var qsProxy = {};
function FrameBuilder(formId,appendTo,initialHeight,iframeCode,title,embedStyleJSON){this.formId=formId;this.initialHeight=initialHeight;this.iframeCode=iframeCode;this.frame=null;this.timeInterval=200;this.appendTo=appendTo||false;this.formSubmitted=0;this.frameMinWidth='100%';this.defaultHeight='';this.init=function(){this.embedURLHash=this.getMD5(window.location.href);this.createFrame();this.addFrameContent(this.iframeCode);};this.createFrame=function(){var tmp_is_ie=!!window.ActiveXObject;this.iframeDomId=document.getElementById(this.formId)?this.formId+'_'+new Date().getTime():this.formId;if(typeof $jot!=='undefined'){var iframe=document.getElementById("230437348247155");var parent=$jot(iframe).closest('.jt-feedback.u-responsive-lightbox');if(parent){this.iframeDomId='lightbox-'+this.iframeDomId;}}
var htmlCode="<"+"iframe title=\""+title.replace(/[\\"']/g,'\\$&').replace(/&amp;/g,'&')+"\" src=\"\" allowtransparency=\"true\" allow=\"geolocation; microphone; camera\" allowfullscreen=\"true\" name=\""+this.formId+"\" id=\""+this.iframeDomId+"\" style=\"width: 10px; min-width:"+this.frameMinWidth+"; display: block; overflow: hidden; height:"+this.initialHeight+"px; border: none;\" scrolling=\"no\""+this.defaultHeight+"></if"+"rame>";if(this.appendTo===false){document.write(htmlCode);}else{var tmp=document.createElement('div');tmp.innerHTML=htmlCode;var a=this.appendTo;document.getElementById(a).appendChild(tmp.firstChild);}
this.frame=document.getElementById(this.iframeDomId);if(tmp_is_ie===true){try{var iframe=this.frame;var doc=iframe.contentDocument?iframe.contentDocument:(iframe.contentWindow.document||iframe.document);doc.open();doc.write("");}
catch(err){this.frame.src="javascript:void((function(){document.open();document.domain=\'"+this.getBaseDomain()+"\';document.close();})())";}}
this.addEvent(this.frame,'load',this.bindMethod(this.setTimer,this));var self=this;if(window.chrome!==undefined){this.frame.onload=function(){try{var doc=this.contentWindow.document;var _jotform=this.contentWindow.JotForm;if(doc!==undefined){var form=doc.getElementById(""+self.iframeDomId);self.addEvent(form,"submit",function(){if(_jotform.validateAll()){self.formSubmitted=1;}});}}catch(e){}}}};this.addEvent=function(obj,type,fn){if(obj.attachEvent){obj["e"+type+fn]=fn;obj[type+fn]=function(){obj["e"+type+fn](window.event);};obj.attachEvent("on"+type,obj[type+fn]);}
else{obj.addEventListener(type,fn,false);}};this.addFrameContent=function(string){if(window.location.search&&window.location.search.indexOf('disableSmartEmbed')>-1||!(this.embedURLHash in embedStyleJSON)){string=string.replace(new RegExp('smartEmbed=1(?:&amp;|&)'),'');string=string.replace(new RegExp('isSmartEmbed'),'');}else{var cssLink='stylebuilder/'+this.formId+'/style.css';var r=new RegExp('(["\'])(?<url>((?:(?!\\1).)+)'+cssLink+'((?:(?!\\1).)+))\\1','gim');var match=r.exec(string);while(match!==null){var url=match.groups.url;var cssPlace=url.indexOf(cssLink);var prepend=url[cssPlace+cssLink.length]==='?'?'&amp;':'?';var embedUrl=prepend+'embedUrl='+encodeURIComponent(window.location.href);var newUrl=url.replace(cssLink,'stylebuilder-new/'+this.formId+'/embed/'+this.embedURLHash+'/default.css');string=string.replace(url,newUrl+embedUrl);match=r.exec(string);}}
string=string.replace(new RegExp('src\\=\\"[^"]*captcha.php\"><\/scr'+'ipt>','gim'),'src="http://api.recaptcha.net/js/recaptcha_ajax.js"></scr'+'ipt><'+'div id="recaptcha_div"><'+'/div>'+'<'+'style>#recaptcha_logo{ display:none;} #recaptcha_tagline{display:none;} #recaptcha_table{border:none !important;} .recaptchatable .recaptcha_image_cell, #recaptcha_table{ background-color:transparent !important; } <'+'/style>'+'<'+'script defer="defer"> window.onload = function(){ Recaptcha.create("6Ld9UAgAAAAAAMon8zjt30tEZiGQZ4IIuWXLt1ky", "recaptcha_div", {theme: "clean",tabindex: 0,callback: function (){'+'if (document.getElementById("uword")) { document.getElementById("uword").parentNode.removeChild(document.getElementById("uword")); } if (window["validate"] !== undefined) { if (document.getElementById("recaptcha_response_field")){ document.getElementById("recaptcha_response_field").onblur = function(){ validate(document.getElementById("recaptcha_response_field"), "Required"); } } } if (document.getElementById("recaptcha_response_field")){ document.getElementsByName("recaptcha_challenge_field")[0].setAttribute("name", "anum"); } if (document.getElementById("recaptcha_response_field")){ document.getElementsByName("recaptcha_response_field")[0].setAttribute("name", "qCap"); }}})'+' }<'+'/script>');string=string.replace(/(type="text\/javascript">)\s+(validate\(\"[^"]*"\);)/,'$1 jTime = setInterval(function(){if("validate" in window){$2clearTimeout(jTime);}}, 1000);');if(string.match('#sublabel_litemode')){string=string.replace('class="form-all"','class="form-all" style="margin-top:0;"');}
var iframe=this.frame;var doc=iframe.contentDocument?iframe.contentDocument:(iframe.contentWindow.document||iframe.document);doc.open();doc.write(string);setTimeout(function(){doc.close();try{if('JotFormFrameLoaded'in window){JotFormFrameLoaded();}}catch(e){}},200);};this.setTimer=function(){var self=this;this.interval=setTimeout(this.changeHeight.bind(this),this.timeInterval);};this.getBaseDomain=function(){var thn=window.location.hostname;var cc=0;var buff="";for(var i=0;i<thn.length;i++){var chr=thn.charAt(i);if(chr=="."){cc++;}
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if(cc==2){thn=thn.replace(buff+".","");}
return thn;}
this.changeHeight=function(){var actualHeight=this.getBodyHeight();var currentHeight=this.getViewPortHeight();var skipAutoHeight=(this.frame.contentWindow)?this.frame.contentWindow.document.querySelector('[data-welcome-view="true"]'):null;if(actualHeight===undefined){this.frame.style.height=this.frameHeight;if(!this.frame.style.minHeight){this.frame.style.minHeight="100vh";if(!('nojump'in(this.frame.contentWindow.document.get)||{})){window.parent.scrollTo(0,0);}}else if(!this.frame.dataset.parentScrolled){this.frame.dataset.parentScrolled=true;var container=window.parent.document&&window.parent.document.querySelector('.jt-content');if(container&&!('nojump'in(window.parent.document.get||{}))){container.scrollTo(0,0);}}}else if(Math.abs(actualHeight-currentHeight)>18&&!skipAutoHeight){this.frame.style.height=(actualHeight)+"px";}
this.setTimer();};this.bindMethod=function(method,scope){return function(){method.apply(scope,arguments);};};this.frameHeight=0;this.getBodyHeight=function(){if(this.formSubmitted===1){return;}
var height;var scrollHeight;var offsetHeight;try{if(this.frame.contentWindow.document.height){height=this.frame.contentWindow.document.height;if(this.frame.contentWindow.document.body.scrollHeight){height=scrollHeight=this.frame.contentWindow.document.body.scrollHeight;}
if(this.frame.contentWindow.document.body.offsetHeight){height=offsetHeight=this.frame.contentWindow.document.body.offsetHeight;}}else if(this.frame.contentWindow){height=offsetHeight=this.frame.contentWindow.innerHeight;}}catch(e){}
this.frameHeight=height;return height;};this.getViewPortHeight=function(){if(this.formSubmitted===1){return;}
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){}
return height;};this.getMD5=function(s){function L(k,d){return(k<<d)|(k>>>(32-d))}function K(G,k){var I,d,F,H,x;F=(G&2147483648);H=(k&2147483648);I=(G&1073741824);d=(k&1073741824);x=(G&1073741823)+(k&1073741823);if(I&d){return(x^2147483648^F^H)}if(I|d){if(x&1073741824){return(x^3221225472^F^H)}else{return(x^1073741824^F^H)}}else{return(x^F^H)}}function r(d,F,k){return(d&F)|((~d)&k)}function q(d,F,k){return(d&k)|(F&(~k))}function p(d,F,k){return(d^F^k)}function n(d,F,k){return(F^(d|(~k)))}function u(G,F,aa,Z,k,H,I){G=K(G,K(K(r(F,aa,Z),k),I));return K(L(G,H),F)}function f(G,F,aa,Z,k,H,I){G=K(G,K(K(q(F,aa,Z),k),I));return K(L(G,H),F)}function D(G,F,aa,Z,k,H,I){G=K(G,K(K(p(F,aa,Z),k),I));return K(L(G,H),F)}function t(G,F,aa,Z,k,H,I){G=K(G,K(K(n(F,aa,Z),k),I));return K(L(G,H),F)}function e(G){var Z;var F=G.length;var x=F+8;var k=(x-(x%64))/64;var I=(k+1)*16;var aa=Array(I-1);var d=0;var H=0;while(H<F){Z=(H-(H%4))/4;d=(H%4)*8;aa[Z]=(aa[Z]|(G.charCodeAt(H)<<d));H++}Z=(H-(H%4))/4;d=(H%4)*8;aa[Z]=aa[Z]|(128<<d);aa[I-2]=F<<3;aa[I-1]=F>>>29;return aa}function B(x){var k="",F="",G,d;for(d=0;d<=3;d++){G=(x>>>(d*8))&255;F="0"+G.toString(16);k=k+F.substr(F.length-2,2)}return k}function J(k){k=k.replace(/rn/g,"n");var d="";for(var F=0;F<k.length;F++){var x=k.charCodeAt(F);if(x<128){d+=String.fromCharCode(x)}else{if((x>127)&&(x<2048)){d+=String.fromCharCode((x>>6)|192);d+=String.fromCharCode((x&63)|128)}else{d+=String.fromCharCode((x>>12)|224);d+=String.fromCharCode(((x>>6)&63)|128);d+=String.fromCharCode((x&63)|128)}}}return d}var C=Array();var P,h,E,v,g,Y,X,W,V;var S=7,Q=12,N=17,M=22;var A=5,z=9,y=14,w=20;var o=4,m=11,l=16,j=23;var U=6,T=10,R=15,O=21;s=J(s);C=e(s);Y=1732584193;X=4023233417;W=2562383102;V=271733878;for(P=0;P<C.length;P+=16){h=Y;E=X;v=W;g=V;Y=u(Y,X,W,V,C[P+0],S,3614090360);V=u(V,Y,X,W,C[P+1],Q,3905402710);W=u(W,V,Y,X,C[P+2],N,606105819);X=u(X,W,V,Y,C[P+3],M,3250441966);Y=u(Y,X,W,V,C[P+4],S,4118548399);V=u(V,Y,X,W,C[P+5],Q,1200080426);W=u(W,V,Y,X,C[P+6],N,2821735955);X=u(X,W,V,Y,C[P+7],M,4249261313);Y=u(Y,X,W,V,C[P+8],S,1770035416);V=u(V,Y,X,W,C[P+9],Q,2336552879);W=u(W,V,Y,X,C[P+10],N,4294925233);X=u(X,W,V,Y,C[P+11],M,2304563134);Y=u(Y,X,W,V,C[P+12],S,1804603682);V=u(V,Y,X,W,C[P+13],Q,4254626195);W=u(W,V,Y,X,C[P+14],N,2792965006);X=u(X,W,V,Y,C[P+15],M,1236535329);Y=f(Y,X,W,V,C[P+1],A,4129170786);V=f(V,Y,X,W,C[P+6],z,3225465664);W=f(W,V,Y,X,C[P+11],y,643717713);X=f(X,W,V,Y,C[P+0],w,3921069994);Y=f(Y,X,W,V,C[P+5],A,3593408605);V=f(V,Y,X,W,C[P+10],z,38016083);W=f(W,V,Y,X,C[P+15],y,3634488961);X=f(X,W,V,Y,C[P+4],w,3889429448);Y=f(Y,X,W,V,C[P+9],A,568446438);V=f(V,Y,X,W,C[P+14],z,3275163606);W=f(W,V,Y,X,C[P+3],y,4107603335);X=f(X,W,V,Y,C[P+8],w,1163531501);Y=f(Y,X,W,V,C[P+13],A,2850285829);V=f(V,Y,X,W,C[P+2],z,4243563512);W=f(W,V,Y,X,C[P+7],y,1735328473);X=f(X,W,V,Y,C[P+12],w,2368359562);Y=D(Y,X,W,V,C[P+5],o,4294588738);V=D(V,Y,X,W,C[P+8],m,2272392833);W=D(W,V,Y,X,C[P+11],l,1839030562);X=D(X,W,V,Y,C[P+14],j,4259657740);Y=D(Y,X,W,V,C[P+1],o,2763975236);V=D(V,Y,X,W,C[P+4],m,1272893353);W=D(W,V,Y,X,C[P+7],l,4139469664);X=D(X,W,V,Y,C[P+10],j,3200236656);Y=D(Y,X,W,V,C[P+13],o,681279174);V=D(V,Y,X,W,C[P+0],m,3936430074);W=D(W,V,Y,X,C[P+3],l,3572445317);X=D(X,W,V,Y,C[P+6],j,76029189);Y=D(Y,X,W,V,C[P+9],o,3654602809);V=D(V,Y,X,W,C[P+12],m,3873151461);W=D(W,V,Y,X,C[P+15],l,530742520);X=D(X,W,V,Y,C[P+2],j,3299628645);Y=t(Y,X,W,V,C[P+0],U,4096336452);V=t(V,Y,X,W,C[P+7],T,1126891415);W=t(W,V,Y,X,C[P+14],R,2878612391);X=t(X,W,V,Y,C[P+5],O,4237533241);Y=t(Y,X,W,V,C[P+12],U,1700485571);V=t(V,Y,X,W,C[P+3],T,2399980690);W=t(W,V,Y,X,C[P+10],R,4293915773);X=t(X,W,V,Y,C[P+1],O,2240044497);Y=t(Y,X,W,V,C[P+8],U,1873313359);V=t(V,Y,X,W,C[P+15],T,4264355552);W=t(W,V,Y,X,C[P+6],R,2734768916);X=t(X,W,V,Y,C[P+13],O,1309151649);Y=t(Y,X,W,V,C[P+4],U,4149444226);V=t(V,Y,X,W,C[P+11],T,3174756917);W=t(W,V,Y,X,C[P+2],R,718787259);X=t(X,W,V,Y,C[P+9],O,3951481745);Y=K(Y,h);X=K(X,E);W=K(W,v);V=K(V,g)}var i=B(Y)+B(X)+B(W)+B(V);return i.toLowerCase()};this.init();}
FrameBuilder.get=qsProxy||[];var initialHeight="LEGACY"==='CARD'?640:539;var i230437348247155=new FrameBuilder("230437348247155",false,initialHeight,"<!DOCTYPE HTML PUBLIC \"-\/\/W3C\/\/DTD HTML 4.01\/\/EN\" \"http:\/\/www.w3.org\/TR\/html4\/strict.dtd\">\n<html lang=\"en-US\"  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%2F230437348247155\" 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%2F230437348247155\" title=\"oEmbed Form\">\n<meta property=\"og:title\" content=\"Request for Call Back - New\" >\n<meta property=\"og:url\" content=\"https:\/\/form.jotform.com\/230437348247155\" >\n<meta property=\"og:description\" content=\"Please click the link to complete this form.\" >\n<meta name=\"slack-app-id\" content=\"AHNMASS8M\">\n<meta data-name=\"preventCloning\" content=\"1\">\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<link rel=\"apple-touch-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\/230437348247155\" \/>\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>Request for Call Back - New<\/title>\n<link type=\"text\/css\" rel=\"stylesheet\" href=\"https:\/\/cdn01.jotfor.ms\/stylebuilder\/static\/form-common.css?v=c80dead\n\"\/>\n<style type=\"text\/css\">@media print{*{-webkit-print-color-adjust: exact !important;color-adjust: exact !important;}.form-section{display:inline!important}.form-pagebreak{display:none!important}.form-section-closed{height:auto!important}.page-section{position:initial!important}}<\/style>\n<link id=\"custom-font\" type=\"text\/css\" rel=\"stylesheet\" href=\"\/\/cdn.jotfor.ms\/fonts\/?family=Cantarell\" \/>\n<link type=\"text\/css\" rel=\"stylesheet\" href=\"https:\/\/cdn02.jotfor.ms\/themes\/CSS\/5e6b428acc8c4e222d1beb91.css?v=3.3.50638&themeRevisionID=63a2351435646363a50e3ee0\"\/>\n<link type=\"text\/css\" rel=\"stylesheet\" href=\"https:\/\/cdn03.jotfor.ms\/css\/styles\/payment\/payment_styles.css?3.3.50638\" \/>\n<link type=\"text\/css\" rel=\"stylesheet\" href=\"https:\/\/cdn01.jotfor.ms\/css\/styles\/payment\/payment_feature.css?3.3.50638\" \/>\n<link type=\"text\/css\" rel=\"stylesheet\" href=\"https:\/\/cdn02.jotfor.ms\/stylebuilder\/static\/donationBox.css?v=3.3.50638\">\n<style type=\"text\/css\" id=\"form-designer-style\">\n@import url('https:\/\/fonts.googleapis.com\/css2?family=Poppins:ital,wght@0,100;0,200;0,300;0,400;0,500;0,600;0,700;0,800;0,900;1,100;1,200;1,300;1,400;1,500;1,600;1,700;1,800&display=swap');\n    \/* Injected CSS Code *\/\n\n*,\n*:after,\n*:before {\n  box-sizing: border-box;\n}\n.form-all {\n  font-family: \"Cantarell\", sans-serif;\n}\n.main .jotform-form {\n  width: 100%;\n  padding: 0 3%;\n}\n.form-all {\n  display: flex;\n  flex-direction: column;\n  width: 100%;\n  max-width: 850px;\n}\n.form-line-active {\n  background-color: #ffffe0 !important;\n}\n.form-all {\n  font-size: 16px;\n}\nli.form-line {\n  margin-top: 12px;\n  margin-bottom: 12px;\n}\n.form-line {\n  padding: 12px 10px;\n}\n.form-all .form-textbox:not(#productSearch-input),\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 .signature-wrapper,\n.form-all .form-error-message {\n  border-radius: 20px;\n}\n.form-all .form-sub-label {\n  margin-left: 3px;\n}\n.form-all .form-textarea {\n  border-radius: 20px;\n  padding: 10px;\n}\n.form-all .form-submit-button,\n.form-all .form-submit-reset,\n.form-all .form-submit-print {\n  border-radius: 100px;\n}\n.form-all .form-sub-label {\n  margin-left: 3px;\n}\n.form-section {\n  padding: 0px 38px;\n}\n.form-textbox,\n.form-textarea,\nli[data-type=control_fileupload] .qq-upload-button,\n.signature-wrapper {\n  border-color: #c3cad8;\n}\n.form-textarea:hover,\n.form-textbox:hover,\nli[data-type=control_fileupload] .qq-upload-button:hover,\n.signature-wrapper:hover {\n  border-color: rgba(195, 202, 216, 0.5);\n  box-shadow: 0 0 0 2px rgba(195, 202, 216, 0.25);\n}\n.form-textarea:focus,\n.form-textbox:focus,\nli[data-type=control_fileupload] .qq-upload-button:focus,\n.signature-wrapper:focus {\n  border-color: #c3cad8;\n  box-shadow: 0 0 0 3px rgba(195, 202, 216, 0.25);\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: rgba(255, 255, 255, 0);\n}\n.form-label {\n  font-family: \"Cantarell\", sans-serif;\n}\n.form-line-column {\n  width: calc(50% - 8px);\n}\n.form-checkbox-item label,\n.form-checkbox-item span,\n.form-radio-item label,\n.form-radio-item span {\n  color: #0d467c;\n}\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.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  left: 0;\n  width: 20px;\n  height: 20px;\n}\n.form-radio-item:not(#foo),\n.form-checkbox-item:not(#foo) {\n  position: relative;\n}\n.form-radio-item:not(#foo) .form-radio + span:before,\n.form-checkbox-item:not(#foo) .form-radio + span:before,\n.form-radio-item:not(#foo) .form-radio + span:after,\n.form-checkbox-item:not(#foo) .form-radio + span:after,\n.form-radio-item:not(#foo) .form-radio:checked + span div:after,\n.form-checkbox-item:not(#foo) .form-radio:checked + span div:after,\n.form-radio-item:not(#foo) .form-checkbox + span:before,\n.form-checkbox-item:not(#foo) .form-checkbox + span:before,\n.form-radio-item:not(#foo) .form-checkbox + span:after,\n.form-checkbox-item:not(#foo) .form-checkbox + span:after,\n.form-radio-item:not(#foo) .form-checkbox:checked + span div:after,\n.form-checkbox-item:not(#foo) .form-checkbox:checked + span div:after {\n  display: none;\n}\n.form-radio-item:not(#foo) .form-radio + label:after,\n.form-checkbox-item:not(#foo) .form-radio + label:after,\n.form-radio-item:not(#foo) .form-radio + span:after,\n.form-checkbox-item:not(#foo) .form-radio + span:after,\n.form-radio-item:not(#foo) .form-checkbox + label:after,\n.form-checkbox-item:not(#foo) .form-checkbox + label:after,\n.form-radio-item:not(#foo) .form-checkbox + span:after,\n.form-checkbox-item:not(#foo) .form-checkbox + span:after {\n  opacity: 1;\n  transform: scale(1);\n}\n.form-radio-item:not(#foo) label:after,\n.form-checkbox-item:not(#foo) label:after {\n  background-color: #ffffff;\n}\n.form-radio-item:not(#foo) .form-checkbox + label,\n.form-checkbox-item:not(#foo) .form-checkbox + label,\n.form-radio-item:not(#foo) .form-checkbox + span,\n.form-checkbox-item:not(#foo) .form-checkbox + span,\n.form-radio-item:not(#foo) .form-radio + label,\n.form-checkbox-item:not(#foo) .form-radio + label,\n.form-radio-item:not(#foo) .form-radio + span,\n.form-checkbox-item:not(#foo) .form-radio + span {\n  padding-left: 50px;\n}\n.form-radio-item:not(#foo) label,\n.form-checkbox-item:not(#foo) label {\n  float: left;\n}\n.form-radio-item:not(#foo) label:before,\n.form-checkbox-item:not(#foo) label:before,\n.form-radio-item:not(#foo) .editor-container div:before,\n.form-checkbox-item:not(#foo) .editor-container div:before {\n  content: '';\n  position: absolute;\n  display: inline-block;\n  vertical-align: baseline;\n  border-radius: 12px;\n  top: 0;\n  left: 4px;\n  width: 36px;\n  height: 22px;\n  cursor: pointer;\n  background: #C3CAD8;\n}\n.form-radio-item:not(#foo) label:after,\n.form-checkbox-item:not(#foo) label:after,\n.form-radio-item:not(#foo) .editor-container div:after,\n.form-checkbox-item:not(#foo) .editor-container div:after {\n  content: '';\n  position: absolute;\n  display: inline-block;\n  top: 3px;\n  left: 8px;\n  width: 15px;\n  height: 15px;\n  border-radius: 12px;\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: 0.2s;\n  -moz-transition-duration: 0.2s;\n  -ms-transition-duration: 0.2s;\n  -o-transition-duration: 0.2s;\n  transition-duration: 0.2s;\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}\n.form-radio-item:not(#foo) input:checked + label:before,\n.form-checkbox-item:not(#foo) input:checked + label:before {\n  background: #363f55;\n}\n.form-radio-item:not(#foo) input:checked + label:after,\n.form-checkbox-item:not(#foo) input:checked + label:after {\n  left: 20px;\n}\n.submit-button {\n  font-size: 16px;\n  font-weight: normal;\n  font-family: \"Cantarell\", sans-serif;\n  border-color: #ef475b;\n}\n.submit-button {\n  min-width: 180px;\n}\nli[data-type=\"control_button\"] .form-submit-button {\n  color: #ffffff;\n  background-color: #ef475b;\n  background-image: none;\n  box-shadow: none;\n  text-shadow: none;\n}\nli[data-type=\"control_button\"] .form-submit-button:hover {\n  background-color: #bf1125;\n}\nli[data-type=\"control_button\"] button.jf-form-buttons.form-sacl-button,\nli[data-type=\"control_button\"] button.jf-form-buttons.form-submit-print {\n  color: #ef475b;\n  border-color: #ef475b;\n  background-image: none;\n  background-color: #fff;\n}\nli[data-type=\"control_button\"] button.jf-form-buttons.form-sacl-button:hover,\nli[data-type=\"control_button\"] button.jf-form-buttons.form-submit-print:hover {\n  background-color: #bf1125;\n  color: #fff;\n}\nli[data-type=\"control_button\"] button.jf-form-buttons.form-pagebreak-back {\n  background-image: none;\n  background-color: #bf1125;\n  box-shadow: none;\n  text-shadow: none;\n}\nli[data-type=\"control_button\"] button.jf-form-buttons.form-pagebreak-back:hover {\n  background-color: #900d1c;\n  color: #fff;\n}\n.form-all .form-pagebreak-back,\n.form-all .form-pagebreak-next {\n  font-family: \"Cantarell\", sans-serif;\n  font-size: 16px;\n  font-weight: normal;\n}\n.form-all .form-pagebreak-back,\n.form-all .form-pagebreak-next {\n  min-width: 128px;\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.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.header-large h1.form-header {\n  font-size: 2em;\n}\n.header-large h2.form-header {\n  font-size: 1.5em;\n}\n.header-large h3.form-header {\n  font-size: 1.17em;\n}\n.header-large h1 + .form-subHeader {\n  font-size: 1em;\n}\n.header-large h2 + .form-subHeader {\n  font-size: .875em;\n}\n.header-large h3 + .form-subHeader {\n  font-size: .75em;\n}\n.header-default h1.form-header {\n  font-size: 2em;\n}\n.header-default h2.form-header {\n  font-size: 1.5em;\n}\n.header-default h3.form-header {\n  font-size: 1.17em;\n}\n.header-default h1 + .form-subHeader {\n  font-size: 1em;\n}\n.header-default h2 + .form-subHeader {\n  font-size: .875em;\n}\n.header-default h3 + .form-subHeader {\n  font-size: .75em;\n}\n.header-small h1.form-header {\n  font-size: 2em;\n}\n.header-small h2.form-header {\n  font-size: 1.5em;\n}\n.header-small h3.form-header {\n  font-size: 1.17em;\n}\n.header-small h1 + .form-subHeader {\n  font-size: 1em;\n}\n.header-small h2 + .form-subHeader {\n  font-size: .875em;\n}\n.header-small h3 + .form-subHeader {\n  font-size: .75em;\n}\n.form-header-group {\n  text-align: left;\n}\n.form-header-group {\n  font-family: \"Cantarell\", sans-serif;\n}\ndiv.form-header-group.header-large,\ndiv.form-header-group.hasImage {\n  margin: 0px -38px;\n}\ndiv.form-header-group.header-large,\ndiv.form-header-group.hasImage {\n  padding: 40px 52px;\n}\n.form-header-group .form-header,\n.form-header-group .form-subHeader {\n  color: 0;\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: #f23a3c;\n  clear: both;\n  float: none;\n}\n.form-line-error .form-error-message .form-error-arrow {\n  border-bottom-color: #f23a3c;\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 #f23a3c;\n  box-shadow: 0 0 3px #f23a3c;\n}\n.supernova {\n  background-color: rgba(255, 255, 255, 0);\n}\n.supernova body {\n  background-color: transparent;\n}\n.supernova .form-all,\n.form-all {\n  background-color: rgba(255, 255, 255, 0);\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: rgba(255, 255, 255, 0);\n}\n.form-matrix-table tr {\n  border-color: rgba(230, 230, 230, 0);\n}\n.form-matrix-table tr:nth-child(2n) {\n  background-color: rgba(242, 242, 242, 0);\n}\n.form-all {\n  color: #082c4e;\n}\n.form-label-top,\n.form-label-left,\n.form-label-right,\n.form-html {\n  color: #082c4e;\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-header-group .form-header,\n.form-header-group .form-subHeader {\n  color: 0;\n}\n\n\/*__INSPECT_SEPERATOR__*\/\n\n.form-textbox {\n    border : 0px;\n    font-family : 'Poppins' !important;\n}\n\n.form-submit-button.submit-button.jf-form-buttons.jsTest-submitField:hover {\n    background-color : white;\n    color : #EF475B;\n    font-family : 'Poppins' !important;\n}\n\n.form-all {\n    border : none !important;\n    box-shadow : none !important;\n    margin-left : auto !important;\n    margin-right : auto !important;\n    padding-left : 0px !important;\n    padding-top : 0px !important;\n    padding-bottom : 0px !important;\n}\n\n.form-line {\n    padding-left : 0px !important;\n}\n\n.form-required {\n    color : #003250 !important;\n}\n\n#id_5 {\n    margin-left : 0px !important;\n}\n\n.form-label.form-label-top {\n    font-family : 'Poppins' !important;\n}\n\n.form-sub-label {\n    font-family : 'Poppins' !important;\n}\n\n.form-radio-item label {\n    font-family : 'Poppins' !important;\n}\n\n.form-submit-button.submit-button.jf-form-buttons.jsTest-submitField {\n    font-family : 'Poppins' !important;\n}\n\n\n    \/* Injected CSS Code *\/\n<\/style>\n\n<script src=\"https:\/\/cdn03.jotfor.ms\/static\/prototype.forms.js?v=3.3.50638\" type=\"text\/javascript\"><\/script>\n<script src=\"https:\/\/cdn01.jotfor.ms\/static\/jotform.forms.js?v=3.3.50638\" type=\"text\/javascript\"><\/script>\n<script src=\"https:\/\/cdn02.jotfor.ms\/js\/punycode-1.4.1.min.js?v=3.3.50638\" type=\"text\/javascript\" defer><\/script>\n<script src=\"https:\/\/cdn03.jotfor.ms\/js\/vendor\/maskedinput_5.0.9.min.js?v=3.3.50638\" type=\"text\/javascript\"><\/script>\n<script src=\"https:\/\/cdn01.jotfor.ms\/js\/payments\/validategateways.js?v=3.3.50638\" type=\"text\/javascript\"><\/script>\n<script src=\"https:\/\/cdn01.jotfor.ms\/s\/umd\/d07ade0890f\/for-appointment-field.js?v=3.3.50638\" type=\"text\/javascript\"><\/script>\n<script src=\"https:\/\/cdn02.jotfor.ms\/js\/vendor\/smoothscroll.min.js?v=3.3.50638\" type=\"text\/javascript\"><\/script>\n<script src=\"https:\/\/cdn03.jotfor.ms\/js\/errorNavigation.js?v=3.3.50638\" type=\"text\/javascript\"><\/script>\n<script type=\"text\/javascript\">\tJotForm.newDefaultTheme = true;\n\tJotForm.extendsNewTheme = false;\n\tJotForm.singleProduct = false;\n\tJotForm.newPaymentUIForNewCreatedForms = true;\n\tJotForm.texts = {\"confirmEmail\":\"E-mail does not match\",\"pleaseWait\":\"Please wait...\",\"validateEmail\":\"You need to validate this e-mail\",\"confirmClearForm\":\"Are you sure you want to clear the form\",\"lessThan\":\"Your score should be less than or equal to\",\"incompleteFields\":\"There are incomplete required fields. Please complete them.\",\"required\":\"This field is required.\",\"requireOne\":\"At least one field required.\",\"requireEveryRow\":\"Every row is required.\",\"requireEveryCell\":\"Every cell is required.\",\"email\":\"Enter a valid e-mail address\",\"alphabetic\":\"This field can only contain letters\",\"numeric\":\"This field can only contain numeric values\",\"alphanumeric\":\"This field can only contain letters and numbers.\",\"cyrillic\":\"This field can only contain cyrillic characters\",\"url\":\"This field can only contain a valid URL\",\"currency\":\"This field can only contain currency values.\",\"fillMask\":\"Field value must fill mask.\",\"uploadExtensions\":\"You can only upload following files:\",\"noUploadExtensions\":\"File has no extension file type (e.g. .txt, .png, .jpeg)\",\"uploadFilesize\":\"File size cannot be bigger than:\",\"uploadFilesizemin\":\"File size cannot be smaller than:\",\"gradingScoreError\":\"Score total should only be less than or equal to\",\"inputCarretErrorA\":\"Input should not be less than the minimum value:\",\"inputCarretErrorB\":\"Input should not be greater than the maximum value:\",\"maxDigitsError\":\"The maximum digits allowed is\",\"minCharactersError\":\"The number of characters should not be less than the minimum value:\",\"maxCharactersError\":\"The number of characters should not be more than the maximum value:\",\"freeEmailError\":\"Free email accounts are not allowed\",\"minSelectionsError\":\"The minimum required number of selections is \",\"maxSelectionsError\":\"The maximum number of selections allowed is \",\"pastDatesDisallowed\":\"Date must not be in the past.\",\"dateLimited\":\"This date is unavailable.\",\"dateInvalid\":\"This date is not valid. The date format is {format}\",\"dateInvalidSeparate\":\"This date is not valid. Enter a valid {element}.\",\"ageVerificationError\":\"You must be older than {minAge} years old to submit this form.\",\"multipleFileUploads_typeError\":\"{file} has invalid extension. Only {extensions} are allowed.\",\"multipleFileUploads_sizeError\":\"{file} is too large, maximum file size is {sizeLimit}.\",\"multipleFileUploads_minSizeError\":\"{file} is too small, minimum file size is {minSizeLimit}.\",\"multipleFileUploads_emptyError\":\"{file} is empty, please select files again without it.\",\"multipleFileUploads_uploadFailed\":\"File upload failed, please remove it and upload the file again.\",\"multipleFileUploads_onLeave\":\"The files are being uploaded, if you leave now the upload will be cancelled.\",\"multipleFileUploads_fileLimitError\":\"Only {fileLimit} file uploads allowed.\",\"dragAndDropFilesHere_infoMessage\":\"Drag and drop files here\",\"chooseAFile_infoMessage\":\"Choose a file\",\"maxFileSize_infoMessage\":\"Max. file size\",\"generalError\":\"There are errors on the form. Please fix them before continuing.\",\"generalPageError\":\"There are errors on this page. Please fix them before continuing.\",\"wordLimitError\":\"Too many words. The limit is\",\"wordMinLimitError\":\"Too few words.  The minimum is\",\"characterLimitError\":\"Too many Characters.  The limit is\",\"characterMinLimitError\":\"Too few characters. The minimum is\",\"ccInvalidNumber\":\"Credit Card Number is invalid.\",\"ccInvalidCVC\":\"CVC number is invalid.\",\"ccInvalidExpireDate\":\"Expire date is invalid.\",\"ccInvalidExpireMonth\":\"Expiration month is invalid.\",\"ccInvalidExpireYear\":\"Expiration year is invalid.\",\"ccMissingDetails\":\"Please fill up the credit card details.\",\"ccMissingProduct\":\"Please select at least one product.\",\"ccMissingDonation\":\"Please enter numeric values for donation amount.\",\"disallowDecimals\":\"Please enter a whole number.\",\"restrictedDomain\":\"This domain is not allowed\",\"ccDonationMinLimitError\":\"Minimum amount is {minAmount} {currency}\",\"requiredLegend\":\"All fields marked with * are required and must be filled.\",\"geoPermissionTitle\":\"Permission Denied\",\"geoPermissionDesc\":\"Check your browser's privacy settings.\",\"geoNotAvailableTitle\":\"Position Unavailable\",\"geoNotAvailableDesc\":\"Location provider not available. Please enter the address manually.\",\"geoTimeoutTitle\":\"Timeout\",\"geoTimeoutDesc\":\"Please check your internet connection and try again.\",\"selectedTime\":\"Selected Time\",\"formerSelectedTime\":\"Former Time\",\"cancelAppointment\":\"Cancel Appointment\",\"cancelSelection\":\"Cancel Selection\",\"noSlotsAvailable\":\"No slots available\",\"slotUnavailable\":\"{time} on {date} has been selected is unavailable. Please select another slot.\",\"multipleError\":\"There are {count} errors on this page. Please correct them before moving on.\",\"oneError\":\"There is {count} error on this page. Please correct it before moving on.\",\"doneMessage\":\"Well done! All errors are fixed.\",\"doneButton\":\"Done\",\"reviewSubmitText\":\"Review and Submit\",\"nextButtonText\":\"Next\",\"prevButtonText\":\"Previous\",\"seeErrorsButton\":\"See Errors\",\"notEnoughStock\":\"Not enough stock for the current selection\",\"notEnoughStock_remainedItems\":\"Not enough stock for the current selection ({count} items left)\",\"soldOut\":\"Sold Out\",\"justSoldOut\":\"Just Sold Out\",\"selectionSoldOut\":\"Selection Sold Out\",\"subProductItemsLeft\":\"({count} items left)\",\"startButtonText\":\"START\",\"submitButtonText\":\"Submit\",\"submissionLimit\":\"Sorry! Only one entry is allowed. Multiple submissions are disabled for this form.\",\"reviewBackText\":\"Back to Form\",\"seeAllText\":\"See All\",\"progressMiddleText\":\"of\",\"fieldError\":\"field has an error.\",\"error\":\"Error\"};\n\tJotForm.newPaymentUI = true;\n\n var jsTime = setInterval(function(){try{\n   JotForm.jsForm = true;\n\tJotForm.replaceTagTest = true;\n\tJotForm.clearFieldOnHide=\"disable\";\n\tJotForm.submitError=\"jumpToFirstError\";\n\n\tJotForm.init(function(){\n\t\/*INIT-START*\/\n      JotForm.setPhoneMaskingValidator( 'input_5_full', '\\u0028\\u0023\\u0023\\u0023\\u0029 \\u0023\\u0023\\u0023\\u002d\\u0023\\u0023\\u0023\\u0023' );\n\n    JotForm.calendarMonths = [\"January\",\"February\",\"March\",\"April\",\"May\",\"June\",\"July\",\"August\",\"September\",\"October\",\"November\",\"December\"];\n    JotForm.appointmentCalendarMonths = [\"January\",\"February\",\"March\",\"April\",\"May\",\"June\",\"July\",\"August\",\"September\",\"October\",\"November\",\"December\"];\n    JotForm.appointmentCalendarDays = [\"Monday\",\"Tuesday\",\"Wednesday\",\"Thursday\",\"Friday\",\"Saturday\",\"Sunday\"];\n    JotForm.calendarOther = \"Today\";\n    window.initializeAppointment({\"text\":{\"text\":\"Question\",\"value\":\"Appointment\"},\"labelAlign\":{\"text\":\"Label Align\",\"value\":\"Top\",\"dropdown\":[[\"Auto\",\"Auto\"],[\"Left\",\"Left\"],[\"Right\",\"Right\"],[\"Top\",\"Top\"]]},\"required\":{\"text\":\"Required\",\"value\":\"Yes\",\"dropdown\":[[\"No\",\"No\"],[\"Yes\",\"Yes\"]]},\"description\":{\"text\":\"Hover Text\",\"value\":\"\",\"textarea\":true},\"slotDuration\":{\"text\":\"Slot Duration\",\"value\":\"60\",\"dropdown\":[[15,\"15 min\"],[30,\"30 min\"],[45,\"45 min\"],[60,\"60 min\"],[\"custom\",\"Custom min\"]],\"hint\":\"Select how long each slot will be.\"},\"startDate\":{\"text\":\"Start Date\",\"value\":\"\"},\"endDate\":{\"text\":\"End 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Hour\"],[\"AM\\u002FPM\",\"AM\\u002FPM\"]],\"icon\":\"images\\u002Fblank.gif\",\"iconClassName\":\"toolbar-time_format_24\"},\"months\":{\"value\":[\"January\",\"February\",\"March\",\"April\",\"May\",\"June\",\"July\",\"August\",\"September\",\"October\",\"November\",\"December\"],\"hidden\":true},\"days\":{\"value\":[\"Monday\",\"Tuesday\",\"Wednesday\",\"Thursday\",\"Friday\",\"Saturday\",\"Sunday\"],\"hidden\":true},\"startWeekOn\":{\"text\":\"Start Week On\",\"value\":\"Sunday\",\"dropdown\":[[\"Monday\",\"Monday\"],[\"Sunday\",\"Sunday\"]],\"toolbar\":false},\"rollingDays\":{\"text\":\"Rolling Days\",\"value\":\"\",\"toolbar\":false},\"prevMonthButtonText\":{\"text\":\"Previous month\",\"value\":\"\"},\"nextMonthButtonText\":{\"text\":\"Next month\",\"value\":\"\"},\"prevYearButtonText\":{\"text\":\"Previous year\",\"value\":\"\"},\"nextYearButtonText\":{\"text\":\"Next year\",\"value\":\"\"},\"prevDayButtonText\":{\"text\":\"Previous day\",\"value\":\"\"},\"nextDayButtonText\":{\"text\":\"Next day\",\"value\":\"\"},\"appointmentType\":{\"hidden\":true,\"value\":\"single\"},\"autoDetectTimezone\":{\"hidden\":true,\"value\":\"Yes\"},\"dateFormat\":{\"hidden\":true,\"value\":\"mm\\u002Fdd\\u002Fyyyy\"},\"maxAttendee\":{\"hidden\":true,\"value\":\"5\"},\"maxEvents\":{\"hidden\":true,\"value\":\"\"},\"minScheduleNotice\":{\"hidden\":true,\"value\":\"3\"},\"name\":{\"hidden\":true,\"value\":\"appointment\"},\"order\":{\"hidden\":true,\"value\":\"4\"},\"qid\":{\"toolbar\":false,\"value\":\"input_8\"},\"reminderEmails\":{\"hidden\":true,\"value\":{\"schedule\":[{\"value\":\"2\",\"unit\":\"hour\"}]}},\"type\":{\"hidden\":true,\"value\":\"control_appointment\"},\"useReminderEmails\":{\"hidden\":true,\"value\":\"No\"},\"id\":{\"toolbar\":false,\"value\":\"8\"},\"qname\":{\"toolbar\":false,\"value\":\"q8_appointment\"},\"cdnconfig\":{\"CDN\":\"https:\\u002F\\u002Fcdn.jotfor.ms\\u002F\"},\"passive\":false,\"formProperties\":{\"highlightLine\":\"Enabled\",\"coupons\":false,\"useStripeCoupons\":false,\"taxes\":false,\"comparePaymentForm\":\"\",\"paymentListSettings\":false,\"newPaymentUIForNewCreatedForms\":\"Yes\",\"formBackground\":\"rgba(255,255,255,0)\",\"newAppointment\":false,\"isAutoCompleteEnabled\":true},\"formID\":230437348247155,\"isPaymentForm\":false,\"isOpenedInPortal\":false,\"isCheckoutForm\":false,\"isOfflineForms\":false,\"SSL_URL\":\"https:\\u002F\\u002Fwww.jotform.com\\u002F\",\"themeVersion\":\"v2\",\"isEnterprise\":false,\"environment\":\"PRODUCTION\"});\n 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method=\"post\" name=\"form_230437348247155\" id=\"230437348247155\" accept-charset=\"utf-8\" autocomplete=\"on\"><input type=\"hidden\" name=\"formID\" value=\"230437348247155\" \/><input type=\"hidden\" id=\"JWTContainer\" value=\"\" \/><input type=\"hidden\" id=\"cardinalOrderNumber\" value=\"\" \/><input type=\"hidden\" id=\"jsExecutionTracker\" name=\"jsExecutionTracker\" value=\"build-date-1706515178144\" \/><input type=\"hidden\" id=\"submitSource\" name=\"submitSource\" value=\"unknown\" \/><input type=\"hidden\" id=\"buildDate\" name=\"buildDate\" value=\"1706515178144\" \/>\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_3\"><label class=\"form-label form-label-top form-label-auto\" id=\"label_3\" for=\"first_3\" aria-hidden=\"false\"> Name<span class=\"form-required\">*<\/span> <\/label>\n        <div id=\"cid_3\" class=\"form-input-wide jf-required\" data-layout=\"full\">\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_3\" name=\"q3_name[first]\" class=\"form-textbox validate[required]\" data-defaultvalue=\"\" autoComplete=\"section-input_3 given-name\" size=\"10\" data-component=\"first\" aria-labelledby=\"label_3 sublabel_3_first\" required=\"\" value=\"\" \/><label class=\"form-sub-label\" for=\"first_3\" id=\"sublabel_3_first\" style=\"min-height:13px\">First Name<\/label><\/span><span class=\"form-sub-label-container\" style=\"vertical-align:top\" data-input-type=\"last\"><input type=\"text\" id=\"last_3\" name=\"q3_name[last]\" class=\"form-textbox validate[required]\" data-defaultvalue=\"\" autoComplete=\"section-input_3 family-name\" size=\"15\" data-component=\"last\" aria-labelledby=\"label_3 sublabel_3_last\" required=\"\" value=\"\" \/><label class=\"form-sub-label\" for=\"last_3\" id=\"sublabel_3_last\" style=\"min-height:13px\">Last Name<\/label><\/span><\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line form-line-column form-col-1 jf-required\" data-type=\"control_email\" id=\"id_4\"><label class=\"form-label form-label-top\" id=\"label_4\" for=\"input_4\" aria-hidden=\"false\"> Email<span class=\"form-required\">*<\/span> <\/label>\n        <div id=\"cid_4\" class=\"form-input-wide jf-required\" data-layout=\"half\"> <span class=\"form-sub-label-container\" style=\"vertical-align:top\"><input type=\"email\" id=\"input_4\" name=\"q4_email\" class=\"form-textbox validate[required, Email]\" data-defaultvalue=\"\" autoComplete=\"section-input_4 email\" style=\"width:310px\" size=\"310\" data-component=\"email\" aria-labelledby=\"label_4 sublabel_input_4\" required=\"\" value=\"\" \/><label class=\"form-sub-label\" for=\"input_4\" id=\"sublabel_input_4\" style=\"min-height:13px\">example@example.com<\/label><\/span> <\/div>\n      <\/li>\n      <li class=\"form-line form-line-column form-col-2 jf-required\" data-type=\"control_phone\" id=\"id_5\"><label class=\"form-label form-label-top\" id=\"label_5\" for=\"input_5_full\"> Phone Number<span class=\"form-required\">*<\/span> <\/label>\n        <div id=\"cid_5\" class=\"form-input-wide jf-required\" data-layout=\"half\"> <span class=\"form-sub-label-container\" style=\"vertical-align:top\"><input type=\"tel\" id=\"input_5_full\" name=\"q5_phoneNumber[full]\" data-type=\"mask-number\" class=\"mask-phone-number form-textbox validate[required, Fill Mask]\" data-defaultvalue=\"\" autoComplete=\"section-input_5 tel-national\" style=\"width:310px\" data-masked=\"true\" placeholder=\"(000) 000-0000\" data-component=\"phone\" aria-labelledby=\"label_5 sublabel_5_masked\" required=\"\" value=\"\" \/><label class=\"form-sub-label\" for=\"input_5_full\" id=\"sublabel_5_masked\" style=\"min-height:13px\">Please enter a valid phone number.<\/label><\/span> <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_appointment\" id=\"id_8\"><label class=\"form-label form-label-top\" id=\"label_8\" for=\"input_8\" aria-hidden=\"false\"> Appointment<span class=\"form-required\">*<\/span> <\/label>\n        <div id=\"cid_8\" class=\"form-input-wide jf-required\" data-layout=\"full\">\n          <div id=\"input_8\" class=\"appointmentFieldWrapper jfQuestion-fields\"><input type=\"hidden\" class=\"appointmentFieldInput\" name=\"q8_appointment[implementation]\" value=\"new\" id=\"input_8implementation\" aria-hidden=\"true\" \/><input type=\"hidden\" class=\"appointmentFieldInput validate\" name=\"q8_appointment[date]\" id=\"input_8_date\" data-timeformat=\"AM\/PM\" aria-hidden=\"true\" \/><input type=\"hidden\" class=\"appointmentFieldInput\" name=\"q8_appointment[duration]\" value=\"60\" id=\"input_8_duration\" aria-hidden=\"true\" \/><input type=\"hidden\" class=\"appointmentFieldInput\" name=\"q8_appointment[timezone]\" value=\"America\/Chicago (GMT-05:00)\" id=\"input_8_timezone\" aria-hidden=\"true\" \/>\n            <div class=\"appointmentField\"><\/div>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_button\" id=\"id_2\">\n        <div id=\"cid_2\" class=\"form-input-wide\" data-layout=\"full\">\n          <div data-align=\"left\" class=\"form-buttons-wrapper form-buttons-left   jsTest-button-wrapperField\"><button id=\"input_2\" type=\"submit\" class=\"form-submit-button submit-button jf-form-buttons jsTest-submitField\" data-component=\"button\" data-content=\"\">Request\u00a0a\u00a0call<\/button><\/div>\n        <\/div>\n      <\/li>\n      <li style=\"display:none\">Should be Empty: <input type=\"text\" name=\"website\" value=\"\" type=\"hidden\" \/><\/li>\n    <\/ul>\n  <\/div>\n  <script>\n    JotForm.showJotFormPowered = \"0\";\n  <\/script>\n  <script>\n    JotForm.poweredByText = \"Powered by Jotform\";\n  <\/script><input type=\"hidden\" class=\"simple_spc\" 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