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this.setTimer();};this.bindMethod=function(method,scope){return function(){method.apply(scope,arguments);};};this.frameHeight=0;this.getBodyHeight=function(){if(this.formSubmitted===1){return;}
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var height=0;try{if(this.frame.contentWindow.window.innerHeight){height=this.frame.contentWindow.window.innerHeight-18;}else if((this.frame.contentWindow.document.documentElement)&&(this.frame.contentWindow.document.documentElement.clientHeight)){height=this.frame.contentWindow.document.documentElement.clientHeight;}else if((this.frame.contentWindow.document.body)&&(this.frame.contentWindow.document.body.clientHeight)){height=this.frame.contentWindow.document.body.clientHeight;}}catch(e){}
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FrameBuilder.get=qsProxy||[];var i211808762644864=new FrameBuilder("211808762644864",false,"","<!DOCTYPE HTML PUBLIC \"-\/\/W3C\/\/DTD HTML 4.01\/\/EN\" \"http:\/\/www.w3.org\/TR\/html4\/strict.dtd\">\n<html class=\"supernova\"><head>\n<meta http-equiv=\"Content-Type\" content=\"text\/html; charset=utf-8\" \/>\n<link rel=\"alternate\" type=\"application\/json+oembed\" href=\"https:\/\/www.jotform.com\/oembed\/?format=json&amp;url=https%3A%2F%2Fform.jotform.com%2F211808762644864\" title=\"oEmbed Form\">\n<link rel=\"alternate\" type=\"text\/xml+oembed\" href=\"https:\/\/www.jotform.com\/oembed\/?format=xml&amp;url=https%3A%2F%2Fform.jotform.com%2F211808762644864\" title=\"oEmbed Form\">\n<meta property=\"og:title\" content=\"DE Web Enquiry - Contact us\" >\n<meta property=\"og:url\" content=\"https:\/\/form.jotform.com\/211808762644864\" >\n<meta property=\"og:description\" content=\"Please click the link to complete this form.\" >\n<meta name=\"slack-app-id\" content=\"AHNMASS8M\">\n<meta property=\"og:image\" content=\"https:\/\/cdn.jotfor.ms\/assets\/img\/landing\/opengraph.png\" \/>\n<link rel=\"shortcut icon\" href=\"https:\/\/cdn.jotfor.ms\/assets\/img\/favicons\/favicon-2021-light%402x.png\">\n<script>\n          var favicon = document.querySelector('link[rel=\"shortcut icon\"]');\n          window.isDarkMode = (window.matchMedia && window.matchMedia('(prefers-color-scheme: dark)').matches);\n          if(favicon && window.isDarkMode) {\n              favicon.href = favicon.href.replaceAll('favicon-2021-light%402x.png', 'favicon-2021-dark%402x.png');\n          }\n      <\/script><link rel=\"canonical\" href=\"https:\/\/form.jotform.com\/211808762644864\" \/>\n<meta name=\"viewport\" content=\"width=device-width, initial-scale=1.0, maximum-scale=2.0, user-scalable=1\" \/>\n<meta name=\"HandheldFriendly\" content=\"true\" \/>\n<title>DE Web Enquiry - Contact us<\/title>\n<link href=\"https:\/\/cdn01.jotfor.ms\/static\/formCss.css?3.3.41906\" rel=\"stylesheet\" type=\"text\/css\" \/>\n<style type=\"text\/css\">@media print{.form-section{display:inline!important}.form-pagebreak{display:none!important}.form-section-closed{height:auto!important}.page-section{position:initial!important}}<\/style>\n<link type=\"text\/css\" rel=\"stylesheet\" href=\"https:\/\/cdn02.jotfor.ms\/css\/styles\/nova.css?3.3.41906\" \/>\n<link id=\"custom-font\" type=\"text\/css\" rel=\"stylesheet\" href=\"\/\/fonts.googleapis.com\/css?family=Roboto:light,lightitalic,normal,italic,bold,bolditalic\" \/>\n<link type=\"text\/css\" rel=\"stylesheet\" href=\"https:\/\/cdn03.jotfor.ms\/themes\/CSS\/566a91c2977cdfcd478b4567.css?v=3.3.41906\"\/>\n<link type=\"text\/css\" rel=\"stylesheet\" href=\"https:\/\/cdn01.jotfor.ms\/css\/styles\/payment\/payment_feature.css?3.3.41906\" \/>\n<style type=\"text\/css\">\n    .form-label-left{\n        width:200px;\n    }\n    .form-line{\n        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| *\/\n@media screen and (max-width: 480px) {\n  .jotform-form .form-all {\n    margin: 0;\n    width: 100%;\n  }\n}\n\/* | *\/\n\/* | *\/\n@media screen and (min-width: 480px) and (max-width: 767px) {\n  .jotform-form .form-all {\n    margin: 0;\n    width: 100%;\n  }\n}\n\/* | *\/\n\/* | *\/\n@media screen and (min-width: 480px) and (max-width: 699px) {\n  .jotform-form .form-all {\n    margin: 0;\n    width: 100%;\n  }\n}\n\/* | *\/\n\/* | *\/\n@media screen and (min-width: 768px) {\n  .jotform-form {\n    padding: 60px 0;\n  }\n}\n\/* | *\/\n\/* | *\/\n@media screen and (max-width: 699px) {\n  .jotform-form .form-all {\n    margin: 0;\n    width: 100%;\n  }\n}\n\/* | *\/\n.supernova .form-all,\n.form-all {\n  background-color: #ffffff;\n  border: 1px solid transparent;\n}\n.form-header-group {\n  border-color: #e6e6e6;\n}\n.form-matrix-table tr {\n  border-color: #e6e6e6;\n}\n.form-matrix-table tr:nth-child(2n) {\n  background-color: #f2f2f2;\n}\n.form-all {\n  color: #000000;\n}\n.form-header-group .form-header {\n  color: #000000;\n}\n.form-header-group .form-subHeader {\n  color: #1a1a1a;\n}\n.form-sub-label {\n  color: #1a1a1a;\n}\n.form-label-top,\n.form-label-left,\n.form-label-right,\n.form-html {\n  color: #000000;\n}\n.form-checkbox-item label,\n.form-radio-item label {\n  color: #1a1a1a;\n}\n.form-line.form-line-active {\n  -webkit-transition-property: all;\n  -moz-transition-property: all;\n  -ms-transition-property: all;\n  -o-transition-property: all;\n  transition-property: all;\n  -webkit-transition-duration: 0.3s;\n  -moz-transition-duration: 0.3s;\n  -ms-transition-duration: 0.3s;\n  -o-transition-duration: 0.3s;\n  transition-duration: 0.3s;\n  -webkit-transition-timing-function: ease;\n  -moz-transition-timing-function: ease;\n  -ms-transition-timing-function: ease;\n  -o-transition-timing-function: ease;\n  transition-timing-function: ease;\n  background-color: rgba(255, 255, 255, 0.75);\n}\n\/* omer *\/\n.form-radio-item,\n.form-checkbox-item {\n  padding-bottom: 0px !important;\n}\n.form-radio-item:last-child,\n.form-checkbox-item:last-child {\n  padding-bottom: 0;\n}\n\/* omer *\/\n.form-single-column .form-checkbox-item,\n.form-single-column .form-radio-item {\n  width: 100%;\n}\n.form-checkbox-item .editor-container div,\n.form-radio-item .editor-container div {\n  position: relative;\n}\n.form-checkbox-item .editor-container div:before,\n.form-radio-item .editor-container div:before {\n  display: inline-block;\n  vertical-align: middle;\n  box-sizing: border-box;\n  left: 0;\n  width: 24px;\n  height: 24px;\n}\n.form-radio-item:not(#foo) {\n  position: relative;\n}\n.form-radio-item:not(#foo) .form-radio-other-input,\n.form-radio-item:not(#foo) .form-checkbox-item:not(#foo) .form-checkbox-other-input {\n  margin-left: 0;\n}\n.form-radio-item:not(#foo) .form-radio-other.form-radio {\n  display: none !important;\n}\n.form-radio-item:not(#foo) input[type=\"checkbox\"],\n.form-radio-item:not(#foo) input[type=\"radio\"] {\n  opacity: 0;\n  width: 0;\n  margin: 0;\n  padding: 0;\n}\n.form-radio-item:not(#foo) .form-radio-other,\n.form-radio-item:not(#foo) .form-checkbox-other {\n  display: inline-block !important;\n  margin-left: 17px;\n  margin-right: 13px;\n  margin-top: 0px;\n}\n.form-radio-item:not(#foo) .form-checkbox-other-input,\n.form-radio-item:not(#foo) .form-radio-other-input {\n  margin: 0;\n}\n.form-radio-item:not(#foo) label {\n  line-height: 18px;\n  float: left;\n  margin-left: 37px;\n  outline: none !important;\n}\n.form-radio-item:not(#foo) label:before {\n  content: '';\n  position: absolute;\n  display: inline-block;\n  vertical-align: baseline;\n  margin-right: 4px;\n  box-sizing: border-box;\n  border-radius: 50%;\n  left: 4px;\n  width: 18px;\n  height: 18px;\n  cursor: pointer;\n}\n.form-radio-item:not(#foo) label:after {\n  content: '';\n  position: absolute;\n  z-index: 10;\n  display: inline-block;\n  opacity: 0;\n  top: 5px;\n  left: 9px;\n  width: 8px;\n  height: 8px;\n}\n.form-radio-item:not(#foo) input:checked + label:after {\n  opacity: 1;\n}\n.form-radio-item:not(#foo) input[type=\"checkbox\"],\n.form-radio-item:not(#foo) input[type=\"radio\"] {\n  opacity: 0;\n  width: 0;\n  margin: 0;\n  padding: 0;\n}\n.form-radio-item:not(#foo) .form-radio-other,\n.form-radio-item:not(#foo) .form-checkbox-other {\n  display: inline-block !important;\n  margin-left: 17px;\n  margin-right: 13px;\n  margin-top: 0px;\n}\n.form-radio-item:not(#foo) .form-checkbox-other-input,\n.form-radio-item:not(#foo) .form-radio-other-input {\n  margin: 0;\n}\n.form-radio-item:not(#foo) label {\n  line-height: 24px;\n  float: left;\n  margin-left: 43px;\n  outline: none !important;\n}\n.form-radio-item:not(#foo) label:before {\n  content: '';\n  position: absolute;\n  display: inline-block;\n  vertical-align: baseline;\n  margin-right: 4px;\n  box-sizing: border-box;\n  border-radius: 50%;\n  left: 4px;\n  width: 24px;\n  height: 24px;\n  cursor: pointer;\n}\n.form-radio-item:not(#foo) label:after {\n  content: '';\n  position: absolute;\n  z-index: 10;\n  display: inline-block;\n  opacity: 0;\n  top: 7px;\n  left: 11px;\n  width: 10px;\n  height: 10px;\n}\n.form-radio-item:not(#foo) input:checked + label:after {\n  opacity: 1;\n}\n.form-radio-item:not(#foo) label:before {\n  border: 2px solid #8dc346;\n}\n.form-radio-item:not(#foo) label:after {\n  background-color: #8dc346;\n  border-radius: 50%;\n  cursor: pointer;\n}\n.form-radio-item:not(#foo) .editor-container div:before {\n  content: '';\n  border: 2px solid #8dc346;\n  border-radius: 50%;\n  margin: 0 4px 0 -6px;\n}\n.form-checkbox-item:not(#foo) {\n  position: relative;\n}\n.form-checkbox-item:not(#foo) label {\n  display: block;\n}\n.form-checkbox-item:not(#foo) .form-radio-other-input,\n.form-checkbox-item:not(#foo) .form-checkbox-item:not(#foo) .form-checkbox-other-input {\n  margin-left: 0;\n}\n.form-checkbox-item:not(#foo) .form-checkbox-other.form-checkbox {\n  display: none !important;\n}\n.form-checkbox-item:not(#foo) input[type=\"checkbox\"],\n.form-checkbox-item:not(#foo) input[type=\"radio\"] {\n  opacity: 0;\n  width: 0;\n  margin: 0;\n  padding: 0;\n}\n.form-checkbox-item:not(#foo) .form-radio-other,\n.form-checkbox-item:not(#foo) .form-checkbox-other {\n  display: inline-block !important;\n  margin-left: 17px;\n  margin-right: 13px;\n  margin-top: 0px;\n}\n.form-checkbox-item:not(#foo) .form-checkbox-other-input,\n.form-checkbox-item:not(#foo) .form-radio-other-input {\n  margin: 0;\n}\n.form-checkbox-item:not(#foo) label {\n  line-height: 18px;\n  float: left;\n  margin-left: 37px;\n  outline: none !important;\n}\n.form-checkbox-item:not(#foo) label:before {\n  content: '';\n  position: absolute;\n  display: inline-block;\n  vertical-align: baseline;\n  margin-right: 4px;\n  box-sizing: border-box;\n  border-radius: 50%;\n  left: 4px;\n  width: 18px;\n  height: 18px;\n  cursor: pointer;\n}\n.form-checkbox-item:not(#foo) label:after {\n  content: '';\n  position: absolute;\n  z-index: 10;\n  display: inline-block;\n  opacity: 0;\n  top: 8px;\n  left: 9px;\n  width: 3px;\n  height: 3px;\n}\n.form-checkbox-item:not(#foo) input:checked + label:after {\n  opacity: 1;\n}\n.form-checkbox-item:not(#foo) label:before {\n  border: 2px solid #8dc346;\n}\n.form-checkbox-item:not(#foo) label:after {\n  background-color: #8dc346;\n  box-shadow: 0 2px 0 0 #8dc346, 2px 2px 0 0 #8dc346, 4px 2px 0 0 #8dc346, 6px 2px 0 0 #8dc346;\n  transform: rotate(-45deg);\n}\n.form-checkbox-item:not(#foo) .editor-container div:before {\n  content: '';\n  border: 2px solid #8dc346;\n  border-radius: 50%;\n  margin: 0 4px 0 -6px;\n}\n.form-checkbox-item:not(#foo) input[type=\"checkbox\"],\n.form-checkbox-item:not(#foo) input[type=\"radio\"] {\n  opacity: 0;\n  width: 0;\n  margin: 0;\n  padding: 0;\n}\n.form-checkbox-item:not(#foo) .form-radio-other,\n.form-checkbox-item:not(#foo) .form-checkbox-other {\n  display: inline-block !important;\n  margin-left: 17px;\n  margin-right: 13px;\n  margin-top: 0px;\n}\n.form-checkbox-item:not(#foo) .form-checkbox-other-input,\n.form-checkbox-item:not(#foo) .form-radio-other-input {\n  margin: 0;\n}\n.form-checkbox-item:not(#foo) label {\n  line-height: 24px;\n  float: left;\n  margin-left: 43px;\n  outline: none !important;\n}\n.form-checkbox-item:not(#foo) label:before {\n  content: '';\n  position: absolute;\n  display: inline-block;\n  vertical-align: baseline;\n  margin-right: 4px;\n  box-sizing: border-box;\n  border-radius: 50%;\n  left: 4px;\n  width: 24px;\n  height: 24px;\n  cursor: pointer;\n}\n.form-checkbox-item:not(#foo) label:after {\n  content: '';\n  position: absolute;\n  z-index: 10;\n  display: inline-block;\n  opacity: 0;\n  top: 11px;\n  left: 10px;\n  width: 4px;\n  height: 4px;\n}\n.form-checkbox-item:not(#foo) input:checked + label:after {\n  opacity: 1;\n}\n.form-checkbox-item:not(#foo) label:after {\n  background-color: #8dc346;\n  box-shadow: 0 3px 0 0 #8dc346, 3px 3px 0 0 #8dc346, 6px 3px 0 0 #8dc346, 8px 3px 0 0 #8dc346;\n  transform: rotate(-45deg);\n}\n.supernova {\n  height: 100%;\n  background-repeat: no-repeat;\n  background-attachment: scroll;\n  background-position: center top;\n  background-repeat: repeat;\n}\n.supernova {\n  background-image: none;\n}\n#stage {\n  background-image: none;\n}\n\/* | *\/\n.form-all {\n  background-repeat: no-repeat;\n  background-attachment: scroll;\n  background-position: center top;\n  background-repeat: repeat;\n}\n.form-header-group {\n  background-repeat: no-repeat;\n  background-attachment: scroll;\n  background-position: center top;\n}\n.form-line {\n  margin-top: 10px;\n  margin-bottom: 10px;\n}\n.form-line {\n  padding: 12px 36px;\n}\n.form-all .form-textbox,\n.form-all .form-radio-other-input,\n.form-all .form-checkbox-other-input,\n.form-all .form-captcha input,\n.form-all .form-spinner input,\n.form-all .form-pagebreak-back,\n.form-all .form-pagebreak-next,\n.form-all .qq-upload-button,\n.form-all .form-error-message {\n  border-radius: 6px;\n}\n.form-all .form-sub-label {\n  margin-left: 3px;\n}\n.form-all .form-textarea {\n  border-radius: 6px;\n}\n.form-all {\n  border-radius: 6px;\n}\n.form-section:first-child {\n  border-radius: 6px 6px 0 0;\n}\n.form-section:last-child {\n  border-radius: 0 0 6px 6px;\n}\n.form-all .qq-upload-button,\n.form-all .form-submit-button,\n.form-all .form-submit-reset,\n.form-all .form-submit-print {\n  font-size: 1em;\n  padding: 9px 15px;\n  font-family: \"Roboto\", sans-serif;\n  font-size: 16px;\n  font-weight: normal;\n}\n.form-all .form-pagebreak-back,\n.form-all .form-pagebreak-next {\n  font-size: 1em;\n  padding: 9px 15px;\n  font-family: \"Roboto\", sans-serif;\n  font-size: 16px;\n  font-weight: normal;\n}\n\/*\n& when ( @buttonFontType = google ) {\n\t\n}\n*\/\nh2.form-header {\n  line-height: 1.618em;\n  font-size: 1.714em;\n}\nh2 ~ .form-subHeader {\n  line-height: 1.5em;\n  font-size: 1.071em;\n}\n.form-header-group {\n  text-align: left;\n}\n\/*.form-dropdown,\n.form-radio-item,\n.form-checkbox-item,\n.form-radio-other-input,\n.form-checkbox-other-input,*\/\n.form-captcha input,\n.form-spinner input,\n.form-error-message {\n  padding: 4px 3px 2px 3px;\n}\n.form-header-group {\n  font-family: \"Roboto\", sans-serif;\n}\n.form-section {\n  padding: 0px 0px 0px 0px;\n}\n.form-header-group {\n  margin: 12px 36px 12px 36px;\n}\n.form-header-group {\n  padding: 24px 0px 24px 0px;\n}\n.form-textbox,\n.form-textarea {\n  padding: 4px 3px 2px 3px;\n}\n.form-textbox,\n.form-textarea,\n.form-radio-other-input,\n.form-checkbox-other-input,\n.form-captcha input,\n.form-spinner input {\n  background-color: ;\n}\n.form-textbox,\n.form-textarea {\n  width: 100%;\n  max-width: 500px;\n  box-sizing: border-box;\n}\n[data-type=\"control_textbox\"] .form-input,\n[data-type=\"control_textarea\"] .form-input,\n[data-type=\"control_fullname\"] .form-input,\n[data-type=\"control_phone\"] .form-input,\n[data-type=\"control_datetime\"] .form-input,\n[data-type=\"control_address\"] .form-input,\n[data-type=\"control_email\"] .form-input,\n[data-type=\"control_passwordbox\"] .form-input,\n[data-type=\"control_autocomp\"] .form-input,\n[data-type=\"control_textbox\"] .form-input-wide,\n[data-type=\"control_textarea\"] .form-input-wide,\n[data-type=\"control_fullname\"] .form-input-wide,\n[data-type=\"control_phone\"] .form-input-wide,\n[data-type=\"control_datetime\"] .form-input-wide,\n[data-type=\"control_address\"] .form-input-wide,\n[data-type=\"control_email\"] .form-input-wide,\n[data-type=\"control_passwordbox\"] .form-input-wide,\n[data-type=\"control_autocomp\"] .form-input-wide {\n  width: 100%;\n  max-width: 500px;\n}\n[data-type=\"control_fullname\"] .form-sub-label-container {\n  box-sizing: border-box;\n  width: 48%;\n  margin-right: 0;\n  float: left;\n}\n[data-type=\"control_fullname\"] .form-sub-label-container:first-child {\n  margin-right: 4%;\n}\n[data-type=\"control_phone\"] .form-sub-label-container {\n  width: 62.5%;\n  margin-left: 2.5%;\n  margin-right: 0;\n  float: left;\n  position: relative;\n}\n[data-type=\"control_phone\"] .form-sub-label-container:first-child {\n  width: 32.5%;\n  margin-right: 2.5%;\n  margin-left: 0;\n}\n[data-type=\"control_phone\"] .form-sub-label-container:first-child [data-component=areaCode] {\n  width: 93%;\n  float: left;\n}\n[data-type=\"control_phone\"] .form-sub-label-container:first-child [data-component=areaCode] ~ .form-sub-label {\n  display: inline-block;\n}\n[data-type=\"control_phone\"] .form-sub-label-container:first-child .phone-separate {\n  position: absolute;\n  top: 0;\n  right: -16%;\n  width: 24%;\n  text-align: center;\n  text-indent: -4px;\n}\n[data-type=\"control_phone\"] .form-sub-label-container .date-separate {\n  visibility: hidden;\n}\n.form-matrix-table {\n  width: 100%;\n  max-width: 500px;\n}\n.form-address-table {\n  width: 100%;\n  max-width: 500px;\n}\n.form-address-table td .form-dropdown {\n  width: 100%;\n}\n.form-address-table td .form-sub-label-container {\n  width: 96%;\n}\n.form-address-table td:last-child .form-sub-label-container {\n  margin-left: 4%;\n}\n.form-address-table td[colspan=\"2\"] .form-sub-label-container {\n  width: 100%;\n  margin: 0;\n}\n.form-matrix-row-headers,\n.form-matrix-column-headers,\n.form-matrix-values {\n  padding: 4px;\n}\n[data-type=\"control_dropdown\"] .form-input,\n[data-type=\"control_dropdown\"] .form-input-wide {\n  width: 150px;\n}\n.form-label {\n  font-family: \"Roboto\", sans-serif;\n}\nli[data-type=\"control_image\"] div {\n  text-align: left;\n}\nli[data-type=\"control_image\"] img {\n  border: none;\n  border-width: 0px !important;\n  border-style: solid !important;\n  border-color: false !important;\n}\n.form-line-column {\n  width: auto;\n}\n.form-line-error {\n  overflow: hidden;\n  -webkit-transition-property: none;\n  -moz-transition-property: none;\n  -ms-transition-property: none;\n  -o-transition-property: none;\n  transition-property: none;\n  -webkit-transition-duration: 0.3s;\n  -moz-transition-duration: 0.3s;\n  -ms-transition-duration: 0.3s;\n  -o-transition-duration: 0.3s;\n  transition-duration: 0.3s;\n  -webkit-transition-timing-function: ease;\n  -moz-transition-timing-function: ease;\n  -ms-transition-timing-function: ease;\n  -o-transition-timing-function: ease;\n  transition-timing-function: ease;\n  background-color: #fff4f4;\n}\n.form-line-error .form-error-message {\n  background-color: #ff3200;\n  clear: both;\n  float: none;\n}\n.form-line-error .form-error-message .form-error-arrow {\n  border-bottom-color: #ff3200;\n}\n.form-line-error input:not(#coupon-input),\n.form-line-error textarea,\n.form-line-error .form-validation-error {\n  border: 1px solid #ff3200;\n  box-shadow: 0 0 3px #ff3200;\n}\n.ie-8 .form-all {\n  margin-top: auto;\n  margin-top: initial;\n}\n.ie-8 .form-all:before {\n  display: none;\n}\n[data-type=\"control_clear\"] {\n  display: none;\n}\n\/* | *\/\n@media screen and (max-width: 480px), screen and (max-device-width: 767px) and (orientation: portrait), screen and (max-device-width: 415px) and (orientation: landscape) {\n  .testOne {\n    letter-spacing: 0;\n  }\n  .form-all {\n    border: 0;\n    max-width: initial;\n  }\n  .form-sub-label-container {\n    width: 100%;\n    margin: 0;\n    margin-right: 0;\n    float: left;\n    box-sizing: border-box;\n  }\n  span.form-sub-label-container + span.form-sub-label-container {\n    margin-right: 0;\n  }\n  .form-sub-label {\n    white-space: normal;\n  }\n  .form-address-table td,\n  .form-address-table th {\n    padding: 0 1px 10px;\n  }\n  .form-submit-button,\n  .form-submit-print,\n  .form-submit-reset {\n    width: 100%;\n    margin-left: 0!important;\n  }\n  div[id*=at_] {\n    font-size: 14px;\n    font-weight: 700;\n    height: 8px;\n    margin-top: 6px;\n  }\n  .showAutoCalendar {\n    width: 20px;\n  }\n  img.form-image {\n    max-width: 100%;\n    height: auto;\n  }\n  .form-matrix-row-headers {\n    width: 100%;\n    word-break: break-all;\n    min-width: 80px;\n  }\n  .form-collapse-table,\n  .form-header-group {\n    margin: 0;\n  }\n  .form-collapse-table {\n    height: 100%;\n    display: inline-block;\n    width: 100%;\n  }\n  .form-collapse-hidden {\n    display: none !important;\n  }\n  .form-input {\n    width: 100%;\n  }\n  .form-label {\n    width: 100% !important;\n  }\n  .form-label-left,\n  .form-label-right {\n    display: block;\n    float: none;\n    text-align: left;\n    width: auto!important;\n  }\n  .form-line,\n  .form-line.form-line-column {\n    padding: 2% 5%;\n    box-sizing: border-box;\n  }\n  input[type=text],\n  input[type=email],\n  input[type=tel],\n  textarea {\n    width: 100%;\n    box-sizing: border-box;\n    max-width: initial !important;\n  }\n  .form-radio-other-input,\n  .form-checkbox-other-input {\n    max-width: 55% !important;\n  }\n  .form-dropdown,\n  .form-textarea,\n  .form-textbox {\n    width: 100%!important;\n    box-sizing: border-box;\n  }\n  .form-input,\n  .form-input-wide,\n  .form-textarea,\n  .form-textbox,\n  .form-dropdown {\n    max-width: initial!important;\n  }\n  .form-checkbox-item:not(#foo),\n  .form-radio-item:not(#foo) {\n    width: 100%;\n  }\n  .form-address-city,\n  .form-address-line,\n  .form-address-postal,\n  .form-address-state,\n  .form-address-table,\n  .form-address-table .form-sub-label-container,\n  .form-address-table select,\n  .form-input {\n    width: 100%;\n  }\n  div.form-header-group {\n    padding: 24px 0px !important;\n    margin: 0 12px 2% !important;\n    margin-left: 5%!important;\n    margin-right: 5%!important;\n    box-sizing: border-box;\n  }\n  div.form-header-group.hasImage img {\n    max-width: 100%;\n  }\n  [data-type=\"control_button\"] {\n    margin-bottom: 0 !important;\n  }\n  [data-type=control_fullname] .form-sub-label-container {\n    width: 48%;\n  }\n  [data-type=control_fullname] .form-sub-label-container:first-child {\n    margin-right: 4%;\n  }\n  [data-type=control_phone] .form-sub-label-container {\n    width: 65%;\n    margin-right: 0;\n    margin-left: 0;\n    float: left;\n  }\n  [data-type=control_phone] .form-sub-label-container:first-child {\n    width: 31%;\n    margin-right: 4%;\n  }\n  [data-type=control_datetime] .allowTime-container {\n    width: 100%;\n  }\n  [data-type=control_datetime] .allowTime-container .form-sub-label-container {\n    width: 24%!important;\n    margin-left: 6%;\n    margin-right: 0;\n  }\n  [data-type=control_datetime] .allowTime-container .form-sub-label-container:first-child {\n    margin-left: 0;\n  }\n  [data-type=control_datetime] span + span + span > span:first-child {\n    display: block;\n    width: 100% !important;\n  }\n  [data-type=control_birthdate] .form-sub-label-container,\n  [data-type=control_time] .form-sub-label-container {\n    width: 27.3%!important;\n    margin-right: 6% !important;\n  }\n  [data-type=control_time] .form-sub-label-container:last-child {\n    width: 33.3%!important;\n    margin-right: 0 !important;\n  }\n  .form-pagebreak-back-container,\n  .form-pagebreak-next-container {\n    min-height: 1px;\n    width: 50% !important;\n  }\n  .form-pagebreak-back,\n  .form-pagebreak-next,\n  .form-product-item.hover-product-item {\n    width: 100%;\n  }\n  .form-pagebreak-back-container {\n    padding: 0;\n    text-align: right;\n  }\n  .form-pagebreak-next-container {\n    padding: 0;\n    text-align: left;\n  }\n  .form-pagebreak {\n    margin: 0 auto;\n  }\n  .form-buttons-wrapper {\n    margin: 0!important;\n    margin-left: 0!important;\n  }\n  .form-buttons-wrapper button {\n    width: 100%;\n  }\n  .form-buttons-wrapper .form-submit-print {\n    margin: 0 !important;\n  }\n  table {\n    width: 100%!important;\n    max-width: 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Please ensure our emails are not blocked or directed to spam folders - thanks!\",\"name\":\"additionalAccount96\",\"qid\":\"96\",\"subLabel\":\"\",\"text\":\"Additional account holder: Email address\",\"type\":\"control_email\"},{\"description\":\"Please enter preferred daytime contact number\",\"name\":\"additionalAccount97\",\"qid\":\"97\",\"subLabel\":\"\",\"text\":\"Additional account phone holder: Number\",\"type\":\"control_number\"},{\"description\":\"\",\"name\":\"additionalAccount98\",\"qid\":\"98\",\"text\":\"Additional account holder: Date of Birth\",\"type\":\"control_datetime\"},{\"description\":\"\",\"name\":\"letUs\",\"qid\":\"99\",\"subLabel\":\"\",\"text\":\"Let us know what you want help with\",\"type\":\"control_dropdown\"},{\"description\":\"\",\"name\":\"whenCan\",\"qid\":\"100\",\"text\":\"When can you pay?\",\"type\":\"control_datetime\"},null,{\"name\":\"input102\",\"qid\":\"102\",\"text\":\"Thanks for advising.\u00a0 We have many options to support you.\u00a0 We'll contact you to discuss\u00a0your Extension request.\u00a0 If you have more information to share, please let us know\u00a0in the text box below\",\"type\":\"control_text\"},{\"description\":\"\",\"name\":\"whatBill\",\"qid\":\"103\",\"subLabel\":\"\",\"text\":\"What bill query do you have?\",\"type\":\"control_dropdown\"},null,null,{\"name\":\"input106\",\"qid\":\"106\",\"text\":\"If you would like to update your Direct Debit\\u002FCredit payment details you can do so\u00a0here.\u00a0 Otherwise provide information in text box below and we will assist you\",\"type\":\"control_text\"},{\"description\":\"Please don't share any bank or credit card details here.  \",\"name\":\"directDebitcredit\",\"qid\":\"107\",\"subLabel\":\"\",\"text\":\"Direct Debit\\u002FCredit: Please tell us how we can help\",\"type\":\"control_textarea\"},{\"description\":\"Please don't share any bank or credit card details here.  \",\"name\":\"paymentPlan108\",\"qid\":\"108\",\"subLabel\":\"\",\"text\":\"Payment plan request details:\",\"type\":\"control_textarea\"},{\"description\":\"Please don't share any bank or credit card details here.  \",\"name\":\"paymentExtension109\",\"qid\":\"109\",\"subLabel\":\"\",\"text\":\"Payment extension request details\",\"type\":\"control_textarea\"},{\"description\":\"Please don't share any bank or credit card details here.  \",\"name\":\"billQuery\",\"qid\":\"110\",\"subLabel\":\"\",\"text\":\"Bill Query: Please tell us how we can help\",\"type\":\"control_textarea\"},{\"name\":\"ltpStyletextalign\",\"qid\":\"111\",\"text\":\"Thanks for advising.\u00a0 We have a number of payment options to support you.\u00a0 We'll contact you to discuss\u00a0your Payment Plan request\",\"type\":\"control_text\"},{\"name\":\"input112\",\"qid\":\"112\",\"text\":\"Find out more information on a new Meter Installation or a Smart Meter upgrade\u00a0here\\nor\\nprovide your specific details below and we'll contact you to discuss\",\"type\":\"control_text\"},{\"name\":\"ltpStyletextalign113\",\"qid\":\"113\",\"text\":\"Find out more information on how to register for MyAccount\u00a0here\\nor\\nprovide your details of your experience below and we'll contact you to\u00a0help\",\"type\":\"control_text\"},{\"description\":\"\",\"name\":\"fullName\",\"qid\":\"114\",\"text\":\"Full name\",\"type\":\"control_fullname\"},{\"description\":\"We prefer email for all notices - please ensure our emails to you are not blocked or directed to spam folders - thanks!\",\"name\":\"emailAddress115\",\"qid\":\"115\",\"subLabel\":\"\",\"text\":\"Email address\",\"type\":\"control_email\"},{\"description\":\"Please enter your preferred daytime contact number\",\"name\":\"phoneNumber\",\"qid\":\"116\",\"subLabel\":\"\",\"text\":\"Phone number\",\"type\":\"control_number\"},{\"description\":\"\",\"name\":\"supplyAddress117\",\"qid\":\"117\",\"text\":\"Supply address\",\"type\":\"control_address\"},{\"description\":\"\",\"name\":\"whatType118\",\"qid\":\"118\",\"text\":\"What type of enquiry do you have?\",\"type\":\"control_radio\"},{\"description\":\"Please don't share any bank or credit card details here.  \",\"name\":\"pleaseTell119\",\"qid\":\"119\",\"subLabel\":\"\",\"text\":\"Please tell us about your feedback here\",\"type\":\"control_textarea\"},null,{\"description\":\"\",\"name\":\"customerType\",\"qid\":\"121\",\"subLabel\":\"\",\"text\":\"Customer type\",\"type\":\"control_dropdown\"},{\"description\":\"\",\"name\":\"businessName\",\"qid\":\"122\",\"subLabel\":\"\",\"text\":\"Business name\",\"type\":\"control_textbox\"}]);\n   setTimeout(function() {\nJotForm.paymentExtrasOnTheFly([null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{\"description\":\"Please don't share any bank or credit card details here.  \",\"name\":\"pleaseTell\",\"qid\":\"32\",\"text\":\"Please tell us how we can help\",\"type\":\"control_textarea\"},null,null,null,null,null,null,null,null,null,null,null,null,{\"name\":\"submit\",\"qid\":\"45\",\"text\":\"Submit\",\"type\":\"control_button\"},null,null,null,null,null,{\"name\":\"pleaseEnter51\",\"qid\":\"51\",\"text\":\"Please enter the text as shown in the box below\",\"type\":\"control_captcha\"},null,{\"name\":\"typeA\",\"qid\":\"53\",\"text\":\"\",\"type\":\"control_widget\"},null,null,null,{\"description\":\"We welcome all enquiries, even if you're not a Diamond Energy customer\",\"name\":\"areYou\",\"qid\":\"57\",\"text\":\"Are you a Diamond Energy customer?\",\"type\":\"control_radio\"},null,null,{\"description\":\"\",\"name\":\"whatCan\",\"qid\":\"60\",\"subLabel\":\"\",\"text\":\"What can we help you with?\",\"type\":\"control_dropdown\"},null,null,null,null,{\"description\":\"\",\"name\":\"diamondEnergy\",\"qid\":\"65\",\"subLabel\":\"\",\"text\":\"Diamond Energy Account Number\",\"type\":\"control_textbox\"},{\"description\":\"\",\"name\":\"whatWould\",\"qid\":\"66\",\"subLabel\":\"\",\"text\":\"What would you like to do?\",\"type\":\"control_dropdown\"},null,null,{\"name\":\"input69\",\"qid\":\"69\",\"text\":\"Find information on our rates here or\u00a0if you know you want support renewables and join Diamond Energy, head straight to our\u00a0sign up page and make the\u00a0Switch4Good.\",\"type\":\"control_text\"},{\"name\":\"input70\",\"qid\":\"70\",\"text\":\"Complete this simple\u00a0Moving Form\u00a0and we'll take care of it for you\",\"type\":\"control_text\"},{\"name\":\"input71\",\"qid\":\"71\",\"text\":\"Complete this simple\u00a0form\u00a0to add an additional property and we'll take care of it for you.\u00a0 Plus you may be eligible to receive our\u00a0Th1ve\u00a0benefits\",\"type\":\"control_text\"},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{\"description\":\"Please upload supporting documents such as a photo of your updated Driver's licence or Proof of Age card, Marriage or Change of Name Certificate\",\"name\":\"changeTo\",\"qid\":\"87\",\"text\":\"Change to full name\",\"type\":\"control_fullname\"},{\"description\":\"Supporting documents such as photo of your updated Driver's licence or Proof of Age card, Marriage or Change of Name Certificate\",\"name\":\"uploadSupporting\",\"qid\":\"88\",\"subLabel\":\"\",\"text\":\"Upload supporting documents for Name Change\",\"type\":\"control_fileupload\"},{\"description\":\"Please enter your email address twice (for verification purposes).  We prefer email for all notices - please ensure our emails to you are not blocked or directed to spam folders - thanks!\",\"name\":\"newEmail\",\"qid\":\"89\",\"subLabel\":\"\",\"text\":\"New email address\",\"type\":\"control_email\"},{\"description\":\"Please enter your preferred daytime contact number\",\"name\":\"newPhone\",\"qid\":\"90\",\"subLabel\":\"\",\"text\":\"New phone number\",\"type\":\"control_number\"},null,{\"name\":\"input92\",\"qid\":\"92\",\"text\":\"Request to update your Contact Details\\nYour account information details are handled consistent with our Privacy Policy. To change any of your contact details we may require supporting information and we may also give you a call to confirm.\",\"type\":\"control_text\"},{\"name\":\"input93\",\"qid\":\"93\",\"text\":\"Click\u00a0here\u00a0to update your concession details specific to your state\",\"type\":\"control_text\"},{\"description\":\"\",\"name\":\"additionalAccount\",\"qid\":\"94\",\"text\":\"Additional account holder: Name\",\"type\":\"control_fullname\"},{\"name\":\"pStyletextalign\",\"qid\":\"95\",\"text\":\"Authorise an additional Account Holder\\nHas full access to account and can make changes. As the primary account holder, you're solely financially responsible for the account.\",\"type\":\"control_text\"},{\"description\":\"You can advise in the comments section if you would like this email address to receive bills.  Please ensure our emails are not blocked or directed to spam folders - thanks!\",\"name\":\"additionalAccount96\",\"qid\":\"96\",\"subLabel\":\"\",\"text\":\"Additional account holder: Email address\",\"type\":\"control_email\"},{\"description\":\"Please enter preferred daytime contact number\",\"name\":\"additionalAccount97\",\"qid\":\"97\",\"subLabel\":\"\",\"text\":\"Additional account phone holder: Number\",\"type\":\"control_number\"},{\"description\":\"\",\"name\":\"additionalAccount98\",\"qid\":\"98\",\"text\":\"Additional account holder: Date of Birth\",\"type\":\"control_datetime\"},{\"description\":\"\",\"name\":\"letUs\",\"qid\":\"99\",\"subLabel\":\"\",\"text\":\"Let us know what you want help with\",\"type\":\"control_dropdown\"},{\"description\":\"\",\"name\":\"whenCan\",\"qid\":\"100\",\"text\":\"When can you pay?\",\"type\":\"control_datetime\"},null,{\"name\":\"input102\",\"qid\":\"102\",\"text\":\"Thanks for advising.\u00a0 We have many options to support you.\u00a0 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\",\"name\":\"paymentPlan108\",\"qid\":\"108\",\"subLabel\":\"\",\"text\":\"Payment plan request details:\",\"type\":\"control_textarea\"},{\"description\":\"Please don't share any bank or credit card details here.  \",\"name\":\"paymentExtension109\",\"qid\":\"109\",\"subLabel\":\"\",\"text\":\"Payment extension request details\",\"type\":\"control_textarea\"},{\"description\":\"Please don't share any bank or credit card details here.  \",\"name\":\"billQuery\",\"qid\":\"110\",\"subLabel\":\"\",\"text\":\"Bill Query: Please tell us how we can help\",\"type\":\"control_textarea\"},{\"name\":\"ltpStyletextalign\",\"qid\":\"111\",\"text\":\"Thanks for advising.\u00a0 We have a number of payment options to support you.\u00a0 We'll contact you to discuss\u00a0your Payment Plan request\",\"type\":\"control_text\"},{\"name\":\"input112\",\"qid\":\"112\",\"text\":\"Find out more information on a new Meter Installation or a Smart Meter upgrade\u00a0here\\nor\\nprovide your specific details 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name=\"formID\" value=\"211808762644864\" \/><input type=\"hidden\" id=\"JWTContainer\" value=\"\" \/><input type=\"hidden\" id=\"cardinalOrderNumber\" value=\"\" \/>\n  <div role=\"main\" class=\"form-all\">\n    <ul class=\"form-section page-section\">\n      <li class=\"form-line jf-required\" data-type=\"control_fullname\" id=\"id_114\"><label class=\"form-label form-label-top form-label-auto\" id=\"label_114\" for=\"first_114\"> Full name<span class=\"form-required\">*<\/span> <\/label>\n        <div id=\"cid_114\" class=\"form-input-wide jf-required\">\n          <div data-wrapper-react=\"true\"><span class=\"form-sub-label-container\" style=\"vertical-align:top\" data-input-type=\"first\"><input type=\"text\" id=\"first_114\" name=\"q114_fullName[first]\" class=\"form-textbox validate[required]\" data-defaultvalue=\"\" autoComplete=\"section-input_114 given-name\" size=\"10\" value=\"\" data-component=\"first\" aria-labelledby=\"label_114 sublabel_114_first\" required=\"\" \/><label class=\"form-sub-label\" for=\"first_114\" id=\"sublabel_114_first\" style=\"min-height:13px\" aria-hidden=\"false\">First Name<\/label><\/span><span class=\"form-sub-label-container\" style=\"vertical-align:top\" data-input-type=\"last\"><input type=\"text\" id=\"last_114\" name=\"q114_fullName[last]\" class=\"form-textbox validate[required]\" data-defaultvalue=\"\" autoComplete=\"section-input_114 family-name\" size=\"15\" value=\"\" data-component=\"last\" aria-labelledby=\"label_114 sublabel_114_last\" required=\"\" \/><label class=\"form-sub-label\" for=\"last_114\" id=\"sublabel_114_last\" style=\"min-height:13px\" aria-hidden=\"false\">Last Name<\/label><\/span><\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_email\" id=\"id_115\"><label class=\"form-label form-label-top form-label-auto\" id=\"label_115\" for=\"input_115\"> Email address<span class=\"form-required\">*<\/span> <\/label>\n        <div id=\"cid_115\" class=\"form-input-wide jf-required\"> <input type=\"email\" id=\"input_115\" name=\"q115_emailAddress115\" class=\"form-textbox validate[required, Email]\" data-defaultvalue=\"\" size=\"30\" value=\"\" placeholder=\"example@example.com\" data-component=\"email\" aria-labelledby=\"label_115\" required=\"\" \/> <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_number\" id=\"id_116\"><label class=\"form-label form-label-top form-label-auto\" id=\"label_116\" for=\"input_116\"> Phone number<span class=\"form-required\">*<\/span> <\/label>\n        <div id=\"cid_116\" class=\"form-input-wide jf-required\"> <input type=\"number\" id=\"input_116\" name=\"q116_phoneNumber\" data-type=\"input-number\" class=\" form-number-input form-textbox validate[required]\" data-defaultvalue=\"\" style=\"width:100px\" size=\"10\" value=\"\" maxLength=\"10\" placeholder=\" \" data-numbermin=\"0\" data-component=\"number\" aria-labelledby=\"label_116\" required=\"\" step=\"any\" \/> <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_address\" id=\"id_117\"><label class=\"form-label form-label-top form-label-auto\" id=\"label_117\" for=\"input_117_addr_line1\"> Supply address <\/label>\n        <div id=\"cid_117\" class=\"form-input-wide\">\n          <div summary=\"\" class=\"form-address-table jsTest-addressField\">\n            <div class=\"form-address-line-wrapper jsTest-address-line-wrapperField\"><span class=\"form-address-line form-address-street-line jsTest-address-lineField\"><span class=\"form-sub-label-container\" style=\"vertical-align:top\"><input type=\"text\" id=\"input_117_addr_line1\" name=\"q117_supplyAddress117[addr_line1]\" class=\"form-textbox form-address-line\" data-defaultvalue=\"\" autoComplete=\"section-input_117 address-line1\" value=\"\" data-component=\"address_line_1\" aria-labelledby=\"label_117 sublabel_117_addr_line1\" required=\"\" \/><label class=\"form-sub-label\" for=\"input_117_addr_line1\" id=\"sublabel_117_addr_line1\" style=\"min-height:13px\" aria-hidden=\"false\">Street address line 1<\/label><\/span><\/span><\/div>\n            <div class=\"form-address-line-wrapper jsTest-address-line-wrapperField\"><span class=\"form-address-line form-address-street-line jsTest-address-lineField\"><span class=\"form-sub-label-container\" style=\"vertical-align:top\"><input type=\"text\" id=\"input_117_addr_line2\" name=\"q117_supplyAddress117[addr_line2]\" class=\"form-textbox form-address-line\" data-defaultvalue=\"\" autoComplete=\"section-input_117 address-line2\" value=\"\" data-component=\"address_line_2\" aria-labelledby=\"label_117 sublabel_117_addr_line2\" \/><label class=\"form-sub-label\" for=\"input_117_addr_line2\" id=\"sublabel_117_addr_line2\" style=\"min-height:13px\" aria-hidden=\"false\">Street address line 2<\/label><\/span><\/span><\/div>\n            <div class=\"form-address-line-wrapper jsTest-address-line-wrapperField\"><span class=\"form-address-line form-address-city-line jsTest-address-lineField \"><span class=\"form-sub-label-container\" style=\"vertical-align:top\"><input type=\"text\" id=\"input_117_city\" name=\"q117_supplyAddress117[city]\" class=\"form-textbox form-address-city\" data-defaultvalue=\"\" autoComplete=\"section-input_117 address-level2\" value=\"\" data-component=\"city\" aria-labelledby=\"label_117 sublabel_117_city\" required=\"\" \/><label class=\"form-sub-label\" for=\"input_117_city\" id=\"sublabel_117_city\" style=\"min-height:13px\" aria-hidden=\"false\">City<\/label><\/span><\/span><span class=\"form-address-line form-address-state-line jsTest-address-lineField \"><span class=\"form-sub-label-container\" style=\"vertical-align:top\"><input type=\"text\" id=\"input_117_state\" name=\"q117_supplyAddress117[state]\" class=\"form-textbox form-address-state\" data-defaultvalue=\"\" autoComplete=\"section-input_117 address-level1\" value=\"\" data-component=\"state\" aria-labelledby=\"label_117 sublabel_117_state\" required=\"\" \/><label class=\"form-sub-label\" for=\"input_117_state\" id=\"sublabel_117_state\" style=\"min-height:13px\" aria-hidden=\"false\">State<\/label><\/span><\/span><\/div>\n            <div class=\"form-address-line-wrapper jsTest-address-line-wrapperField\"><span class=\"form-address-line form-address-zip-line jsTest-address-lineField \"><span class=\"form-sub-label-container\" style=\"vertical-align:top\"><input type=\"text\" id=\"input_117_postal\" name=\"q117_supplyAddress117[postal]\" class=\"form-textbox form-address-postal\" data-defaultvalue=\"\" autoComplete=\"section-input_117 postal-code\" value=\"\" data-component=\"zip\" aria-labelledby=\"label_117 sublabel_117_postal\" required=\"\" \/><label class=\"form-sub-label\" for=\"input_117_postal\" id=\"sublabel_117_postal\" style=\"min-height:13px\" aria-hidden=\"false\">Postcode<\/label><\/span><\/span><\/div>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_radio\" id=\"id_57\"><label class=\"form-label form-label-top form-label-auto\" id=\"label_57\" for=\"input_57\"> Are you a Diamond Energy customer?<span class=\"form-required\">*<\/span> <\/label>\n        <div id=\"cid_57\" class=\"form-input-wide jf-required\">\n          <div class=\"form-single-column\" role=\"group\" aria-labelledby=\"label_57\" data-component=\"radio\"><span class=\"form-radio-item\" style=\"clear:left\"><span class=\"dragger-item\"><\/span><input type=\"radio\" aria-describedby=\"label_57\" class=\"form-radio validate[required]\" id=\"input_57_0\" name=\"q57_areYou\" value=\"Yes\" required=\"\" \/><label id=\"label_input_57_0\" for=\"input_57_0\">Yes<\/label><\/span><span class=\"form-radio-item\" style=\"clear:left\"><span class=\"dragger-item\"><\/span><input type=\"radio\" aria-describedby=\"label_57\" class=\"form-radio validate[required]\" id=\"input_57_1\" name=\"q57_areYou\" value=\"No\" required=\"\" \/><label id=\"label_input_57_1\" for=\"input_57_1\">No<\/label><\/span><\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line always-hidden form-field-hidden\" style=\"display:none;\" data-type=\"control_textbox\" id=\"id_65\"><label class=\"form-label form-label-top form-label-auto\" id=\"label_65\" for=\"input_65\"> Diamond Energy Account Number <\/label>\n        <div id=\"cid_65\" class=\"form-input-wide always-hidden\"> <input type=\"text\" id=\"input_65\" name=\"q65_diamondEnergy\" data-type=\"input-textbox\" class=\"form-textbox\" data-defaultvalue=\"\" size=\"10\" value=\"\" maxLength=\"10\" data-component=\"textbox\" aria-labelledby=\"label_65\" \/> <\/div>\n      <\/li>\n      <li class=\"form-line always-hidden form-field-hidden\" style=\"display:none;\" data-type=\"control_radio\" id=\"id_118\"><label class=\"form-label form-label-top form-label-auto\" id=\"label_118\" for=\"input_118\"> What type of enquiry do you have? <\/label>\n        <div id=\"cid_118\" class=\"form-input-wide always-hidden\">\n          <div class=\"form-single-column\" role=\"group\" aria-labelledby=\"label_118\" data-component=\"radio\"><span class=\"form-radio-item\" style=\"clear:left\"><span class=\"dragger-item\"><\/span><input type=\"radio\" aria-describedby=\"label_118\" class=\"form-radio\" id=\"input_118_0\" name=\"q118_whatType118\" value=\"I have a general enquiry\" \/><label id=\"label_input_118_0\" for=\"input_118_0\">I have a general enquiry<\/label><\/span><span class=\"form-radio-item\" style=\"clear:left\"><span class=\"dragger-item\"><\/span><input type=\"radio\" aria-describedby=\"label_118\" class=\"form-radio\" id=\"input_118_1\" name=\"q118_whatType118\" value=\"I&#x27;m seeking more information on joining Diamond Energy\" \/><label id=\"label_input_118_1\" for=\"input_118_1\">I'm seeking more information on joining Diamond Energy<\/label><\/span><\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line always-hidden form-field-hidden\" style=\"display:none;\" data-type=\"control_dropdown\" id=\"id_60\"><label class=\"form-label form-label-top form-label-auto\" id=\"label_60\" for=\"input_60\"> What can we help you with? <\/label>\n        <div id=\"cid_60\" class=\"form-input-wide always-hidden\"> <select class=\"form-dropdown\" id=\"input_60\" name=\"q60_whatCan\" style=\"width:150px\" data-component=\"dropdown\" aria-label=\"What can we help you with?\">\n            <option value=\"\"><\/option>\n            <option value=\"Electricity and\/or Electricity Account\">Electricity and\/or Electricity Account<\/option>\n            <option value=\"Solar\">Solar<\/option>\n            <option value=\"Meter installation \/ Meter upgrade\">Meter installation \/ Meter upgrade<\/option>\n            <option value=\"MyAccount registration or login\">MyAccount registration or login<\/option>\n            <option value=\"Payment enquiry \/ Payment support request\">Payment enquiry \/ Payment support request<\/option>\n            <option value=\"Other\">Other<\/option>\n          <\/select> <\/div>\n      <\/li>\n      <li class=\"form-line always-hidden form-field-hidden\" style=\"display:none;\" data-type=\"control_dropdown\" id=\"id_66\"><label class=\"form-label form-label-top form-label-auto\" id=\"label_66\" for=\"input_66\"> What would you like to do? <\/label>\n        <div id=\"cid_66\" class=\"form-input-wide always-hidden\"> <select class=\"form-dropdown\" id=\"input_66\" name=\"q66_whatWould\" style=\"width:150px\" data-component=\"dropdown\" aria-label=\"What would you like to do?\">\n            <option value=\"\"><\/option>\n            <option value=\"Move out \/ Move in (disconnect current property \/ connect new property)\">Move out \/ Move in (disconnect current property \/ connect new property)<\/option>\n            <option value=\"Add an additional property\">Add an additional property<\/option>\n            <option value=\"Update your Contact Details\">Update your Contact Details<\/option>\n            <option value=\"Add an Additional Account Holder\">Add an Additional Account Holder<\/option>\n            <option value=\"Update concession details\">Update concession details<\/option>\n            <option value=\"Manage payments\">Manage payments<\/option>\n            <option value=\"Query bill\">Query bill<\/option>\n            <option value=\"Other\">Other<\/option>\n          <\/select> <\/div>\n      <\/li>\n      <li class=\"form-line always-hidden form-field-hidden\" style=\"display:none;\" data-type=\"control_text\" id=\"id_69\">\n        <div id=\"cid_69\" class=\"form-input-wide always-hidden\">\n          <div id=\"text_69\" class=\"form-html\" data-component=\"text\" tabindex=\"0\">\n            <p style=\"text-align: center;\"><span style=\"font-size: 12pt;\">Find information on our <a href=\"https:\/\/diamondenergy.com.au\/electricity-rates-and-offers\/\" target=\"_blank\" rel=\"nofollow\">rates here<\/a> or\u00a0if you know you want support renewables and join Diamond Energy, head straight to our\u00a0<a href=\"https:\/\/diamondenergy.com.au\/switch-4-good\/\" target=\"_blank\" rel=\"nofollow\">sign up page<\/a> and make the\u00a0<\/span><span style=\"font-size: 12pt;\">Switch4<strong>Good.<\/strong><\/span><\/p>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line always-hidden form-field-hidden\" style=\"display:none;\" data-type=\"control_text\" id=\"id_70\">\n        <div id=\"cid_70\" class=\"form-input-wide always-hidden\">\n          <div id=\"text_70\" class=\"form-html\" data-component=\"text\" tabindex=\"0\">\n            <p style=\"text-align: center; padding-left: 30px;\">Complete this simple\u00a0<a href=\"https:\/\/diamondenergy.com.au\/existing-customers\/\" target=\"_blank\" rel=\"nofollow\">Moving Form<\/a>\u00a0and we'll take care of it for you<\/p>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line always-hidden form-field-hidden\" style=\"display:none;\" data-type=\"control_text\" id=\"id_71\">\n        <div id=\"cid_71\" class=\"form-input-wide always-hidden\">\n          <div id=\"text_71\" class=\"form-html\" data-component=\"text\" tabindex=\"0\">\n            <p style=\"text-align: center;\">Complete this simple\u00a0<a href=\"https:\/\/diamondenergy.com.au\/existing-customers\/\" target=\"_blank\" rel=\"nofollow\">form<\/a>\u00a0to add an additional property and we'll take care of it for you.\u00a0 Plus you may be eligible to receive our\u00a0<a href=\"https:\/\/diamondenergy.com.au\/thrive\/\" target=\"_blank\" rel=\"nofollow\">Th1ve<\/a>\u00a0benefits<\/p>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line always-hidden form-field-hidden\" style=\"display:none;\" data-type=\"control_text\" id=\"id_92\">\n        <div id=\"cid_92\" class=\"form-input-wide always-hidden\">\n          <div id=\"text_92\" class=\"form-html\" data-component=\"text\" tabindex=\"0\">\n            <p style=\"text-align: center;\"><span style=\"font-size: 14pt; font-family: arial, helvetica, sans-serif;\"><strong><span style=\"text-decoration: underline;\">Request to update your Contact D<\/span><span style=\"text-decoration: underline;\">etails<\/span><\/strong><\/span><\/p>\n            <p style=\"text-align: center;\"><span style=\"font-size: 12pt; font-family: verdana, geneva, sans-serif;\">Your account information details are handled consistent with our <a href=\"https:\/\/diamondenergy.com.au\/your-privacy\/\" rel=\"nofollow\">Privacy Policy<\/a>. To change any of your contact details we may require supporting information and we may also give you a call to confirm.<\/span><\/p>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line always-hidden form-field-hidden\" style=\"display:none;\" data-type=\"control_fullname\" id=\"id_87\"><label class=\"form-label form-label-top form-label-auto\" id=\"label_87\" for=\"first_87\"> Change to full name <\/label>\n        <div id=\"cid_87\" class=\"form-input-wide always-hidden\">\n          <div data-wrapper-react=\"true\"><span class=\"form-sub-label-container\" style=\"vertical-align:top\" data-input-type=\"first\"><input type=\"text\" id=\"first_87\" name=\"q87_changeTo[first]\" class=\"form-textbox\" data-defaultvalue=\"\" autoComplete=\"section-input_87 given-name\" size=\"10\" value=\"\" data-component=\"first\" aria-labelledby=\"label_87 sublabel_87_first\" \/><label class=\"form-sub-label\" for=\"first_87\" id=\"sublabel_87_first\" style=\"min-height:13px\" aria-hidden=\"false\">First Name<\/label><\/span><span class=\"form-sub-label-container\" style=\"vertical-align:top\" data-input-type=\"last\"><input type=\"text\" id=\"last_87\" name=\"q87_changeTo[last]\" class=\"form-textbox\" data-defaultvalue=\"\" autoComplete=\"section-input_87 family-name\" size=\"15\" value=\"\" data-component=\"last\" aria-labelledby=\"label_87 sublabel_87_last\" \/><label class=\"form-sub-label\" for=\"last_87\" id=\"sublabel_87_last\" style=\"min-height:13px\" aria-hidden=\"false\">Last Name<\/label><\/span><\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line always-hidden form-field-hidden\" style=\"display:none;\" data-type=\"control_fileupload\" id=\"id_88\"><label class=\"form-label form-label-top form-label-auto\" id=\"label_88\" for=\"input_88\"> Upload supporting documents for Name Change <\/label>\n        <div id=\"cid_88\" class=\"form-input-wide always-hidden\">\n          <div data-wrapper-react=\"true\">\n            <div data-wrapper-react=\"true\">\n              <div class=\"qq-uploader-buttonText-value\">Browse Files<\/div><input type=\"file\" id=\"input_88\" name=\"q88_uploadSupporting[]\" multiple=\"\" class=\"form-upload-multiple\" data-imagevalidate=\"yes\" data-file-accept=\"pdf, doc, docx, xls, xlsx, csv, txt, rtf, html, zip, mp3, wma, mpg, flv, avi, jpg, jpeg, png, gif\" data-limit-file-size=\"Yes\" data-file-maxsize=\"10854\" data-file-minsize=\"0\" data-file-limit=\"\" data-component=\"fileupload\" \/>\n            <\/div><span style=\"display:none\" class=\"cancelText\">Cancel<\/span><span style=\"display:none\" class=\"ofText\">of<\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line always-hidden form-field-hidden\" style=\"display:none;\" data-type=\"control_email\" id=\"id_89\"><label class=\"form-label form-label-top form-label-auto\" id=\"label_89\" for=\"input_89\"> New email address <\/label>\n        <div id=\"cid_89\" class=\"form-input-wide always-hidden\"> <input type=\"email\" id=\"input_89\" name=\"q89_newEmail\" class=\"form-textbox validate[Email]\" data-defaultvalue=\"\" size=\"30\" value=\"\" placeholder=\"example@example.com\" data-component=\"email\" aria-labelledby=\"label_89\" \/> <\/div>\n      <\/li>\n      <li class=\"form-line always-hidden form-field-hidden\" style=\"display:none;\" data-type=\"control_number\" id=\"id_90\"><label class=\"form-label form-label-top form-label-auto\" id=\"label_90\" for=\"input_90\"> New phone number <\/label>\n        <div id=\"cid_90\" class=\"form-input-wide always-hidden\"> <input type=\"number\" id=\"input_90\" name=\"q90_newPhone\" data-type=\"input-number\" class=\" form-number-input form-textbox\" data-defaultvalue=\"\" style=\"width:100px\" size=\"10\" value=\"\" maxLength=\"10\" placeholder=\" \" data-numbermin=\"0\" data-component=\"number\" aria-labelledby=\"label_90\" step=\"any\" \/> <\/div>\n      <\/li>\n      <li class=\"form-line always-hidden form-field-hidden\" style=\"display:none;\" data-type=\"control_text\" id=\"id_95\">\n        <div id=\"cid_95\" class=\"form-input-wide always-hidden\">\n          <div id=\"text_95\" class=\"form-html\" data-component=\"text\" tabindex=\"0\">\n            <p style=\"text-align: center;\"><span style=\"font-size: 14pt;\"><strong><span style=\"text-decoration: underline;\">Authorise an additional Account Holder<\/span><\/strong><\/span><\/p>\n            <p style=\"text-align: center;\"><span style=\"font-size: 12pt;\">Has full access to account and can make changes. As the primary account holder, you're solely financially responsible for the account.<\/span><\/p>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line always-hidden form-field-hidden\" style=\"display:none;\" data-type=\"control_fullname\" id=\"id_94\"><label class=\"form-label form-label-top form-label-auto\" id=\"label_94\" for=\"first_94\"> Additional account holder: Name <\/label>\n        <div id=\"cid_94\" class=\"form-input-wide always-hidden\">\n          <div data-wrapper-react=\"true\"><span class=\"form-sub-label-container\" style=\"vertical-align:top\" data-input-type=\"first\"><input type=\"text\" id=\"first_94\" name=\"q94_additionalAccount[first]\" class=\"form-textbox\" data-defaultvalue=\"\" autoComplete=\"section-input_94 given-name\" size=\"10\" value=\"\" data-component=\"first\" aria-labelledby=\"label_94 sublabel_94_first\" \/><label class=\"form-sub-label\" for=\"first_94\" id=\"sublabel_94_first\" style=\"min-height:13px\" aria-hidden=\"false\">First Name<\/label><\/span><span class=\"form-sub-label-container\" style=\"vertical-align:top\" data-input-type=\"last\"><input type=\"text\" id=\"last_94\" name=\"q94_additionalAccount[last]\" class=\"form-textbox\" data-defaultvalue=\"\" autoComplete=\"section-input_94 family-name\" size=\"15\" value=\"\" data-component=\"last\" aria-labelledby=\"label_94 sublabel_94_last\" \/><label class=\"form-sub-label\" for=\"last_94\" id=\"sublabel_94_last\" style=\"min-height:13px\" aria-hidden=\"false\">Last Name<\/label><\/span><\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line always-hidden form-field-hidden\" style=\"display:none;\" data-type=\"control_email\" id=\"id_96\"><label class=\"form-label form-label-top form-label-auto\" id=\"label_96\" for=\"input_96\"> Additional account holder: Email address <\/label>\n        <div id=\"cid_96\" class=\"form-input-wide always-hidden\"> <input type=\"email\" id=\"input_96\" name=\"q96_additionalAccount96\" class=\"form-textbox validate[Email]\" data-defaultvalue=\"\" size=\"30\" value=\"\" placeholder=\"example@example.com\" data-component=\"email\" aria-labelledby=\"label_96\" \/> <\/div>\n      <\/li>\n      <li class=\"form-line always-hidden form-field-hidden\" style=\"display:none;\" data-type=\"control_number\" id=\"id_97\"><label class=\"form-label form-label-top form-label-auto\" id=\"label_97\" for=\"input_97\"> Additional account phone holder: Number <\/label>\n        <div id=\"cid_97\" class=\"form-input-wide always-hidden\"> <input type=\"number\" id=\"input_97\" name=\"q97_additionalAccount97\" data-type=\"input-number\" class=\" form-number-input form-textbox\" data-defaultvalue=\"\" style=\"width:100px\" size=\"10\" value=\"\" maxLength=\"10\" placeholder=\" \" data-numbermin=\"0\" data-component=\"number\" aria-labelledby=\"label_97\" step=\"any\" \/> <\/div>\n      <\/li>\n      <li class=\"form-line always-hidden form-field-hidden\" style=\"display:none;\" data-type=\"control_datetime\" id=\"id_98\"><label class=\"form-label form-label-top form-label-auto\" id=\"label_98\" for=\"lite_mode_98\"> Additional account holder: Date of Birth <\/label>\n        <div id=\"cid_98\" class=\"form-input-wide always-hidden\">\n          <div data-wrapper-react=\"true\">\n            <div style=\"display:none\"><span class=\"form-sub-label-container\" style=\"vertical-align:top\"><input type=\"tel\" class=\"form-textbox validate[limitDate]\" id=\"day_98\" name=\"q98_additionalAccount98[day]\" size=\"2\" data-maxlength=\"2\" data-age=\"\" maxLength=\"2\" value=\"\" autoComplete=\"off\" aria-labelledby=\"label_98 sublabel_98_day\" \/><span class=\"date-separate\" aria-hidden=\"true\">\u00a0\/<\/span><label class=\"form-sub-label\" for=\"day_98\" id=\"sublabel_98_day\" style=\"min-height:13px\" aria-hidden=\"false\">Day<\/label><\/span><span class=\"form-sub-label-container\" style=\"vertical-align:top\"><input type=\"tel\" class=\"form-textbox validate[limitDate]\" id=\"month_98\" name=\"q98_additionalAccount98[month]\" size=\"2\" data-maxlength=\"2\" data-age=\"\" maxLength=\"2\" value=\"\" autoComplete=\"off\" aria-labelledby=\"label_98 sublabel_98_month\" \/><span class=\"date-separate\" aria-hidden=\"true\">\u00a0\/<\/span><label class=\"form-sub-label\" for=\"month_98\" id=\"sublabel_98_month\" style=\"min-height:13px\" aria-hidden=\"false\">Month<\/label><\/span><span class=\"form-sub-label-container\" style=\"vertical-align:top\"><input type=\"tel\" class=\"form-textbox validate[limitDate]\" id=\"year_98\" name=\"q98_additionalAccount98[year]\" size=\"4\" data-maxlength=\"4\" data-age=\"\" maxLength=\"4\" value=\"\" autoComplete=\"off\" aria-labelledby=\"label_98 sublabel_98_year\" \/><label class=\"form-sub-label\" for=\"year_98\" id=\"sublabel_98_year\" style=\"min-height:13px\" aria-hidden=\"false\">Year<\/label><\/span><\/div><span class=\"form-sub-label-container\" style=\"vertical-align:top\"><input type=\"text\" class=\"form-textbox validate[limitDate, validateLiteDate]\" id=\"lite_mode_98\" size=\"12\" data-maxlength=\"12\" maxLength=\"12\" data-age=\"\" value=\"\" data-format=\"ddmmyyyy\" data-seperator=\"\/\" placeholder=\"dd\/mm\/yyyy\" autoComplete=\"off\" aria-labelledby=\"label_98 sublabel_98_litemode\" \/><img class=\" newDefaultTheme-dateIcon icon-liteMode\" alt=\"Pick a Date\" id=\"input_98_pick\" src=\"https:\/\/cdn.jotfor.ms\/images\/calendar.png\" data-component=\"datetime\" aria-hidden=\"true\" data-allow-time=\"No\" data-version=\"v1\" \/><label class=\"form-sub-label\" for=\"lite_mode_98\" id=\"sublabel_98_litemode\" style=\"min-height:13px\" aria-hidden=\"false\">Date<\/label><\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line always-hidden form-field-hidden\" style=\"display:none;\" data-type=\"control_text\" id=\"id_93\">\n        <div id=\"cid_93\" class=\"form-input-wide always-hidden\">\n          <div id=\"text_93\" class=\"form-html\" data-component=\"text\" tabindex=\"0\">\n            <p style=\"text-align: center;\">Click\u00a0<a href=\"https:\/\/diamondenergy.com.au\/concessions-rebates\/\" target=\"_blank\" rel=\"nofollow\">here<\/a>\u00a0to update your concession details specific to your state<\/p>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line always-hidden form-field-hidden\" style=\"display:none;\" data-type=\"control_dropdown\" id=\"id_99\"><label class=\"form-label form-label-top form-label-auto\" id=\"label_99\" for=\"input_99\"> Let us know what you want help with <\/label>\n        <div id=\"cid_99\" class=\"form-input-wide always-hidden\"> <select class=\"form-dropdown\" id=\"input_99\" name=\"q99_letUs\" style=\"width:150px\" data-component=\"dropdown\" aria-label=\"Let us know what you want help with\">\n            <option value=\"\"><\/option>\n            <option value=\"Direct Debit\/Credit\">Direct Debit\/Credit<\/option>\n            <option value=\"Payment Plan\">Payment Plan<\/option>\n            <option value=\"Payment Extension\">Payment Extension<\/option>\n            <option value=\"Missing payment \/ Double payment\">Missing payment \/ Double payment<\/option>\n          <\/select> <\/div>\n      <\/li>\n      <li class=\"form-line always-hidden form-field-hidden\" style=\"display:none;\" data-type=\"control_text\" id=\"id_106\">\n        <div id=\"cid_106\" class=\"form-input-wide always-hidden\">\n          <div id=\"text_106\" class=\"form-html\" data-component=\"text\" tabindex=\"0\">\n            <p style=\"text-align: center;\">If you would like to update your Direct Debit\/Credit payment details you can do so\u00a0<a href=\"https:\/\/diamondenergy.com.au\/direct-debit-payment-method\/\" target=\"_blank\" rel=\"nofollow\">here<\/a>.\u00a0 Otherwise provide information in text box below and we will assist you<\/p>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line always-hidden form-field-hidden\" style=\"display:none;\" data-type=\"control_textarea\" id=\"id_107\"><label class=\"form-label form-label-top form-label-auto\" id=\"label_107\" for=\"input_107\"> Direct Debit\/Credit: Please tell us how we can help <\/label>\n        <div id=\"cid_107\" class=\"form-input-wide always-hidden\"> <textarea id=\"input_107\" class=\"form-textarea\" name=\"q107_directDebitcredit\" cols=\"45\" rows=\"6\" data-component=\"textarea\" aria-labelledby=\"label_107\"><\/textarea> <\/div>\n      <\/li>\n      <li class=\"form-line always-hidden form-field-hidden\" style=\"display:none;\" data-type=\"control_textarea\" id=\"id_108\"><label class=\"form-label form-label-top form-label-auto\" id=\"label_108\" for=\"input_108\"> Payment plan request details: <\/label>\n        <div id=\"cid_108\" class=\"form-input-wide always-hidden\"> <textarea id=\"input_108\" class=\"form-textarea\" name=\"q108_paymentPlan108\" cols=\"45\" rows=\"6\" data-component=\"textarea\" aria-labelledby=\"label_108\"><\/textarea> <\/div>\n      <\/li>\n      <li class=\"form-line always-hidden form-field-hidden\" style=\"display:none;\" data-type=\"control_text\" id=\"id_111\">\n        <div id=\"cid_111\" class=\"form-input-wide always-hidden\">\n          <div id=\"text_111\" class=\"form-html\" data-component=\"text\" tabindex=\"0\">\n            <p style=\"text-align: center;\">Thanks for advising.\u00a0 We have a number of payment options to support you.\u00a0 We'll contact you to discuss\u00a0your Payment Plan request<\/p>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line always-hidden form-field-hidden\" style=\"display:none;\" data-type=\"control_datetime\" id=\"id_100\"><label class=\"form-label form-label-top form-label-auto\" id=\"label_100\" for=\"lite_mode_100\"> When can you pay? <\/label>\n        <div id=\"cid_100\" class=\"form-input-wide always-hidden\">\n          <div data-wrapper-react=\"true\">\n            <div style=\"display:none\"><span class=\"form-sub-label-container\" style=\"vertical-align:top\"><input type=\"tel\" class=\"form-textbox validate[limitDate]\" id=\"day_100\" name=\"q100_whenCan[day]\" size=\"2\" data-maxlength=\"2\" data-age=\"\" maxLength=\"2\" value=\"\" autoComplete=\"off\" aria-labelledby=\"label_100 sublabel_100_day\" \/><span class=\"date-separate\" aria-hidden=\"true\">\u00a0-<\/span><label class=\"form-sub-label\" for=\"day_100\" id=\"sublabel_100_day\" style=\"min-height:13px\" aria-hidden=\"false\">Day<\/label><\/span><span class=\"form-sub-label-container\" style=\"vertical-align:top\"><input type=\"tel\" class=\"form-textbox validate[limitDate]\" id=\"month_100\" name=\"q100_whenCan[month]\" size=\"2\" data-maxlength=\"2\" data-age=\"\" maxLength=\"2\" value=\"\" autoComplete=\"off\" aria-labelledby=\"label_100 sublabel_100_month\" \/><span class=\"date-separate\" aria-hidden=\"true\">\u00a0-<\/span><label class=\"form-sub-label\" for=\"month_100\" id=\"sublabel_100_month\" style=\"min-height:13px\" aria-hidden=\"false\">Month<\/label><\/span><span class=\"form-sub-label-container\" style=\"vertical-align:top\"><input type=\"tel\" class=\"form-textbox validate[limitDate]\" id=\"year_100\" name=\"q100_whenCan[year]\" size=\"4\" data-maxlength=\"4\" data-age=\"\" maxLength=\"4\" value=\"\" autoComplete=\"off\" aria-labelledby=\"label_100 sublabel_100_year\" \/><label class=\"form-sub-label\" for=\"year_100\" id=\"sublabel_100_year\" style=\"min-height:13px\" aria-hidden=\"false\">Year<\/label><\/span><\/div><span class=\"form-sub-label-container\" style=\"vertical-align:top\"><input type=\"text\" class=\"form-textbox validate[limitDate, validateLiteDate]\" id=\"lite_mode_100\" size=\"12\" data-maxlength=\"12\" maxLength=\"12\" data-age=\"\" value=\"\" data-format=\"ddmmyyyy\" data-seperator=\"-\" placeholder=\"dd-mm-yyyy\" autoComplete=\"off\" aria-labelledby=\"label_100 sublabel_100_litemode\" \/><img class=\" newDefaultTheme-dateIcon icon-liteMode\" alt=\"Pick a Date\" id=\"input_100_pick\" src=\"https:\/\/cdn.jotfor.ms\/images\/calendar.png\" data-component=\"datetime\" aria-hidden=\"true\" data-allow-time=\"No\" data-version=\"v1\" \/><label class=\"form-sub-label\" for=\"lite_mode_100\" id=\"sublabel_100_litemode\" style=\"min-height:13px\" aria-hidden=\"false\">Date<\/label><\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line always-hidden form-field-hidden\" style=\"display:none;\" data-type=\"control_text\" id=\"id_102\">\n        <div id=\"cid_102\" class=\"form-input-wide always-hidden\">\n          <div id=\"text_102\" class=\"form-html\" data-component=\"text\" tabindex=\"0\">\n            <p style=\"text-align: center;\">Thanks for advising.\u00a0 We have many options to support you.\u00a0 We'll contact you to discuss\u00a0your Extension request.\u00a0 If you have more information to share, please let us know\u00a0in the text box below<\/p>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line always-hidden form-field-hidden\" style=\"display:none;\" data-type=\"control_textarea\" id=\"id_109\"><label class=\"form-label form-label-top form-label-auto\" id=\"label_109\" for=\"input_109\"> Payment extension request details <\/label>\n        <div id=\"cid_109\" class=\"form-input-wide always-hidden\"> <textarea id=\"input_109\" class=\"form-textarea\" name=\"q109_paymentExtension109\" cols=\"45\" rows=\"6\" data-component=\"textarea\" aria-labelledby=\"label_109\"><\/textarea> <\/div>\n      <\/li>\n      <li class=\"form-line always-hidden form-field-hidden\" style=\"display:none;\" data-type=\"control_dropdown\" id=\"id_103\"><label class=\"form-label form-label-top form-label-auto\" id=\"label_103\" for=\"input_103\"> What bill query do you have? <\/label>\n        <div id=\"cid_103\" class=\"form-input-wide always-hidden\"> <select class=\"form-dropdown\" id=\"input_103\" name=\"q103_whatBill\" style=\"width:150px\" data-component=\"dropdown\" aria-label=\"What bill query do you have?\">\n            <option value=\"\"><\/option>\n            <option value=\"Copy of bill\/s\">Copy of bill\/s<\/option>\n            <option value=\"Estimated bill\">Estimated bill<\/option>\n            <option value=\"High bill\">High bill<\/option>\n            <option value=\"Delayed bill\">Delayed bill<\/option>\n            <option value=\"Bill frequency\">Bill frequency<\/option>\n            <option value=\"Query a fee\">Query a fee<\/option>\n            <option value=\"Other\">Other<\/option>\n          <\/select> <\/div>\n      <\/li>\n      <li class=\"form-line always-hidden form-field-hidden\" style=\"display:none;\" data-type=\"control_textarea\" id=\"id_110\"><label class=\"form-label form-label-top form-label-auto\" id=\"label_110\" for=\"input_110\"> Bill Query: Please tell us how we can help <\/label>\n        <div id=\"cid_110\" class=\"form-input-wide always-hidden\"> <textarea id=\"input_110\" class=\"form-textarea\" name=\"q110_billQuery\" cols=\"45\" rows=\"6\" data-component=\"textarea\" aria-labelledby=\"label_110\"><\/textarea> <\/div>\n      <\/li>\n      <li class=\"form-line always-hidden form-field-hidden\" style=\"display:none;\" data-type=\"control_text\" id=\"id_112\">\n        <div id=\"cid_112\" class=\"form-input-wide always-hidden\">\n          <div id=\"text_112\" class=\"form-html\" data-component=\"text\" tabindex=\"0\">\n            <p style=\"text-align: center;\">Find out more information on a new Meter Installation or a Smart Meter upgrade\u00a0<a href=\"https:\/\/diamondenergy.com.au\/your-meter\/\" target=\"_blank\" rel=\"nofollow\">here<\/a><\/p>\n            <p style=\"text-align: center;\">or<\/p>\n            <p style=\"text-align: center;\">provide your specific details below and we'll contact you to discuss<\/p>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line always-hidden form-field-hidden\" style=\"display:none;\" data-type=\"control_text\" id=\"id_113\">\n        <div id=\"cid_113\" class=\"form-input-wide always-hidden\">\n          <div id=\"text_113\" class=\"form-html\" data-component=\"text\" tabindex=\"0\">\n            <p style=\"text-align: center;\">Find out more information on how to register for MyAccount\u00a0<a href=\"https:\/\/diamondenergy.com.au\/my-account-information\/\" target=\"_blank\" rel=\"nofollow\">here<\/a><\/p>\n            <p style=\"text-align: center;\">or<\/p>\n            <p style=\"text-align: center;\">provide your details of your experience below and we'll contact you to\u00a0help<\/p>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line always-hidden form-field-hidden\" style=\"display:none;\" data-type=\"control_dropdown\" id=\"id_121\"><label class=\"form-label form-label-top form-label-auto\" id=\"label_121\" for=\"input_121\"> Customer type <\/label>\n        <div id=\"cid_121\" class=\"form-input-wide always-hidden\"> <select class=\"form-dropdown\" id=\"input_121\" name=\"q121_customerType\" style=\"width:150px\" data-component=\"dropdown\" aria-label=\"Customer type\">\n            <option value=\"\"><\/option>\n            <option value=\"Residential\">Residential<\/option>\n            <option value=\"Small\/Medium business\">Small\/Medium business<\/option>\n            <option value=\"Large Market Commercial &amp; Industry\">Large Market Commercial &amp; Industry<\/option>\n            <option value=\"\"><\/option>\n          <\/select> <\/div>\n      <\/li>\n      <li class=\"form-line always-hidden form-field-hidden\" style=\"display:none;\" data-type=\"control_textbox\" id=\"id_122\"><label class=\"form-label form-label-top form-label-auto\" id=\"label_122\" for=\"input_122\"> Business name <\/label>\n        <div id=\"cid_122\" class=\"form-input-wide always-hidden\"> <input type=\"text\" id=\"input_122\" name=\"q122_businessName\" data-type=\"input-textbox\" class=\"form-textbox\" data-defaultvalue=\"\" size=\"20\" value=\"\" data-component=\"textbox\" aria-labelledby=\"label_122\" \/> <\/div>\n      <\/li>\n      <li class=\"form-line always-hidden form-field-hidden\" style=\"display:none;\" data-type=\"control_textarea\" id=\"id_32\"><label class=\"form-label form-label-top form-label-auto\" id=\"label_32\" for=\"input_32\"> Please tell us how we can help <\/label>\n        <div id=\"cid_32\" class=\"form-input-wide always-hidden\"> <textarea id=\"input_32\" class=\"form-textarea\" name=\"q32_pleaseTell\" cols=\"45\" rows=\"6\" data-component=\"textarea\" aria-labelledby=\"label_32\"><\/textarea> <\/div>\n      <\/li>\n      <li class=\"form-line always-hidden\" data-type=\"control_textarea\" id=\"id_119\"><label class=\"form-label form-label-top form-label-auto\" id=\"label_119\" for=\"input_119\"> Please tell us about your feedback here <\/label>\n        <div id=\"cid_119\" 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