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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: 7ac93d96 —
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<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"> How can we help you? </h2>
<p class="GDForm-2020__Subtitle">Thank you for your interest in Emco Wheaton. Please fill out the form below and we will get back to you as soon as possible.</p>
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<div id="thankYouModal" class="modal">
<div class="thankYouModalContent fade in">
<div class="modal-dialog modal-lg">
<div style="text-align: center">
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<h1>Thank You!</h1>
<p>Thank you for submitting this form.</p>
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<div class="firstname"> <label style="vertical-align:top">First Name</label><input class="input formfield GDForm-2020__Input" type="text" id="firstname" name="7ccd329af8" 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="7ccd329aff" placeholder="Required" value="" data-order="" required=""></div>
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<div class="company"> <label style="vertical-align:top">Company</label><input class="input formfield GDForm-2020__Input" type="text" id="company" name="7ccd329bfe" 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="7ccd329afd" placeholder="" value="" data-order=""></div>
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<div class="city hidden"> <label style="vertical-align:top">City</label><input class="input formfield GDForm-2020__Input" type="text" id="city" name="7ccd329bfc" placeholder="" value="" data-order=""></div>
<div class="country hidden"> <label style="vertical-align:top">Country</label><select id="country" name="7ccd329afb" 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>
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<option value="BB">Barbados</option>
<option value="BY">Belarus</option>
<option value="BE">Belgium</option>
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<option value="BO">Bolivia</option>
<option value="BA">Bosnia</option>
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<option value="BR">Brazil</option>
<option value="BN">Brunei Darussalam</option>
<option value="BG">Bulgaria</option>
<option value="BF">Burkina-Faso</option>
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<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>
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<option value="TL">East Timor</option>
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<option value="DE">Germany</option>
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<option value="ML">Mali</option>
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<option value="MX">Mexico</option>
<option value="MC">Monaco</option>
<option value="MN">Mongolia</option>
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<option value="NL">Netherlands</option>
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<option value="ZA">South Africa</option>
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<option value="" selected="">-- please select --</option>
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<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="7ccd329bf2" placeholder="" value="" data-order=""></div>
<div class="inquirytype"> <label style="vertical-align:top">I am contacting you because </label><select id="inquirytype" name="7ccd329bfb" class="formfield GDForm-2020__Select" required="">
<option value="" selected="">-- please select --</option>
<option value="Quote">I would like a quote on a product or service</option>
<option value="Information">I would like more information about a product or service</option>
<option value="Service">I have a service request</option>
</select></div>
<div class="productcategory"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="productcategory" name="7ccd329bfa" placeholder="" value="Transport"></div>
<div class="technology"> <label style="vertical-align:top">Product Category </label><select id="technology" name="7ccd329bf9" class="formfield GDForm-2020__Select" required="">
<option value="" selected="">-- please select --</option>
<option value="DBC">Dry Break/TODO</option>
<option value="TTE">Tank Truck Products</option>
<option value="LLS">Land Loading Systems</option>
<option value="MLS">Marine Loading Systems</option>
<option value="FF">Fleet Fueling Products</option>
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<div class="wgamt"> <label style="vertical-align:top">Area of Interest </label><select id="wgamt" name="7ccd329bf8" class="formfield GDForm-2020__Select" required="">
<option value="" selected="">-- please select --</option>
<option value="WG">New Machine</option>
<option value="AMT">Parts & Service</option>
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<div class="message"> <label style="vertical-align:top">Additional Information</label><textarea class="formfield GDForm-2020__Textarea" id="message" name="7ccd329bff" value="" data-order=""
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<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="7ccd3294fd" placeholder="" value="Contact"></div>
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<div class="seriesmodel"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="seriesmodel" name="7ccd329afc" placeholder="" value=""></div>
<div class="serial"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="serial" name="7ccd3393fb" placeholder="" value=""></div>
<div class="application"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="application" name="7ccd329af3" placeholder="" value=""></div>
<div class="issue"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="issue" name="7ccd329af2" placeholder="" value=""></div>
<div class="typeofdocument"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="typeofdocument" name="7ccd3393fa" placeholder="" value=""></div>
<div class="industry"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="industry" name="7ccd3393f9" placeholder="" value=""></div>
<div class="distribution"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="distribution" name="7ccd3294f2" placeholder="" value=""></div>
<div class="distributor"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="distributor" name="7ccd3393f8" placeholder="" value=""></div>
<div class="leadinitiator"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="leadinitiator" name="7ccd3392ff" 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="7ccd3393ff" placeholder="" value=""></div>
<div class="utmreferralsource"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="utmreferralsource" name="7ccd3393fe" placeholder="" value=""></div>
<div class="utmmedium"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="utmmedium" name="7ccd3393fd" placeholder="" value=""></div>
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<div class="utmcontent"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="utmcontent" name="7ccd3393f3" placeholder="" value=""></div>
<div class="energycrmproduct"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="energycrmproduct" name="7ccd3392fa" placeholder="" value=""></div>
<div class="energycrmleadsource"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="energycrmleadsource" name="7ccd3392f9" placeholder="" value=""></div>
<div class="googleclientid"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="googleclientid" name="7ccd3393f2" placeholder="" value=""></div>
<div class="referrerurl"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="referrerurl" name="7ccd3392fb" placeholder="" value=""></div>
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<div class="inquirydate"> <label class="hidden"></label><input class="input formfield GDForm-2020__Input" type="hidden" id="inquirydate" name="7ccd3391fe" 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="7ccd3392fc" 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>
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</div>
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<div class="singleoptin">
<div class="modal-footer GDForm-2020__Footer" style="margin-top: 5px;">
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<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>
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<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
HOW CAN WE HELP YOU? Thank you for your interest in Emco Wheaton. Please fill out the form below and we will get back to you 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 I am contacting you because -- please select --I would like a quote on a product or serviceI would like more information about a product or serviceI have a service request Product Category -- please select --Dry Break/TODOTank Truck ProductsLand Loading SystemsMarine Loading SystemsFleet Fueling Products Area of Interest -- please select --New MachineParts & Service 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