{"id":42,"date":"2025-06-03T16:18:57","date_gmt":"2025-06-03T16:18:57","guid":{"rendered":"https:\/\/samap.wpenginepowered.com\/?page_id=42"},"modified":"2026-05-01T13:41:39","modified_gmt":"2026-05-01T13:41:39","slug":"register","status":"publish","type":"page","link":"https:\/\/sam.annuityapplication.com\/index.php\/register\/","title":{"rendered":"Register"},"content":{"rendered":"\n[logged_in_only]\n<div id=\"wpmem_reg\"><a id=\"register\"><\/a><form name=\"form\" method=\"post\" action=\"https:\/\/sam.annuityapplication.com\/index.php\/register\/\" id=\"wpmem_register_form\" class=\"form\"><input type=\"hidden\" id=\"_wpmem_register_nonce\" name=\"_wpmem_register_nonce\" value=\"0900c72328\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php\/wp-json\/wp\/v2\/pages\/42\" \/><fieldset><legend>New User Registration<\/legend><label for=\"username\" class=\"text\">Choose a Username<span class=\"req\">*<\/span><\/label><div class=\"div_text\"><input name=\"username\" type=\"text\" id=\"username\" value=\"\" class=\"textbox\" required  \/><\/div><label for=\"password\" class=\"text\">Password<span class=\"req\">*<\/span><\/label><div class=\"div_text\"><input name=\"password\" type=\"password\" id=\"password\" class=\"textbox\" required  \/><\/div><label for=\"first_name\" class=\"text\">First Name<span class=\"req\">*<\/span><\/label><div class=\"div_text\"><input name=\"first_name\" type=\"text\" id=\"first_name\" value=\"\" class=\"textbox\" required  \/><\/div><label for=\"last_name\" class=\"text\">Last Name<span class=\"req\">*<\/span><\/label><div class=\"div_text\"><input name=\"last_name\" type=\"text\" id=\"last_name\" value=\"\" class=\"textbox\" required  \/><\/div><label for=\"billing_address_1\" class=\"text\">Address 1<span class=\"req\">*<\/span><\/label><div class=\"div_text\"><input name=\"billing_address_1\" type=\"text\" id=\"billing_address_1\" value=\"\" class=\"textbox\" required  \/><\/div><label for=\"billing_address_2\" class=\"text\">Address 2<\/label><div class=\"div_text\"><input name=\"billing_address_2\" type=\"text\" id=\"billing_address_2\" value=\"\" class=\"textbox\" \/><\/div><label for=\"billing_city\" class=\"text\">City<span class=\"req\">*<\/span><\/label><div class=\"div_text\"><input name=\"billing_city\" type=\"text\" id=\"billing_city\" value=\"\" class=\"textbox\" required  \/><\/div><label for=\"billing_state\" class=\"select\">State<span class=\"req\">*<\/span><\/label><div class=\"div_select\"><select name=\"billing_state\" id=\"billing_state\" class=\"dropdown\" required ><option value=\"\">---- Select One ----<\/option><option value=\"AL\">Alabama<\/option><option value=\"AK\">Alaska<\/option><option value=\"AZ\">Arizona<\/option><option value=\"AR\">Arkansas<\/option><option value=\"CA\">California<\/option><option value=\"CO\">Colorado<\/option><option value=\"CT\">Connecticut<\/option><option value=\"DE\">Delaware<\/option><option value=\"DC\">District of Columbia<\/option><option value=\"FL\">Florida<\/option><option value=\"GA\">Georgia<\/option><option value=\"HI\">Hawaii<\/option><option value=\"ID\">Idaho<\/option><option value=\"IL\">Illinois<\/option><option value=\"IN\">Indiana<\/option><option value=\"IA\">Iowa<\/option><option value=\"KS\">Kansas<\/option><option value=\"KY\">Kentucky<\/option><option value=\"LA\">Louisiana<\/option><option value=\"ME\">Maine<\/option><option value=\"MT\">Montana<\/option><option value=\"NE\">Nebraska<\/option><option value=\"NV\">Nevada<\/option><option value=\"NH\">New Hampshire<\/option><option value=\"NJ\">New Jersey<\/option><option value=\"NM\">New Mexico<\/option><option value=\"NY\">New York<\/option><option value=\"NC\">North Carolina<\/option><option value=\"ND\">North Dakota<\/option><option value=\"OH\">Ohio<\/option><option value=\"OK\">Oklahoma<\/option><option value=\"OR\">Oregon<\/option><option value=\"MD\">Maryland<\/option><option value=\"MA\">Massachusetts<\/option><option value=\"MI\">Michigan<\/option><option value=\"MN\">Minnesota<\/option><option value=\"MS\">Mississippi<\/option><option value=\"MO\">Missouri<\/option><option value=\"PA\">Pennsylvania<\/option><option value=\"RI\">Rhode Island<\/option><option value=\"SC\">South Carolina<\/option><option value=\"SD\">South Dakota<\/option><option value=\"TN\">Tennessee<\/option><option value=\"TX\">Texas<\/option><option value=\"UT\">Utah<\/option><option value=\"VT\">Vermont<\/option><option value=\"VA\">Virginia<\/option><option value=\"WA\">Washington<\/option><option value=\"WV\">West Virginia<\/option><option value=\"WI\">Wisconsin<\/option><option value=\"WY\">Wyoming<\/option><\/select><\/div><label for=\"billing_postcode\" class=\"number\">Zip<span class=\"req\">*<\/span><\/label><div class=\"div_number\"><input name=\"billing_postcode\" type=\"number\" id=\"billing_postcode\" value=\"0\" class=\"textbox\" min=\"00001\" max=\"99999\" required  \/><\/div><label for=\"billing_country\" class=\"text\">Country<span class=\"req\">*<\/span><\/label><div class=\"div_text\"><input name=\"billing_country\" type=\"text\" id=\"billing_country\" value=\"\" class=\"textbox\" required  \/><\/div><label for=\"billing_phone\" class=\"number\">Phone<span class=\"req\">*<\/span><\/label><div class=\"div_number\"><input name=\"billing_phone\" type=\"number\" id=\"billing_phone\" value=\"0\" class=\"textbox\" placeholder=\"xxxxxxxxxx\" min=\"1000000000\" max=\"9999999999\" required  \/><\/div><label for=\"user_email\" class=\"text\">Email<span class=\"req\">*<\/span><\/label><div class=\"div_text\"><input name=\"user_email\" type=\"email\" id=\"user_email\" value=\"\" class=\"textbox\" required  \/><\/div><input name=\"a\" type=\"hidden\" value=\"register\" \/><input name=\"wpmem_reg_page\" type=\"hidden\" value=\"https:\/\/sam.annuityapplication.com\/index.php\/register\/\" \/><div class=\"button_div\"><input name=\"submit\" type=\"submit\" value=\"Register\" class=\"buttons\" \/><\/div><div class=\"req-text\"><span class=\"req\">*<\/span>Required field<\/div><\/fieldset><\/form><\/div>\n[\/logged_in_only]\n\n\n\n[logged_out_only]\n<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gform-theme gform-theme--foundation gform-theme--framework gform-theme--orbital' data-form-theme='orbital' data-form-index='0' id='gform_wrapper_1' ><style>#gform_wrapper_1[data-form-index=\"0\"].gform-theme{--gf-color-primary: #204ce5;--gf-color-primary-rgb: 32, 76, 229;--gf-color-primary-contrast: #fff;--gf-color-primary-contrast-rgb: 255, 255, 255;--gf-color-primary-darker: #001AB3;--gf-color-primary-lighter: #527EFF;--gf-color-secondary: #fff;--gf-color-secondary-rgb: 255, 255, 255;--gf-color-secondary-contrast: #112337;--gf-color-secondary-contrast-rgb: 17, 35, 55;--gf-color-secondary-darker: #F5F5F5;--gf-color-secondary-lighter: #FFFFFF;--gf-color-out-ctrl-light: rgba(17, 35, 55, 0.1);--gf-color-out-ctrl-light-rgb: 17, 35, 55;--gf-color-out-ctrl-light-darker: rgba(104, 110, 119, 0.35);--gf-color-out-ctrl-light-lighter: #F5F5F5;--gf-color-out-ctrl-dark: #585e6a;--gf-color-out-ctrl-dark-rgb: 88, 94, 106;--gf-color-out-ctrl-dark-darker: #112337;--gf-color-out-ctrl-dark-lighter: rgba(17, 35, 55, 0.65);--gf-color-in-ctrl: #fff;--gf-color-in-ctrl-rgb: 255, 255, 255;--gf-color-in-ctrl-contrast: #112337;--gf-color-in-ctrl-contrast-rgb: 17, 35, 55;--gf-color-in-ctrl-darker: #F5F5F5;--gf-color-in-ctrl-lighter: #FFFFFF;--gf-color-in-ctrl-primary: #204ce5;--gf-color-in-ctrl-primary-rgb: 32, 76, 229;--gf-color-in-ctrl-primary-contrast: #fff;--gf-color-in-ctrl-primary-contrast-rgb: 255, 255, 255;--gf-color-in-ctrl-primary-darker: #001AB3;--gf-color-in-ctrl-primary-lighter: #527EFF;--gf-color-in-ctrl-light: rgba(17, 35, 55, 0.1);--gf-color-in-ctrl-light-rgb: 17, 35, 55;--gf-color-in-ctrl-light-darker: rgba(104, 110, 119, 0.35);--gf-color-in-ctrl-light-lighter: #F5F5F5;--gf-color-in-ctrl-dark: #585e6a;--gf-color-in-ctrl-dark-rgb: 88, 94, 106;--gf-color-in-ctrl-dark-darker: #112337;--gf-color-in-ctrl-dark-lighter: rgba(17, 35, 55, 0.65);--gf-radius: 3px;--gf-font-size-secondary: 14px;--gf-font-size-tertiary: 13px;--gf-icon-ctrl-number: url(\"data:image\/svg+xml,%3Csvg width='8' height='14' viewBox='0 0 8 14' fill='none' xmlns='http:\/\/www.w3.org\/2000\/svg'%3E%3Cpath fill-rule='evenodd' clip-rule='evenodd' d='M4 0C4.26522 5.96046e-08 4.51957 0.105357 4.70711 0.292893L7.70711 3.29289C8.09763 3.68342 8.09763 4.31658 7.70711 4.70711C7.31658 5.09763 6.68342 5.09763 6.29289 4.70711L4 2.41421L1.70711 4.70711C1.31658 5.09763 0.683417 5.09763 0.292893 4.70711C-0.0976311 4.31658 -0.097631 3.68342 0.292893 3.29289L3.29289 0.292893C3.48043 0.105357 3.73478 0 4 0ZM0.292893 9.29289C0.683417 8.90237 1.31658 8.90237 1.70711 9.29289L4 11.5858L6.29289 9.29289C6.68342 8.90237 7.31658 8.90237 7.70711 9.29289C8.09763 9.68342 8.09763 10.3166 7.70711 10.7071L4.70711 13.7071C4.31658 14.0976 3.68342 14.0976 3.29289 13.7071L0.292893 10.7071C-0.0976311 10.3166 -0.0976311 9.68342 0.292893 9.29289Z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-icon-ctrl-select: url(\"data:image\/svg+xml,%3Csvg width='10' height='6' viewBox='0 0 10 6' fill='none' xmlns='http:\/\/www.w3.org\/2000\/svg'%3E%3Cpath fill-rule='evenodd' clip-rule='evenodd' d='M0.292893 0.292893C0.683417 -0.097631 1.31658 -0.097631 1.70711 0.292893L5 3.58579L8.29289 0.292893C8.68342 -0.0976311 9.31658 -0.0976311 9.70711 0.292893C10.0976 0.683417 10.0976 1.31658 9.70711 1.70711L5.70711 5.70711C5.31658 6.09763 4.68342 6.09763 4.29289 5.70711L0.292893 1.70711C-0.0976311 1.31658 -0.0976311 0.683418 0.292893 0.292893Z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-icon-ctrl-search: url(\"data:image\/svg+xml,%3Csvg width='640' height='640' xmlns='http:\/\/www.w3.org\/2000\/svg'%3E%3Cpath d='M256 128c-70.692 0-128 57.308-128 128 0 70.691 57.308 128 128 128 70.691 0 128-57.309 128-128 0-70.692-57.309-128-128-128zM64 256c0-106.039 85.961-192 192-192s192 85.961 192 192c0 41.466-13.146 79.863-35.498 111.248l154.125 154.125c12.496 12.496 12.496 32.758 0 45.254s-32.758 12.496-45.254 0L367.248 412.502C335.862 434.854 297.467 448 256 448c-106.039 0-192-85.962-192-192z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-label-space-y-secondary: var(--gf-label-space-y-md-secondary);--gf-ctrl-border-color: #686e77;--gf-ctrl-size: var(--gf-ctrl-size-md);--gf-ctrl-label-color-primary: #112337;--gf-ctrl-label-color-secondary: #112337;--gf-ctrl-choice-size: var(--gf-ctrl-choice-size-md);--gf-ctrl-checkbox-check-size: var(--gf-ctrl-checkbox-check-size-md);--gf-ctrl-radio-check-size: var(--gf-ctrl-radio-check-size-md);--gf-ctrl-btn-font-size: var(--gf-ctrl-btn-font-size-md);--gf-ctrl-btn-padding-x: var(--gf-ctrl-btn-padding-x-md);--gf-ctrl-btn-size: var(--gf-ctrl-btn-size-md);--gf-ctrl-btn-border-color-secondary: #686e77;--gf-ctrl-btn-bg-color-hover-tertiary: #EBEBEB;--gf-field-img-choice-size: var(--gf-field-img-choice-size-md);--gf-field-img-choice-card-space: var(--gf-field-img-choice-card-space-md);--gf-field-img-choice-check-ind-size: var(--gf-field-img-choice-check-ind-size-md);--gf-field-img-choice-check-ind-icon-size: var(--gf-field-img-choice-check-ind-icon-size-md);--gf-field-pg-steps-number-color: rgba(17, 35, 55, 0.8);}<\/style>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">New User Registration<\/h2>\n                            <p class='gform_description'><\/p>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>&quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_1'  action='\/index.php\/wp-json\/wp\/v2\/pages\/42' data-formid='1' novalidate><div class='gf_invisible ginput_recaptchav3'  data-tabindex='0'><input id=\"input_d6940e429b33b630150a5335bca4b629\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_d6940e429b33b630150a5335bca4b629\" value=\"\"\/><\/div>\n                        <div class='gform-body gform_body'><div id='gform_fields_1' class='gform_fields top_label form_sublabel_above description_above validation_below'><div id=\"field_1_14\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_14'><span class='gform-field-label__text'>Phone<\/span><\/label><div class='gfield_description' id='gfield_description_1_14'>This field is for validation purposes and should be left unchanged.<\/div><div class='ginput_container'><input name='input_14' id='input_1_14' type='text' value='' autocomplete='new-password'\/><\/div><\/div><div id=\"field_1_3\" class=\"gfield gfield--type-username gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_3'><span class='gform-field-label__text'>Choose a Username<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_3' id='input_1_3' type='text' value='' class='large'  aria-describedby=\"input_1_3_desc\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_4\" class=\"gfield gfield--type-password gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_1_4'><span class='gform-field-label__text'>Password<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_password'>\n\t\t\t\t\t\t<span id='input_1_4_1_container' class='ginput_password large'>\n\t\t\t\t\t\t\t<span class='password_input_container'>\n\t\t\t\t\t\t\t<input type='password' name='input_4' id='input_1_4'    value=''   aria-required=\"true\" aria-invalid=\"false\" \/>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t<div class='gf_clear gf_clear_complex'><\/div>\n\t\t\t\t\t<\/div><\/div><div id=\"field_1_5\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_5'><span class='gform-field-label__text'>First Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_5' id='input_1_5' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_6\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_6'><span class='gform-field-label__text'>Last Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_6' id='input_1_6' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_8\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_8'><span class='gform-field-label__text'>Address 1<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_8' id='input_1_8' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_9\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_9'><span class='gform-field-label__text'>Address 2<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_9' id='input_1_9' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_10\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_10'><span class='gform-field-label__text'>City<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_10' id='input_1_10' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_11\" class=\"gfield gfield--type-select gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_11'><span class='gform-field-label__text'>State<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_11' id='input_1_11' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>-- Select One --<\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select><\/div><\/div><div id=\"field_1_12\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_12'><span class='gform-field-label__text'>Zip<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_12' id='input_1_12' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_2\" class=\"gfield gfield--type-email gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_2'><span class='gform-field-label__text'>Email<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_2' id='input_1_2' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  autocomplete=\"email\"\/>\n                        <\/div><\/div><div id=\"field_1_13\" class=\"gfield gfield--type-phone gfield--phone-format-standard gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_13'><span class='gform-field-label__text'>Phone<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_13' id='input_1_13' type='tel' value='' class='large'  placeholder='(999) 999-9999' aria-required=\"true\" aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/div><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <button type='submit' id='gform_submit_button_1' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' >Submit<\/button> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_1' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_1' id='gform_theme_1' value='orbital' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_1' id='gform_style_settings_1' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_1' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='1' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='USD' value='QJAgJtY\/n2OM38CEH+QW+gvYaNZ0uRUvCNp6zWgVlJ0fAKRkHb6OebZcFCPVBqktEvx0ciPw5xNQvltpbKlRr7PdeYTRnr8cLmfooQhu1ruKxg4=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_1' value='WyJ7XCIxMVwiOltcIjIzMWI3MjAyYjljNjcxZjQ3NTgxZGMzZmJhNGMyZGQxXCIsXCI4ODJiMTUyMTg0Zjg3Mjk2OGRjNDExYzljOGJhNjIwYVwiLFwiMDJhNmNhZGU1MDIwYmJmYjlhNmM2NmQ5MjgzNjE5YWZcIixcImU4ZmIzOWE4YTQ3YThhOWZiMDNiMDk3NDE1OGYzODk2XCIsXCJhNDYyYWM2ZWM3YTc3NWE5Y2Y1NTU3MWJkN2YzMzhlNFwiLFwiODU4NTdjNjRmZDEyZjEwOTIwMjIwMjI3MDdkN2E5M2VcIixcIjc1ZTUyOGEzMDUzNjU1NDE4NGMxOTVmZTZiZWQ5YmM4XCIsXCJhMDk1ZmNiMTgzOGY2ZjAwZjI0ZGVjOTNkMTRlYmNkNFwiLFwiNTQ1NjQ1OGJmNWQyMjc2MTgzZjY5OGE5OWVkMzYxODJcIixcIjI1MDFmOThlYmMzMTJlM2EyMDNmMWU3ZThmNTgwYjNiXCIsXCI5YTJlYTExOGU5YmRmZmNlNzExNTBmZTljMjU0MmJkYlwiLFwiZmM4N2E0ZGM0YjJkNDAxNmI5Yzk2NTBiYmQ2NzA0ODNcIixcImNjYjE5YTMyZGJhYWEwOWMxNzhhZjE3MjJkZjcxN2NjXCIsXCJhN2I1NzBjN2FhOTI0MzQ2MDEzMzQ1OWU4N2Q4OTJiNVwiLFwiZWJhNmRlMmJiZWEyMGE3MDY2MmZjMTJlMzNkNjQ2YzdcIixcIjNlZWY1ODU4MmNkZjk0MTMzMWYyODBhMGYxMDQyOTIxXCIsXCIzYzQxMTc5MGExOGZhNGJjYjJlNzI3YTk3ZDgzNzFkOFwiLFwiZTI0M2Y2MjE3ZGQ1NzRlZWQ1M2E5ZDVmYmM2MTU2ZGRcIixcIjAxNTliYTQzMjcwNDVlNGRlMWM5ZTZhODZhOGNlY2ZlXCIsXCI0YjU3MzUyNmMwMzZmZjg3ZWQ4ZjhjNmUyMGZlNGE1MlwiLFwiZjg4ZWEyZDI2NjNlMDA2NzFiZDc5ZmRkZjU4OTM4NzJcIixcIjQxNGJmMmFjOGZlOTY4YTM2YjA1NGU0ZDVjZTllMjdmXCIsXCIyZDQxNDkxZmNlOGI4NTQ0ZTJmM2U0NGUwZDMyYmY4ZFwiLFwiYTAxOWQyODI2MjkwYzBlMTUxMDgxZmM1NDVkZTM4MmVcIixcIjRiN2ViNTMyODg5YjJkMWFlYjQyMGRkYjM3MGVmMGI0XCIsXCI2ODlhYzBiMWFkZmRkZmNjNWM5ZWUwMzI1NzI1NTc5ZVwiLFwiZWRhZTNhN2E2OGQwNWRjMTMxNjc3MGMwZDZiMGE5NDhcIixcIjk5ODQyOTQ3YTAwNjAwNTM4NmEzNmQ4MWVmMjI0ZGRhXCIsXCI1MWRmMWIyZDk2OTc2MDFkMzMwMzUyZGQ0OTdmNGMzYlwiLFwiMzQ4NTAwNTRlNDUyZTk2ZmE4YWEwZmY3ZDU5ZTY1ZmJcIixcImEyMmI5NzllNjk0OTlmMzk1NWY5NTZkZGE5MzY3NjVkXCIsXCJhZTI5NmEzNjczMzQ2YzhlOGMzMTA2ZDM4NTJkNGMxMVwiLFwiNTY5YmI0Y2JjYzc3MjdhMzk1OGM2NGU4YzdmY2JiYWFcIixcImU2MWIzZWU5MWNiNTlkYmYyMTg1NjYzM2Y5NzY3MGE2XCIsXCJmYjYwOTRhN2M3OTJmMGI5Mzk2NjdmZTcyNGYwY2RlZVwiLFwiMDg4OTEwNzJlODdhMWNkZTQ5NTkxNzhmMTJiNTFiODlcIixcIjliNjg0ODA5MDg1ZDQ0OGI3NGM3M2M0MjhmN2JjNzEyXCIsXCJiZWZiNjc3NzI2NGU1YzFjZDcwZjExNzJkMWZjNTQ0ZFwiLFwiMGYzMzEyM2YwODlmMGMwY2VjZTI0ZjY3N2Y1YTM4NDVcIixcIjk1ZDE3Y2UyNmYxZmVlNTgxMDY4MWJlMzE3Mzc5YTAyXCIsXCI1MzQzNzFhOWExZDUxMDNhOGY3NTIzYjdiNDI3NzE5YVwiLFwiY2JmNzgyMjRmOTJhNmMyY2QyN2I0MGQ5ODhmMjhjM2NcIixcImQ1ZTcyODVjY2MzYjQ1MjQzOGFlY2JiNDU0Yjc0NDhmXCIsXCI1NWZjY2IwYWMwMTUyYTYyYTM0MTAyZDYzZWNmYTk5MFwiLFwiODUxNTAyYjA2ZTY5OTYxZWM4ZjVmNTQwM2Q4MDYzYThcIixcIjljZTNlNzgwZDRjZThkNTM0ZmNhNDgxNTllMTU5OGRmXCIsXCI2MGI2NjU2NDg5YjExNjM5YTNhMGQyNTc2MTg3ZjZhYVwiLFwiNTdhNTJkY2JkNjljNzA0YjJkN2Y0NjFlOGM4OTUwNjVcIixcIjExY2JlNzA0OTU5YTc1NjhiZDg1ODhmZDFhY2EzMmMyXCIsXCJlZDI5M2VjYzQwMGU4NWFkYmEzNjMzMGYyMDVhZmJkMlwiLFwiNGI5NGFlMTZhZGQ0NDQzNGYzY2Y0YzIwYThiMmYzNzBcIixcIjk0OTQzMGI1YWE1OThmNDY2ZjE5NmU0NDc2NWJkNDEyXCIsXCIyMjY0ZWJmOWNjMGQzYzJmOTdhNGYzZDE4YjNjYmI3ZFwiLFwiMGQ5MGI2YTBiMTkzYzQxNGU4OTJmNjBjZWIyMmJhNzBcIixcImNkYWMzMDY4ZWRjN2Q3ZjcyODFjOTAwMjI4YmI2ZGZhXCIsXCIzZjQ3ZTZlN2ZkNGVhNzM4MjdkZGQyNTYzOTMwYWE4ZFwiLFwiNDI1YzE2ZjZmMjg3YmU0NDYyNjgwZjQ2ZjU4YzkyMWRcIixcIjNkMWQzM2I5NzQ3MTcxYzk5NzU3ZjhkMWNhYTM3OTg3XCIsXCI1OTBmYmFjMjI4OWNiZTU4Y2NmMGVmNjA3ZTk1NDQ1MlwiXSxcImdmb3JtX3N1Ym1pc3Npb25fbWV0aG9kXCI6W1wiNTczZjA5MjU1NWQ2NDBiMDYxNjJmMjQ5ZDg0ZjRhMDZcIixcImFhN2NmMzZlMjNkNWYwNjk0YjU4ODg2MDNhZGI5NzQzXCJdLFwiZ2Zvcm1fdGhlbWVcIjpcIjU1MTE3ODZhYWZiZTZiNjg0NzAzMjQ2NzE3ZjYxNDYyXCIsXCJnZm9ybV9zdHlsZV9zZXR0aW5nc1wiOlwiODI3NzhiNDlkMGIzMGEyYTY3MmE1ODA3ZDYyZTZjOWNcIixcImZvcm1faWRcIjpcImYzYzhhODNjODRkNGRhYjFmYTYwMWJlM2FhZTA1MDcwXCIsXCJ1cmxcIjpcIjg3MTJmNzdmZjM3Njc2YmJhMDdjOTY0MTQ1ZjY4ZWQwXCIsXCJzdGF0ZV90aW1lc3RhbXBcIjpcImQxZmViOTZmY2E4ODg4NDE4NmU1MzIyMjgyODQ0MmU1XCJ9IiwiNDFjYWZjZThlMmI1MzljOTE0ZTZhZDFkMGIzZTQwYzgiLDE3ODkzNDE5NThd' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_1' id='gform_target_page_number_1' value='0' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_1' id='gform_source_page_number_1' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"ak_\"><label>&#916;<textarea name=\"ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_1\" name=\"ak_js\" value=\"50\"\/><script>\ndocument.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );\n<\/script>\n<\/p><\/form>\n                        <\/div>\n[\/logged_out_only]\n","protected":false},"excerpt":{"rendered":"<p>[logged_in_only] [\/logged_in_only] [logged_out_only] [\/logged_out_only]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"open","template":"","meta":{"footnotes":""},"class_list":["post-42","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/sam.annuityapplication.com\/index.php\/wp-json\/wp\/v2\/pages\/42","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/sam.annuityapplication.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/sam.annuityapplication.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/sam.annuityapplication.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/sam.annuityapplication.com\/index.php\/wp-json\/wp\/v2\/comments?post=42"}],"version-history":[{"count":0,"href":"https:\/\/sam.annuityapplication.com\/index.php\/wp-json\/wp\/v2\/pages\/42\/revisions"}],"wp:attachment":[{"href":"https:\/\/sam.annuityapplication.com\/index.php\/wp-json\/wp\/v2\/media?parent=42"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}