{"id":22401,"date":"2025-11-21T11:25:03","date_gmt":"2025-11-21T17:25:03","guid":{"rendered":"https:\/\/techops.cuicable.com\/?page_id=22401"},"modified":"2025-11-25T11:00:51","modified_gmt":"2025-11-25T17:00:51","slug":"vendor-application","status":"publish","type":"page","link":"https:\/\/techops.cuicable.com\/index.php\/vendorportal\/vendor-application\/","title":{"rendered":"Vendor Application"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221; theme_builder_area=&#8221;post_content&#8221;][et_pb_row _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221; theme_builder_area=&#8221;post_content&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221; theme_builder_area=&#8221;post_content&#8221;][et_pb_text _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; text_text_color=&#8221;#0C71C3&#8243; text_font_size=&#8221;40px&#8221; text_orientation=&#8221;center&#8221; hover_enabled=&#8221;0&#8243; global_colors_info=&#8221;{}&#8221; theme_builder_area=&#8221;post_content&#8221; text_font_size_last_edited=&#8221;on|desktop&#8221; sticky_enabled=&#8221;0&#8243; text_font_size_phone=&#8221;19px&#8221; text_font_size_tablet=&#8221;40px&#8221;]<\/p>\n<p>Subcontractor Application<\/p>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; border_radii=&#8221;on|20px|20px|20px|20px&#8221; border_width_all=&#8221;3px&#8221; global_colors_info=&#8221;{}&#8221; theme_builder_area=&#8221;post_content&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221; theme_builder_area=&#8221;post_content&#8221;][wpforms_selector form_id=&#8221;22414&#8243; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; custom_padding=&#8221;|||20px|false|false&#8221; global_colors_info=&#8221;{}&#8221; theme_builder_area=&#8221;post_content&#8221;][\/wpforms_selector][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Subcontractor Application<div class=\"et_pb_module wpforms_selector wpforms_selector_0\">\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<div class=\"et_pb_module_inner\">\n\t\t\t\t\t<div class=\"wpforms-container wpforms-container-full\" id=\"wpforms-22414\"><form id=\"wpforms-form-22414\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"22414\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php\/wp-json\/wp\/v2\/pages\/22401\" data-token=\"113f2fee8985579b301678859de9d3dc\" data-token-time=\"1776303348\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript>    <style>\n      .cui-ret-hide { display:none !important; }\n      .cui-ret-show { display:block !important; }\n    <\/style>\n\n    <script>\n    document.addEventListener(\"DOMContentLoaded\", function() {\n\n        const form = document.querySelector('#wpforms-form-22414');\n        if (!form) return;\n\n        \/\/ Retainage containers\n        const lowPct  = document.querySelector('#wpforms-22414-field_67-container');\n        const lowAmt  = document.querySelector('#wpforms-22414-field_70-container');\n        const midPct  = document.querySelector('#wpforms-22414-field_68-container');\n        const midAmt  = document.querySelector('#wpforms-22414-field_71-container');\n        const highPct = document.querySelector('#wpforms-22414-field_69-container');\n        const highAmt = document.querySelector('#wpforms-22414-field_72-container');\n\n        const allRetainage = [lowPct, lowAmt, midPct, midAmt, highPct, highAmt].filter(Boolean);\n\n        function hideAll() {\n            allRetainage.forEach(el => {\n                el.classList.remove('cui-ret-show');\n                el.classList.add('cui-ret-hide');\n            });\n        }\n\n        function showPair(pctEl, amtEl) {\n            [pctEl, amtEl].forEach(el => {\n                if (!el) return;\n                el.classList.remove('cui-ret-hide');\n                el.classList.add('cui-ret-show');\n            });\n        }\n\n        function updateRetainage() {\n            hideAll();\n\n            \/\/ Re-query Field 73 every time (it may be shown\/hidden by WPForms logic)\n            const checks = form.querySelectorAll('input[name=\"wpforms[fields][73][]\"]');\n            if (!checks.length) return;\n\n            \/\/ Collect selected values (lowercased)\n            const selected = [];\n            checks.forEach(chk => {\n                if (chk.checked) selected.push((chk.value || '').trim().toLowerCase());\n            });\n\n            if (selected.length === 0) return;\n\n            \/\/ High \/ Mid triggers\n            const hasUnderground = selected.includes('underground construction');\n            const hasAerial      = selected.includes('aerial construction');\n\n            \/\/ LOW group (any combo of these should return LOW)\n            const lowGroup = new Set([\n                'pole transfers',\n                'coax splicing',\n                'fiber splicing',\n                'engineering'\n            ]);\n\n            const hasAnyLowGroup = selected.some(v => lowGroup.has(v));\n\n            \/\/ PRIORITY:\n            \/\/ 1) Any Underground \u2192 HIGH\n            if (hasUnderground) {\n                showPair(highPct, highAmt);\n                return;\n            }\n\n            \/\/ 2) Any Aerial \u2192 MID\n            if (hasAerial) {\n                showPair(midPct, midAmt);\n                return;\n            }\n\n            \/\/ 3) Any selection from LOW group (and no Aerial\/Underground due to priority above) \u2192 LOW\n            if (hasAnyLowGroup) {\n                showPair(lowPct, lowAmt);\n                return;\n            }\n        }\n\n        \/\/ Run after any change; delay lets WPForms finish conditional logic first\n        form.addEventListener('change', function() {\n            setTimeout(updateRetainage, 50);\n        });\n\n        \/\/ Initial run\n        updateRetainage();\n\n    });\n    <\/script>\n    <div class=\"wpforms-field-container\"><div id=\"wpforms-22414-field_1-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-type=\"date-time\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-22414-field_1\">Date <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-22414-field_1\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-small\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][1][date]\" required><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-22414-field_3-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline wpforms-conditional-trigger\" data-field-type=\"checkbox\" data-field-id=\"3\"><label class=\"wpforms-field-label\">Type of Work <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-22414-field_3\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_3_1\" name=\"wpforms[fields][3][]\" value=\"Fulfillment\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_3_1\">Fulfillment<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_3_4\" name=\"wpforms[fields][3][]\" value=\"Drop Bury\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_3_4\">Drop Bury<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_3_3\" name=\"wpforms[fields][3][]\" value=\"MDU\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_3_3\">MDU<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_3_5\" name=\"wpforms[fields][3][]\" value=\"Engineering\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_3_5\">Engineering<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_3_2\" name=\"wpforms[fields][3][]\" value=\"Construction\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_3_2\">Construction<\/label><\/li><\/ul><\/div><div id=\"wpforms-22414-field_73-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"checkbox\" data-field-id=\"73\" style=\"display:none;\"><label class=\"wpforms-field-label\">Type of Construction to be performed. <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-22414-field_73\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_73_1\" name=\"wpforms[fields][73][]\" value=\"Pole Transfers\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_73_1\">Pole Transfers<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_73_2\" name=\"wpforms[fields][73][]\" value=\"Aerial Construction\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_73_2\">Aerial Construction<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_73_3\" name=\"wpforms[fields][73][]\" value=\"Underground Construction\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_73_3\">Underground Construction<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_73_4\" name=\"wpforms[fields][73][]\" value=\"Fiber Splicing\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_73_4\">Fiber Splicing<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_73_5\" name=\"wpforms[fields][73][]\" value=\"COAX Splicing\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_73_5\">COAX Splicing<\/label><\/li><\/ul><\/div><div id=\"wpforms-22414-field_84-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"checkbox\" data-field-id=\"84\" style=\"display:none;\"><label class=\"wpforms-field-label\">Are you interested in working in Comcast markets? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-22414-field_84\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_84_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][84][]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_84_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_84_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][84][]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_84_2\">No<\/label><\/li><\/ul><div class=\"wpforms-field-description\">Note - Working in a Comcast market will require a higher value for insurance coverage.<\/div><\/div><div id=\"wpforms-22414-field_90-container\" class=\"wpforms-field wpforms-field-html\" data-field-type=\"html\" data-field-id=\"90\"><div id=\"wpforms-22414-field_90\"><p>\r\n  <a href=\"\/index.php\/vendorportal\/insurance-information-full\/\" target=\"_blank\">\r\n    Click here for Certificate of Insurance information\r\n  <\/a>\r\n<\/p>\r\n<\/div><\/div><div id=\"wpforms-22414-field_87-container\" class=\"wpforms-field wpforms-field-html\" data-field-type=\"html\" data-field-id=\"87\"><div id=\"wpforms-22414-field_87\"><p>\r\n  <a href=\"\/index.php\/vendorportal\/insurance-information\/\" target=\"_blank\">\r\n    Click here for Certificate of Insurance information\r\n  <\/a>\r\n<\/p>\r\n<\/div><\/div><div id=\"wpforms-22414-field_89-container\" class=\"wpforms-field wpforms-field-html\" data-field-type=\"html\" data-field-id=\"89\"><div id=\"wpforms-22414-field_89\"><p>\r\n  <a href=\"\/index.php\/vendorportal\/insurance-information-comcast-const\/\" target=\"_blank\">\r\n    Click here for Certificate of Insurance information\r\n  <\/a>\r\n<\/p>\r\n<\/div><\/div><div id=\"wpforms-22414-field_83-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-3-columns\" data-field-type=\"checkbox\" data-field-id=\"83\"><label class=\"wpforms-field-label\">In which states are you available to work? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-22414-field_83\" class=\"wpforms-field-required\"><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_83_4\" name=\"wpforms[fields][83][]\" value=\"[Select All]\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_83_4\">[Select All]<\/label><\/li><li class=\"choice-54 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_83_54\" name=\"wpforms[fields][83][]\" value=\"AL\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_83_54\">AL<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_83_5\" name=\"wpforms[fields][83][]\" value=\"AK\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_83_5\">AK<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_83_6\" name=\"wpforms[fields][83][]\" value=\"AZ\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_83_6\">AZ<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_83_7\" name=\"wpforms[fields][83][]\" value=\"AR\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_83_7\">AR<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_83_8\" name=\"wpforms[fields][83][]\" value=\"CA\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_83_8\">CA<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_83_9\" name=\"wpforms[fields][83][]\" value=\"CO\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_83_9\">CO<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_83_10\" name=\"wpforms[fields][83][]\" value=\"CT\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_83_10\">CT<\/label><\/li><li class=\"choice-11 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_83_11\" name=\"wpforms[fields][83][]\" value=\"DE\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_83_11\">DE<\/label><\/li><li class=\"choice-12 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_83_12\" name=\"wpforms[fields][83][]\" value=\"DC\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_83_12\">DC<\/label><\/li><li class=\"choice-13 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_83_13\" name=\"wpforms[fields][83][]\" value=\"FL\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_83_13\">FL<\/label><\/li><li class=\"choice-14 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_83_14\" name=\"wpforms[fields][83][]\" value=\"GA\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_83_14\">GA<\/label><\/li><li class=\"choice-15 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_83_15\" name=\"wpforms[fields][83][]\" value=\"ID\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_83_15\">ID<\/label><\/li><li class=\"choice-16 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_83_16\" name=\"wpforms[fields][83][]\" value=\"IL\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_83_16\">IL<\/label><\/li><li class=\"choice-17 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_83_17\" name=\"wpforms[fields][83][]\" value=\"IN\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_83_17\">IN<\/label><\/li><li class=\"choice-18 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_83_18\" name=\"wpforms[fields][83][]\" value=\"IA\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_83_18\">IA<\/label><\/li><li class=\"choice-19 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_83_19\" name=\"wpforms[fields][83][]\" value=\"KS\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_83_19\">KS<\/label><\/li><li class=\"choice-20 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_83_20\" name=\"wpforms[fields][83][]\" value=\"KY\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_83_20\">KY<\/label><\/li><li class=\"choice-21 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_83_21\" name=\"wpforms[fields][83][]\" value=\"LA\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_83_21\">LA<\/label><\/li><li class=\"choice-22 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_83_22\" name=\"wpforms[fields][83][]\" value=\"ME\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_83_22\">ME<\/label><\/li><li class=\"choice-23 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_83_23\" name=\"wpforms[fields][83][]\" value=\"MD\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_83_23\">MD<\/label><\/li><li class=\"choice-24 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_83_24\" name=\"wpforms[fields][83][]\" value=\"MA\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_83_24\">MA<\/label><\/li><li class=\"choice-25 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_83_25\" name=\"wpforms[fields][83][]\" value=\"MI\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_83_25\">MI<\/label><\/li><li class=\"choice-26 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_83_26\" name=\"wpforms[fields][83][]\" value=\"MN\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_83_26\">MN<\/label><\/li><li class=\"choice-27 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_83_27\" name=\"wpforms[fields][83][]\" value=\"MS\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_83_27\">MS<\/label><\/li><li class=\"choice-28 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_83_28\" name=\"wpforms[fields][83][]\" value=\"MO\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_83_28\">MO<\/label><\/li><li class=\"choice-29 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_83_29\" name=\"wpforms[fields][83][]\" value=\"MT\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_83_29\">MT<\/label><\/li><li class=\"choice-30 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_83_30\" name=\"wpforms[fields][83][]\" value=\"NE\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_83_30\">NE<\/label><\/li><li class=\"choice-31 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_83_31\" name=\"wpforms[fields][83][]\" value=\"NV\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_83_31\">NV<\/label><\/li><li class=\"choice-32 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_83_32\" name=\"wpforms[fields][83][]\" value=\"NH\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_83_32\">NH<\/label><\/li><li class=\"choice-33 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_83_33\" name=\"wpforms[fields][83][]\" value=\"NJ\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_83_33\">NJ<\/label><\/li><li class=\"choice-34 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_83_34\" name=\"wpforms[fields][83][]\" value=\"NM\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_83_34\">NM<\/label><\/li><li class=\"choice-35 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_83_35\" name=\"wpforms[fields][83][]\" value=\"NY\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_83_35\">NY<\/label><\/li><li class=\"choice-36 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_83_36\" name=\"wpforms[fields][83][]\" value=\"NC\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_83_36\">NC<\/label><\/li><li class=\"choice-37 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_83_37\" name=\"wpforms[fields][83][]\" value=\"ND\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_83_37\">ND<\/label><\/li><li class=\"choice-38 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_83_38\" name=\"wpforms[fields][83][]\" value=\"OH\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_83_38\">OH<\/label><\/li><li class=\"choice-39 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_83_39\" name=\"wpforms[fields][83][]\" value=\"OK\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_83_39\">OK<\/label><\/li><li class=\"choice-40 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_83_40\" name=\"wpforms[fields][83][]\" value=\"OR\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_83_40\">OR<\/label><\/li><li class=\"choice-41 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_83_41\" name=\"wpforms[fields][83][]\" value=\"PA\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_83_41\">PA<\/label><\/li><li class=\"choice-42 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_83_42\" name=\"wpforms[fields][83][]\" value=\"RI\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_83_42\">RI<\/label><\/li><li class=\"choice-43 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_83_43\" name=\"wpforms[fields][83][]\" value=\"SC\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_83_43\">SC<\/label><\/li><li class=\"choice-44 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_83_44\" name=\"wpforms[fields][83][]\" value=\"SD\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_83_44\">SD<\/label><\/li><li class=\"choice-45 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_83_45\" name=\"wpforms[fields][83][]\" value=\"TN\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_83_45\">TN<\/label><\/li><li class=\"choice-46 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_83_46\" name=\"wpforms[fields][83][]\" value=\"TX\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_83_46\">TX<\/label><\/li><li class=\"choice-47 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_83_47\" name=\"wpforms[fields][83][]\" value=\"UT\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_83_47\">UT<\/label><\/li><li class=\"choice-48 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_83_48\" name=\"wpforms[fields][83][]\" value=\"VT\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_83_48\">VT<\/label><\/li><li class=\"choice-49 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_83_49\" name=\"wpforms[fields][83][]\" value=\"VA\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_83_49\">VA<\/label><\/li><li class=\"choice-50 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_83_50\" name=\"wpforms[fields][83][]\" value=\"WA\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_83_50\">WA<\/label><\/li><li class=\"choice-51 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_83_51\" name=\"wpforms[fields][83][]\" value=\"WV\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_83_51\">WV<\/label><\/li><li class=\"choice-52 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_83_52\" name=\"wpforms[fields][83][]\" value=\"WI\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_83_52\">WI<\/label><\/li><li class=\"choice-53 depth-1\"><input type=\"checkbox\" id=\"wpforms-22414-field_83_53\" name=\"wpforms[fields][83][]\" value=\"WY\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-22414-field_83_53\">WY<\/label><\/li><\/ul><\/div><div id=\"wpforms-22414-field_49-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"49\"><label class=\"wpforms-field-label\" for=\"wpforms-22414-field_49\">Company Name <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-22414-field_49\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][49]\" required><\/div><div id=\"wpforms-22414-field_74-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"74\"><label class=\"wpforms-field-label\" for=\"wpforms-22414-field_74\">State of Incorporation <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-22414-field_74\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][74]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Please Select<\/option><option value=\"Alabama\"  class=\"choice-4 depth-1\"  >Alabama<\/option><option value=\"Alaska\"  class=\"choice-5 depth-1\"  >Alaska<\/option><option value=\"Arizona\"  class=\"choice-6 depth-1\"  >Arizona<\/option><option value=\"Arkansas\"  class=\"choice-7 depth-1\"  >Arkansas<\/option><option value=\"California\"  class=\"choice-8 depth-1\"  >California<\/option><option value=\"Colorado\"  class=\"choice-9 depth-1\"  >Colorado<\/option><option value=\"Connecticut\"  class=\"choice-10 depth-1\"  >Connecticut<\/option><option value=\"Delaware\"  class=\"choice-11 depth-1\"  >Delaware<\/option><option value=\"District of Columbia\"  class=\"choice-12 depth-1\"  >District of Columbia<\/option><option value=\"Florida\"  class=\"choice-13 depth-1\"  >Florida<\/option><option value=\"Georgia\"  class=\"choice-14 depth-1\"  >Georgia<\/option><option value=\"Idaho\"  class=\"choice-15 depth-1\"  >Idaho<\/option><option value=\"Illinois\"  class=\"choice-16 depth-1\"  >Illinois<\/option><option value=\"Indiana\"  class=\"choice-17 depth-1\"  >Indiana<\/option><option value=\"Iowa\"  class=\"choice-18 depth-1\"  >Iowa<\/option><option value=\"Kansas\"  class=\"choice-19 depth-1\"  >Kansas<\/option><option value=\"Kentucky\"  class=\"choice-20 depth-1\"  >Kentucky<\/option><option value=\"Louisiana\"  class=\"choice-21 depth-1\"  >Louisiana<\/option><option value=\"Maine\"  class=\"choice-22 depth-1\"  >Maine<\/option><option value=\"Maryland\"  class=\"choice-23 depth-1\"  >Maryland<\/option><option value=\"Massachusetts\"  class=\"choice-24 depth-1\"  >Massachusetts<\/option><option value=\"Michigan\"  class=\"choice-25 depth-1\"  >Michigan<\/option><option value=\"Minnesota\"  class=\"choice-26 depth-1\"  >Minnesota<\/option><option value=\"Mississippi\"  class=\"choice-27 depth-1\"  >Mississippi<\/option><option value=\"Missouri\"  class=\"choice-28 depth-1\"  >Missouri<\/option><option value=\"Montana\"  class=\"choice-29 depth-1\"  >Montana<\/option><option value=\"Nebraska\"  class=\"choice-30 depth-1\"  >Nebraska<\/option><option value=\"Nevada\"  class=\"choice-31 depth-1\"  >Nevada<\/option><option value=\"New Hampshire\"  class=\"choice-32 depth-1\"  >New Hampshire<\/option><option value=\"New Jersey\"  class=\"choice-33 depth-1\"  >New Jersey<\/option><option value=\"New Mexico\"  class=\"choice-34 depth-1\"  >New Mexico<\/option><option value=\"New York\"  class=\"choice-35 depth-1\"  >New York<\/option><option value=\"North Carolina\"  class=\"choice-36 depth-1\"  >North Carolina<\/option><option value=\"North Dakota\"  class=\"choice-37 depth-1\"  >North Dakota<\/option><option value=\"Ohio\"  class=\"choice-38 depth-1\"  >Ohio<\/option><option value=\"Oklahoma\"  class=\"choice-39 depth-1\"  >Oklahoma<\/option><option value=\"Oregon\"  class=\"choice-40 depth-1\"  >Oregon<\/option><option value=\"Pennsylvania\"  class=\"choice-41 depth-1\"  >Pennsylvania<\/option><option value=\"Rhode Island\"  class=\"choice-42 depth-1\"  >Rhode Island<\/option><option value=\"South Carolina\"  class=\"choice-43 depth-1\"  >South Carolina<\/option><option value=\"South Dakota\"  class=\"choice-44 depth-1\"  >South Dakota<\/option><option value=\"Tennessee\"  class=\"choice-45 depth-1\"  >Tennessee<\/option><option value=\"Texas\"  class=\"choice-46 depth-1\"  >Texas<\/option><option value=\"Utah\"  class=\"choice-47 depth-1\"  >Utah<\/option><option value=\"Vermont\"  class=\"choice-48 depth-1\"  >Vermont<\/option><option value=\"Virginia\"  class=\"choice-49 depth-1\"  >Virginia<\/option><option value=\"Washington\"  class=\"choice-50 depth-1\"  >Washington<\/option><option value=\"West Virginia\"  class=\"choice-51 depth-1\"  >West Virginia<\/option><option value=\"Wisconsin\"  class=\"choice-52 depth-1\"  >Wisconsin<\/option><option value=\"Wyoming\"  class=\"choice-53 depth-1\"  >Wyoming<\/option><\/select><\/div><div id=\"wpforms-22414-field_81-container\" class=\"wpforms-field wpforms-field-number wpf-num-limit3 wpforms-conditional-trigger\" data-field-type=\"number\" data-field-id=\"81\"><label class=\"wpforms-field-label\" for=\"wpforms-22414-field_81\">Number of business owners <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"number\" id=\"wpforms-22414-field_81\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][81]\" step=\"any\" required><div class=\"wpforms-field-description\">Please select up to 3 business owner fields<\/div><\/div><div id=\"wpforms-22414-field_5-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"5\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-22414-field_6-container\" class=\"wpforms-field wpforms-field-name wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"name\" data-field-id=\"6\" style=\"display:none;\"><label class=\"wpforms-field-label\">Owner Name 1 <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-22414-field_6\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][6][first]\" required><label for=\"wpforms-22414-field_6\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-22414-field_6-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][6][last]\" required><label for=\"wpforms-22414-field_6-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-22414-field_7-container\" class=\"wpforms-field wpforms-field-email wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"email\" data-field-id=\"7\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-22414-field_7\">Owner Email 1 <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-22414-field_7\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][7]\" spellcheck=\"false\" required><\/div><\/div><\/div><\/div><div id=\"wpforms-22414-field_75-container\" class=\"wpforms-field wpforms-field-phone wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"phone\" data-field-id=\"75\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-22414-field_75\">Owner Phone # 1 <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-22414-field_75\" class=\"wpforms-field-small wpforms-field-required wpforms-masked-input\" data-inputmask=\"&#039;mask&#039;: &#039;(999) 999-9999&#039;\" data-rule-us-phone-field=\"true\" data-inputmask-inputmode=\"tel\" name=\"wpforms[fields][75]\" aria-label=\"Owner Phone # 1\" required><\/div><div id=\"wpforms-22414-field_8-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"8\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-22414-field_9-container\" class=\"wpforms-field wpforms-field-name wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"name\" data-field-id=\"9\" style=\"display:none;\"><label class=\"wpforms-field-label\">Owner Name 2 <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-22414-field_9\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][9][first]\" required><label for=\"wpforms-22414-field_9\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-22414-field_9-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][9][last]\" required><label for=\"wpforms-22414-field_9-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-22414-field_10-container\" class=\"wpforms-field wpforms-field-email wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"email\" data-field-id=\"10\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-22414-field_10\">Owner Email 2 <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-22414-field_10\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][10]\" spellcheck=\"false\" required><\/div><\/div><\/div><\/div><div id=\"wpforms-22414-field_76-container\" class=\"wpforms-field wpforms-field-phone wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"phone\" data-field-id=\"76\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-22414-field_76\">Owner Phone #  2 <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-22414-field_76\" class=\"wpforms-field-small wpforms-field-required wpforms-masked-input\" data-inputmask=\"&#039;mask&#039;: &#039;(999) 999-9999&#039;\" data-rule-us-phone-field=\"true\" data-inputmask-inputmode=\"tel\" name=\"wpforms[fields][76]\" aria-label=\"Owner Phone #  2\" required><\/div><div id=\"wpforms-22414-field_11-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"11\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-22414-field_12-container\" class=\"wpforms-field wpforms-field-name wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"name\" data-field-id=\"12\" style=\"display:none;\"><label class=\"wpforms-field-label\">Owner Name 3 <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-22414-field_12\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][12][first]\" required><label for=\"wpforms-22414-field_12\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-22414-field_12-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][12][last]\" required><label for=\"wpforms-22414-field_12-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-22414-field_13-container\" class=\"wpforms-field wpforms-field-email wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"email\" data-field-id=\"13\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-22414-field_13\">Owner Email 3 <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-22414-field_13\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][13]\" spellcheck=\"false\" required><\/div><\/div><\/div><\/div><div id=\"wpforms-22414-field_77-container\" class=\"wpforms-field wpforms-field-phone wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"phone\" data-field-id=\"77\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-22414-field_77\">Owner Phone # 3 <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-22414-field_77\" class=\"wpforms-field-small wpforms-field-required wpforms-masked-input\" data-inputmask=\"&#039;mask&#039;: &#039;(999) 999-9999&#039;\" data-rule-us-phone-field=\"true\" data-inputmask-inputmode=\"tel\" name=\"wpforms[fields][77]\" aria-label=\"Owner Phone # 3\" required><\/div><div id=\"wpforms-22414-field_14-container\" class=\"wpforms-field wpforms-field-address\" data-field-type=\"address\" data-field-id=\"14\"><label class=\"wpforms-field-label\">Company Address <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-22414-field_14\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][14][address1]\" required><label for=\"wpforms-22414-field_14\" class=\"wpforms-field-sublabel after\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-22414-field_14-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][14][address2]\" ><label for=\"wpforms-22414-field_14-address2\" class=\"wpforms-field-sublabel after\">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-22414-field_14-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][14][city]\" required><label for=\"wpforms-22414-field_14-city\" class=\"wpforms-field-sublabel after\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-22414-field_14-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][14][state]\" required><option class=\"placeholder\" value=\"\" selected disabled>--- Select state ---<\/option><option value=\"AL\" >Alabama<\/option><option value=\"AK\" >Alaska<\/option><option value=\"AZ\" >Arizona<\/option><option value=\"AR\" >Arkansas<\/option><option value=\"CA\" >California<\/option><option value=\"CO\" >Colorado<\/option><option value=\"CT\" >Connecticut<\/option><option value=\"DE\" >Delaware<\/option><option value=\"DC\" >District of Columbia<\/option><option value=\"FL\" >Florida<\/option><option value=\"GA\" >Georgia<\/option><option value=\"HI\" >Hawaii<\/option><option value=\"ID\" >Idaho<\/option><option value=\"IL\" >Illinois<\/option><option value=\"IN\" >Indiana<\/option><option value=\"IA\" >Iowa<\/option><option value=\"KS\" >Kansas<\/option><option value=\"KY\" >Kentucky<\/option><option value=\"LA\" >Louisiana<\/option><option value=\"ME\" >Maine<\/option><option value=\"MD\" >Maryland<\/option><option value=\"MA\" >Massachusetts<\/option><option value=\"MI\" >Michigan<\/option><option value=\"MN\" >Minnesota<\/option><option value=\"MS\" >Mississippi<\/option><option value=\"MO\" >Missouri<\/option><option value=\"MT\" >Montana<\/option><option value=\"NE\" >Nebraska<\/option><option value=\"NV\" >Nevada<\/option><option value=\"NH\" >New Hampshire<\/option><option value=\"NJ\" >New Jersey<\/option><option value=\"NM\" >New Mexico<\/option><option value=\"NY\" >New York<\/option><option value=\"NC\" >North Carolina<\/option><option value=\"ND\" >North Dakota<\/option><option value=\"OH\" >Ohio<\/option><option value=\"OK\" >Oklahoma<\/option><option value=\"OR\" >Oregon<\/option><option value=\"PA\" >Pennsylvania<\/option><option value=\"RI\" >Rhode Island<\/option><option value=\"SC\" >South Carolina<\/option><option value=\"SD\" >South Dakota<\/option><option value=\"TN\" >Tennessee<\/option><option value=\"TX\" >Texas<\/option><option value=\"UT\" >Utah<\/option><option value=\"VT\" >Vermont<\/option><option value=\"VA\" >Virginia<\/option><option value=\"WA\" >Washington<\/option><option value=\"WV\" >West Virginia<\/option><option value=\"WI\" >Wisconsin<\/option><option value=\"WY\" >Wyoming<\/option><\/select><label for=\"wpforms-22414-field_14-state\" class=\"wpforms-field-sublabel after\">State<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-22414-field_14-postal\" class=\"wpforms-field-address-postal wpforms-field-required wpforms-masked-input\" data-inputmask-mask=\"(99999)|(99999-9999)\" data-inputmask-keepstatic=\"true\" data-rule-inputmask-incomplete=\"1\" name=\"wpforms[fields][14][postal]\" required><label for=\"wpforms-22414-field_14-postal\" class=\"wpforms-field-sublabel after\">Zip Code<\/label><\/div><\/div><\/div><div id=\"wpforms-22414-field_15-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-22414-field_15\">EIN <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-22414-field_15\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][15]\" required><\/div><div id=\"wpforms-22414-field_39-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"39\"><label class=\"wpforms-field-label\">Company contact name <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-22414-field_39\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][39][first]\" required><label for=\"wpforms-22414-field_39\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-22414-field_39-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][39][last]\" required><label for=\"wpforms-22414-field_39-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-22414-field_40-container\" class=\"wpforms-field wpforms-field-email\" data-field-type=\"email\" data-field-id=\"40\"><label class=\"wpforms-field-label\" for=\"wpforms-22414-field_40\">Company contact email address <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-22414-field_40\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][40]\" spellcheck=\"false\" required><\/div><div id=\"wpforms-22414-field_41-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"41\"><label class=\"wpforms-field-label\">Insurance contact name<\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-22414-field_41\" class=\"wpforms-field-name-first\" name=\"wpforms[fields][41][first]\" ><label for=\"wpforms-22414-field_41\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-22414-field_41-last\" class=\"wpforms-field-name-last\" name=\"wpforms[fields][41][last]\" ><label for=\"wpforms-22414-field_41-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-22414-field_42-container\" class=\"wpforms-field wpforms-field-email\" data-field-type=\"email\" data-field-id=\"42\"><label class=\"wpforms-field-label\" for=\"wpforms-22414-field_42\">Insurance contact email address<\/label><input type=\"email\" id=\"wpforms-22414-field_42\" class=\"wpforms-field-medium\" name=\"wpforms[fields][42]\" spellcheck=\"false\" ><\/div><div id=\"wpforms-22414-field_43-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"43\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-22414-field_79-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-hide\" data-field-type=\"text\" data-field-id=\"79\"><label class=\"wpforms-field-label\" for=\"wpforms-22414-field_79\">Retainage Fulfillment (%) <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-22414-field_79\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][79]\" value=\"3%\" placeholder=\"3%\" required><\/div><div id=\"wpforms-22414-field_67-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"67\"><label class=\"wpforms-field-label\" for=\"wpforms-22414-field_67\">Retainage (%)<\/label><input type=\"text\" id=\"wpforms-22414-field_67\" class=\"wpforms-field-medium\" name=\"wpforms[fields][67]\" value=\"3%\" placeholder=\"3%\" ><\/div><div id=\"wpforms-22414-field_68-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"68\"><label class=\"wpforms-field-label\" for=\"wpforms-22414-field_68\">Retainage (%)<\/label><input type=\"text\" id=\"wpforms-22414-field_68\" class=\"wpforms-field-medium\" name=\"wpforms[fields][68]\" value=\"3%\" placeholder=\"3%\" ><\/div><div id=\"wpforms-22414-field_69-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"69\"><label class=\"wpforms-field-label\" for=\"wpforms-22414-field_69\">Retainage (%)<\/label><input type=\"text\" id=\"wpforms-22414-field_69\" class=\"wpforms-field-medium\" name=\"wpforms[fields][69]\" value=\"3%\" placeholder=\"3%\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-22414-field_80-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-hide\" data-field-type=\"text\" data-field-id=\"80\"><label class=\"wpforms-field-label\" for=\"wpforms-22414-field_80\">Retainage Fulfillment (amount)  <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-22414-field_80\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][80]\" value=\"$50,000\" required><\/div><div id=\"wpforms-22414-field_70-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"70\"><label class=\"wpforms-field-label\" for=\"wpforms-22414-field_70\">Retainage (amount)<\/label><input type=\"text\" id=\"wpforms-22414-field_70\" class=\"wpforms-field-medium\" name=\"wpforms[fields][70]\" value=\"$25,000\" ><\/div><div id=\"wpforms-22414-field_71-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"71\"><label class=\"wpforms-field-label\" for=\"wpforms-22414-field_71\">Retainage (amount)<\/label><input type=\"text\" id=\"wpforms-22414-field_71\" class=\"wpforms-field-medium\" name=\"wpforms[fields][71]\" value=\"$50,000\" placeholder=\"50K\" ><\/div><div id=\"wpforms-22414-field_72-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"72\"><label class=\"wpforms-field-label\" for=\"wpforms-22414-field_72\">Retainage (amount)<\/label><input type=\"text\" id=\"wpforms-22414-field_72\" class=\"wpforms-field-medium\" name=\"wpforms[fields][72]\" value=\"$100,000\" ><\/div><\/div><\/div><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-recaptcha-container wpforms-is-recaptcha wpforms-is-recaptcha-type-v2\" ><div class=\"g-recaptcha\" data-sitekey=\"6LeEmlcmAAAAAIucCO4Ts599D58hoG0JnMF_-ElL\"><\/div><input type=\"text\" name=\"g-recaptcha-hidden\" class=\"wpforms-recaptcha-hidden\" style=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\" data-rule-recaptcha=\"1\"><\/div><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"22414\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/techops.cuicable.com\/index.php\/wp-json\/wp\/v2\/pages\/22401\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-22414\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/techops.cuicable.com\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->\n\t\t\t\t<\/div>\n\t\t\t<\/div><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":22369,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"class_list":["post-22401","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/techops.cuicable.com\/index.php\/wp-json\/wp\/v2\/pages\/22401","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/techops.cuicable.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/techops.cuicable.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/techops.cuicable.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/techops.cuicable.com\/index.php\/wp-json\/wp\/v2\/comments?post=22401"}],"version-history":[{"count":1,"href":"https:\/\/techops.cuicable.com\/index.php\/wp-json\/wp\/v2\/pages\/22401\/revisions"}],"predecessor-version":[{"id":22491,"href":"https:\/\/techops.cuicable.com\/index.php\/wp-json\/wp\/v2\/pages\/22401\/revisions\/22491"}],"up":[{"embeddable":true,"href":"https:\/\/techops.cuicable.com\/index.php\/wp-json\/wp\/v2\/pages\/22369"}],"wp:attachment":[{"href":"https:\/\/techops.cuicable.com\/index.php\/wp-json\/wp\/v2\/media?parent=22401"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}