1. System Generated Field Panel
2. Author Entered Field Panel
3. Form Title Panel
4. End-user Entered Field Panel
5. Thank You and Error Message Panel
6. Hidden Panel

• System Generated Field Panel
• Author Entered Field Panel
• Form Title Panel
• End-user Entered Field Panel
• Thank You and Error Message Panel
• Hidden Panel

System Generated Field Panel 

 Author Entered Field Panel

Author Input Panel - Required fields

*Type of Form Integration siteComponent slider contactCardForm

*Region ASIA APAC EMEA LATAM USA

*Country Bangladesh Australia Hongkong United Kingdom Turkey Kuwait Bahrain Egypt Jordan Greece Oman Lebanon Romania Bulgaria France Poland Portugal Spain UAE Italy Russia Portugal Argentina Columbia Brazil USA

*Type Of Form Contactform Inquiry Grievance

Form Title  Panel

End-user Entered Field Panel

* Required Fields

Agency Information

* Agency/Location Name

* Street Address (Cannot be a PO Box)

Address 2 (Cannot be a PO Box)

* City

* State

* State

* ZIP Code

Room Name

* Contact First Name

* Contact Last Name

Phone

Phone Extension

* Email

* Alternate Contact Name

* Alternate Contact Email

Alternate Phone

Alternate Phone Extension

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Event Information

* Event Date

MM

MM 01 02 03 04 05 06 07 08 09 10 11 12

DD

DD 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

YYYY

YYYY 2020 2021

* Event Start Time

Hour

Hour 01 02 03 04 05 06 07 08 09 10 11 12

Min

Min 00 15 30 45

AM/PM

AM/PM AM PM

* Event End Time

Hour

Hour 01 02 03 04 05 06 07 08 09 10 11 12

Min

Min 00 15 30 45

AM/PM

AM/PM AM PM

Number of employees

Number of attendees

Number of additional event days

# of additional event days 0 1 2 3 4 5 6 7 8 9 10

Dates/Times for Additional Events

Please provide dates and times for additional days

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Shipping Address

MetLife will ship materials to this event. You do not need to order them.

check if same as agency

* Street Address (Cannot be a PO Box)

Address 2 (Cannot be a PO Box)

* City

State

* State

* ZIP Code

* Shipping Contact First Name

* Shipping Contact Last Name

Shipping Contact Phone

Shipping Contact Phone Extension

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Comments

Comments

Submission of this request does not guarantee representation at your event.

SUBMIT

MetLife respects your Privacy

Thank You/Error Panel Configuration

Message Option Same page-fadeout Same page-fixed New page

Option One/Two Configuration

Message Delay

Error

An error has occurred. Please try again later.

Go back to homepage.

Thank you

Your request has been submitted.

Go back to homepage or submit another request.

 

Option Three Configuration

Error Page

Thank You Page

Page Target Same Tab New Tab

Hidden Panel