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<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01//EN" "http://www.w3.org/TR/html4/strict.dtd">
<html class="supernova"><head>
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<link rel="alternate" type="application/json+oembed" href="https://www.jotform.com/oembed/?format=json&url=https%3A%2F%2Fform.jotform.com%2F221883580362459" title="oEmbed Form">
<link rel="alternate" type="text/xml+oembed" href="https://www.jotform.com/oembed/?format=xml&url=https%3A%2F%2Fform.jotform.com%2F221883580362459" title="oEmbed Form">
<meta property="og:title" content="Order Form" >
<meta property="og:url" content="https://form.jotform.com/221883580362459" >
<meta property="og:description" content="Please click the link to complete this form." >
<meta name="slack-app-id" content="AHNMASS8M">
<link rel="shortcut icon" href="https://cdn.jotfor.ms/assets/img/favicons/favicon-2021.svg">
<link rel="canonical" href="https://form.jotform.com/221883580362459" />
<meta name="viewport" content="width=device-width, initial-scale=1.0, maximum-scale=2.0, user-scalable=1" />
<meta name="HandheldFriendly" content="true" />
<title>Order Form</title>
<style type="text/css">@media print{.form-section{display:inline!important}.form-pagebreak{display:none!important}.form-section-closed{height:auto!important}.page-section{position:initial!important}}</style>
<link type="text/css" rel="stylesheet" href="https://cdn01.jotfor.ms/themes/CSS/5e6b428acc8c4e222d1beb91.css?themeRevisionID=5eb3b4ae85bd2e1e2966db96"/>
<link type="text/css" rel="stylesheet" href="https://cdn02.jotfor.ms/css/styles/payment/payment_styles.css?3.3.34528" />
<link type="text/css" rel="stylesheet" href="https://cdn03.jotfor.ms/css/styles/payment/payment_feature.css?3.3.34528" />
<style type="text/css" id="form-designer-style">
/* Injected CSS Code */
/*PREFERENCES STYLE*/
/* NEW THEME STYLE */
/* colors */
.form-textbox, .form-textarea {
color: undefined;
}
.rating-item input:hover+label {
color: rgba(17, 17, 27, 0.75);
}
li[data-type=control_fileupload] .qq-upload-button,
.until-text,
.form-submit-reset {
color: rgba(17, 17, 27, 0.75);
}
.stageEmpty{
color: #FFFFFF;
}
.rating-item label {
color: rgba(17, 17, 27, 0.75);
}
.currentDate,
.pickerItem select,
.appointmentCalendar .calendarDay,
.calendar.popup th,
.calendar.popup table tbody td,
.calendar-new-header>*,
.form-collapse-table {
color: #FFFFFF;
}
.appointmentCalendar .dayOfWeek {
color: #FFFFFF;
}
.appointmentSlotsContainer > * {
color: rgba(17, 17, 27, 0.75);
}
li[data-type=control_fileupload] .jfUpload-heading,
::placeholder,
.form-dropdown.is-active,
.form-dropdown:first-child,
.form-spinner-input {
color: #1A1F2F;
}
.appointmentCalendar .calendarWeek .calendarDay.isUnavailable,
.calendar tr.days td.otherDay,
.calendar tr.days td:hover:not(.unselectable) {
color: #1A1F2F;
}
span.form-sub-label, label.form-sub-label, div.form-header-group .form-subHeader,
.rating-item-title.for-to > label:first-child,
.rating-item-title.for-from > label:first-child,
.rating-item-title .editor-container * {
color: #838895;
}
.form-pagebreak-back{
color: #FFFFFF;
}
.rating-item input:checked+label,
.rating-item input:focus+label {
color: #FFFFFF;
}
.clear-pad-btn {
color: #FFFFFF;
}
.form-textbox::placeholder,
.form-dropdown:not(.time-dropdown):not(:required),
.form-dropdown:not(:required),
.form-dropdown:required:invalid {
color: #1A1F2F;
}
/* border-colors */
.form-dropdown,
.form-textarea,
.form-textbox,
li[data-type=control_fileupload] .qq-upload-button,
.rating-item label,
.rating-item input:focus+label,
.rating-item input:checked+label,
.jf-form-buttons,
.form-checkbox+label:before, .form-checkbox+span:before, .form-radio+label:before, .form-radio+span:before,
.signature-pad-passive,
.signature-wrapper,
.appointmentCalendarContainer,
.appointmentField .timezonePickerName,
.appointmentDayPickerButton,
.appointmentCalendarContainer .monthYearPicker .pickerItem+.pickerItem,
.appointmentCalendarContainer .monthYearPicker,
.appointmentCalendar .calendarDay.isActive .calendarDayEach, .appointmentCalendar .calendarDay.isToday .calendarDayEach, .appointmentCalendar .calendarDay:not(.empty):hover .calendarDayEach,
.calendar.popup:before,
.calendar-new-month,
.form-matrix-column-headers, .form-matrix-table td, .form-matrix-table td:last-child,
.form-matrix-table th, .form-matrix-table th:last-child, .form-matrix-table tr:last-child td, .form-matrix-table tr:last-child th, .form-matrix-table tr:not([role=group])+tr[role=group] th,
.form-matrix-headers.form-matrix-column-headers,
.isSelected .form-matrix-column-headers:nth-last-of-type(2),
li[data-type=control_inline] input[type=email], li[data-type=control_inline] input[type=number],
li[data-type=control_inline] input[type=tel], li[data-type=control_inline] input[type=text] {
border-color: rgba(17, 17, 27, 0.75);
}
.stageEmpty {
border-color: rgba(17, 17, 27, 0.75);
}
.rating-item input:hover+label {
border-color: rgba(17, 17, 27, 0.75);
}
.appointmentSlot,
.form-checkbox:checked+label:before, .form-checkbox:checked+span:before, .form-checkbox:checked+span label:before,
.form-radio:checked+label:before, .form-radio:checked+span:before,
.form-dropdown:focus, .form-textarea:focus, .form-textbox:focus, .signature-wrapper:focus,
.form-line[data-payment="true"] .form-product-item .p_checkbox .checked,
.form-dropdown:hover, .form-textarea:hover, .form-textbox:hover, .signature-wrapper:hover {
border-color: rgba(17, 17, 27, 0.75);
}
.calendar tr.days td:hover:not(.unselectable):after {
border-color: #1A1F2F;
}
.form-header-group,
.form-buttons-wrapper, .form-pagebreak, .form-submit-clear-wrapper,
.form-pagebreak-next,
.form-pagebreak-back,
.form-checkbox:hover+label:before, .form-checkbox:hover+span:before, .form-radio:hover+label:before, .form-radio:hover+span:before,
.divider {
border-color: #11111B;
}
.form-pagebreak-back:focus, .form-pagebreak-next:focus, .form-submit-button:focus {
border-color: rgba(17, 17, 27, 1);
}
/* background-colors */
.form-line-active {
background-color: #4F5B77;
}
.stageEmpty {
background-color: #11111B;
}
.form-line-error {
background-color: #642733;
}
.form-matrix-column-headers, .form-matrix-row-headers,
.form-spinner-button-container>*,
.form-collapse-table,
.form-collapse-table:hover,
.appointmentDayPickerButton {
background-color: #1A1F2F;
}
.calendar.popup, .calendar.popup table,
.calendar.popup table tbody td:after{
background-color: #424756;
}
.appointmentCalendar .calendarDay.isActive .calendarDayEach,
.appointmentFieldRow.forSelectedDate,
.calendar.popup tr.days td.selected:after,
.calendar.popup:after,
.submit-button,
.form-checkbox:checked+label:before, .form-checkbox:checked+span:before, .form-checkbox:checked+span label:before,
.form-radio+label:after, .form-radio+span:after,
.rating-item input:checked+label,
.appointmentCalendar .calendarDay:after,
.form-line[data-payment="true"] .form-product-item .p_checkbox .checked,
.rating-item input:focus+label {
background-color: #2E69FF;
}
.appointmentSlot.active {
background-color: #2E69FF !important;
}
.clear-pad-btn,
.appointmentCalendar .dayOfWeek,
.calendar.popup th {
background-color: #11111B !important;
}
.appointmentField .timezonePicker:hover+.timezonePickerName,
.form-spinner-button-container>*:hover {
background-color: #96B4FF;
}
.form-matrix-values,
.form-matrix-values,
.signature-wrapper,
.signature-pad-passive,
.rating-item label,
.form-checkbox+label:before, .form-checkbox+span:before,
.form-radio+label:before, .form-radio+span:before {
background-color: #838895;
}
li[data-type=control_fileupload] .qq-upload-button {
background-color: #838895;
}
.JotFormBuilder .appContainer #app li.form-line[data-type=control_matrix].isSelected
.questionLine-editButton.forRemove:after,
.JotFormBuilder .appContainer #app li.form-line[data-type=control_matrix].isSelected .questionLine-editButton.forRemove:before {
background-color: #FFFFFF;
}
.appointmentCalendarContainer, .appointmentSlot,
.rating-item-title.for-to > label:first-child,
.rating-item-title.for-from > label:first-child,
.rating-item-title .editor-container *,
.calendar-opened {
background-color: transparent;
}
.page-section li.form-line-active[data-type="control_button"] {
background-color: #4F5B77;
}
.appointmentCalendar .calendarDay.isSelected:after {
color: #838895;
}
/* shadow */
.form-dropdown:hover, .form-textarea:hover, .form-textbox:hover, .signature-wrapper:hover,
.calendar.popup:before,
.jSignature:hover,
li[data-type=control_fileupload] .qq-upload-button-hover,
.form-line[data-payment="true"] .form-product-item .p_checkbox .checked,
.form-line[data-payment="true"] .form-product-item .p_checkbox:hover .select_border,
.form-checkbox:hover+label:before, .form-checkbox:hover+span:before, .form-radio:hover+label:before, .form-radio:hover+span:before,
.calendar.popup:before {
border-color: rgba(17, 17, 27, 0.5);
box-shadow: 0 0 0 2px rgba(17, 17, 27, 0.25);
}
.form-dropdown:focus, .form-textarea:focus, .form-textbox:focus, .signature-wrapper:focus,
li[data-type=control_fileupload] .qq-upload-button-focus,
.form-checkbox:focus+label:before, .form-checkbox:focus+span:before, .form-radio:focus+label:before, .form-radio:focus+span:before,
.calendar.popup:before {
border-color: rgba(17, 17, 27, 1);
box-shadow: 0 0 0 3px rgba(17, 17, 27, 0.25);
}
.calendar.popup table tbody td{
box-shadow: none;
}
/* button colors */
.submit-button {
background-color: #2E69FF;
border-color: #2E69FF;
}
.submit-button:hover {
background-color: #1C3F99;
border-color: #1C3F99;
}
.form-pagebreak-next {
background-color: #11111B;
}
.form-pagebreak-back {
background-color: #11111B;
}
.form-pagebreak-back:hover {
background-color: #11141C;
border-color: #11141C;
}
.form-pagebreak-next:hover {
background-color: #11141C;
border-color: #11141C;
}
.form-sacl-button, .form-submit-print {
background-color: transparent;
color: rgba(17, 17, 27, 0.75);
border-color: rgba(17, 17, 27, 0.75);
}
.form-sacl-button:hover, .form-submit-print:hover,
.appointmentSlot:not(.disabled):not(.active):hover,
.appointmentDayPickerButton:hover,
.rating-item input:hover+label {
background-color: #96B4FF;
}
/* payment styles */
.form-line[data-payment=true] .form-textbox,
.form-line[data-payment=true] .select-area,
.form-line[data-payment=true] #coupon-input,
.form-line[data-payment=true] #coupon-container input,
.form-line[data-payment=true] input#productSearch-input,
.form-line[data-payment=true] .form-product-category-item:after,
.form-line[data-payment=true] .filter-container .dropdown-container .select-content,
.form-line[data-payment=true] .form-textbox.form-product-custom_quantity,
.form-line[data-payment="true"] .form-product-item .p_checkbox .select_border,
.form-line[data-payment="true"] .form-product-item .form-product-container .form-sub-label-container span.select_cont,
.form-line[data-payment=true] select.form-dropdown,
.form-line[data-payment=true] #payment-category-dropdown .select-area,
.form-line[data-payment=true] #payment-sorting-products-dropdown .select-area,
.form-line[data-payment=true] .dropdown-container .select-content {
border-color: rgba(17, 17, 27, 0.75);
border-color: rgba(17,17,27,.7);
}
.form-line[data-payment="true"] hr,
.form-line[data-payment=true] .p_item_separator,
.form-line[data-payment="true"] .payment_footer.new_ui,
.form-line.card-3col .form-product-item.new_ui,
.form-line.card-2col .form-product-item.new_ui {
border-color: rgba(17, 17, 27, 0.75);
border-color: rgba(17,17,27,.4);
}
.form-line[data-payment=true] .form-product-category-item {
border-color: rgba(17, 17, 27, 0.75);
border-color: undefined;
}
.form-line[data-payment=true] #coupon-input,
.form-line[data-payment=true] .form-textbox.form-product-custom_quantity,
.form-line[data-payment=true] input#productSearch-input,
.form-line[data-payment=true] .select-area,
.form-line[data-payment=true] .custom_quantity,
.form-line[data-payment=true] .filter-container .select-content,
.form-line[data-payment=true] .p_checkbox .select_border,
.form-line[data-payment=true] #payment-category-dropdown .select-area,
.form-line[data-payment=true] #payment-sorting-products-dropdown .select-area,
.form-line[data-payment=true] .dropdown-container .select-content {
background-color: #838895;
}
.form-line[data-payment=true] .form-product-category-item.title_collapsed.has_selected_product .selected-items-icon {
background-color: #11111B;
border-color: #11111B;
}
.form-line[data-payment=true].form-line.card-3col .form-product-item,
.form-line[data-payment=true].form-line.card-2col .form-product-item {
background-color: rgba(0,0,0,.05);
}
.form-line[data-payment=true] .payment-form-table input.form-textbox,
.form-line[data-payment=true] .payment-form-table input.form-dropdown,
.form-line[data-payment=true] .payment-form-table .form-sub-label-container > div,
.form-line[data-payment=true] .payment-form-table span.form-sub-label-container iframe,
.form-line[data-type=control_square] .payment-form-table span.form-sub-label-container iframe {
border-color: rgba(17, 17, 27, 0.75);
}
/* icons */
.appointmentField .timezonePickerName:before {
background-image: url(data:image/svg+xml;base64,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);
}
.appointmentCalendarContainer .monthYearPicker .pickerArrow.prev:after {
background-image: url(data:image/svg+xml;base64,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);
}
.appointmentCalendarContainer .monthYearPicker .pickerArrow.next:after {
background-image: url(data:image/svg+xml;base64,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);
}
.appointmentField .timezonePickerName:after {
background-image: url(data:image/svg+xml;base64,PHN2ZyB3aWR0aD0iMTAiIGhlaWdodD0iNiIgdmlld0JveD0iMCAwIDEwIDYiIGZpbGw9Im5vbmUiIHhtbG5zPSJodHRwOi8vd3d3LnczLm9yZy8yMDAwL3N2ZyI+CjxwYXRoIGQ9Ik0xIDFMNSA1TDkgMSIgc3Ryb2tlPSJ3aGl0ZSIgc3Ryb2tlLXdpZHRoPSIyIiBzdHJva2UtbGluZWNhcD0icm91bmQiIHN0cm9rZS1saW5lam9pbj0icm91bmQiLz4KPC9zdmc+Cg==);
width: 11px;
}
li[data-type=control_datetime] [data-wrapper-react=true].extended>div+.form-sub-label-container .form-textbox:placeholder-shown,
li[data-type=control_datetime] [data-wrapper-react=true]:not(.extended) .form-textbox:not(.time-dropdown):placeholder-shown,
.appointmentCalendarContainer .currentDate {
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}
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}
.signature-pad-passive, .signature-placeholder:after {
background-image: url(data:image/svg+xml;base64,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);
}
.form-spinner-button.form-spinner-up:before {
background-image: url(data:image/svg+xml;base64,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);
}
.form-spinner-button.form-spinner-down:before {
background-image: url(data:image/svg+xml;base64,PHN2ZyB3aWR0aD0iMTQiIGhlaWdodD0iMiIgdmlld0JveD0iMCAwIDE0IDIiIGZpbGw9Im5vbmUiIHhtbG5zPSJodHRwOi8vd3d3LnczLm9yZy8yMDAwL3N2ZyI+CjxwYXRoIGQ9Ik0xMi41IDEuNUw3LjUgMS41TDEuNSAxLjVDMS4yMjQgMS41IDEgMS4yNzYgMSAwLjk5OTk5OUMxIDAuNzIzOTk5IDEuMjI0IDAuNDk5OTk5IDEuNSAwLjQ5OTk5OUw2LjUgMC41TDEyLjUgMC41QzEyLjc3NiAwLjUgMTMgMC43MjQgMTMgMUMxMyAxLjI3NiAxMi43NzYgMS41IDEyLjUgMS41WiIgZmlsbD0iIzhBOTRBQSIgc3Ryb2tlPSIjOEE5NEFBIiBzdHJva2Utd2lkdGg9IjAuNSIvPgo8L3N2Zz4K);
}
.form-collapse-table:after{
background-image: url(data:image/svg+xml;base64,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);
}
li[data-type=control_fileupload] .qq-upload-button:before {
background-image: url(data:image/svg+xml;base64,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);
}
.appointmentDayPickerButton {
}
/* NEW THEME STYLE */
/*PREFERENCES STYLE*/
/*PREFERENCES STYLE*/
.form-all {
font-family: Inter, sans-serif;
}
.form-all .qq-upload-button,
.form-all .form-submit-button,
.form-all .form-submit-reset,
.form-all .form-submit-print {
font-family: Inter, sans-serif;
}
.form-all .form-pagebreak-back-container,
.form-all .form-pagebreak-next-container {
font-family: Inter, sans-serif;
}
.form-header-group {
font-family: Inter, sans-serif;
}
.form-label {
font-family: Inter, sans-serif;
}
.form-label.form-label-auto {
display: block;
float: none;
text-align: left;
width: 100%;
}
.form-line {
margin-top: 12px 36px 12px 36px px;
margin-bottom: 12px 36px 12px 36px px;
}
.form-all {
max-width: 752px;
width: 100%;
}
.form-label.form-label-left,
.form-label.form-label-right,
.form-label.form-label-left.form-label-auto,
.form-label.form-label-right.form-label-auto {
width: 230px;
}
.form-all {
font-size: 16px
}
.form-all .qq-upload-button,
.form-all .qq-upload-button,
.form-all .form-submit-button,
.form-all .form-submit-reset,
.form-all .form-submit-print {
font-size: 16px
}
.form-all .form-pagebreak-back-container,
.form-all .form-pagebreak-next-container {
font-size: 16px
}
.supernova {
background-color: #11111B;
}
.supernova body {
background: transparent;
}
.supernova .form-all, .form-all {
background-color: #424756;
}
.form-all {
color: #FFFFFF;
}
.form-header-group .form-header {
color: #FFFFFF;
}
.form-header-group .form-subHeader {
color: #FFFFFF;
}
.form-label-top,
.form-label-left,
.form-label-right,
.form-html,
.form-checkbox-item label,
.form-radio-item label {
color: #FFFFFF;
}
.form-sub-label {
color: #ffffff;
}
.form-textbox,
.form-textarea,
.form-dropdown,
.form-radio-other-input,
.form-checkbox-other-input,
.form-captcha input,
.form-spinner input {
background-color: #838895;
}
.form-line-error {
overflow: hidden;
transition: none;
background-color: #642733;
}
.form-line-error .form-error-message {
background-color: #FF3200;
clear: both;
float: none;
}
.form-line-error .form-error-arrow {
border-bottom-color: #FF3200;
}
.form-line-error input:not(#coupon-input),
.form-line-error textarea,
.form-line-error .form-validation-error {
border: 1px solid #FF3200;
.box-shadow(0 0 3px #FF3200);
}
.supernova {
background-image: none;
}
#stage {
background-image: none;
}
.form-all {
background-image: none;
}
.form-all {
position: relative;
}
.form-all:before {
content: "";
background-image: url("https://www.jotform.com/uploads/xpertsachwani/form_files/Logo.62c8249ae5d5d7.01644586.png");
display: inline-block;
height: 140px;
position: absolute;
background-size: 555px 140px;
background-repeat: no-repeat;
width: 100%;
}
.form-all {
margin-top: 160px !important;
}
.form-all:before {
top: -150px;
background-position: top center;
left: 0;
}
.ie-8 .form-all:before { display: none; }
.ie-8 {
margin-top: auto;
margin-top: initial;
}
/*PREFERENCES STYLE*//*__INSPECT_SEPERATOR__*/
/* Injected CSS Code */
</style>
<!--[if lt IE 9]><script src="https://cdn01.jotfor.ms/js/vendor/flashcanvas.js?3.3.34528" type="text/javascript"></script><![endif]-->
<script src="https://cdn02.jotfor.ms/js/vendor/jquery-1.8.0.min.js?3.3.34528" type="text/javascript"></script>
<script src="https://cdn03.jotfor.ms/js/vendor/jSignature.min.noconflict.js?3.3.34528" type="text/javascript"></script>
<script src="https://cdn01.jotfor.ms/js/vendor/jotform.signaturepad.js?3.3.34528" type="text/javascript"></script>
<script src="https://cdn02.jotfor.ms/static/prototype.forms.js?3.3.34528" type="text/javascript"></script>
<script src="https://cdn03.jotfor.ms/static/jotform.forms.js?3.3.34528" type="text/javascript"></script>
<script defer src="https://cdn01.jotfor.ms/js/vendor/maskedinput.min.js?v=3.3.34528" type="text/javascript"></script>
<script defer src="https://cdn02.jotfor.ms/js/vendor/jquery.maskedinput.min.js?v=3.3.34528" type="text/javascript"></script>
<script defer src="https://cdnjs.cloudflare.com/ajax/libs/punycode/1.4.1/punycode.js"></script>
<script type="text/javascript"> JotForm.newDefaultTheme = true;
JotForm.extendsNewTheme = false;
JotForm.newPaymentUIForNewCreatedForms = false;
JotForm.newPaymentUI = true;
JotForm.setConditions([{"action":[{"field":"9","visibility":"Show","id":"action_0_1579704830003"}],"id":"1579704830003","index":"0","link":"Any","priority":"0","terms":[{"field":"8","operator":"equals","value":"Other (Please specify...)"}],"type":"field"}]);
JotForm.init(function(){
/*INIT-START*/
JotForm.setPhoneMaskingValidator( 'input_5_full', '(###) ###-####' );
setTimeout(function() {
$('input_6').hint('ex: email@yahoo.com');
}, 20);
/*INIT-END*/
});
JotForm.prepareCalculationsOnTheFly([null,{"name":"clickTo","qid":"1","text":"Customer Details:","type":"control_head"},{"name":"submit","qid":"2","text":"Submit","type":"control_button"},{"name":"fullName3","qid":"3","text":"Full Name","type":"control_fullname"},{"name":"address4","qid":"4","text":"Address","type":"control_address"},{"name":"phoneNumber5","qid":"5","text":"Phone Number","type":"control_phone"},{"name":"email6","qid":"6","subLabel":"example@example.com","text":"E-mail","type":"control_email"},null,null,null,null,null,null,{"name":"inWhich","qid":"13","text":"In Which Services you are interested?","type":"control_checkbox"},null,null,null,null,{"description":"","name":"signature","qid":"18","subLabel":"","text":"Signature","type":"control_signature"}]);
setTimeout(function() {
JotForm.paymentExtrasOnTheFly([null,{"name":"clickTo","qid":"1","text":"Customer Details:","type":"control_head"},{"name":"submit","qid":"2","text":"Submit","type":"control_button"},{"name":"fullName3","qid":"3","text":"Full Name","type":"control_fullname"},{"name":"address4","qid":"4","text":"Address","type":"control_address"},{"name":"phoneNumber5","qid":"5","text":"Phone Number","type":"control_phone"},{"name":"email6","qid":"6","subLabel":"example@example.com","text":"E-mail","type":"control_email"},null,null,null,null,null,null,{"name":"inWhich","qid":"13","text":"In Which Services you are interested?","type":"control_checkbox"},null,null,null,null,{"description":"","name":"signature","qid":"18","subLabel":"","text":"Signature","type":"control_signature"}]);}, 20);
</script>
</head>
<body>
<form class="jotform-form" action="https://submit.jotform.com/submit/221883580362459/" method="post" name="form_221883580362459" id="221883580362459" accept-charset="utf-8" autocomplete="on">
<input type="hidden" name="formID" value="221883580362459" />
<input type="hidden" id="JWTContainer" value="" />
<input type="hidden" id="cardinalOrderNumber" value="" />
<div role="main" class="form-all">
<div class="formLogoWrapper Center">
<img loading="lazy" class="formLogoImg" src="https://www.jotform.com/uploads/xpertsachwani/form_files/Logo.62c8249ae5d5d7.01644586.png" height="140" width="555">
</div>
<style>
.formLogoWrapper { display:inline-block; position: absolute; width: 100%;} .form-all:before { background: none !important;} .formLogoWrapper.Center { top: -150px; text-align: center;}
</style>
<ul class="form-section page-section">
<li id="cid_1" class="form-input-wide" data-type="control_head">
<div class="form-header-group header-large">
<div class="header-text httal htvam">
<h1 id="header_1" class="form-header" data-component="header">
Customer Details:
</h1>
</div>
</div>
</li>
<li class="form-line jf-required" data-type="control_fullname" id="id_3" data-compound-hint=",">
<label class="form-label form-label-top form-label-auto" id="label_3" for="first_3">
Full Name
<span class="form-required">
*
</span>
</label>
<div id="cid_3" class="form-input-wide jf-required" data-layout="full">
<div data-wrapper-react="true">
<span class="form-sub-label-container" style="vertical-align:top" data-input-type="first">
<input type="text" id="first_3" name="q3_fullName3[first]" class="form-textbox validate[required]" data-defaultvalue="" autoComplete="section-input_3 given-name" size="30" value="" data-component="first" aria-labelledby="label_3 sublabel_3_first" required="" />
<label class="form-sub-label" for="first_3" id="sublabel_3_first" style="min-height:13px" aria-hidden="false"> Full Name </label>
</span>
</div>
</div>
</li>
<li class="form-line" data-type="control_address" id="id_4">
<label class="form-label form-label-top form-label-auto" id="label_4" for="input_4_state"> Address </label>
<div id="cid_4" class="form-input-wide" data-layout="full">
<div summary="" class="form-address-table jsTest-addressField">
<div class="form-address-line-wrapper jsTest-address-line-wrapperField" style="display:none">
<span class="form-address-line form-address-street-line jsTest-address-lineField">
<span class="form-sub-label-container" style="vertical-align:top">
<input type="text" id="input_4_addr_line1" name="q4_address4[addr_line1]" class="form-textbox form-address-line" data-defaultvalue="" autoComplete="section-input_4 address-line1" value="" data-component="address_line_1" aria-labelledby="label_4 sublabel_4_addr_line1" />
<label class="form-sub-label" for="input_4_addr_line1" id="sublabel_4_addr_line1" style="min-height:13px" aria-hidden="false"> Street Address </label>
</span>
</span>
</div>
<div class="form-address-line-wrapper jsTest-address-line-wrapperField" style="display:none">
<span class="form-address-line form-address-street-line jsTest-address-lineField">
<span class="form-sub-label-container" style="vertical-align:top">
<input type="text" id="input_4_addr_line2" name="q4_address4[addr_line2]" class="form-textbox form-address-line" data-defaultvalue="" autoComplete="section-input_4 off" value="" data-component="address_line_2" aria-labelledby="label_4 sublabel_4_addr_line2" />
<label class="form-sub-label" for="input_4_addr_line2" id="sublabel_4_addr_line2" style="min-height:13px" aria-hidden="false"> Street Address Line 2 </label>
</span>
</span>
</div>
<div class="form-address-line-wrapper jsTest-address-line-wrapperField">
<span class="form-address-line form-address-city-line jsTest-address-lineField form-address-hiddenLine" style="display:none">
<span class="form-sub-label-container" style="vertical-align:top">
<input type="text" id="input_4_city" name="q4_address4[city]" class="form-textbox form-address-city" data-defaultvalue="" autoComplete="section-input_4 address-level2" value="" data-component="city" aria-labelledby="label_4 sublabel_4_city" />
<label class="form-sub-label" for="input_4_city" id="sublabel_4_city" style="min-height:13px" aria-hidden="false"> City </label>
</span>
</span>
<span class="form-address-line form-address-state-line jsTest-address-lineField ">
<span class="form-sub-label-container" style="vertical-align:top">
<input type="text" id="input_4_state" name="q4_address4[state]" class="form-textbox form-address-state" data-defaultvalue="" autoComplete="section-input_4 address-level1" value="" data-component="state" aria-labelledby="label_4 sublabel_4_state" />
<label class="form-sub-label" for="input_4_state" id="sublabel_4_state" style="min-height:13px" aria-hidden="false"> State / Province </label>
</span>
</span>
</div>
<div class="form-address-line-wrapper jsTest-address-line-wrapperField">
<span class="form-address-line form-address-zip-line jsTest-address-lineField ">
<span class="form-sub-label-container" style="vertical-align:top">
<input type="text" id="input_4_postal" name="q4_address4[postal]" class="form-textbox form-address-postal" data-defaultvalue="" autoComplete="section-input_4 postal-code" value="" data-component="zip" aria-labelledby="label_4 sublabel_4_postal" required="" />
<label class="form-sub-label" for="input_4_postal" id="sublabel_4_postal" style="min-height:13px" aria-hidden="false"> Postal / Zip Code </label>
</span>
</span>
</div>
</div>
</div>
</li>
<li class="form-line jf-required" data-type="control_phone" id="id_5">
<label class="form-label form-label-top form-label-auto" id="label_5" for="input_5_full">
Phone Number
<span class="form-required">
*
</span>
</label>
<div id="cid_5" class="form-input-wide jf-required" data-layout="half">
<span class="form-sub-label-container" style="vertical-align:top">
<input type="tel" id="input_5_full" name="q5_phoneNumber5[full]" data-type="mask-number" class="mask-phone-number form-textbox validate[required, Fill Mask]" data-defaultvalue="" autoComplete="section-input_5 tel-national" style="width:310px" data-masked="true" value="" placeholder="(000) 000-0000" data-component="phone" aria-labelledby="label_5" required="" />
<label class="form-sub-label is-empty" for="input_5_full" id="sublabel_5_masked" style="min-height:13px" aria-hidden="false"> </label>
</span>
</div>
</li>
<li class="form-line" data-type="control_email" id="id_6">
<label class="form-label form-label-top form-label-auto" id="label_6" for="input_6"> E-mail </label>
<div id="cid_6" class="form-input-wide" data-layout="half">
<span class="form-sub-label-container" style="vertical-align:top">
<input type="email" id="input_6" name="q6_email6" class="form-textbox validate[Email]" data-defaultvalue="" style="width:310px" size="310" value="" placeholder="ex: email@yahoo.com" data-component="email" aria-labelledby="label_6 sublabel_input_6" />
<label class="form-sub-label" for="input_6" id="sublabel_input_6" style="min-height:13px" aria-hidden="false"> example@example.com </label>
</span>
</div>
</li>
<li id="cid_22" class="form-input-wide" data-type="control_head">
<div class="form-header-group header-default">
<div class="header-text httal htvam">
<h2 id="header_22" class="form-header" data-component="header">
In Which Services you are interested?
</h2>
</div>
</div>
</li>
<li class="form-line" data-type="control_dropdown" id="id_20">
<label class="form-label form-label-top form-label-auto" id="label_20" for="input_20"> Web Designing </label>
<div id="cid_20" class="form-input-wide" data-layout="half">
<select class="form-dropdown" id="input_20" name="q20_webDesigning" style="width:310px" data-component="dropdown">
<option value=""> Please Select </option>
<option value="Basic $399"> Basic $399 </option>
<option value="Standard $799"> Standard $799 </option>
<option value="Professional $1199"> Professional $1199 </option>
<option value="E-Commerce Website $1799"> E-Commerce Website $1799 </option>
<option value="Corporate $3999"> Corporate $3999 </option>
<option value="Platinum $6999"> Platinum $6999 </option>
</select>
</div>
</li>
<li class="form-line" data-type="control_dropdown" id="id_23">
<label class="form-label form-label-top form-label-auto" id="label_23" for="input_23"> Logo Designing </label>
<div id="cid_23" class="form-input-wide" data-layout="half">
<select class="form-dropdown" id="input_23" name="q23_logoDesigning" style="width:310px" data-component="dropdown">
<option value=""> Please Select </option>
<option value="Economy $35"> Economy $35 </option>
<option value="Special $59"> Special $59 </option>
<option value="Plus $199"> Plus $199 </option>
<option value="Infinite $399"> Infinite $399 </option>
<option value="Platinum $999"> Platinum $999 </option>
<option value="Mascot $599"> Mascot $599 </option>
<option value="3D $699"> 3D $699 </option>
</select>
</div>
</li>
<li class="form-line" data-type="control_dropdown" id="id_26">
<label class="form-label form-label-top form-label-auto" id="label_26" for="input_26"> Printing </label>
<div id="cid_26" class="form-input-wide" data-layout="half">
<select class="form-dropdown" id="input_26" name="q26_printing" style="width:310px" data-component="dropdown">
<option value=""> Please Select </option>
<option value="Basic $249"> Basic $249 </option>
<option value="Plus $499"> Plus $499 </option>
<option value="Classic $1299"> Classic $1299 </option>
</select>
</div>
</li>
<li class="form-line" data-type="control_dropdown" id="id_27">
<label class="form-label form-label-top form-label-auto" id="label_27" for="input_27"> App Development </label>
<div id="cid_27" class="form-input-wide" data-layout="half">
<select class="form-dropdown" id="input_27" name="q27_appDevelopment" style="width:310px" data-component="dropdown">
<option value=""> Please Select </option>
<option value="As on Requirements"> As on Requirements </option>
</select>
</div>
</li>
<li class="form-line" data-type="control_dropdown" id="id_28">
<label class="form-label form-label-top form-label-auto" id="label_28" for="input_28"> SEO </label>
<div id="cid_28" class="form-input-wide" data-layout="half">
<select class="form-dropdown" id="input_28" name="q28_seo" style="width:310px" data-component="dropdown">
<option value=""> Please Select </option>
<option value="Basic $299"> Basic $299 </option>
<option value="Standard $499"> Standard $499 </option>
<option value="Professional $799"> Professional $799 </option>
<option value="Enterprise $1499"> Enterprise $1499 </option>
</select>
</div>
</li>
<li class="form-line" data-type="control_dropdown" id="id_29">
<label class="form-label form-label-top form-label-auto" id="label_29" for="input_29"> Video Animation </label>
<div id="cid_29" class="form-input-wide" data-layout="half">
<select class="form-dropdown" id="input_29" name="q29_videoAnimation" style="width:310px" data-component="dropdown">
<option value=""> Please Select </option>
<option value="Teaser $499"> Teaser $499 </option>
<option value="Startup $799"> Startup $799 </option>
<option value="Classic $999"> Classic $999 </option>
</select>
</div>
</li>
<li class="form-line" data-type="control_signature" id="id_18">
<label class="form-label form-label-top form-label-auto" id="label_18" for="input_18"> Signature </label>
<div id="cid_18" class="form-input-wide" data-layout="half">
<div data-wrapper-react="true">
<div id="signature_pad_18" class="signature-pad-wrapper" style="width:312px;height:116px">
<div data-wrapper-react="true">
<!--[if IE 7]>
<script type="text/javascript" src="/js/vendor/json2.js"></script>
<![endif]-->
</div>
<div class="signature-line signature-wrapper signature-placeholder" data-component="signature" style="width:312px;height:116px">
<div id="sig_pad_18" data-width="310" data-height="114" data-id="18" data-required="false" class="pad " aria-labelledby="label_18">
</div>
<input type="hidden" name="q18_signature" class="output4" id="input_18" />
</div>
<span class="clear-pad-btn clear-pad" role="button" tabindex="0">
Clear
</span>
</div>
<div data-wrapper-react="true">
<script type="text/javascript">
window.signatureForm = true
</script>
</div>
</div>
</div>
</li>
<li class="form-line" data-type="control_button" id="id_2">
<div id="cid_2" class="form-input-wide" data-layout="full">
<div data-align="left" class="form-buttons-wrapper form-buttons-left jsTest-button-wrapperField">
<button id="input_2" type="submit" class="form-submit-button submit-button jf-form-buttons jsTest-submitField" data-component="button" data-content="">
Submit
</button>
</div>
</div>
</li>
<li style="display:none">
Should be Empty:
<input type="text" name="website" value="" />
</li>
</ul>
</div>
<input type="hidden" class="simple_spc" id="simple_spc" name="simple_spc" value="221883580362459" />
<script type="text/javascript">
var all_spc = document.querySelectorAll("form[id='221883580362459'] .si" + "mple" + "_spc");
for (var i = 0; i < all_spc.length; i++)
{
all_spc[i].value = "221883580362459-221883580362459";
}
</script>
</form></body>
</html>
<script type="text/javascript">JotForm.ownerView=true;</script><script src="https://cdn.jotfor.ms//js/vendor/smoothscroll.min.js?v=3.3.34528"></script>
<script src="https://cdn.jotfor.ms//js/errorNavigation.js?v=3.3.34528"></script>