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Thank you.聽 </h1> </div> </div> </li> <li class="form-line jf-required" data-type="control_fullname" id="id_3"><label class="form-label form-label-top form-label-auto" id="label_3" for="first_3" aria-hidden="false"> Name<span class="form-required">*</span> </label> <div id="cid_3" class="form-input-wide jf-required" data-layout="full"> <div data-wrapper-react="true"><span class="form-sub-label-container" style="vertical-align:top" data-input-type="first"><input type="text" id="first_3" name="q3_name[first]" class="form-textbox validate[required]" data-defaultvalue="" autoComplete="section-input_3 given-name" size="10" data-component="first" aria-labelledby="label_3 sublabel_3_first" required="" value="" /><label class="form-sub-label" for="first_3" id="sublabel_3_first" style="min-height:13px">First Name</label></span><span class="form-sub-label-container" style="vertical-align:top" data-input-type="last"><input type="text" id="last_3" name="q3_name[last]" class="form-textbox validate[required]" data-defaultvalue="" autoComplete="section-input_3 family-name" size="15" data-component="last" aria-labelledby="label_3 sublabel_3_last" required="" value="" /><label class="form-sub-label" for="last_3" id="sublabel_3_last" style="min-height:13px">Last Name</label></span></div> </div> </li> <li class="form-line" data-type="control_textbox" id="id_4"><label class="form-label form-label-top form-label-auto" id="label_4" for="input_4" aria-hidden="false"> Company </label> <div id="cid_4" class="form-input-wide" data-layout="half"> <input type="text" id="input_4" name="q4_typeA" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:310px" size="310" data-component="textbox" aria-labelledby="label_4" value="" /> </div> </li> <li class="form-line jf-required" data-type="control_email" id="id_5"><label class="form-label form-label-top form-label-auto" id="label_5" for="input_5" aria-hidden="false"> Email<span class="form-required">*</span> </label> <div id="cid_5" class="form-input-wide jf-required" data-layout="half"> <span class="form-sub-label-container" style="vertical-align:top"><input type="email" id="input_5" name="q5_email" class="form-textbox validate[required, Email]" data-defaultvalue="" autoComplete="section-input_5 email" style="width:310px" size="310" data-component="email" aria-labelledby="label_5 sublabel_input_5" required="" value="" /><label class="form-sub-label" for="input_5" id="sublabel_input_5" style="min-height:13px">example@example.com</label></span> </div> </li> <li class="form-line jf-required" data-type="control_radio" id="id_7"><label class="form-label form-label-top form-label-auto" id="label_7" for="input_7_0" aria-hidden="false"> Acceptance<span class="form-required">*</span> </label> <div id="cid_7" class="form-input-wide jf-required" data-layout="full"> <div class="form-single-column" role="group" aria-labelledby="label_7" data-component="radio"><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input aria-describedby="label_7" type="radio" class="form-radio validate[required]" id="input_7_0" name="q7_acceptance" required="" value="for the purpose of managing my request" /><label id="label_input_7_0" for="input_7_0">for the purpose of managing my request</label></span></div> </div> </li> <li class="form-line" data-type="control_text" id="id_9"> <div id="cid_9" class="form-input-wide" data-layout="full"> <div id="text_9" class="form-html" data-component="text" tabindex="-1"> <p>I have read the <a href="https://www.nervianoms.com/privacy-policy/" target="_blank" rel="nofollow">Privacy Notice</a> and I allow processing my personal data</p> </div> </div> </li> <li class="form-line" data-type="control_button" id="id_2"> <div id="cid_2" class="form-input-wide" data-layout="full"> <div data-align="auto" class="form-buttons-wrapper form-buttons-auto jsTest-button-wrapperField"><button id="input_2" type="submit" class="form-submit-button submit-button jf-form-buttons jsTest-submitField legacy-submit" data-component="button" data-content="">Submit</button></div> </div> </li> <li style="display:none">Should be Empty: <input type="text" name="website" value="" type="hidden" /></li> </ul> </div> <script> JotForm.showJotFormPowered = "0"; </script> <script> JotForm.poweredByText = "Powered by Jotform"; </script><input type="hidden" class="simple_spc" id="simple_spc" name="simple_spc" value="243224198060351" /> <script type="text/javascript"> var all_spc = document.querySelectorAll("form[id='243224198060351'] .si" + "mple" + "_spc"); for (var i = 0; i < all_spc.length; i++) { all_spc[i].value = "243224198060351-243224198060351"; } </script> </form></body> </html><script type="text/javascript">JotForm.forwardToEu=true;</script><script type="text/javascript">JotForm.isNewSACL=true;</script>