{"id":30358,"date":"2023-09-08T16:56:38","date_gmt":"2023-09-08T20:56:38","guid":{"rendered":"https:\/\/nccumc.org\/treasurer\/?page_id=30358"},"modified":"2023-09-08T17:00:39","modified_gmt":"2023-09-08T21:00:39","slug":"property-insurance-provider-referrals-form","status":"publish","type":"page","link":"https:\/\/nccumc.org\/treasurer\/property-insurance-provider-referrals-form\/","title":{"rendered":"Property Insurance Provider Referral Form"},"content":{"rendered":"<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof 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data-form-theme='legacy' data-form-index='0' id='gform_wrapper_24' ><form method='post' enctype='multipart\/form-data'  id='gform_24'  action='\/treasurer\/wp-json\/wp\/v2\/pages\/30358' data-formid='24' novalidate>\n                        <div class='gform-body gform_body'><ul id='gform_fields_24' class='gform_fields top_label form_sublabel_below description_above validation_below'><li id=\"field_24_12\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_24_12'>X\/Twitter<\/label><div class='gfield_description' id='gfield_description_24_12'>This field is for validation purposes and should be left unchanged.<\/div><div class='ginput_container'><input name='input_12' id='input_24_12' type='text' value='' autocomplete='new-password'\/><\/div><\/li><li id=\"field_24_10\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Referred by:<\/h2><\/li><li id=\"field_24_1\" class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Your Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_24_1'>\n                            \n                            <span id='input_24_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.3' id='input_24_1_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_24_1_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_24_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.6' id='input_24_1_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_24_1_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_24_2\" class=\"gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_24_2'>Your Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_2' id='input_24_2' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_24_9\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Include my name with my review<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_24_9'>\n\t\t\t<li class='gchoice gchoice_24_9_0'>\n\t\t\t\t<input name='input_9' type='radio' value='Yes'  id='choice_24_9_0'    \/>\n\t\t\t\t<label for='choice_24_9_0' id='label_24_9_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_24_9_1'>\n\t\t\t\t<input name='input_9' type='radio' value='No'  id='choice_24_9_1'    \/>\n\t\t\t\t<label for='choice_24_9_1' id='label_24_9_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_24_11\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Your Referral<\/h2><div class='gsection_description' id='gfield_description_24_11'>Please include as much of their contact information as you have available to 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gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_4' id='input_24_4' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_24_5\" class=\"gfield gfield--type-address field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Address<\/label>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_24_5' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_24_5_1_container' >\n                                        <input type='text' name='input_5.1' id='input_24_5_1' value=''    aria-required='false'    \/>\n                                    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