Forms | Allianz Life

Text Fields

Ensure you are using the proper type on form inputs: text, password, url, email, search, number.

Text

Password

Postal/Zip code*

Web Address

Email Address

Static control

larry.king@monstersofrock.com

Search

Number Input

Text Area

Error State

This field is required

Valid State

Date range

From

To

* Required field

Select Menu

Select

Checkboxes

Select any of the checkbox options

Option one

Option two

Radio Buttons

Select only one of the radio buttons

Option one

Option two

Option three

Checkbox Replacement

In a form-group with a Label

Select any of the checkbox options

One

Two

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With some help text Help text goes here

Mango dango

One

Two

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"has-error"

Select any of the checkbox options

One

Two

This field is required

Disabled

One

Two

Three

Disabled

Partial - Example: Select All

Select All (Partial)

One

Two

Three

Inline

One

Two

Three

Table with checkbox-replacement

Index	Cap	Declared Protection Strategy Credit	Current Allocation	Index Option Base
S&P 500 Index	10.25%	NA	29.21 %	$21,465.34
Russell 2000	14.25%	NA	35.43 %	$25,927.77
NASDAQ 100 Stock	10.25%	NA	35.36 %	$25,731.08

Radio Buttons Replacement

Toggle Switches

Notification Preferences

Subscribed Unsubscribed

Notification Preferences

Subscribed Unsubscribed

Label

Yes No

Label

Yes No

Login Form

Username*

Password*

Remember me

Get access to your online account.

Register

Contact us form

Please note: We cannot reply with personal account information unless you first

My reason for contacting Allianz is

I have a question about a policy or contract ( recommended)

I would like to become appointed to sell Allianz products

I would like to purchase Allianz products

Other

Select the product category about which you are inquiring*

Fixed annuities or Fixed index annuities

Variable annuities or Index Variable annuities

Life Insurance

Name*

Email address*

Phone number*

Postal/Zip code*

Comment*

Inline form

Name

Email

Inline form XS (stays inline on mobile)

Search

Designation

%

Table form (yes, that's a thing...)

To	% Allocation


Total XX% (must be 100%)	100%

Use selections to rebalance
One Year All Policy Years

Multi-select dropdown

Product Type

Date Picker - Calendar

On button

Payment Date

On text input

Some Date

Petition

Text Fields

Select Menu

Checkboxes

Radio Buttons

Checkbox Replacement

In a form-group with a Label

"has-error"

Disabled

Partial - Example: Select All

Inline

Table with checkbox-replacement

Radio Buttons Replacement

In a form-horizontal 2 column layout with a Label

"has-error"

Disabled

Title required for accessability

Inline

Radios/Checkboxes with inputs in fieldsets

Radio Cards

Radio Cards Inline

Toggle Switches

Login Form

Contact us form

Inline form

Inline form XS (stays inline on mobile)

Table form (yes, that's a thing...)

Multi-select dropdown

Date Picker - Calendar

On button

On text input

Petition

Text Fields

Select Menu

Checkboxes

Radio Buttons

Checkbox Replacement

In a form-group with a Label

"has-error"

Disabled

Partial - Example: Select All

Inline

Table with checkbox-replacement

Radio Buttons Replacement

In a form-horizontal 2 column layout with a Label

"has-error"

Disabled

Title required for accessability

Inline

Radios/Checkboxes with inputs in fieldsets

Radio Cards

Radio Cards Inline

Toggle Switches

Login Form

Contact us form

Inline form

Inline form XS (stays inline on mobile)

Table form (yes, that's a thing...)

Multi-select dropdown

Date Picker - Calendar

On button

On text input

Login / Register

Connect with Allianz Life

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