hylandinsuranceco.com
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urlscan Pro
34.69.219.172
Public Scan
URL:
https://hylandinsuranceco.com/
Submission: On December 24 via api from US — Scanned from US
Submission: On December 24 via api from US — Scanned from US
Form analysis
4 forms found in the DOM#
<form id="quote-start-pl0uya8" action="#" class="w-full mt-4 grid gap-6 @2xl:grid-cols-3 @2xl:items-center @2xl:bg-sf-charcoal-100 @2xl:p-6 @2xl:mt-0 @5xl:gap-6 @5xl:p-8 @lg:grid-cols-2 @lg:gap-4"
:class="!['zip', 'loc'].includes(type()) ? '@lg:grid-cols-1 gap-x-0 @lg:gap-y-4 @2xl:gap-x-4' : '@lg:grid-cols-2 @lg:gap-4'">
<div :class="!['zip', 'loc'].includes(type()) ? '@2xl:col-span-2' : ''" class="">
<!-- start partial: shared/components/ui/select-input-label.hbs -->
<label for="gaq-product-pl0uya8"
class="font-mecherlesans-reg relative block h-12 w-full border-b border-sf-charcoal text-base text-sf-charcoal placeholder-current [&_select]:h-full [&_select]:w-full [&_select]:cursor-pointer [&_select]:appearance-none [&_select]:px-3 [&_select]:transition-shadow [&_select]:focus-within:outline-none [&_select]:focus-within:ring [&_select]:focus-within:ring-inset [&_select]:focus-within:ring-sf-red-500 "
:class="{}">
<span class="absolute -top-4 left-0 text-xs font-semi">Select an Insurance Product</span>
<div class="relative flex flex-row items-center w-full h-full">
<select id="gaq-product-pl0uya8" name="field-auto" @change="selectProduct()" x-model="productKey" aria-controls="specific-location-info-pl0uya8" :aria-describedby="productSelected ? '' : describeErrorsID()" class="bg-white"
aria-describedby="">
<option value="" selected="" hidden="">Select Product</option>
<template x-for="line in lineOptions">
<option :value="line.key" x-text="line.label" :selected="line.key === productKey"></option>
</template>
<option :value="line.key" x-text="line.label" :selected="line.key === productKey" value="auto">Auto</option>
<option :value="line.key" x-text="line.label" :selected="line.key === productKey" value="motorcycle">Motorcycle</option>
<option :value="line.key" x-text="line.label" :selected="line.key === productKey" value="homeowners">Homeowners</option>
<option :value="line.key" x-text="line.label" :selected="line.key === productKey" value="condo">Condo Owners</option>
<option :value="line.key" x-text="line.label" :selected="line.key === productKey" value="renters">Renters</option>
<option :value="line.key" x-text="line.label" :selected="line.key === productKey" value="life">Life</option>
<option :value="line.key" x-text="line.label" :selected="line.key === productKey" value="medicare">Medicare Supplement</option>
<option :value="line.key" x-text="line.label" :selected="line.key === productKey" value="hospital">Supplemental Health</option>
<option :value="line.key" x-text="line.label" :selected="line.key === productKey" value="business">Small Business</option>
<option :value="line.key" x-text="line.label" :selected="line.key === productKey" value="pet">Pet Insurance</option>
</select>
<div class="absolute right-4 pointer-events-none">
<div class="svg-outer"><svg xmlns="http://www.w3.org/2000/svg" fill="none" viewBox="0 0 12 7" class="svg-inner" aria-hidden="true" style="fill: currentColor; " preserveAspectRatio="xMinYMid meet">
<path fill="currentColor" fill-rule="evenodd" d="M.293.293a1 1 0 0 1 1.414 0L6 4.586 10.293.293a1 1 0 1 1 1.414 1.414l-5 5a1 1 0 0 1-1.414 0l-5-5a1 1 0 0 1 0-1.414" clip-rule="evenodd"></path>
</svg></div>
</div>
</div>
</label>
<!-- end partial: shared/components/ui/select-input-label.hbs -->
</div>
<template x-if="['zip', 'loc'].includes(type())">
<div id="specific-location-info-pl0uya8">
<div x-show="type() === 'zip'" x-cloak="">
<!-- start partial: shared/components/ui/text-input-label.hbs -->
<div class="relative w-full " :class="{}">
<input id="gaq-zip-pl0uya8" type="text" class="bg-white m2-form-input peer" x-model="zip" name="field-zip" autocomplete="postal-code" placeholder="ZIP Code" aria-required="true" :aria-invalid="!isZipValid()"
:aria-describedby="isZipValid() ? '' : describeErrorsID()" @keydown.enter.prevent="validate()">
<label
class="font-semi peer-placeholder-shown:font-reg peer-focus:font-semi absolute -top-4 left-0 cursor-default text-xs text-sf-charcoal transition-all peer-placeholder-shown:left-3 peer-placeholder-shown:top-3 peer-placeholder-shown:cursor-text peer-placeholder-shown:select-none peer-placeholder-shown:text-base peer-focus:-top-4 peer-focus:left-0 peer-focus:cursor-default peer-focus:text-xs peer-focus:text-sf-charcoal"
for="gaq-zip-pl0uya8"> ZIP Code </label>
</div><!-- end partial: shared/components/ui/text-input-label.hbs -->
</div>
<div x-show="type() === 'loc'" x-cloak="">
<!-- start partial: shared/components/ui/select-input-label.hbs -->
<label for="gaq-loc-pl0uya8"
class="font-mecherlesans-reg relative block h-12 w-full border-b border-sf-charcoal text-base text-sf-charcoal placeholder-current [&_select]:h-full [&_select]:w-full [&_select]:cursor-pointer [&_select]:appearance-none [&_select]:px-3 [&_select]:transition-shadow [&_select]:focus-within:outline-none [&_select]:focus-within:ring [&_select]:focus-within:ring-inset [&_select]:focus-within:ring-sf-red-500 "
:class="{}">
<span class="absolute -top-4 left-0 text-xs font-semi">State Selection</span>
<div class="relative flex flex-row items-center w-full h-full">
<select id="gaq-loc-pl0uya8" class="bg-white" x-model="state" name="field-state" aria-required="true" :aria-invalid="!isStateValid()" :aria-describedby="isStateValid() ? '' : describeErrorsID()" @keydown.enter.prevent="validate()">
<option value="" selected="" hidden="">Your State</option>
<option value="AL" :selected="'AL' === state">Alabama</option>
<option value="AK" :selected="'AK' === state">Alaska</option>
<option value="AZ" :selected="'AZ' === state">Arizona</option>
<option value="AR" :selected="'AR' === state">Arkansas</option>
<option value="CA" :selected="'CA' === state">California</option>
<option value="CO" :selected="'CO' === state">Colorado</option>
<option value="CT" :selected="'CT' === state">Connecticut</option>
<option value="DE" :selected="'DE' === state">Delaware</option>
<option value="FL" :selected="'FL' === state">Florida</option>
<option value="GA" :selected="'GA' === state">Georgia</option>
<option value="HI" :selected="'HI' === state">Hawaii</option>
<option value="ID" :selected="'ID' === state">Idaho</option>
<option value="IL" :selected="'IL' === state">Illinois</option>
<option value="IN" :selected="'IN' === state">Indiana</option>
<option value="IA" :selected="'IA' === state">Iowa</option>
<option value="KS" :selected="'KS' === state">Kansas</option>
<option value="KY" :selected="'KY' === state">Kentucky</option>
<option value="LA" :selected="'LA' === state">Louisiana</option>
<option value="ME" :selected="'ME' === state">Maine</option>
<option value="MD" :selected="'MD' === state">Maryland</option>
<option value="MA" :selected="'MA' === state">Massachusetts</option>
<option value="MI" :selected="'MI' === state">Michigan</option>
<option value="MN" :selected="'MN' === state">Minnesota</option>
<option value="MS" :selected="'MS' === state">Mississippi</option>
<option value="MO" :selected="'MO' === state">Missouri</option>
<option value="MT" :selected="'MT' === state">Montana</option>
<option value="NE" :selected="'NE' === state">Nebraska</option>
<option value="NV" :selected="'NV' === state">Nevada</option>
<option value="NH" :selected="'NH' === state">New Hampshire</option>
<option value="NJ" :selected="'NJ' === state">New Jersey</option>
<option value="NM" :selected="'NM' === state">New Mexico</option>
<option value="NY" :selected="'NY' === state">New York</option>
<option value="NC" :selected="'NC' === state">North Carolina</option>
<option value="ND" :selected="'ND' === state">North Dakota</option>
<option value="OH" :selected="'OH' === state">Ohio</option>
<option value="OK" :selected="'OK' === state">Oklahoma</option>
<option value="OR" :selected="'OR' === state">Oregon</option>
<option value="PA" :selected="'PA' === state">Pennsylvania</option>
<option value="RI" :selected="'RI' === state">Rhode Island</option>
<option value="SC" :selected="'SC' === state">South Carolina</option>
<option value="SD" :selected="'SD' === state">South Dakota</option>
<option value="TN" :selected="'TN' === state">Tennessee</option>
<option value="TX" :selected="'TX' === state">Texas</option>
<option value="UT" :selected="'UT' === state">Utah</option>
<option value="VT" :selected="'VT' === state">Vermont</option>
<option value="VA" :selected="'VA' === state">Virginia</option>
<option value="WA" :selected="'WA' === state">Washington</option>
<option value="DC" :selected="'DC' === state">Washington, D.C.</option>
<option value="WV" :selected="'WV' === state">West Virginia</option>
<option value="WI" :selected="'WI' === state">Wisconsin</option>
<option value="WY" :selected="'WY' === state">Wyoming</option>
</select>
<div class="absolute right-4 pointer-events-none">
<div class="svg-outer"><svg xmlns="http://www.w3.org/2000/svg" fill="none" viewBox="0 0 12 7" class="svg-inner" aria-hidden="true" style="fill: currentColor; " preserveAspectRatio="xMinYMid meet">
<path fill="currentColor" fill-rule="evenodd" d="M.293.293a1 1 0 0 1 1.414 0L6 4.586 10.293.293a1 1 0 1 1 1.414 1.414l-5 5a1 1 0 0 1-1.414 0l-5-5a1 1 0 0 1 0-1.414" clip-rule="evenodd"></path>
</svg></div>
</div>
</div>
</label>
<!-- end partial: shared/components/ui/select-input-label.hbs -->
</div>
</div>
</template>
<div id="specific-location-info-pl0uya8">
<div x-show="type() === 'zip'">
<!-- start partial: shared/components/ui/text-input-label.hbs -->
<div class="relative w-full " :class="{}">
<input id="gaq-zip-pl0uya8" type="text" class="bg-white m2-form-input peer" x-model="zip" name="field-zip" autocomplete="postal-code" placeholder="ZIP Code" aria-required="true" :aria-invalid="!isZipValid()"
:aria-describedby="isZipValid() ? '' : describeErrorsID()" @keydown.enter.prevent="validate()" aria-describedby="">
<label
class="font-semi peer-placeholder-shown:font-reg peer-focus:font-semi absolute -top-4 left-0 cursor-default text-xs text-sf-charcoal transition-all peer-placeholder-shown:left-3 peer-placeholder-shown:top-3 peer-placeholder-shown:cursor-text peer-placeholder-shown:select-none peer-placeholder-shown:text-base peer-focus:-top-4 peer-focus:left-0 peer-focus:cursor-default peer-focus:text-xs peer-focus:text-sf-charcoal"
for="gaq-zip-pl0uya8"> ZIP Code </label>
</div><!-- end partial: shared/components/ui/text-input-label.hbs -->
</div>
<div x-show="type() === 'loc'" style="display: none;">
<!-- start partial: shared/components/ui/select-input-label.hbs -->
<label for="gaq-loc-pl0uya8"
class="font-mecherlesans-reg relative block h-12 w-full border-b border-sf-charcoal text-base text-sf-charcoal placeholder-current [&_select]:h-full [&_select]:w-full [&_select]:cursor-pointer [&_select]:appearance-none [&_select]:px-3 [&_select]:transition-shadow [&_select]:focus-within:outline-none [&_select]:focus-within:ring [&_select]:focus-within:ring-inset [&_select]:focus-within:ring-sf-red-500 "
:class="{}">
<span class="absolute -top-4 left-0 text-xs font-semi">State Selection</span>
<div class="relative flex flex-row items-center w-full h-full">
<select id="gaq-loc-pl0uya8" class="bg-white" x-model="state" name="field-state" aria-required="true" :aria-invalid="!isStateValid()" :aria-describedby="isStateValid() ? '' : describeErrorsID()" @keydown.enter.prevent="validate()"
aria-describedby="">
<option value="" selected="" hidden="">Your State</option>
<option value="AL" :selected="'AL' === state">Alabama</option>
<option value="AK" :selected="'AK' === state">Alaska</option>
<option value="AZ" :selected="'AZ' === state">Arizona</option>
<option value="AR" :selected="'AR' === state">Arkansas</option>
<option value="CA" :selected="'CA' === state">California</option>
<option value="CO" :selected="'CO' === state">Colorado</option>
<option value="CT" :selected="'CT' === state">Connecticut</option>
<option value="DE" :selected="'DE' === state">Delaware</option>
<option value="FL" :selected="'FL' === state">Florida</option>
<option value="GA" :selected="'GA' === state">Georgia</option>
<option value="HI" :selected="'HI' === state">Hawaii</option>
<option value="ID" :selected="'ID' === state">Idaho</option>
<option value="IL" :selected="'IL' === state">Illinois</option>
<option value="IN" :selected="'IN' === state">Indiana</option>
<option value="IA" :selected="'IA' === state">Iowa</option>
<option value="KS" :selected="'KS' === state">Kansas</option>
<option value="KY" :selected="'KY' === state">Kentucky</option>
<option value="LA" :selected="'LA' === state">Louisiana</option>
<option value="ME" :selected="'ME' === state">Maine</option>
<option value="MD" :selected="'MD' === state">Maryland</option>
<option value="MA" :selected="'MA' === state">Massachusetts</option>
<option value="MI" :selected="'MI' === state">Michigan</option>
<option value="MN" :selected="'MN' === state">Minnesota</option>
<option value="MS" :selected="'MS' === state">Mississippi</option>
<option value="MO" :selected="'MO' === state">Missouri</option>
<option value="MT" :selected="'MT' === state">Montana</option>
<option value="NE" :selected="'NE' === state">Nebraska</option>
<option value="NV" :selected="'NV' === state">Nevada</option>
<option value="NH" :selected="'NH' === state">New Hampshire</option>
<option value="NJ" :selected="'NJ' === state">New Jersey</option>
<option value="NM" :selected="'NM' === state">New Mexico</option>
<option value="NY" :selected="'NY' === state">New York</option>
<option value="NC" :selected="'NC' === state">North Carolina</option>
<option value="ND" :selected="'ND' === state">North Dakota</option>
<option value="OH" :selected="'OH' === state">Ohio</option>
<option value="OK" :selected="'OK' === state">Oklahoma</option>
<option value="OR" :selected="'OR' === state">Oregon</option>
<option value="PA" :selected="'PA' === state">Pennsylvania</option>
<option value="RI" :selected="'RI' === state">Rhode Island</option>
<option value="SC" :selected="'SC' === state">South Carolina</option>
<option value="SD" :selected="'SD' === state">South Dakota</option>
<option value="TN" :selected="'TN' === state">Tennessee</option>
<option value="TX" :selected="'TX' === state">Texas</option>
<option value="UT" :selected="'UT' === state">Utah</option>
<option value="VT" :selected="'VT' === state">Vermont</option>
<option value="VA" :selected="'VA' === state">Virginia</option>
<option value="WA" :selected="'WA' === state">Washington</option>
<option value="DC" :selected="'DC' === state">Washington, D.C.</option>
<option value="WV" :selected="'WV' === state">West Virginia</option>
<option value="WI" :selected="'WI' === state">Wisconsin</option>
<option value="WY" :selected="'WY' === state">Wyoming</option>
</select>
<div class="absolute right-4 pointer-events-none">
<div class="svg-outer"><svg xmlns="http://www.w3.org/2000/svg" fill="none" viewBox="0 0 12 7" class="svg-inner" aria-hidden="true" style="fill: currentColor; " preserveAspectRatio="xMinYMid meet">
<path fill="currentColor" fill-rule="evenodd" d="M.293.293a1 1 0 0 1 1.414 0L6 4.586 10.293.293a1 1 0 1 1 1.414 1.414l-5 5a1 1 0 0 1-1.414 0l-5-5a1 1 0 0 1 0-1.414" clip-rule="evenodd"></path>
</svg></div>
</div>
</div>
</label>
<!-- end partial: shared/components/ui/select-input-label.hbs -->
</div>
</div>
<div class="w-full @lg:col-span-2 @2xl:col-span-1">
<button @click.stop.prevent="validate()" type="button" :disabled="submitting" class="btn btn-primary">
<span x-show="!['business', 'motorcycle'].includes(productKey)">Start a Quote</span>
<span x-show="['business', 'motorcycle'].includes(productKey)" style="display: none;">Request a Quote</span>
</button>
</div>
<template x-if="errors.length > 0">
<div role="alert" aria-atomic="true" :id="ariaDescribedByErrorsID">
<template x-for="error in errors">
<h3 class="p-3 border-2 font-med text-sf-red-700 bg-sf-red-100 border-sf-red-700 rounded-2xl" x-html="error"></h3>
</template>
</div>
</template>
</form>
#
<form id="quote-start-h63un1w" action="#" class="w-full mt-4 grid gap-6 @2xl:grid-cols-3 @2xl:items-center @2xl:bg-sf-charcoal-100 @2xl:p-6 @2xl:mt-0 @5xl:gap-6 @5xl:p-8 @lg:grid-cols-2 @lg:gap-4"
:class="!['zip', 'loc'].includes(type()) ? '@lg:grid-cols-1 gap-x-0 @lg:gap-y-4 @2xl:gap-x-4' : '@lg:grid-cols-2 @lg:gap-4'">
<div :class="!['zip', 'loc'].includes(type()) ? '@2xl:col-span-2' : ''" class="">
<!-- start partial: shared/components/ui/select-input-label.hbs -->
<label for="gaq-product-h63un1w"
class="font-mecherlesans-reg relative block h-12 w-full border-b border-sf-charcoal text-base text-sf-charcoal placeholder-current [&_select]:h-full [&_select]:w-full [&_select]:cursor-pointer [&_select]:appearance-none [&_select]:px-3 [&_select]:transition-shadow [&_select]:focus-within:outline-none [&_select]:focus-within:ring [&_select]:focus-within:ring-inset [&_select]:focus-within:ring-sf-red-500 "
:class="{}">
<span class="absolute -top-4 left-0 text-xs font-semi">Select an Insurance Product</span>
<div class="relative flex flex-row items-center w-full h-full">
<select id="gaq-product-h63un1w" name="field-auto" @change="selectProduct()" x-model="productKey" aria-controls="specific-location-info-h63un1w" :aria-describedby="productSelected ? '' : describeErrorsID()" class="bg-white"
aria-describedby="">
<option value="" selected="" hidden="">Select Product</option>
<template x-for="line in lineOptions">
<option :value="line.key" x-text="line.label" :selected="line.key === productKey"></option>
</template>
<option :value="line.key" x-text="line.label" :selected="line.key === productKey" value="auto">Auto</option>
<option :value="line.key" x-text="line.label" :selected="line.key === productKey" value="motorcycle">Motorcycle</option>
<option :value="line.key" x-text="line.label" :selected="line.key === productKey" value="homeowners">Homeowners</option>
<option :value="line.key" x-text="line.label" :selected="line.key === productKey" value="condo">Condo Owners</option>
<option :value="line.key" x-text="line.label" :selected="line.key === productKey" value="renters">Renters</option>
<option :value="line.key" x-text="line.label" :selected="line.key === productKey" value="life">Life</option>
<option :value="line.key" x-text="line.label" :selected="line.key === productKey" value="medicare">Medicare Supplement</option>
<option :value="line.key" x-text="line.label" :selected="line.key === productKey" value="hospital">Supplemental Health</option>
<option :value="line.key" x-text="line.label" :selected="line.key === productKey" value="business">Small Business</option>
<option :value="line.key" x-text="line.label" :selected="line.key === productKey" value="pet">Pet Insurance</option>
</select>
<div class="absolute right-4 pointer-events-none">
<div class="svg-outer"><svg xmlns="http://www.w3.org/2000/svg" fill="none" viewBox="0 0 12 7" class="svg-inner" aria-hidden="true" style="fill: currentColor; " preserveAspectRatio="xMinYMid meet">
<path fill="currentColor" fill-rule="evenodd" d="M.293.293a1 1 0 0 1 1.414 0L6 4.586 10.293.293a1 1 0 1 1 1.414 1.414l-5 5a1 1 0 0 1-1.414 0l-5-5a1 1 0 0 1 0-1.414" clip-rule="evenodd"></path>
</svg></div>
</div>
</div>
</label>
<!-- end partial: shared/components/ui/select-input-label.hbs -->
</div>
<template x-if="['zip', 'loc'].includes(type())">
<div id="specific-location-info-h63un1w">
<div x-show="type() === 'zip'" x-cloak="">
<!-- start partial: shared/components/ui/text-input-label.hbs -->
<div class="relative w-full " :class="{}">
<input id="gaq-zip-h63un1w" type="text" class="bg-white m2-form-input peer" x-model="zip" name="field-zip" autocomplete="postal-code" placeholder="ZIP Code" aria-required="true" :aria-invalid="!isZipValid()"
:aria-describedby="isZipValid() ? '' : describeErrorsID()" @keydown.enter.prevent="validate()">
<label
class="font-semi peer-placeholder-shown:font-reg peer-focus:font-semi absolute -top-4 left-0 cursor-default text-xs text-sf-charcoal transition-all peer-placeholder-shown:left-3 peer-placeholder-shown:top-3 peer-placeholder-shown:cursor-text peer-placeholder-shown:select-none peer-placeholder-shown:text-base peer-focus:-top-4 peer-focus:left-0 peer-focus:cursor-default peer-focus:text-xs peer-focus:text-sf-charcoal"
for="gaq-zip-h63un1w"> ZIP Code </label>
</div><!-- end partial: shared/components/ui/text-input-label.hbs -->
</div>
<div x-show="type() === 'loc'" x-cloak="">
<!-- start partial: shared/components/ui/select-input-label.hbs -->
<label for="gaq-loc-h63un1w"
class="font-mecherlesans-reg relative block h-12 w-full border-b border-sf-charcoal text-base text-sf-charcoal placeholder-current [&_select]:h-full [&_select]:w-full [&_select]:cursor-pointer [&_select]:appearance-none [&_select]:px-3 [&_select]:transition-shadow [&_select]:focus-within:outline-none [&_select]:focus-within:ring [&_select]:focus-within:ring-inset [&_select]:focus-within:ring-sf-red-500 "
:class="{}">
<span class="absolute -top-4 left-0 text-xs font-semi">State Selection</span>
<div class="relative flex flex-row items-center w-full h-full">
<select id="gaq-loc-h63un1w" class="bg-white" x-model="state" name="field-state" aria-required="true" :aria-invalid="!isStateValid()" :aria-describedby="isStateValid() ? '' : describeErrorsID()" @keydown.enter.prevent="validate()">
<option value="" selected="" hidden="">Your State</option>
<option value="AL" :selected="'AL' === state">Alabama</option>
<option value="AK" :selected="'AK' === state">Alaska</option>
<option value="AZ" :selected="'AZ' === state">Arizona</option>
<option value="AR" :selected="'AR' === state">Arkansas</option>
<option value="CA" :selected="'CA' === state">California</option>
<option value="CO" :selected="'CO' === state">Colorado</option>
<option value="CT" :selected="'CT' === state">Connecticut</option>
<option value="DE" :selected="'DE' === state">Delaware</option>
<option value="FL" :selected="'FL' === state">Florida</option>
<option value="GA" :selected="'GA' === state">Georgia</option>
<option value="HI" :selected="'HI' === state">Hawaii</option>
<option value="ID" :selected="'ID' === state">Idaho</option>
<option value="IL" :selected="'IL' === state">Illinois</option>
<option value="IN" :selected="'IN' === state">Indiana</option>
<option value="IA" :selected="'IA' === state">Iowa</option>
<option value="KS" :selected="'KS' === state">Kansas</option>
<option value="KY" :selected="'KY' === state">Kentucky</option>
<option value="LA" :selected="'LA' === state">Louisiana</option>
<option value="ME" :selected="'ME' === state">Maine</option>
<option value="MD" :selected="'MD' === state">Maryland</option>
<option value="MA" :selected="'MA' === state">Massachusetts</option>
<option value="MI" :selected="'MI' === state">Michigan</option>
<option value="MN" :selected="'MN' === state">Minnesota</option>
<option value="MS" :selected="'MS' === state">Mississippi</option>
<option value="MO" :selected="'MO' === state">Missouri</option>
<option value="MT" :selected="'MT' === state">Montana</option>
<option value="NE" :selected="'NE' === state">Nebraska</option>
<option value="NV" :selected="'NV' === state">Nevada</option>
<option value="NH" :selected="'NH' === state">New Hampshire</option>
<option value="NJ" :selected="'NJ' === state">New Jersey</option>
<option value="NM" :selected="'NM' === state">New Mexico</option>
<option value="NY" :selected="'NY' === state">New York</option>
<option value="NC" :selected="'NC' === state">North Carolina</option>
<option value="ND" :selected="'ND' === state">North Dakota</option>
<option value="OH" :selected="'OH' === state">Ohio</option>
<option value="OK" :selected="'OK' === state">Oklahoma</option>
<option value="OR" :selected="'OR' === state">Oregon</option>
<option value="PA" :selected="'PA' === state">Pennsylvania</option>
<option value="RI" :selected="'RI' === state">Rhode Island</option>
<option value="SC" :selected="'SC' === state">South Carolina</option>
<option value="SD" :selected="'SD' === state">South Dakota</option>
<option value="TN" :selected="'TN' === state">Tennessee</option>
<option value="TX" :selected="'TX' === state">Texas</option>
<option value="UT" :selected="'UT' === state">Utah</option>
<option value="VT" :selected="'VT' === state">Vermont</option>
<option value="VA" :selected="'VA' === state">Virginia</option>
<option value="WA" :selected="'WA' === state">Washington</option>
<option value="DC" :selected="'DC' === state">Washington, D.C.</option>
<option value="WV" :selected="'WV' === state">West Virginia</option>
<option value="WI" :selected="'WI' === state">Wisconsin</option>
<option value="WY" :selected="'WY' === state">Wyoming</option>
</select>
<div class="absolute right-4 pointer-events-none">
<div class="svg-outer"><svg xmlns="http://www.w3.org/2000/svg" fill="none" viewBox="0 0 12 7" class="svg-inner" aria-hidden="true" style="fill: currentColor; " preserveAspectRatio="xMinYMid meet">
<path fill="currentColor" fill-rule="evenodd" d="M.293.293a1 1 0 0 1 1.414 0L6 4.586 10.293.293a1 1 0 1 1 1.414 1.414l-5 5a1 1 0 0 1-1.414 0l-5-5a1 1 0 0 1 0-1.414" clip-rule="evenodd"></path>
</svg></div>
</div>
</div>
</label>
<!-- end partial: shared/components/ui/select-input-label.hbs -->
</div>
</div>
</template>
<div id="specific-location-info-h63un1w">
<div x-show="type() === 'zip'">
<!-- start partial: shared/components/ui/text-input-label.hbs -->
<div class="relative w-full " :class="{}">
<input id="gaq-zip-h63un1w" type="text" class="bg-white m2-form-input peer" x-model="zip" name="field-zip" autocomplete="postal-code" placeholder="ZIP Code" aria-required="true" :aria-invalid="!isZipValid()"
:aria-describedby="isZipValid() ? '' : describeErrorsID()" @keydown.enter.prevent="validate()" aria-describedby="">
<label
class="font-semi peer-placeholder-shown:font-reg peer-focus:font-semi absolute -top-4 left-0 cursor-default text-xs text-sf-charcoal transition-all peer-placeholder-shown:left-3 peer-placeholder-shown:top-3 peer-placeholder-shown:cursor-text peer-placeholder-shown:select-none peer-placeholder-shown:text-base peer-focus:-top-4 peer-focus:left-0 peer-focus:cursor-default peer-focus:text-xs peer-focus:text-sf-charcoal"
for="gaq-zip-h63un1w"> ZIP Code </label>
</div><!-- end partial: shared/components/ui/text-input-label.hbs -->
</div>
<div x-show="type() === 'loc'" style="display: none;">
<!-- start partial: shared/components/ui/select-input-label.hbs -->
<label for="gaq-loc-h63un1w"
class="font-mecherlesans-reg relative block h-12 w-full border-b border-sf-charcoal text-base text-sf-charcoal placeholder-current [&_select]:h-full [&_select]:w-full [&_select]:cursor-pointer [&_select]:appearance-none [&_select]:px-3 [&_select]:transition-shadow [&_select]:focus-within:outline-none [&_select]:focus-within:ring [&_select]:focus-within:ring-inset [&_select]:focus-within:ring-sf-red-500 "
:class="{}">
<span class="absolute -top-4 left-0 text-xs font-semi">State Selection</span>
<div class="relative flex flex-row items-center w-full h-full">
<select id="gaq-loc-h63un1w" class="bg-white" x-model="state" name="field-state" aria-required="true" :aria-invalid="!isStateValid()" :aria-describedby="isStateValid() ? '' : describeErrorsID()" @keydown.enter.prevent="validate()"
aria-describedby="">
<option value="" selected="" hidden="">Your State</option>
<option value="AL" :selected="'AL' === state">Alabama</option>
<option value="AK" :selected="'AK' === state">Alaska</option>
<option value="AZ" :selected="'AZ' === state">Arizona</option>
<option value="AR" :selected="'AR' === state">Arkansas</option>
<option value="CA" :selected="'CA' === state">California</option>
<option value="CO" :selected="'CO' === state">Colorado</option>
<option value="CT" :selected="'CT' === state">Connecticut</option>
<option value="DE" :selected="'DE' === state">Delaware</option>
<option value="FL" :selected="'FL' === state">Florida</option>
<option value="GA" :selected="'GA' === state">Georgia</option>
<option value="HI" :selected="'HI' === state">Hawaii</option>
<option value="ID" :selected="'ID' === state">Idaho</option>
<option value="IL" :selected="'IL' === state">Illinois</option>
<option value="IN" :selected="'IN' === state">Indiana</option>
<option value="IA" :selected="'IA' === state">Iowa</option>
<option value="KS" :selected="'KS' === state">Kansas</option>
<option value="KY" :selected="'KY' === state">Kentucky</option>
<option value="LA" :selected="'LA' === state">Louisiana</option>
<option value="ME" :selected="'ME' === state">Maine</option>
<option value="MD" :selected="'MD' === state">Maryland</option>
<option value="MA" :selected="'MA' === state">Massachusetts</option>
<option value="MI" :selected="'MI' === state">Michigan</option>
<option value="MN" :selected="'MN' === state">Minnesota</option>
<option value="MS" :selected="'MS' === state">Mississippi</option>
<option value="MO" :selected="'MO' === state">Missouri</option>
<option value="MT" :selected="'MT' === state">Montana</option>
<option value="NE" :selected="'NE' === state">Nebraska</option>
<option value="NV" :selected="'NV' === state">Nevada</option>
<option value="NH" :selected="'NH' === state">New Hampshire</option>
<option value="NJ" :selected="'NJ' === state">New Jersey</option>
<option value="NM" :selected="'NM' === state">New Mexico</option>
<option value="NY" :selected="'NY' === state">New York</option>
<option value="NC" :selected="'NC' === state">North Carolina</option>
<option value="ND" :selected="'ND' === state">North Dakota</option>
<option value="OH" :selected="'OH' === state">Ohio</option>
<option value="OK" :selected="'OK' === state">Oklahoma</option>
<option value="OR" :selected="'OR' === state">Oregon</option>
<option value="PA" :selected="'PA' === state">Pennsylvania</option>
<option value="RI" :selected="'RI' === state">Rhode Island</option>
<option value="SC" :selected="'SC' === state">South Carolina</option>
<option value="SD" :selected="'SD' === state">South Dakota</option>
<option value="TN" :selected="'TN' === state">Tennessee</option>
<option value="TX" :selected="'TX' === state">Texas</option>
<option value="UT" :selected="'UT' === state">Utah</option>
<option value="VT" :selected="'VT' === state">Vermont</option>
<option value="VA" :selected="'VA' === state">Virginia</option>
<option value="WA" :selected="'WA' === state">Washington</option>
<option value="DC" :selected="'DC' === state">Washington, D.C.</option>
<option value="WV" :selected="'WV' === state">West Virginia</option>
<option value="WI" :selected="'WI' === state">Wisconsin</option>
<option value="WY" :selected="'WY' === state">Wyoming</option>
</select>
<div class="absolute right-4 pointer-events-none">
<div class="svg-outer"><svg xmlns="http://www.w3.org/2000/svg" fill="none" viewBox="0 0 12 7" class="svg-inner" aria-hidden="true" style="fill: currentColor; " preserveAspectRatio="xMinYMid meet">
<path fill="currentColor" fill-rule="evenodd" d="M.293.293a1 1 0 0 1 1.414 0L6 4.586 10.293.293a1 1 0 1 1 1.414 1.414l-5 5a1 1 0 0 1-1.414 0l-5-5a1 1 0 0 1 0-1.414" clip-rule="evenodd"></path>
</svg></div>
</div>
</div>
</label>
<!-- end partial: shared/components/ui/select-input-label.hbs -->
</div>
</div>
<div class="w-full @lg:col-span-2 @2xl:col-span-1">
<button @click.stop.prevent="validate()" type="button" :disabled="submitting" class="btn btn-primary">
<span x-show="!['business', 'motorcycle'].includes(productKey)">Start a Quote</span>
<span x-show="['business', 'motorcycle'].includes(productKey)" style="display: none;">Request a Quote</span>
</button>
</div>
<template x-if="errors.length > 0">
<div role="alert" aria-atomic="true" :id="ariaDescribedByErrorsID">
<template x-for="error in errors">
<h3 class="p-3 border-2 font-med text-sf-red-700 bg-sf-red-100 border-sf-red-700 rounded-2xl" x-html="error"></h3>
</template>
</div>
</template>
</form>
POST
<form x-show="!sendResponse && !sending" :action="`/contact${qs}`" method="post" aria-describedby="disclaimers">
<h2 x-show="true" class="hidden text-2xl font-med md:block"> You can also call us at <a :id="$id('phone-link-contact-form')" aria-label="You can also call us at (970) 842-4555" href="tel:9708424555" class="red-link">
(970) 842-4555
</a>
</h2>
<!-- start partial: shared/components/contact-forms/cf-more-prefs.hbs -->
<label x-id="['preferred__alpha']" :for="$id('preferred__alpha')" class="absolute -left-[9999px] -top-[9999px] opacity-0 -z-10"> preferred__alpha <input :id="$id('preferred__alpha')" type="url" name="preferred__alpha" tabindex="-1"
x-model="form.preferred__alpha" autocomplete="off" value="">
</label>
<label x-id="['preferred__beta']" :for="$id('preferred__beta')" class="absolute -left-[9999px] -top-[9999px] opacity-0 -z-10"> preferred__beta <input :id="$id('preferred__beta')" type="text" name="preferred__beta" tabindex="-1"
x-model="form.preferred__beta" autocomplete="off" value="">
</label>
<label x-id="['preferred__extra']" :for="$id('preferred__extra')" class="absolute -left-[9999px] -top-[9999px] opacity-0 -z-10"> preferred__extra <input :id="$id('preferred__extra')" type="checkbox" name="preferred__extra" tabindex="-1"
x-model="form.preferred__extra" autocomplete="off" value="">
</label>
<!-- end partial: shared/components/contact-forms/cf-more-prefs.hbs -->
<h2 class="text-2xl text-center mb-4 font-med md:hidden"> Contact Us </h2>
<div class="flex flex-col min-w-0 md:mt-8 md:flex-row">
<div class="w-full md:w-1/2 md:shrink-0 md:mr-8 lg:w-2/3 xl:m-0">
<div class="flex flex-col w-full xl:flex-row">
<div class="flex flex-col xl:h-full xl:justify-between xl:w-1/2 xl:pr-8">
<div class="hidden mt-4 xl:block">
<!-- start partial: shared/components/contact-forms/cf-prefs.hbs -->
<fieldset x-id="[
'xl-contact-form-pref-email',
'xl-contact-form-pref-phone',
'xl-contact-form-pref',
]">
<legend class="text-sm uppercase"> Your preferred method of contact </legend>
<ul class="mt-2 flex flex-row">
<li>
<input :id="$id('xl-contact-form-pref-email')" class="m2-radio-input pointer-events-none absolute m-0 h-0 w-0 p-0 opacity-0" :name="$id('xl-contact-form-pref')" type="radio" value="email" x-model="form.pref"
@change="clearPrefErrors()">
<label :for="$id('xl-contact-form-pref-email')" class="m2-radio-label mr-4 inline-flex cursor-pointer select-none items-start text-sm leading-6"> Your Email </label>
</li>
<li>
<input :id="$id('xl-contact-form-pref-phone')" class="m2-radio-input pointer-events-none absolute m-0 h-0 w-0 p-0 opacity-0" :name="$id('xl-contact-form-pref')" type="radio" value="phone" x-model="form.pref"
@change="clearPrefErrors()">
<label :for="$id('xl-contact-form-pref-phone')" class="m2-radio-label mr-4 inline-flex cursor-pointer select-none items-start text-sm leading-6"> Your Phone </label>
</li>
</ul>
</fieldset><!-- end partial: shared/components/contact-forms/cf-prefs.hbs -->
</div>
<div class="xl:mt-6">
<!-- start partial: shared/components/contact-forms/cf-contact-info.hbs -->
<div class="flex flex-col w-full space-y-5" x-id="['contact-form-name', 'contact-form-phone', 'contact-form-email', 'contact-form-email-or-phone']">
<!-- start partial: shared/components/contact-forms/cf-text-field.hbs -->
<!-- start partial: shared/components/ui/text-input-label.hbs -->
<div class="relative w-full " :class="{}">
<input :id="$id('contact-form-name')" class="m2-form-input peer " name="contact-form-name" x-model="form.name" :aria-required="true" autocomplete="name" type="text" placeholder="Your Name" :aria-invalid="hasError('name')"
:aria-describedby="hasError('name') ? $id('error', 'name') : null" :error="hasError('name')" @keydown.debounce.750ms="validateName()">
<label
class="font-semi peer-placeholder-shown:font-reg peer-focus:font-semi absolute -top-4 left-0 cursor-default text-xs text-sf-charcoal transition-all peer-placeholder-shown:left-3 peer-placeholder-shown:top-3 peer-placeholder-shown:cursor-text peer-placeholder-shown:select-none peer-placeholder-shown:text-base peer-focus:-top-4 peer-focus:left-0 peer-focus:cursor-default peer-focus:text-xs peer-focus:text-sf-charcoal"
:for="$id('contact-form-name')"> Your Name<span aria-hidden="true" x-show="hasError('name')">*</span>
</label>
</div><!-- end partial: shared/components/ui/text-input-label.hbs -->
<!-- end partial: shared/components/contact-forms/cf-text-field.hbs -->
<!-- start partial: shared/components/contact-forms/cf-text-field.hbs -->
<!-- start partial: shared/components/ui/text-input-label.hbs -->
<div class="relative w-full " :class="{}">
<input :id="$id('contact-form-phone')" class="m2-form-input peer " name="contact-form-phone" x-model="form.phone" :aria-required="hasError('phone') && form.pref == 'phone'" autocomplete="tel" type="text"
placeholder="Your Phone" :aria-invalid="hasError('phone')" :aria-describedby="hasError('phone') ? $id('error', 'phone') : null" :error="hasError('phone')" @keydown.debounce.750ms="validatePhone()">
<label
class="font-semi peer-placeholder-shown:font-reg peer-focus:font-semi absolute -top-4 left-0 cursor-default text-xs text-sf-charcoal transition-all peer-placeholder-shown:left-3 peer-placeholder-shown:top-3 peer-placeholder-shown:cursor-text peer-placeholder-shown:select-none peer-placeholder-shown:text-base peer-focus:-top-4 peer-focus:left-0 peer-focus:cursor-default peer-focus:text-xs peer-focus:text-sf-charcoal"
:for="$id('contact-form-phone')"> Your Phone<span aria-hidden="true" x-show="hasError('phone')">*</span>
</label>
</div><!-- end partial: shared/components/ui/text-input-label.hbs -->
<!-- end partial: shared/components/contact-forms/cf-text-field.hbs -->
<!-- start partial: shared/components/contact-forms/cf-text-field.hbs -->
<!-- start partial: shared/components/ui/text-input-label.hbs -->
<div class="relative w-full " :class="{}">
<input :id="$id('contact-form-email')" class="m2-form-input peer " name="contact-form-email" x-model="form.email" :aria-required="hasError('email') && form.pref == 'email'" autocomplete="email" type="text"
placeholder="Your Email" :aria-invalid="hasError('email')" :aria-describedby="hasError('email') ? $id('error', 'email') : null" :error="hasError('email')" @keydown.debounce.750ms="validateEmail()">
<label
class="font-semi peer-placeholder-shown:font-reg peer-focus:font-semi absolute -top-4 left-0 cursor-default text-xs text-sf-charcoal transition-all peer-placeholder-shown:left-3 peer-placeholder-shown:top-3 peer-placeholder-shown:cursor-text peer-placeholder-shown:select-none peer-placeholder-shown:text-base peer-focus:-top-4 peer-focus:left-0 peer-focus:cursor-default peer-focus:text-xs peer-focus:text-sf-charcoal"
:for="$id('contact-form-email')"> Your Email<span aria-hidden="true" x-show="hasError('email')">*</span>
</label>
</div><!-- end partial: shared/components/ui/text-input-label.hbs -->
<!-- end partial: shared/components/contact-forms/cf-text-field.hbs -->
</div><!-- end partial: shared/components/contact-forms/cf-contact-info.hbs -->
</div>
</div>
<div class="flex-col hidden xl:w-1/2 md:flex xl:flex-col-reverse xl:justify-end">
<div class="h-full mt-5">
<!-- start partial: shared/components/contact-forms/cf-message.hbs -->
<div class="relative h-full" x-id="[
'md-contact-form-message'
]">
<!-- start partial: shared/components/ui/text-input-label.hbs -->
<div class="relative w-full h-full" :class="{}">
<textarea :id="$id('md-contact-form-message')" ref="message" x-model="form.message" class="m2-form-input peer h-48 xl:h-full pa11y-ignore" placeholder="Your Message:" :maxlength="MAX_MESSAGE_LENGTH" :aria-invalid="hasError('message')"
:aria-describedby="`char-limit, md-message-warning ${hasError("message") ? $id("error", "message") : ""}`" :aria-required="hasError('message')"
@keydown.debounce.750ms="validateMessage(), validateMessageLength()" @keydown.debounce.5ms="displayMessageLength()" :error="hasError('message')"></textarea>
<p id="char-limit" class="flex justify-end" aria-live="polite" x-text="`${remainingCharacters}`"></p>
<label
class="font-semi peer-placeholder-shown:font-reg peer-focus:font-semi absolute -top-4 left-0 cursor-default text-xs text-sf-charcoal transition-all peer-placeholder-shown:left-3 peer-placeholder-shown:top-3 peer-placeholder-shown:cursor-text peer-placeholder-shown:select-none peer-placeholder-shown:text-base peer-focus:-top-4 peer-focus:left-0 peer-focus:cursor-default peer-focus:text-xs peer-focus:text-sf-charcoal"
:for="$id('md-contact-form-message')"> Your Message:<span aria-hidden="true" x-show="hasError('message')">*</span>
</label>
</div><!-- end partial: shared/components/ui/text-input-label.hbs -->
</div><!-- end partial: shared/components/contact-forms/cf-message.hbs -->
</div>
<div class="mt-4">
<!-- start partial: shared/components/contact-forms/cf-message-warning.hbs -->
<p class="text-xs" id="md-message-warning"> For your protection, please do not include sensitive personal information such as social security numbers, credit/debit card number, or health/medical information. </p>
<!-- end partial: shared/components/contact-forms/cf-message-warning.hbs -->
</div>
</div>
</div>
</div>
<div class="flex flex-col w-full md:w-1/2 lg:w-1/3 xl:justify-between xl:pl-8">
<div class="mt-6 xl:hidden md:m-0">
<!-- start partial: shared/components/contact-forms/cf-prefs.hbs -->
<fieldset x-id="[
'xl-contact-form-pref-email',
'xl-contact-form-pref-phone',
'xl-contact-form-pref',
]">
<legend class="text-sm uppercase"> Your preferred method of contact </legend>
<ul class="mt-2 flex flex-row">
<li>
<input :id="$id('xl-contact-form-pref-email')" class="m2-radio-input pointer-events-none absolute m-0 h-0 w-0 p-0 opacity-0" :name="$id('xl-contact-form-pref')" type="radio" value="email" x-model="form.pref" @change="clearPrefErrors()">
<label :for="$id('xl-contact-form-pref-email')" class="m2-radio-label mr-4 inline-flex cursor-pointer select-none items-start text-sm leading-6"> Your Email </label>
</li>
<li>
<input :id="$id('xl-contact-form-pref-phone')" class="m2-radio-input pointer-events-none absolute m-0 h-0 w-0 p-0 opacity-0" :name="$id('xl-contact-form-pref')" type="radio" value="phone" x-model="form.pref" @change="clearPrefErrors()">
<label :for="$id('xl-contact-form-pref-phone')" class="m2-radio-label mr-4 inline-flex cursor-pointer select-none items-start text-sm leading-6"> Your Phone </label>
</li>
</ul>
</fieldset><!-- end partial: shared/components/contact-forms/cf-prefs.hbs -->
</div>
<div class="flex w-full mt-4 xl:h-full">
<!-- start partial: shared/components/contact-forms/cf-more-info.hbs -->
<fieldset class="flex w-full flex-col" x-id="['contact-form-checkbox-input']">
<legend class="mb-2 text-sm uppercase"> I'd like more info about: <span aria-hidden="true" x-show="hasError('message')"> * </span>
</legend>
<div class="grid sm:grid-flow-col sm:grid-cols-2 sm:grid-rows-3 md:grid-cols-1 md:grid-rows-6 xl:h-full">
<template x-for="(i, k) in moreVals" :key="i.id">
<div :id="$id(`contact-form-checkbox-${i.id}`)" class="m2-contact-form-checkbox">
<input :id="$id('contact-form-checkbox-input', i.id)" class="m2-checkbox-input absolute h-0 w-0 overflow-hidden border-none p-0" x-model="form.more" type="checkbox"
:aria-describedby="hasError('message') ? $id('error', 'message') : null" :value="i.label" :aria-label="`${k + 1} of ${moreVals().length}, I'd like more info about ${i.label}`" :aria-invalid="hasError('more')"
@click="validateMessage()">
<label :for="$id('contact-form-checkbox-input', i.id)" class="m2-checkbox-label flex cursor-pointer items-center rounded py-2 pl-8 transition-all hover:bg-sf-charcoal-100">
<svg viewBox="0 0 100 100" class="absolute left-1 h-4 w-4">
<path class="path" fill="none" stroke="#000" stroke-width="13" stroke-linecap="round" stroke-linejoin="round" stroke-miterlimit="10" d="M12.1 52.1l24.4 24.4 53-53"></path>
</svg>
<span class="text-sm" x-html="i.label"></span>
</label>
</div>
</template>
</div>
</fieldset><!-- end partial: shared/components/contact-forms/cf-more-info.hbs -->
</div>
<div class="mt-4 text-xs md:hidden">
<!-- start partial: shared/components/contact-forms/cf-message-warning.hbs -->
<p class="text-xs" id="message-warning"> For your protection, please do not include sensitive personal information such as social security numbers, credit/debit card number, or health/medical information. </p>
<!-- end partial: shared/components/contact-forms/cf-message-warning.hbs -->
</div>
<div class="mt-5 md:hidden">
<!-- start partial: shared/components/contact-forms/cf-message.hbs -->
<div class="relative h-full" x-id="[
'contact-form-message'
]">
<!-- start partial: shared/components/ui/text-input-label.hbs -->
<div class="relative w-full h-full" :class="{}">
<textarea :id="$id('contact-form-message')" ref="message" x-model="form.message" class="m2-form-input peer h-48 pa11y-ignore" placeholder="Your Message:" :maxlength="MAX_MESSAGE_LENGTH" :aria-invalid="hasError('message')"
:aria-describedby="`char-limit, message-warning ${hasError("message") ? $id("error", "message") : ""}`" :aria-required="hasError('message')"
@keydown.debounce.750ms="validateMessage(), validateMessageLength()" @keydown.debounce.5ms="displayMessageLength()" :error="hasError('message')"></textarea>
<p id="char-limit" class="flex justify-end" aria-live="polite" x-text="`${remainingCharacters}`"></p>
<label
class="font-semi peer-placeholder-shown:font-reg peer-focus:font-semi absolute -top-4 left-0 cursor-default text-xs text-sf-charcoal transition-all peer-placeholder-shown:left-3 peer-placeholder-shown:top-3 peer-placeholder-shown:cursor-text peer-placeholder-shown:select-none peer-placeholder-shown:text-base peer-focus:-top-4 peer-focus:left-0 peer-focus:cursor-default peer-focus:text-xs peer-focus:text-sf-charcoal"
:for="$id('contact-form-message')"> Your Message:<span aria-hidden="true" x-show="hasError('message')">*</span>
</label>
</div><!-- end partial: shared/components/ui/text-input-label.hbs -->
</div><!-- end partial: shared/components/contact-forms/cf-message.hbs -->
</div>
</div>
</div>
<div class="flex flex-col w-full mt-4 pt-3 md:flex-row xl:justify-end">
<div class="md:w-1/2 xl:w-1/3">
<!-- start partial: shared/components/contact-forms/cf-file-input.hbs -->
<div x-ref="contactFormAttachments" class="w-full" x-data="initFileInput()">
<div x-show="$store.fileList.length" class="w-full mb-2 text-xl italic text-center border-b-2 border-gray-400 border-dashed" x-text="$store.fileList.length + ' attached file' + ($store.fileList.length > 1 ? 's:' : ':')">
</div>
<template x-for="(att, idx) in $store.fileList">
<div :key="idx" class="relative my-2 grid w-full grid-cols-4 flex-nowrap bg-sf-charcoal-100 p-4">
<div class="flex justify-center h-12 col-span-1 mr-4">
<img x-show="checkType(att) === 'img'" :id="att.name" class="object-contain" :alt="att.name">
<template x-if="checkType(att) != 'img'">
<div x-html="svgIcon(checkType(att), "h-full")" class="h-full">
</div>
</template>
</div>
<div class="flex flex-col justify-center col-span-3 mr-1">
<div class="flex flex-row w-full mb-1">
<span :aria-label="`This file is ${friendlySize(att.size)} in size`" data-microtip-position="bottom-right" role="tooltip" class="px-2 py-1 text-xs rounded-full w-max bg-sf-charcoal-200" x-html="friendlySize(att.size)"></span>
<span :aria-label="`This file is a ${friendlyExtension(att.name)} file`" data-microtip-position="bottom-right" role="tooltip" class="px-2 py-1 ml-1 text-xs rounded-full w-max bg-sf-charcoal-200"
x-html="friendlyExtension(att.name)"></span>
</div>
<p class="text-sm truncate md:text-base" x-text="att.name">
</p>
</div>
<a href="#" :title="`Cancel upload of ${att.name}`" @click.prevent="removeFile(idx)" class="absolute top-0 p-2 right-1">
<span class="red-link whitespace-nowrap">
<div class="svg-outer"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 12 14" class="svg-inner" aria-hidden="true" style="fill: currentColor; " preserveAspectRatio="xMinYMid meet"><path d="M8.57 8.43 7.429 9.571a.25.25 0 0 1-.359 0L6 8.501l-1.07 1.07a.25.25 0 0 1-.359 0L3.43 8.43a.25.25 0 0 1 0-.359l1.07-1.07-1.07-1.07a.25.25 0 0 1 0-.359l1.141-1.141a.25.25 0 0 1 .359 0L6 5.501l1.07-1.07a.25.25 0 0 1 .359 0L8.57 5.572a.25.25 0 0 1 0 .359L7.5 7.001l1.07 1.07a.25.25 0 0 1 0 .359M10.25 7c0-2.344-1.906-4.25-4.25-4.25S1.75 4.656 1.75 7 3.656 11.25 6 11.25 10.25 9.344 10.25 7M12 7A6 6 0 0 1 0 7a6 6 0 0 1 12 0"></path></svg></div>
Remove
</span>
</a>
</div>
</template>
<div x-id="['m2-file-upload-input']">
<label :for="$id("m2-file-upload-input")">
<span role="button" class="text-lg btn btn-secondary" :aria-controls="$id("m2-file-upload-input")" tabindex="0" @keydown.enter="$refs['file-upload-input'].click()" @keydown.space="$refs['file-upload-input'].click()"
x-text="`Add Attachments ${sizeRemainingMessage()}`">
</span>
</label>
<input x-ref="file-upload-input" type="file" hidden="" :id="$id("m2-file-upload-input")" name="m2-cf-attachments" multiple="" :aria-disabled="tooManyBytes" :accept="acceptableFileTypes" @change="pickFiles($event.target.files)">
<div class="mt-2 text-xs"> Please attach only <span x-text="readableExtensionList()"></span> file(s) — Unsupported file types will not be delivered to the agent. </div>
</div>
</div><!-- end partial: shared/components/contact-forms/cf-file-input.hbs -->
</div>
<div class="w-full mt-4 md:w-1/2 md:m-0 md:pl-8 xl:w-1/3">
<!-- start partial: shared/components/contact-forms/cf-submit.hbs -->
<button @click="submit" type="button" :aria-disabled="isSendDisabled()" class="btn btn-primary"> Send Email </button><!-- end partial: shared/components/contact-forms/cf-submit.hbs -->
</div>
</div>
<!-- start partial: shared/components/contact-forms/cf-errors.hbs -->
<div x-show="hasErrors" role="alert" class="my-4 rounded-2xl bg-sf-red-100 p-4 text-sf-red-700">
<!-- The only way ATs will read all of the text below on failed validation is if they are rendered as <p> elements -->
<!-- "Please forgive this" -->
<h3 class="font-semi mb-2 text-xl"> Please correct the following: </h3>
<ul class="list-inside list-disc">
<template x-for="(message, key) in errors" :key="$id('error', key)">
<li class="mb-1" :id="$id('error', key)" x-html="message"></li>
</template>
</ul>
</div><!-- end partial: shared/components/contact-forms/cf-errors.hbs -->
<div id="disclaimers">
<div class="mt-4">
<!-- start partial: shared/components/contact-forms/cf-disclaimer.hbs -->
<p :id="$id('cf-disclaimer')" class="text-xs leading-3"> By filling out the form, you are providing express consent by electronic signature that you may be contacted by telephone (via call and/or text messages) and/or email for marketing
purposes by State Farm Mutual Automobile Insurance Company, its subsidiaries and affiliates ("State Farm") or an independent contractor State Farm agent regarding insurance products and services using the phone number and/or email address you
have provided to State Farm, even if your phone number is listed on a Do Not Call Registry. You further agree that such contact may be made using an automatic telephone dialing system and/or prerecorded voice (message and data rates may
apply). Your consent is not a condition of purchase. By continuing, you agree to the terms of the disclosures above. </p><!-- end partial: shared/components/contact-forms/cf-disclaimer.hbs -->
</div>
<p class="mt-2" x-show="!false">
<!-- start partial: shared/components/contact-forms/cf-coverage-disclaimer.hbs -->
</p>
<p class="text-xs leading-3">
<span class="font-bold"> Please note: </span> Insurance coverage cannot be bound or changed via submission of this online e-mail form or via voice mail. To make policy changes or request additional coverage, please speak with a licensed
representative in the agent's office, or by contacting the State Farm toll-free customer service line at
<span><a href="tel:8557337333" class="red-link" aria-label="Contact the State Farm toll-free customer service line at (855) 733-7333">(855) 733-7333</a>.</span>
</p><!-- end partial: shared/components/contact-forms/cf-coverage-disclaimer.hbs -->
<p></p>
</div>
</form>
POST
<form x-show="!sendResponse && !sending" :action="`/contact${qs}`" method="post" aria-describedby="disclaimers">
<h2 x-show="true" class="hidden text-2xl font-med md:block"> You can also call us at <a :id="$id('phone-link-contact-form')" aria-label="You can also call us at (970) 842-4555" href="tel:9708424555" class="red-link">
(970) 842-4555
</a>
</h2>
<!-- start partial: shared/components/contact-forms/cf-more-prefs.hbs -->
<label x-id="['preferred__alpha']" :for="$id('preferred__alpha')" class="absolute -left-[9999px] -top-[9999px] opacity-0 -z-10"> preferred__alpha <input :id="$id('preferred__alpha')" type="url" name="preferred__alpha" tabindex="-1"
x-model="form.preferred__alpha" autocomplete="off" value="">
</label>
<label x-id="['preferred__beta']" :for="$id('preferred__beta')" class="absolute -left-[9999px] -top-[9999px] opacity-0 -z-10"> preferred__beta <input :id="$id('preferred__beta')" type="text" name="preferred__beta" tabindex="-1"
x-model="form.preferred__beta" autocomplete="off" value="">
</label>
<label x-id="['preferred__extra']" :for="$id('preferred__extra')" class="absolute -left-[9999px] -top-[9999px] opacity-0 -z-10"> preferred__extra <input :id="$id('preferred__extra')" type="checkbox" name="preferred__extra" tabindex="-1"
x-model="form.preferred__extra" autocomplete="off" value="">
</label>
<!-- end partial: shared/components/contact-forms/cf-more-prefs.hbs -->
<h2 class="text-2xl text-center mb-4 font-med md:hidden"> Contact Us </h2>
<div class="flex flex-col min-w-0 md:mt-8 md:flex-row">
<div class="w-full md:w-1/2 md:shrink-0 md:mr-8 lg:w-2/3 xl:m-0">
<div class="flex flex-col w-full xl:flex-row">
<div class="flex flex-col xl:h-full xl:justify-between xl:w-1/2 xl:pr-8">
<div class="hidden mt-4 xl:block">
<!-- start partial: shared/components/contact-forms/cf-prefs.hbs -->
<fieldset x-id="[
'xl-contact-form-pref-email',
'xl-contact-form-pref-phone',
'xl-contact-form-pref',
]">
<legend class="text-sm uppercase"> Your preferred method of contact </legend>
<ul class="mt-2 flex flex-row">
<li>
<input :id="$id('xl-contact-form-pref-email')" class="m2-radio-input pointer-events-none absolute m-0 h-0 w-0 p-0 opacity-0" :name="$id('xl-contact-form-pref')" type="radio" value="email" x-model="form.pref"
@change="clearPrefErrors()">
<label :for="$id('xl-contact-form-pref-email')" class="m2-radio-label mr-4 inline-flex cursor-pointer select-none items-start text-sm leading-6"> Your Email </label>
</li>
<li>
<input :id="$id('xl-contact-form-pref-phone')" class="m2-radio-input pointer-events-none absolute m-0 h-0 w-0 p-0 opacity-0" :name="$id('xl-contact-form-pref')" type="radio" value="phone" x-model="form.pref"
@change="clearPrefErrors()">
<label :for="$id('xl-contact-form-pref-phone')" class="m2-radio-label mr-4 inline-flex cursor-pointer select-none items-start text-sm leading-6"> Your Phone </label>
</li>
</ul>
</fieldset><!-- end partial: shared/components/contact-forms/cf-prefs.hbs -->
</div>
<div class="xl:mt-6">
<!-- start partial: shared/components/contact-forms/cf-contact-info.hbs -->
<div class="flex flex-col w-full space-y-5" x-id="['contact-form-name', 'contact-form-phone', 'contact-form-email', 'contact-form-email-or-phone']">
<!-- start partial: shared/components/contact-forms/cf-text-field.hbs -->
<!-- start partial: shared/components/ui/text-input-label.hbs -->
<div class="relative w-full " :class="{}">
<input :id="$id('contact-form-name')" class="m2-form-input peer " name="contact-form-name" x-model="form.name" :aria-required="true" autocomplete="name" type="text" placeholder="Your Name" :aria-invalid="hasError('name')"
:aria-describedby="hasError('name') ? $id('error', 'name') : null" :error="hasError('name')" @keydown.debounce.750ms="validateName()">
<label
class="font-semi peer-placeholder-shown:font-reg peer-focus:font-semi absolute -top-4 left-0 cursor-default text-xs text-sf-charcoal transition-all peer-placeholder-shown:left-3 peer-placeholder-shown:top-3 peer-placeholder-shown:cursor-text peer-placeholder-shown:select-none peer-placeholder-shown:text-base peer-focus:-top-4 peer-focus:left-0 peer-focus:cursor-default peer-focus:text-xs peer-focus:text-sf-charcoal"
:for="$id('contact-form-name')"> Your Name<span aria-hidden="true" x-show="hasError('name')">*</span>
</label>
</div><!-- end partial: shared/components/ui/text-input-label.hbs -->
<!-- end partial: shared/components/contact-forms/cf-text-field.hbs -->
<!-- start partial: shared/components/contact-forms/cf-text-field.hbs -->
<!-- start partial: shared/components/ui/text-input-label.hbs -->
<div class="relative w-full " :class="{}">
<input :id="$id('contact-form-phone')" class="m2-form-input peer " name="contact-form-phone" x-model="form.phone" :aria-required="hasError('phone') && form.pref == 'phone'" autocomplete="tel" type="text"
placeholder="Your Phone" :aria-invalid="hasError('phone')" :aria-describedby="hasError('phone') ? $id('error', 'phone') : null" :error="hasError('phone')" @keydown.debounce.750ms="validatePhone()">
<label
class="font-semi peer-placeholder-shown:font-reg peer-focus:font-semi absolute -top-4 left-0 cursor-default text-xs text-sf-charcoal transition-all peer-placeholder-shown:left-3 peer-placeholder-shown:top-3 peer-placeholder-shown:cursor-text peer-placeholder-shown:select-none peer-placeholder-shown:text-base peer-focus:-top-4 peer-focus:left-0 peer-focus:cursor-default peer-focus:text-xs peer-focus:text-sf-charcoal"
:for="$id('contact-form-phone')"> Your Phone<span aria-hidden="true" x-show="hasError('phone')">*</span>
</label>
</div><!-- end partial: shared/components/ui/text-input-label.hbs -->
<!-- end partial: shared/components/contact-forms/cf-text-field.hbs -->
<!-- start partial: shared/components/contact-forms/cf-text-field.hbs -->
<!-- start partial: shared/components/ui/text-input-label.hbs -->
<div class="relative w-full " :class="{}">
<input :id="$id('contact-form-email')" class="m2-form-input peer " name="contact-form-email" x-model="form.email" :aria-required="hasError('email') && form.pref == 'email'" autocomplete="email" type="text"
placeholder="Your Email" :aria-invalid="hasError('email')" :aria-describedby="hasError('email') ? $id('error', 'email') : null" :error="hasError('email')" @keydown.debounce.750ms="validateEmail()">
<label
class="font-semi peer-placeholder-shown:font-reg peer-focus:font-semi absolute -top-4 left-0 cursor-default text-xs text-sf-charcoal transition-all peer-placeholder-shown:left-3 peer-placeholder-shown:top-3 peer-placeholder-shown:cursor-text peer-placeholder-shown:select-none peer-placeholder-shown:text-base peer-focus:-top-4 peer-focus:left-0 peer-focus:cursor-default peer-focus:text-xs peer-focus:text-sf-charcoal"
:for="$id('contact-form-email')"> Your Email<span aria-hidden="true" x-show="hasError('email')">*</span>
</label>
</div><!-- end partial: shared/components/ui/text-input-label.hbs -->
<!-- end partial: shared/components/contact-forms/cf-text-field.hbs -->
</div><!-- end partial: shared/components/contact-forms/cf-contact-info.hbs -->
</div>
</div>
<div class="flex-col hidden xl:w-1/2 md:flex xl:flex-col-reverse xl:justify-end">
<div class="h-full mt-5">
<!-- start partial: shared/components/contact-forms/cf-message.hbs -->
<div class="relative h-full" x-id="[
'md-contact-form-message'
]">
<!-- start partial: shared/components/ui/text-input-label.hbs -->
<div class="relative w-full h-full" :class="{}">
<textarea :id="$id('md-contact-form-message')" ref="message" x-model="form.message" class="m2-form-input peer h-48 xl:h-full pa11y-ignore" placeholder="Your Message:" :maxlength="MAX_MESSAGE_LENGTH" :aria-invalid="hasError('message')"
:aria-describedby="`char-limit, md-message-warning ${hasError("message") ? $id("error", "message") : ""}`" :aria-required="hasError('message')"
@keydown.debounce.750ms="validateMessage(), validateMessageLength()" @keydown.debounce.5ms="displayMessageLength()" :error="hasError('message')"></textarea>
<p id="char-limit" class="flex justify-end" aria-live="polite" x-text="`${remainingCharacters}`"></p>
<label
class="font-semi peer-placeholder-shown:font-reg peer-focus:font-semi absolute -top-4 left-0 cursor-default text-xs text-sf-charcoal transition-all peer-placeholder-shown:left-3 peer-placeholder-shown:top-3 peer-placeholder-shown:cursor-text peer-placeholder-shown:select-none peer-placeholder-shown:text-base peer-focus:-top-4 peer-focus:left-0 peer-focus:cursor-default peer-focus:text-xs peer-focus:text-sf-charcoal"
:for="$id('md-contact-form-message')"> Your Message:<span aria-hidden="true" x-show="hasError('message')">*</span>
</label>
</div><!-- end partial: shared/components/ui/text-input-label.hbs -->
</div><!-- end partial: shared/components/contact-forms/cf-message.hbs -->
</div>
<div class="mt-4">
<!-- start partial: shared/components/contact-forms/cf-message-warning.hbs -->
<p class="text-xs" id="md-message-warning"> For your protection, please do not include sensitive personal information such as social security numbers, credit/debit card number, or health/medical information. </p>
<!-- end partial: shared/components/contact-forms/cf-message-warning.hbs -->
</div>
</div>
</div>
</div>
<div class="flex flex-col w-full md:w-1/2 lg:w-1/3 xl:justify-between xl:pl-8">
<div class="mt-6 xl:hidden md:m-0">
<!-- start partial: shared/components/contact-forms/cf-prefs.hbs -->
<fieldset x-id="[
'xl-contact-form-pref-email',
'xl-contact-form-pref-phone',
'xl-contact-form-pref',
]">
<legend class="text-sm uppercase"> Your preferred method of contact </legend>
<ul class="mt-2 flex flex-row">
<li>
<input :id="$id('xl-contact-form-pref-email')" class="m2-radio-input pointer-events-none absolute m-0 h-0 w-0 p-0 opacity-0" :name="$id('xl-contact-form-pref')" type="radio" value="email" x-model="form.pref" @change="clearPrefErrors()">
<label :for="$id('xl-contact-form-pref-email')" class="m2-radio-label mr-4 inline-flex cursor-pointer select-none items-start text-sm leading-6"> Your Email </label>
</li>
<li>
<input :id="$id('xl-contact-form-pref-phone')" class="m2-radio-input pointer-events-none absolute m-0 h-0 w-0 p-0 opacity-0" :name="$id('xl-contact-form-pref')" type="radio" value="phone" x-model="form.pref" @change="clearPrefErrors()">
<label :for="$id('xl-contact-form-pref-phone')" class="m2-radio-label mr-4 inline-flex cursor-pointer select-none items-start text-sm leading-6"> Your Phone </label>
</li>
</ul>
</fieldset><!-- end partial: shared/components/contact-forms/cf-prefs.hbs -->
</div>
<div class="flex w-full mt-4 xl:h-full">
<!-- start partial: shared/components/contact-forms/cf-more-info.hbs -->
<fieldset class="flex w-full flex-col" x-id="['contact-form-checkbox-input']">
<legend class="mb-2 text-sm uppercase"> I'd like more info about: <span aria-hidden="true" x-show="hasError('message')"> * </span>
</legend>
<div class="grid sm:grid-flow-col sm:grid-cols-2 sm:grid-rows-3 md:grid-cols-1 md:grid-rows-6 xl:h-full">
<template x-for="(i, k) in moreVals" :key="i.id">
<div :id="$id(`contact-form-checkbox-${i.id}`)" class="m2-contact-form-checkbox">
<input :id="$id('contact-form-checkbox-input', i.id)" class="m2-checkbox-input absolute h-0 w-0 overflow-hidden border-none p-0" x-model="form.more" type="checkbox"
:aria-describedby="hasError('message') ? $id('error', 'message') : null" :value="i.label" :aria-label="`${k + 1} of ${moreVals().length}, I'd like more info about ${i.label}`" :aria-invalid="hasError('more')"
@click="validateMessage()">
<label :for="$id('contact-form-checkbox-input', i.id)" class="m2-checkbox-label flex cursor-pointer items-center rounded py-2 pl-8 transition-all hover:bg-sf-charcoal-100">
<svg viewBox="0 0 100 100" class="absolute left-1 h-4 w-4">
<path class="path" fill="none" stroke="#000" stroke-width="13" stroke-linecap="round" stroke-linejoin="round" stroke-miterlimit="10" d="M12.1 52.1l24.4 24.4 53-53"></path>
</svg>
<span class="text-sm" x-html="i.label"></span>
</label>
</div>
</template>
</div>
</fieldset><!-- end partial: shared/components/contact-forms/cf-more-info.hbs -->
</div>
<div class="mt-4 text-xs md:hidden">
<!-- start partial: shared/components/contact-forms/cf-message-warning.hbs -->
<p class="text-xs" id="message-warning"> For your protection, please do not include sensitive personal information such as social security numbers, credit/debit card number, or health/medical information. </p>
<!-- end partial: shared/components/contact-forms/cf-message-warning.hbs -->
</div>
<div class="mt-5 md:hidden">
<!-- start partial: shared/components/contact-forms/cf-message.hbs -->
<div class="relative h-full" x-id="[
'contact-form-message'
]">
<!-- start partial: shared/components/ui/text-input-label.hbs -->
<div class="relative w-full h-full" :class="{}">
<textarea :id="$id('contact-form-message')" ref="message" x-model="form.message" class="m2-form-input peer h-48 pa11y-ignore" placeholder="Your Message:" :maxlength="MAX_MESSAGE_LENGTH" :aria-invalid="hasError('message')"
:aria-describedby="`char-limit, message-warning ${hasError("message") ? $id("error", "message") : ""}`" :aria-required="hasError('message')"
@keydown.debounce.750ms="validateMessage(), validateMessageLength()" @keydown.debounce.5ms="displayMessageLength()" :error="hasError('message')"></textarea>
<p id="char-limit" class="flex justify-end" aria-live="polite" x-text="`${remainingCharacters}`"></p>
<label
class="font-semi peer-placeholder-shown:font-reg peer-focus:font-semi absolute -top-4 left-0 cursor-default text-xs text-sf-charcoal transition-all peer-placeholder-shown:left-3 peer-placeholder-shown:top-3 peer-placeholder-shown:cursor-text peer-placeholder-shown:select-none peer-placeholder-shown:text-base peer-focus:-top-4 peer-focus:left-0 peer-focus:cursor-default peer-focus:text-xs peer-focus:text-sf-charcoal"
:for="$id('contact-form-message')"> Your Message:<span aria-hidden="true" x-show="hasError('message')">*</span>
</label>
</div><!-- end partial: shared/components/ui/text-input-label.hbs -->
</div><!-- end partial: shared/components/contact-forms/cf-message.hbs -->
</div>
</div>
</div>
<div class="flex flex-col w-full mt-4 pt-3 md:flex-row xl:justify-end">
<div class="md:w-1/2 xl:w-1/3">
<!-- start partial: shared/components/contact-forms/cf-file-input.hbs -->
<div x-ref="contactFormAttachments" class="w-full" x-data="initFileInput()">
<div x-show="$store.fileList.length" class="w-full mb-2 text-xl italic text-center border-b-2 border-gray-400 border-dashed" x-text="$store.fileList.length + ' attached file' + ($store.fileList.length > 1 ? 's:' : ':')">
</div>
<template x-for="(att, idx) in $store.fileList">
<div :key="idx" class="relative my-2 grid w-full grid-cols-4 flex-nowrap bg-sf-charcoal-100 p-4">
<div class="flex justify-center h-12 col-span-1 mr-4">
<img x-show="checkType(att) === 'img'" :id="att.name" class="object-contain" :alt="att.name">
<template x-if="checkType(att) != 'img'">
<div x-html="svgIcon(checkType(att), "h-full")" class="h-full">
</div>
</template>
</div>
<div class="flex flex-col justify-center col-span-3 mr-1">
<div class="flex flex-row w-full mb-1">
<span :aria-label="`This file is ${friendlySize(att.size)} in size`" data-microtip-position="bottom-right" role="tooltip" class="px-2 py-1 text-xs rounded-full w-max bg-sf-charcoal-200" x-html="friendlySize(att.size)"></span>
<span :aria-label="`This file is a ${friendlyExtension(att.name)} file`" data-microtip-position="bottom-right" role="tooltip" class="px-2 py-1 ml-1 text-xs rounded-full w-max bg-sf-charcoal-200"
x-html="friendlyExtension(att.name)"></span>
</div>
<p class="text-sm truncate md:text-base" x-text="att.name">
</p>
</div>
<a href="#" :title="`Cancel upload of ${att.name}`" @click.prevent="removeFile(idx)" class="absolute top-0 p-2 right-1">
<span class="red-link whitespace-nowrap">
<div class="svg-outer"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 12 14" class="svg-inner" aria-hidden="true" style="fill: currentColor; " preserveAspectRatio="xMinYMid meet"><path d="M8.57 8.43 7.429 9.571a.25.25 0 0 1-.359 0L6 8.501l-1.07 1.07a.25.25 0 0 1-.359 0L3.43 8.43a.25.25 0 0 1 0-.359l1.07-1.07-1.07-1.07a.25.25 0 0 1 0-.359l1.141-1.141a.25.25 0 0 1 .359 0L6 5.501l1.07-1.07a.25.25 0 0 1 .359 0L8.57 5.572a.25.25 0 0 1 0 .359L7.5 7.001l1.07 1.07a.25.25 0 0 1 0 .359M10.25 7c0-2.344-1.906-4.25-4.25-4.25S1.75 4.656 1.75 7 3.656 11.25 6 11.25 10.25 9.344 10.25 7M12 7A6 6 0 0 1 0 7a6 6 0 0 1 12 0"></path></svg></div>
Remove
</span>
</a>
</div>
</template>
<div x-id="['m2-file-upload-input']">
<label :for="$id("m2-file-upload-input")">
<span role="button" class="text-lg btn btn-secondary" :aria-controls="$id("m2-file-upload-input")" tabindex="0" @keydown.enter="$refs['file-upload-input'].click()" @keydown.space="$refs['file-upload-input'].click()"
x-text="`Add Attachments ${sizeRemainingMessage()}`">
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<div class="mt-2 text-xs"> Please attach only <span x-text="readableExtensionList()"></span> file(s) — Unsupported file types will not be delivered to the agent. </div>
</div>
</div><!-- end partial: shared/components/contact-forms/cf-file-input.hbs -->
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<div class="w-full mt-4 md:w-1/2 md:m-0 md:pl-8 xl:w-1/3">
<!-- start partial: shared/components/contact-forms/cf-submit.hbs -->
<button @click="submit" type="button" :aria-disabled="isSendDisabled()" class="btn btn-primary"> Send Email </button><!-- end partial: shared/components/contact-forms/cf-submit.hbs -->
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<div x-show="hasErrors" role="alert" class="my-4 rounded-2xl bg-sf-red-100 p-4 text-sf-red-700">
<!-- The only way ATs will read all of the text below on failed validation is if they are rendered as <p> elements -->
<!-- "Please forgive this" -->
<h3 class="font-semi mb-2 text-xl"> Please correct the following: </h3>
<ul class="list-inside list-disc">
<template x-for="(message, key) in errors" :key="$id('error', key)">
<li class="mb-1" :id="$id('error', key)" x-html="message"></li>
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</div><!-- end partial: shared/components/contact-forms/cf-errors.hbs -->
<div id="disclaimers">
<div class="mt-4">
<!-- start partial: shared/components/contact-forms/cf-disclaimer.hbs -->
<p :id="$id('cf-disclaimer')" class="text-xs leading-3"> By filling out the form, you are providing express consent by electronic signature that you may be contacted by telephone (via call and/or text messages) and/or email for marketing
purposes by State Farm Mutual Automobile Insurance Company, its subsidiaries and affiliates ("State Farm") or an independent contractor State Farm agent regarding insurance products and services using the phone number and/or email address you
have provided to State Farm, even if your phone number is listed on a Do Not Call Registry. You further agree that such contact may be made using an automatic telephone dialing system and/or prerecorded voice (message and data rates may
apply). Your consent is not a condition of purchase. By continuing, you agree to the terms of the disclosures above. </p><!-- end partial: shared/components/contact-forms/cf-disclaimer.hbs -->
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<span class="font-bold"> Please note: </span> Insurance coverage cannot be bound or changed via submission of this online e-mail form or via voice mail. To make policy changes or request additional coverage, please speak with a licensed
representative in the agent's office, or by contacting the State Farm toll-free customer service line at
<span><a href="tel:8557337333" class="red-link" aria-label="Contact the State Farm toll-free customer service line at (855) 733-7333">(855) 733-7333</a>.</span>
</p><!-- end partial: shared/components/contact-forms/cf-coverage-disclaimer.hbs -->
<p></p>
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Text Content
Skip to content * Account * Create an account * Log in * Contact Us * Jobs * Reviews * Insurance * Auto * Motorcycle * Homeowners * Condo * Renters * Business * Life * Pet * Rec Vehicles * Boat * Close Navigation Menu * Insurance * Auto * Motorcycle * Homeowners * Condo * Renters * Business * Life * Pet * Rec Vehicles * Boat * EXIT SUBMENU * Auto * Motorcycle * Homeowners * Condo * Renters * Business * Life * Pet * Rec Vehicles * Boat * EXIT SUBMENU * Reviews * Jobs * Contact Us * Account * Create an account * Log in * EXIT SUBMENU * Create an account * Log in * EXIT SUBMENU Call Text (970) 842-4555 OFFICE HOURS Today 9am - 5pm (Mountain) Mon-Fri 9am - 5pm Sat-Sun Closed Call or text us 24 hours a day! * * * * INSURANCE PRODUCTS OFFERED Auto, Homeowners, Condo, Renters, Personal Articles, Business, Life, Health, Pet OTHER PRODUCTS Banking, Mutual Funds, Annuities FINRA’s BrokerCheck View Licenses WOULD YOU LIKE TO CREATE A PERSONALIZED QUOTE? Select an Insurance Product Select Product AutoMotorcycleHomeownersCondo OwnersRentersLifeMedicare SupplementSupplemental HealthSmall BusinessPet Insurance ZIP Code State Selection Your State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, D.C. 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West Virginia Wisconsin Wyoming Start a Quote Request a Quote Continue a saved quote | Items needed for a quote File a Claim Send Payment State Farm® Insurance Agent DYLAN HYLAND 5/5 average rating on Google (7 reviews) OFFICE HOURS Today 9am - 5pm (Mountain) Mon-Fri 9am - 5pm Sat-Sun Closed ADDRESS 209 Clayton Street Brush, CO 80723-2103 Contact Us Contact Us Text Us Map & Directions Get ID Card ABOUT ME My office in Brush, Colorado is a family-run business focusing on excellent customer service. I'm a proud local, and a dedicated member of our community. Serving the Hi-Plains region of Colorado, my agency's goal is to help you protect what is most important while always understanding your coverage. My wife and three beautiful children have thrived in a small town, and we hope to get to know each one of our customers and their unique goals. We are here to serve the residents of Northeastern Colorado including Brush, Akron, Snyder, Hillrose, New Raymer, Woodrow, and Otis. Please visit us in-person at our office in Brush or call us to help you with your insurance needs. Car insurance, Home Insurance, Renters Insurance, Life Insurance, Business Insurance, Commercial Auto Insurance, Workers Comp Insurance, Professional Liability Insurance. We offer a free notary service! …Read More * * * * 5/5 average rating on Google (7 reviews) OFFICE HOURS Today 9am - 5pm (Mountain) Mon-Fri 9am - 5pm Sat-Sun Closed Call or text us 24 hours a day! * * * * INSURANCE PRODUCTS OFFERED Auto, Homeowners, Condo, Renters, Personal Articles, Business, Life, Health, Pet OTHER PRODUCTS Banking, Mutual Funds, Annuities FINRA’s BrokerCheck View Licenses * * * * 5/5 average rating on Google (7 reviews) Contact Us Contact Us Text Us Map & Directions Get ID Card WOULD YOU LIKE TO CREATE A PERSONALIZED QUOTE? Select an Insurance Product Select Product AutoMotorcycleHomeownersCondo OwnersRentersLifeMedicare SupplementSupplemental HealthSmall BusinessPet Insurance ZIP Code State Selection Your State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, D.C. West Virginia Wisconsin Wyoming ZIP Code State Selection Your State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, D.C. West Virginia Wisconsin Wyoming Start a Quote Request a Quote Continue a saved quote | Items needed for a quote File a Claim Send Payment * Auto Insurance * Motorcycle Insurance * Homeowners Insurance * Condo Insurance * Renters Insurance * Business Insurance * Life Insurance * Pet Insurance * Rec Vehicles Insurance * Boat Insurance * See More OFFICE INFO OFFICE INFO OFFICE HOURS Today 9am - 5pm (Mountain) Mon-Fri 9am - 5pm Sat-Sun Closed Call or text us 24 hours a day! ADDRESS 209 Clayton Street Brush, CO 80723-2103 Map & Directions * PHONE (970) 842-4555 LANGUAGES English About Me My office in Brush, Colorado is a family-run business focusing on excellent customer service. I'm a proud local, and a dedicated member of our community. Serving the Hi-Plains region of Colorado, my agency's goal is to help you protect what is most important while always understanding your coverage. My wife and three beautiful children have thrived in a small town, and we hope to get to know each one of our customers and their unique goals. We are here to serve the residents of Northeastern Colorado including Brush, Akron, Snyder, Hillrose, New Raymer, Woodrow, and Otis. Please visit us in-person at our office in Brush or call us to help you with your insurance needs. Car insurance, Home Insurance, Renters Insurance, Life Insurance, Business Insurance, Commercial Auto Insurance, Workers Comp Insurance, Professional Liability Insurance. We offer a free notary service! Products INSURANCE PRODUCTS OFFERED Auto, Homeowners, Condo, Renters, Personal Articles, Business, Life, Health, Pet OTHER PRODUCTS Banking, Mutual Funds, Annuities FINRA’s BrokerCheck View Licenses OFFICE INFO OFFICE INFO OFFICE HOURS Today 9am - 5pm (Mountain) Mon-Fri 9am - 5pm Sat-Sun Closed Call or text us 24 hours a day! ADDRESS 209 Clayton Street Brush, CO 80723-2103 Map & Directions * PHONE (970) 842-4555 LANGUAGES English Simple Insights® SIMPLE INSIGHTS® PHONE APPLICATIONS - DOWNLOADING SAFETY PHONE APPLICATIONS - DOWNLOADING SAFETY This article outlines safety precautions to keep in mind when downloading phone applications and tips to keep you safer when using your phone. SAFETY TIPS FOR CAMPING AND HIKING WITH YOUR DOG SAFETY TIPS FOR CAMPING AND HIKING WITH YOUR DOG Whether you're taking your dog for a hike or a cross-country camping adventure, read these tips first. THE REAL CONSEQUENCES OF DRUNK DRIVING THE REAL CONSEQUENCES OF DRUNK DRIVING What's at stake if you're caught drunk driving? A lot. These tips help you avoid the dangers of drinking and driving. View More Articles Social Media SOCIAL MEDIA Skip to end of Facebook feed Skip to beginning of Facebook feed Videos VIDEOS YOU DID IT :30 NO-BRAINER :30 BUNDLE IS LIFE (FEAT. PATRICK MAHOMES & CRISTO FERNÁNDEZ) :30 GIVE ME A BREAK :15 Contact Us Our Mission Our Team YOU CAN ALSO CALL US AT (970) 842-4555 preferred__alpha preferred__beta preferred__extra CONTACT US Your preferred method of contact * Your Email * Your Phone Your Name* Your Phone* Your Email* Your Message:* For your protection, please do not include sensitive personal information such as social security numbers, credit/debit card number, or health/medical information. Your preferred method of contact * Your Email * Your Phone I'd like more info about: * For your protection, please do not include sensitive personal information such as social security numbers, credit/debit card number, or health/medical information. Your Message:* Remove Please attach only file(s) — Unsupported file types will not be delivered to the agent. Send Email PLEASE CORRECT THE FOLLOWING: By filling out the form, you are providing express consent by electronic signature that you may be contacted by telephone (via call and/or text messages) and/or email for marketing purposes by State Farm Mutual Automobile Insurance Company, its subsidiaries and affiliates ("State Farm") or an independent contractor State Farm agent regarding insurance products and services using the phone number and/or email address you have provided to State Farm, even if your phone number is listed on a Do Not Call Registry. You further agree that such contact may be made using an automatic telephone dialing system and/or prerecorded voice (message and data rates may apply). Your consent is not a condition of purchase. By continuing, you agree to the terms of the disclosures above. Please note: Insurance coverage cannot be bound or changed via submission of this online e-mail form or via voice mail. To make policy changes or request additional coverage, please speak with a licensed representative in the agent's office, or by contacting the State Farm toll-free customer service line at (855) 733-7333. We help our community prepare for the worst; we cultivate lasting relationships with State Farm customers through exemplary customer service. …Read More Serena Ortega Account Representative License #806307 Yesenia Martinez Camacho Account Representative License #786375 Viewing team member 1 of 2 Serena Ortega Account Representative License #806307 Viewing team member 2 of 2 Yesenia Martinez Camacho Account Representative License #786375 Previous Next Close YOU CAN ALSO CALL US AT (970) 842-4555 preferred__alpha preferred__beta preferred__extra CONTACT US Your preferred method of contact * Your Email * Your Phone Your Name* Your Phone* Your Email* Your Message:* For your protection, please do not include sensitive personal information such as social security numbers, credit/debit card number, or health/medical information. Your preferred method of contact * Your Email * Your Phone I'd like more info about: * For your protection, please do not include sensitive personal information such as social security numbers, credit/debit card number, or health/medical information. Your Message:* Remove Please attach only file(s) — Unsupported file types will not be delivered to the agent. Send Email PLEASE CORRECT THE FOLLOWING: By filling out the form, you are providing express consent by electronic signature that you may be contacted by telephone (via call and/or text messages) and/or email for marketing purposes by State Farm Mutual Automobile Insurance Company, its subsidiaries and affiliates ("State Farm") or an independent contractor State Farm agent regarding insurance products and services using the phone number and/or email address you have provided to State Farm, even if your phone number is listed on a Do Not Call Registry. You further agree that such contact may be made using an automatic telephone dialing system and/or prerecorded voice (message and data rates may apply). Your consent is not a condition of purchase. By continuing, you agree to the terms of the disclosures above. Please note: Insurance coverage cannot be bound or changed via submission of this online e-mail form or via voice mail. To make policy changes or request additional coverage, please speak with a licensed representative in the agent's office, or by contacting the State Farm toll-free customer service line at (855) 733-7333. AGENT LICENSE FOR DYLAN HYLAND CO-804015 If you are using a screen reader and having difficulty with this website please call (970) 842-4555. DISCLOSURES Prices vary by state. Options selected by customer; availability, amount of discounts, savings and eligibility may vary. Securities are not FDIC insured, are not bank guaranteed and are subject to investment risk, including possible loss of principal. Neither State Farm nor its agents provide tax or legal advice. State Farm VP Management Corp. is a separate entity from those State Farm and/or unaffiliated entities which provide banking and insurance products. AP2024/07/0846 Securities distributed by State Farm VP Management Corp. State Farm VP Management Corp. Customer Relationship Summary Securities Supervisor address:1415 State St Ste 1000 , Richardson, TX 75082-2306 Phone: 972-732-3009 Life Insurance and annuities are issued by State Farm Life Insurance Company. (Not Licensed in MA, NY, and WI) State Farm Life and Accident Assurance Company (Licensed in New York and Wisconsin) Home Office, Bloomington, Illinois. Deposit products offered by U.S. Bank National Association. Member FDIC. The creditor and issuer of this credit card is U.S. Bank National Association, pursuant to a license from Visa U.S.A. Inc. Pre-existing conditions: If you currently have a pet medical insurance policy, switching carriers or purchasing a new policy may affect certain provisions such as coverages for pre-existing conditions or deductibles already established under your current policy. Let your State Farm® agent know if your existing policy has provisions that might make it beneficial for you to keep. Pet insurance products are underwritten in the United States by American Pet Insurance Company and ZPIC Insurance Company, 6100-4th Ave. S, Seattle, WA 98108. Administered by Trupanion Managers USA, Inc. (CA license No. 0G22803, NPN 9588590). Terms and conditions apply, see full policy on Trupanion's website for details. State Farm Mutual Automobile Insurance Company, its subsidiaries and affiliates, neither offer nor are financially responsible for pet insurance products. State Farm is a separate entity and is not affiliated with Trupanion or American Pet Insurance. State Farm (including State Farm Mutual Automobile Insurance Company and its subsidiaries and affiliates) is not responsible for, and does not endorse or approve, either implicitly or explicitly, the content of any third party sites referenced in this material. Products and services are offered by third parties and State Farm does not warrant the merchantability, fitness or quality of the products and services of the third parties. Like a good neighbor, State Farm is there.® Legal Information Ads & Tracking Security & Fraud Accessibility Terms of Use Notice of Privacy Policy State Privacy Rights Site Map Download the State Farm mobile app today Give Agent Dylan a call (970) 842-4555 © Copyright State Farm Mutual Automobile Insurance Company 2024. Viewing team member 1 of 2 Serena Ortega Account Representative License #806307 Viewing team member 2 of 2 Yesenia Martinez Camacho Account Representative License #786375 Previous Next Close