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1 forms found in the DOM

POST /review/leave-feedback/117460/24fd3d920ad656b648eb889f8baa9ce51e9fe8f8

<form class="content-form" action="/review/leave-feedback/117460/24fd3d920ad656b648eb889f8baa9ce51e9fe8f8" method="post" novalidate="">
  <div class="spaced-content question-wrapper" data-selected-value="">
    <input type="hidden" name="questions[score]" required="">
    <h5 class="size-5 question-index highlight-when-error"> Question 1 of 2: <span class="error-message">(Please select a rating)</span></h5>
    <label class="label"> How likely is it that you would recommend our company to a friend or colleague? </label>
    <div class="ratings-box ">
      <div class="row">
        <div class="item" data-value="0">0</div>
        <div class="item" data-value="1">1</div>
        <div class="item" data-value="2">2</div>
        <div class="item" data-value="3">3</div>
        <div class="item" data-value="4">4</div>
        <div class="item" data-value="5">5</div>
      </div>
      <div class="row">
        <div class="item" data-value="6">6</div>
        <div class="item" data-value="7">7</div>
        <div class="item" data-value="8">8</div>
        <div class="item" data-value="9">9</div>
        <div class="item" data-value="10">10</div>
      </div>
      <div class="row">
        <div class="is-pulled-left"> 0 = Not likely </div>
        <div class="is-pulled-right"> 10 = Very likely </div>
      </div>
    </div>
  </div>
  <div class="spaced-content question-wrapper" data-selected-value="">
    <h5 class="size-5 question-index highlight-when-error"> Question 2 of 2: <span class="error-message">(Please fill out this field)</span>
    </h5>
    <label class="label">How did you feel about your experience with us?</label>
    <div class="comment-wrapper">
      <div class="vertical-range">
        <svg class="feedback-strength-indicator" width="100%" height="100%">
          <circle class="immobile-circle" cx="40%" cy="20%" r="9px" fill="silver"></circle>
          <rect class="js-immobile-bar" x="32%" y="10%" width="16%" height="100%" fill="silver"></rect>
          <rect class="js-mobile-bar strength-color percent-y" x="35%" y="96%" width="10%" height="100%"></rect>
          <circle class="js-mobile-outline-circle percent-cy" cx="40%" cy="96%" r="11px" fill="silver"></circle>
          <circle class="js-mobile-circle strength-color percent-cy" cx="40%" cy="96%" r="9px" stroke="white" width="1"></circle>
          <path class="js-mobile-triangle strength-color" d="M 40,288 60,278 60,298"></path>
        </svg>
        <div class="feedback-strength-label">Feedback<br>Strength</div>
      </div>
      <div class="comment">
        <textarea class="textarea" name="reviewText" placeholder="Write comments here..." maxlength="1200&quot;" required=""></textarea>
        <div class="characters"><span class="num-characters">0</span> / 1200 characters maximum</div>
      </div>
    </div>
  </div>
  <div class="spaced-content">
    <h5 class="size-5 question-index highlight-when-error">Contact Information:</h5>
    <div class="question-wrapper">
      <div class="field">
        <label class="label"><span class="highlight-when-error">First Name* <span class="error-message"> (Please provide first name)</span>
          </span>
          <span class="tooltip-wrapper"> ? <span class="tooltip">
              <p class="has-text-weight-bold">Why do we ask?</p>
              <p>First Name is collected for the customer record of feedback and if the business owner shares your feedback and rating on their website. It’s displayed with your first name and last initial.</p>
            </span>
          </span>
        </label>
        <div class="control">
          <input class="input" type="text" name="firstName" required="" value="">
        </div>
      </div>
    </div>
    <div class="question-wrapper">
      <div class="field">
        <label class="label">
          <span class="highlight-when-error">Last Name* <span class="error-message"> (Please provide last name)</span>
          </span>
          <span class="tooltip-wrapper"> ? <span class="tooltip">
              <p class="has-text-weight-bold">Why do we ask?</p>
              <p>Last name is collected for the customer record of feedback and if the business owner shares your feedback and rating on their website. It’s displayed with your first name and last initial.</p>
            </span>
          </span>
        </label>
        <div class="control">
          <input class="input" type="text" name="lastName" id="lastName" required="" value="">
        </div>
      </div>
    </div>
    <div class="question-wrapper">
      <div class="field">
        <label class="label">
          <span class="highlight-when-error">Email* <span class="error-message"> (Email seems to be incorrect)</span>
          </span>
          <span class="tooltip-wrapper"> ? <span class="tooltip">
              <p class="has-text-weight-bold">Why do we ask?</p>
              <p>Your email address is collected for the customer record and to follow-up with you.</p>
            </span>
          </span>
        </label>
        <div class="control">
          <input class="input" type="text" name="email" id="email" required="" value="">
        </div>
      </div>
    </div>
    <div class="question-wrapper">
      <div class="field">
        <label class="label">
          <span class="highlight-when-error">Phone <span class="error-message"> (Please provide correct phone number)</span>
          </span>
          <span class="tooltip-wrapper"> ? <span class="tooltip">
              <p class="has-text-weight-bold">Why do we ask?</p>
              <p>Your phone number is collected for the customer record and to follow-up with you.</p>
            </span></span>
        </label>
        <div class="control">
          <input class="input phone" type="text" name="phone" id="phone" value="">
        </div>
      </div>
    </div>
  </div>
  <div class="spaced-content">
    <button type="submit" class="button is-rounded is-large is-primary give-feedback-button">Send Feedback</button>
  </div>
  <div class="spaced-content">
    <label>
      <input type="hidden" name="allowFeedback" value="0">
      <input type="checkbox" checked="checked" name="allowFeedback" value="1"> By checking this box, I agree to allow my rating and review to be used by Modern Cabinet Remodelers for marketing and promotional purposes and to be posted publicly on
      review sites across the web with my name. </label>
  </div>
  <div class="spaced-content">
    <label>
      <input type="hidden" name="allowTextMessageUpdates" value="0">
      <input type="checkbox" checked="checked" name="allowTextMessageUpdates" value="1"> By checking this box, I agree to receive transaction and recurring promotional and personalized advertising messages (SMS and MMS) from Modern Cabinet
      Remodelers, and I consent to these text messages being sent via autodialer to the mobile number I provided above. I understand consent is not a condition of purchase, message and data rates may apply, message frequency varies, and I can reply
      "STOP" to any Modern Cabinet Remodelers text to stop receiving texts or "HELP" for help. I also agree to the Modern Cabinet Remodelers Terms &amp; Conditions and Privacy Policy. </label>
  </div>
</form>

Text Content

Please tell us about your experience.

QUESTION 1 OF 2: (PLEASE SELECT A RATING)

How likely is it that you would recommend our company to a friend or colleague?
0
1
2
3
4
5
6
7
8
9
10
0 = Not likely
10 = Very likely

QUESTION 2 OF 2: (PLEASE FILL OUT THIS FIELD)

How did you feel about your experience with us?
Feedback
Strength
0 / 1200 characters maximum

CONTACT INFORMATION:

First Name* (Please provide first name) ?

Why do we ask?

First Name is collected for the customer record of feedback and if the business
owner shares your feedback and rating on their website. It’s displayed with your
first name and last initial.


Last Name* (Please provide last name) ?

Why do we ask?

Last name is collected for the customer record of feedback and if the business
owner shares your feedback and rating on their website. It’s displayed with your
first name and last initial.


Email* (Email seems to be incorrect) ?

Why do we ask?

Your email address is collected for the customer record and to follow-up with
you.


Phone (Please provide correct phone number) ?

Why do we ask?

Your phone number is collected for the customer record and to follow-up with
you.


Send Feedback
By checking this box, I agree to allow my rating and review to be used by Modern
Cabinet Remodelers for marketing and promotional purposes and to be posted
publicly on review sites across the web with my name.
By checking this box, I agree to receive transaction and recurring promotional
and personalized advertising messages (SMS and MMS) from Modern Cabinet
Remodelers, and I consent to these text messages being sent via autodialer to
the mobile number I provided above. I understand consent is not a condition of
purchase, message and data rates may apply, message frequency varies, and I can
reply "STOP" to any Modern Cabinet Remodelers text to stop receiving texts or
"HELP" for help. I also agree to the Modern Cabinet Remodelers Terms &
Conditions and Privacy Policy.


By submitting this feedback, I understand and agree to the Review and Mobile
Marketing Policy.

Modern Cabinet Remodelers
420 Airport Road
Elgin, IL, 60123
(312) 646-4225

*Your email address will not be shared or publicly visible.

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