{"id":5091,"date":"2019-05-01T00:00:59","date_gmt":"2019-04-30T12:00:59","guid":{"rendered":"https:\/\/accurateautoglass.co.nz\/aag\/?page_id=5091"},"modified":"2021-04-19T14:16:05","modified_gmt":"2021-04-19T02:16:05","slug":"job-request","status":"publish","type":"page","link":"https:\/\/www.accurateautoglass.co.nz\/aag\/job-request\/","title":{"rendered":"Job Request"},"content":{"rendered":"<section class=\"l-section wpb_row height_full valign_center color_primary with_img parallax_hor bgwidth_120 with_overlay\"><div class=\"l-section-img\" style=\"background-image: url(https:\/\/www.accurateautoglass.co.nz\/aag\/wp-content\/uploads\/2017\/11\/stock-call-centre-1920.jpg);\" data-img-width=\"1920\" data-img-height=\"1280\"><\/div><div class=\"l-section-overlay\" style=\"background: rgba(0,0,0,0.85)\"><\/div><div class=\"l-section-h i-cf\"><div class=\"g-cols vc_row type_default valign_middle\"><div class=\"vc_col-sm-12 wpb_column vc_column_container\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\"><div class=\"w-message color_yellow with_icon\"><div class=\"w-message-icon\"><i class=\"fas fa-exclamation-circle\"><\/i><\/div><div class=\"w-message-body\"><p>This form is intended for use by <b>ACCURATE AUTO GLASS account holders only.<\/b> [*] Denotes a required field.<\/p>\n<\/div><\/div><div class=\"wpb_text_column\" ><div class=\"wpb_wrapper\"><div id=\"iphorm-outer-69e766e812bdb\" class=\"iphorm-outer iphorm-outer-1 iphorm-theme-light-rounded iphorm-has-logic iphorm-responsive\" style='width: 100%;margin-left: auto;margin-right: auto;'>\n    <script type=\"text\/javascript\">\n        jQuery(document).ready(function($) {\n                            iPhorm.logic[1] = {\"logic\":{\"72\":{\"action\":\"show\",\"match\":\"any\",\"rules\":[{\"element_id\":\"73\",\"operator\":\"eq\",\"value\":\"Yes\"}]},\"48\":{\"action\":\"show\",\"match\":\"all\",\"rules\":[{\"element_id\":\"45\",\"operator\":\"eq\",\"value\":\"Other\"}]},\"7\":{\"action\":\"show\",\"match\":\"all\",\"rules\":[{\"element_id\":\"35\",\"operator\":\"eq\",\"value\":\"Other\"}]},\"20\":{\"action\":\"show\",\"match\":\"all\",\"rules\":[{\"element_id\":\"10\",\"operator\":\"eq\",\"value\":\"Other\"}]},\"57\":{\"action\":\"show\",\"match\":\"all\",\"rules\":[{\"element_id\":\"12\",\"operator\":\"eq\",\"value\":\"Other\"}]},\"33\":{\"action\":\"show\",\"match\":\"any\",\"rules\":[{\"element_id\":\"12\",\"operator\":\"eq\",\"value\":\"Windscreen Repair\"},{\"element_id\":\"12\",\"operator\":\"eq\",\"value\":\"Windscreen Replacement\"}]},\"74\":{\"action\":\"show\",\"match\":\"any\",\"rules\":[{\"element_id\":\"12\",\"operator\":\"eq\",\"value\":\"Windscreen Replacement\"},{\"element_id\":\"12\",\"operator\":\"eq\",\"value\":\"Windscreen Repair\"}]},\"58\":{\"action\":\"show\",\"match\":\"all\",\"rules\":[{\"element_id\":\"12\",\"operator\":\"eq\",\"value\":\"Side \\\/ Door Glass Replacement\"}]},\"52\":{\"action\":\"show\",\"match\":\"all\",\"rules\":[{\"element_id\":\"12\",\"operator\":\"eq\",\"value\":\"Side \\\/ Door Glass Replacement\"}]},\"68\":{\"action\":\"show\",\"match\":\"all\",\"rules\":[{\"element_id\":\"12\",\"operator\":\"eq\",\"value\":\"Rearscreen Replacement\"}]}},\"dependents\":{\"73\":[72],\"45\":[48],\"35\":[7],\"10\":[20],\"12\":[57,33,33,74,74,58,52,68]},\"animate\":true};\n                        $('#iphorm-69e766e812bdb').iPhorm({\"id\":1,\"uniqueId\":\"69e766e812bdb\",\"useAjax\":true,\"successMessageTimeout\":10,\"resetFormValues\":\"\",\"clElementIds\":[72,48,7,20,57,33,74,58,52,68],\"clDependentElementIds\":[73,45,35,10,12],\"centerFancybox\":true,\"centerFancyboxSpeed\":true});\n                        if ($.isFunction($.fn.qtip)) {\n                $('.iphorm-tooltip-hover', iPhorm.instance.$form).qtip({\n                    style: {\n                        classes: 'qtip-tipsy qtip-shadow qtip-rounded'\n                    },\n                    position: {\n                        my: 'left center',\n                        at: 'right center',\n                        viewport: $(window),\n                        adjust: {\n                            method: 'shift'\n                        }\n                    }\n                });\n                $('.iphorm-tooltip-click', iPhorm.instance.$form).qtip({\n                    style: {\n                        classes: 'qtip-tipsy qtip-shadow qtip-rounded'\n                    },\n                    position: {\n                        my: 'left center',\n                        at: 'right center',\n                        viewport: $(window),\n                        adjust: {\n                            method: 'shift'\n                        }\n                    },\n                    show: {\n                        event: 'focus'\n                    },\n                    hide: {\n                        event: 'unfocus'\n                    }\n                });\n                $('.iphorm-tooltip-icon-hover', iPhorm.instance.$form).qtip({\n                    style: {\n                        classes: 'qtip-tipsy qtip-shadow qtip-rounded'\n                    },\n                    position: {\n                        my: 'left center',\n                        at: 'right center',\n                        viewport: $(window),\n                        adjust: {\n                            method: 'shift'\n                        }\n                    },\n                    content: {\n                        text: function (api) {\n                            return $(this).find('.iphorm-tooltip-icon-content').html();\n                        }\n                    }\n                });\n                $('.iphorm-tooltip-icon-click', iPhorm.instance.$form).qtip({\n                    style: {\n                        classes: 'qtip-tipsy qtip-shadow qtip-rounded'\n                    },\n                    position: {\n                        my: 'left center',\n                        at: 'right center',\n                        viewport: $(window),\n                        adjust: {\n                            method: 'shift'\n                        }\n                    },\n                    show: {\n                        event: 'click'\n                    },\n                    hide: {\n                        event: 'unfocus'\n                    },\n                    content: {\n                        text: function (api) {\n                            return $(this).find('.iphorm-tooltip-icon-content').html();\n                        }\n                    }\n                });\n                $('.iphorm-labels-inside > .iphorm-element-spacer > label').hover(function () {\n                    $(this).siblings('.iphorm-input-wrap').find('.iphorm-tooltip-hover').qtip('show');\n                }, function () {\n                    $(this).siblings('.iphorm-input-wrap').find('.iphorm-tooltip-hover').qtip('hide');\n                });\n            }\n                                    if ($.isFunction($.fn.inFieldLabels)) {\n                $('.iphorm-labels-inside:not(.iphorm-element-wrap-recaptcha) > .iphorm-element-spacer > label', iPhorm.instance.$form).inFieldLabels();\n            }\n                        $('.iphorm-group-row > div:last-child:not(:first-child)', iPhorm.instance.$form).add('.iphorm-group-row:last-child', iPhorm.instance.$form).addClass('last-child');\n                            iPhorm.instance.applyAllLogic(true);\n                $('#iphorm-outer-69e766e812bdb').css('visibility', 'visible');\n                    });\n    <\/script>\n    <form id=\"iphorm-69e766e812bdb\" class=\"iphorm iphorm-form-1\" action=\"\/aag\/wp-json\/wp\/v2\/pages\/5091#iphorm-69e766e812bdb\" method=\"post\" enctype=\"multipart\/form-data\" novalidate=\"novalidate\">\n        <div class=\"iphorm-inner iphorm-inner-1\" style='padding: 14px;background-color: rgb(238, 238, 238);'>\n            <input type=\"hidden\" name=\"iphorm_id\" value=\"1\" \/>\n            <input type=\"hidden\" name=\"iphorm_uid\" value=\"69e766e812bdb\" \/>\n            <input type=\"hidden\" name=\"form_url\" value=\"https:\/\/www.accurateautoglass.co.nz\/aag\/wp-json\/wp\/v2\/pages\/5091\" \/>\n            <input type=\"hidden\" name=\"referring_url\" value=\"\" \/>\n            <input type=\"hidden\" name=\"post_id\" value=\"\" \/>\n            <input type=\"hidden\" name=\"post_title\" value=\"\" \/>\n                                                <div class=\"iphorm-elements iphorm-elements-1 iphorm-clearfix\" >\n                <div class=\"iphorm-group-wrap iphorm_1_50-group-wrap iphorm-clearfix iphorm-labels-above iphorm-group-style-bordered iphorm-group-alignment-proportional\" >\n    <div class=\"iphorm-group-elements\" style='background-color: rgb(238, 238, 238);'>\n                <div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-html iphorm_1_49-element-wrap iphorm-clearfix\">\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-html iphorm_1_49-element-spacer\">\n        <h2><strong>JOB REQUEST<\/strong><\/h2>    <\/div>\n<\/div>\n<\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><\/div><\/div><\/div><div class=\"iphorm-group-wrap iphorm_1_16-group-wrap iphorm-clearfix iphorm-labels-above iphorm-group-style-bordered iphorm-group-alignment-proportional\" >\n    <div class=\"iphorm-group-elements\" >\n                \t<div class=\"iphorm-group-title-description-wrap iphorm-clearfix\">\n    \t\t\t                <div class=\"iphorm-group-title\" style='font-weight: bold;text-transform: uppercase;'>\/\/ Job Details<\/div>\n                                            <\/div>\n                <div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-2cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_1_18-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-required\" >\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_1_18-element-spacer\">\n        <label for=\"iphorm_1_18_69e766e812bdb\" class=\"iphorm_1_18-outer-label\" style='font-weight: bold;font-size: 0.9em;text-transform: uppercase;color: rgb(51, 51, 51) !important;'>Order #<span class=\"iphorm-required\">[*]<\/span><\/label>        <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_1_18-input-wrap\" >\n            <input class=\"iphorm-element-text  iphorm_1_18\" id=\"iphorm_1_18_69e766e812bdb\" type=\"text\" name=\"iphorm_1_18\"  value=\"\" style='width: 100%;' \/>\n                    <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n    <\/div><div class=\"iphorm-element-wrap iphorm-element-wrap-select iphorm_1_63-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-required\" >\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-select iphorm_1_63-element-spacer\">\n        <label for=\"iphorm_1_63_69e766e812bdb\" class=\"iphorm_1_63-outer-label\" style='font-weight: bold;font-size: 0.9em;text-transform: uppercase;color: rgb(51, 51, 51) !important;'>Job Priority<span class=\"iphorm-required\">[*]<\/span><\/label>        <div class=\"iphorm-input-wrap iphorm-input-wrap-select iphorm_1_63-input-wrap\" >\n            <select class=\"iphorm-element-select  iphorm_1_63\" name=\"iphorm_1_63\" id=\"iphorm_1_63_69e766e812bdb\"  style='width: 100%;'>\n                                    <option value=\"\" >Select Job Priority<\/option>\n                                    <option value=\"At earliest convenience\" >At earliest convenience<\/option>\n                                    <option value=\"ASAP (genuinely urgent request)\" >ASAP (genuinely urgent request)<\/option>\n                            <\/select>\n                    <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n<\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-2cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-radio iphorm_1_73-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-optional\" >\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-radio iphorm_1_73-element-spacer\">\n        <label class=\"iphorm_1_73-outer-label\" style='font-weight: bold;font-size: 0.9em;text-transform: uppercase;color: rgb(51, 51, 51) !important;'>Do You Want To Be Notified When The Job Will Be Done?<\/label>        <div class=\"iphorm-input-wrap iphorm-input-wrap-radio iphorm_1_73-input-wrap\" >\n            <div class=\"iphorm-input-ul iphorm-input-radio-ul iphorm_1_73-input-radio-ul iphorm-options-inline iphorm-clearfix\" >\n                            <div class=\"iphorm-input-li iphorm-input-radio-li iphorm_1_73-input-li\" >\n                    <label for=\"iphorm_1_73_69e766e812bdb_1\"  class=\"iphorm_1_73_1_label\">\n                        <input class=\"iphorm-element-radio iphorm_1_73 iphorm_1_73_1\" type=\"radio\" name=\"iphorm_1_73\" id=\"iphorm_1_73_69e766e812bdb_1\" value=\"Yes\"  \/>\n                        Yes                    <\/label>\n                <\/div>\n                            <div class=\"iphorm-input-li iphorm-input-radio-li iphorm_1_73-input-li\" >\n                    <label for=\"iphorm_1_73_69e766e812bdb_2\"  class=\"iphorm_1_73_2_label\">\n                        <input class=\"iphorm-element-radio iphorm_1_73 iphorm_1_73_2\" type=\"radio\" name=\"iphorm_1_73\" id=\"iphorm_1_73_69e766e812bdb_2\" value=\"No\" checked=\"checked\" \/>\n                        No                    <\/label>\n                <\/div>\n                        <\/div>\n                    <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n<\/div><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_1_72-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-required\" >\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_1_72-element-spacer\">\n        <label for=\"iphorm_1_72_69e766e812bdb\" class=\"iphorm_1_72-outer-label\" style='font-weight: bold;font-size: 0.9em;text-transform: uppercase;color: rgb(51, 51, 51) !important;'>Contact Email Address<span class=\"iphorm-required\">[*]<\/span><\/label>        <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_1_72-input-wrap\" >\n            <input class=\"iphorm-element-text  iphorm_1_72\" id=\"iphorm_1_72_69e766e812bdb\" type=\"email\" name=\"iphorm_1_72\"  value=\"\" style='width: 100%;' \/>\n                    <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n    <\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-2cols\"><\/div><\/div><\/div><div class=\"iphorm-group-wrap iphorm_1_3-group-wrap iphorm-clearfix iphorm-labels-above iphorm-group-style-bordered iphorm-group-alignment-proportional\" >\n    <div class=\"iphorm-group-elements\" >\n                \t<div class=\"iphorm-group-title-description-wrap iphorm-clearfix\">\n    \t\t\t                <div class=\"iphorm-group-title\" style='font-weight: bold;text-transform: uppercase;'>\/\/ Company Details<\/div>\n                                            <\/div>\n                <div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-2cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_1_1-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-required\" >\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_1_1-element-spacer\">\n        <label for=\"iphorm_1_1_69e766e812bdb\" class=\"iphorm_1_1-outer-label\" style='font-weight: bold;font-size: 0.9em;text-transform: uppercase;color: rgb(51, 51, 51) !important;'>Company Name<span class=\"iphorm-required\">[*]<\/span><\/label>        <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_1_1-input-wrap\" >\n            <input class=\"iphorm-element-text  iphorm_1_1\" id=\"iphorm_1_1_69e766e812bdb\" type=\"text\" name=\"iphorm_1_1\"  value=\"\" placeholder=\"e.g. ACME Rentals\" style='width: 100%;' \/>\n                    <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n    <\/div><div class=\"iphorm-group-wrap iphorm_1_46-group-wrap iphorm-clearfix iphorm-labels-above iphorm-group-style-plain iphorm-group-alignment-proportional\" >\n    <div class=\"iphorm-group-elements\" >\n                <div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-select iphorm_1_45-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-required\" >\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-select iphorm_1_45-element-spacer\">\n        <label for=\"iphorm_1_45_69e766e812bdb\" class=\"iphorm_1_45-outer-label\" style='font-weight: bold;font-size: 0.9em;text-transform: uppercase;color: rgb(51, 51, 51) !important;'>Branch<span class=\"iphorm-required\">[*]<\/span><\/label>        <div class=\"iphorm-input-wrap iphorm-input-wrap-select iphorm_1_45-input-wrap\" >\n            <select class=\"iphorm-element-select  iphorm_1_45\" name=\"iphorm_1_45\" id=\"iphorm_1_45_69e766e812bdb\"  style='width: 100%;'>\n                                    <option value=\"\" >Select Branch<\/option>\n                                    <option value=\"Auckland\" >Auckland<\/option>\n                                    <option value=\"AKL Airport\" >&gt; AKL Airport<\/option>\n                                    <option value=\"AKL Penrose\" >&gt; AKL Penrose<\/option>\n                                    <option value=\"AKL Penrose Workshop\" >&gt; AKL Penrose Workshop<\/option>\n                                    <option value=\"Christchurch\" >Christchurch<\/option>\n                                    <option value=\"Dunedin\" >Dunedin<\/option>\n                                    <option value=\"Hamilton\" >Hamilton<\/option>\n                                    <option value=\"Nelson\" >Nelson<\/option>\n                                    <option value=\"Queenstown\" >Queenstown<\/option>\n                                    <option value=\"Wellington\" >Wellington<\/option>\n                                    <option value=\"Other\" >Other<\/option>\n                            <\/select>\n                <p class=\"iphorm-description\" >Select 'Other' if your Branch is not listed above<\/p>\n        <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n<\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_1_48-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-required\" >\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_1_48-element-spacer\">\n        <label for=\"iphorm_1_48_69e766e812bdb\" class=\"iphorm_1_48-outer-label\" style='font-weight: bold;font-size: 0.9em;text-transform: uppercase;color: rgb(51, 51, 51) !important;'>Branch (Other)<span class=\"iphorm-required\">[*]<\/span><\/label>        <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_1_48-input-wrap\" >\n            <input class=\"iphorm-element-text  iphorm_1_48\" id=\"iphorm_1_48_69e766e812bdb\" type=\"text\" name=\"iphorm_1_48\"  value=\"\" placeholder=\"e.g. Tauranga\" style='width: 100%;' \/>\n                    <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n    <\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><\/div><\/div><\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-2cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_1_61-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-required\" >\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_1_61-element-spacer\">\n        <label for=\"iphorm_1_61_69e766e812bdb\" class=\"iphorm_1_61-outer-label\" style='font-weight: bold;font-size: 0.9em;text-transform: uppercase;color: rgb(51, 51, 51) !important;'>Contact Name<span class=\"iphorm-required\">[*]<\/span><\/label>        <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_1_61-input-wrap\" >\n            <input class=\"iphorm-element-text  iphorm_1_61\" id=\"iphorm_1_61_69e766e812bdb\" type=\"text\" name=\"iphorm_1_61\"  value=\"\" style='width: 100%;' \/>\n                    <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n    <\/div><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_1_62-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-required\" >\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_1_62-element-spacer\">\n        <label for=\"iphorm_1_62_69e766e812bdb\" class=\"iphorm_1_62-outer-label\" style='font-weight: bold;font-size: 0.9em;text-transform: uppercase;color: rgb(51, 51, 51) !important;'>Contact Mobile or Landline Number<span class=\"iphorm-required\">[*]<\/span><\/label>        <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_1_62-input-wrap\" >\n            <input class=\"iphorm-element-text  iphorm_1_62\" id=\"iphorm_1_62_69e766e812bdb\" type=\"text\" name=\"iphorm_1_62\"  value=\"\" style='width: 100%;' \/>\n                    <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n    <\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-2cols\"><\/div><\/div><\/div><div class=\"iphorm-group-wrap iphorm_1_5-group-wrap iphorm-clearfix iphorm-labels-above iphorm-group-style-bordered iphorm-group-alignment-proportional\" >\n    <div class=\"iphorm-group-elements\" >\n                \t<div class=\"iphorm-group-title-description-wrap iphorm-clearfix\">\n    \t\t\t                <div class=\"iphorm-group-title\" style='font-weight: bold;text-transform: uppercase;'>\/\/ Vehicle Details<\/div>\n                                            <\/div>\n                <div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-2cols\"><div class=\"iphorm-group-wrap iphorm_1_36-group-wrap iphorm-clearfix iphorm-labels-above iphorm-group-style-plain iphorm-group-alignment-proportional\" >\n    <div class=\"iphorm-group-elements\" >\n                <div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-select iphorm_1_35-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-required\" >\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-select iphorm_1_35-element-spacer\">\n        <label for=\"iphorm_1_35_69e766e812bdb\" class=\"iphorm_1_35-outer-label\" style='font-weight: bold;font-size: 0.9em;text-transform: uppercase;color: rgb(51, 51, 51) !important;'>Make<span class=\"iphorm-required\">[*]<\/span><\/label>        <div class=\"iphorm-input-wrap iphorm-input-wrap-select iphorm_1_35-input-wrap\" >\n            <select class=\"iphorm-element-select  iphorm_1_35\" name=\"iphorm_1_35\" id=\"iphorm_1_35_69e766e812bdb\"  style='width: 100%;'>\n                                    <option value=\"\" >Select Make<\/option>\n                                    <option value=\"Ford\" >Ford<\/option>\n                                    <option value=\"Holden\" >Holden<\/option>\n                                    <option value=\"Hyundai\" >Hyundai<\/option>\n                                    <option value=\"Mazda\" >Mazda<\/option>\n                                    <option value=\"Nissan\" >Nissan<\/option>\n                                    <option value=\"Toyota\" >Toyota<\/option>\n                                    <option value=\"Other\" >Other<\/option>\n                            <\/select>\n                <p class=\"iphorm-description\" >Select 'Other' if your Make is not listed above<\/p>\n        <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n<\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_1_7-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-required\" >\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_1_7-element-spacer\">\n        <label for=\"iphorm_1_7_69e766e812bdb\" class=\"iphorm_1_7-outer-label\" style='font-weight: bold;font-size: 0.9em;text-transform: uppercase;color: rgb(51, 51, 51) !important;'>Make (Other)<span class=\"iphorm-required\">[*]<\/span><\/label>        <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_1_7-input-wrap\" >\n            <input class=\"iphorm-element-text  iphorm_1_7\" id=\"iphorm_1_7_69e766e812bdb\" type=\"text\" name=\"iphorm_1_7\"  value=\"\" placeholder=\"e.g. Subaru\" style='width: 100%;' \/>\n                    <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n    <\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><\/div><\/div><\/div><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_1_8-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-required\" >\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_1_8-element-spacer\">\n        <label for=\"iphorm_1_8_69e766e812bdb\" class=\"iphorm_1_8-outer-label\" style='font-weight: bold;font-size: 0.9em;text-transform: uppercase;color: rgb(51, 51, 51) !important;'>Model<span class=\"iphorm-required\">[*]<\/span><\/label>        <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_1_8-input-wrap\" >\n            <input class=\"iphorm-element-text  iphorm_1_8\" id=\"iphorm_1_8_69e766e812bdb\" type=\"text\" name=\"iphorm_1_8\"  value=\"\" placeholder=\"e.g. Corolla\" style='width: 100%;' \/>\n                    <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n    <\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-2cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-select iphorm_1_38-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-required\" >\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-select iphorm_1_38-element-spacer\">\n        <label for=\"iphorm_1_38_69e766e812bdb\" class=\"iphorm_1_38-outer-label\" style='font-weight: bold;font-size: 0.9em;text-transform: uppercase;color: rgb(51, 51, 51) !important;'>Year<span class=\"iphorm-required\">[*]<\/span><\/label>        <div class=\"iphorm-input-wrap iphorm-input-wrap-select iphorm_1_38-input-wrap\" >\n            <select class=\"iphorm-element-select  iphorm_1_38\" name=\"iphorm_1_38\" id=\"iphorm_1_38_69e766e812bdb\"  style='width: 100%;'>\n                                    <option value=\"\" >Select Year<\/option>\n                                    <option value=\"2026\" >2026<\/option>\n                                    <option value=\"2025\" >2025<\/option>\n                                    <option value=\"2024\" >2024<\/option>\n                                    <option value=\"2023\" >2023<\/option>\n                                    <option value=\"2022\" >2022<\/option>\n                                    <option value=\"2021\" >2021<\/option>\n                                    <option value=\"2020\" >2020<\/option>\n                                    <option value=\"2019\" >2019<\/option>\n                                    <option value=\"2018\" >2018<\/option>\n                                    <option value=\"2017\" >2017<\/option>\n                                    <option value=\"2016\" >2016<\/option>\n                                    <option value=\"2015\" >2015<\/option>\n                                    <option value=\"2014\" >2014<\/option>\n                                    <option value=\"2013\" >2013<\/option>\n                                    <option value=\"2012\" >2012<\/option>\n                                    <option value=\"2011\" >2011<\/option>\n                                    <option value=\"2010\" >2010<\/option>\n                                    <option value=\"2009\" >2009<\/option>\n                                    <option value=\"2008\" >2008<\/option>\n                                    <option value=\"2007\" >2007<\/option>\n                                    <option value=\"2006\" >2006<\/option>\n                                    <option value=\"2005\" >2005<\/option>\n                                    <option value=\"2004\" >2004<\/option>\n                                    <option value=\"2003\" >2003<\/option>\n                                    <option value=\"2002\" >2002<\/option>\n                                    <option value=\"2001\" >2001<\/option>\n                                    <option value=\"2000\" >2000<\/option>\n                                    <option value=\"1999\" >1999<\/option>\n                                    <option value=\"1998\" >1998<\/option>\n                                    <option value=\"1997\" >1997<\/option>\n                                    <option value=\"1996\" >1996<\/option>\n                                    <option value=\"1995\" >1995<\/option>\n                            <\/select>\n                    <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n<\/div><div class=\"iphorm-group-wrap iphorm_1_21-group-wrap iphorm-clearfix iphorm-labels-above iphorm-group-style-plain iphorm-group-alignment-proportional\" >\n    <div class=\"iphorm-group-elements\" >\n                <div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-select iphorm_1_10-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-required\" >\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-select iphorm_1_10-element-spacer\">\n        <label for=\"iphorm_1_10_69e766e812bdb\" class=\"iphorm_1_10-outer-label\" style='font-weight: bold;font-size: 0.9em;text-transform: uppercase;color: rgb(51, 51, 51) !important;'>Body Style<span class=\"iphorm-required\">[*]<\/span><\/label>        <div class=\"iphorm-input-wrap iphorm-input-wrap-select iphorm_1_10-input-wrap\" >\n            <select class=\"iphorm-element-select  iphorm_1_10\" name=\"iphorm_1_10\" id=\"iphorm_1_10_69e766e812bdb\"  style='width: 100%;'>\n                                    <option value=\"\" >Select Body Style<\/option>\n                                    <option value=\"4-Door Sedan\" >4-Door Sedan<\/option>\n                                    <option value=\"5-Door Hatch\" >5-Door Hatch<\/option>\n                                    <option value=\"5-Door Wagon\" >5-Door Wagon<\/option>\n                                    <option value=\"Other\" >Other<\/option>\n                            <\/select>\n                <p class=\"iphorm-description\" >Select 'Other' if your Body Style is not listed above<\/p>\n        <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n<\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_1_20-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-required\" >\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_1_20-element-spacer\">\n        <label for=\"iphorm_1_20_69e766e812bdb\" class=\"iphorm_1_20-outer-label\" style='font-weight: bold;font-size: 0.9em;text-transform: uppercase;color: rgb(51, 51, 51) !important;'>Body Style (Other)<span class=\"iphorm-required\">[*]<\/span><\/label>        <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_1_20-input-wrap\" >\n            <input class=\"iphorm-element-text  iphorm_1_20\" id=\"iphorm_1_20_69e766e812bdb\" type=\"text\" name=\"iphorm_1_20\"  value=\"\" placeholder=\"e.g. 2-Door Coupe\" style='width: 100%;' \/>\n                    <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n    <\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><\/div><\/div><\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-2cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_1_11-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-required\" >\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_1_11-element-spacer\">\n        <label for=\"iphorm_1_11_69e766e812bdb\" class=\"iphorm_1_11-outer-label\" style='font-weight: bold;font-size: 0.9em;text-transform: uppercase;color: rgb(51, 51, 51) !important;'>Number Plate<span class=\"iphorm-required\">[*]<\/span><\/label>        <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_1_11-input-wrap\" >\n            <input class=\"iphorm-element-text  iphorm_1_11\" id=\"iphorm_1_11_69e766e812bdb\" type=\"text\" name=\"iphorm_1_11\"  value=\"\" style='width: 100%;' \/>\n                    <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n    <\/div><div class=\"iphorm-group-wrap iphorm_1_23-group-wrap iphorm-clearfix iphorm-labels-above iphorm-group-style-plain iphorm-group-alignment-proportional\" >\n    <div class=\"iphorm-group-elements\" >\n                <div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-select iphorm_1_12-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-required\" >\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-select iphorm_1_12-element-spacer\">\n        <label for=\"iphorm_1_12_69e766e812bdb\" class=\"iphorm_1_12-outer-label\" style='font-weight: bold;font-size: 0.9em;text-transform: uppercase;color: rgb(51, 51, 51) !important;'>Work Required<span class=\"iphorm-required\">[*]<\/span><\/label>        <div class=\"iphorm-input-wrap iphorm-input-wrap-select iphorm_1_12-input-wrap\" >\n            <select class=\"iphorm-element-select  iphorm_1_12\" name=\"iphorm_1_12\" id=\"iphorm_1_12_69e766e812bdb\"  style='width: 100%;'>\n                                    <option value=\"\" >Select Work Required<\/option>\n                                    <option value=\"Windscreen Repair\" >Windscreen Repair<\/option>\n                                    <option value=\"Windscreen Replacement\" selected=\"selected\">Windscreen Replacement<\/option>\n                                    <option value=\"Rearscreen Replacement\" >Rearscreen Replacement<\/option>\n                                    <option value=\"Side \/ Door Glass Replacement\" >Side \/ Door Glass Replacement<\/option>\n                                    <option value=\"Other\" >Other<\/option>\n                            <\/select>\n                <p class=\"iphorm-description\" >Select 'Other' if your Work Required is not listed above<\/p>\n        <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n<\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-textarea iphorm_1_57-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-required\" >\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-textarea iphorm_1_57-element-spacer\">\n        <label for=\"iphorm_1_57_69e766e812bdb\" class=\"iphorm_1_57-outer-label\" style='font-weight: bold;font-size: 0.9em;text-transform: uppercase;color: rgb(51, 51, 51) !important;'>Work Required (Other)<span class=\"iphorm-required\">[*]<\/span><\/label>        <div class=\"iphorm-input-wrap iphorm-input-wrap-textarea iphorm_1_57-input-wrap\" >\n            <textarea class=\"iphorm-element-textarea  iphorm_1_57\" id=\"iphorm_1_57_69e766e812bdb\" name=\"iphorm_1_57\"  style='width: 100%;' rows=\"5\" cols=\"25\" placeholder=\"e.g. Wing Mirror Glass\"><\/textarea>\n                <p class=\"iphorm-description\" >Specify the Work Required above<\/p>\n        <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n    <\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><\/div><\/div><\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-2cols\"><\/div><\/div><\/div><div class=\"iphorm-group-wrap iphorm_1_33-group-wrap iphorm-clearfix iphorm-labels-above iphorm-group-style-bordered iphorm-group-alignment-proportional\" >\n    <div class=\"iphorm-group-elements\" >\n                \t<div class=\"iphorm-group-title-description-wrap iphorm-clearfix\">\n    \t\t\t                <div class=\"iphorm-group-title\" style='font-weight: bold;text-transform: uppercase;'>\/\/ Windscreen Feature(s)<\/div>\n                                            <\/div>\n                <div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-checkbox iphorm_1_32-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-optional\" >\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-checkbox iphorm_1_32-element-spacer\">\n                <div class=\"iphorm-input-wrap iphorm-input-wrap-checkbox iphorm_1_32-input-wrap\" >\n            <div class=\"iphorm-input-ul iphorm-input-checkbox-ul iphorm_1_32-input-ul iphorm-options-block iphorm-clearfix\" >\n                            <div class=\"iphorm-input-li iphorm-input-checkbox-li iphorm_1_32-input-li\" >\n                    <label for=\"iphorm_1_32_69e766e812bdb_1\"  class=\"iphorm_1_32_1_label\">\n                        <input class=\"iphorm-element-checkbox iphorm_1_32 iphorm_1_32_1\" type=\"checkbox\" name=\"iphorm_1_32[]\" id=\"iphorm_1_32_69e766e812bdb_1\" value=\"Rain sensor\"  \/>\n                        Rain sensor                    <\/label>\n                <\/div>\n                            <div class=\"iphorm-input-li iphorm-input-checkbox-li iphorm_1_32-input-li\" >\n                    <label for=\"iphorm_1_32_69e766e812bdb_2\"  class=\"iphorm_1_32_2_label\">\n                        <input class=\"iphorm-element-checkbox iphorm_1_32 iphorm_1_32_2\" type=\"checkbox\" name=\"iphorm_1_32[]\" id=\"iphorm_1_32_69e766e812bdb_2\" value=\"Camera (Lane change warning system)\"  \/>\n                        Camera (Lane change warning system)                    <\/label>\n                <\/div>\n                            <div class=\"iphorm-input-li iphorm-input-checkbox-li iphorm_1_32-input-li\" >\n                    <label for=\"iphorm_1_32_69e766e812bdb_3\"  class=\"iphorm_1_32_3_label\">\n                        <input class=\"iphorm-element-checkbox iphorm_1_32 iphorm_1_32_3\" type=\"checkbox\" name=\"iphorm_1_32[]\" id=\"iphorm_1_32_69e766e812bdb_3\" value=\"Heated wiper area\"  \/>\n                        Heated wiper area                    <\/label>\n                <\/div>\n                            <div class=\"iphorm-input-li iphorm-input-checkbox-li iphorm_1_32-input-li\" >\n                    <label for=\"iphorm_1_32_69e766e812bdb_4\"  class=\"iphorm_1_32_4_label\">\n                        <input class=\"iphorm-element-checkbox iphorm_1_32 iphorm_1_32_4\" type=\"checkbox\" name=\"iphorm_1_32[]\" id=\"iphorm_1_32_69e766e812bdb_4\" value=\"Windscreen antenna (Radio and\/or GPS)\"  \/>\n                        Windscreen antenna (Radio and\/or GPS)                    <\/label>\n                <\/div>\n                            <div class=\"iphorm-input-li iphorm-input-checkbox-li iphorm_1_32-input-li\" >\n                    <label for=\"iphorm_1_32_69e766e812bdb_5\"  class=\"iphorm_1_32_5_label\">\n                        <input class=\"iphorm-element-checkbox iphorm_1_32 iphorm_1_32_5\" type=\"checkbox\" name=\"iphorm_1_32[]\" id=\"iphorm_1_32_69e766e812bdb_5\" value=\"HUD (Heads-up Display)\"  \/>\n                        HUD (Heads-up Display)                    <\/label>\n                <\/div>\n                        <\/div>\n                <p class=\"iphorm-description\" >Check all that apply above<\/p>\n        <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n<\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-checkbox iphorm_1_64-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-required\" >\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-checkbox iphorm_1_64-element-spacer\">\n                <div class=\"iphorm-input-wrap iphorm-input-wrap-checkbox iphorm_1_64-input-wrap\" >\n            <div class=\"iphorm-input-ul iphorm-input-checkbox-ul iphorm_1_64-input-ul iphorm-options-block iphorm-clearfix\" >\n                            <div class=\"iphorm-input-li iphorm-input-checkbox-li iphorm_1_64-input-li\" >\n                    <label for=\"iphorm_1_64_69e766e812bdb_1\"  class=\"iphorm_1_64_1_label\">\n                        <input class=\"iphorm-element-checkbox iphorm_1_64 iphorm_1_64_1\" type=\"checkbox\" name=\"iphorm_1_64[]\" id=\"iphorm_1_64_69e766e812bdb_1\" value=\"I have ensured that the information I have supplied in the windscreen features section is accurate\"  \/>\n                        I have ensured that the information I have supplied in the windscreen features section is accurate                    <\/label>\n                <\/div>\n                        <\/div>\n                    <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n<\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><\/div><\/div><\/div><div class=\"iphorm-group-wrap iphorm_1_74-group-wrap iphorm-clearfix iphorm-labels-above iphorm-group-style-bordered iphorm-group-alignment-proportional\" >\n    <div class=\"iphorm-group-elements\" >\n                \t<div class=\"iphorm-group-title-description-wrap iphorm-clearfix\">\n    \t\t\t                <div class=\"iphorm-group-title\" style='font-weight: bold;text-transform: uppercase;'>\/\/ Camera Recalibration<\/div>\n                                            <\/div>\n                <div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-radio iphorm_1_76-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-optional\" >\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-radio iphorm_1_76-element-spacer\">\n        <label class=\"iphorm_1_76-outer-label\" style='font-weight: bold;font-size: 0.9em;text-transform: uppercase;color: rgb(51, 51, 51) !important;'>Do you want the windscreen camera recalibrated?<\/label>        <div class=\"iphorm-input-wrap iphorm-input-wrap-radio iphorm_1_76-input-wrap\" >\n            <div class=\"iphorm-input-ul iphorm-input-radio-ul iphorm_1_76-input-radio-ul iphorm-options-inline iphorm-clearfix\" >\n                            <div class=\"iphorm-input-li iphorm-input-radio-li iphorm_1_76-input-li\" >\n                    <label for=\"iphorm_1_76_69e766e812bdb_1\"  class=\"iphorm_1_76_1_label\">\n                        <input class=\"iphorm-element-radio iphorm_1_76 iphorm_1_76_1\" type=\"radio\" name=\"iphorm_1_76\" id=\"iphorm_1_76_69e766e812bdb_1\" value=\"Yes (Recommended)\"  \/>\n                        Yes (Recommended)                    <\/label>\n                <\/div>\n                            <div class=\"iphorm-input-li iphorm-input-radio-li iphorm_1_76-input-li\" >\n                    <label for=\"iphorm_1_76_69e766e812bdb_2\"  class=\"iphorm_1_76_2_label\">\n                        <input class=\"iphorm-element-radio iphorm_1_76 iphorm_1_76_2\" type=\"radio\" name=\"iphorm_1_76\" id=\"iphorm_1_76_69e766e812bdb_2\" value=\"No\" checked=\"checked\" \/>\n                        No                    <\/label>\n                <\/div>\n                        <\/div>\n                    <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n<\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><\/div><\/div><\/div><div class=\"iphorm-group-wrap iphorm_1_58-group-wrap iphorm-clearfix iphorm-labels-above iphorm-group-style-bordered iphorm-group-alignment-proportional\" >\n    <div class=\"iphorm-group-elements\" >\n                \t<div class=\"iphorm-group-title-description-wrap iphorm-clearfix\">\n    \t\t\t                <div class=\"iphorm-group-title\" style='font-weight: bold;text-transform: uppercase;'>\/\/ Side \/ Door Glass Part(s)<\/div>\n                                            <\/div>\n                <div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-checkbox iphorm_1_60-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-required\" >\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-checkbox iphorm_1_60-element-spacer\">\n                <div class=\"iphorm-input-wrap iphorm-input-wrap-checkbox iphorm_1_60-input-wrap\" >\n            <div class=\"iphorm-input-ul iphorm-input-checkbox-ul iphorm_1_60-input-ul iphorm-options-inline iphorm-clearfix\" >\n                            <div class=\"iphorm-input-li iphorm-input-checkbox-li iphorm_1_60-input-li\" >\n                    <label for=\"iphorm_1_60_69e766e812bdb_1\"  class=\"iphorm_1_60_1_label\">\n                        <input class=\"iphorm-element-checkbox iphorm_1_60 iphorm_1_60_1\" type=\"checkbox\" name=\"iphorm_1_60[]\" id=\"iphorm_1_60_69e766e812bdb_1\" value=\"Driver's Side Front Door Glass\"  \/>\n                        Driver's Side Front Door Glass                    <\/label>\n                <\/div>\n                            <div class=\"iphorm-input-li iphorm-input-checkbox-li iphorm_1_60-input-li\" >\n                    <label for=\"iphorm_1_60_69e766e812bdb_2\"  class=\"iphorm_1_60_2_label\">\n                        <input class=\"iphorm-element-checkbox iphorm_1_60 iphorm_1_60_2\" type=\"checkbox\" name=\"iphorm_1_60[]\" id=\"iphorm_1_60_69e766e812bdb_2\" value=\"Driver's Side \u00bc Glass in Front\"  \/>\n                        Driver's Side \u00bc Glass in Front                    <\/label>\n                <\/div>\n                            <div class=\"iphorm-input-li iphorm-input-checkbox-li iphorm_1_60-input-li\" >\n                    <label for=\"iphorm_1_60_69e766e812bdb_3\"  class=\"iphorm_1_60_3_label\">\n                        <input class=\"iphorm-element-checkbox iphorm_1_60 iphorm_1_60_3\" type=\"checkbox\" name=\"iphorm_1_60[]\" id=\"iphorm_1_60_69e766e812bdb_3\" value=\"Driver's Side Rear Door Glass\"  \/>\n                        Driver's Side Rear Door Glass                    <\/label>\n                <\/div>\n                            <div class=\"iphorm-input-li iphorm-input-checkbox-li iphorm_1_60-input-li\" >\n                    <label for=\"iphorm_1_60_69e766e812bdb_4\"  class=\"iphorm_1_60_4_label\">\n                        <input class=\"iphorm-element-checkbox iphorm_1_60 iphorm_1_60_4\" type=\"checkbox\" name=\"iphorm_1_60[]\" id=\"iphorm_1_60_69e766e812bdb_4\" value=\"Driver's Side \u00bc Glass in Rear Door\"  \/>\n                        Driver's Side \u00bc Glass in Rear Door                    <\/label>\n                <\/div>\n                            <div class=\"iphorm-input-li iphorm-input-checkbox-li iphorm_1_60-input-li\" >\n                    <label for=\"iphorm_1_60_69e766e812bdb_5\"  class=\"iphorm_1_60_5_label\">\n                        <input class=\"iphorm-element-checkbox iphorm_1_60 iphorm_1_60_5\" type=\"checkbox\" name=\"iphorm_1_60[]\" id=\"iphorm_1_60_69e766e812bdb_5\" value=\"Driver's Side Rear \u00bc Glass in Body\"  \/>\n                        Driver's Side Rear \u00bc Glass in Body                    <\/label>\n                <\/div>\n                            <div class=\"iphorm-input-li iphorm-input-checkbox-li iphorm_1_60-input-li\" >\n                    <label for=\"iphorm_1_60_69e766e812bdb_6\"  class=\"iphorm_1_60_6_label\">\n                        <input class=\"iphorm-element-checkbox iphorm_1_60 iphorm_1_60_6\" type=\"checkbox\" name=\"iphorm_1_60[]\" id=\"iphorm_1_60_69e766e812bdb_6\" value=\"Passenger's Side Front Door Glass\"  \/>\n                        Passenger's Side Front Door Glass                    <\/label>\n                <\/div>\n                            <div class=\"iphorm-input-li iphorm-input-checkbox-li iphorm_1_60-input-li\" >\n                    <label for=\"iphorm_1_60_69e766e812bdb_7\"  class=\"iphorm_1_60_7_label\">\n                        <input class=\"iphorm-element-checkbox iphorm_1_60 iphorm_1_60_7\" type=\"checkbox\" name=\"iphorm_1_60[]\" id=\"iphorm_1_60_69e766e812bdb_7\" value=\"Passenger's Side \u00bc Glass in Front\"  \/>\n                        Passenger's Side \u00bc Glass in Front                    <\/label>\n                <\/div>\n                            <div class=\"iphorm-input-li iphorm-input-checkbox-li iphorm_1_60-input-li\" >\n                    <label for=\"iphorm_1_60_69e766e812bdb_8\"  class=\"iphorm_1_60_8_label\">\n                        <input class=\"iphorm-element-checkbox iphorm_1_60 iphorm_1_60_8\" type=\"checkbox\" name=\"iphorm_1_60[]\" id=\"iphorm_1_60_69e766e812bdb_8\" value=\"Passenger's Side Rear Door Glass\"  \/>\n                        Passenger's Side Rear Door Glass                    <\/label>\n                <\/div>\n                            <div class=\"iphorm-input-li iphorm-input-checkbox-li iphorm_1_60-input-li\" >\n                    <label for=\"iphorm_1_60_69e766e812bdb_9\"  class=\"iphorm_1_60_9_label\">\n                        <input class=\"iphorm-element-checkbox iphorm_1_60 iphorm_1_60_9\" type=\"checkbox\" name=\"iphorm_1_60[]\" id=\"iphorm_1_60_69e766e812bdb_9\" value=\"Passenger's Side \u00bc Glass in Rear Door\"  \/>\n                        Passenger's Side \u00bc Glass in Rear Door                    <\/label>\n                <\/div>\n                            <div class=\"iphorm-input-li iphorm-input-checkbox-li iphorm_1_60-input-li\" >\n                    <label for=\"iphorm_1_60_69e766e812bdb_10\"  class=\"iphorm_1_60_10_label\">\n                        <input class=\"iphorm-element-checkbox iphorm_1_60 iphorm_1_60_10\" type=\"checkbox\" name=\"iphorm_1_60[]\" id=\"iphorm_1_60_69e766e812bdb_10\" value=\"Passenger's Side Rear \u00bc Glass in Body\"  \/>\n                        Passenger's Side Rear \u00bc Glass in Body                    <\/label>\n                <\/div>\n                        <\/div>\n                <p class=\"iphorm-description\" >Check all that apply above<\/p>\n        <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n<\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><\/div><\/div><\/div><div class=\"iphorm-group-wrap iphorm_1_52-group-wrap iphorm-clearfix iphorm-labels-above iphorm-group-style-bordered iphorm-group-alignment-proportional\" >\n    <div class=\"iphorm-group-elements\" >\n                \t<div class=\"iphorm-group-title-description-wrap iphorm-clearfix\">\n    \t\t\t                <div class=\"iphorm-group-title\" style='font-weight: bold;text-transform: uppercase;'>\/\/ Side \/ Door Glass Feature(s)<\/div>\n                                            <\/div>\n                <div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-checkbox iphorm_1_56-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-optional\" >\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-checkbox iphorm_1_56-element-spacer\">\n                <div class=\"iphorm-input-wrap iphorm-input-wrap-checkbox iphorm_1_56-input-wrap\" >\n            <div class=\"iphorm-input-ul iphorm-input-checkbox-ul iphorm_1_56-input-ul iphorm-options-block iphorm-clearfix\" >\n                            <div class=\"iphorm-input-li iphorm-input-checkbox-li iphorm_1_56-input-li\" >\n                    <label for=\"iphorm_1_56_69e766e812bdb_1\"  class=\"iphorm_1_56_1_label\">\n                        <input class=\"iphorm-element-checkbox iphorm_1_56 iphorm_1_56_1\" type=\"checkbox\" name=\"iphorm_1_56[]\" id=\"iphorm_1_56_69e766e812bdb_1\" value=\"Privacy tinted\"  \/>\n                        Privacy tinted                    <\/label>\n                <\/div>\n                        <\/div>\n                <p class=\"iphorm-description\" >Check all that apply above<\/p>\n        <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n<\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><\/div><\/div><\/div><div class=\"iphorm-group-wrap iphorm_1_68-group-wrap iphorm-clearfix iphorm-labels-above iphorm-group-style-bordered iphorm-group-alignment-proportional\" >\n    <div class=\"iphorm-group-elements\" >\n                \t<div class=\"iphorm-group-title-description-wrap iphorm-clearfix\">\n    \t\t\t                <div class=\"iphorm-group-title\" style='font-weight: bold;text-transform: uppercase;'>\/\/ Rearscreen Feature(s)<\/div>\n                                            <\/div>\n                <div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-checkbox iphorm_1_70-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-optional\" >\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-checkbox iphorm_1_70-element-spacer\">\n                <div class=\"iphorm-input-wrap iphorm-input-wrap-checkbox iphorm_1_70-input-wrap\" >\n            <div class=\"iphorm-input-ul iphorm-input-checkbox-ul iphorm_1_70-input-ul iphorm-options-block iphorm-clearfix\" >\n                            <div class=\"iphorm-input-li iphorm-input-checkbox-li iphorm_1_70-input-li\" >\n                    <label for=\"iphorm_1_70_69e766e812bdb_1\"  class=\"iphorm_1_70_1_label\">\n                        <input class=\"iphorm-element-checkbox iphorm_1_70 iphorm_1_70_1\" type=\"checkbox\" name=\"iphorm_1_70[]\" id=\"iphorm_1_70_69e766e812bdb_1\" value=\"Privacy tinted\"  \/>\n                        Privacy tinted                    <\/label>\n                <\/div>\n                        <\/div>\n                <p class=\"iphorm-description\" >Check all that apply above<\/p>\n        <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n<\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><\/div><\/div><\/div><div class=\"iphorm-group-wrap iphorm_1_65-group-wrap iphorm-clearfix iphorm-labels-above iphorm-group-style-bordered iphorm-group-alignment-proportional\" >\n    <div class=\"iphorm-group-elements\" >\n                \t<div class=\"iphorm-group-title-description-wrap iphorm-clearfix\">\n    \t\t\t                <div class=\"iphorm-group-title\" style='font-weight: bold;text-transform: uppercase;'>\/\/ Image Upload<\/div>\n                                            <\/div>\n                <div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-file iphorm_1_67-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-optional\" >\r\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-file iphorm_1_67-element-spacer\">\r\n        <label for=\"iphorm_1_67_69e766e812bdb\" class=\"iphorm_1_67-outer-label\" style='font-weight: bold;font-size: 0.9em;text-transform: uppercase;color: rgb(51, 51, 51) !important;'>Upload an image of the glass that needs to be repaired or replaced<\/label>        <div class=\"iphorm-input-outer-wrap iphorm_1_67-input-outer-wrap\" >\r\n                            <div class=\"iphorm-input-wrap iphorm-input-wrap-file iphorm-clearfix iphorm_1_67-input-wrap\" >\r\n                    <span class=\"iphorm-element-file-inner\"><input id=\"iphorm_1_67_69e766e812bdb\" class=\"iphorm-element-file  iphorm_1_67\" type=\"file\" name=\"iphorm_1_67\"  \/><\/span>\r\n                <\/div>\r\n                                    <script type=\"text\/javascript\">\r\n            jQuery(document).ready(function ($) {\r\n              \t$('.iphorm_1_67-input-wrap', iPhorm.instance.$form).show();\r\n            });\r\n            <\/script>\r\n                            <div id=\"iphorm_1_67_69e766e812bdb-swfupload\" class=\"iphorm-swfupload\">\r\n                \t<div class=\"iphorm-clearfix\">\r\n                        <div id=\"iphorm_1_67_69e766e812bdb-file-queue\" class=\"iphorm-file-queue iphorm-clearfix\"><\/div>\r\n                        <div id=\"iphorm_1_67_69e766e812bdb-file-queue-errors\" class=\"iphorm-queue-errors iphorm-hidden\"><\/div>\r\n                        <div class=\"iphorm-swfupload-browse-wrap iphorm-clearfix\">\r\n                            <div class=\"iphorm-swfupload-browse\" id=\"iphorm_1_67_69e766e812bdb-browse\">\r\n                                <span class=\"iphorm-upload-browse-text\">Browse...<\/span>\r\n                                <input id=\"iphorm_1_67_69e766e812bdb-enhanced\" class=\"iphorm-upload-enhanced iphorm_1_67\" type=\"file\" \/>\r\n                            <\/div>\r\n                        <\/div>\r\n                    <\/div>\r\n                <\/div>\r\n                <script type=\"text\/javascript\">\r\n                jQuery(document).ready(function ($) {\r\n                    iPhorm.instance.addUploader({\r\n                        id: 67,\r\n                        name: 'iphorm_1_67',\r\n                        uniqueId: 'iphorm_1_67_69e766e812bdb',\r\n                        allowedExtensions: [\"jpg\",\"jpeg\",\"png\",\"gif\",\"heic\"],\r\n                        fileSizeLimit : 10485760,\r\n                        fileUploadLimit : 1                    });\r\n                });\r\n                <\/script>\r\n                            <p class=\"iphorm-description\" >Maximum filesize of 10 MB<\/p>\n        <\/div>\r\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\r\n<\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-1cols\"><\/div><\/div><\/div><div class=\"iphorm-group-wrap iphorm_1_13-group-wrap iphorm-clearfix iphorm-labels-above iphorm-group-style-bordered iphorm-group-alignment-proportional\" >\n    <div class=\"iphorm-group-elements\" >\n                <div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-2cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-textarea iphorm_1_15-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-optional\" >\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-textarea iphorm_1_15-element-spacer\">\n        <label for=\"iphorm_1_15_69e766e812bdb\" class=\"iphorm_1_15-outer-label\" style='font-weight: bold;font-size: 0.9em;text-transform: uppercase;color: rgb(51, 51, 51) !important;'>Comments \/ Information<\/label>        <div class=\"iphorm-input-wrap iphorm-input-wrap-textarea iphorm_1_15-input-wrap\" >\n            <textarea class=\"iphorm-element-textarea  iphorm_1_15\" id=\"iphorm_1_15_69e766e812bdb\" name=\"iphorm_1_15\"  style='width: 100%;' rows=\"5\" cols=\"25\" placeholder=\"Optional\"><\/textarea>\n                    <\/div>\n        <div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\n    <\/div>    <\/div>\n    <\/div><\/div><\/div><\/div><div class=\"iphorm-hidden\">\n    <label>This field should be left blank<input type=\"text\" name=\"iphorm_1_0\" \/><\/label>\n<\/div>                <div class=\"iphorm-submit-wrap iphorm-submit-wrap-1 iphorm-clearfix\" >\n                    <div class=\"iphorm-submit-input-wrap iphorm-submit-input-wrap-1\" >\n                        <button class=\"iphorm-submit-element\" type=\"submit\" name=\"iphorm_submit\" ><span ><em >Send Job Request<\/em><\/span><\/button>\n                    <\/div>\n                    <div class=\"iphorm-loading-wrap\"><span class=\"iphorm-loading\">Please wait...<\/span><\/div>\n                <\/div>\n            <\/div>\n                                        <div class=\"iphom-upload-progress-wrap\">\n                    <div class=\"iphorm-upload-progress-bar-wrap\">\n                        <div class=\"iphorm-upload-progress-bar\"><\/div>\n                    <\/div>\n                    <div class=\"iphorm-upload-info iphorm-clearfix\">\n                        <div class=\"iphorm-upload-filename\"><\/div>\n                        <div class=\"iphorm-upload-error\"><\/div>\n                    <\/div>\n                <\/div>\n                                                            <div class=\"iphorm-success-message iphorm-hidden\" ><\/div>\n                                    <\/div>\n            <\/form>\n    <script type=\"text\/javascript\">\n    jQuery('#iphorm-outer-69e766e812bdb script').remove();\n    <\/script>\n<\/div>\n<\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/section>\n","protected":false},"excerpt":{"rendered":"This form is intended for use by ACCURATE AUTO GLASS account holders only. [*] Denotes a required field. JOB REQUEST \/\/ Job Details Order #[*] Job Priority[*] Select Job Priority At earliest convenience ASAP (genuinely urgent request) Do You Want To Be Notified When The Job Will Be Done? Yes No Contact Email Address[*] \/\/...","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-5091","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Job Request - Accurate Auto Glass<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.accurateautoglass.co.nz\/aag\/job-request\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Job Request - Accurate Auto Glass\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.accurateautoglass.co.nz\/aag\/job-request\/\" \/>\n<meta property=\"og:site_name\" content=\"Accurate Auto Glass\" \/>\n<meta property=\"article:modified_time\" content=\"2021-04-19T02:16:05+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/www.accurateautoglass.co.nz\\\/aag\\\/job-request\\\/\",\"url\":\"https:\\\/\\\/www.accurateautoglass.co.nz\\\/aag\\\/job-request\\\/\",\"name\":\"Job Request - 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