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https://www.seepex.com/en/modals/request-a-quote
Submission: On September 18 via api from GB — Scanned from GB
Submission: On September 18 via api from GB — Scanned from GB
Form analysis 1 forms found in the DOM
Name: d088b4fe —
<form v-on:submit.prevent="submitHandler" class="NewForm ng-pristine ng-valid" name="d088b4fe" id="form">
<div class="modal-content GDForm-2020__Modal">
<div class="modal-header GDForm-2020__Modal__Header">
<h2 class="brandcolor GDForm-2020__Title" style="margin-top: 0px"> Get your Quote. </h2>
<p class="GDForm-2020__Subtitle">Please complete the form below to request your quote. We will be in contact as soon as possible.</p>
</div>
<div id="thankYouModal" class="modal">
<div class="thankYouModalContent fade in">
<div class="modal-dialog modal-lg">
<div style="text-align: center">
<p id="thankYouModalImage"></p>
<h1>Thank You!</h1>
<p>Thank you for submitting this form.</p>
</div>
</div>
</div>
</div>
<div class="modal-body white">
<div id="elements" style="padding: 0 15px;">
<!-- All elements will be rendered here -->
<div class="firstname"> <label style="vertical-align:top">First Name</label><input class="input formfield GDForm-2020__Input" type="text" id="firstname" name="d68cbbf202" placeholder="Required" value="" data-order="" required=""></div>
<div class="lastname"> <label style="vertical-align:top">Last Name</label><input class="input formfield GDForm-2020__Input" type="text" id="lastname" name="d68cbbf205" placeholder="Required" value="" data-order="" required=""></div>
<div class="emailaddress"> <label style="vertical-align:top">Email Address</label><input class="input formfield GDForm-2020__Input" pattern="[A-Za-z0-9._%+-]+@[A-Za-z0-9.-]+.[A-Za-z]{1,63}$" type="email" id="emailaddress" name="d68cbbfc09"
placeholder="Required" value="" data-order="" required=""></div>
<div class="businessphone"> <label style="vertical-align:top">Business Phone</label><input class="input formfield GDForm-2020__Input" type="text" id="businessphone" name="d68cbbf204" placeholder="Required" value="" data-order="" required="">
</div>
<div class="company"> <label style="vertical-align:top">Company</label><input class="input formfield GDForm-2020__Input" type="text" id="company" name="d68cbbf304" placeholder="Required" value="" data-order="" required=""></div>
<div class="title"> <label style="vertical-align:top">Job Title</label><input class="input formfield GDForm-2020__Input" type="text" id="title" name="d68cbbf207" placeholder="" value="" data-order=""></div>
<div class="address1"> <label style="vertical-align:top">Street Address</label><input class="input formfield GDForm-2020__Input pac-target-input" type="text" id="address1" name="d68cbbf307"
placeholder="Note: Pick one of the suggested addresses. Type again to see suggestions." value="" data-order="" required="" autocomplete="off"></div>
<div class="city hidden"> <label style="vertical-align:top">City</label><input class="input formfield GDForm-2020__Input" type="text" id="city" name="d68cbbf306" placeholder="" value="" data-order=""></div>
<div class="country hidden"> <label style="vertical-align:top">Country</label><select id="country" name="d68cbbf201" class="formfield GDForm-2020__Select" required="">
<option value="" selected="">-- please select --</option>
<option value="AF">Afghanistan</option>
<option value="AL">Albania</option>
<option value="DZ">Algeria</option>
<option value="AO">Angola</option>
<option value="AG">Antigua and Barbuda</option>
<option value="AR">Argentina</option>
<option value="AM">Armenia</option>
<option value="AU">Australia</option>
<option value="AT">Austria</option>
<option value="AZ">Azerbaijan</option>
<option value="BS">Bahamas</option>
<option value="BH">Bahrain</option>
<option value="BD">Bangladesh</option>
<option value="BB">Barbados</option>
<option value="BY">Belarus</option>
<option value="BE">Belgium</option>
<option value="BZ">Belize</option>
<option value="BJ">Benin</option>
<option value="BT">Bhutan</option>
<option value="BO">Bolivia</option>
<option value="BA">Bosnia</option>
<option value="BW">Botswana</option>
<option value="BR">Brazil</option>
<option value="BN">Brunei Darussalam</option>
<option value="BG">Bulgaria</option>
<option value="BF">Burkina-Faso</option>
<option value="BI">Burundi</option>
<option value="KH">Cambodia</option>
<option value="CA">Canada</option>
<option value="CL">Chile</option>
<option value="CN">China</option>
<option value="CO">Colombia</option>
<option value="KM">Comoros</option>
<option value="CR">Costa Rica</option>
<option value="HR">Croatia</option>
<option value="CY">Cyprus</option>
<option value="CZ">Czech Republic</option>
<option value="CD">Dem Rep of Congo</option>
<option value="DK">Denmark</option>
<option value="DJ">Djibouti</option>
<option value="DM">Dominica</option>
<option value="DO">Dominican Republic</option>
<option value="TL">East Timor</option>
<option value="EC">Ecuador</option>
<option value="EG">Egypt</option>
<option value="SV">El Salvador</option>
<option value="ER">Eritrea</option>
<option value="EE">Estonia</option>
<option value="ET">Ethiopia</option>
<option value="FI">Finland</option>
<option value="FR">France</option>
<option value="GA">Gabon</option>
<option value="GM">Gambia</option>
<option value="GE">Georgia</option>
<option value="DE">Germany</option>
<option value="GH">Ghana</option>
<option value="GR">Greece</option>
<option value="GD">Grenada</option>
<option value="GT">Guatemala</option>
<option value="GN">Guinea</option>
<option value="GW">Guinea-Bissau</option>
<option value="GY">Guyana</option>
<option value="HT">Haiti</option>
<option value="HN">Honduras</option>
<option value="HK">Hong Kong China</option>
<option value="HU">Hungary</option>
<option value="IS">Iceland</option>
<option value="IN">India</option>
<option value="ID">Indonesia</option>
<option value="IQ">Iraq</option>
<option value="IE">Ireland</option>
<option value="IL">Israel</option>
<option value="IT">Italy</option>
<option value="JM">Jamaica</option>
<option value="JP">Japan</option>
<option value="JO">Jordan</option>
<option value="KZ">Kazakhstan</option>
<option value="KE">Kenya</option>
<option value="KI">Kiribati</option>
<option value="KW">Kuwait</option>
<option value="KG">Kyrgyzstan</option>
<option value="LA">Laos</option>
<option value="LV">Latvia</option>
<option value="LB">Lebanon</option>
<option value="LS">Lesotho</option>
<option value="LR">Liberia</option>
<option value="LY">Libya</option>
<option value="LI">Liechtenstein</option>
<option value="LT">Lithuania</option>
<option value="LU">Luxembourg</option>
<option value="MK">Macedonia</option>
<option value="MG">Madagascar</option>
<option value="MW">Malawi</option>
<option value="MY">Malaysia</option>
<option value="ML">Mali</option>
<option value="MT">Malta</option>
<option value="MR">Mauritania</option>
<option value="MU">Mauritius</option>
<option value="MX">Mexico</option>
<option value="MC">Monaco</option>
<option value="MN">Mongolia</option>
<option value="ME">Montenegro</option>
<option value="MA">Morocco</option>
<option value="MZ">Mozambique</option>
<option value="NA">Namibia</option>
<option value="NP">Nepal</option>
<option value="NL">Netherlands</option>
<option value="NZ">New Zealand</option>
<option value="NI">Nicaragua</option>
<option value="NE">Niger</option>
<option value="NG">Nigeria</option>
<option value="NO">Norway</option>
<option value="OM">Oman</option>
<option value="PK">Pakistan</option>
<option value="PA">Panama</option>
<option value="PG">Papua New Guinea</option>
<option value="PY">Paraguay</option>
<option value="PE">Peru</option>
<option value="PH">Philippines</option>
<option value="PL">Poland</option>
<option value="PT">Portugal</option>
<option value="PR">Puerto Rico</option>
<option value="QA">Qatar</option>
<option value="RO">Romania</option>
<option value="RU">Russia</option>
<option value="RW">Rwanda</option>
<option value="VC">Saint Vincent and the Grenadin</option>
<option value="SM">San Marino</option>
<option value="ST">Sao Tome and Principe</option>
<option value="SA">Saudi Arabia</option>
<option value="SN">Senegal</option>
<option value="RS">Serbia</option>
<option value="SC">Seychelles</option>
<option value="SL">Sierra Leone</option>
<option value="SG">Singapore</option>
<option value="SK">Slovakia</option>
<option value="SI">Slovenia</option>
<option value="SO">Somalia</option>
<option value="ZA">South Africa</option>
<option value="KR">South Korea</option>
<option value="ES">Spain</option>
<option value="LK">Sri Lanka</option>
<option value="KN">St Kitts and Nevis</option>
<option value="LC">St Lucia</option>
<option value="SR">Suriname</option>
<option value="SZ">Swaziland</option>
<option value="SE">Sweden</option>
<option value="CH">Switzerland</option>
<option value="TW">Taiwan</option>
<option value="TJ">Tajikistan</option>
<option value="TZ">Tanzania</option>
<option value="TH">Thailand</option>
<option value="TG">Togo</option>
<option value="TT">Trinidad and Tobago</option>
<option value="TN">Tunisia</option>
<option value="TR">Turkey</option>
<option value="UG">Uganda</option>
<option value="UA">Ukraine</option>
<option value="AE">United Arab Emirates</option>
<option value="GB">United Kingdom</option>
<option value="UY">Uruguay</option>
<option value="US">USA</option>
<option value="UZ">Uzbekistan</option>
<option value="VN">Vietnam</option>
<option value="YE">Yemen</option>
<option value="ZM">Zambia</option>
<option value="ZW">Zimbabwe</option>
</select></div>
<div class="stateprovince hidden"> <label style="vertical-align:top">State or Province </label><select id="stateprovince" name="d68cbbf309" class="formfield GDForm-2020__Select">
<option value="" selected="">-- please select --</option>
</select></div>
<div class="postalcode hidden"> <label style="vertical-align:top">Zip or Postal Code</label><input class="input formfield GDForm-2020__Input" type="text" id="postalcode" name="d68cbbf308" placeholder="" value="" data-order=""></div>
<div class="technology"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="technology" name="d68cbbf303" placeholder="" value=""></div>
<div class="industry"> <label style="vertical-align:top">Industry </label><select id="industry" name="d68cbafb03" class="formfield GDForm-2020__Select" required="">
<option value="" selected="">-- please select --</option>
<option value="Agriculture">Agriculture</option>
<option value="Food & Beverage">Food & Beverage</option>
<option value="Mining & Construction">Mining & Construction</option>
<option value="Oil & Gas">Oil & Gas</option>
<option value="Pulp & Paper">Pulp & Paper</option>
<option value="Chemical & Petrochemical">Chemical & Petrochemical</option>
<option value="Pharmaceutical">Pharmaceutical</option>
<option value="Power Generation">Power Generation</option>
<option value="Environmental/Wastewater">Environmental/Wastewater</option>
<option value="Others">Others</option>
</select></div>
<div class="wgamt"> <label style="vertical-align:top">Area of Interest </label><select id="wgamt" name="d68cbbf302" class="formfield GDForm-2020__Select" required="">
<option value="" selected="">-- please select --</option>
<option value="WG">New Machine</option>
<option value="AMT">Parts & Service</option>
</select></div>
<div class="seriesmodel"> <label style="vertical-align:top">Model</label><input class="input formfield GDForm-2020__Input" type="text" id="seriesmodel" name="d68cbbf206" placeholder="" value="" data-order=""></div>
<div class="message"> <label style="vertical-align:top">Additional Information</label><textarea class="formfield GDForm-2020__Textarea" id="message" name="d68cbbf305" value="" data-order=""
placeholder="Please describe what you are looking for."></textarea></div>
<div class="formid"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="formid" name="" placeholder="" value=""></div>
<div class="formsubmitted"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="formsubmitted" name="d68cbbfc07" placeholder="" value="Quote"></div>
<div class="inquirytype"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="inquirytype" name="d68cbbf301" placeholder="" value="Quote"></div>
<div class="productcategory"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="productcategory" name="d68cbbf300" placeholder="" value="LiquidPumps"></div>
<div class="brandsource"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="brandsource" name="d68cbbfc06" placeholder="" value="SEP"></div>
<div class="salutation"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="salutation" name="d68cbbf203" placeholder="" value=""></div>
<div class="serial"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="serial" name="d68cbafb01" placeholder="" value=""></div>
<div class="application"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="application" name="d68cbbf209" placeholder="" value=""></div>
<div class="issue"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="issue" name="d68cbbf208" placeholder="" value=""></div>
<div class="typeofdocument"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="typeofdocument" name="d68cbafb00" placeholder="" value=""></div>
<div class="distribution"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="distribution" name="d68cbbfc08" placeholder="" value=""></div>
<div class="distributor"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="distributor" name="d68cbafb02" placeholder="" value=""></div>
<div class="leadinitiator"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="leadinitiator" name="d68cbafa05" placeholder="" value="Online Form Submission"></div>
<div class="utmcampaign"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="utmcampaign" name="d68cbafb05" placeholder="" value=""></div>
<div class="utmreferralsource"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="utmreferralsource" name="d68cbafb04" placeholder="" value=""></div>
<div class="utmmedium"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="utmmedium" name="d68cbafb07" placeholder="" value=""></div>
<div class="utmterm"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="utmterm" name="d68cbafb06" placeholder="" value=""></div>
<div class="utmcontent"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="utmcontent" name="d68cbafb09" placeholder="" value=""></div>
<div class="energycrmproduct"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="energycrmproduct" name="d68cbafa00" placeholder="" value=""></div>
<div class="energycrmleadsource"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="energycrmleadsource" name="d68cbafa03" placeholder="" value=""></div>
<div class="googleclientid"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="googleclientid" name="d68cbafb08" placeholder="" value=""></div>
<div class="referrerurl"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="referrerurl" name="d68cbafa01" placeholder="" value=""></div>
<div class="sourcecategory"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="sourcecategory" name="d68cbafa04" placeholder="" value="Online Form"></div>
<div class="sourcespecific"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="sourcespecific" name="d68cbafa07" placeholder="" value="System - Request a quote"></div>
<div class="language"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="language" name="d68cbafa02" placeholder="" value="en"></div>
<div class="submitterid"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="submitterid" name="d68cbaf901" placeholder="" value="PRD|a5cc67b0-bca7-4bc4-ab12-57acc573a08a"></div>
<div class="inquirydate"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="inquirydate" name="d68cbaf904" placeholder="" value="2023-09-18"></div>
<div class="privacy">
<div class="modal-footer GDForm-2020__Footer" style="margin-top: 5px;">
<div class="GDForm-2020__Footer__EU">
<div class="row">
<div class="col-sm-1"> <input id="privacy" class="input formfield" v-model="privacyPolicy" type="checkbox" name="d68cbafa06" required=""> </div>
<div class="col-sm-11">
<p> I have read and agree to the <a rel="noopener noreferrer" href="https://www.irco.com/terms" target="_blank">Privacy Policy</a> </p>
</div>
</div>
</div>
</div>
</div>
<div class="singleoptin">
<div class="modal-footer GDForm-2020__Footer" style="margin-top: 5px;">
<div class="GDForm-2020__Footer__EU">
<div class="row">
<div class="col-sm-1"> <input id="singleoptin" class="input formfield" v-model="privacyPolicy" type="checkbox" name="d68cbafa09" value="1"> </div>
<div class="col-sm-11">
<p> I would like to receive exclusive information about challenging applications, upcoming exhibitions, seminars and innovations.</p>
</div>
</div>
</div>
</div>
</div>
<div class="publicip"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="publicip" name="d68cbafa08" placeholder="" value=""></div>
<div class="additional1"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="additional1" name="d68cbaf906" placeholder="" value=""></div>
<div class="additional2"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="additional2" name="d68cbaf909" placeholder="" value=""></div>
<div class="additional3"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="additional3" name="d68cbaf908" placeholder="" value=""></div>
<div class="additional4"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="additional4" name="d68cbaf801" placeholder="" value=""></div>
<div class="additional5"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="additional5" name="d68cbaf800" placeholder="" value=""></div>
<div class="elqcustomerguid"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="elqcustomerguid" name="d78abef905" placeholder="" value="7AF601FAC4844637B22FF50FDA497D17"></div>
<div class="elqcookiewrite"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="elqcookiewrite" name="d78abef904" placeholder="" value="0"></div>
</div>
<div class="modal-footer GDForm-2020__Footer" style="margin-bottom: 30px;">
<button id="submitButton" type="submit" class="btn btn-success GDForm-2020__Footer__Submit"> Submit </button>
<div id="privacy_statement" class="" v-html="privacyStatement">
</div>
</div>
</div>
</div>
</form>Text Content
GET YOUR QUOTE. Please complete the form below to request your quote. We will be in contact as soon as possible. THANK YOU! Thank you for submitting this form. First Name Last Name Email Address Business Phone Company Job Title Street Address City Country-- please select --AfghanistanAlbaniaAlgeriaAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosniaBotswanaBrazilBrunei DarussalamBulgariaBurkina-FasoBurundiCambodiaCanadaChileChinaColombiaComorosCosta RicaCroatiaCyprusCzech RepublicDem Rep of CongoDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEritreaEstoniaEthiopiaFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong Kong ChinaHungaryIcelandIndiaIndonesiaIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaliMaltaMauritaniaMauritiusMexicoMonacoMongoliaMontenegroMoroccoMozambiqueNamibiaNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Vincent and the GrenadinSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSomaliaSouth AfricaSouth KoreaSpainSri LankaSt Kitts and NevisSt LuciaSurinameSwazilandSwedenSwitzerlandTaiwanTajikistanTanzaniaThailandTogoTrinidad and TobagoTunisiaTurkeyUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUSAUzbekistanVietnamYemenZambiaZimbabwe State or Province -- please select -- Zip or Postal Code Industry -- please select --AgricultureFood & BeverageMining & ConstructionOil & GasPulp & PaperChemical & PetrochemicalPharmaceuticalPower GenerationEnvironmental/WastewaterOthers Area of Interest -- please select --New MachineParts & Service Model Additional Information I have read and agree to the Privacy Policy I would like to receive exclusive information about challenging applications, upcoming exhibitions, seminars and innovations. Submit