{"id":194,"date":"2020-12-31T19:54:30","date_gmt":"2020-12-31T19:54:30","guid":{"rendered":"https:\/\/wcc-tech.ca\/devel\/?page_id=194"},"modified":"2021-10-11T21:40:52","modified_gmt":"2021-10-11T21:40:52","slug":"sign-up","status":"publish","type":"page","link":"https:\/\/wcc-tech.ca\/devel\/sign-up\/","title":{"rendered":"Sign Up"},"content":{"rendered":"<body><p>[et_pb_section fb_built=\u201d1\u2033 fullwidth=\u201don\u201d _builder_version=\u201d4.7.7\u2033 _module_preset=\u201ddefault\u201d global_colors_info=\u201d{}\u201d][et_pb_fullwidth_menu menu_id=\u201d4\u2033 active_link_color=\u201d#f7f9ff\u201d logo=\u201dhttps:\/\/wcc-tech.ca\/devel\/wp-content\/uploads\/2020\/12\/WCCT.png\u201d _builder_version=\u201d4.7.7\u2033 _module_preset=\u201ddefault\u201d menu_text_color=\u201d#ffffff\u201d background_color=\u201d#201c44\u2033 text_orientation=\u201dright\u201d background_layout=\u201ddark\u201d menu_font_tablet=\u201d\u201d menu_font_phone=\u201d\u201d menu_font_last_edited=\u201don|desktop\u201d box_shadow_style=\u201dpreset2\u2033 global_colors_info=\u201d{}\u201d][\/et_pb_fullwidth_menu][\/et_pb_section][et_pb_section fb_built=\u201d1\u2033 _builder_version=\u201d4.7.7\u2033 _module_preset=\u201ddefault\u201d background_image=\u201dhttps:\/\/wcc-tech.ca\/devel\/wp-content\/uploads\/2020\/12\/communication-tower-design-02.png\u201d custom_padding=\u201d54px||54px||false|\u201d global_colors_info=\u201d{}\u201d][et_pb_row _builder_version=\u201d4.7.7\u2033 _module_preset=\u201ddefault\u201d background_color=\u201d#201c44\u2033 custom_padding=\u201d|20px||20px|false|true\u201d global_colors_info=\u201d{}\u201d][et_pb_column type=\u201d4_4\u2033 _builder_version=\u201d4.7.7\u2033 _module_preset=\u201ddefault\u201d background_color=\u201d#201c44\u2033 global_colors_info=\u201d{}\u201d][et_pb_text _builder_version=\u201d4.7.7\u2033 _module_preset=\u201ddefault\u201d text_line_height=\u201d1.4em\u201d header_font=\u201d|600|||||||\u201d header_font_size=\u201d42px\u201d header_line_height=\u201d3em\u201d background_image=\u201dhttps:\/\/wcc-tech.ca\/devel\/wp-content\/uploads\/2021\/01\/Sign-up-Image.jpeg\u201d min_height=\u201d54px\u201d min_height_tablet=\u201d\u201d min_height_phone=\u201d\u201d min_height_last_edited=\u201don|desktop\u201d custom_margin=\u201d0px||||false|true\u201d custom_padding=\u201d|10px||10px|false|true\u201d custom_padding_tablet=\u201d\u201d custom_padding_phone=\u201d\u201d custom_padding_last_edited=\u201don|phone\u201d header_font_size_tablet=\u201d30px\u201d header_font_size_phone=\u201d\u201d header_font_size_last_edited=\u201don|desktop\u201d background_last_edited=\u201don|tablet\u201d text_text_shadow_style=\u201dpreset2\u2033 text_text_shadow_color=\u201d#201c44\u2033 header_text_shadow_style=\u201dpreset2\u2033 header_text_shadow_color=\u201d#201c44\u2033 global_colors_info=\u201d{}\u201d]<\/p>\n<h1 style=\"text-align: center;\"><strong><span style=\"color: #ffffff;\">Sign Up Now<\/span><\/strong><\/h1>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=\u201d4.7.7\u2033 _module_preset=\u201ddefault\u201d background_color=\u201d#d7deed\u201d box_shadow_style=\u201dpreset6\u2033 global_colors_info=\u201d{}\u201d][et_pb_column type=\u201d4_4\u2033 _builder_version=\u201d4.6.0\u2033 _module_preset=\u201ddefault\u201d global_colors_info=\u201d{}\u201d][et_pb_text _builder_version=\u201d4.11.2\u2033 _module_preset=\u201ddefault\u201d min_height=\u201d190px\u201d custom_padding=\u201d|20px||20px|false|true\u201d hover_enabled=\u201d0\u2033 global_colors_info=\u201d{}\u201d sticky_enabled=\u201d0\u2033]<div id=\"quform-e4d3d0\" class=\"quform quform-8 quform-theme-light quform-support-page-caching\"><form id=\"quform-form-e4d3d0\" class=\"quform-form quform-form-8\" action=\"\/devel\/wp-json\/wp\/v2\/pages\/194#quform-e4d3d0\" method=\"post\" enctype=\"multipart\/form-data\" novalidate=\"novalidate\" data-options=\"{&quot;id&quot;:8,&quot;uniqueId&quot;:&quot;e4d3d0&quot;,&quot;theme&quot;:&quot;light&quot;,&quot;ajax&quot;:true,&quot;logic&quot;:{&quot;logic&quot;:{&quot;51&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;273&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;2&quot;,&quot;value&quot;:&quot;Yes&quot;}]},&quot;131&quot;:{&quot;action&quot;:false,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;130&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;1&quot;,&quot;value&quot;:&quot;Same as Above&quot;}]},&quot;94&quot;:{&quot;action&quot;:false,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;75&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;1&quot;,&quot;value&quot;:&quot;Email&quot;}]},&quot;115&quot;:{&quot;action&quot;:false,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;94&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;1&quot;,&quot;value&quot;:&quot;Same as Above&quot;}]},&quot;257&quot;:{&quot;action&quot;:false,&quot;match&quot;:&quot;any&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;97&quot;,&quot;operator&quot;:&quot;empty&quot;,&quot;optionId&quot;:null,&quot;value&quot;:&quot;&quot;},{&quot;elementId&quot;:&quot;101&quot;,&quot;operator&quot;:&quot;empty&quot;,&quot;optionId&quot;:null,&quot;value&quot;:&quot;&quot;},{&quot;elementId&quot;:&quot;98&quot;,&quot;operator&quot;:&quot;empty&quot;,&quot;optionId&quot;:null,&quot;value&quot;:&quot;&quot;},{&quot;elementId&quot;:&quot;99&quot;,&quot;operator&quot;:&quot;empty&quot;,&quot;optionId&quot;:null,&quot;value&quot;:&quot;&quot;},{&quot;elementId&quot;:&quot;37&quot;,&quot;operator&quot;:&quot;empty&quot;,&quot;optionId&quot;:null,&quot;value&quot;:&quot;&quot;},{&quot;elementId&quot;:&quot;44&quot;,&quot;operator&quot;:&quot;empty&quot;,&quot;optionId&quot;:null,&quot;value&quot;:&quot;&quot;},{&quot;elementId&quot;:&quot;46&quot;,&quot;operator&quot;:&quot;empty&quot;,&quot;optionId&quot;:null,&quot;value&quot;:&quot;&quot;},{&quot;elementId&quot;:&quot;76&quot;,&quot;operator&quot;:&quot;empty&quot;,&quot;optionId&quot;:null,&quot;value&quot;:&quot;&quot;},{&quot;elementId&quot;:&quot;242&quot;,&quot;operator&quot;:&quot;empty&quot;,&quot;optionId&quot;:null,&quot;value&quot;:&quot;&quot;}]}},&quot;dependents&quot;:{&quot;273&quot;:[51],&quot;130&quot;:[131],&quot;75&quot;:[94],&quot;94&quot;:[115],&quot;97&quot;:[257],&quot;101&quot;:[257],&quot;98&quot;:[257],&quot;99&quot;:[257],&quot;37&quot;:[257],&quot;44&quot;:[257],&quot;46&quot;:[257],&quot;76&quot;:[257],&quot;242&quot;:[257]},&quot;elementIds&quot;:[51,131,94,115,257],&quot;dependentElementIds&quot;:[&quot;273&quot;,&quot;130&quot;,&quot;75&quot;,&quot;94&quot;,&quot;97&quot;,&quot;101&quot;,&quot;98&quot;,&quot;99&quot;,&quot;37&quot;,&quot;44&quot;,&quot;46&quot;,&quot;76&quot;,&quot;242&quot;],&quot;animate&quot;:true},&quot;currentPageId&quot;:1,&quot;errorsIcon&quot;:&quot;&quot;,&quot;updateFancybox&quot;:true,&quot;hasPages&quot;:false,&quot;pages&quot;:[1],&quot;pageProgressType&quot;:&quot;numbers&quot;,&quot;tooltipsEnabled&quot;:true,&quot;tooltipClasses&quot;:&quot;qtip-quform-dark qtip-shadow&quot;,&quot;tooltipMy&quot;:&quot;left center&quot;,&quot;tooltipAt&quot;:&quot;right center&quot;,&quot;isRtl&quot;:false,&quot;scrollOffset&quot;:-50,&quot;scrollSpeed&quot;:800}\"><button class=\"quform-default-submit\" name=\"quform_submit\" type=\"submit\" value=\"submit\" aria-hidden=\"true\" tabindex=\"-1\"><\/button><div class=\"quform-form-inner quform-form-inner-8\"><input type=\"hidden\" name=\"quform_form_id\" value=\"8\" \/><input type=\"hidden\" name=\"quform_form_uid\" value=\"e4d3d0\" \/><input type=\"hidden\" name=\"quform_count\" value=\"1\" \/><input type=\"hidden\" name=\"form_url\" value=\"https:\/\/wcc-tech.ca\/devel\/wp-json\/wp\/v2\/pages\/194\" \/><input type=\"hidden\" name=\"referring_url\" value=\"\" \/><input type=\"hidden\" name=\"post_id\" value=\"\" \/><input type=\"hidden\" name=\"post_title\" value=\"\" \/><input type=\"hidden\" name=\"quform_current_page_id\" value=\"1\" \/><input type=\"hidden\" name=\"quform_csrf_token\" value=\"BD0ZOUHsyYxT5EwqVNzqJM6kTn2QMuUjcBAtIP5i\" \/><div class=\"quform-form-title-description\"><div class=\"quform-form-title\"><div style=\"text-align:center\"><p>Items with an asterisk (*) are required and must be filled out before the form can be submitted. Once your submission is received, a WCCT representative will follow up with you to answer any additional questions that you might have about the service to be provided and pricing.<\/p><br><\/div><\/div><\/div><div class=\"quform-elements quform-elements-8 quform-cf quform-responsive-elements-phone-landscape\"><div class=\"quform-element quform-element-page quform-page-1 quform-page-8_1 quform-cf quform-group-style-plain quform-first-page quform-last-page quform-current-page\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-group quform-element-8_33 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><h4 class=\"quform-group-title\">Customer Information and Service Address<\/h4><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-8_260 quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-8_261\"><div class=\"quform-element quform-element-text quform-element-8_97 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_97\"><label class=\"quform-label-text\" for=\"quform_8_97_e4d3d0\">First Name<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-8_97\"><div class=\"quform-input quform-input-text quform-input-8_97 quform-cf\"><input type=\"text\" id=\"quform_8_97_e4d3d0\" name=\"quform_8_97\" class=\"quform-field quform-field-text quform-field-8_97\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-8_262\"><div class=\"quform-element quform-element-text quform-element-8_101 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_101\"><label class=\"quform-label-text\" for=\"quform_8_101_e4d3d0\">Last Name<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-8_101\"><div class=\"quform-input quform-input-text quform-input-8_101 quform-cf\"><input type=\"text\" id=\"quform_8_101_e4d3d0\" name=\"quform_8_101\" class=\"quform-field quform-field-text quform-field-8_101\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-8_263 quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-8_264\"><div class=\"quform-element quform-element-text quform-element-8_98 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_98\"><label class=\"quform-label-text\" for=\"quform_8_98_e4d3d0\">Primary Phone Number<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-8_98\"><div class=\"quform-input quform-input-text quform-input-8_98 quform-cf\"><input type=\"text\" id=\"quform_8_98_e4d3d0\" name=\"quform_8_98\" class=\"quform-field quform-field-text quform-field-8_98\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-8_265\"><div class=\"quform-element quform-element-text quform-element-8_102 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_102\"><label class=\"quform-label-text\" for=\"quform_8_102_e4d3d0\">Other Phone Number<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-8_102\"><div class=\"quform-input quform-input-text quform-input-8_102 quform-cf\"><input type=\"text\" id=\"quform_8_102_e4d3d0\" name=\"quform_8_102\" class=\"quform-field quform-field-text quform-field-8_102\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-8_95 quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-8_96\"><div class=\"quform-element quform-element-text quform-element-8_99 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_99\"><label class=\"quform-label-text\" for=\"quform_8_99_e4d3d0\">Email<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-8_99\"><div class=\"quform-input quform-input-text quform-input-8_99 quform-cf\"><input type=\"text\" id=\"quform_8_99_e4d3d0\" name=\"quform_8_99\" class=\"quform-field quform-field-text quform-field-8_99\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-8_100\"><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-8_38 quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-8_39\"><div class=\"quform-element quform-element-text quform-element-8_37 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_37\"><label class=\"quform-label-text\" for=\"quform_8_37_e4d3d0\">Street<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-8_37\"><div class=\"quform-input quform-input-text quform-input-8_37 quform-cf\"><input type=\"text\" id=\"quform_8_37_e4d3d0\" name=\"quform_8_37\" class=\"quform-field quform-field-text quform-field-8_37\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-8_40\"><div class=\"quform-element quform-element-text quform-element-8_41 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_41\"><label class=\"quform-label-text\" for=\"quform_8_41_e4d3d0\">PO Box \/ RR#<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-8_41\"><div class=\"quform-input quform-input-text quform-input-8_41 quform-cf\"><input type=\"text\" id=\"quform_8_41_e4d3d0\" name=\"quform_8_41\" class=\"quform-field quform-field-text quform-field-8_41\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-8_42 quform-3-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-8_43\"><div class=\"quform-element quform-element-text quform-element-8_44 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_44\"><label class=\"quform-label-text\" for=\"quform_8_44_e4d3d0\">City<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-8_44\"><div class=\"quform-input quform-input-text quform-input-8_44 quform-cf\"><input type=\"text\" id=\"quform_8_44_e4d3d0\" name=\"quform_8_44\" class=\"quform-field quform-field-text quform-field-8_44\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-8_45\"><div class=\"quform-element quform-element-select quform-element-8_4 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_4\"><label class=\"quform-label-text\" for=\"quform_8_4_e4d3d0\">Province<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-8_4\"><div class=\"quform-input quform-input-select quform-input-8_4 quform-cf\"><select id=\"quform_8_4_e4d3d0\" name=\"quform_8_4\" class=\"quform-field quform-field-select quform-field-8_4\"><option value=\"ON\">ON<\/option><option value=\"QC\">QC<\/option><option value=\"Other\">Other<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-8_47\"><div class=\"quform-element quform-element-text quform-element-8_46 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_46\"><label class=\"quform-label-text\" for=\"quform_8_46_e4d3d0\">Postal Code<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-8_46\"><div class=\"quform-input quform-input-text quform-input-8_46 quform-cf\"><input type=\"text\" id=\"quform_8_46_e4d3d0\" name=\"quform_8_46\" class=\"quform-field quform-field-text quform-field-8_46\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-8_250 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_250\"><span class=\"quform-label-icon\"><i class=\"fa fa-rss\"><\/i><\/span><label class=\"quform-label-text\" id=\"quform_8_250_e4d3d0_label\">Do you currently have internet service at this location?<\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-8_250\"><div class=\"quform-input quform-input-radio quform-input-8_250 quform-cf\"><div class=\"quform-options quform-cf quform-options-inline quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_8_250_e4d3d0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_8_250\" id=\"quform_8_250_e4d3d0_1\" class=\"quform-field quform-field-radio quform-field-8_250 quform-field-8_250_1\" value=\"Yes\" checked \/><label for=\"quform_8_250_e4d3d0_1\" class=\"quform-option-label quform-option-label-8_250_1\"><span class=\"quform-option-text\">Yes<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_8_250\" id=\"quform_8_250_e4d3d0_2\" class=\"quform-field quform-field-radio quform-field-8_250 quform-field-8_250_2\" value=\"No\" \/><label for=\"quform_8_250_e4d3d0_2\" class=\"quform-option-label quform-option-label-8_250_2\"><span class=\"quform-option-text\">No<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-8_292 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_292\"><span class=\"quform-label-icon\"><i class=\"fa fa-rss\"><\/i><\/span><label class=\"quform-label-text\" id=\"quform_8_292_e4d3d0_label\">Allow WCCT to share name, address and home phone number with phone directory publishers<\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-8_292\"><div class=\"quform-input quform-input-radio quform-input-8_292 quform-cf\"><div class=\"quform-options quform-cf quform-options-inline quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_8_292_e4d3d0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_8_292\" id=\"quform_8_292_e4d3d0_1\" class=\"quform-field quform-field-radio quform-field-8_292 quform-field-8_292_1\" value=\"Yes\" checked \/><label for=\"quform_8_292_e4d3d0_1\" class=\"quform-option-label quform-option-label-8_292_1\"><span class=\"quform-option-text\">Yes<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_8_292\" id=\"quform_8_292_e4d3d0_2\" class=\"quform-field quform-field-radio quform-field-8_292 quform-field-8_292_2\" value=\"No\" \/><label for=\"quform_8_292_e4d3d0_2\" class=\"quform-option-label quform-option-label-8_292_2\"><span class=\"quform-option-text\">No<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-8_49 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><h4 class=\"quform-group-title\">Requested Service and Cost Estimate excluding HST<\/h4><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-8_53 quform-3-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-8_55\"><div class=\"quform-element quform-element-radio quform-element-8_274 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_274\"><label class=\"quform-label-text\" id=\"quform_8_274_e4d3d0_label\">Internet<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-8_274\"><div class=\"quform-input quform-input-radio quform-input-8_274 quform-cf\"><div class=\"quform-options quform-cf quform-options-inline quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_8_274_e4d3d0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_8_274\" id=\"quform_8_274_e4d3d0_1\" class=\"quform-field quform-field-radio quform-field-8_274 quform-field-8_274_1\" value=\"5\/1\" \/><label for=\"quform_8_274_e4d3d0_1\" class=\"quform-option-label quform-option-label-8_274_1\"><span class=\"quform-option-text\">5\/1<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_8_274\" id=\"quform_8_274_e4d3d0_2\" class=\"quform-field quform-field-radio quform-field-8_274 quform-field-8_274_2\" value=\"10\/5\" checked \/><label for=\"quform_8_274_e4d3d0_2\" class=\"quform-option-label quform-option-label-8_274_2\"><span class=\"quform-option-text\">10\/5<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_8_274\" id=\"quform_8_274_e4d3d0_4\" class=\"quform-field quform-field-radio quform-field-8_274 quform-field-8_274_4\" value=\"25\/5\" \/><label for=\"quform_8_274_e4d3d0_4\" class=\"quform-option-label quform-option-label-8_274_4\"><span class=\"quform-option-text\">25\/5<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_8_274\" id=\"quform_8_274_e4d3d0_5\" class=\"quform-field quform-field-radio quform-field-8_274 quform-field-8_274_5\" value=\"50\/10\" \/><label for=\"quform_8_274_e4d3d0_5\" class=\"quform-option-label quform-option-label-8_274_5\"><span class=\"quform-option-text\">50\/10<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-8_270\"><div class=\"quform-element quform-element-radio quform-element-8_273 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_273\"><label class=\"quform-label-text\" id=\"quform_8_273_e4d3d0_label\">Phone<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-8_273\"><div class=\"quform-input quform-input-radio quform-input-8_273 quform-cf\"><div class=\"quform-options quform-cf quform-options-inline quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_8_273_e4d3d0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_8_273\" id=\"quform_8_273_e4d3d0_1\" class=\"quform-field quform-field-radio quform-field-8_273 quform-field-8_273_1\" value=\"No\" checked \/><label for=\"quform_8_273_e4d3d0_1\" class=\"quform-option-label quform-option-label-8_273_1\"><span class=\"quform-option-text\">No<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_8_273\" id=\"quform_8_273_e4d3d0_2\" class=\"quform-field quform-field-radio quform-field-8_273 quform-field-8_273_2\" value=\"Yes\" \/><label for=\"quform_8_273_e4d3d0_2\" class=\"quform-option-label quform-option-label-8_273_2\"><span class=\"quform-option-text\">Yes<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-8_268\"><div class=\"quform-element quform-element-radio quform-element-8_275 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_275\"><label class=\"quform-label-text\" id=\"quform_8_275_e4d3d0_label\">TV<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-8_275\"><div class=\"quform-input quform-input-radio quform-input-8_275 quform-cf\"><div class=\"quform-options quform-cf quform-options-inline quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_8_275_e4d3d0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_8_275\" id=\"quform_8_275_e4d3d0_1\" class=\"quform-field quform-field-radio quform-field-8_275 quform-field-8_275_1\" value=\"0\" checked \/><label for=\"quform_8_275_e4d3d0_1\" class=\"quform-option-label quform-option-label-8_275_1\"><span class=\"quform-option-text\">0<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_8_275\" id=\"quform_8_275_e4d3d0_2\" class=\"quform-field quform-field-radio quform-field-8_275 quform-field-8_275_2\" value=\"1\" \/><label for=\"quform_8_275_e4d3d0_2\" class=\"quform-option-label quform-option-label-8_275_2\"><span class=\"quform-option-text\">1<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_8_275\" id=\"quform_8_275_e4d3d0_4\" class=\"quform-field quform-field-radio quform-field-8_275 quform-field-8_275_4\" value=\"2\" \/><label for=\"quform_8_275_e4d3d0_4\" class=\"quform-option-label quform-option-label-8_275_4\"><span class=\"quform-option-text\">2<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_8_275\" id=\"quform_8_275_e4d3d0_5\" class=\"quform-field quform-field-radio quform-field-8_275 quform-field-8_275_5\" value=\"3\" \/><label for=\"quform_8_275_e4d3d0_5\" class=\"quform-option-label quform-option-label-8_275_5\"><span class=\"quform-option-text\">3<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-8_284 quform-1-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-8_285\"><input type=\"hidden\" name=\"quform_8_293\" class=\"quform-field quform-field-hidden quform-field-8_293\" data-default=\"\" \/><div class=\"quform-element quform-element-html quform-element-8_291 quform-cf\"><div class=\"quform-spacer\"><div id=\"cost-estimate\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-8_51 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><h4 class=\"quform-group-title\">Phone Information<\/h4><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-8_57 quform-4-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-8_58\"><div class=\"quform-element quform-element-select quform-element-8_279 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_279\"><label class=\"quform-label-text\" for=\"quform_8_279_e4d3d0\">Current Provider<\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-8_279\"><div class=\"quform-input quform-input-select quform-input-8_279 quform-cf\"><select id=\"quform_8_279_e4d3d0\" name=\"quform_8_279\" class=\"quform-field quform-field-select quform-field-8_279\"><option value=\"\" selected=\"selected\">Please select<\/option><option value=\"Bell\">Bell<\/option><option value=\"Primus\">Primus<\/option><option value=\"Vianet\">Vianet<\/option><option value=\"Acanac\">Acanac<\/option><option value=\"Other\">Other<\/option><option value=\"Need New Number\">Need New Number<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-8_276\"><div class=\"quform-element quform-element-text quform-element-8_278 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_278\"><label class=\"quform-label-text\" for=\"quform_8_278_e4d3d0\">Phone Number<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-8_278 quform-field-width-small\"><div class=\"quform-input quform-input-text quform-input-8_278 quform-cf\"><input type=\"text\" id=\"quform_8_278_e4d3d0\" name=\"quform_8_278\" class=\"quform-field quform-field-text quform-field-8_278\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-8_59\"><div class=\"quform-element quform-element-text quform-element-8_61 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_61\"><label class=\"quform-label-text\" for=\"quform_8_61_e4d3d0\">Account Owner<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-8_61 quform-field-width-medium\"><div class=\"quform-input quform-input-text quform-input-8_61 quform-cf\"><input type=\"text\" id=\"quform_8_61_e4d3d0\" name=\"quform_8_61\" class=\"quform-field quform-field-text quform-field-8_61\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-8_63\"><div class=\"quform-element quform-element-text quform-element-8_64 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_64\"><label class=\"quform-label-text\" for=\"quform_8_64_e4d3d0\">Account Number<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-8_64\"><div class=\"quform-input quform-input-text quform-input-8_64 quform-cf\"><input type=\"text\" id=\"quform_8_64_e4d3d0\" name=\"quform_8_64\" class=\"quform-field quform-field-text quform-field-8_64\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-8_145 quform-1-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-8_146\"><div class=\"quform-element quform-element-checkbox quform-element-8_130 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_130\"><label class=\"quform-label-text\" id=\"quform_8_130_e4d3d0_label\">Phone Address Info<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-8_130\"><div class=\"quform-input quform-input-checkbox quform-input-8_130 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"group\" aria-labelledby=\"quform_8_130_e4d3d0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_8_130[]\" id=\"quform_8_130_e4d3d0_1\" class=\"quform-field quform-field-checkbox quform-field-8_130 quform-field-8_130_1\" value=\"Same as Above\" checked \/><label for=\"quform_8_130_e4d3d0_1\" class=\"quform-option-label quform-option-label-8_130_1\"><span class=\"quform-option-text\">Same as Above<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-8_131 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><h4 class=\"quform-group-title\">Phone Account Address<\/h4><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-8_132 quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-8_133\"><div class=\"quform-element quform-element-text quform-element-8_134 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_134\"><label class=\"quform-label-text\" for=\"quform_8_134_e4d3d0\">Phone Account Street<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-8_134\"><div class=\"quform-input quform-input-text quform-input-8_134 quform-cf\"><input type=\"text\" id=\"quform_8_134_e4d3d0\" name=\"quform_8_134\" class=\"quform-field quform-field-text quform-field-8_134\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-8_135\"><div class=\"quform-element quform-element-text quform-element-8_136 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_136\"><label class=\"quform-label-text\" for=\"quform_8_136_e4d3d0\">Phone Account PO Box<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-8_136\"><div class=\"quform-input quform-input-text quform-input-8_136 quform-cf\"><input type=\"text\" id=\"quform_8_136_e4d3d0\" name=\"quform_8_136\" class=\"quform-field quform-field-text quform-field-8_136\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-8_137 quform-3-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-8_138\"><div class=\"quform-element quform-element-text quform-element-8_139 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_139\"><label class=\"quform-label-text\" for=\"quform_8_139_e4d3d0\">Phone Acct City<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-8_139\"><div class=\"quform-input quform-input-text quform-input-8_139 quform-cf\"><input type=\"text\" id=\"quform_8_139_e4d3d0\" name=\"quform_8_139\" class=\"quform-field quform-field-text quform-field-8_139\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-8_140\"><div class=\"quform-element quform-element-select quform-element-8_141 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_141\"><label class=\"quform-label-text\" for=\"quform_8_141_e4d3d0\">Phone Acct Province<\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-8_141\"><div class=\"quform-input quform-input-select quform-input-8_141 quform-cf\"><select id=\"quform_8_141_e4d3d0\" name=\"quform_8_141\" class=\"quform-field quform-field-select quform-field-8_141\"><option value=\"ON\">ON<\/option><option value=\"QC\">QC<\/option><option value=\"Other\">Other<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-8_142\"><div class=\"quform-element quform-element-text quform-element-8_143 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_143\"><label class=\"quform-label-text\" for=\"quform_8_143_e4d3d0\">Phone Acct Postal Code<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-8_143\"><div class=\"quform-input quform-input-text quform-input-8_143 quform-cf\"><input type=\"text\" id=\"quform_8_143_e4d3d0\" name=\"quform_8_143\" class=\"quform-field quform-field-text quform-field-8_143\" \/><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-8_52 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><h4 class=\"quform-group-title\">Billing and Payment Information<\/h4><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-8_72 quform-3-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-8_73\"><div class=\"quform-element quform-element-select quform-element-8_75 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_75\"><label class=\"quform-label-text\" for=\"quform_8_75_e4d3d0\">Invoice Delivery<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-8_75\"><div class=\"quform-input quform-input-select quform-input-8_75 quform-cf\"><select id=\"quform_8_75_e4d3d0\" name=\"quform_8_75\" class=\"quform-field quform-field-select quform-field-8_75\"><option value=\"Email\">Email<\/option><option value=\"Paper - Mailed ($2 fee\/invoice)\">Paper - Mailed ($2 fee\/invoice)<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-8_74\"><div class=\"quform-element quform-element-select quform-element-8_76 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_76\"><label class=\"quform-label-text\" for=\"quform_8_76_e4d3d0\">Financial Institution<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-8_76\"><div class=\"quform-input quform-input-select quform-input-8_76 quform-cf\"><select id=\"quform_8_76_e4d3d0\" name=\"quform_8_76\" class=\"quform-field quform-field-select quform-field-8_76\"><option value=\"\" selected=\"selected\">Please select preferred institution<\/option><option value=\"Bank of Montreal\">Bank of Montreal<\/option><option value=\"Scotiabank \/ Tangerine\">Scotiabank \/ Tangerine<\/option><option value=\"Credit Union\">Credit Union<\/option><option value=\"CIBC \/ Simplii\">CIBC \/ Simplii<\/option><option value=\"Royal Bank of Canada\">Royal Bank of Canada<\/option><option value=\"Toronto Dominion\">Toronto Dominion<\/option><option value=\"Other\">Other<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-8_243\"><div class=\"quform-element quform-element-select quform-element-8_242 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_242\"><label class=\"quform-label-text\" for=\"quform_8_242_e4d3d0\">Payment Option<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-8_242\"><div class=\"quform-input quform-input-select quform-input-8_242 quform-cf\"><select id=\"quform_8_242_e4d3d0\" name=\"quform_8_242\" class=\"quform-field quform-field-select quform-field-8_242\"><option value=\"\" selected=\"selected\">Please select preferred option<\/option><option value=\"Pre-Authorized Debit (PAD)\">Pre-Authorized Debit (PAD)<\/option><option value=\"Online from Financial Insitution as Payee\">Online from Financial Insitution as Payee<\/option><option value=\"eTransfer\">eTransfer<\/option><option value=\"Cheque\">Cheque<\/option><option value=\"Cash\">Cash<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-checkbox quform-element-8_94 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_94\"><label class=\"quform-label-text\" id=\"quform_8_94_e4d3d0_label\">Billing Address Info<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-8_94\"><div class=\"quform-input quform-input-checkbox quform-input-8_94 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"group\" aria-labelledby=\"quform_8_94_e4d3d0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_8_94[]\" id=\"quform_8_94_e4d3d0_1\" class=\"quform-field quform-field-checkbox quform-field-8_94 quform-field-8_94_1\" value=\"Same as Above\" checked \/><label for=\"quform_8_94_e4d3d0_1\" class=\"quform-option-label quform-option-label-8_94_1\"><span class=\"quform-option-text\">Same as Above<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-8_115 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><h4 class=\"quform-group-title\">Billing Address<\/h4><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-8_103 quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-8_104\"><div class=\"quform-element quform-element-text quform-element-8_105 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_105\"><label class=\"quform-label-text\" for=\"quform_8_105_e4d3d0\">Billing Street<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-8_105\"><div class=\"quform-input quform-input-text quform-input-8_105 quform-cf\"><input type=\"text\" id=\"quform_8_105_e4d3d0\" name=\"quform_8_105\" class=\"quform-field quform-field-text quform-field-8_105\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-8_106\"><div class=\"quform-element quform-element-text quform-element-8_107 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_107\"><label class=\"quform-label-text\" for=\"quform_8_107_e4d3d0\">Billing PO Box<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-8_107\"><div class=\"quform-input quform-input-text quform-input-8_107 quform-cf\"><input type=\"text\" id=\"quform_8_107_e4d3d0\" name=\"quform_8_107\" class=\"quform-field quform-field-text quform-field-8_107\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-8_108 quform-3-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-8_109\"><div class=\"quform-element quform-element-text quform-element-8_110 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_110\"><label class=\"quform-label-text\" for=\"quform_8_110_e4d3d0\">Billing City<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-8_110\"><div class=\"quform-input quform-input-text quform-input-8_110 quform-cf\"><input type=\"text\" id=\"quform_8_110_e4d3d0\" name=\"quform_8_110\" class=\"quform-field quform-field-text quform-field-8_110\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-8_111\"><div class=\"quform-element quform-element-select quform-element-8_112 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_112\"><label class=\"quform-label-text\" for=\"quform_8_112_e4d3d0\">Billing Province<\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-8_112\"><div class=\"quform-input quform-input-select quform-input-8_112 quform-cf\"><select id=\"quform_8_112_e4d3d0\" name=\"quform_8_112\" class=\"quform-field quform-field-select quform-field-8_112\"><option value=\"ON\">ON<\/option><option value=\"QC\">QC<\/option><option value=\"Other\">Other<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-8_113\"><div class=\"quform-element quform-element-text quform-element-8_114 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_114\"><label class=\"quform-label-text\" for=\"quform_8_114_e4d3d0\">Billing Postal Code<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-8_114\"><div class=\"quform-input quform-input-text quform-input-8_114 quform-cf\"><input type=\"text\" id=\"quform_8_114_e4d3d0\" name=\"quform_8_114\" class=\"quform-field quform-field-text quform-field-8_114\" \/><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-8_144 quform-cf quform-group-style-plain\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><h4 class=\"quform-group-title\">Customer Notes<\/h4><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-textarea quform-element-8_70 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_70\"><label class=\"quform-label-text\" for=\"quform_8_70_e4d3d0\">Additional Information<\/label><\/div><div class=\"quform-inner quform-inner-textarea quform-inner-8_70\"><div class=\"quform-input quform-input-textarea quform-input-8_70 quform-cf\"><textarea id=\"quform_8_70_e4d3d0\" name=\"quform_8_70\" class=\"quform-field quform-field-textarea quform-field-8_70\"><\/textarea><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-8_252 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_252\"><span class=\"quform-label-icon\"><i class=\"fa fa-rss\"><\/i><\/span><label class=\"quform-label-text\" id=\"quform_8_252_e4d3d0_label\">Allow WCCT to send communications (bill information, notices, and newsletters) by email<\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-8_252\"><div class=\"quform-input quform-input-radio quform-input-8_252 quform-cf\"><div class=\"quform-options quform-cf quform-options-inline quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_8_252_e4d3d0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_8_252\" id=\"quform_8_252_e4d3d0_1\" class=\"quform-field quform-field-radio quform-field-8_252 quform-field-8_252_1\" value=\"Yes\" checked \/><label for=\"quform_8_252_e4d3d0_1\" class=\"quform-option-label quform-option-label-8_252_1\"><span class=\"quform-option-text\">Yes<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_8_252\" id=\"quform_8_252_e4d3d0_2\" class=\"quform-field quform-field-radio quform-field-8_252 quform-field-8_252_2\" value=\"No\" \/><label for=\"quform_8_252_e4d3d0_2\" class=\"quform-option-label quform-option-label-8_252_2\"><span class=\"quform-option-text\">No<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-8_65 quform-cf quform-group-style-plain\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><h4 class=\"quform-group-title\">Customer Approval<\/h4><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-recaptcha quform-element-8_257 quform-cf quform-element-required quform-recaptcha-no-size\"><div class=\"quform-spacer\"><div class=\"quform-inner quform-inner-recaptcha quform-inner-8_257\"><div class=\"quform-input quform-input-recaptcha quform-input-8_257 quform-cf\"><div class=\"quform-recaptcha\" data-config=\"{&quot;sitekey&quot;:&quot;6Lf5NiYaAAAAAPLfaCxmaml5vFmEnzhrqj97CvwH&quot;,&quot;_version&quot;:&quot;v3&quot;,&quot;size&quot;:&quot;invisible&quot;,&quot;type&quot;:&quot;image&quot;,&quot;theme&quot;:&quot;light&quot;,&quot;badge&quot;:&quot;bottomright&quot;}\"><\/div><noscript>Please enable JavaScript to submit this form.<\/noscript><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-submit quform-element-8_151 quform-cf quform-button-style-theme\"><div class=\"quform-button-submit quform-button-submit-default quform-button-submit-8_151\"><button name=\"quform_submit\" type=\"submit\" class=\"quform-submit\" value=\"submit\"><span class=\"quform-button-text quform-button-submit-text\">Submit<\/span><\/button><\/div><div class=\"quform-loading quform-loading-position-left quform-loading-type-spinner-1\"><div class=\"quform-loading-inner\"><div class=\"quform-loading-spinner\"><div class=\"quform-loading-spinner-inner\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element-tree\"><label for=\"quform_8_0_e4d3d0\">This field should be left blank<\/label><input type=\"text\" id=\"quform_8_0_e4d3d0\" name=\"quform_8_0\" class=\"quform-field quform-field-tree quform-field-8_0\" tabindex=\"-1\" autocomplete=\"off\" \/><\/div><\/div><\/div><\/div><\/div><\/form><\/div>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n<\/body>","protected":false},"excerpt":{"rendered":"<p>Sign Up Now<div id=\"quform-55d644\" class=\"quform quform-8 quform-theme-light quform-support-page-caching\"><form id=\"quform-form-55d644\" class=\"quform-form quform-form-8\" action=\"\/devel\/wp-json\/wp\/v2\/pages\/194#quform-55d644\" method=\"post\" enctype=\"multipart\/form-data\" novalidate=\"novalidate\" data-options=\"{&quot;id&quot;:8,&quot;uniqueId&quot;:&quot;55d644&quot;,&quot;theme&quot;:&quot;light&quot;,&quot;ajax&quot;:true,&quot;logic&quot;:{&quot;logic&quot;:{&quot;51&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;273&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;2&quot;,&quot;value&quot;:&quot;Yes&quot;}]},&quot;131&quot;:{&quot;action&quot;:false,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;130&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;1&quot;,&quot;value&quot;:&quot;Same as Above&quot;}]},&quot;94&quot;:{&quot;action&quot;:false,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;75&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;1&quot;,&quot;value&quot;:&quot;Email&quot;}]},&quot;115&quot;:{&quot;action&quot;:false,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;94&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;1&quot;,&quot;value&quot;:&quot;Same as Above&quot;}]},&quot;257&quot;:{&quot;action&quot;:false,&quot;match&quot;:&quot;any&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;97&quot;,&quot;operator&quot;:&quot;empty&quot;,&quot;optionId&quot;:null,&quot;value&quot;:&quot;&quot;},{&quot;elementId&quot;:&quot;101&quot;,&quot;operator&quot;:&quot;empty&quot;,&quot;optionId&quot;:null,&quot;value&quot;:&quot;&quot;},{&quot;elementId&quot;:&quot;98&quot;,&quot;operator&quot;:&quot;empty&quot;,&quot;optionId&quot;:null,&quot;value&quot;:&quot;&quot;},{&quot;elementId&quot;:&quot;99&quot;,&quot;operator&quot;:&quot;empty&quot;,&quot;optionId&quot;:null,&quot;value&quot;:&quot;&quot;},{&quot;elementId&quot;:&quot;37&quot;,&quot;operator&quot;:&quot;empty&quot;,&quot;optionId&quot;:null,&quot;value&quot;:&quot;&quot;},{&quot;elementId&quot;:&quot;44&quot;,&quot;operator&quot;:&quot;empty&quot;,&quot;optionId&quot;:null,&quot;value&quot;:&quot;&quot;},{&quot;elementId&quot;:&quot;46&quot;,&quot;operator&quot;:&quot;empty&quot;,&quot;optionId&quot;:null,&quot;value&quot;:&quot;&quot;},{&quot;elementId&quot;:&quot;76&quot;,&quot;operator&quot;:&quot;empty&quot;,&quot;optionId&quot;:null,&quot;value&quot;:&quot;&quot;},{&quot;elementId&quot;:&quot;242&quot;,&quot;operator&quot;:&quot;empty&quot;,&quot;optionId&quot;:null,&quot;value&quot;:&quot;&quot;}]}},&quot;dependents&quot;:{&quot;273&quot;:[51],&quot;130&quot;:[131],&quot;75&quot;:[94],&quot;94&quot;:[115],&quot;97&quot;:[257],&quot;101&quot;:[257],&quot;98&quot;:[257],&quot;99&quot;:[257],&quot;37&quot;:[257],&quot;44&quot;:[257],&quot;46&quot;:[257],&quot;76&quot;:[257],&quot;242&quot;:[257]},&quot;elementIds&quot;:[51,131,94,115,257],&quot;dependentElementIds&quot;:[&quot;273&quot;,&quot;130&quot;,&quot;75&quot;,&quot;94&quot;,&quot;97&quot;,&quot;101&quot;,&quot;98&quot;,&quot;99&quot;,&quot;37&quot;,&quot;44&quot;,&quot;46&quot;,&quot;76&quot;,&quot;242&quot;],&quot;animate&quot;:true},&quot;currentPageId&quot;:1,&quot;errorsIcon&quot;:&quot;&quot;,&quot;updateFancybox&quot;:true,&quot;hasPages&quot;:false,&quot;pages&quot;:[1],&quot;pageProgressType&quot;:&quot;numbers&quot;,&quot;tooltipsEnabled&quot;:true,&quot;tooltipClasses&quot;:&quot;qtip-quform-dark qtip-shadow&quot;,&quot;tooltipMy&quot;:&quot;left center&quot;,&quot;tooltipAt&quot;:&quot;right center&quot;,&quot;isRtl&quot;:false,&quot;scrollOffset&quot;:-50,&quot;scrollSpeed&quot;:800}\"><button class=\"quform-default-submit\" name=\"quform_submit\" type=\"submit\" value=\"submit\" aria-hidden=\"true\" tabindex=\"-1\"><\/button><div class=\"quform-form-inner quform-form-inner-8\"><input type=\"hidden\" name=\"quform_form_id\" value=\"8\" \/><input type=\"hidden\" name=\"quform_form_uid\" value=\"55d644\" \/><input type=\"hidden\" name=\"quform_count\" value=\"2\" \/><input type=\"hidden\" name=\"form_url\" value=\"https:\/\/wcc-tech.ca\/devel\/wp-json\/wp\/v2\/pages\/194\" \/><input type=\"hidden\" name=\"referring_url\" value=\"\" \/><input type=\"hidden\" name=\"post_id\" value=\"\" \/><input type=\"hidden\" name=\"post_title\" value=\"\" \/><input type=\"hidden\" name=\"quform_current_page_id\" value=\"1\" \/><input type=\"hidden\" name=\"quform_csrf_token\" value=\"BD0ZOUHsyYxT5EwqVNzqJM6kTn2QMuUjcBAtIP5i\" \/><div class=\"quform-form-title-description\"><div class=\"quform-form-title\"><div style=\"text-align:center\"><p>Items with an asterisk (*) are required and must be filled out before the form can be submitted. Once your submission is received, a WCCT representative will follow up with you to answer any additional questions that you might have about the service to be provided and pricing.<\/p><br><\/div><\/div><\/div><div class=\"quform-elements quform-elements-8 quform-cf quform-responsive-elements-phone-landscape\"><div class=\"quform-element quform-element-page quform-page-1 quform-page-8_1 quform-cf quform-group-style-plain quform-first-page quform-last-page quform-current-page\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-group quform-element-8_33 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><h4 class=\"quform-group-title\">Customer Information and Service Address<\/h4><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-8_260 quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-8_261\"><div class=\"quform-element quform-element-text quform-element-8_97 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_97\"><label class=\"quform-label-text\" for=\"quform_8_97_55d644\">First Name<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-8_97\"><div class=\"quform-input quform-input-text quform-input-8_97 quform-cf\"><input type=\"text\" id=\"quform_8_97_55d644\" name=\"quform_8_97\" class=\"quform-field quform-field-text quform-field-8_97\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-8_262\"><div class=\"quform-element quform-element-text quform-element-8_101 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_101\"><label class=\"quform-label-text\" for=\"quform_8_101_55d644\">Last Name<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-8_101\"><div class=\"quform-input quform-input-text quform-input-8_101 quform-cf\"><input type=\"text\" id=\"quform_8_101_55d644\" name=\"quform_8_101\" class=\"quform-field quform-field-text quform-field-8_101\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-8_263 quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-8_264\"><div class=\"quform-element quform-element-text quform-element-8_98 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_98\"><label class=\"quform-label-text\" for=\"quform_8_98_55d644\">Primary Phone Number<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-8_98\"><div class=\"quform-input quform-input-text quform-input-8_98 quform-cf\"><input type=\"text\" id=\"quform_8_98_55d644\" name=\"quform_8_98\" class=\"quform-field quform-field-text quform-field-8_98\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-8_265\"><div class=\"quform-element quform-element-text quform-element-8_102 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_102\"><label class=\"quform-label-text\" for=\"quform_8_102_55d644\">Other Phone Number<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-8_102\"><div class=\"quform-input quform-input-text quform-input-8_102 quform-cf\"><input type=\"text\" id=\"quform_8_102_55d644\" name=\"quform_8_102\" class=\"quform-field quform-field-text quform-field-8_102\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-8_95 quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-8_96\"><div class=\"quform-element quform-element-text quform-element-8_99 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_99\"><label class=\"quform-label-text\" for=\"quform_8_99_55d644\">Email<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-8_99\"><div class=\"quform-input quform-input-text quform-input-8_99 quform-cf\"><input type=\"text\" id=\"quform_8_99_55d644\" name=\"quform_8_99\" class=\"quform-field quform-field-text quform-field-8_99\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-8_100\"><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-8_38 quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-8_39\"><div class=\"quform-element quform-element-text quform-element-8_37 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_37\"><label class=\"quform-label-text\" for=\"quform_8_37_55d644\">Street<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-8_37\"><div class=\"quform-input quform-input-text quform-input-8_37 quform-cf\"><input type=\"text\" id=\"quform_8_37_55d644\" name=\"quform_8_37\" class=\"quform-field quform-field-text quform-field-8_37\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-8_40\"><div class=\"quform-element quform-element-text quform-element-8_41 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_41\"><label class=\"quform-label-text\" for=\"quform_8_41_55d644\">PO Box \/ RR#<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-8_41\"><div class=\"quform-input quform-input-text quform-input-8_41 quform-cf\"><input type=\"text\" id=\"quform_8_41_55d644\" name=\"quform_8_41\" class=\"quform-field quform-field-text quform-field-8_41\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-8_42 quform-3-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-8_43\"><div class=\"quform-element quform-element-text quform-element-8_44 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_44\"><label class=\"quform-label-text\" for=\"quform_8_44_55d644\">City<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-8_44\"><div class=\"quform-input quform-input-text quform-input-8_44 quform-cf\"><input type=\"text\" id=\"quform_8_44_55d644\" name=\"quform_8_44\" class=\"quform-field quform-field-text quform-field-8_44\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-8_45\"><div class=\"quform-element quform-element-select quform-element-8_4 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_4\"><label class=\"quform-label-text\" for=\"quform_8_4_55d644\">Province<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-8_4\"><div class=\"quform-input quform-input-select quform-input-8_4 quform-cf\"><select id=\"quform_8_4_55d644\" name=\"quform_8_4\" class=\"quform-field quform-field-select quform-field-8_4\"><option value=\"ON\">ON<\/option><option value=\"QC\">QC<\/option><option value=\"Other\">Other<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-8_47\"><div class=\"quform-element quform-element-text quform-element-8_46 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_46\"><label class=\"quform-label-text\" for=\"quform_8_46_55d644\">Postal Code<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-8_46\"><div class=\"quform-input quform-input-text quform-input-8_46 quform-cf\"><input type=\"text\" id=\"quform_8_46_55d644\" name=\"quform_8_46\" class=\"quform-field quform-field-text quform-field-8_46\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-8_250 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_250\"><span class=\"quform-label-icon\"><i class=\"fa fa-rss\"><\/i><\/span><label class=\"quform-label-text\" id=\"quform_8_250_55d644_label\">Do you currently have internet service at this location?<\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-8_250\"><div class=\"quform-input quform-input-radio quform-input-8_250 quform-cf\"><div class=\"quform-options quform-cf quform-options-inline quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_8_250_55d644_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_8_250\" id=\"quform_8_250_55d644_1\" class=\"quform-field quform-field-radio quform-field-8_250 quform-field-8_250_1\" value=\"Yes\" checked \/><label for=\"quform_8_250_55d644_1\" class=\"quform-option-label quform-option-label-8_250_1\"><span class=\"quform-option-text\">Yes<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_8_250\" id=\"quform_8_250_55d644_2\" class=\"quform-field quform-field-radio quform-field-8_250 quform-field-8_250_2\" value=\"No\" \/><label for=\"quform_8_250_55d644_2\" class=\"quform-option-label quform-option-label-8_250_2\"><span class=\"quform-option-text\">No<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-8_292 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_292\"><span class=\"quform-label-icon\"><i class=\"fa fa-rss\"><\/i><\/span><label class=\"quform-label-text\" id=\"quform_8_292_55d644_label\">Allow WCCT to share name, address and home phone number with phone directory publishers<\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-8_292\"><div class=\"quform-input quform-input-radio quform-input-8_292 quform-cf\"><div class=\"quform-options quform-cf quform-options-inline quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_8_292_55d644_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_8_292\" id=\"quform_8_292_55d644_1\" class=\"quform-field quform-field-radio quform-field-8_292 quform-field-8_292_1\" value=\"Yes\" checked \/><label for=\"quform_8_292_55d644_1\" class=\"quform-option-label quform-option-label-8_292_1\"><span class=\"quform-option-text\">Yes<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_8_292\" id=\"quform_8_292_55d644_2\" class=\"quform-field quform-field-radio quform-field-8_292 quform-field-8_292_2\" value=\"No\" \/><label for=\"quform_8_292_55d644_2\" class=\"quform-option-label quform-option-label-8_292_2\"><span class=\"quform-option-text\">No<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-8_49 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><h4 class=\"quform-group-title\">Requested Service and Cost Estimate excluding HST<\/h4><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-8_53 quform-3-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-8_55\"><div class=\"quform-element quform-element-radio quform-element-8_274 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_274\"><label class=\"quform-label-text\" id=\"quform_8_274_55d644_label\">Internet<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-8_274\"><div class=\"quform-input quform-input-radio quform-input-8_274 quform-cf\"><div class=\"quform-options quform-cf quform-options-inline quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_8_274_55d644_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_8_274\" id=\"quform_8_274_55d644_1\" class=\"quform-field quform-field-radio quform-field-8_274 quform-field-8_274_1\" value=\"5\/1\" \/><label for=\"quform_8_274_55d644_1\" class=\"quform-option-label quform-option-label-8_274_1\"><span class=\"quform-option-text\">5\/1<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_8_274\" id=\"quform_8_274_55d644_2\" class=\"quform-field quform-field-radio quform-field-8_274 quform-field-8_274_2\" value=\"10\/5\" checked \/><label for=\"quform_8_274_55d644_2\" class=\"quform-option-label quform-option-label-8_274_2\"><span class=\"quform-option-text\">10\/5<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_8_274\" id=\"quform_8_274_55d644_4\" class=\"quform-field quform-field-radio quform-field-8_274 quform-field-8_274_4\" value=\"25\/5\" \/><label for=\"quform_8_274_55d644_4\" class=\"quform-option-label quform-option-label-8_274_4\"><span class=\"quform-option-text\">25\/5<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_8_274\" id=\"quform_8_274_55d644_5\" class=\"quform-field quform-field-radio quform-field-8_274 quform-field-8_274_5\" value=\"50\/10\" \/><label for=\"quform_8_274_55d644_5\" class=\"quform-option-label quform-option-label-8_274_5\"><span class=\"quform-option-text\">50\/10<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-8_270\"><div class=\"quform-element quform-element-radio quform-element-8_273 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_273\"><label class=\"quform-label-text\" id=\"quform_8_273_55d644_label\">Phone<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-8_273\"><div class=\"quform-input quform-input-radio quform-input-8_273 quform-cf\"><div class=\"quform-options quform-cf quform-options-inline quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_8_273_55d644_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_8_273\" id=\"quform_8_273_55d644_1\" class=\"quform-field quform-field-radio quform-field-8_273 quform-field-8_273_1\" value=\"No\" checked \/><label for=\"quform_8_273_55d644_1\" class=\"quform-option-label quform-option-label-8_273_1\"><span class=\"quform-option-text\">No<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_8_273\" id=\"quform_8_273_55d644_2\" class=\"quform-field quform-field-radio quform-field-8_273 quform-field-8_273_2\" value=\"Yes\" \/><label for=\"quform_8_273_55d644_2\" class=\"quform-option-label quform-option-label-8_273_2\"><span class=\"quform-option-text\">Yes<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-8_268\"><div class=\"quform-element quform-element-radio quform-element-8_275 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_275\"><label class=\"quform-label-text\" id=\"quform_8_275_55d644_label\">TV<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-8_275\"><div class=\"quform-input quform-input-radio quform-input-8_275 quform-cf\"><div class=\"quform-options quform-cf quform-options-inline quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_8_275_55d644_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_8_275\" id=\"quform_8_275_55d644_1\" class=\"quform-field quform-field-radio quform-field-8_275 quform-field-8_275_1\" value=\"0\" checked \/><label for=\"quform_8_275_55d644_1\" class=\"quform-option-label quform-option-label-8_275_1\"><span class=\"quform-option-text\">0<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_8_275\" id=\"quform_8_275_55d644_2\" class=\"quform-field quform-field-radio quform-field-8_275 quform-field-8_275_2\" value=\"1\" \/><label for=\"quform_8_275_55d644_2\" class=\"quform-option-label quform-option-label-8_275_2\"><span class=\"quform-option-text\">1<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_8_275\" id=\"quform_8_275_55d644_4\" class=\"quform-field quform-field-radio quform-field-8_275 quform-field-8_275_4\" value=\"2\" \/><label for=\"quform_8_275_55d644_4\" class=\"quform-option-label quform-option-label-8_275_4\"><span class=\"quform-option-text\">2<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_8_275\" id=\"quform_8_275_55d644_5\" class=\"quform-field quform-field-radio quform-field-8_275 quform-field-8_275_5\" value=\"3\" \/><label for=\"quform_8_275_55d644_5\" class=\"quform-option-label quform-option-label-8_275_5\"><span class=\"quform-option-text\">3<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-8_284 quform-1-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-8_285\"><input type=\"hidden\" name=\"quform_8_293\" class=\"quform-field quform-field-hidden quform-field-8_293\" data-default=\"\" \/><div class=\"quform-element quform-element-html quform-element-8_291 quform-cf\"><div class=\"quform-spacer\"><div id=\"cost-estimate\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-8_51 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><h4 class=\"quform-group-title\">Phone Information<\/h4><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-8_57 quform-4-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-8_58\"><div class=\"quform-element quform-element-select quform-element-8_279 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_279\"><label class=\"quform-label-text\" for=\"quform_8_279_55d644\">Current Provider<\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-8_279\"><div class=\"quform-input quform-input-select quform-input-8_279 quform-cf\"><select id=\"quform_8_279_55d644\" name=\"quform_8_279\" class=\"quform-field quform-field-select quform-field-8_279\"><option value=\"\" selected=\"selected\">Please select<\/option><option value=\"Bell\">Bell<\/option><option value=\"Primus\">Primus<\/option><option value=\"Vianet\">Vianet<\/option><option value=\"Acanac\">Acanac<\/option><option value=\"Other\">Other<\/option><option value=\"Need New Number\">Need New Number<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-8_276\"><div class=\"quform-element quform-element-text quform-element-8_278 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_278\"><label class=\"quform-label-text\" for=\"quform_8_278_55d644\">Phone Number<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-8_278 quform-field-width-small\"><div class=\"quform-input quform-input-text quform-input-8_278 quform-cf\"><input type=\"text\" id=\"quform_8_278_55d644\" name=\"quform_8_278\" class=\"quform-field quform-field-text quform-field-8_278\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-8_59\"><div class=\"quform-element quform-element-text quform-element-8_61 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_61\"><label class=\"quform-label-text\" for=\"quform_8_61_55d644\">Account Owner<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-8_61 quform-field-width-medium\"><div class=\"quform-input quform-input-text quform-input-8_61 quform-cf\"><input type=\"text\" id=\"quform_8_61_55d644\" name=\"quform_8_61\" class=\"quform-field quform-field-text quform-field-8_61\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-8_63\"><div class=\"quform-element quform-element-text quform-element-8_64 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_64\"><label class=\"quform-label-text\" for=\"quform_8_64_55d644\">Account Number<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-8_64\"><div class=\"quform-input quform-input-text quform-input-8_64 quform-cf\"><input type=\"text\" id=\"quform_8_64_55d644\" name=\"quform_8_64\" class=\"quform-field quform-field-text quform-field-8_64\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-8_145 quform-1-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-8_146\"><div class=\"quform-element quform-element-checkbox quform-element-8_130 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_130\"><label class=\"quform-label-text\" id=\"quform_8_130_55d644_label\">Phone Address Info<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-8_130\"><div class=\"quform-input quform-input-checkbox quform-input-8_130 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"group\" aria-labelledby=\"quform_8_130_55d644_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_8_130[]\" id=\"quform_8_130_55d644_1\" class=\"quform-field quform-field-checkbox quform-field-8_130 quform-field-8_130_1\" value=\"Same as Above\" checked \/><label for=\"quform_8_130_55d644_1\" class=\"quform-option-label quform-option-label-8_130_1\"><span class=\"quform-option-text\">Same as Above<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-8_131 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><h4 class=\"quform-group-title\">Phone Account Address<\/h4><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-8_132 quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-8_133\"><div class=\"quform-element quform-element-text quform-element-8_134 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_134\"><label class=\"quform-label-text\" for=\"quform_8_134_55d644\">Phone Account Street<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-8_134\"><div class=\"quform-input quform-input-text quform-input-8_134 quform-cf\"><input type=\"text\" id=\"quform_8_134_55d644\" name=\"quform_8_134\" class=\"quform-field quform-field-text quform-field-8_134\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-8_135\"><div class=\"quform-element quform-element-text quform-element-8_136 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_136\"><label class=\"quform-label-text\" for=\"quform_8_136_55d644\">Phone Account PO Box<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-8_136\"><div class=\"quform-input quform-input-text quform-input-8_136 quform-cf\"><input type=\"text\" id=\"quform_8_136_55d644\" name=\"quform_8_136\" class=\"quform-field quform-field-text quform-field-8_136\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-8_137 quform-3-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-8_138\"><div class=\"quform-element quform-element-text quform-element-8_139 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_139\"><label class=\"quform-label-text\" for=\"quform_8_139_55d644\">Phone Acct City<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-8_139\"><div class=\"quform-input quform-input-text quform-input-8_139 quform-cf\"><input type=\"text\" id=\"quform_8_139_55d644\" name=\"quform_8_139\" class=\"quform-field quform-field-text quform-field-8_139\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-8_140\"><div class=\"quform-element quform-element-select quform-element-8_141 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_141\"><label class=\"quform-label-text\" for=\"quform_8_141_55d644\">Phone Acct Province<\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-8_141\"><div class=\"quform-input quform-input-select quform-input-8_141 quform-cf\"><select id=\"quform_8_141_55d644\" name=\"quform_8_141\" class=\"quform-field quform-field-select quform-field-8_141\"><option value=\"ON\">ON<\/option><option value=\"QC\">QC<\/option><option value=\"Other\">Other<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-8_142\"><div class=\"quform-element quform-element-text quform-element-8_143 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_143\"><label class=\"quform-label-text\" for=\"quform_8_143_55d644\">Phone Acct Postal Code<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-8_143\"><div class=\"quform-input quform-input-text quform-input-8_143 quform-cf\"><input type=\"text\" id=\"quform_8_143_55d644\" name=\"quform_8_143\" class=\"quform-field quform-field-text quform-field-8_143\" \/><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-8_52 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><h4 class=\"quform-group-title\">Billing and Payment Information<\/h4><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-8_72 quform-3-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-8_73\"><div class=\"quform-element quform-element-select quform-element-8_75 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_75\"><label class=\"quform-label-text\" for=\"quform_8_75_55d644\">Invoice Delivery<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-8_75\"><div class=\"quform-input quform-input-select quform-input-8_75 quform-cf\"><select id=\"quform_8_75_55d644\" name=\"quform_8_75\" class=\"quform-field quform-field-select quform-field-8_75\"><option value=\"Email\">Email<\/option><option value=\"Paper - Mailed ($2 fee\/invoice)\">Paper - Mailed ($2 fee\/invoice)<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-8_74\"><div class=\"quform-element quform-element-select quform-element-8_76 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_76\"><label class=\"quform-label-text\" for=\"quform_8_76_55d644\">Financial Institution<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-8_76\"><div class=\"quform-input quform-input-select quform-input-8_76 quform-cf\"><select id=\"quform_8_76_55d644\" name=\"quform_8_76\" class=\"quform-field quform-field-select quform-field-8_76\"><option value=\"\" selected=\"selected\">Please select preferred institution<\/option><option value=\"Bank of Montreal\">Bank of Montreal<\/option><option value=\"Scotiabank \/ Tangerine\">Scotiabank \/ Tangerine<\/option><option value=\"Credit Union\">Credit Union<\/option><option value=\"CIBC \/ Simplii\">CIBC \/ Simplii<\/option><option value=\"Royal Bank of Canada\">Royal Bank of Canada<\/option><option value=\"Toronto Dominion\">Toronto Dominion<\/option><option value=\"Other\">Other<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-8_243\"><div class=\"quform-element quform-element-select quform-element-8_242 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_242\"><label class=\"quform-label-text\" for=\"quform_8_242_55d644\">Payment Option<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-8_242\"><div class=\"quform-input quform-input-select quform-input-8_242 quform-cf\"><select id=\"quform_8_242_55d644\" name=\"quform_8_242\" class=\"quform-field quform-field-select quform-field-8_242\"><option value=\"\" selected=\"selected\">Please select preferred option<\/option><option value=\"Pre-Authorized Debit (PAD)\">Pre-Authorized Debit (PAD)<\/option><option value=\"Online from Financial Insitution as Payee\">Online from Financial Insitution as Payee<\/option><option value=\"eTransfer\">eTransfer<\/option><option value=\"Cheque\">Cheque<\/option><option value=\"Cash\">Cash<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-checkbox quform-element-8_94 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_94\"><label class=\"quform-label-text\" id=\"quform_8_94_55d644_label\">Billing Address Info<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-8_94\"><div class=\"quform-input quform-input-checkbox quform-input-8_94 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"group\" aria-labelledby=\"quform_8_94_55d644_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_8_94[]\" id=\"quform_8_94_55d644_1\" class=\"quform-field quform-field-checkbox quform-field-8_94 quform-field-8_94_1\" value=\"Same as Above\" checked \/><label for=\"quform_8_94_55d644_1\" class=\"quform-option-label quform-option-label-8_94_1\"><span class=\"quform-option-text\">Same as Above<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-8_115 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><h4 class=\"quform-group-title\">Billing Address<\/h4><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-8_103 quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-8_104\"><div class=\"quform-element quform-element-text quform-element-8_105 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_105\"><label class=\"quform-label-text\" for=\"quform_8_105_55d644\">Billing Street<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-8_105\"><div class=\"quform-input quform-input-text quform-input-8_105 quform-cf\"><input type=\"text\" id=\"quform_8_105_55d644\" name=\"quform_8_105\" class=\"quform-field quform-field-text quform-field-8_105\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-8_106\"><div class=\"quform-element quform-element-text quform-element-8_107 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_107\"><label class=\"quform-label-text\" for=\"quform_8_107_55d644\">Billing PO Box<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-8_107\"><div class=\"quform-input quform-input-text quform-input-8_107 quform-cf\"><input type=\"text\" id=\"quform_8_107_55d644\" name=\"quform_8_107\" class=\"quform-field quform-field-text quform-field-8_107\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-8_108 quform-3-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-8_109\"><div class=\"quform-element quform-element-text quform-element-8_110 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_110\"><label class=\"quform-label-text\" for=\"quform_8_110_55d644\">Billing City<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-8_110\"><div class=\"quform-input quform-input-text quform-input-8_110 quform-cf\"><input type=\"text\" id=\"quform_8_110_55d644\" name=\"quform_8_110\" class=\"quform-field quform-field-text quform-field-8_110\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-8_111\"><div class=\"quform-element quform-element-select quform-element-8_112 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_112\"><label class=\"quform-label-text\" for=\"quform_8_112_55d644\">Billing Province<\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-8_112\"><div class=\"quform-input quform-input-select quform-input-8_112 quform-cf\"><select id=\"quform_8_112_55d644\" name=\"quform_8_112\" class=\"quform-field quform-field-select quform-field-8_112\"><option value=\"ON\">ON<\/option><option value=\"QC\">QC<\/option><option value=\"Other\">Other<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-8_113\"><div class=\"quform-element quform-element-text quform-element-8_114 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_114\"><label class=\"quform-label-text\" for=\"quform_8_114_55d644\">Billing Postal Code<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-8_114\"><div class=\"quform-input quform-input-text quform-input-8_114 quform-cf\"><input type=\"text\" id=\"quform_8_114_55d644\" name=\"quform_8_114\" class=\"quform-field quform-field-text quform-field-8_114\" \/><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-8_144 quform-cf quform-group-style-plain\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><h4 class=\"quform-group-title\">Customer Notes<\/h4><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-textarea quform-element-8_70 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_70\"><label class=\"quform-label-text\" for=\"quform_8_70_55d644\">Additional Information<\/label><\/div><div class=\"quform-inner quform-inner-textarea quform-inner-8_70\"><div class=\"quform-input quform-input-textarea quform-input-8_70 quform-cf\"><textarea id=\"quform_8_70_55d644\" name=\"quform_8_70\" class=\"quform-field quform-field-textarea quform-field-8_70\"><\/textarea><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-8_252 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-8_252\"><span class=\"quform-label-icon\"><i class=\"fa fa-rss\"><\/i><\/span><label class=\"quform-label-text\" id=\"quform_8_252_55d644_label\">Allow WCCT to send communications (bill information, notices, and newsletters) by email<\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-8_252\"><div class=\"quform-input quform-input-radio quform-input-8_252 quform-cf\"><div class=\"quform-options quform-cf quform-options-inline quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_8_252_55d644_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_8_252\" id=\"quform_8_252_55d644_1\" class=\"quform-field quform-field-radio quform-field-8_252 quform-field-8_252_1\" value=\"Yes\" checked \/><label for=\"quform_8_252_55d644_1\" class=\"quform-option-label quform-option-label-8_252_1\"><span class=\"quform-option-text\">Yes<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_8_252\" id=\"quform_8_252_55d644_2\" class=\"quform-field quform-field-radio quform-field-8_252 quform-field-8_252_2\" value=\"No\" \/><label for=\"quform_8_252_55d644_2\" class=\"quform-option-label quform-option-label-8_252_2\"><span class=\"quform-option-text\">No<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-8_65 quform-cf quform-group-style-plain\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><h4 class=\"quform-group-title\">Customer Approval<\/h4><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-recaptcha quform-element-8_257 quform-cf quform-element-required quform-recaptcha-no-size\"><div class=\"quform-spacer\"><div class=\"quform-inner quform-inner-recaptcha quform-inner-8_257\"><div class=\"quform-input quform-input-recaptcha quform-input-8_257 quform-cf\"><div class=\"quform-recaptcha\" data-config=\"{&quot;sitekey&quot;:&quot;6Lf5NiYaAAAAAPLfaCxmaml5vFmEnzhrqj97CvwH&quot;,&quot;_version&quot;:&quot;v3&quot;,&quot;size&quot;:&quot;invisible&quot;,&quot;type&quot;:&quot;image&quot;,&quot;theme&quot;:&quot;light&quot;,&quot;badge&quot;:&quot;bottomright&quot;}\"><\/div><noscript>Please enable JavaScript to submit this form.<\/noscript><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-submit quform-element-8_151 quform-cf quform-button-style-theme\"><div class=\"quform-button-submit quform-button-submit-default quform-button-submit-8_151\"><button name=\"quform_submit\" type=\"submit\" class=\"quform-submit\" value=\"submit\"><span class=\"quform-button-text quform-button-submit-text\">Submit<\/span><\/button><\/div><div class=\"quform-loading quform-loading-position-left quform-loading-type-spinner-1\"><div class=\"quform-loading-inner\"><div class=\"quform-loading-spinner\"><div class=\"quform-loading-spinner-inner\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element-tree\"><label for=\"quform_8_0_55d644\">This field should be left blank<\/label><input type=\"text\" id=\"quform_8_0_55d644\" name=\"quform_8_0\" class=\"quform-field quform-field-tree quform-field-8_0\" tabindex=\"-1\" autocomplete=\"off\" \/><\/div><\/div><\/div><\/div><\/div><\/form><\/div><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/wcc-tech.ca\/devel\/wp-json\/wp\/v2\/pages\/194"}],"collection":[{"href":"https:\/\/wcc-tech.ca\/devel\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/wcc-tech.ca\/devel\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/wcc-tech.ca\/devel\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/wcc-tech.ca\/devel\/wp-json\/wp\/v2\/comments?post=194"}],"version-history":[{"count":13,"href":"https:\/\/wcc-tech.ca\/devel\/wp-json\/wp\/v2\/pages\/194\/revisions"}],"predecessor-version":[{"id":235638,"href":"https:\/\/wcc-tech.ca\/devel\/wp-json\/wp\/v2\/pages\/194\/revisions\/235638"}],"wp:attachment":[{"href":"https:\/\/wcc-tech.ca\/devel\/wp-json\/wp\/v2\/media?parent=194"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}