maxed out test

Multi-Step Insurance Form

1. Select vehicle year

2. Select your vehicle make

3. Select your vehicle model

4. Add a second vehicle? You may be eligible for savings.

5. Select second vehicle year

6. Select second vehicle make

7. Select second vehicle model

8. When does your current policy expire?

9. What is/was your auto-insurance provider?

10. What is your gender?

11. Are you married?

12. Are you a homeowner?

13. What is your employment status?

14. What is your date of birth?

15. Add a second driver? You may qualify for discounts.

16. Second driver’s gender

17. Is the second driver married?

18. Second driver’s employment status

19. Second driver’s date of birth

20. Have you or a family member honorably served in the U.S. military? Military discounts may be available!

21. We found your matches! Please enter your ZIP code.

22. Ready for your results? Enter your address & phone.

23. Your quotes are almost ready!

Click below to see insurance options

QuoteHero
Compare Top Auto Insurance Providers in Seconds and Save!
  • Affordable Rates
  • Comprehensive Coverage
  • Instant Quotes

To do:

  • add offers
    • with links
    • and DB
  • add cert and trigger
  • add images maybe (may be complicated)
  • input type validation (phone, email)
  • alerts logging maybe

DONE:

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