<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<title>Xpress Benefits | Secure Your Family's Future</title>
<link href="https://fonts.googleapis.com/css2?family=Poppins:wght@300;400;600;700&display=swap" rel="stylesheet">
<style>
:root {
--royal-blue: #002366;
--gold: #D4AF37;
--light-gold: #F4E4AD;
--white: #ffffff;
--text-dark: #333333;
--gray: #f4f7f6;
}
* {
box-sizing: border-box;
margin: 0;
padding: 0;
}
body {
font-family: 'Poppins', sans-serif;
line-height: 1.6;
color: var(--text-dark);
background-color: var(--white);
}
/* Header */
header {
background-color: var(--white);
padding: 15px 5%;
display: flex;
justify-content: space-between;
align-items: center;
border-bottom: 3px solid var(--gold);
position: sticky;
top: 0;
z-index: 1000;
}
.logo {
font-size: 24px;
font-weight: 700;
color: var(--royal-blue);
text-transform: uppercase;
}
.logo span {
color: var(--gold);
}
.phone-cta {
font-weight: 600;
color: var(--royal-blue);
}
/* Hero Section */
.hero {
background: linear-gradient(rgba(0, 35, 102, 0.8), rgba(0, 35, 102, 0.8)),
url('https://images.unsplash.com/photo-1509059852496-f3822ae057bf?ixlib=rb-1.2.1&auto=format&fit=crop&w=1350&q=80');
background-size: cover;
background-position: center;
padding: 60px 5%;
display: flex;
flex-wrap: wrap;
justify-content: space-between;
align-items: center;
}
.hero-text {
flex: 1;
min-width: 300px;
color: var(--white);
padding-right: 40px;
}
.hero-text h1 {
font-size: 3rem;
line-height: 1.2;
margin-bottom: 20px;
}
.hero-text h1 span {
color: var(--gold);
}
.hero-text p {
font-size: 1.2rem;
margin-bottom: 30px;
}
/* Form Styling */
.form-container {
flex: 0 1 450px;
background: var(--white);
padding: 30px;
border-radius: 10px;
box-shadow: 0 10px 30px rgba(0,0,0,0.3);
border-top: 5px solid var(--gold);
}
.form-container h2 {
text-align: center;
color: var(--royal-blue);
margin-bottom: 10px;
}
.form-container p {
text-align: center;
font-size: 0.9rem;
margin-bottom: 20px;
color: #666;
}
.form-group {
margin-bottom: 15px;
}
.form-row {
display: flex;
gap: 15px;
}
.form-row .form-group {
flex: 1;
}
label {
display: block;
font-size: 0.85rem;
font-weight: 600;
margin-bottom: 5px;
color: var(--royal-blue);
}
input, select {
width: 100%;
padding: 12px;
border: 1px solid #ccc;
border-radius: 5px;
font-family: inherit;
font-size: 1rem;
}
input:focus, select:focus {
outline: none;
border-color: var(--royal-blue);
box-shadow: 0 0 5px rgba(0,35,102,0.2);
}
.submit-btn {
width: 100%;
background-color: var(--gold);
color: var(--royal-blue);
border: none;
padding: 15px;
font-size: 1.1rem;
font-weight: 700;
text-transform: uppercase;
border-radius: 5px;
cursor: pointer;
transition: background 0.3s;
margin-top: 10px;
}
.submit-btn:hover {
background-color: #b3912d;
}
/* Trust Section */
.trust-bar {
background: var(--gray);
padding: 20px 5%;
text-align: center;
display: flex;
justify-content: center;
gap: 50px;
flex-wrap: wrap;
}
.trust-item {
font-weight: 600;
color: #555;
display: flex;
align-items: center;
gap: 8px;
}
.trust-item span {
color: var(--gold);
font-size: 1.5rem;
}
/* Footer */
footer {
background: var(--royal-blue);
color: var(--white);
text-align: center;
padding: 40px 5%;
}
.footer-links {
margin-top: 20px;
}
.footer-links a {
color: var(--light-gold);
text-decoration: none;
margin: 0 10px;
font-size: 0.8rem;
}
@media (max-width: 768px) {
.hero-text {
padding-right: 0;
text-align: center;
margin-bottom: 40px;
}
.hero-text h1 {
font-size: 2.2rem;
}
.form-row {
flex-direction: column;
gap: 0;
}
}
</style>
</head>
<body>
<header>
<div class="logo">Xpress<span>Benefits</span></div>
<div class="phone-cta">Questions? Call: 1-800-XXX-XXXX</div>
</header>
<section class="hero">
<div class="hero-text">
<h1>Protect Your Legacy With <span>Affordable</span> Life Insurance</h1>
<p>Get a free, no-obligation quote in under 2 minutes. We compare top-rated providers to find you the best rates for final expenses and legacy planning.</p>
<ul style="list-style: none; margin-bottom: 20px;">
<li>✅ Rates locked in for life</li>
<li>✅ No medical exam required options</li>
<li>✅ Quick payout for beneficiaries</li>
</ul>
</div>
<div class="form-container">
<h2>Get Your Free Quote</h2>
<p>Secure, fast, and 100% confidential.</p>
<form action="https://formspree.io/f/hello@xpressbenefits.net" method="POST">
<div class="form-group">
<label>Full Name</label>
<input type="text" name="full_name" placeholder="John Doe" required>
</div>
<input type="hidden" name="_subject" value="New Life Insurance Lead - Xpress Benefits">
<div class="form-row">
<div class="form-group">
<label>Zip Code</label>
<input type="number" name="zip_code" placeholder="12345" required>
</div>
<div class="form-group">
<label>State</label>
<select name="state" required>
<option value="">Select State</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="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="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="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="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>
</div>
<div class="form-row">
<div class="form-group">
<label>Age</label>
<input type="number" name="age" min="18" max="100" placeholder="e.g. 55" required>
</div>
<div class="form-group">
<label>Gender</label>
<select name="gender" required>
<option value="">Select</option>
<option value="Male">Male</option>
<option value="Female">Female</option>
</select>
</div>
</div>
<div class="form-group">
<label>Amount of Coverage Desired</label>
<select name="coverage_amount" required>
<option value="">Select Amount</option>
<option value="$5,000 - $10,000">$5,000 - $10,000</option>
<option value="$10,000 - $25,000">$10,000 - $25,000</option>
<option value="$25,000 - $50,000">$25,000 - $50,000</option>
<option value="$50,000+">$50,000+</option>
</select>
</div>
<div class="form-group">
<label>Desired Beneficiary (e.g. Spouse, Child)</label>
<input type="text" name="beneficiary" placeholder="Relationship to you" required>
</div>
<div class="form-group">
<label>Phone Number</label>
<input type="tel" name="phone_number" placeholder="(555) 555-5555" required>
</div>
<button type="submit" class="submit-btn">Get My Free Quote</button>
</form>
</div>
</section>
<div class="trust-bar">
<div class="trust-item"><span>★</span> Top Rated Carriers</div>
<div class="trust-item"><span>★</span> Secure 256-bit SSL</div>
<div class="trust-item"><span>★</span> Fast Approvals</div>
</div>
<footer>
<p>© 2024 Xpress Benefits. All rights reserved.</p>
<p style="font-size: 0.7rem; margin-top: 10px; opacity: 0.8;">
By clicking "Get My Free Quote", you agree to be contacted via phone/email/SMS regarding insurance options.
</p>
<div class="footer-links">
<a href="#">Privacy Policy</a>
<a href="#">Terms of Service</a>
<a href="mailto:hello@xpressbenefits.net">Contact Us</a>
</div>
</footer>
</body>
</html>
