sfcincyinsurance.com
Open in
urlscan Pro
34.69.219.172
Public Scan
URL:
https://sfcincyinsurance.com/
Submission: On September 30 via api from BE — Scanned from DE
Submission: On September 30 via api from BE — Scanned from DE
Form analysis 4 forms found in the DOM
#
<form id="quote-start-nfvafrd" 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-nfvafrd"
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-nfvafrd" name="field-auto" @change="selectProduct()" x-model="productKey" aria-controls="specific-location-info-nfvafrd" :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-nfvafrd">
<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-nfvafrd" 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-nfvafrd"> 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-nfvafrd"
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-nfvafrd" 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-nfvafrd">
<div x-show="type() === 'zip'">
<!-- start partial: shared/components/ui/text-input-label.hbs -->
<div class="relative w-full " :class="{}">
<input id="gaq-zip-nfvafrd" 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-nfvafrd"> 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-nfvafrd"
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-nfvafrd" 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-u1bvnph" 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-u1bvnph"
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-u1bvnph" name="field-auto" @change="selectProduct()" x-model="productKey" aria-controls="specific-location-info-u1bvnph" :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-u1bvnph">
<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-u1bvnph" 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-u1bvnph"> 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-u1bvnph"
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-u1bvnph" 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-u1bvnph">
<div x-show="type() === 'zip'">
<!-- start partial: shared/components/ui/text-input-label.hbs -->
<div class="relative w-full " :class="{}">
<input id="gaq-zip-u1bvnph" 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-u1bvnph"> 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-u1bvnph"
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-u1bvnph" 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 (513) 385-0081" href="tel:5133850081" class="red-link">
(513) 385-0081
</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 (513) 385-0081" href="tel:5133850081" class="red-link">
(513) 385-0081
</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")">
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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>
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<h3 class="font-semi mb-2 text-xl"> Please correct the following: </h3>
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<!-- 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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<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>
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State Farm® Insurance Agent
MARK MIKLAUTSCH
MIKLAUTSCH INSURANCE AGCY INC
4.9 out of 5 average rating on Google (155 reviews)
ChFC®
5636 Springdale Rd
Suite A
Cincinnati, OH 45251
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ABOUT ME
Licensed In Ohio, Indiana & Kentucky Ambassador Travel Qualifier Advisory
Committee of Northwest High School Proud Sponsor of Colerain High School
Athletics University of Cincinnati Alumni Long time resident of Hamilton County
Financial Services Free Notary Public Service Offering Auto & Home Insurance in
Ohio Offering Auto & Home Insurance in Kentucky Offering Auto & Home Insurance
in Indiana Renters Insurance Cincinnati Car & Auto Insurance Lawrenceburg, IN
Car & Auto Insurance Cincinnati Car & Auto Insurance Newport, KY Life Insurance
Cincinnati
*
4.9 out of 5 average rating on Google (155 reviews)
OFFICE HOURS
Mon-Thursday 8:30am - 5:00pm
Friday 8:30am - 5:00 pm
Saturday: Appointments Only
*
INSURANCE PRODUCTS OFFERED
Auto, Homeowners, Condo, Renters, Personal Articles, Business, Life, Health
OTHER PRODUCTS
Banking, Mutual Funds, Annuities
FINRA’s BrokerCheck View Licenses
*
4.9 out of 5 average rating on Google (155 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
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Your State Alabama Alaska Arizona Arkansas California Colorado Connecticut
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State Selection
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Mon-Thursday 8:30am - 5:00pm
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Saturday: Appointments Only
ADDRESS
5636 Springdale Rd
Suite A
Cincinnati, OH 45251
Map & Directions
* PHONE
(513) 385-0081
LANGUAGES
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About Me
Licensed In Ohio, Indiana & Kentucky Ambassador Travel Qualifier Advisory
Committee of Northwest High School Proud Sponsor of Colerain High School
Athletics University of Cincinnati Alumni Long time resident of Hamilton County
Financial Services Free Notary Public Service Offering Auto & Home Insurance in
Ohio Offering Auto & Home Insurance in Kentucky Offering Auto & Home Insurance
in Indiana Renters Insurance Cincinnati Car & Auto Insurance Lawrenceburg, IN
Car & Auto Insurance Cincinnati Car & Auto Insurance Newport, KY Life Insurance
Cincinnati
Products
INSURANCE PRODUCTS OFFERED
Auto, Homeowners, Condo, Renters, Personal Articles, Business, Life, Health
OTHER PRODUCTS
Banking, Mutual Funds, Annuities
FINRA’s BrokerCheck View Licenses
OFFICE INFO
OFFICE INFO
OFFICE HOURS
Mon-Thursday 8:30am - 5:00pm
Friday 8:30am - 5:00 pm
Saturday: Appointments Only
ADDRESS
5636 Springdale Rd
Suite A
Cincinnati, OH 45251
Map & Directions
* PHONE
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Simple Insights®
SIMPLE INSIGHTS®
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.
WAYS TO HELP WITH TEEN DRIVING SAFETY
WAYS TO HELP WITH TEEN DRIVING SAFETY
Teenage speeding is a major problem, causing fatal car accidents throughout the
US. These driving tips can help prevent speeding and help teens drive safer.
WHAT IS RENTAL CAR COVERAGE AND HOW DOES IT WORK?
WHAT IS RENTAL CAR COVERAGE AND HOW DOES IT WORK?
Understand your options before getting rental car insurance through a rental car
company. Double check whether you’re already covered or if it’s necessary to
purchase more coverage.
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agent.
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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.
My passion is helping people! I have built a team that focuses on customer
service by recommending the right insurance to you based on your needs. We will
be there for our policyholders by helping them manage their risks and building a
road map to provide a path for realizing their dreams.
Emily Castellanos
Customer Service Manager
License #1110388
Matt Paluga
Office Manager
License #1138408
Conner Hellyer
Insurance Account Representative
License #1298375
Colton Lipps
Insurance Account Representative
License #1352153
Jamie Brosz
Customer Service Representative
License #1457113
Viewing team member 1 of 5
Emily Castellanos
Customer Service Manager
License #1110388
Viewing team member 2 of 5
Matt Paluga
Office Manager
License #1138408
Viewing team member 3 of 5
Conner Hellyer
Insurance Account Representative
License #1298375
Viewing team member 4 of 5
Colton Lipps
Insurance Account Representative
License #1352153
Viewing team member 5 of 5
Jamie Brosz
Customer Service Representative
License #1457113
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YOU CAN ALSO CALL US AT (513) 385-0081
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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.
DESIGNATION FOR MARK MIKLAUTSCH
ChFC®
AGENT LICENSES FOR MARK MIKLAUTSCH
OH-1186774
KY-DOI-1079625
IN-3441738
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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:2021 Auburn Ave Fl 2nd , Cincinnati, OH 45219-3024
Phone: 513-770-5141
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(Not Licensed in MA, NY, and WI) State Farm Life and Accident Assurance Company
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Viewing team member 1 of 5
Emily Castellanos
Customer Service Manager
License #1110388
Viewing team member 2 of 5
Matt Paluga
Office Manager
License #1138408
Viewing team member 3 of 5
Conner Hellyer
Insurance Account Representative
License #1298375
Viewing team member 4 of 5
Colton Lipps
Insurance Account Representative
License #1352153
Viewing team member 5 of 5
Jamie Brosz
Customer Service Representative
License #1457113
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