business.epb.com Open in urlscan Pro
74.221.178.70  Public Scan

Form analysis
2 forms found in the DOM

<form data-form-builder="1VY" data-form-name="Simple Ticket - Business Support" data-on-success="/form-success/" data-captcha="required" data-api="business">
  <input type="hidden" name="_form_id" value="1VY">
  <div class="row">
    <div class="col-12 lg:col-6 pb-2 lg:pb-4">
      <div class="form-group">
        <input type="text" class="w-full" required="" name="first_name" value="" data-value="">
        <label translate="yes">* First Name</label>
      </div>
    </div>
    <div class="col-12 lg:col-6 pb-2 lg:pb-4">
      <div class="form-group">
        <input type="text" class="w-full" required="" name="last_name" value="" data-value="">
        <label translate="yes">* Last Name</label>
      </div>
    </div>
    <div class="col-12 pb-2 lg:pb-4">
      <div class="form-group">
        <input type="text" class="w-full" name="company_name" value="" data-value="">
        <label translate="yes">Company Name</label>
      </div>
    </div>
    <div class="col-12 lg:col-6 pb-2 lg:pb-4">
      <div class="form-group">
        <input type="email" class="w-full" required="" name="email" value="" data-value="">
        <label translate="yes">* Email</label>
      </div>
    </div>
    <div class="col-12 lg:col-6 pb-2 lg:pb-4">
      <div class="form-group">
        <input type="text" class="w-full" required="" name="phone" pattern="\d{10}" value="" data-value="">
        <label translate="yes">* 10-Digit Phone Number</label>
      </div>
    </div>
    <div class="col-12 pb-2 lg:pb-4">
      <div class="form-group">
        <select class="w-full" name="best_time_to_contact">
          <option translate="yes" value="MORNING">Morning</option>
          <option translate="yes" value="AFTERNOON">Afternoon</option>
        </select>
        <label translate="yes" name="best_time_to_contact">Best Time To Contact</label>
      </div>
    </div>
    <div class="col-12 pb-2 lg:pb-4">
      <div class="form-group">
        <input type="text" class="w-full" required="" name="street_address" value="" data-value="">
        <label translate="yes">* Street Address</label>
      </div>
    </div>
    <div class="col-12 lg:col-6 pb-2 lg:pb-4">
      <div class="form-group">
        <input type="text" class="w-full" name="street_address2" value="" data-value="">
        <label translate="yes">Secondary Street Address</label>
      </div>
    </div>
    <div class="col-12 lg:col-6 pb-2 lg:pb-4">
      <div class="form-group">
        <input type="text" class="w-full" required="" name="city" value="" data-value="">
        <label translate="yes">* City</label>
      </div>
    </div>
    <div class="col-12 lg:col-6 pb-2 lg:pb-4">
      <div class="form-group">
        <input type="text" class="w-full" required="" name="state" value="" data-value="">
        <label translate="yes">* State</label>
      </div>
    </div>
    <div class="col-12 lg:col-6 pb-2 lg:pb-4">
      <div class="form-group">
        <input type="text" class="w-full" required="" name="zip" pattern="\d+" value="" data-value="">
        <label translate="yes">* Zipcode</label>
      </div>
    </div>
    <div class="container">
      <div class="row">
        <div class="col-12 lg:col-8 pb-6">
          <h3>I'm requesting assistance with (select all that apply):</h3>
        </div>
      </div>
      <input-group-field class="row" data-valid="false" tabindex="0">
        <span class="text-red text-bold pb-4 hidden validation col-12">At least 1 input in this group is required to continue</span>
        <div class="col-12 pb-2 lg:pb-4" tabindex="0">
          <label class="form-group checkbox-container text-grey-body pl-12 "> Energy Services <input type="checkbox" value="ENERGY SERVICES" class="w-full" name="interested_in">
            <span class="checkmark"></span>
          </label>
          <style>
            /* The container */
            /* The checkbox-container */
            .checkbox-container {
              display: block;
              position: relative;
              padding-left: 48px;
              margin-bottom: 12px;
              cursor: pointer;
              font-size: 16px;
              -webkit-user-select: none;
              -moz-user-select: none;
              -ms-user-select: none;
              user-select: none;
            }

            /* Hide the browser's default checkbox */
            .checkbox-container input {
              position: absolute;
              opacity: 0;
              cursor: pointer;
              height: 0;
              width: 0;
            }

            /* Create a custom checkbox */
            .checkmark {
              position: absolute;
              top: 0;
              left: 0;
              height: 25px;
              width: 25px;
              border: 1px solid #cccccc;
              color: #404040;
              background-color: white;
            }

            /* On mouse-over, add a grey background color */
            .checkbox-container:hover input~.checkmark {
              background-color: #ccc;
            }

            /* Create the checkmark/indicator (hidden when not checked) */
            .checkmark:after {
              content: "";
              position: absolute;
              display: none;
            }

            /* Show the checkmark when checked */
            .checkbox-container input:checked~.checkmark:after {
              display: block;
            }

            /* Style the checkmark/indicator */
            .checkbox-container .checkmark:after {
              left: 9px;
              top: 5px;
              width: 5px;
              height: 10px;
              border: solid black;
              border-width: 0 3px 3px 0;
              -webkit-transform: rotate(45deg);
              -ms-transform: rotate(45deg);
              transform: rotate(45deg);
            }
          </style>
        </div>
        <div class="col-12 pb-2 lg:pb-4" tabindex="0">
          <label class="form-group checkbox-container text-grey-body pl-12 "> Internet/WiFi Services <input type="checkbox" value="INTERNET" class="w-full" name="interested_in">
            <span class="checkmark"></span>
          </label>
          <style>
            /* The container */
            /* The checkbox-container */
            .checkbox-container {
              display: block;
              position: relative;
              padding-left: 48px;
              margin-bottom: 12px;
              cursor: pointer;
              font-size: 16px;
              -webkit-user-select: none;
              -moz-user-select: none;
              -ms-user-select: none;
              user-select: none;
            }

            /* Hide the browser's default checkbox */
            .checkbox-container input {
              position: absolute;
              opacity: 0;
              cursor: pointer;
              height: 0;
              width: 0;
            }

            /* Create a custom checkbox */
            .checkmark {
              position: absolute;
              top: 0;
              left: 0;
              height: 25px;
              width: 25px;
              border: 1px solid #cccccc;
              color: #404040;
              background-color: white;
            }

            /* On mouse-over, add a grey background color */
            .checkbox-container:hover input~.checkmark {
              background-color: #ccc;
            }

            /* Create the checkmark/indicator (hidden when not checked) */
            .checkmark:after {
              content: "";
              position: absolute;
              display: none;
            }

            /* Show the checkmark when checked */
            .checkbox-container input:checked~.checkmark:after {
              display: block;
            }

            /* Style the checkmark/indicator */
            .checkbox-container .checkmark:after {
              left: 9px;
              top: 5px;
              width: 5px;
              height: 10px;
              border: solid black;
              border-width: 0 3px 3px 0;
              -webkit-transform: rotate(45deg);
              -ms-transform: rotate(45deg);
              transform: rotate(45deg);
            }
          </style>
        </div>
        <div class="col-12 pb-2 lg:pb-4" tabindex="0">
          <label class="form-group checkbox-container text-grey-body pl-12 "> Voice Services <input type="checkbox" value="VOICE" class="w-full" name="interested_in">
            <span class="checkmark"></span>
          </label>
          <style>
            /* The container */
            /* The checkbox-container */
            .checkbox-container {
              display: block;
              position: relative;
              padding-left: 48px;
              margin-bottom: 12px;
              cursor: pointer;
              font-size: 16px;
              -webkit-user-select: none;
              -moz-user-select: none;
              -ms-user-select: none;
              user-select: none;
            }

            /* Hide the browser's default checkbox */
            .checkbox-container input {
              position: absolute;
              opacity: 0;
              cursor: pointer;
              height: 0;
              width: 0;
            }

            /* Create a custom checkbox */
            .checkmark {
              position: absolute;
              top: 0;
              left: 0;
              height: 25px;
              width: 25px;
              border: 1px solid #cccccc;
              color: #404040;
              background-color: white;
            }

            /* On mouse-over, add a grey background color */
            .checkbox-container:hover input~.checkmark {
              background-color: #ccc;
            }

            /* Create the checkmark/indicator (hidden when not checked) */
            .checkmark:after {
              content: "";
              position: absolute;
              display: none;
            }

            /* Show the checkmark when checked */
            .checkbox-container input:checked~.checkmark:after {
              display: block;
            }

            /* Style the checkmark/indicator */
            .checkbox-container .checkmark:after {
              left: 9px;
              top: 5px;
              width: 5px;
              height: 10px;
              border: solid black;
              border-width: 0 3px 3px 0;
              -webkit-transform: rotate(45deg);
              -ms-transform: rotate(45deg);
              transform: rotate(45deg);
            }
          </style>
        </div>
        <div class="col-12 pb-2 lg:pb-4" tabindex="0">
          <label class="form-group checkbox-container text-grey-body pl-12 "> Small Business Bundles <input type="checkbox" value="SMALL BUSINESS BUNDLES" class="w-full" name="interested_in">
            <span class="checkmark"></span>
          </label>
          <style>
            /* The container */
            /* The checkbox-container */
            .checkbox-container {
              display: block;
              position: relative;
              padding-left: 48px;
              margin-bottom: 12px;
              cursor: pointer;
              font-size: 16px;
              -webkit-user-select: none;
              -moz-user-select: none;
              -ms-user-select: none;
              user-select: none;
            }

            /* Hide the browser's default checkbox */
            .checkbox-container input {
              position: absolute;
              opacity: 0;
              cursor: pointer;
              height: 0;
              width: 0;
            }

            /* Create a custom checkbox */
            .checkmark {
              position: absolute;
              top: 0;
              left: 0;
              height: 25px;
              width: 25px;
              border: 1px solid #cccccc;
              color: #404040;
              background-color: white;
            }

            /* On mouse-over, add a grey background color */
            .checkbox-container:hover input~.checkmark {
              background-color: #ccc;
            }

            /* Create the checkmark/indicator (hidden when not checked) */
            .checkmark:after {
              content: "";
              position: absolute;
              display: none;
            }

            /* Show the checkmark when checked */
            .checkbox-container input:checked~.checkmark:after {
              display: block;
            }

            /* Style the checkmark/indicator */
            .checkbox-container .checkmark:after {
              left: 9px;
              top: 5px;
              width: 5px;
              height: 10px;
              border: solid black;
              border-width: 0 3px 3px 0;
              -webkit-transform: rotate(45deg);
              -ms-transform: rotate(45deg);
              transform: rotate(45deg);
            }
          </style>
        </div>
        <div class="col-12 pb-2 lg:pb-4" tabindex="0">
          <label class="form-group checkbox-container text-grey-body pl-12 "> Hosted Camera <input type="checkbox" value="HOSTED CAMERA" class="w-full" name="interested_in">
            <span class="checkmark"></span>
          </label>
          <style>
            /* The container */
            /* The checkbox-container */
            .checkbox-container {
              display: block;
              position: relative;
              padding-left: 48px;
              margin-bottom: 12px;
              cursor: pointer;
              font-size: 16px;
              -webkit-user-select: none;
              -moz-user-select: none;
              -ms-user-select: none;
              user-select: none;
            }

            /* Hide the browser's default checkbox */
            .checkbox-container input {
              position: absolute;
              opacity: 0;
              cursor: pointer;
              height: 0;
              width: 0;
            }

            /* Create a custom checkbox */
            .checkmark {
              position: absolute;
              top: 0;
              left: 0;
              height: 25px;
              width: 25px;
              border: 1px solid #cccccc;
              color: #404040;
              background-color: white;
            }

            /* On mouse-over, add a grey background color */
            .checkbox-container:hover input~.checkmark {
              background-color: #ccc;
            }

            /* Create the checkmark/indicator (hidden when not checked) */
            .checkmark:after {
              content: "";
              position: absolute;
              display: none;
            }

            /* Show the checkmark when checked */
            .checkbox-container input:checked~.checkmark:after {
              display: block;
            }

            /* Style the checkmark/indicator */
            .checkbox-container .checkmark:after {
              left: 9px;
              top: 5px;
              width: 5px;
              height: 10px;
              border: solid black;
              border-width: 0 3px 3px 0;
              -webkit-transform: rotate(45deg);
              -ms-transform: rotate(45deg);
              transform: rotate(45deg);
            }
          </style>
        </div>
        <div class="col-12 pb-2 lg:pb-4" tabindex="0">
          <label class="form-group checkbox-container text-grey-body pl-12 "> Streaming TV Solution <input type="checkbox" value="STREAMING TV SOLUTION" class="w-full" name="interested_in">
            <span class="checkmark"></span>
          </label>
          <style>
            /* The container */
            /* The checkbox-container */
            .checkbox-container {
              display: block;
              position: relative;
              padding-left: 48px;
              margin-bottom: 12px;
              cursor: pointer;
              font-size: 16px;
              -webkit-user-select: none;
              -moz-user-select: none;
              -ms-user-select: none;
              user-select: none;
            }

            /* Hide the browser's default checkbox */
            .checkbox-container input {
              position: absolute;
              opacity: 0;
              cursor: pointer;
              height: 0;
              width: 0;
            }

            /* Create a custom checkbox */
            .checkmark {
              position: absolute;
              top: 0;
              left: 0;
              height: 25px;
              width: 25px;
              border: 1px solid #cccccc;
              color: #404040;
              background-color: white;
            }

            /* On mouse-over, add a grey background color */
            .checkbox-container:hover input~.checkmark {
              background-color: #ccc;
            }

            /* Create the checkmark/indicator (hidden when not checked) */
            .checkmark:after {
              content: "";
              position: absolute;
              display: none;
            }

            /* Show the checkmark when checked */
            .checkbox-container input:checked~.checkmark:after {
              display: block;
            }

            /* Style the checkmark/indicator */
            .checkbox-container .checkmark:after {
              left: 9px;
              top: 5px;
              width: 5px;
              height: 10px;
              border: solid black;
              border-width: 0 3px 3px 0;
              -webkit-transform: rotate(45deg);
              -ms-transform: rotate(45deg);
              transform: rotate(45deg);
            }
          </style>
        </div>
        <div class="col-12 pb-2 lg:pb-4" tabindex="0">
          <label class="form-group checkbox-container text-grey-body pl-12 "> EV Charging Incentive for Business <input type="checkbox" value="EV CHARGING INCENTIVE FOR BUSINESS" class="w-full" name="interested_in">
            <span class="checkmark"></span>
          </label>
          <style>
            /* The container */
            /* The checkbox-container */
            .checkbox-container {
              display: block;
              position: relative;
              padding-left: 48px;
              margin-bottom: 12px;
              cursor: pointer;
              font-size: 16px;
              -webkit-user-select: none;
              -moz-user-select: none;
              -ms-user-select: none;
              user-select: none;
            }

            /* Hide the browser's default checkbox */
            .checkbox-container input {
              position: absolute;
              opacity: 0;
              cursor: pointer;
              height: 0;
              width: 0;
            }

            /* Create a custom checkbox */
            .checkmark {
              position: absolute;
              top: 0;
              left: 0;
              height: 25px;
              width: 25px;
              border: 1px solid #cccccc;
              color: #404040;
              background-color: white;
            }

            /* On mouse-over, add a grey background color */
            .checkbox-container:hover input~.checkmark {
              background-color: #ccc;
            }

            /* Create the checkmark/indicator (hidden when not checked) */
            .checkmark:after {
              content: "";
              position: absolute;
              display: none;
            }

            /* Show the checkmark when checked */
            .checkbox-container input:checked~.checkmark:after {
              display: block;
            }

            /* Style the checkmark/indicator */
            .checkbox-container .checkmark:after {
              left: 9px;
              top: 5px;
              width: 5px;
              height: 10px;
              border: solid black;
              border-width: 0 3px 3px 0;
              -webkit-transform: rotate(45deg);
              -ms-transform: rotate(45deg);
              transform: rotate(45deg);
            }
          </style>
        </div>
        <div class="col-12 pb-2 lg:pb-4" tabindex="0">
          <label class="form-group checkbox-container text-grey-body pl-12 "> Free Consultation <input type="checkbox" value="FREE CONSULTATION" class="w-full" name="interested_in">
            <span class="checkmark"></span>
          </label>
          <style>
            /* The container */
            /* The checkbox-container */
            .checkbox-container {
              display: block;
              position: relative;
              padding-left: 48px;
              margin-bottom: 12px;
              cursor: pointer;
              font-size: 16px;
              -webkit-user-select: none;
              -moz-user-select: none;
              -ms-user-select: none;
              user-select: none;
            }

            /* Hide the browser's default checkbox */
            .checkbox-container input {
              position: absolute;
              opacity: 0;
              cursor: pointer;
              height: 0;
              width: 0;
            }

            /* Create a custom checkbox */
            .checkmark {
              position: absolute;
              top: 0;
              left: 0;
              height: 25px;
              width: 25px;
              border: 1px solid #cccccc;
              color: #404040;
              background-color: white;
            }

            /* On mouse-over, add a grey background color */
            .checkbox-container:hover input~.checkmark {
              background-color: #ccc;
            }

            /* Create the checkmark/indicator (hidden when not checked) */
            .checkmark:after {
              content: "";
              position: absolute;
              display: none;
            }

            /* Show the checkmark when checked */
            .checkbox-container input:checked~.checkmark:after {
              display: block;
            }

            /* Style the checkmark/indicator */
            .checkbox-container .checkmark:after {
              left: 9px;
              top: 5px;
              width: 5px;
              height: 10px;
              border: solid black;
              border-width: 0 3px 3px 0;
              -webkit-transform: rotate(45deg);
              -ms-transform: rotate(45deg);
              transform: rotate(45deg);
            }
          </style>
        </div>
        <div class="col-12 pb-2 lg:pb-4" tabindex="0">
          <label class="form-group checkbox-container text-grey-body pl-12 "> Tech Support <input type="checkbox" value="TECH SUPPORT" class="w-full" name="interested_in">
            <span class="checkmark"></span>
          </label>
          <style>
            /* The container */
            /* The checkbox-container */
            .checkbox-container {
              display: block;
              position: relative;
              padding-left: 48px;
              margin-bottom: 12px;
              cursor: pointer;
              font-size: 16px;
              -webkit-user-select: none;
              -moz-user-select: none;
              -ms-user-select: none;
              user-select: none;
            }

            /* Hide the browser's default checkbox */
            .checkbox-container input {
              position: absolute;
              opacity: 0;
              cursor: pointer;
              height: 0;
              width: 0;
            }

            /* Create a custom checkbox */
            .checkmark {
              position: absolute;
              top: 0;
              left: 0;
              height: 25px;
              width: 25px;
              border: 1px solid #cccccc;
              color: #404040;
              background-color: white;
            }

            /* On mouse-over, add a grey background color */
            .checkbox-container:hover input~.checkmark {
              background-color: #ccc;
            }

            /* Create the checkmark/indicator (hidden when not checked) */
            .checkmark:after {
              content: "";
              position: absolute;
              display: none;
            }

            /* Show the checkmark when checked */
            .checkbox-container input:checked~.checkmark:after {
              display: block;
            }

            /* Style the checkmark/indicator */
            .checkbox-container .checkmark:after {
              left: 9px;
              top: 5px;
              width: 5px;
              height: 10px;
              border: solid black;
              border-width: 0 3px 3px 0;
              -webkit-transform: rotate(45deg);
              -ms-transform: rotate(45deg);
              transform: rotate(45deg);
            }
          </style>
        </div>
      </input-group-field>
    </div>
    <div class="col-12 pb-2 lg:pb-4">
      <label class="py-2 text-sm" "="">Comments</label>
<div class=" form-group">
        <textarea class="w-full" name="comments" rows="7" value="" data-value=""></textarea>
    </div>
  </div>
  </div>
  <div class="row">
    <div class="col-12">
      <div class="g-recaptcha pb-6 lg:pb-8" data-sitekey="6LejptgUAAAAAF8Gog269JP1LAkDi9xbT183J9k1">
        <div style="width: 304px; height: 78px;">
          <div><iframe title="reCAPTCHA" width="304" height="78" role="presentation" name="a-acktnvhaghsh" frameborder="0" scrolling="no"
              sandbox="allow-forms allow-popups allow-same-origin allow-scripts allow-top-navigation allow-modals allow-popups-to-escape-sandbox allow-storage-access-by-user-activation"
              src="https://www.google.com/recaptcha/api2/anchor?ar=1&amp;k=6LejptgUAAAAAF8Gog269JP1LAkDi9xbT183J9k1&amp;co=aHR0cHM6Ly9idXNpbmVzcy5lcGIuY29tOjQ0Mw..&amp;hl=de&amp;v=xds0rzGrktR88uEZ2JUvdgOY&amp;size=normal&amp;cb=rtpqfx73s536"></iframe>
          </div><textarea id="g-recaptcha-response" name="g-recaptcha-response" class="g-recaptcha-response"
            style="width: 250px; height: 40px; border: 1px solid rgb(193, 193, 193); margin: 10px 25px; padding: 0px; resize: none; display: none;"></textarea>
        </div><iframe style="display: none;"></iframe>
      </div>
      <button class="btn-cta" type="submit" value="">Submit</button>
      <div class="inline refresh-counter-container pl-5 hidden">
        <span translate="yes"> Refreshing page in</span> <span class="refresh-counter">5</span>...
      </div>
    </div>
  </div>
  <div class="hidden formbuilder-recaptcha-error">
    <div class="row">
      <div class="col-12">
        <p translate="yes">Invalid reCaptcha. Please check the "I am not a robot" box and try again.</p>
      </div>
    </div>
  </div>
  <div class="hidden formbuilder-error">
    <div class="row">
      <div class="col-12">
        <p translate="yes">We are unable to submit your request. Please try again ensuring all required fields are complete and your email and phone number are entered correctly.</p>
      </div>
    </div>
  </div>
</form>

<form class="vanilla-form">
  <div id="form-grid">
    <div class="lg:col-start-1 lg:col-end-3">
      <div class="row lg:py-3">
        <div class="col-12 lg:py-0 lg:col-6">
          <div class="input-field">
            <label for="first_name" class="text-grey-body block font-circular-book font-hairline text-lg raised" translate="yes">
              <span>* </span>First Name </label>
            <input required="" type="text" class="text-grey-body font-circular-book font-hairline text-xl border-solid border border-grey-border block w-full h-12 cursor-auto mt-2 pl-4 empty" name="first_name">
          </div>
        </div>
        <div class="col-12 py-3 lg:py-0 lg:col-6">
          <div class="input-field">
            <label for="last_name" class="text-grey-body block font-circular-book font-hairline text-lg raised" translate="yes">
              <span>* </span>Last Name </label>
            <input required="" type="text" class="text-grey-body font-circular-book font-hairline text-xl border-solid border border-grey-border block w-full h-12 cursor-auto mt-2 pl-4 empty" name="last_name">
          </div>
        </div>
      </div>
      <div class="row lg:py-3">
        <div class="col-12 py-3 lg:py-0 lg:col-6">
          <div class="input-field">
            <label for="phone_number" class="text-grey-body block font-circular-book font-hairline text-lg raised" translate="yes">
              <span>* </span>Phone Number </label>
            <input required="" type="tel" class="text-grey-body font-circular-book font-hairline text-xl border-solid border border-grey-border block w-full h-12 cursor-auto pl-4 empty" name="phone_number">
          </div>
        </div>
        <div class="col-12 py-3 lg:py-0 lg:col-6">
          <div class="select-field">
            <label class="raised" for="call_when" translate="yes"><span>* </span>What's the best time to call?</label>
            <select required="" name="call_when" class="not-empty w-full" value="now">
              <option value="now" translate="yes">Call Now</option>
              <option value="later" translate="yes">Call Later</option>
            </select>
          </div>
        </div>
      </div>
      <div class="hidden" id="call-when-time">
        <div class="row hidden lg:py-3">
          <div class="col-12 py-3 lg:py-0 lg:col-6">
            <div class="select-field">
              <label for="call_day" class="raised">Day</label>
              <select translate="yes" name="call_day" class="not-empty w-full" value="2024-10-09">
                <option value="2024-10-09">Today</option>
                <option value="2024-10-10">Thursday</option>
                <option value="2024-10-11">Friday</option>
                <option value="2024-10-12">Saturday</option>
              </select>
            </div>
          </div>
          <div class="col-12 py-3 lg:py-0 lg:col-6">
            <div class="input-field">
              <label for="call_time" class="raised" translate="yes">Time</label>
              <input type="text" class="text-grey-body font-circular-book font-hairline text-xl border-solid border border-grey-border block w-full h-12 cursor-auto pl-4 empty" name="call_time" value="12:00AM">
            </div>
          </div>
        </div>
      </div>
      <div class="row lg:py-3">
        <div class="col-12 py-3 lg:py-0 lg:col-6">
          <div class="select-field">
            <label for="call_target" class="raised" translate="yes"><span>* </span>I'd like to speak with</label>
            <select required="" name="call_target" class="w-full not-empty" value="customer_service">
              <option value="CUSTOMER_SERVICE" translate="yes">Customer Service</option>
              <option value="TECH_SUPPORT" translate="yes">Technical Support</option>
            </select>
          </div>
        </div>
      </div>
    </div>
  </div>
  <div class="row pt-10">
    <div class="col-12 lg:col-6">
      <input class="submit bg-white py-4 px-12 border border-blue-dark hover:bg-grey-05 hover:cursor-pointer" type="submit" value="Submit">
    </div>
    <div class="form-success hidden col-12 lg:col-6">
      <p translate="yes">Thanks, we'll be in touch soon!</p>
    </div>
  </div>
</form>

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