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 Panel 

Market Region ASIA APAC EMEA LATAM

This is a Required field for GLU to process this request:

*Nation / 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

LanguageValue

 Author Input Panel

Author Input Panel - Required fields

*Type of Form Integration siteComponent slider contactCardForm

*Type Of Form Contactform Inquiry Grievance

*Request Type

Lead

Case

*Xmlformname

Date field format

Select the date format used in the form (if date field is used) yyyy/mm/dd mm/dd/yyyy dd/mm/yyyy yyyy-mm-dd mm-dd-yyyy dd-mm-yyyy

Author Input Panel - Optional fields

Analytics Medium

Email

WebSite

Form Title  Panel

Let's Connect

User Input Panel

We'd love to help you know more about our Products and Services

First Name

Last Name

Email Id

Phone Number

Location

Existing customer?

Yes

No

I'm interested to Know about Purchased

I'm interested to Know about Existing Policy Claims Others

Interested in

I'm interested to Know about Life insurance Business insurance Accident &Health insurance

Write your message here

I agree on the Terms & Conditions

SUBMIT

By clicking Submit, you agree that we* may contact you at the number you've provided, possibly using automated technology or a prerecorded voice, to talk about our products and services.

Thank You/Error Panel Configuration

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

Option One/Two Configuration

Message Delay

There was a problem with Submission 

Please Try submitting after some time

Thank You for Contacting Us

We will be in touch with you shortly

Option Three Configuration

Error Page

Thank You Page

Page Target Same Tab New Tab

Hidden Panel