{"id":112,"date":"2020-09-11T08:23:23","date_gmt":"2020-09-11T13:23:23","guid":{"rendered":"http:\/\/marcusagent.com\/?page_id=112"},"modified":"2021-10-26T17:14:38","modified_gmt":"2021-10-26T22:14:38","slug":"homeowners","status":"publish","type":"page","link":"https:\/\/marcusagent.com\/homeowners\/","title":{"rendered":"Homeowners"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"112\" class=\"elementor elementor-112\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-abfe9b5 elementor-section-height-min-height elementor-section-items-bottom elementor-section-boxed elementor-section-height-default\" data-id=\"abfe9b5\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t\t<div class=\"elementor-background-overlay\"><\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-4a65620\" data-id=\"4a65620\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-ca370f0 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"ca370f0\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-184e1b5\" data-id=\"184e1b5\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-b308506 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"b308506\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-95927fd\" data-id=\"95927fd\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-0f54126 elementor-widget elementor-widget-text-editor\" data-id=\"0f54126\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\tPrefer to fill out by hand?\u00a0\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-30a06c2\" data-id=\"30a06c2\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-bd3c81d elementor-align-center elementor-widget elementor-widget-button\" data-id=\"bd3c81d\" data-element_type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm\" href=\"https:\/\/marcusagent.com\/wp-content\/uploads\/2021\/10\/Homeowner-App-1-1.pdf\" target=\"_blank\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t<span class=\"elementor-button-icon elementor-align-icon-right\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"far fa-file-pdf\"><\/i>\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Download PDF<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<div class=\"elementor-element elementor-element-f12cd64 uael-gf-ajax-yes uael-gf-check-yes uael-gf-style-box uael-gf-input-size-sm uael-gf-button-left uael-gf-btn-size-sm elementor-widget elementor-widget-uael-gf-styler\" data-id=\"f12cd64\" data-element_type=\"widget\" data-widget_type=\"uael-gf-styler.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<div class=\"uael-gf-style uael-gf-check-style elementor-clickable\">\n\t<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_safari gform_wrapper gravity-theme gform-theme--no-framework gf_stylespro_wrapper sp_flat_wrapper' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_11' style='display:none'><div id='gf_11' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>&quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_11' id='gform_11' class=' gf_stylespro sp_flat' action='\/wp-json\/wp\/v2\/pages\/112#gf_11' data-formid='11' novalidate><div class='gf_invisible ginput_recaptchav3' data-sitekey='6Ldp8PYcAAAAAINtibmU-8VaOxIEUjlWW9EpdmEj' data-tabindex='1'><input id=\"input_cfae3b0ebe4a953f72fa3718381dbca1\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_cfae3b0ebe4a953f72fa3718381dbca1\" value=\"\"\/><\/div>\n        <div id='gf_progressbar_wrapper_11' class='gf_progressbar_wrapper'>\n        \t<p class=\"gf_progressbar_title\">Step <span class='gf_step_current_page'>1<\/span> of <span class='gf_step_page_count'>2<\/span>\n        \t<\/p>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_50' style='width:50%;'><span>50%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_11_1' class='gform_page ' data-js='page-field-id-1' >\n                                    <div class='gform_page_fields'><div id='gform_fields_11' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_11_148\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_third gf_left o_medium\"  data-field-class=\"gf_third gf_left o_medium\" data-js-reload=\"field_11_148\" ><label class='gfield_label gform-field-label' for='input_11_148'>Insured Name<\/label><div class='ginput_container ginput_container_text'><input name='input_148' id='input_11_148' type='text' value='' class='small'   tabindex='2'   aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_11_5\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_third o_medium\"  data-field-class=\"gf_third o_medium\" data-js-reload=\"field_11_5\" ><label class='gfield_label gform-field-label' for='input_11_5'>SS Number<\/label><div class='ginput_container ginput_container_text'><input name='input_5' id='input_11_5' type='text' value='' class='small'   tabindex='3'   aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_11_2\" class=\"gfield gfield--type-date gfield--input-type-datefield field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_third gf_right o_medium\"  data-field-class=\"gf_third gf_right o_medium\" data-js-reload=\"field_11_2\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Today&#039;s Date<\/legend><div id='input_11_2' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_11_2_1_container'>\n                                            <input type='number' maxlength='2' name='input_2[]' id='input_11_2_1' value='' tabindex='4'  aria-required='false'   placeholder='MM' min='1' max='12' step='1'\/>\n                                            <label for='input_11_2_1' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Month<\/label>\n                                        <\/div><div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_11_2_2_container'>\n                                            <input type='number' maxlength='2' name='input_2[]' id='input_11_2_2' value='' tabindex='5'  aria-required='false'   placeholder='DD' min='1' max='31' step='1'\/>\n                                            <label for='input_11_2_2' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Day<\/label>\n                                        <\/div><div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_11_2_3_container'>\n                                            <input type='number' maxlength='4' name='input_2[]' id='input_11_2_3' value='' tabindex='6'  aria-required='false'   placeholder='YYYY' min='1920' max='2025' step='1'\/>\n                                            <label for='input_11_2_3' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Year<\/label>\n                                       <\/div>\n                                   <\/div><\/fieldset><div id=\"field_11_6\" class=\"gfield gfield--type-number field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_third gf_left o_medium\"  data-field-class=\"gf_third gf_left o_medium\" data-js-reload=\"field_11_6\" ><label class='gfield_label gform-field-label' for='input_11_6'>Number in Household<\/label><div class='ginput_container ginput_container_number'><input name='input_6' id='input_11_6' type='number' step='any'   value='' class='small' tabindex='7'     aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_11_4\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_third gf_list_2col gfsp_dot o_medium\"  data-field-class=\"gf_third gf_list_2col gfsp_dot o_medium\" data-js-reload=\"field_11_4\" ><legend class='gfield_label gform-field-label' >Marital Status<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_11_4'>\n\t\t\t<div class='gchoice gchoice_11_4_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_4' type='radio' value='Single'  id='choice_11_4_0' onchange='gformToggleRadioOther( this )'  tabindex='8'  \/>\n\t\t\t\t\t<label for='choice_11_4_0' id='label_11_4_0' class='gform-field-label gform-field-label--type-inline'>Single<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_4_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_4' type='radio' value='Married'  id='choice_11_4_1' onchange='gformToggleRadioOther( this )'  tabindex='9'  \/>\n\t\t\t\t\t<label for='choice_11_4_1' id='label_11_4_1' class='gform-field-label gform-field-label--type-inline'>Married<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_11_3\" class=\"gfield gfield--type-date gfield--input-type-datefield field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_third gf_right o_medium\"  data-field-class=\"gf_third gf_right o_medium\" data-js-reload=\"field_11_3\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Date of Birth<\/legend><div id='input_11_3' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_11_3_1_container'>\n                                            <input type='number' maxlength='2' name='input_3[]' id='input_11_3_1' value='' tabindex='10'  aria-required='false'   placeholder='MM' min='1' max='12' step='1'\/>\n                                            <label for='input_11_3_1' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Month<\/label>\n                                        <\/div><div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_11_3_2_container'>\n                                            <input type='number' maxlength='2' name='input_3[]' id='input_11_3_2' value='' tabindex='11'  aria-required='false'   placeholder='DD' min='1' max='31' step='1'\/>\n                                            <label for='input_11_3_2' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Day<\/label>\n                                        <\/div><div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_11_3_3_container'>\n                                            <input type='number' maxlength='4' name='input_3[]' id='input_11_3_3' value='' tabindex='12'  aria-required='false'   placeholder='YYYY' min='1920' max='2025' step='1'\/>\n                                            <label for='input_11_3_3' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Year<\/label>\n                                       <\/div>\n                                   <\/div><\/fieldset><div id=\"field_11_7\" class=\"gfield gfield--type-email field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_third gf_newline gf_left o_medium\"  data-field-class=\"gf_third gf_newline gf_left o_medium\" data-js-reload=\"field_11_7\" ><label class='gfield_label gform-field-label' for='input_11_7'>Email<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_7' id='input_11_7' type='email' value='' class='small' tabindex='13'    aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_11_8\" class=\"gfield gfield--type-phone field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_third o_medium\"  data-field-class=\"gf_third o_medium\" data-js-reload=\"field_11_8\" ><label class='gfield_label gform-field-label' for='input_11_8'>Home Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_8' id='input_11_8' type='tel' value='' class='small' tabindex='14'   aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_11_9\" class=\"gfield gfield--type-phone field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_third gf_right o_medium\"  data-field-class=\"gf_third gf_right o_medium\" data-js-reload=\"field_11_9\" ><label class='gfield_label gform-field-label' for='input_11_9'>Cell Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_9' id='input_11_9' type='tel' value='' class='small' tabindex='15'   aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_11_165\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label gfield_visibility_visible\"  data-js-reload=\"field_11_165\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Privacy Policy<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_11_165'><div class='gchoice gchoice_11_165_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_165.1' type='checkbox'  value='By submitting my phone number, I hereby authorize Lighthouse Insurance Agency LLC to communicate with me through text messaging. View our &lt;a href=&quot;https:\/\/marcusagent.com\/privacy-policy\/&quot; target=&quot;_blank&quot;&gt;Privacy Policy here&lt;\/a&gt;.'  id='choice_11_165_1' tabindex='16'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_165_1' id='label_11_165_1' class='gform-field-label gform-field-label--type-inline'>By submitting my phone number, I hereby authorize Lighthouse Insurance Agency LLC to communicate with me through text messaging. View our <a href=\"https:\/\/marcusagent.com\/privacy-policy\/\" target=\"_blank\">Privacy Policy here<\/a>.<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_11_10\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_third gf_left o_medium\"  data-field-class=\"gf_third gf_left o_medium\" data-js-reload=\"field_11_10\" ><label class='gfield_label gform-field-label' for='input_11_10'>Occupation<\/label><div class='ginput_container ginput_container_text'><input name='input_10' id='input_11_10' type='text' value='' class='small'   tabindex='17'   aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_11_11\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_third o_medium\"  data-field-class=\"gf_third o_medium\" data-js-reload=\"field_11_11\" ><label class='gfield_label gform-field-label' for='input_11_11'>Employer<\/label><div class='ginput_container ginput_container_text'><input name='input_11' id='input_11_11' type='text' value='' class='small'   tabindex='18'   aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_11_12\" class=\"gfield gfield--type-number field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_third gf_right o_medium\"  data-field-class=\"gf_third gf_right o_medium\" data-js-reload=\"field_11_12\" ><label class='gfield_label gform-field-label' for='input_11_12'>Number of Years<\/label><div class='ginput_container ginput_container_number'><input name='input_12' id='input_11_12' type='number' step='any'   value='' class='small' tabindex='19'     aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_11_149\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_third gf_left o_medium\"  data-field-class=\"gf_third gf_left o_medium\" data-js-reload=\"field_11_149\" ><label class='gfield_label gform-field-label' for='input_11_149'>Co-Insured Name<\/label><div class='ginput_container ginput_container_text'><input name='input_149' id='input_11_149' type='text' value='' class='small'   tabindex='20'   aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_11_15\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_third o_medium\"  data-field-class=\"gf_third o_medium\" data-js-reload=\"field_11_15\" ><label class='gfield_label gform-field-label' for='input_11_15'>SS Number<\/label><div class='ginput_container ginput_container_text'><input name='input_15' id='input_11_15' type='text' value='' class='small'   tabindex='21'   aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_11_14\" class=\"gfield gfield--type-date gfield--input-type-datefield field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_third gf_right o_medium\"  data-field-class=\"gf_third gf_right o_medium\" data-js-reload=\"field_11_14\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Date of Birth<\/legend><div id='input_11_14' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_11_14_1_container'>\n                                            <input type='number' maxlength='2' name='input_14[]' id='input_11_14_1' value='' tabindex='22'  aria-required='false'   placeholder='MM' min='1' max='12' step='1'\/>\n                                            <label for='input_11_14_1' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Month<\/label>\n                                        <\/div><div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_11_14_2_container'>\n                                            <input type='number' maxlength='2' name='input_14[]' id='input_11_14_2' value='' tabindex='23'  aria-required='false'   placeholder='DD' min='1' max='31' step='1'\/>\n                                            <label for='input_11_14_2' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Day<\/label>\n                                        <\/div><div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_11_14_3_container'>\n                                            <input type='number' maxlength='4' name='input_14[]' id='input_11_14_3' value='' tabindex='24'  aria-required='false'   placeholder='YYYY' min='1920' max='2025' step='1'\/>\n                                            <label for='input_11_14_3' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Year<\/label>\n                                       <\/div>\n                                   <\/div><\/fieldset><div id=\"field_11_16\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_third gf_newline gf_left o_medium\"  data-field-class=\"gf_third gf_newline gf_left o_medium\" data-js-reload=\"field_11_16\" ><label class='gfield_label gform-field-label' for='input_11_16'>Occupation<\/label><div class='ginput_container ginput_container_text'><input name='input_16' id='input_11_16' type='text' value='' class='small'   tabindex='25'   aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_11_17\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_third o_medium\"  data-field-class=\"gf_third o_medium\" data-js-reload=\"field_11_17\" ><label class='gfield_label gform-field-label' for='input_11_17'>Employer<\/label><div class='ginput_container ginput_container_text'><input name='input_17' id='input_11_17' type='text' value='' class='small'   tabindex='26'   aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_11_18\" class=\"gfield gfield--type-number field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_third gf_right o_medium\"  data-field-class=\"gf_third gf_right o_medium\" data-js-reload=\"field_11_18\" ><label class='gfield_label gform-field-label' for='input_11_18'>Number of Years<\/label><div class='ginput_container ginput_container_number'><input name='input_18' id='input_11_18' type='number' step='any'   value='' class='small' tabindex='27'     aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_11_19\" class=\"gfield gfield--type-address field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_11_19\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Property Address<\/legend>    \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_11_19' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_11_19_1_container' >\n                                        <input type='text' name='input_19.1' id='input_11_19_1' value='' tabindex='28'   aria-required='false'    \/>\n                                        <label for='input_11_19_1' id='input_11_19_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_11_19_2_container' >\n                                        <input type='text' name='input_19.2' id='input_11_19_2' value='' tabindex='29'    aria-required='false'   \/>\n                                        <label for='input_11_19_2' id='input_11_19_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_11_19_3_container' >\n                                    <input type='text' name='input_19.3' id='input_11_19_3' value='' tabindex='30'   aria-required='false'    \/>\n                                    <label for='input_11_19_3' id='input_11_19_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_11_19_4_container' >\n                                        <input type='text' name='input_19.4' id='input_11_19_4' value='' tabindex='32'     aria-required='false'    \/>\n                                        <label for='input_11_19_4' id='input_11_19_4_label' class='gform-field-label gform-field-label--type-sub '>State \/ Province \/ Region<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_11_19_5_container' >\n                                    <input type='text' name='input_19.5' id='input_11_19_5' value='' tabindex='33'   aria-required='false'    \/>\n                                    <label for='input_11_19_5' id='input_11_19_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_19.6' id='input_11_19_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><fieldset id=\"field_11_20\" class=\"gfield gfield--type-address field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_11_20\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Previous address if less than 3 years<\/legend>    \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_11_20' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_11_20_1_container' >\n                                        <input type='text' name='input_20.1' id='input_11_20_1' value='' tabindex='34'   aria-required='false'    \/>\n                                        <label for='input_11_20_1' id='input_11_20_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_11_20_2_container' >\n                                        <input type='text' name='input_20.2' id='input_11_20_2' value='' tabindex='35'    aria-required='false'   \/>\n                                        <label for='input_11_20_2' id='input_11_20_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_11_20_3_container' >\n                                    <input type='text' name='input_20.3' id='input_11_20_3' value='' tabindex='36'   aria-required='false'    \/>\n                                    <label for='input_11_20_3' id='input_11_20_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_11_20_4_container' >\n                                        <input type='text' name='input_20.4' id='input_11_20_4' value='' tabindex='38'     aria-required='false'    \/>\n                                        <label for='input_11_20_4' id='input_11_20_4_label' class='gform-field-label gform-field-label--type-sub '>State \/ Province \/ Region<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_11_20_5_container' >\n                                    <input type='text' name='input_20.5' id='input_11_20_5' value='' tabindex='39'   aria-required='false'    \/>\n                                    <label for='input_11_20_5' id='input_11_20_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_20.6' id='input_11_20_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><fieldset id=\"field_11_21\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below hidden_label gfield_visibility_visible gf_list_inline gfsp_dot o_small\"  data-field-class=\"gf_list_inline gfsp_dot o_small\" data-js-reload=\"field_11_21\" ><legend class='gfield_label gform-field-label' >Untitled<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_11_21'>\n\t\t\t<div class='gchoice gchoice_11_21_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_21' type='radio' value='Single Family'  id='choice_11_21_0' onchange='gformToggleRadioOther( this )'  tabindex='40'  \/>\n\t\t\t\t\t<label for='choice_11_21_0' id='label_11_21_0' class='gform-field-label gform-field-label--type-inline'>Single Family<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_21_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_21' type='radio' value='Duplex'  id='choice_11_21_1' onchange='gformToggleRadioOther( this )'  tabindex='41'  \/>\n\t\t\t\t\t<label for='choice_11_21_1' id='label_11_21_1' class='gform-field-label gform-field-label--type-inline'>Duplex<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_21_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_21' type='radio' value='Triplex'  id='choice_11_21_2' onchange='gformToggleRadioOther( this )'  tabindex='42'  \/>\n\t\t\t\t\t<label for='choice_11_21_2' id='label_11_21_2' class='gform-field-label gform-field-label--type-inline'>Triplex<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_21_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_21' type='radio' value='Condo'  id='choice_11_21_3' onchange='gformToggleRadioOther( this )'  tabindex='43'  \/>\n\t\t\t\t\t<label for='choice_11_21_3' id='label_11_21_3' class='gform-field-label gform-field-label--type-inline'>Condo<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_21_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_21' type='radio' value='Townhouse'  id='choice_11_21_4' onchange='gformToggleRadioOther( this )'  tabindex='44'  \/>\n\t\t\t\t\t<label for='choice_11_21_4' id='label_11_21_4' class='gform-field-label gform-field-label--type-inline'>Townhouse<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_11_162\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_list_2col gfsp_dot o_medium\"  data-field-class=\"gf_list_2col gfsp_dot o_medium\" data-js-reload=\"field_11_162\" ><legend class='gfield_label gform-field-label' >Owner or tenant occupied?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_11_162'>\n\t\t\t<div class='gchoice gchoice_11_162_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_162' type='radio' value='Owner Occupied'  id='choice_11_162_0' onchange='gformToggleRadioOther( this )'  tabindex='45'  \/>\n\t\t\t\t\t<label for='choice_11_162_0' id='label_11_162_0' class='gform-field-label gform-field-label--type-inline'>Owner Occupied<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_162_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_162' type='radio' value='Tenant Occupied'  id='choice_11_162_1' onchange='gformToggleRadioOther( this )'  tabindex='46'  \/>\n\t\t\t\t\t<label for='choice_11_162_1' id='label_11_162_1' class='gform-field-label gform-field-label--type-inline'>Tenant Occupied<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_11_23' class='gform_next_button gform-theme-button button' value='Next' tabindex='47' onclick='jQuery(\"#gform_target_page_number_11\").val(\"2\");  jQuery(\"#gform_11\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_11\").val(\"2\");  jQuery(\"#gform_11\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_11_2' class='gform_page' data-js='page-field-id-23' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_11_2' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_11_139\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter gf_left o_medium\"  data-field-class=\"gf_quarter gf_left o_medium\" data-js-reload=\"field_11_139\" ><label class='gfield_label gform-field-label' for='input_11_139'>Estimate closing date\/Exp date<\/label><div class='ginput_container ginput_container_text'><input name='input_139' id='input_11_139' type='text' value='' class='small'   tabindex='48'   aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_11_27\" class=\"gfield gfield--type-number field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" data-js-reload=\"field_11_27\" ><label class='gfield_label gform-field-label' for='input_11_27'>Purchase Price<\/label><div class='ginput_container ginput_container_number'><input name='input_27' id='input_11_27' type='text' step='any'   value='' class='small' tabindex='49'     aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_11_28\" class=\"gfield gfield--type-number field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" data-js-reload=\"field_11_28\" ><label class='gfield_label gform-field-label' for='input_11_28'>Loan Amount<\/label><div class='ginput_container ginput_container_number'><input name='input_28' id='input_11_28' type='number' step='any'   value='' class='small' tabindex='50'     aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_11_29\" class=\"gfield gfield--type-number field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" data-js-reload=\"field_11_29\" ><label class='gfield_label gform-field-label' for='input_11_29'>Current\/Desired Dwelling Coverage Limit<\/label><div class='ginput_container ginput_container_number'><input name='input_29' id='input_11_29' type='text' step='any'   value='' class='small' tabindex='51'     aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_11_30\" class=\"gfield gfield--type-number field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_half o_medium\"  data-field-class=\"gf_half o_medium\" data-js-reload=\"field_11_30\" ><label class='gfield_label gform-field-label' for='input_11_30'>Deductibles<\/label><div class='ginput_container ginput_container_number'><input name='input_30' id='input_11_30' type='text' step='any'   value='' class='small' tabindex='52'     aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_11_31\" class=\"gfield gfield--type-number field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" data-js-reload=\"field_11_31\" ><label class='gfield_label gform-field-label' for='input_11_31'>Liability Coverage Amount<\/label><div class='ginput_container ginput_container_number'><input name='input_31' id='input_11_31' type='text' step='any'   value='' class='small' tabindex='53'     aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_11_32\" class=\"gfield gfield--type-number field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" data-js-reload=\"field_11_32\" ><label class='gfield_label gform-field-label' for='input_11_32'>Medical Payment Amount<\/label><div class='ginput_container ginput_container_number'><input name='input_32' id='input_11_32' type='text' step='any'   value='' class='small' tabindex='54'     aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_11_158\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_11_158\" ><h4> Home: <\/h4><\/div><div id=\"field_11_35\" class=\"gfield gfield--type-number field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" data-js-reload=\"field_11_35\" ><label class='gfield_label gform-field-label' for='input_11_35'>Current Premium<\/label><div class='ginput_container ginput_container_number'><input name='input_35' id='input_11_35' type='text' step='any'   value='' class='small' tabindex='55'     aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_11_36\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" data-js-reload=\"field_11_36\" ><label class='gfield_label gform-field-label' for='input_11_36'>Current Policy Number<\/label><div class='ginput_container ginput_container_text'><input name='input_36' id='input_11_36' type='text' value='' class='small'   tabindex='56'   aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_11_37\" class=\"gfield gfield--type-number field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" data-js-reload=\"field_11_37\" ><label class='gfield_label gform-field-label' for='input_11_37'>Years with prior carrier<\/label><div class='ginput_container ginput_container_number'><input name='input_37' id='input_11_37' type='number' step='any'   value='' class='small' tabindex='57'     aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_11_33\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" data-js-reload=\"field_11_33\" ><label class='gfield_label gform-field-label' for='input_11_33'>Prior Insurance Carrier<\/label><div class='ginput_container ginput_container_text'><input name='input_33' id='input_11_33' type='text' value='' class='small'   tabindex='58'   aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_11_163\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_newline o_medium\"  data-field-class=\"gf_newline o_medium\" data-js-reload=\"field_11_163\" ><label class='gfield_label gform-field-label' for='input_11_163'>Current Policy Expiration<\/label><div class='ginput_container ginput_container_text'><input name='input_163' id='input_11_163' type='text' value='' class='small'   tabindex='59'   aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_11_159\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_11_159\" ><h4> Flood: <\/h4><\/div><div id=\"field_11_154\" class=\"gfield gfield--type-number field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" data-js-reload=\"field_11_154\" ><label class='gfield_label gform-field-label' for='input_11_154'>Current Premium<\/label><div class='ginput_container ginput_container_number'><input name='input_154' id='input_11_154' type='text' step='any'   value='' class='small' tabindex='60'     aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_11_155\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" data-js-reload=\"field_11_155\" ><label class='gfield_label gform-field-label' for='input_11_155'>Current Policy Number<\/label><div class='ginput_container ginput_container_text'><input name='input_155' id='input_11_155' type='text' value='' class='small'   tabindex='61'   aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_11_156\" class=\"gfield gfield--type-number field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" data-js-reload=\"field_11_156\" ><label class='gfield_label gform-field-label' for='input_11_156'>Years with prior carrier<\/label><div class='ginput_container ginput_container_number'><input name='input_156' id='input_11_156' type='number' step='any'   value='' class='small' tabindex='62'     aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_11_157\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" data-js-reload=\"field_11_157\" ><label class='gfield_label gform-field-label' for='input_11_157'>Flood zone<\/label><div class='ginput_container ginput_container_text'><input name='input_157' id='input_11_157' type='text' value='' class='small'   tabindex='63'   aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_11_164\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_newline o_medium\"  data-field-class=\"gf_newline o_medium\" data-js-reload=\"field_11_164\" ><label class='gfield_label gform-field-label' for='input_11_164'>Current Policy Expiration<\/label><div class='ginput_container ginput_container_text'><input name='input_164' id='input_11_164' type='text' value='' class='small'   tabindex='64'   aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_11_43\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter gf_left gf_list_2col gfsp_dot o_medium\"  data-field-class=\"gf_quarter gf_left gf_list_2col gfsp_dot o_medium\" data-js-reload=\"field_11_43\" ><legend class='gfield_label gform-field-label' >Losses or claims in the past three years on any homes owned?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_11_43'>\n\t\t\t<div class='gchoice gchoice_11_43_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_43' type='radio' value='Yes'  id='choice_11_43_0' onchange='gformToggleRadioOther( this )'  tabindex='65'  \/>\n\t\t\t\t\t<label for='choice_11_43_0' id='label_11_43_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_43_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_43' type='radio' value='No'  id='choice_11_43_1' onchange='gformToggleRadioOther( this )'  tabindex='66'  \/>\n\t\t\t\t\t<label for='choice_11_43_1' id='label_11_43_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_11_45\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" data-js-reload=\"field_11_45\" ><label class='gfield_label gform-field-label' for='input_11_45'>Type of loss<\/label><div class='ginput_container ginput_container_text'><input name='input_45' id='input_11_45' type='text' value='' class='small'   tabindex='67'   aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_11_46\" class=\"gfield gfield--type-number field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" data-js-reload=\"field_11_46\" ><label class='gfield_label gform-field-label' for='input_11_46'>Amount Paid: $<\/label><div class='ginput_container ginput_container_number'><input name='input_46' id='input_11_46' type='text' step='any'   value='' class='small' tabindex='68'     aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_11_44\" class=\"gfield gfield--type-date gfield--input-type-datefield field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" data-js-reload=\"field_11_44\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Date<\/legend><div id='input_11_44' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_11_44_1_container'>\n                                            <input type='number' maxlength='2' name='input_44[]' id='input_11_44_1' value='' tabindex='69'  aria-required='false'   placeholder='MM' min='1' max='12' step='1'\/>\n                                            <label for='input_11_44_1' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Month<\/label>\n                                        <\/div><div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_11_44_2_container'>\n                                            <input type='number' maxlength='2' name='input_44[]' id='input_11_44_2' value='' tabindex='70'  aria-required='false'   placeholder='DD' min='1' max='31' step='1'\/>\n                                            <label for='input_11_44_2' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Day<\/label>\n                                        <\/div><div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_11_44_3_container'>\n                                            <input type='number' maxlength='4' name='input_44[]' id='input_11_44_3' value='' tabindex='71'  aria-required='false'   placeholder='YYYY' min='1920' max='2025' step='1'\/>\n                                            <label for='input_11_44_3' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Year<\/label>\n                                       <\/div>\n                                   <\/div><\/fieldset><div id=\"field_11_50\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_11_50\" ><h3 class=\"gsection_title\">Dwelling Information<\/h3><\/div><div id=\"field_11_48\" class=\"gfield gfield--type-number field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter gf_left o_medium\"  data-field-class=\"gf_quarter gf_left o_medium\" data-js-reload=\"field_11_48\" ><label class='gfield_label gform-field-label' for='input_11_48'>Year Built<\/label><div class='ginput_container ginput_container_number'><input name='input_48' id='input_11_48' type='number' step='any'   value='' class='small' tabindex='72'     aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_11_49\" class=\"gfield gfield--type-number field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" data-js-reload=\"field_11_49\" ><label class='gfield_label gform-field-label' for='input_11_49'>Living Square Feet<\/label><div class='ginput_container ginput_container_number'><input name='input_49' id='input_11_49' type='number' step='any'   value='' class='small' tabindex='73'     aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_11_51\" class=\"gfield gfield--type-number field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" data-js-reload=\"field_11_51\" ><label class='gfield_label gform-field-label' for='input_11_51'>Number of Stories<\/label><div class='ginput_container ginput_container_number'><input name='input_51' id='input_11_51' type='number' step='any'   value='' class='small' tabindex='74'     aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_11_140\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter gf_list_2col gfsp_dot o_medium\"  data-field-class=\"gf_quarter gf_list_2col gfsp_dot o_medium\" data-js-reload=\"field_11_140\" ><legend class='gfield_label gform-field-label' >Any part of home over water?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_11_140'>\n\t\t\t<div class='gchoice gchoice_11_140_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_140' type='radio' value='Yes'  id='choice_11_140_0' onchange='gformToggleRadioOther( this )'  tabindex='75'  \/>\n\t\t\t\t\t<label for='choice_11_140_0' id='label_11_140_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_140_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_140' type='radio' value='No'  id='choice_11_140_1' onchange='gformToggleRadioOther( this )'  tabindex='76'  \/>\n\t\t\t\t\t<label for='choice_11_140_1' id='label_11_140_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_11_153\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_11_153\" ><label class='gfield_label gform-field-label' for='input_11_153'>What part\/Square feet?<\/label><div class='ginput_container ginput_container_text'><input name='input_153' id='input_11_153' type='text' value='' class='medium'   tabindex='77'   aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_11_150\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter gf_newline gf_left o_medium\"  data-field-class=\"gf_quarter gf_newline gf_left o_medium\" data-js-reload=\"field_11_150\" ><label class='gfield_label gform-field-label' for='input_11_150'>Story unit is on<\/label><div class='ginput_container ginput_container_text'><input name='input_150' id='input_11_150' type='text' value='' class='small'   tabindex='78'   aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_11_151\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" data-js-reload=\"field_11_151\" ><label class='gfield_label gform-field-label' for='input_11_151'>How many units in building?<\/label><div class='ginput_container ginput_container_text'><input name='input_151' id='input_11_151' type='text' value='' class='small'   tabindex='79'   aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_11_55\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter gf_list_2col gfsp_dot o_medium\"  data-field-class=\"gf_quarter gf_list_2col gfsp_dot o_medium\" data-js-reload=\"field_11_55\" ><legend class='gfield_label gform-field-label' >Has home been renovated to studs including new windows and doors?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_11_55'>\n\t\t\t<div class='gchoice gchoice_11_55_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_55' type='radio' value='Yes'  id='choice_11_55_0' onchange='gformToggleRadioOther( this )'  tabindex='80'  \/>\n\t\t\t\t\t<label for='choice_11_55_0' id='label_11_55_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_55_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_55' type='radio' value='No'  id='choice_11_55_1' onchange='gformToggleRadioOther( this )'  tabindex='81'  \/>\n\t\t\t\t\t<label for='choice_11_55_1' id='label_11_55_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_11_56\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter gf_right o_medium\"  data-field-class=\"gf_quarter gf_right o_medium\" data-js-reload=\"field_11_56\" ><label class='gfield_label gform-field-label' for='input_11_56'>What year?<\/label><div class='ginput_container ginput_container_text'><input name='input_56' id='input_11_56' type='text' value='' class='small'   tabindex='82'   aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_11_57\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_half gf_left gf_list_2col gfsp_dot o_medium\"  data-field-class=\"gf_half gf_left gf_list_2col gfsp_dot o_medium\" data-js-reload=\"field_11_57\" ><legend class='gfield_label gform-field-label' >Type of foundation<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_11_57'>\n\t\t\t<div class='gchoice gchoice_11_57_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_57' type='radio' value='Slab'  id='choice_11_57_0' onchange='gformToggleRadioOther( this )'  tabindex='83'  \/>\n\t\t\t\t\t<label for='choice_11_57_0' id='label_11_57_0' class='gform-field-label gform-field-label--type-inline'>Slab<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_57_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_57' type='radio' value='Piers'  id='choice_11_57_1' onchange='gformToggleRadioOther( this )'  tabindex='84'  \/>\n\t\t\t\t\t<label for='choice_11_57_1' id='label_11_57_1' class='gform-field-label gform-field-label--type-inline'>Piers<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_11_59\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter gf_list_2col gfsp_dot o_medium\"  data-field-class=\"gf_quarter gf_list_2col gfsp_dot o_medium\" data-js-reload=\"field_11_59\" ><legend class='gfield_label gform-field-label' >Open or closed foundation between piers?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_11_59'>\n\t\t\t<div class='gchoice gchoice_11_59_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_59' type='radio' value='Open'  id='choice_11_59_0' onchange='gformToggleRadioOther( this )'  tabindex='85'  \/>\n\t\t\t\t\t<label for='choice_11_59_0' id='label_11_59_0' class='gform-field-label gform-field-label--type-inline'>Open<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_59_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_59' type='radio' value='Closed'  id='choice_11_59_1' onchange='gformToggleRadioOther( this )'  tabindex='86'  \/>\n\t\t\t\t\t<label for='choice_11_59_1' id='label_11_59_1' class='gform-field-label gform-field-label--type-inline'>Closed<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_11_58\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" data-js-reload=\"field_11_58\" ><label class='gfield_label gform-field-label' for='input_11_58'>Pier Height<\/label><div class='ginput_container ginput_container_text'><input name='input_58' id='input_11_58' type='text' value='' class='small'   tabindex='87'   aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_11_60\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter gf_left gf_list_2col gfsp_dot o_medium\"  data-field-class=\"gf_quarter gf_left gf_list_2col gfsp_dot o_medium\" data-js-reload=\"field_11_60\" ><legend class='gfield_label gform-field-label' >Roof type<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_11_60'>\n\t\t\t<div class='gchoice gchoice_11_60_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_60' type='radio' value='Shingle'  id='choice_11_60_0' onchange='gformToggleRadioOther( this )'  tabindex='88'  \/>\n\t\t\t\t\t<label for='choice_11_60_0' id='label_11_60_0' class='gform-field-label gform-field-label--type-inline'>Shingle<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_60_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_60' type='radio' value='Metal'  id='choice_11_60_1' onchange='gformToggleRadioOther( this )'  tabindex='89'  \/>\n\t\t\t\t\t<label for='choice_11_60_1' id='label_11_60_1' class='gform-field-label gform-field-label--type-inline'>Metal<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_60_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_60' type='radio' value='gf_other_choice'  id='choice_11_60_2' onchange='gformToggleRadioOther( this )'  tabindex='90'  \/>\n\t\t\t\t\t<label for='choice_11_60_2' id='label_11_60_2' class='gform-field-label gform-field-label--type-inline'>Other<\/label><br \/><input id='input_11_60_other' class='gchoice_other_control' name='input_60_other' type='text' value='Other' aria-label='Other Choice, please specify' tabindex='90' disabled='disabled' \/>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_11_63\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter gf_list_3col gfsp_dot o_medium\"  data-field-class=\"gf_quarter gf_list_3col gfsp_dot o_medium\" data-js-reload=\"field_11_63\" ><legend class='gfield_label gform-field-label' >Roof Shape<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_11_63'>\n\t\t\t<div class='gchoice gchoice_11_63_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_63' type='radio' value='Flat'  id='choice_11_63_0' onchange='gformToggleRadioOther( this )'  tabindex='91'  \/>\n\t\t\t\t\t<label for='choice_11_63_0' id='label_11_63_0' class='gform-field-label gform-field-label--type-inline'>Flat<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_63_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_63' type='radio' value='Gable'  id='choice_11_63_1' onchange='gformToggleRadioOther( this )'  tabindex='92'  \/>\n\t\t\t\t\t<label for='choice_11_63_1' id='label_11_63_1' class='gform-field-label gform-field-label--type-inline'>Gable<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_63_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_63' type='radio' value='Hip'  id='choice_11_63_2' onchange='gformToggleRadioOther( this )'  tabindex='93'  \/>\n\t\t\t\t\t<label for='choice_11_63_2' id='label_11_63_2' class='gform-field-label gform-field-label--type-inline'>Hip<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_11_62\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" data-js-reload=\"field_11_62\" ><label class='gfield_label gform-field-label' for='input_11_62'>Year roof was updated<\/label><div class='ginput_container ginput_container_text'><input name='input_62' id='input_11_62' type='text' value='' class='small'   tabindex='94'   aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_11_160\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter gf_list_2col gfsp_dot o_medium\"  data-field-class=\"gf_quarter gf_list_2col gfsp_dot o_medium\" data-js-reload=\"field_11_160\" ><legend class='gfield_label gform-field-label' >Shingle Type<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_11_160'>\n\t\t\t<div class='gchoice gchoice_11_160_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_160' type='radio' value='Architectural'  id='choice_11_160_0' onchange='gformToggleRadioOther( this )'  tabindex='95'  \/>\n\t\t\t\t\t<label for='choice_11_160_0' id='label_11_160_0' class='gform-field-label gform-field-label--type-inline'>Architectural<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_160_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_160' type='radio' value='3-tab'  id='choice_11_160_1' onchange='gformToggleRadioOther( this )'  tabindex='96'  \/>\n\t\t\t\t\t<label for='choice_11_160_1' id='label_11_160_1' class='gform-field-label gform-field-label--type-inline'>3-tab<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_11_144\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_11_144\" ><center><img decoding=\"async\" src=\"http:\/\/marcusagent.com\/wp-content\/uploads\/2020\/10\/Lighthouse-Roof-Diagram.jpg\" alt=\"\"><\/center><\/div><div id=\"field_11_141\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter gf_left o_medium\"  data-field-class=\"gf_quarter gf_left o_medium\" data-js-reload=\"field_11_141\" ><label class='gfield_label gform-field-label' for='input_11_141'>Water heater update year<\/label><div class='ginput_container ginput_container_text'><input name='input_141' id='input_11_141' type='text' value='' class='small'   tabindex='97'   aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_11_65\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" data-js-reload=\"field_11_65\" ><label class='gfield_label gform-field-label' for='input_11_65'>AC\/Heating update year<\/label><div class='ginput_container ginput_container_text'><input name='input_65' id='input_11_65' type='text' value='' class='small'   tabindex='98'   aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_11_66\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" data-js-reload=\"field_11_66\" ><label class='gfield_label gform-field-label' for='input_11_66'>Wiring update year<\/label><div class='ginput_container ginput_container_text'><input name='input_66' id='input_11_66' type='text' value='' class='small'   tabindex='99'   aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_11_67\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter gf_right o_medium\"  data-field-class=\"gf_quarter gf_right o_medium\" data-js-reload=\"field_11_67\" ><label class='gfield_label gform-field-label' for='input_11_67'>Plumbing update year<\/label><div class='ginput_container ginput_container_text'><input name='input_67' id='input_11_67' type='text' value='' class='small'   tabindex='100'   aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_11_68\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_third gf_left gf_list_inline gfsp_dot o_medium\"  data-field-class=\"gf_third gf_left gf_list_inline gfsp_dot o_medium\" data-js-reload=\"field_11_68\" ><legend class='gfield_label gform-field-label' >Type of A\/C &amp; Heating<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_11_68'>\n\t\t\t<div class='gchoice gchoice_11_68_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_68' type='radio' value='Central Unit'  id='choice_11_68_0' onchange='gformToggleRadioOther( this )'  tabindex='101'  \/>\n\t\t\t\t\t<label for='choice_11_68_0' id='label_11_68_0' class='gform-field-label gform-field-label--type-inline'>Central Unit<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_68_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_68' type='radio' value='Window Unit'  id='choice_11_68_1' onchange='gformToggleRadioOther( this )'  tabindex='102'  \/>\n\t\t\t\t\t<label for='choice_11_68_1' id='label_11_68_1' class='gform-field-label gform-field-label--type-inline'>Window Unit<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_68_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_68' type='radio' value='Gas'  id='choice_11_68_2' onchange='gformToggleRadioOther( this )'  tabindex='103'  \/>\n\t\t\t\t\t<label for='choice_11_68_2' id='label_11_68_2' class='gform-field-label gform-field-label--type-inline'>Gas<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_68_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_68' type='radio' value='Electric'  id='choice_11_68_3' onchange='gformToggleRadioOther( this )'  tabindex='104'  \/>\n\t\t\t\t\t<label for='choice_11_68_3' id='label_11_68_3' class='gform-field-label gform-field-label--type-inline'>Electric<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_11_69\" class=\"gfield gfield--type-number field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_third o_medium\"  data-field-class=\"gf_third o_medium\" data-js-reload=\"field_11_69\" ><label class='gfield_label gform-field-label' for='input_11_69'>Number of A\/C Units<\/label><div class='ginput_container ginput_container_number'><input name='input_69' id='input_11_69' type='number' step='any'   value='' class='small' tabindex='105'     aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_11_161\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_third gf_list_inline gfsp_dot o_medium\"  data-field-class=\"gf_third gf_list_inline gfsp_dot o_medium\" data-js-reload=\"field_11_161\" ><legend class='gfield_label gform-field-label' >Plumbing type<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_11_161'>\n\t\t\t<div class='gchoice gchoice_11_161_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_161' type='radio' value='Copper'  id='choice_11_161_0' onchange='gformToggleRadioOther( this )'  tabindex='106'  \/>\n\t\t\t\t\t<label for='choice_11_161_0' id='label_11_161_0' class='gform-field-label gform-field-label--type-inline'>Copper<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_161_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_161' type='radio' value='Polybutylene'  id='choice_11_161_1' onchange='gformToggleRadioOther( this )'  tabindex='107'  \/>\n\t\t\t\t\t<label for='choice_11_161_1' id='label_11_161_1' class='gform-field-label gform-field-label--type-inline'>Polybutylene<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_161_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_161' type='radio' value='Galvanized'  id='choice_11_161_2' onchange='gformToggleRadioOther( this )'  tabindex='108'  \/>\n\t\t\t\t\t<label for='choice_11_161_2' id='label_11_161_2' class='gform-field-label gform-field-label--type-inline'>Galvanized<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_161_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_161' type='radio' value='PEX installed prior to 2006'  id='choice_11_161_3' onchange='gformToggleRadioOther( this )'  tabindex='109'  \/>\n\t\t\t\t\t<label for='choice_11_161_3' id='label_11_161_3' class='gform-field-label gform-field-label--type-inline'>PEX installed prior to 2006<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_161_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_161' type='radio' value='PEX installed post-2006'  id='choice_11_161_4' onchange='gformToggleRadioOther( this )'  tabindex='110'  \/>\n\t\t\t\t\t<label for='choice_11_161_4' id='label_11_161_4' class='gform-field-label gform-field-label--type-inline'>PEX installed post-2006<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_11_70\" class=\"gfield gfield--type-number field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter gf_newline gf_left o_medium\"  data-field-class=\"gf_quarter gf_newline gf_left o_medium\" data-js-reload=\"field_11_70\" ><label class='gfield_label gform-field-label' for='input_11_70'>Number of Bedrooms<\/label><div class='ginput_container ginput_container_number'><input name='input_70' id='input_11_70' type='number' step='any'   value='' class='small' tabindex='111'     aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_11_71\" class=\"gfield gfield--type-number field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" data-js-reload=\"field_11_71\" ><label class='gfield_label gform-field-label' for='input_11_71'>Number of Bathrooms<\/label><div class='ginput_container ginput_container_number'><input name='input_71' id='input_11_71' type='number' step='any'   value='' class='small' tabindex='112'     aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_11_73\" class=\"gfield gfield--type-number field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" data-js-reload=\"field_11_73\" ><label class='gfield_label gform-field-label' for='input_11_73'>Number of Fireplaces<\/label><div class='ginput_container ginput_container_number'><input name='input_73' id='input_11_73' type='number' step='any'   value='' class='small' tabindex='113'     aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_11_152\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter gf_right gfsp_dot o_medium\"  data-field-class=\"gf_quarter gf_right gfsp_dot o_medium\" data-js-reload=\"field_11_152\" ><legend class='gfield_label gform-field-label' >Type of Fireplace<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_11_152'>\n\t\t\t<div class='gchoice gchoice_11_152_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_152' type='radio' value='Gas Burning'  id='choice_11_152_0' onchange='gformToggleRadioOther( this )'  tabindex='114'  \/>\n\t\t\t\t\t<label for='choice_11_152_0' id='label_11_152_0' class='gform-field-label gform-field-label--type-inline'>Gas Burning<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_152_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_152' type='radio' value='Wood Burning'  id='choice_11_152_1' onchange='gformToggleRadioOther( this )'  tabindex='115'  \/>\n\t\t\t\t\t<label for='choice_11_152_1' id='label_11_152_1' class='gform-field-label gform-field-label--type-inline'>Wood Burning<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_11_72\" class=\"gfield gfield--type-number field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter gf_newline gf_left o_medium\"  data-field-class=\"gf_quarter gf_newline gf_left o_medium\" data-js-reload=\"field_11_72\" ><label class='gfield_label gform-field-label' for='input_11_72'>Number of cars<\/label><div class='ginput_container ginput_container_number'><input name='input_72' id='input_11_72' type='number' step='any'   value='' class='small' tabindex='116'     aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_11_75\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter gf_list_2col gfsp_dot o_medium\"  data-field-class=\"gf_quarter gf_list_2col gfsp_dot o_medium\" data-js-reload=\"field_11_75\" ><legend class='gfield_label gform-field-label' >Carport?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_11_75'>\n\t\t\t<div class='gchoice gchoice_11_75_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_75' type='radio' value='Yes'  id='choice_11_75_0' onchange='gformToggleRadioOther( this )'  tabindex='117'  \/>\n\t\t\t\t\t<label for='choice_11_75_0' id='label_11_75_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_75_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_75' type='radio' value='No'  id='choice_11_75_1' onchange='gformToggleRadioOther( this )'  tabindex='118'  \/>\n\t\t\t\t\t<label for='choice_11_75_1' id='label_11_75_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_11_76\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter gf_list_2col gfsp_dot o_medium\"  data-field-class=\"gf_quarter gf_list_2col gfsp_dot o_medium\" data-js-reload=\"field_11_76\" ><legend class='gfield_label gform-field-label' >Garage?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_11_76'>\n\t\t\t<div class='gchoice gchoice_11_76_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_76' type='radio' value='Yes'  id='choice_11_76_0' onchange='gformToggleRadioOther( this )'  tabindex='119'  \/>\n\t\t\t\t\t<label for='choice_11_76_0' id='label_11_76_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_76_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_76' type='radio' value='No'  id='choice_11_76_1' onchange='gformToggleRadioOther( this )'  tabindex='120'  \/>\n\t\t\t\t\t<label for='choice_11_76_1' id='label_11_76_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_11_142\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter gf_list_2col gfsp_dot o_medium\"  data-field-class=\"gf_quarter gf_list_2col gfsp_dot o_medium\" data-js-reload=\"field_11_142\" ><legend class='gfield_label gform-field-label' >Type of garage\/carport<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_11_142'>\n\t\t\t<div class='gchoice gchoice_11_142_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_142' type='radio' value='Attached'  id='choice_11_142_0' onchange='gformToggleRadioOther( this )'  tabindex='121'  \/>\n\t\t\t\t\t<label for='choice_11_142_0' id='label_11_142_0' class='gform-field-label gform-field-label--type-inline'>Attached<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_142_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_142' type='radio' value='Unattached'  id='choice_11_142_1' onchange='gformToggleRadioOther( this )'  tabindex='122'  \/>\n\t\t\t\t\t<label for='choice_11_142_1' id='label_11_142_1' class='gform-field-label gform-field-label--type-inline'>Unattached<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_11_128\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_list_5col gfsp_dot o_medium\"  data-field-class=\"gf_list_5col gfsp_dot o_medium\" data-js-reload=\"field_11_128\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Flooring type (check one or multiple)<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_11_128'><div class='gchoice gchoice_11_128_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_128.1' type='checkbox'  value='Wood'  id='choice_11_128_1' tabindex='123'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_128_1' id='label_11_128_1' class='gform-field-label gform-field-label--type-inline'>Wood<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_11_128_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_128.2' type='checkbox'  value='Carpet'  id='choice_11_128_2' tabindex='124'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_128_2' id='label_11_128_2' class='gform-field-label gform-field-label--type-inline'>Carpet<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_11_128_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_128.3' type='checkbox'  value='Ceramic Tile'  id='choice_11_128_3' tabindex='125'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_128_3' id='label_11_128_3' class='gform-field-label gform-field-label--type-inline'>Ceramic Tile<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_11_128_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_128.4' type='checkbox'  value='Vinyl'  id='choice_11_128_4' tabindex='126'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_128_4' id='label_11_128_4' class='gform-field-label gform-field-label--type-inline'>Vinyl<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_11_128_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_128.5' type='checkbox'  value='Other'  id='choice_11_128_5' tabindex='127'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_128_5' id='label_11_128_5' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_11_79\" class=\"gfield gfield--type-number field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_inline o_medium\"  data-field-class=\"gf_inline o_medium\" data-js-reload=\"field_11_79\" ><label class='gfield_label gform-field-label' for='input_11_79'>% Wood<\/label><div class='ginput_container ginput_container_number'><input name='input_79' id='input_11_79' type='number' step='any'   value='' class='medium' tabindex='128'     aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_11_80\" class=\"gfield gfield--type-number field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_inline o_medium\"  data-field-class=\"gf_inline o_medium\" data-js-reload=\"field_11_80\" ><label class='gfield_label gform-field-label' for='input_11_80'>% Carpet<\/label><div class='ginput_container ginput_container_number'><input name='input_80' id='input_11_80' type='number' step='any'   value='' class='medium' tabindex='129'     aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_11_81\" class=\"gfield gfield--type-number field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_inline o_medium\"  data-field-class=\"gf_inline o_medium\" data-js-reload=\"field_11_81\" ><label class='gfield_label gform-field-label' for='input_11_81'>% Ceramic Tile<\/label><div class='ginput_container ginput_container_number'><input name='input_81' id='input_11_81' type='number' step='any'   value='' class='medium' tabindex='130'     aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_11_82\" class=\"gfield gfield--type-number field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_inline o_medium\"  data-field-class=\"gf_inline o_medium\" data-js-reload=\"field_11_82\" ><label class='gfield_label gform-field-label' for='input_11_82'>% Vinyl<\/label><div class='ginput_container ginput_container_number'><input name='input_82' id='input_11_82' type='number' step='any'   value='' class='medium' tabindex='131'     aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_11_83\" class=\"gfield gfield--type-number field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_inline o_medium\"  data-field-class=\"gf_inline o_medium\" data-js-reload=\"field_11_83\" ><label class='gfield_label gform-field-label' for='input_11_83'>% Other<\/label><div class='ginput_container ginput_container_number'><input name='input_83' id='input_11_83' type='number' step='any'   value='' class='medium' tabindex='132'     aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_11_84\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_inline o_medium\"  data-field-class=\"gf_inline o_medium\" data-js-reload=\"field_11_84\" ><label class='gfield_label gform-field-label' for='input_11_84'>Specify Other<\/label><div class='ginput_container ginput_container_text'><input name='input_84' id='input_11_84' type='text' value='' class='medium'   tabindex='133'   aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_11_130\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_list_5col gfsp_dot o_medium\"  data-field-class=\"gf_list_5col gfsp_dot o_medium\" data-js-reload=\"field_11_130\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Exterior<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_11_130'><div class='gchoice gchoice_11_130_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_130.1' type='checkbox'  value='Wood'  id='choice_11_130_1' tabindex='134'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_130_1' id='label_11_130_1' class='gform-field-label gform-field-label--type-inline'>Wood<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_11_130_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_130.2' type='checkbox'  value='Stucco'  id='choice_11_130_2' tabindex='135'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_130_2' id='label_11_130_2' class='gform-field-label gform-field-label--type-inline'>Stucco<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_11_130_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_130.3' type='checkbox'  value='Brick Veneer'  id='choice_11_130_3' tabindex='136'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_130_3' id='label_11_130_3' class='gform-field-label gform-field-label--type-inline'>Brick Veneer<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_11_130_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_130.4' type='checkbox'  value='Vinyl'  id='choice_11_130_4' tabindex='137'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_130_4' id='label_11_130_4' class='gform-field-label gform-field-label--type-inline'>Vinyl<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_11_130_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_130.5' type='checkbox'  value='Other'  id='choice_11_130_5' tabindex='138'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_130_5' id='label_11_130_5' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_11_131\" class=\"gfield gfield--type-number field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_inline o_medium\"  data-field-class=\"gf_inline o_medium\" data-js-reload=\"field_11_131\" ><label class='gfield_label gform-field-label' for='input_11_131'>% Wood<\/label><div class='ginput_container ginput_container_number'><input name='input_131' id='input_11_131' type='number' step='any'   value='' class='medium' tabindex='139'     aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_11_132\" class=\"gfield gfield--type-number field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_inline o_medium\"  data-field-class=\"gf_inline o_medium\" data-js-reload=\"field_11_132\" ><label class='gfield_label gform-field-label' for='input_11_132'>% Stucco<\/label><div class='ginput_container ginput_container_number'><input name='input_132' id='input_11_132' type='number' step='any'   value='' class='medium' tabindex='140'     aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_11_133\" class=\"gfield gfield--type-number field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_inline o_medium\"  data-field-class=\"gf_inline o_medium\" data-js-reload=\"field_11_133\" ><label class='gfield_label gform-field-label' for='input_11_133'>% Brick Veneer<\/label><div class='ginput_container ginput_container_number'><input name='input_133' id='input_11_133' type='number' step='any'   value='' class='medium' tabindex='141'     aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_11_134\" class=\"gfield gfield--type-number field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_inline o_medium\"  data-field-class=\"gf_inline o_medium\" data-js-reload=\"field_11_134\" ><label class='gfield_label gform-field-label' for='input_11_134'>% Vinyl<\/label><div class='ginput_container ginput_container_number'><input name='input_134' id='input_11_134' type='number' step='any'   value='' class='medium' tabindex='142'     aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_11_135\" class=\"gfield gfield--type-number field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_inline o_medium\"  data-field-class=\"gf_inline o_medium\" data-js-reload=\"field_11_135\" ><label class='gfield_label gform-field-label' for='input_11_135'>% Other<\/label><div class='ginput_container ginput_container_number'><input name='input_135' id='input_11_135' type='number' step='any'   value='' class='medium' tabindex='143'     aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_11_136\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_inline o_medium\"  data-field-class=\"gf_inline o_medium\" data-js-reload=\"field_11_136\" ><label class='gfield_label gform-field-label' for='input_11_136'>Specify Other<\/label><div class='ginput_container ginput_container_text'><input name='input_136' id='input_11_136' type='text' value='' class='medium'   tabindex='144'   aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_11_95\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible o_medium\"  data-field-class=\"o_medium\" data-js-reload=\"field_11_95\" ><label class='gfield_label gform-field-label' for='input_11_95'>Any interior items that may add value? (Elevator, Wet Bar, Whirlpool Tub, Sky Lights, Bay Windows, Interior French Doors)<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_95' id='input_11_95' class='textarea small' tabindex='145'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_11_96\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter gf_left gf_list_2col gfsp_dot o_medium\"  data-field-class=\"gf_quarter gf_left gf_list_2col gfsp_dot o_medium\" data-js-reload=\"field_11_96\" ><legend class='gfield_label gform-field-label' >Porches\/Patios under roofline?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_11_96'>\n\t\t\t<div class='gchoice gchoice_11_96_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_96' type='radio' value='Yes'  id='choice_11_96_0' onchange='gformToggleRadioOther( this )'  tabindex='146'  \/>\n\t\t\t\t\t<label for='choice_11_96_0' id='label_11_96_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_96_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_96' type='radio' value='No'  id='choice_11_96_1' onchange='gformToggleRadioOther( this )'  tabindex='147'  \/>\n\t\t\t\t\t<label for='choice_11_96_1' id='label_11_96_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_11_97\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter gf_list_2col gfsp_dot o_medium\"  data-field-class=\"gf_quarter gf_list_2col gfsp_dot o_medium\" data-js-reload=\"field_11_97\" ><legend class='gfield_label gform-field-label' >Open\/Screened?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_11_97'>\n\t\t\t<div class='gchoice gchoice_11_97_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_97' type='radio' value='Open'  id='choice_11_97_0' onchange='gformToggleRadioOther( this )'  tabindex='148'  \/>\n\t\t\t\t\t<label for='choice_11_97_0' id='label_11_97_0' class='gform-field-label gform-field-label--type-inline'>Open<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_97_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_97' type='radio' value='Screened'  id='choice_11_97_1' onchange='gformToggleRadioOther( this )'  tabindex='149'  \/>\n\t\t\t\t\t<label for='choice_11_97_1' id='label_11_97_1' class='gform-field-label gform-field-label--type-inline'>Screened<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_11_98\" class=\"gfield gfield--type-number field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter gf_right o_medium\"  data-field-class=\"gf_quarter gf_right o_medium\" data-js-reload=\"field_11_98\" ><label class='gfield_label gform-field-label' for='input_11_98'>Square footage of porch<\/label><div class='ginput_container ginput_container_number'><input name='input_98' id='input_11_98' type='number' step='any'   value='' class='small' tabindex='150'     aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_11_99\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter gf_left gf_list_2col gfsp_dot o_medium\"  data-field-class=\"gf_quarter gf_left gf_list_2col gfsp_dot o_medium\" data-js-reload=\"field_11_99\" ><legend class='gfield_label gform-field-label' >Patio\/Decks NOT under roof line?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_11_99'>\n\t\t\t<div class='gchoice gchoice_11_99_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_99' type='radio' value='Yes'  id='choice_11_99_0' onchange='gformToggleRadioOther( this )'  tabindex='151'  \/>\n\t\t\t\t\t<label for='choice_11_99_0' id='label_11_99_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_99_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_99' type='radio' value='No'  id='choice_11_99_1' onchange='gformToggleRadioOther( this )'  tabindex='152'  \/>\n\t\t\t\t\t<label for='choice_11_99_1' id='label_11_99_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_11_100\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter gf_list_2col gfsp_dot o_medium\"  data-field-class=\"gf_quarter gf_list_2col gfsp_dot o_medium\" data-js-reload=\"field_11_100\" ><legend class='gfield_label gform-field-label' >Attached to home?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_11_100'>\n\t\t\t<div class='gchoice gchoice_11_100_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_100' type='radio' value='Yes'  id='choice_11_100_0' onchange='gformToggleRadioOther( this )'  tabindex='153'  \/>\n\t\t\t\t\t<label for='choice_11_100_0' id='label_11_100_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_100_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_100' type='radio' value='No'  id='choice_11_100_1' onchange='gformToggleRadioOther( this )'  tabindex='154'  \/>\n\t\t\t\t\t<label for='choice_11_100_1' id='label_11_100_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_11_101\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter gf_list_2col gfsp_dot o_medium\"  data-field-class=\"gf_quarter gf_list_2col gfsp_dot o_medium\" data-js-reload=\"field_11_101\" ><legend class='gfield_label gform-field-label' >Open\/Screened?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_11_101'>\n\t\t\t<div class='gchoice gchoice_11_101_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_101' type='radio' value='Open'  id='choice_11_101_0' onchange='gformToggleRadioOther( this )'  tabindex='155'  \/>\n\t\t\t\t\t<label for='choice_11_101_0' id='label_11_101_0' class='gform-field-label gform-field-label--type-inline'>Open<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_101_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_101' type='radio' value='Screened'  id='choice_11_101_1' onchange='gformToggleRadioOther( this )'  tabindex='156'  \/>\n\t\t\t\t\t<label for='choice_11_101_1' id='label_11_101_1' class='gform-field-label gform-field-label--type-inline'>Screened<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_11_102\" class=\"gfield gfield--type-number field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter gf_right o_medium\"  data-field-class=\"gf_quarter gf_right o_medium\" data-js-reload=\"field_11_102\" ><label class='gfield_label gform-field-label' for='input_11_102'>Square footage of porch<\/label><div class='ginput_container ginput_container_number'><input name='input_102' id='input_11_102' type='number' step='any'   value='' class='small' tabindex='157'     aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_11_145\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_half gf_newline gf_left o_medium\"  data-field-class=\"gf_half gf_newline gf_left o_medium\" data-js-reload=\"field_11_145\" ><label class='gfield_label gform-field-label' for='input_11_145'>Unattached structures (sheds, barns, fences, etc.) on property?<\/label><div class='ginput_container ginput_container_text'><input name='input_145' id='input_11_145' type='text' value='' class='small'   tabindex='158'   aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_11_146\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_half gf_right o_medium\"  data-field-class=\"gf_half gf_right o_medium\" data-js-reload=\"field_11_146\" ><label class='gfield_label gform-field-label' for='input_11_146'>Unattached Structure Value<\/label><div class='ginput_container ginput_container_text'><input name='input_146' id='input_11_146' type='text' value='' class='small'   tabindex='159'   aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_11_110\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_half gf_newline gf_left o_medium\"  data-field-class=\"gf_half gf_newline gf_left o_medium\" data-js-reload=\"field_11_110\" ><label class='gfield_label gform-field-label' for='input_11_110'>Distance to fire hydrant<\/label><div class='ginput_container ginput_container_text'><input name='input_110' id='input_11_110' type='text' value='' class='small'   tabindex='160'   aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_11_111\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_half gf_right o_medium\"  data-field-class=\"gf_half gf_right o_medium\" data-js-reload=\"field_11_111\" ><label class='gfield_label gform-field-label' for='input_11_111'>Miles to fire station<\/label><div class='ginput_container ginput_container_text'><input name='input_111' id='input_11_111' type='text' value='' class='small'   tabindex='161'   aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_11_112\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter gf_newline gf_left gf_list_3col gfsp_dot o_medium\"  data-field-class=\"gf_quarter gf_newline gf_left gf_list_3col gfsp_dot o_medium\" data-js-reload=\"field_11_112\" ><legend class='gfield_label gform-field-label' >Swimming pool?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_11_112'>\n\t\t\t<div class='gchoice gchoice_11_112_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_112' type='radio' value='Yes, in ground'  id='choice_11_112_0' onchange='gformToggleRadioOther( this )'  tabindex='162'  \/>\n\t\t\t\t\t<label for='choice_11_112_0' id='label_11_112_0' class='gform-field-label gform-field-label--type-inline'>Yes, in ground<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_112_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_112' type='radio' value='Yes, above ground'  id='choice_11_112_1' onchange='gformToggleRadioOther( this )'  tabindex='163'  \/>\n\t\t\t\t\t<label for='choice_11_112_1' id='label_11_112_1' class='gform-field-label gform-field-label--type-inline'>Yes, above ground<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_112_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_112' type='radio' value='No'  id='choice_11_112_2' onchange='gformToggleRadioOther( this )'  tabindex='164'  \/>\n\t\t\t\t\t<label for='choice_11_112_2' id='label_11_112_2' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_11_113\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter gf_list_2col gfsp_dot o_medium\"  data-field-class=\"gf_quarter gf_list_2col gfsp_dot o_medium\" data-js-reload=\"field_11_113\" ><legend class='gfield_label gform-field-label' >Diving board?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_11_113'>\n\t\t\t<div class='gchoice gchoice_11_113_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_113' type='radio' value='Yes'  id='choice_11_113_0' onchange='gformToggleRadioOther( this )'  tabindex='165'  \/>\n\t\t\t\t\t<label for='choice_11_113_0' id='label_11_113_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_113_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_113' type='radio' value='No'  id='choice_11_113_1' onchange='gformToggleRadioOther( this )'  tabindex='166'  \/>\n\t\t\t\t\t<label for='choice_11_113_1' id='label_11_113_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_11_115\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter gf_list_2col gfsp_dot o_medium\"  data-field-class=\"gf_quarter gf_list_2col gfsp_dot o_medium\" data-js-reload=\"field_11_115\" ><legend class='gfield_label gform-field-label' >4 ft fence w\/ locking gate?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_11_115'>\n\t\t\t<div class='gchoice gchoice_11_115_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_115' type='radio' value='Yes'  id='choice_11_115_0' onchange='gformToggleRadioOther( this )'  tabindex='167'  \/>\n\t\t\t\t\t<label for='choice_11_115_0' id='label_11_115_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_115_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_115' type='radio' value='No'  id='choice_11_115_1' onchange='gformToggleRadioOther( this )'  tabindex='168'  \/>\n\t\t\t\t\t<label for='choice_11_115_1' id='label_11_115_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_11_114\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter gf_list_2col gfsp_dot o_medium\"  data-field-class=\"gf_quarter gf_list_2col gfsp_dot o_medium\" data-js-reload=\"field_11_114\" ><legend class='gfield_label gform-field-label' >Slide?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_11_114'>\n\t\t\t<div class='gchoice gchoice_11_114_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_114' type='radio' value='Yes'  id='choice_11_114_0' onchange='gformToggleRadioOther( this )'  tabindex='169'  \/>\n\t\t\t\t\t<label for='choice_11_114_0' id='label_11_114_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_114_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_114' type='radio' value='No'  id='choice_11_114_1' onchange='gformToggleRadioOther( this )'  tabindex='170'  \/>\n\t\t\t\t\t<label for='choice_11_114_1' id='label_11_114_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_11_105\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter gf_left gf_list_2col gfsp_dot o_medium\"  data-field-class=\"gf_quarter gf_left gf_list_2col gfsp_dot o_medium\" data-js-reload=\"field_11_105\" ><legend class='gfield_label gform-field-label' >Burglar Alarm<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_11_105'>\n\t\t\t<div class='gchoice gchoice_11_105_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_105' type='radio' value='Monitored'  id='choice_11_105_0' onchange='gformToggleRadioOther( this )'  tabindex='171'  \/>\n\t\t\t\t\t<label for='choice_11_105_0' id='label_11_105_0' class='gform-field-label gform-field-label--type-inline'>Monitored<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_105_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_105' type='radio' value='Unmonitored'  id='choice_11_105_1' onchange='gformToggleRadioOther( this )'  tabindex='172'  \/>\n\t\t\t\t\t<label for='choice_11_105_1' id='label_11_105_1' class='gform-field-label gform-field-label--type-inline'>Unmonitored<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_11_106\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter gf_list_2col gfsp_dot o_medium\"  data-field-class=\"gf_quarter gf_list_2col gfsp_dot o_medium\" data-js-reload=\"field_11_106\" ><legend class='gfield_label gform-field-label' >Fire Alarm<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_11_106'>\n\t\t\t<div class='gchoice gchoice_11_106_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_106' type='radio' value='Monitored'  id='choice_11_106_0' onchange='gformToggleRadioOther( this )'  tabindex='173'  \/>\n\t\t\t\t\t<label for='choice_11_106_0' id='label_11_106_0' class='gform-field-label gform-field-label--type-inline'>Monitored<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_106_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_106' type='radio' value='Unmonitored'  id='choice_11_106_1' onchange='gformToggleRadioOther( this )'  tabindex='174'  \/>\n\t\t\t\t\t<label for='choice_11_106_1' id='label_11_106_1' class='gform-field-label gform-field-label--type-inline'>Unmonitored<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_11_108\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter gf_list_2col gfsp_dot o_medium\"  data-field-class=\"gf_quarter gf_list_2col gfsp_dot o_medium\" data-js-reload=\"field_11_108\" ><legend class='gfield_label gform-field-label' >Fire Extinguishers?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_11_108'>\n\t\t\t<div class='gchoice gchoice_11_108_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_108' type='radio' value='Yes'  id='choice_11_108_0' onchange='gformToggleRadioOther( this )'  tabindex='175'  \/>\n\t\t\t\t\t<label for='choice_11_108_0' id='label_11_108_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_108_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_108' type='radio' value='No'  id='choice_11_108_1' onchange='gformToggleRadioOther( this )'  tabindex='176'  \/>\n\t\t\t\t\t<label for='choice_11_108_1' id='label_11_108_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_11_107\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter gf_right gf_list_2col gfsp_dot o_medium\"  data-field-class=\"gf_quarter gf_right gf_list_2col gfsp_dot o_medium\" data-js-reload=\"field_11_107\" ><legend class='gfield_label gform-field-label' >Deadbolts on all exterior doors?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_11_107'>\n\t\t\t<div class='gchoice gchoice_11_107_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_107' type='radio' value='Yes'  id='choice_11_107_0' onchange='gformToggleRadioOther( this )'  tabindex='177'  \/>\n\t\t\t\t\t<label for='choice_11_107_0' id='label_11_107_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_107_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_107' type='radio' value='No'  id='choice_11_107_1' onchange='gformToggleRadioOther( this )'  tabindex='178'  \/>\n\t\t\t\t\t<label for='choice_11_107_1' id='label_11_107_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_11_109\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter gf_newline gf_left gf_list_2col gfsp_dot o_medium\"  data-field-class=\"gf_quarter gf_newline gf_left gf_list_2col gfsp_dot o_medium\" data-js-reload=\"field_11_109\" ><legend class='gfield_label gform-field-label' >Gated Subdivision?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_11_109'>\n\t\t\t<div class='gchoice gchoice_11_109_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_109' type='radio' value='Yes'  id='choice_11_109_0' onchange='gformToggleRadioOther( this )'  tabindex='179'  \/>\n\t\t\t\t\t<label for='choice_11_109_0' id='label_11_109_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_109_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_109' type='radio' value='No'  id='choice_11_109_1' onchange='gformToggleRadioOther( this )'  tabindex='180'  \/>\n\t\t\t\t\t<label for='choice_11_109_1' id='label_11_109_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_11_116\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter gf_list_2col gfsp_dot o_medium\"  data-field-class=\"gf_quarter gf_list_2col gfsp_dot o_medium\" data-js-reload=\"field_11_116\" ><legend class='gfield_label gform-field-label' >Trampoline?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_11_116'>\n\t\t\t<div class='gchoice gchoice_11_116_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_116' type='radio' value='Yes'  id='choice_11_116_0' onchange='gformToggleRadioOther( this )'  tabindex='181'  \/>\n\t\t\t\t\t<label for='choice_11_116_0' id='label_11_116_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_116_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_116' type='radio' value='No'  id='choice_11_116_1' onchange='gformToggleRadioOther( this )'  tabindex='182'  \/>\n\t\t\t\t\t<label for='choice_11_116_1' id='label_11_116_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_11_119\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter gf_list_2col gfsp_dot o_medium\"  data-field-class=\"gf_quarter gf_list_2col gfsp_dot o_medium\" data-js-reload=\"field_11_119\" ><legend class='gfield_label gform-field-label' >Hot tub on premises?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_11_119'>\n\t\t\t<div class='gchoice gchoice_11_119_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_119' type='radio' value='Yes'  id='choice_11_119_0' onchange='gformToggleRadioOther( this )'  tabindex='183'  \/>\n\t\t\t\t\t<label for='choice_11_119_0' id='label_11_119_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_119_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_119' type='radio' value='No'  id='choice_11_119_1' onchange='gformToggleRadioOther( this )'  tabindex='184'  \/>\n\t\t\t\t\t<label for='choice_11_119_1' id='label_11_119_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_11_120\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter gf_list_2col gfsp_dot o_medium\"  data-field-class=\"gf_quarter gf_list_2col gfsp_dot o_medium\" data-js-reload=\"field_11_120\" ><legend class='gfield_label gform-field-label' >Smokers in household?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_11_120'>\n\t\t\t<div class='gchoice gchoice_11_120_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_120' type='radio' value='Yes'  id='choice_11_120_0' onchange='gformToggleRadioOther( this )'  tabindex='185'  \/>\n\t\t\t\t\t<label for='choice_11_120_0' id='label_11_120_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_120_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_120' type='radio' value='No'  id='choice_11_120_1' onchange='gformToggleRadioOther( this )'  tabindex='186'  \/>\n\t\t\t\t\t<label for='choice_11_120_1' id='label_11_120_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_11_117\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter gf_newline gf_left gf_list_2col gfsp_dot o_medium\"  data-field-class=\"gf_quarter gf_newline gf_left gf_list_2col gfsp_dot o_medium\" data-js-reload=\"field_11_117\" ><legend class='gfield_label gform-field-label' >Pets?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_11_117'>\n\t\t\t<div class='gchoice gchoice_11_117_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_117' type='radio' value='Yes'  id='choice_11_117_0' onchange='gformToggleRadioOther( this )'  tabindex='187'  \/>\n\t\t\t\t\t<label for='choice_11_117_0' id='label_11_117_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_117_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_117' type='radio' value='No'  id='choice_11_117_1' onchange='gformToggleRadioOther( this )'  tabindex='188'  \/>\n\t\t\t\t\t<label for='choice_11_117_1' id='label_11_117_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_11_118\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\" data-js-reload=\"field_11_118\" ><label class='gfield_label gform-field-label' for='input_11_118'>Breed?<\/label><div class='ginput_container ginput_container_text'><input name='input_118' id='input_11_118' type='text' value='' class='small'   tabindex='189'   aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_11_143\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_quarter gf_list_2col gfsp_dot o_medium\"  data-field-class=\"gf_quarter gf_list_2col gfsp_dot o_medium\" data-js-reload=\"field_11_143\" ><legend class='gfield_label gform-field-label' >Bite History?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_11_143'>\n\t\t\t<div class='gchoice gchoice_11_143_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_143' type='radio' value='Yes'  id='choice_11_143_0' onchange='gformToggleRadioOther( this )'  tabindex='190'  \/>\n\t\t\t\t\t<label for='choice_11_143_0' id='label_11_143_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_143_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_143' type='radio' value='No'  id='choice_11_143_1' onchange='gformToggleRadioOther( this )'  tabindex='191'  \/>\n\t\t\t\t\t<label for='choice_11_143_1' id='label_11_143_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_11_147\" class=\"gfield gfield--type-signature field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_11_147\" ><label class='gfield_label gform-field-label' for='input_11_147'>By signing below, I certify that the information above is true.<\/label><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_11_147_Container' class='gfield_signature_container ginput_container' style='height:180px; width:1150px; ' ><input type='hidden' class='gform_hidden' name='input_11_147_valid' id='input_11_147_valid' \/><canvas id='input_11_147' width='1150' height='180'><\/canvas><\/div><\/div><\/div><div id=\"field_11_166\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_11_166\" ><label class='gfield_label gform-field-label' for='input_11_166'>Email<\/label><div class='ginput_container'><input name='input_166' id='input_11_166' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_11_166'>This field is for validation purposes and should be left unchanged.<\/div><\/div><\/div><\/div>\n        <div class='gform_page_footer top_label'><input type='submit' id='gform_previous_button_11' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous' tabindex='192' onclick='if(window[\"gf_submitting_11\"]){return false;}  if( !jQuery(\"#gform_11\")[0].checkValidity || jQuery(\"#gform_11\")[0].checkValidity()){window[\"gf_submitting_11\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_11\"]){return false;} if( !jQuery(\"#gform_11\")[0].checkValidity || jQuery(\"#gform_11\")[0].checkValidity()){window[\"gf_submitting_11\"]=true;}  jQuery(\"#gform_11\").trigger(\"submit\",[true]); }' \/> <input type='submit' id='gform_submit_button_11' class='gform_button button' value='Submit' tabindex='193' onclick='if(window[\"gf_submitting_11\"]){return false;}  if( !jQuery(\"#gform_11\")[0].checkValidity || jQuery(\"#gform_11\")[0].checkValidity()){window[\"gf_submitting_11\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_11\"]){return false;} if( !jQuery(\"#gform_11\")[0].checkValidity || jQuery(\"#gform_11\")[0].checkValidity()){window[\"gf_submitting_11\"]=true;}  jQuery(\"#gform_11\").trigger(\"submit\",[true]); }' \/> <input type='hidden' name='gform_ajax' value='form_id=11&amp;title=&amp;description=&amp;tabindex=1&amp;theme=gravity-theme' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_11' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='11' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_11' value='WyJ7XCIxNjUuMVwiOlwiMDJiOTIzMzhiNTI3ODlhYjc2YzUyY2Y4Y2UyMmNmZmRcIn0iLCIxZDM1YzMwZjIwMDBhMmI1MjcxZjI5ZWFjZjM0ODVlNCJd' \/>\n            <input type='hidden' class='gform_hidden' name='gform_target_page_number_11' id='gform_target_page_number_11' value='2' \/>\n            <input type='hidden' class='gform_hidden' name='gform_source_page_number_11' id='gform_source_page_number_11' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/div><\/div>\n                        <p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"ak_\"><label>&#916;<textarea name=\"ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_1\" name=\"ak_js\" value=\"84\"\/><script>document.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );<\/script><\/p><\/form>\n                        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