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Auto Insurance Lead Form

$10-1500 USD

Completed
Posted over 10 years ago

$10-1500 USD

Paid on delivery
I need a form to capture lead info for auto insurance quotes. The results need to be sent via HTTP Post string to a leads manager. I would like the form to format to mobile too. It needs to be either 4 pages or 4 tabs: Page 1 - Contact Info (All mandatory fields) First Name Last Name Street Address City Zip State (dropdown) Phone Number Email Are you currently insured Y/N (radio button - default "No") Page 2 - Vehicles (Year/Make/Model need to be dynamic dropdown menus derived from database - probably using AJAX from a vehicle database) Year Make Model Collision Deductible ($250/500/1000) Comprehensive Deductible ($250/500/1000) "Add Another Car" (Button) or "Continue to Drivers" (Button) Page 3 - Drivers (Pre-fill 1st driver with contact name - relation to insured "self" for 1st driver) First Name Last Name DOB Marital Status (dropdown) Relation to Insured (dropdown) Occupation Licensed 3+ Years? Y/N (Radio button, default "Yes") "Add Another Driver" or "Continue to Coverages" Page 4 - Coverages (3 "packages" with radio buttons or check box) State Minimum (default) Enhanced Premium
Project ID: 5216331

About the project

2 proposals
Remote project
Active 10 yrs ago

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Hello, I hope you are good. I have read project details and interested to provide my services for your auto insurance quote project. I have 16 years of development experience and there is no-doubt that you will get results in the given timeline. I can deliver a mobile, tablets and desktop compatible form with required functionality. I have 2 questions for you. 1. You have mentioned about post string to a lead manager. Can you provide me details about this point? According to my understanding, you are looking to process this form on another page which accept POST variables. Please verify it in your reply. 2. Vehicle database. Do you have this database already? If you have than don't worry. I can implement it very easily. Please tell me about Vehicle database structure. You can visit my websites for portoflio: 1. [login to view URL] 2. [login to view URL] If you have any question, please don't hesitate to ask. I am waiting for your reply with answers to above mentioned question. Your faithfully, NeOLiO
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About the client

Flag of UNITED STATES
bradenton, United States
5.0
1
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Member since Dec 10, 2013

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