-class="[el.default, el.inline, con[0].field_align, el.li_class, "fe_"+$index, "required-"+el.req]" scale="" style="padding-bottom: 8px; padding-top: 8px;">
<div compile="el.el_f" ng-style="{marginBottom: el.divspa, marginTop: el.divspa}"><input type="hidden" class="name_holder ng-scope" value="Email address"><span class="cap_cover relative"><span class="cap1 "
ng-style="{ fontSize: con[0].lfs, color: con[0].lfc }" style="font-size: 13px;">Email address<span class="show_1">*</span></span><span class="cap2 " ng-bind="el.cap2" ng-style="{fontSize: con[0].slfs, color: con[0].slfc }"
style="font-size: 11px;"></span></span><span class="input_cover text_cover ng-scope"><span class="emailfield-cover" ng-style="{ width: el.wid, fontSize: con[0].field_font }" style="width: 100%; font-size: 15px;"><input type="email"
ng-style="{fontSize: con[0].field_font, color: con[0].input_color}" placeholder="Email address" has_p="placeholder" style="width: 100%; font-size: 15px;" name="Email address_email_email_1___field3_____" do_what="[]"
class="field_class"></span><span class="q_cover" style="display: none;"><span class="inst ttip" ng-style="{ fontSize: con[0].ifs, color: con[0].lfc }" data-original-title=""
style="position: absolute;"><i class="formcraft-help-circled"></i></span></span><span class="field3 valid_show" style="display: none;"></span></span></div><span class="element_id ng-binding">3</span>
</li>
<li ng-repeat="el in build" ng-style="{paddingBottom: con[0].space+"px", paddingTop: con[0].space+"px"}" id="fe_4_12345" class="nform_li ng-scope inline1 left fe_4 required-1"
ng-class="[el.default, el.inline, con[0].field_align, el.li_class, "fe_"+$index, "required-"+el.req]" scale="" style="padding-bottom: 8px; padding-top: 8px;">
<div compile="el.el_f" ng-style="{marginBottom: el.divspa, marginTop: el.divspa}"><input type="hidden" class="name_holder ng-scope" value="Type your message (sorry we don't service auto, home or liability insurance)"><span
class="cap_cover relative"><span class="cap1 " ng-style="{ fontSize: con[0].lfs, color: con[0].lfc }" style="font-size: 13px;">Type your message (sorry we don't service auto, home or liability insurance)<span
class="show_1">*</span></span><span class="cap2 " ng-bind="el.cap2" ng-style="{ fontSize: con[0].slfs, color: con[0].slfc }" style="font-size: 11px;"></span></span><span class="input_cover text_cover ng-scope"><textarea rows="2"
ng-style="{width: el.wid, fontSize: con[0].field_font, color: con[0].input_color}" placeholder="Type your message (sorry we don't service auto, home or liability insurance)" has_p="placeholder"
name="Type your message (sorry we don't service auto, home or liability insurance)_para__1__300_field4_" class="field_class" do_what="[]" style="width: 100%; font-size: 15px;"></textarea><span class="q_cover" style="display: none;"><span
class="inst ttip" ng-style="{ fontSize: con[0].ifs, color: con[0].lfc }" data-original-title="" style="position: absolute;"><i class="formcraft-help-circled"></i></span></span><span class="field4 valid_show"
style="display: none;"></span></span></div><span class="element_id ng-binding">4</span>
</li>
<li ng-repeat="el in build" ng-style="{paddingBottom: con[0].space+"px", paddingTop: con[0].space+"px"}" id="fe_5_12345" class="nform_li ng-scope inline2 left fe_5 required-1"
ng-class="[el.default, el.inline, con[0].field_align, el.li_class, "fe_"+$index, "required-"+el.req]" scale="" style="padding-bottom: 8px; padding-top: 8px;">
<div compile="el.el_f" ng-style="{marginBottom: el.divspa, marginTop: el.divspa}"><input type="hidden" class="name_holder ng-scope" value="Reason"><span class="cap_cover relative"><span class="cap1 "
ng-style="{ fontSize: con[0].lfs, color: con[0].lfc }" style="font-size: 13px;">Reason<span class="show_1">*</span></span><span class="cap2 " ng-bind="el.cap2" ng-style="{ fontSize: con[0].slfs, color: con[0].slfc }"
style="font-size: 11px;"></span></span><span class="input_cover text_cover ng-scope">
<div class="select-cover no-ar" ng-style="{width: el.wid}" style="width: 100%;"><select class="field_class" do_what="[]" ng-style="{fontSize: con[0].field_font, color: con[0].input_color}" name="Reason_dropdown__1___field5_"
style="font-size: 15px;">
<option ng-repeat="opt in el.options_final" value="0" class="ng-scope ng-binding">Type of inquiry...</option>
<option ng-repeat="opt in el.options_final" value="PHS" class="ng-scope ng-binding">Policyholder looking for service</option>
<option ng-repeat="opt in el.options_final" value="L01" class="ng-scope ng-binding">Life insurance quotes</option>
<option ng-repeat="opt in el.options_final" value="G01" class="ng-scope ng-binding">Employee benefits quotes</option>
<option ng-repeat="opt in el.options_final" value="L13" class="ng-scope ng-binding">Corporate insurance quotes</option>
<option ng-repeat="opt in el.options_final" value="H02" class="ng-scope ng-binding">Critical illness insurance quotes</option>
<option ng-repeat="opt in el.options_final" value="H01" class="ng-scope ng-binding">Disability insurance quotes</option>
<option ng-repeat="opt in el.options_final" value="T01" class="ng-scope ng-binding">Travel medical insurance quotes</option>
<option ng-repeat="opt in el.options_final" value="H05" class="ng-scope ng-binding">Supplementary health quotes</option>
<option ng-repeat="opt in el.options_final" value="RCB" class="ng-scope ng-binding">Other insurance-related inquiries</option>
</select></div><span class="q_cover" style="display: none;"><span class="inst ttip" ng-style="{ fontSize: con[0].ifs, color: con[0].lfc }" data-original-title=""
style="position: absolute;"><i class="formcraft-help-circled"></i></span></span><span class="field5 valid_show" style="display: none;"></span>
</span></div><span class="element_id ng-binding">5</span>
</li>
<li ng-repeat="el in build" ng-style="{paddingBottom: con[0].space+"px", paddingTop: con[0].space+"px"}" id="fe_6_12345" class="nform_li ng-scope inline2 left fe_6 required-0"
ng-class="[el.default, el.inline, con[0].field_align, el.li_class, "fe_"+$index, "required-"+el.req]" scale="" style="padding-bottom: 8px; padding-top: 8px;">
<div compile="el.el_f" ng-style="{marginBottom: el.divspa, marginTop: el.divspa}"><input type="hidden" class="name_holder ng-scope" value="Call me back"><button type="submit" class="submit_button nform_btn boots"
ng-style="{backgroundColor: el.sco, fontSize: el.sfs, left: el.lp, marginTop: el.tp, marginBottom: el.bp, marginRight: el.rp, height: el.spad1, width: el.spad2, borderRadius: el.curve, MozBorderRadius: el.curve, WebkitBorderRadius: el.curve, fontFamily: el.sfamily, fontWeight: el.sbold, color: el.sbfco}"
style="background-color: rgb(255, 165, 0); font-size: 18px; height: 38px; width: 100%; border-radius: 2px; font-weight: bold; color: rgb(255, 255, 255);">Call me back</button></div><span class="element_id ng-binding">6</span>
</li>
<li ng-repeat="el in build" ng-style="{paddingBottom: con[0].space+"px", paddingTop: con[0].space+"px"}" id="fe_7_12345" class="nform_li ng-scope inline1 left fe_7 required-0"
ng-class="[el.default, el.inline, con[0].field_align, el.li_class, "fe_"+$index, "required-"+el.req]" scale="" style="padding-bottom: 8px; padding-top: 8px;">
<div compile="el.el_f" ng-style="{marginBottom: el.divspa, marginTop: el.divspa}"><input type="hidden" class="name_holder ng-scope" value=""><span class="custom-text ng-scope"
ng-style="{ paddingTop: el.divspa_in, paddingBottom: el.divspa_in, fontSize: el.divfs, color: el.divfc, fontFamily: el.family, background: el.custom_bg_color }" compile="el.customText"
style="display: block; position: relative; white-space: pre-line; line-height: 1.2; padding-left: 6px; padding-right: 6px; font-size: 15px; color: rgb(102, 102, 102);"><span class="ng-scope">IDC Insurance Direct Canada Inc. 4400 Dominion
St. #260 Burnaby, BC V5G 4G3 Mon to Sat - 9AM to 6PM PST</span></span><input type="hidden" name="_custom__0_0_99999999_field7_" class="field_class text_hidden_class ng-scope" value="" do_what="[]"></div><span
class="element_id ng-binding">7</span>
</li>
</ul>
<div id="fe_submit" class="form_submit" style="position: relative">
<div class="res_div"><span class="nform_res"></span></div><span
style="text-align: center; display: inline; padding-top: 8px; padding-bottom: 4px"><a class="ref_link" ng-href="" compile="con[0].rlink" target="_blank" title="Opens in a new tab" href=""></a></span>
</div><input type="text" name="name" id="waspnet" value="">
</form><form id="fc47499_54" class="a_12354 nform no_submit_hidden save_form placeholder ltr none spin check_conflict allow_multi three block_label star_true horizontal fc-common"
ng-style="{background: con[0].bg_image, width: con[0].fw, borderRadius: con[0].fr+"px", MozBorderRadius: con[0].fr+"px", WebkitBorderRadius: con[0].fr+"px", fontFamily: con[0].formfamily}"
style="width: 480px; font-family: "Helvetica Neue", Arial;"><input type="hidden" class="form_id ng-pristine ng-valid" val="54" ng-model="con[0].form_main_id"><input type="hidden" class="getlocation" val=""
name="location_hidden__0_0_1000_" value="https://www.insurancedirectcanada.com/wp-admin/admin.php?page=formcraft_admin&id=54"><a id="anchor_13903_anchor"></a><a href="#anchor_13903_anchor" class="anchor_trigger"></a>
<div id="fe_title" class="nform_li form_title none"
ng-style="{fontSize: con[0].ft_px+"px", borderTopLeftRadius: con[0].fr+"px", MozBorderTopLeftRadius: con[0].fr+"px", WebkitBorderTopLeftRadius: con[0].fr+"px", borderTopRightRadius: con[0].fr+"px", MozBorderTopRightRadius: con[0].fr+"px", WebkitBorderTopRightRadius: con[0].fr+"px", color: con[0].ft_co, backgroundColor: con[0].ft_bg, fontFamily: con[0].tfamily, fontWeight: con[0].tbold, backgroundImage: con[0].bg_image, textAlign: con[0].ftalign}"
style="font-size: 18px; color: rgb(255, 255, 255); background-color: rgb(0, 0, 255); font-weight: bold; text-align: left;">Request a call back</div>
<ul class="form_ul none" id="form_ul" style="height: auto; opacity: 1;">
<li ng-repeat="el in build" ng-style="{paddingBottom: con[0].space+"px", paddingTop: con[0].space+"px"}" id="fe_0_12354" class="nform_li ng-scope inline2 left fe_0 required-1"
ng-class="[el.default, el.inline, con[0].field_align, el.li_class, "fe_"+$index, "required-"+el.req]" scale="" style="padding-bottom: 8px; padding-top: 8px;">
<div compile="el.el_f" ng-style="{marginBottom: el.divspa, marginTop: el.divspa}"><input type="hidden" class="name_holder ng-scope" value="First name"><span class="cap_cover relative"><span class="cap1 "
ng-style="{ fontSize: con[0].lfs, color: con[0].lfc}" style="font-size: 13px;">First name<span class="show_1">*</span></span><span class="cap2 " ng-bind="el.cap2" ng-style="{ fontSize: con[0].slfs, color: con[0].slfc }"
style="font-size: 11px;"></span></span><span class="input_cover text_cover ng-scope"><input type="text" ng-style="{width: el.wid, fontSize: con[0].field_font, color: con[0].input_color}" placeholder="First name" has_p="placeholder"
name="First name_text__1_2_30_field0_txtfirstname" class="field_class" do_what="[]" style="width: 90%; font-size: 15px;"><span class="q_cover" style="display: none;"><span class="inst ttip"
ng-style="{ fontSize: con[0].ifs, color: con[0].lfc }" data-original-title="" style="position: absolute;"><i class="formcraft-help-circled"></i></span></span><span class="field0 valid_show" style="display: none;"></span></span></div>
<span class="element_id ng-binding">0</span>
</li>
<li ng-repeat="el in build" ng-style="{paddingBottom: con[0].space+"px", paddingTop: con[0].space+"px"}" id="fe_1_12354" class="nform_li ng-scope inline2 left fe_1 required-1"
ng-class="[el.default, el.inline, con[0].field_align, el.li_class, "fe_"+$index, "required-"+el.req]" scale="" style="padding-bottom: 8px; padding-top: 8px;">
<div compile="el.el_f" ng-style="{marginBottom: el.divspa, marginTop: el.divspa}"><input type="hidden" class="name_holder ng-scope" value="Last name"><span class="cap_cover relative"><span class="cap1 "
ng-style="{ fontSize: con[0].lfs, color: con[0].lfc}" style="font-size: 13px;">Last name<span class="show_1">*</span></span><span class="cap2 " ng-bind="el.cap2" ng-style="{ fontSize: con[0].slfs, color: con[0].slfc }"
style="font-size: 11px;"></span></span><span class="input_cover text_cover ng-scope"><input type="text" ng-style="{width: el.wid, fontSize: con[0].field_font, color: con[0].input_color}" placeholder="Last name" has_p="placeholder"
name="Last name_text__1_2_30_field1_txtlastname" class="field_class" do_what="[]" style="width: 100%; font-size: 15px;"><span class="q_cover" style="display: none;"><span class="inst ttip"
ng-style="{ fontSize: con[0].ifs, color: con[0].lfc }" data-original-title="" style="position: absolute;"><i class="formcraft-help-circled"></i></span></span><span class="field1 valid_show" style="display: none;"></span></span></div>
<span class="element_id ng-binding">1</span>
</li>
<li ng-repeat="el in build" ng-style="{paddingBottom: con[0].space+"px", paddingTop: con[0].space+"px"}" id="fe_2_12354" class="nform_li ng-scope inline1 left fe_2 required-true"
ng-class="[el.default, el.inline, con[0].field_align, el.li_class, "fe_"+$index, "required-"+el.req]" scale="" style="padding-bottom: 8px; padding-top: 8px;">
<div compile="el.el_f" ng-style="{marginBottom: el.divspa, marginTop: el.divspa}"><input type="hidden" class="name_holder ng-scope" value="Mobile number"><span class="cap_cover relative"><span class="cap1 "
ng-style="{ fontSize: con[0].lfs, color: con[0].lfc}" style="font-size: 13px;">Mobile number<span class="show_true">*</span></span><span class="cap2 " ng-bind="el.cap2" ng-style="{ fontSize: con[0].slfs, color: con[0].slfc }"
style="font-size: 11px;"></span></span><span class="input_cover text_cover ng-scope"><input type="text" ng-style="{width: el.wid, fontSize: con[0].field_font, color: con[0].input_color}" placeholder="Mobile number" has_p="placeholder"
name="Mobile number_text_alphabets_true_10__field2_txtphone_valid" class="field_class" do_what="[]" style="width: 100%; font-size: 15px;"><span class="q_cover" style="display: none;"><span class="inst ttip"
ng-style="{ fontSize: con[0].ifs, color: con[0].lfc }" data-original-title="" style="position: absolute;"><i class="formcraft-help-circled"></i></span></span><span class="field2 valid_show" style="display: none;"></span></span></div>
<span class="element_id ng-binding">2</span>
</li>
<li ng-repeat="el in build" ng-style="{paddingBottom: con[0].space+"px", paddingTop: con[0].space+"px"}" id="fe_3_12354" class="nform_li ng-scope inline1 left fe_3 required-1"
ng-class="[el.default, el.inline, con[0].field_align, el.li_class, "fe_"+$index, "required-"+el.req]" scale="" style="padding-bottom: 8px; padding-top: 8px;">
<div compile="el.el_f" ng-style="{marginBottom: el.divspa, marginTop: el.divspa}"><input type="hidden" class="name_holder ng-scope" value="Email address"><span class="cap_cover relative"><span class="cap1 "
ng-style="{ fontSize: con[0].lfs, color: con[0].lfc }" style="font-size: 13px;">Email address<span class="show_1">*</span></span><span class="cap2 " ng-bind="el.cap2" ng-style="{fontSize: con[0].slfs, color: con[0].slfc }"
style="font-size: 11px;"></span></span><span class="input_cover text_cover ng-scope"><span class="emailfield-cover" ng-style="{ width: el.wid, fontSize: con[0].field_font }" style="width: 100%; font-size: 15px;"><input type="email"
ng-style="{fontSize: con[0].field_font, color: con[0].input_color}" placeholder="Email address" has_p="placeholder" style="width: 100%; font-size: 15px;" name="Email address_email_email_1___field3_____" do_what="[]"
class="field_class"></span><span class="q_cover" style="display: none;"><span class="inst ttip" ng-style="{ fontSize: con[0].ifs, color: con[0].lfc }" data-original-title=""
style="position: absolute;"><i class="formcraft-help-circled"></i></span></span><span class="field3 valid_show" style="display: none;"></span></span></div><span class="element_id ng-binding">3</span>
</li>
<li ng-repeat="el in build" ng-style="{paddingBottom: con[0].space+"px", paddingTop: con[0].space+"px"}" id="fe_4_12354" class="nform_li ng-scope inline1 left fe_4 required-1"
ng-class="[el.default, el.inline, con[0].field_align, el.li_class, "fe_"+$index, "required-"+el.req]" scale="" style="padding-bottom: 8px; padding-top: 8px;">
<div compile="el.el_f" ng-style="{marginBottom: el.divspa, marginTop: el.divspa}"><input type="hidden" class="name_holder ng-scope" value="Type your message (sorry we don't service auto, home or liability insurance)"><span
class="cap_cover relative"><span class="cap1 " ng-style="{ fontSize: con[0].lfs, color: con[0].lfc }" style="font-size: 13px;">Type your message (sorry we don't service auto, home or liability insurance)<span
class="show_1">*</span></span><span class="cap2 " ng-bind="el.cap2" ng-style="{ fontSize: con[0].slfs, color: con[0].slfc }" style="font-size: 11px;"></span></span><span class="input_cover text_cover ng-scope"><textarea rows="3"
ng-style="{width: el.wid, fontSize: con[0].field_font, color: con[0].input_color}" placeholder="Type your message (sorry we don't service auto, home or liability insurance)" has_p="placeholder"
name="Type your message (sorry we don't service auto, home or liability insurance)_para__1__300_field4_" class="field_class" do_what="[]" style="width: 100%; font-size: 15px;"></textarea><span class="q_cover" style="display: none;"><span
class="inst ttip" ng-style="{ fontSize: con[0].ifs, color: con[0].lfc }" data-original-title="" style="position: absolute;"><i class="formcraft-help-circled"></i></span></span><span class="field4 valid_show"
style="display: none;"></span></span></div><span class="element_id ng-binding">4</span>
</li>
<li ng-repeat="el in build" ng-style="{paddingBottom: con[0].space+"px", paddingTop: con[0].space+"px"}" id="fe_5_12354" class="nform_li ng-scope inline1 left fe_5 required-1"
ng-class="[el.default, el.inline, con[0].field_align, el.li_class, "fe_"+$index, "required-"+el.req]" scale="" style="padding-bottom: 8px; padding-top: 8px;">
<div compile="el.el_f" ng-style="{marginBottom: el.divspa, marginTop: el.divspa}"><input type="hidden" class="name_holder ng-scope" value="Reason"><span class="cap_cover relative"><span class="cap1 "
ng-style="{ fontSize: con[0].lfs, color: con[0].lfc }" style="font-size: 13px;">Reason<span class="show_1">*</span></span><span class="cap2 " ng-bind="el.cap2" ng-style="{ fontSize: con[0].slfs, color: con[0].slfc }"
style="font-size: 11px;"></span></span><span class="input_cover text_cover ng-scope">
<div class="select-cover no-ar" ng-style="{width: el.wid}" style="width: 100%;"><select class="field_class" do_what="[]" ng-style="{fontSize: con[0].field_font, color: con[0].input_color}" name="Reason_dropdown__1___field5_"
style="font-size: 15px;">
<option ng-repeat="opt in el.options_final" value="0" class="ng-scope ng-binding">Type of inquiry...</option>
<option ng-repeat="opt in el.options_final" value="PHS" class="ng-scope ng-binding">Policyholder looking for service</option>
<option ng-repeat="opt in el.options_final" value="L01" class="ng-scope ng-binding">Life insurance quotes</option>
<option ng-repeat="opt in el.options_final" value="G01" class="ng-scope ng-binding">Employee benefits quotes</option>
<option ng-repeat="opt in el.options_final" value="L13" class="ng-scope ng-binding">Corporate insurance quotes</option>
<option ng-repeat="opt in el.options_final" value="H02" class="ng-scope ng-binding">Critical illness insurance quotes</option>
<option ng-repeat="opt in el.options_final" value="H01" class="ng-scope ng-binding">Disability insurance quotes</option>
<option ng-repeat="opt in el.options_final" value="T01" class="ng-scope ng-binding">Travel medical insurance quotes</option>
<option ng-repeat="opt in el.options_final" value="H05" class="ng-scope ng-binding">Supplementary health quotes</option>
<option ng-repeat="opt in el.options_final" value="RCB" class="ng-scope ng-binding">Other insurance-related inquiries</option>
</select></div><span class="q_cover" style="display: none;"><span class="inst ttip" ng-style="{ fontSize: con[0].ifs, color: con[0].lfc }" data-original-title=""
style="position: absolute;"><i class="formcraft-help-circled"></i></span></span><span class="field5 valid_show" style="display: none;"></span>
</span></div><span class="element_id ng-binding">5</span>
</li>
<li ng-repeat="el in build" ng-style="{paddingBottom: con[0].space+"px", paddingTop: con[0].space+"px"}" id="fe_6_12354" class="nform_li ng-scope is_hidden inline1 left fe_6 required-0"
ng-class="[el.default, el.inline, con[0].field_align, el.li_class, "fe_"+$index, "required-"+el.req]" scale="" style="padding-bottom: 8px; padding-top: 8px;">
<div compile="el.el_f" ng-style="{marginBottom: el.divspa, marginTop: el.divspa}" style="margin-bottom: 20px; margin-top: 20px;"><input type="hidden" class="name_holder ng-scope no_show" value="Your Name"><span class="custom-text ng-scope"
ng-style="{ paddingTop: el.divspa_in, paddingBottom: el.divspa_in, fontSize: el.divfs, color: el.divfc, fontFamily: el.family, background: el.custom_bg_color }" compile="el.customText"
style="display: block; position: relative; white-space: pre-line; line-height: 1.2; padding-left: 6px; padding-right: 6px; font-size: 14px; color: rgb(102, 102, 102);"></span><input type="hidden"
name="Your Name_custom__0_0_99999999_field6_" class="field_class text_hidden_class ng-scope no_show" value="Your Name" do_what="[]"></div><span class="element_id ng-binding">6</span>
</li>
<li ng-repeat="el in build" ng-style="{paddingBottom: con[0].space+"px", paddingTop: con[0].space+"px"}" id="fe_7_12354" class="nform_li ng-scope inline1 left fe_7 required-0"
ng-class="[el.default, el.inline, con[0].field_align, el.li_class, "fe_"+$index, "required-"+el.req]" scale="" style="padding-bottom: 8px; padding-top: 8px;">
<div compile="el.el_f" ng-style="{marginBottom: el.divspa, marginTop: el.divspa}"><input type="hidden" class="name_holder ng-scope" value="Call me back"><button type="submit" class="submit_button nform_btn boots"
ng-style="{backgroundColor: el.sco, fontSize: el.sfs, left: el.lp, marginTop: el.tp, marginBottom: el.bp, marginRight: el.rp, height: el.spad1, width: el.spad2, borderRadius: el.curve, MozBorderRadius: el.curve, WebkitBorderRadius: el.curve, fontFamily: el.sfamily, fontWeight: el.sbold, color: el.sbfco}"
style="background-color: rgb(0, 185, 247); font-size: 18px; height: 38px; width: 100%; border-radius: 2px; font-weight: bold; color: rgb(0, 0, 0);">Call me back</button></div><span class="element_id ng-binding">7</span>
</li>
</ul>
<div id="fe_submit" class="form_submit" style="position: relative">
<div class="res_div"><span class="nform_res"></span></div><span
style="text-align: center; display: inline; padding-top: 8px; padding-bottom: 4px"><a class="ref_link" ng-href="" compile="con[0].rlink" target="_blank" title="Opens in a new tab" href=""></a></span>
</div><input type="text" name="name" id="waspnet" value="">
</form><form id="fc20283_45" class="a_12345 nform no_submit_hidden save_form placeholder false ltr none spin check_conflict allow_multi three block_label star_true vertical fc-common"
ng-style="{background: con[0].bg_image, width: con[0].fw, borderRadius: con[0].fr+"px", MozBorderRadius: con[0].fr+"px", WebkitBorderRadius: con[0].fr+"px", fontFamily: con[0].formfamily}"
style="width: 480px; border-radius: 0px; font-family: "Helvetica Neue", Arial;"><input type="hidden" class="form_id ng-pristine ng-valid" val="45" ng-model="con[0].form_main_id"><input type="hidden" class="getlocation" val=""
name="location_hidden__0_0_1000_" value="https://www.insurancedirectcanada.com/wp-admin/admin.php?page=formcraft_admin&id=45"><a id="anchor_10604_anchor"></a><a href="#anchor_10604_anchor" class="anchor_trigger"></a>
<div id="fe_title" class="nform_li form_title none"
ng-style="{fontSize: con[0].ft_px+"px", borderTopLeftRadius: con[0].fr+"px", MozBorderTopLeftRadius: con[0].fr+"px", WebkitBorderTopLeftRadius: con[0].fr+"px", borderTopRightRadius: con[0].fr+"px", MozBorderTopRightRadius: con[0].fr+"px", WebkitBorderTopRightRadius: con[0].fr+"px", color: con[0].ft_co, backgroundColor: con[0].ft_bg, fontFamily: con[0].tfamily, fontWeight: con[0].tbold, backgroundImage: con[0].bg_image, textAlign: con[0].ftalign}"
style="font-size: 18px; border-top-left-radius: 0px; border-top-right-radius: 0px; color: rgb(255, 255, 255); background-color: rgb(0, 0, 255); font-weight: bold; text-align: left;">Request a call back</div>
<ul class="form_ul none" id="form_ul" style="height: auto; opacity: 1;">
<li ng-repeat="el in build" ng-style="{paddingBottom: con[0].space+"px", paddingTop: con[0].space+"px"}" id="fe_0_12345" class="nform_li ng-scope inline2 left fe_0 required-1"
ng-class="[el.default, el.inline, con[0].field_align, el.li_class, "fe_"+$index, "required-"+el.req]" scale="" style="padding-bottom: 8px; padding-top: 8px;">
<div compile="el.el_f" ng-style="{marginBottom: el.divspa, marginTop: el.divspa}"><input type="hidden" class="name_holder ng-scope" value="First name"><span class="cap_cover relative"><span class="cap1 "
ng-style="{ fontSize: con[0].lfs, color: con[0].lfc}" style="font-size: 13px;">First name<span class="show_1">*</span></span><span class="cap2 " ng-bind="el.cap2" ng-style="{ fontSize: con[0].slfs, color: con[0].slfc }"
style="font-size: 11px;"></span></span><span class="input_cover text_cover ng-scope"><input type="text" ng-style="{width: el.wid, fontSize: con[0].field_font, color: con[0].input_color}" placeholder="First name" has_p="placeholder"
name="First name_text__1_2_30_field0_txtfirstname" class="field_class" do_what="[]" style="width: 100%; font-size: 15px;"><span class="q_cover" style="display: none;"><span class="inst ttip"
ng-style="{ fontSize: con[0].ifs, color: con[0].lfc }" data-original-title="" style="position: absolute;"><i class="formcraft-help-circled"></i></span></span><span class="field0 valid_show" style="display: none;"></span></span></div>
<span class="element_id ng-binding">0</span>
</li>
<li ng-repeat="el in build" ng-style="{paddingBottom: con[0].space+"px", paddingTop: con[0].space+"px"}" id="fe_1_12345" class="nform_li ng-scope inline2 left fe_1 required-1"
ng-class="[el.default, el.inline, con[0].field_align, el.li_class, "fe_"+$index, "required-"+el.req]" scale="" style="padding-bottom: 8px; padding-top: 8px;">
<div compile="el.el_f" ng-style="{marginBottom: el.divspa, marginTop: el.divspa}"><input type="hidden" class="name_holder ng-scope" value="Last name"><span class="cap_cover relative"><span class="cap1 "
ng-style="{ fontSize: con[0].lfs, color: con[0].lfc}" style="font-size: 13px;">Last name<span class="show_1">*</span></span><span class="cap2 " ng-bind="el.cap2" ng-style="{ fontSize: con[0].slfs, color: con[0].slfc }"
style="font-size: 11px;"></span></span><span class="input_cover text_cover ng-scope"><input type="text" ng-style="{width: el.wid, fontSize: con[0].field_font, color: con[0].input_color}" placeholder="Last name" has_p="placeholder"
name="Last name_text__1_2_30_field1_txtlastname" class="field_class" do_what="[]" style="width: 100%; font-size: 15px;"><span class="q_cover" style="display: none;"><span class="inst ttip"
ng-style="{ fontSize: con[0].ifs, color: con[0].lfc }" data-original-title="" style="position: absolute;"><i class="formcraft-help-circled"></i></span></span><span class="field1 valid_show" style="display: none;"></span></span></div>
<span class="element_id ng-binding">1</span>
</li>
<li ng-repeat="el in build" ng-style="{paddingBottom: con[0].space+"px", paddingTop: con[0].space+"px"}" id="fe_2_12345" class="nform_li ng-scope inline1 left fe_2 required-1"
ng-class="[el.default, el.inline, con[0].field_align, el.li_class, "fe_"+$index, "required-"+el.req]" scale="" style="padding-bottom: 8px; padding-top: 8px;">
<div compile="el.el_f" ng-style="{marginBottom: el.divspa, marginTop: el.divspa}"><input type="hidden" class="name_holder ng-scope" value="Mobile number"><span class="cap_cover relative"><span class="cap1 "
ng-style="{ fontSize: con[0].lfs, color: con[0].lfc}" style="font-size: 13px;">Mobile number<span class="show_1">*</span></span><span class="cap2 " ng-bind="el.cap2" ng-style="{ fontSize: con[0].slfs, color: con[0].slfc }"
style="font-size: 11px;"></span></span><span class="input_cover text_cover ng-scope"><input type="text" ng-style="{width: el.wid, fontSize: con[0].field_font, color: con[0].input_color}" placeholder="Mobile number" has_p="placeholder"
name="Mobile number_text_alphabets_1_10__field2_txtphone_valid" class="field_class" do_what="[]" style="width: 100%; font-size: 15px;"><span class="q_cover" style="display: none;"><span class="inst ttip"
ng-style="{ fontSize: con[0].ifs, color: con[0].lfc }" data-original-title="" style="position: absolute;"><i class="formcraft-help-circled"></i></span></span><span class="field2 valid_show" style="display: none;"></span></span></div>
<span class="element_id ng-binding">2</span>
</li>
<li ng-repeat="el in build" ng-style="{paddingBottom: con[0].space+"px", paddingTop: con[0].space+"px"}" id="fe_3_12345" class="nform_li ng-scope inline1 left fe_3 required-1"
ng-class="[el.default, el.inline, con[0].field_align, el.li_class, "fe_"+$index, "required-"+el.req]" scale="" style="padding-bottom: 8px; padding-top: 8px;">
<div compile="el.el_f" ng-style="{marginBottom: el.divspa, marginTop: el.divspa}"><input type="hidden" class="name_holder ng-scope" value="Email address"><span class="cap_cover relative"><span class="cap1 "
ng-style="{ fontSize: con[0].lfs, color: con[0].lfc }" style="font-size: 13px;">Email address<span class="show_1">*</span></span><span class="cap2 " ng-bind="el.cap2" ng-style="{fontSize: con[0].slfs, color: con[0].slfc }"
style="font-size: 11px;"></span></span><span class="input_cover text_cover ng-scope"><span class="emailfield-cover" ng-style="{ width: el.wid, fontSize: con[0].field_font }" style="width: 100%; font-size: 15px;"><input type="email"
ng-style="{fontSize: con[0].field_font, color: con[0].input_color}" placeholder="Email address" has_p="placeholder" style="width: 100%; font-size: 15px;" name="Email address_email_email_1___field3_____" do_what="[]"
class="field_class"></span><span class="q_cover" style="display: none;"><span class="inst ttip" ng-style="{ fontSize: con[0].ifs, color: con[0].lfc }" data-original-title=""
style="position: absolute;"><i class="formcraft-help-circled"></i></span></span><span class="field3 valid_show" style="display: none;"></span></span></div><span class="element_id ng-binding">3</span>
</li>
<li ng-repeat="el in build" ng-style="{paddingBottom: con[0].space+"px", paddingTop: con[0].space+"px"}" id="fe_4_12345" class="nform_li ng-scope inline1 left fe_4 required-1"
ng-class="[el.default, el.inline, con[0].field_align, el.li_class, "fe_"+$index, "required-"+el.req]" scale="" style="padding-bottom: 8px; padding-top: 8px;">
<div compile="el.el_f" ng-style="{marginBottom: el.divspa, marginTop: el.divspa}"><input type="hidden" class="name_holder ng-scope" value="Type your message (sorry we don't service auto, home or liability insurance)"><span
class="cap_cover relative"><span class="cap1 " ng-style="{ fontSize: con[0].lfs, color: con[0].lfc }" style="font-size: 13px;">Type your message (sorry we don't service auto, home or liability insurance)<span
class="show_1">*</span></span><span class="cap2 " ng-bind="el.cap2" ng-style="{ fontSize: con[0].slfs, color: con[0].slfc }" style="font-size: 11px;"></span></span><span class="input_cover text_cover ng-scope"><textarea rows="2"
ng-style="{width: el.wid, fontSize: con[0].field_font, color: con[0].input_color}" placeholder="Type your message (sorry we don't service auto, home or liability insurance)" has_p="placeholder"
name="Type your message (sorry we don't service auto, home or liability insurance)_para__1__300_field4_" class="field_class" do_what="[]" style="width: 100%; font-size: 15px;"></textarea><span class="q_cover" style="display: none;"><span
class="inst ttip" ng-style="{ fontSize: con[0].ifs, color: con[0].lfc }" data-original-title="" style="position: absolute;"><i class="formcraft-help-circled"></i></span></span><span class="field4 valid_show"
style="display: none;"></span></span></div><span class="element_id ng-binding">4</span>
</li>
<li ng-repeat="el in build" ng-style="{paddingBottom: con[0].space+"px", paddingTop: con[0].space+"px"}" id="fe_5_12345" class="nform_li ng-scope inline2 left fe_5 required-1"
ng-class="[el.default, el.inline, con[0].field_align, el.li_class, "fe_"+$index, "required-"+el.req]" scale="" style="padding-bottom: 8px; padding-top: 8px;">
<div compile="el.el_f" ng-style="{marginBottom: el.divspa, marginTop: el.divspa}"><input type="hidden" class="name_holder ng-scope" value="Reason"><span class="cap_cover relative"><span class="cap1 "
ng-style="{ fontSize: con[0].lfs, color: con[0].lfc }" style="font-size: 13px;">Reason<span class="show_1">*</span></span><span class="cap2 " ng-bind="el.cap2" ng-style="{ fontSize: con[0].slfs, color: con[0].slfc }"
style="font-size: 11px;"></span></span><span class="input_cover text_cover ng-scope">
<div class="select-cover no-ar" ng-style="{width: el.wid}" style="width: 100%;"><select class="field_class" do_what="[]" ng-style="{fontSize: con[0].field_font, color: con[0].input_color}" name="Reason_dropdown__1___field5_"
style="font-size: 15px;">
<option ng-repeat="opt in el.options_final" value="0" class="ng-scope ng-binding">Type of inquiry...</option>
<option ng-repeat="opt in el.options_final" value="PHS" class="ng-scope ng-binding">Policyholder looking for service</option>
<option ng-repeat="opt in el.options_final" value="L01" class="ng-scope ng-binding">Life insurance quotes</option>
<option ng-repeat="opt in el.options_final" value="G01" class="ng-scope ng-binding">Employee benefits quotes</option>
<option ng-repeat="opt in el.options_final" value="L13" class="ng-scope ng-binding">Corporate insurance quotes</option>
<option ng-repeat="opt in el.options_final" value="H02" class="ng-scope ng-binding">Critical illness insurance quotes</option>
<option ng-repeat="opt in el.options_final" value="H01" class="ng-scope ng-binding">Disability insurance quotes</option>
<option ng-repeat="opt in el.options_final" value="T01" class="ng-scope ng-binding">Travel medical insurance quotes</option>
<option ng-repeat="opt in el.options_final" value="H05" class="ng-scope ng-binding">Supplementary health quotes</option>
<option ng-repeat="opt in el.options_final" value="RCB" class="ng-scope ng-binding">Other insurance-related inquiries</option>
</select></div><span class="q_cover" style="display: none;"><span class="inst ttip" ng-style="{ fontSize: con[0].ifs, color: con[0].lfc }" data-original-title=""
style="position: absolute;"><i class="formcraft-help-circled"></i></span></span><span class="field5 valid_show" style="display: none;"></span>
</span></div><span class="element_id ng-binding">5</span>
</li>
<li ng-repeat="el in build" ng-style="{paddingBottom: con[0].space+"px", paddingTop: con[0].space+"px"}" id="fe_6_12345" class="nform_li ng-scope inline2 left fe_6 required-0"
ng-class="[el.default, el.inline, con[0].field_align, el.li_class, "fe_"+$index, "required-"+el.req]" scale="" style="padding-bottom: 8px; padding-top: 8px;">
<div compile="el.el_f" ng-style="{marginBottom: el.divspa, marginTop: el.divspa}"><input type="hidden" class="name_holder ng-scope" value="Call me back"><button type="submit" class="submit_button nform_btn boots"
ng-style="{backgroundColor: el.sco, fontSize: el.sfs, left: el.lp, marginTop: el.tp, marginBottom: el.bp, marginRight: el.rp, height: el.spad1, width: el.spad2, borderRadius: el.curve, MozBorderRadius: el.curve, WebkitBorderRadius: el.curve, fontFamily: el.sfamily, fontWeight: el.sbold, color: el.sbfco}"
style="background-color: rgb(255, 165, 0); font-size: 18px; height: 38px; width: 100%; border-radius: 2px; font-weight: bold; color: rgb(255, 255, 255);">Call me back</button></div><span class="element_id ng-binding">6</span>
</li>
<li ng-repeat="el in build" ng-style="{paddingBottom: con[0].space+"px", paddingTop: con[0].space+"px"}" id="fe_7_12345" class="nform_li ng-scope inline1 left fe_7 required-0"
ng-class="[el.default, el.inline, con[0].field_align, el.li_class, "fe_"+$index, "required-"+el.req]" scale="" style="padding-bottom: 8px; padding-top: 8px;">
<div compile="el.el_f" ng-style="{marginBottom: el.divspa, marginTop: el.divspa}"><input type="hidden" class="name_holder ng-scope" value=""><span class="custom-text ng-scope"
ng-style="{ paddingTop: el.divspa_in, paddingBottom: el.divspa_in, fontSize: el.divfs, color: el.divfc, fontFamily: el.family, background: el.custom_bg_color }" compile="el.customText"
style="display: block; position: relative; white-space: pre-line; line-height: 1.2; padding-left: 6px; padding-right: 6px; font-size: 15px; color: rgb(102, 102, 102);"><span class="ng-scope">IDC Insurance Direct Canada Inc. 4400 Dominion
St. #260 Burnaby, BC V5G 4G3 Mon to Sat - 9AM to 6PM PST</span></span><input type="hidden" name="_custom__0_0_99999999_field7_" class="field_class text_hidden_class ng-scope" value="" do_what="[]"></div><span
class="element_id ng-binding">7</span>
</li>
</ul>
<div id="fe_submit" class="form_submit" style="position: relative">
<div class="res_div"><span class="nform_res"></span></div><span
style="text-align: center; display: inline; padding-top: 8px; padding-bottom: 4px"><a class="ref_link" ng-href="" compile="con[0].rlink" target="_blank" title="Opens in a new tab" href=""></a></span>
</div><input type="text" name="name" id="waspnet" value="">
</form>Name: login_form — POST https://insurancedirectcanada.com/wp-login.php
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<button class="btn btn-lg btn-default btn-block" type="submit">Sign in</button>
<label class="checkbox pull-left">
<input class="sq-rememberme" name="rememberme" type="checkbox" value="forever"> Remember me </label>
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<span class="clearfix"></span>
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<button class="btn btn-lg btn-default btn-block" type="submit">Reset Password</button>
<a href="#kleo-login-modal" class="kleo-show-login kleo-other-action pull-right">I remember my details</a>
<span class="clearfix"></span>
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Toggle navigation * ABOUT US * TESTIMONIALS * ARTICLES YOUR QUOTE RESULTS THANK YOU FOR TAKING THE TIME TO SHARE YOUR DETAILS. BASED ON YOUR INFORMATION AND CHOSEN HEALTH CLASS, HERE ARE THE LIFE INSURANCE QUOTES FROM SEVERAL COMPANIES FOR YOUR REVIEW. WE ARE HERE TO HELP. PLEASE EXPECT A CALL FROM ONE OF OUR ADVISORS TO GO OVER YOUR LIFE INSURANCE QUOTE. WHAT HAPPENS NEXT? ONE OF OUR ADVISORS WILL CONTACT YOU TO UNDERSTAND YOUR NEEDS BETTER AND DISCUSS THE INSURANCE OPTIONS AVAILABLE FOR YOU. WE KNOW LIFE INSURANCE VERY WELL BECAUSE WE HAVE BEEN HELPING CLIENTS LIKE YOU FOR A LONG TIME. WE ARE HERE TO HELP – NO HIGH-PRESSURE SELLING TACTICS ARE INVOLVED. WE ARE CALM, COOL CANADIANS, JUST LIKE YOU, EH! SEE SOMETHING YOU LIKE? YOU CAN CLICK ON THE NEXT BUTTON TO COMPLETE THE MEDICAL QUESTIONAIRE TO GET A HEAD START ON THE APPLICATION PROCESS. IF UNSURE, YOU CAN ALWAYS CLICK ON THE REQUEST CALL BACK × REQUEST A CALL BACK * FIRST NAME* 0 * LAST NAME* 1 * MOBILE NUMBER* 2 * EMAIL ADDRESS* 3 * TYPE YOUR MESSAGE...* 4 * WHEN* BEST TIME TO CALL...CALL ME NOWWEEKDAYS MORNINGWEEKDAYS AFTERNOONWEEKDAYS EVENINGSATURDAYS MORNINGSATURDAYS AFTERNOON 5 * CALL ME BACK 6 BUTTON TO BOOK A TIME OR WAIT TO HEAR BACK FROM ONE OF OUR ADVISORS. DON’T WORRY; WE ARE POLITE! PLEASE NOTE THAT THE RATES SHOWN ARE BASED ON DEFAULT PRODUCT AND HEALTH CLASS OPTIONS AND MAY BE SUBJECT TO CHANGE WITHOUT NOTICE. ALL INFORMATION SHOWN IS FOR ILLUSTRATION PURPOSES ONLY. THIS INFORMATION AND ANY CALCULATIONS SHOWN SHOULD NOT BE CONSIDERED ADVICE AND MAY NOT APPLY TO YOUR NEEDS, OBJECTIVES AND PERSONAL CIRCUMSTANCES. OUR LICENSED INSURANCE ADVISORS ARE AVAILABLE TO HELP YOU FURTHER. Search for more quotes * TYPE OF INSURANCE* Type of life insurance...---Term Life Insurance---Term Life 10-yearTerm Life 15-yearTerm Life 20-yearTerm Life 25-yearTerm Life 30-yearTerm Life 35-yearTerm Life 40-yearTerm Life - Pay to Age 65Term 100 - Pay Lifetime---Whole Life Insurance---Whole Life - Pay LifetimeWhole Life - Pay to Age 65Whole Life - Pay 20-yearWhole Life - Pay 15-yearWhole Life - Pay 10-year---Universal Life Insurance---Universal Life - Pay MinimumUniversal Life - Pay 20-yearUniversal Life - Pay 15-yearUniversal Life - Pay 10-year 0 * FACE AMOUNT* Face amount...$10,000$25,000$50,000$75,000$100,000$125,000$150,000$175,000$200,000$225,000$250,000$300,000$350,000$400,000$450,000$500,000$550,000$600,000$650,000$700,000$750,000$800,000$900,000$1,000,000$1,100,000$1,250,000$1,500,000$1,750,000$2,000,000$2,500,000$3,000,000$4,000,000$5,000,000$6,000,000$7,000,000$8,000,000$9,000,000$10,000,000 1 * TOBACCO/NICOTINE USE* Smoking...No, I do not smokeYes, I am a smoker 2 * HEALTH CLASS* Health class...AverageGoodExcellent 3 * New quotes* Get a new quote 4 * Related* Who is the quote for...Just for meSpouse/PartnerChild/GrandchildParent/GrandparentFriend/RelativePartner/ShareholderKey-Person/Employee 5 * PROVINCE* Province/Territory...British ColumbiaAlbertaSaskatchewanManitobaOntarioQuebecNew BrunswickNewfoundlandNova ScotiaPrince Edward IslandYukonNorthwest TerritoriesNunavut 6 * GENDER* Gender...FemaleMale 7 * MONTH* Birth month...JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember 8 * DATE* Birth date...12345678910111213141516171819202122232425262728293031 9 * YEAR* Birth year...19371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022 10 * Get Quotes 11 1-866-747-7615 Request a call back - We'll call you. × Request a call back * First name* 0 * Last name* 1 * Mobile number* 2 * Email address* 3 * Type your message...* 4 * When* Best time to call...Call me nowWeekdays MorningWeekdays AfternoonWeekdays EveningSaturdays MorningSaturdays Afternoon 5 * Call me back 6 Our advisors can guide you to get the best product at the lowest rates and avoid costly mistakes. So let us help you through this important decision. © 2003-2024 INSURANCEDIRECTCANADA.com, an Internet brand and property of I.D.C. Insurance Direct Canada Inc. All rights reserved. Last updated March 2022. Trade names and regulations All product names, trademarks, and trade names are the property of their respective owners. The Insurance Council (BC, AB, SK, MB), Financial Services Commission (ON), Chambre de la Sécurité Financière (QC), The Superintendent of Insurance (NB, NL, PE, NS) are the provincial and federal authorities that regulate, supervise and enforce standards for life insurance professionals. IDC member websites include: Life Insurance Newspaper, Employee Benefits Newspaper × Request a call back * First name* 0 * Last name* 1 * Mobile number* 2 * Email address* 3 * Type your message (sorry we don't service auto, home or liability insurance)* 4 * Reason* Type of inquiry...Policyholder looking for serviceLife insurance quotesEmployee benefits quotesCorporate insurance quotesCritical illness insurance quotesDisability insurance quotesTravel medical insurance quotesSupplementary health quotesOther insurance-related inquiries 5 * Call me back 6 * IDC Insurance Direct Canada Inc. 4400 Dominion St. #260 Burnaby, BC V5G 4G3 Mon to Sat - 9AM to 6PM PST 7 Request a call back * First name* 0 * Last name* 1 * Mobile number* 2 * Email address* 3 * Type your message (sorry we don't service auto, home or liability insurance)* 4 * Reason* Type of inquiry...Policyholder looking for serviceLife insurance quotesEmployee benefits quotesCorporate insurance quotesCritical illness insurance quotesDisability insurance quotesTravel medical insurance quotesSupplementary health quotesOther insurance-related inquiries 5 * 6 * Call me back 7 Request Call Back × Request a call back * First name* 0 * Last name* 1 * Mobile number* 2 * Email address* 3 * Type your message (sorry we don't service auto, home or liability insurance)* 4 * Reason* Type of inquiry...Policyholder looking for serviceLife insurance quotesEmployee benefits quotesCorporate insurance quotesCritical illness insurance quotesDisability insurance quotesTravel medical insurance quotesSupplementary health quotesOther insurance-related inquiries 5 * Call me back 6 * IDC Insurance Direct Canada Inc. 4400 Dominion St. #260 Burnaby, BC V5G 4G3 Mon to Sat - 9AM to 6PM PST 7 * Get Free Quotes * Life Insurance Quotes * Compare Benefit Plans * Life Insurance Canada * Employee Benefits Canada * Corporate Life Insurance * Personal Insurance * Term Life Insurance * Mortgage Protection * Final Expense Insurance * No Medical Insurance * Whole Life Insurance * Business Solutions * Employee Benefit Plans * Key Person Life Insurance * About Us * Contact Us * Our Advisors * Testimonials LOG IN WITH YOUR CREDENTIALS Sign in Remember me Lost your password? 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