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 

MCID

Sort Order

Required Fields

Page From

Site

 Author Entered Field Panel

Author Input Panel - Required fields

Select the form layout

*Type of Form Integration siteComponent slider contactCardForm

Analytics form title

Email address to which form data will be sent

Subject line of the email

Select the market region

*Region ASIA APAC EMEA LATAM USA

Select the country

*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

Analytics form type

*Type Of Form Contactform Inquiry Grievance

Backend Integration Type

Select the Backend Integration - Email or KANA (US Only) email kana

Form Title  Panel

YOUR INFORMATION:

End-user Entered Field Panel

By opting out, you are instructing MetLife not to share your personal information (including information about your income, account history, or credit worthiness) with our affiliates — or our unaffiliated business partners as part of a joint marketing arrangement — for marketing purposes.

* Required Fields

* First Name

* Last Name

* Address

* City

* State

* State AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

* Zip Code

* Date of birth

Last 4 Digits of SSN

* Account/Policy Number(s)

Enter up to 3 account or policy numbers that you may have with MetLife's family of companies*

* Preferences

I don't want MetLife to share information about me with other MetLife affiliates to market their own products to me.

I don't want MetLife to share information about me with companies with whom it has joint marketing arrangements for those companies to market their own products to me.

SUBMIT

 

MetLife respects your privacy.

Thank You/Error Panel Configuration

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

Settings for same page thank you/error message

Message Delay

Error!

An error occurred while submitting your information.

Thank you for your information.

A MetLife representative will be contacting you soon.

Settings for separate page thank you/error message

Error Page

Thank You Page

Page Target

Page Target Same Tab New Tab

Hidden Panel

Name Of The Template