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

Form Title Panel

System Generated Field Panel 

MCID

Sort Order

Required Fields

Page From

Site

 Author Entered Field Panel

Author Input Panel - Required fields

*Type of Form Integration

*Type of Form IntegrationsiteComponentslidercontactCardForm

Analytics form title

Email address to which form data will be sent

Subject line of the email

*Region

*RegionASIAAPACEMEALATAMUSA

*Country

*CountryBangladeshAustraliaHongkongUnited KingdomTurkeyKuwaitBahrainEgyptJordanGreeceOmanLebanonRomaniaBulgariaFrancePolandPortugalSpainUAEItalyRussiaPortugalArgentinaColumbiaBrazilUSA

*Type Of Form

*Type Of FormContactformInquiryGrievance

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

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

Form Title  Panel

Have a small business expert contact you

End-user Entered Field Panel

All fields are required

Name

Email

Phone

Company Name

State

StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachussettsMichiganMinnesotaMissouriMississippiMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

State

• State
• Alabama
• Alaska
• Arizona
• Arkansas
• California
• Colorado
• Connecticut
• Delaware
• District of Columbia
• Florida
• Georgia
• Hawaii
• Idaho
• Illinois
• Indiana
• Iowa
• Kansas
• Kentucky
• Louisiana
• Maine
• Maryland
• Massachussetts
• Michigan
• Minnesota
• Missouri
• Mississippi
• Montana
• Nebraska
• Nevada
• New Hampshire
• New Jersey
• New Mexico
• New York
• North Carolina
• North Dakota
• Ohio
• Oklahoma
• Oregon
• Pennsylvania
• Puerto Rico
• Rhode Island
• South Carolina
• South Dakota
• Tennessee
• Texas
• Utah
• Vermont
• Virginia
• Washington
• West Virginia
• Wisconsin
• Wyoming

Zip

Role within your Organization

Number of employees

Do you have a Broker

Do you have a BrokerYesNo

Do you have a Broker

• Do you have a Broker
• Yes
• No

Broker Name

Firm Name

SUBMIT

Thank You/Error Panel Configuration

Message Option

Message OptionSame page-fadeoutSame page-fixedNew page

Settings for same page thank you/error message

Message Delay

Error!

An error occured while submitting your information.

Thank you for contacting us.

Your information has been submitted. A MetLife small business expert will be contacting you shortly.

Settings for separate page thank you/error message

Error Page

Thank You Page

Page Target

Page TargetSame TabNew Tab

Hidden Panel

Name Of The Template