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Form analysis
1 forms found in the DOM

POST /website/form/

<form action="/website/form/" method="post" enctype="multipart/form-data" class="o_mark_required" data-mark="*" data-model_name="x_valuation" data-success-page="">
  <div class="s_website_form_rows row s_col_no_bgcolor">
    <div class="form-group s_website_form_field col-12  s_website_form_required  " data-type="char" data-name="Field">
      <div class="row s_col_no_resize s_col_no_bgcolor">
        <label class="col-form-label col-sm-auto s_website_form_label" style="width: 250px !important;" for="f4btlzaji7">
          <span class="s_website_form_label_content">Company Name</span>
          <span class="s_website_form_mark"> *</span>
        </label>
        <div class="col-sm">
          <input type="text" class="form-control s_website_form_input" name="x_name" required="1" placeholder="" id="f4btlzaji7">
        </div>
      </div>
    </div>
    <div class="form-group s_website_form_field col-12 s_website_form_custom   " data-type="char" data-name="Field">
      <div class="row s_col_no_resize s_col_no_bgcolor">
        <label class="col-form-label col-sm-auto s_website_form_label" style="width: 250px !important;" for="abbn4620s8">
          <span class="s_website_form_label_content">Adjuster Name</span>
        </label>
        <div class="col-sm">
          <input type="text" class="form-control s_website_form_input" name="Adjuster Name" id="abbn4620s8" placeholder="">
        </div>
      </div>
    </div>
    <div class="form-group s_website_form_field col-12 s_website_form_custom col-lg-6" data-type="tel" data-name="Field">
      <div class="row s_col_no_resize s_col_no_bgcolor">
        <label class="col-form-label col-sm-auto s_website_form_label" style="width: 250px !important;" for="q7mid3ijiqn">
          <span class="s_website_form_label_content">Adjuster Phone</span>
        </label>
        <div class="col-sm">
          <input type="tel" class="form-control s_website_form_input" name="Adjuster Phone" placeholder="" id="q7mid3ijiqn">
        </div>
      </div>
    </div>
    <div class="form-group s_website_form_field col-12 col-lg-6" data-type="char" data-name="Field">
      <div class="row s_col_no_resize s_col_no_bgcolor">
        <label class="col-form-label col-sm-auto s_website_form_label" style="width: 250px !important;" for="hfg9aiwkcbw">
          <span class="s_website_form_label_content">Adjuster Email</span>
        </label>
        <div class="col-sm">
          <input type="text" class="form-control s_website_form_input" name="x_studio_partner_email" placeholder="" id="hfg9aiwkcbw">
        </div>
      </div>
    </div>
    <div class="form-group s_website_form_field col-12 s_website_form_custom   " data-type="char" data-name="Field">
      <div class="row s_col_no_resize s_col_no_bgcolor">
        <label class="col-form-label col-sm-auto s_website_form_label" style="width: 250px !important;" for="rcijzlg9etr">
          <span class="s_website_form_label_content">Adjuster Address</span>
        </label>
        <div class="col-sm">
          <input type="text" class="form-control s_website_form_input" name="Adjuster Address" placeholder="" id="rcijzlg9etr">
        </div>
      </div>
    </div>
    <div class="form-group s_website_form_field col-12 col-lg-6" data-type="date" data-name="Field">
      <div class="row s_col_no_resize s_col_no_bgcolor">
        <label class="col-form-label col-sm-auto s_website_form_label" style="width: 250px !important;" for="bs7gofyicca">
          <span class="s_website_form_label_content">Date of Loss</span>
        </label>
        <div class="col-sm">
          <div class="s_website_form_date input-group date s_website_form_datepicker_initialized" id="datepicker38117059467162573" data-target-input="nearest">
            <input type="text" class="form-control datetimepicker-input s_website_form_input" data-target="#datepicker38117059467162573" name="x_studio_loss_date" placeholder="" id="bs7gofyicca">
            <div class="input-group-append" data-target="#datepicker38117059467162573" data-toggle="datetimepicker">
              <div class="input-group-text">
                <i class="fa fa-calendar"></i>
              </div>
            </div>
          </div>
        </div>
      </div>
    </div>
    <div data-visibility-condition="" data-visibility-between="" class="form-group s_website_form_field col-12 col-lg-6" data-type="char" data-name="Field">
      <div class="row s_col_no_resize s_col_no_bgcolor">
        <label class="col-form-label col-sm-auto s_website_form_label " style="width: 250px" for="q4ao4u93wwf">
          <span class="s_website_form_label_content">Claim Number</span>
        </label>
        <div class="col-sm">
          <input type="text" class="form-control s_website_form_input" name="x_studio_claim_number" value="" placeholder="" id="q4ao4u93wwf">
        </div>
      </div>
    </div>
    <div class="form-group s_website_form_field col-12    " data-type="char" data-name="Field">
      <div class="row s_col_no_resize s_col_no_bgcolor">
        <label class="col-form-label col-sm-auto s_website_form_label" style="width: 250px !important;" for="uksxcw69c5k">
          <span class="s_website_form_label_content">Policy Holder Name</span>
        </label>
        <div class="col-sm">
          <input type="text" class="form-control s_website_form_input" name="x_studio_policy_holder_name" placeholder="" id="uksxcw69c5k">
        </div>
      </div>
    </div>
    <div class="form-group s_website_form_field col-12    " data-type="char" data-name="Field">
      <div class="row s_col_no_resize s_col_no_bgcolor">
        <label class="col-form-label col-sm-auto s_website_form_label" style="width: 250px !important;" for="v298vvous2g">
          <span class="s_website_form_label_content">Loss Address</span>
        </label>
        <div class="col-sm">
          <input type="text" class="form-control s_website_form_input" name="x_studio_loss_address" placeholder="" id="v298vvous2g">
        </div>
      </div>
    </div>
    <div class="form-group s_website_form_field col-12 col-lg-6" data-type="char" data-name="Field">
      <div class="row s_col_no_resize s_col_no_bgcolor">
        <label class="col-form-label col-sm-auto s_website_form_label" style="width: 250px !important;" for="42vz6vwpunp">
          <span class="s_website_form_label_content">Primary Phone</span>
        </label>
        <div class="col-sm">
          <input type="text" class="form-control s_website_form_input" name="x_studio_primary_phone" placeholder="" id="42vz6vwpunp">
        </div>
      </div>
    </div>
    <div class="form-group s_website_form_field col-12 col-lg-6" data-type="char" data-name="Field">
      <div class="row s_col_no_resize s_col_no_bgcolor">
        <label class="col-form-label col-sm-auto s_website_form_label" style="width: 250px !important;" for="35u8lqwjjoh">
          <span class="s_website_form_label_content">Secondary Phone</span>
        </label>
        <div class="col-sm">
          <input type="text" class="form-control s_website_form_input" name="x_studio_secondary_phone" placeholder="" id="35u8lqwjjoh">
        </div>
      </div>
    </div>
    <div class="form-group s_website_form_field col-12 col-lg-6" data-type="float" data-name="Field">
      <div class="row s_col_no_resize s_col_no_bgcolor">
        <label class="col-form-label col-sm-auto s_website_form_label" style="width: 250px !important;" for="053f39yhtdwj">
          <span class="s_website_form_label_content">Sales Tax</span>
        </label>
        <div class="col-sm">
          <input type="number" class="form-control s_website_form_input" name="x_studio_sales_tax" step="any" placeholder="" id="053f39yhtdwj">
        </div>
      </div>
    </div>
    <div class="form-group s_website_form_field col-12 col-lg-6" data-type="monetary" data-name="Field">
      <div class="row s_col_no_resize s_col_no_bgcolor">
        <label class="col-form-label col-sm-auto s_website_form_label" style="width: 250px !important;" for="sd29333feqm">
          <span class="s_website_form_label_content">Deductible Amount</span>
        </label>
        <div class="col-sm">
          <input type="number" class="form-control s_website_form_input" name="x_studio_deductible_amount" step="any" placeholder="" id="sd29333feqm">
        </div>
      </div>
    </div>
    <div class="form-group s_website_form_field col-12 col-lg-4    " data-type="boolean" data-name="Field">
      <div class="row s_col_no_resize s_col_no_bgcolor">
        <label class=" col-sm-auto s_website_form_label " style="width: 250px" for="fasjftlmcrt">
          <span class="s_website_form_label_content">Services: Contents Valuation</span>
        </label>
        <div class="col-sm">
          <input type="checkbox" value="Yes" class="s_website_form_input" name="x_studio_contents_valuation" id="fasjftlmcrt">
        </div>
      </div>
    </div>
    <div class="form-group s_website_form_field col-12 col-lg-4" data-type="boolean" data-name="Field">
      <div class="row s_col_no_resize s_col_no_bgcolor">
        <label class="col-sm-auto s_website_form_label" style="width: 250px !important;" for="ex704iwlkgw">
          <span class="s_website_form_label_content">Recoverable Depreciation</span>
        </label>
        <div class="col-sm">
          <input type="checkbox" value="Yes" class="s_website_form_input" name="x_studio_recoverable_depreciation" id="ex704iwlkgw">
        </div>
      </div>
    </div>
    <div class="form-group s_website_form_field col-12 col-lg-4" data-type="boolean" data-name="Field">
      <div class="row s_col_no_resize s_col_no_bgcolor">
        <label class="col-sm-auto s_website_form_label" style="width: 250px !important;" for="v4ffjncbfb">
          <span class="s_website_form_label_content">Contents Inventory Creation</span>
        </label>
        <div class="col-sm">
          <input type="checkbox" value="Yes" class="s_website_form_input" name="x_studio_contents_inventory_creation" id="v4ffjncbfb">
        </div>
      </div>
    </div>
    <div class="form-group s_website_form_field col-12 col-lg-8" data-type="selection" data-name="Field">
      <div class="row s_col_no_resize s_col_no_bgcolor">
        <label class="col-sm-auto s_website_form_label" style="width: 250px !important;" for="8dbkhs7xqtx">
          <span class="s_website_form_label_content">Policy Type</span>
        </label>
        <div class="col-sm">
          <div class="row s_col_no_resize s_col_no_bgcolor s_website_form_multiple" data-name="x_studio_method" data-display="horizontal">
            <div class="radio col-12 col-lg-4 col-md-6">
              <div class="form-check">
                <input type="radio" class="s_website_form_input form-check-input" id="8dbkhs7xqtx0" name="x_studio_method" value="ACV">
                <label class="form-check-label s_website_form_check_label" for="8dbkhs7xqtx0"> ACV </label>
              </div>
            </div>
            <div class="radio col-12 col-lg-4 col-md-6">
              <div class="form-check">
                <input type="radio" class="s_website_form_input form-check-input" id="8dbkhs7xqtx1" name="x_studio_method" value="MV">
                <label class="form-check-label s_website_form_check_label" for="8dbkhs7xqtx1"> MV </label>
              </div>
            </div>
            <div class="radio col-12 col-lg-4 col-md-6">
              <div class="form-check">
                <input type="radio" class="s_website_form_input form-check-input" id="8dbkhs7xqtx2" name="x_studio_method" value="RC">
                <label class="form-check-label s_website_form_check_label" for="8dbkhs7xqtx2"> RC </label>
              </div>
            </div>
          </div>
        </div>
      </div>
    </div>
    <div class="form-group s_website_form_field col-12 col-lg-6" data-type="monetary" data-name="Field">
      <div class="row s_col_no_resize s_col_no_bgcolor">
        <label class="col-form-label col-sm-auto s_website_form_label " style="width: 250px" for="cygjbmf2esv">
          <span class="s_website_form_label_content">Total Contents Limit</span>
        </label>
        <div class="col-sm">
          <input type="number" class="form-control s_website_form_input" name="x_studio_total_contents_limit" step="any" placeholder="" id="cygjbmf2esv">
        </div>
      </div>
    </div>
    <div class="form-group s_website_form_field col-12 col-lg-6" data-type="char" data-name="Field">
      <div class="row s_col_no_resize s_col_no_bgcolor">
        <label class="col-form-label col-sm-auto s_website_form_label " style="width: 250px" for="9yutzbb7o5m">
          <span class="s_website_form_label_content">Other Limits</span>
        </label>
        <div class="col-sm">
          <input type="text" class="form-control s_website_form_input" name="x_studio_other_limits" placeholder="" id="9yutzbb7o5m">
        </div>
      </div>
    </div>
    <div class="form-group s_website_form_field col-12 col-lg-12" data-type="text" data-name="Field">
      <div class="row s_col_no_resize s_col_no_bgcolor">
        <label class="col-form-label col-sm-auto s_website_form_label " style="width: 250px" for="0koiml8j9vwm">
          <span class="s_website_form_label_content">Notes</span>
        </label>
        <div class="col-sm">
          <textarea class="form-control s_website_form_input" name="x_studio_notes" placeholder="" id="0koiml8j9vwm" rows="3"></textarea>
        </div>
      </div>
    </div>
    <div class="form-group s_website_form_field col-12 col-lg-8 s_website_form_custom   " data-type="binary" data-name="Field">
      <div class="row s_col_no_resize s_col_no_bgcolor">
        <label class=" col-sm-auto s_website_form_label " style="width: 250px" for="9ytwba1s846">
          <span class="s_website_form_label_content">Attachment(s)</span>
        </label>
        <div class="col-sm">
          <input type="file" class="form-control-file s_website_form_input" name="Attachment(s)" id="9ytwba1s846">
        </div>
      </div>
    </div>
    <div class="form-group col-12 s_website_form_submit" data-name="Submit Button">
      <div style="width: 250px !important;" class="s_website_form_label"></div>
      <a href="#" role="button" class="btn btn-primary btn-lg s_website_form_send">Submit</a>
      <span id="s_website_form_result"></span>
    </div>
  </div>
</form>

Text Content

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Company Name *

Adjuster Name

Adjuster Phone

Adjuster Email

Adjuster Address

Date of Loss

Claim Number

Policy Holder Name

Loss Address

Primary Phone

Secondary Phone

Sales Tax

Deductible Amount

Services: Contents Valuation

Recoverable Depreciation

Contents Inventory Creation

Policy Type
ACV
MV
RC
Total Contents Limit

Other Limits

Notes

Attachment(s)


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