{"id":194,"date":"2020-12-31T19:54:30","date_gmt":"2020-12-31T19:54:30","guid":{"rendered":"https:\/\/wcc-tech.ca\/home\/?page_id=194"},"modified":"2021-10-11T19:08:09","modified_gmt":"2021-10-11T19:08:09","slug":"sign-up","status":"publish","type":"page","link":"https:\/\/wcc-tech.ca\/home\/sign-up\/","title":{"rendered":"Sign Up"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; fullwidth=&#8221;on&#8221; _builder_version=&#8221;4.7.7&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_fullwidth_menu menu_id=&#8221;4&#8243; active_link_color=&#8221;#f7f9ff&#8221; logo=&#8221;https:\/\/wcc-tech.ca\/home\/wp-content\/uploads\/2020\/12\/WCCT.png&#8221; _builder_version=&#8221;4.7.7&#8243; _module_preset=&#8221;default&#8221; menu_text_color=&#8221;#ffffff&#8221; background_color=&#8221;#201c44&#8243; text_orientation=&#8221;right&#8221; background_layout=&#8221;dark&#8221; menu_font_tablet=&#8221;&#8221; menu_font_phone=&#8221;&#8221; 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global_colors_info=&#8221;{}&#8221;]<\/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=&#8221;4.7.7&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;#d7deed&#8221; box_shadow_style=&#8221;preset6&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.6.0&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.11.2&#8243; _module_preset=&#8221;default&#8221; min_height=&#8221;190px&#8221; custom_padding=&#8221;|20px||20px|false|true&#8221; hover_enabled=&#8221;0&#8243; global_colors_info=&#8221;{}&#8221; sticky_enabled=&#8221;0&#8243;]<div id=\"quform-d97b82\" class=\"quform quform-7 quform-theme-light quform-support-page-caching\"><form id=\"quform-form-d97b82\" class=\"quform-form quform-form-7\" 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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-7\"><input type=\"hidden\" name=\"quform_form_id\" value=\"7\" \/><input type=\"hidden\" name=\"quform_form_uid\" value=\"d97b82\" \/><input type=\"hidden\" name=\"quform_count\" value=\"1\" \/><input type=\"hidden\" name=\"form_url\" value=\"https:\/\/wcc-tech.ca\/home\/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=\"JqcmYeY9GX1QRCA4afK21DUHp3bQLMlNwnK7XFtv\" \/><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-7 quform-cf quform-responsive-elements-phone-landscape\"><div class=\"quform-element quform-element-page quform-page-1 quform-page-7_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-7_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-7_260 quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-7_261\"><div class=\"quform-element quform-element-text quform-element-7_97 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_97\"><label class=\"quform-label-text\" for=\"quform_7_97_d97b82\">First Name<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-7_97\"><div class=\"quform-input quform-input-text quform-input-7_97 quform-cf\"><input type=\"text\" id=\"quform_7_97_d97b82\" name=\"quform_7_97\" class=\"quform-field quform-field-text quform-field-7_97\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-7_262\"><div class=\"quform-element quform-element-text quform-element-7_101 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_101\"><label class=\"quform-label-text\" for=\"quform_7_101_d97b82\">Last Name<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-7_101\"><div class=\"quform-input quform-input-text quform-input-7_101 quform-cf\"><input type=\"text\" id=\"quform_7_101_d97b82\" name=\"quform_7_101\" class=\"quform-field quform-field-text quform-field-7_101\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-7_263 quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-7_264\"><div class=\"quform-element quform-element-text quform-element-7_98 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_98\"><label class=\"quform-label-text\" for=\"quform_7_98_d97b82\">Primary Phone Number<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-7_98\"><div class=\"quform-input quform-input-text quform-input-7_98 quform-cf\"><input type=\"text\" id=\"quform_7_98_d97b82\" name=\"quform_7_98\" class=\"quform-field quform-field-text quform-field-7_98\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-7_265\"><div class=\"quform-element quform-element-text quform-element-7_102 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_102\"><label class=\"quform-label-text\" for=\"quform_7_102_d97b82\">Other Phone Number<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-7_102\"><div class=\"quform-input quform-input-text quform-input-7_102 quform-cf\"><input type=\"text\" id=\"quform_7_102_d97b82\" name=\"quform_7_102\" class=\"quform-field quform-field-text quform-field-7_102\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-7_95 quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-7_96\"><div class=\"quform-element quform-element-text quform-element-7_99 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_99\"><label class=\"quform-label-text\" for=\"quform_7_99_d97b82\">Email<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-7_99\"><div class=\"quform-input quform-input-text quform-input-7_99 quform-cf\"><input type=\"text\" id=\"quform_7_99_d97b82\" name=\"quform_7_99\" class=\"quform-field quform-field-text quform-field-7_99\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-7_100\"><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-7_38 quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-7_39\"><div class=\"quform-element quform-element-text quform-element-7_37 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_37\"><label class=\"quform-label-text\" for=\"quform_7_37_d97b82\">Street<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-7_37\"><div class=\"quform-input quform-input-text quform-input-7_37 quform-cf\"><input type=\"text\" id=\"quform_7_37_d97b82\" name=\"quform_7_37\" class=\"quform-field quform-field-text quform-field-7_37\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-7_40\"><div class=\"quform-element quform-element-text quform-element-7_41 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_41\"><label class=\"quform-label-text\" for=\"quform_7_41_d97b82\">PO Box \/ RR#<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-7_41\"><div class=\"quform-input quform-input-text quform-input-7_41 quform-cf\"><input type=\"text\" id=\"quform_7_41_d97b82\" name=\"quform_7_41\" class=\"quform-field quform-field-text quform-field-7_41\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-7_42 quform-3-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-7_43\"><div class=\"quform-element quform-element-text quform-element-7_44 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_44\"><label class=\"quform-label-text\" for=\"quform_7_44_d97b82\">City<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-7_44\"><div class=\"quform-input quform-input-text quform-input-7_44 quform-cf\"><input type=\"text\" id=\"quform_7_44_d97b82\" name=\"quform_7_44\" class=\"quform-field quform-field-text quform-field-7_44\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-7_45\"><div class=\"quform-element quform-element-select quform-element-7_4 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_4\"><label class=\"quform-label-text\" for=\"quform_7_4_d97b82\">Province<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-7_4\"><div class=\"quform-input quform-input-select quform-input-7_4 quform-cf\"><select id=\"quform_7_4_d97b82\" name=\"quform_7_4\" class=\"quform-field quform-field-select quform-field-7_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-7_47\"><div class=\"quform-element quform-element-text quform-element-7_46 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_46\"><label class=\"quform-label-text\" for=\"quform_7_46_d97b82\">Postal Code<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-7_46\"><div class=\"quform-input quform-input-text quform-input-7_46 quform-cf\"><input type=\"text\" id=\"quform_7_46_d97b82\" name=\"quform_7_46\" class=\"quform-field quform-field-text quform-field-7_46\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-7_250 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_250\"><span class=\"quform-label-icon\"><i class=\"fa fa-rss\"><\/i><\/span><label class=\"quform-label-text\" id=\"quform_7_250_d97b82_label\">Do you currently have internet service at this location?<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-7_250\"><div class=\"quform-input quform-input-radio quform-input-7_250 quform-cf\"><div class=\"quform-options quform-cf quform-options-inline quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_7_250_d97b82_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_7_250\" id=\"quform_7_250_d97b82_1\" class=\"quform-field quform-field-radio quform-field-7_250 quform-field-7_250_1\" value=\"Yes\" checked \/><label for=\"quform_7_250_d97b82_1\" class=\"quform-option-label quform-option-label-7_250_1\"><span class=\"quform-option-text\">Yes<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_7_250\" id=\"quform_7_250_d97b82_2\" class=\"quform-field quform-field-radio quform-field-7_250 quform-field-7_250_2\" value=\"No\" \/><label for=\"quform_7_250_d97b82_2\" class=\"quform-option-label quform-option-label-7_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-7_292 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_292\"><span class=\"quform-label-icon\"><i class=\"fa fa-rss\"><\/i><\/span><label class=\"quform-label-text\" id=\"quform_7_292_d97b82_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-7_292\"><div class=\"quform-input quform-input-radio quform-input-7_292 quform-cf\"><div class=\"quform-options quform-cf quform-options-inline quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_7_292_d97b82_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_7_292\" id=\"quform_7_292_d97b82_1\" class=\"quform-field quform-field-radio quform-field-7_292 quform-field-7_292_1\" value=\"Yes\" checked \/><label for=\"quform_7_292_d97b82_1\" class=\"quform-option-label quform-option-label-7_292_1\"><span class=\"quform-option-text\">Yes<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_7_292\" id=\"quform_7_292_d97b82_2\" class=\"quform-field quform-field-radio quform-field-7_292 quform-field-7_292_2\" value=\"No\" \/><label for=\"quform_7_292_d97b82_2\" class=\"quform-option-label quform-option-label-7_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-7_49 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><h4 class=\"quform-group-title\">Requested Service<\/h4><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-7_53 quform-4-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-7_55\"><div class=\"quform-element quform-element-radio quform-element-7_274 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_274\"><label class=\"quform-label-text\" id=\"quform_7_274_d97b82_label\">Internet<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-7_274\"><div class=\"quform-input quform-input-radio quform-input-7_274 quform-cf\"><div class=\"quform-options quform-cf quform-options-columns quform-4-columns quform-responsive-columns-phone-landscape quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_7_274_d97b82_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_7_274\" id=\"quform_7_274_d97b82_1\" class=\"quform-field quform-field-radio quform-field-7_274 quform-field-7_274_1\" value=\"5\/1\" \/><label for=\"quform_7_274_d97b82_1\" class=\"quform-option-label quform-option-label-7_274_1\"><span class=\"quform-option-text\">5\/1<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_7_274\" id=\"quform_7_274_d97b82_2\" class=\"quform-field quform-field-radio quform-field-7_274 quform-field-7_274_2\" value=\"10\/5\" checked \/><label for=\"quform_7_274_d97b82_2\" class=\"quform-option-label quform-option-label-7_274_2\"><span class=\"quform-option-text\">10\/5<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_7_274\" id=\"quform_7_274_d97b82_4\" class=\"quform-field quform-field-radio quform-field-7_274 quform-field-7_274_4\" value=\"25\/10\" \/><label for=\"quform_7_274_d97b82_4\" class=\"quform-option-label quform-option-label-7_274_4\"><span class=\"quform-option-text\">25\/10<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_7_274\" id=\"quform_7_274_d97b82_8\" class=\"quform-field quform-field-radio quform-field-7_274 quform-field-7_274_8\" value=\"50\/15\" \/><label for=\"quform_7_274_d97b82_8\" class=\"quform-option-label quform-option-label-7_274_8\"><span class=\"quform-option-text\">50\/15<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_7_274\" id=\"quform_7_274_d97b82_9\" class=\"quform-field quform-field-radio quform-field-7_274 quform-field-7_274_9\" value=\"75\/20\" \/><label for=\"quform_7_274_d97b82_9\" class=\"quform-option-label quform-option-label-7_274_9\"><span class=\"quform-option-text\">75\/20<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_7_274\" id=\"quform_7_274_d97b82_10\" class=\"quform-field quform-field-radio quform-field-7_274 quform-field-7_274_10\" value=\"100\/35\" \/><label for=\"quform_7_274_d97b82_10\" class=\"quform-option-label quform-option-label-7_274_10\"><span class=\"quform-option-text\">100\/35<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-7_270\"><div class=\"quform-element quform-element-radio quform-element-7_296 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_296\"><label class=\"quform-label-text\" id=\"quform_7_296_d97b82_label\">Router<\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-7_296\"><div class=\"quform-input quform-input-radio quform-input-7_296 quform-cf\"><div class=\"quform-options quform-cf quform-options-inline quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_7_296_d97b82_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_7_296\" id=\"quform_7_296_d97b82_1\" class=\"quform-field quform-field-radio quform-field-7_296 quform-field-7_296_1\" value=\"Purchase ($50 +hst)\" checked \/><label for=\"quform_7_296_d97b82_1\" class=\"quform-option-label quform-option-label-7_296_1\"><span class=\"quform-option-text\">Purchase ($50 +hst)<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_7_296\" id=\"quform_7_296_d97b82_2\" class=\"quform-field quform-field-radio quform-field-7_296 quform-field-7_296_2\" value=\"Rent ($5 +hst \/mon)\" \/><label for=\"quform_7_296_d97b82_2\" class=\"quform-option-label quform-option-label-7_296_2\"><span class=\"quform-option-text\">Rent ($5 +hst \/mon)<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_7_296\" id=\"quform_7_296_d97b82_3\" class=\"quform-field quform-field-radio quform-field-7_296 quform-field-7_296_3\" value=\"Providing Own\" \/><label for=\"quform_7_296_d97b82_3\" class=\"quform-option-label quform-option-label-7_296_3\"><span class=\"quform-option-text\">Providing Own<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-7_268\"><div class=\"quform-element quform-element-radio quform-element-7_593 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_593\"><label class=\"quform-label-text\" id=\"quform_7_593_d97b82_label\">TV<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-7_593\"><div class=\"quform-input quform-input-radio quform-input-7_593 quform-cf\"><div class=\"quform-options quform-cf quform-options-inline quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_7_593_d97b82_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_7_593\" id=\"quform_7_593_d97b82_1\" class=\"quform-field quform-field-radio quform-field-7_593 quform-field-7_593_1\" value=\"No\" checked \/><label for=\"quform_7_593_d97b82_1\" class=\"quform-option-label quform-option-label-7_593_1\"><span class=\"quform-option-text\">No<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_7_593\" id=\"quform_7_593_d97b82_2\" class=\"quform-field quform-field-radio quform-field-7_593 quform-field-7_593_2\" value=\"Yes\" \/><label for=\"quform_7_593_d97b82_2\" class=\"quform-option-label quform-option-label-7_593_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-7_592\"><div class=\"quform-element quform-element-radio quform-element-7_273 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_273\"><label class=\"quform-label-text\" id=\"quform_7_273_d97b82_label\">Phone<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-7_273\"><div class=\"quform-input quform-input-radio quform-input-7_273 quform-cf\"><div class=\"quform-options quform-cf quform-options-inline quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_7_273_d97b82_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_7_273\" id=\"quform_7_273_d97b82_1\" class=\"quform-field quform-field-radio quform-field-7_273 quform-field-7_273_1\" value=\"No\" checked \/><label for=\"quform_7_273_d97b82_1\" class=\"quform-option-label quform-option-label-7_273_1\"><span class=\"quform-option-text\">No<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_7_273\" id=\"quform_7_273_d97b82_2\" class=\"quform-field quform-field-radio quform-field-7_273 quform-field-7_273_2\" value=\"Yes\" \/><label for=\"quform_7_273_d97b82_2\" class=\"quform-option-label quform-option-label-7_273_2\"><span class=\"quform-option-text\">Yes<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-7_284 quform-1-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-7_285\"><input type=\"hidden\" name=\"quform_7_293\" class=\"quform-field quform-field-hidden quform-field-7_293\" data-default=\"\" \/><div class=\"quform-element quform-element-html quform-element-7_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-7_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-7_57 quform-4-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-7_58\"><div class=\"quform-element quform-element-select quform-element-7_279 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_279\"><label class=\"quform-label-text\" for=\"quform_7_279_d97b82\">Current Provider<\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-7_279\"><div class=\"quform-input quform-input-select quform-input-7_279 quform-cf\"><select id=\"quform_7_279_d97b82\" name=\"quform_7_279\" class=\"quform-field quform-field-select quform-field-7_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-7_276\"><div class=\"quform-element quform-element-text quform-element-7_278 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_278\"><label class=\"quform-label-text\" for=\"quform_7_278_d97b82\">Phone Number<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-7_278 quform-field-width-small\"><div class=\"quform-input quform-input-text quform-input-7_278 quform-cf\"><input type=\"text\" id=\"quform_7_278_d97b82\" name=\"quform_7_278\" class=\"quform-field quform-field-text quform-field-7_278\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-7_59\"><div class=\"quform-element quform-element-text quform-element-7_61 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_61\"><label class=\"quform-label-text\" for=\"quform_7_61_d97b82\">Account Owner<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-7_61 quform-field-width-medium\"><div class=\"quform-input quform-input-text quform-input-7_61 quform-cf\"><input type=\"text\" id=\"quform_7_61_d97b82\" name=\"quform_7_61\" class=\"quform-field quform-field-text quform-field-7_61\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-7_63\"><div class=\"quform-element quform-element-text quform-element-7_64 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_64\"><label class=\"quform-label-text\" for=\"quform_7_64_d97b82\">Account Number<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-7_64\"><div class=\"quform-input quform-input-text quform-input-7_64 quform-cf\"><input type=\"text\" id=\"quform_7_64_d97b82\" name=\"quform_7_64\" class=\"quform-field quform-field-text quform-field-7_64\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-7_145 quform-1-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-7_146\"><div class=\"quform-element quform-element-checkbox quform-element-7_130 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_130\"><label class=\"quform-label-text\" id=\"quform_7_130_d97b82_label\">Phone Address Info<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-7_130\"><div class=\"quform-input quform-input-checkbox quform-input-7_130 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"group\" aria-labelledby=\"quform_7_130_d97b82_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_7_130[]\" id=\"quform_7_130_d97b82_1\" class=\"quform-field quform-field-checkbox quform-field-7_130 quform-field-7_130_1\" value=\"Same as Above\" checked \/><label for=\"quform_7_130_d97b82_1\" class=\"quform-option-label quform-option-label-7_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-7_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-7_132 quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-7_133\"><div class=\"quform-element quform-element-text quform-element-7_134 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_134\"><label class=\"quform-label-text\" for=\"quform_7_134_d97b82\">Phone Account Street<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-7_134\"><div class=\"quform-input quform-input-text quform-input-7_134 quform-cf\"><input type=\"text\" id=\"quform_7_134_d97b82\" name=\"quform_7_134\" class=\"quform-field quform-field-text quform-field-7_134\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-7_135\"><div class=\"quform-element quform-element-text quform-element-7_136 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_136\"><label class=\"quform-label-text\" for=\"quform_7_136_d97b82\">Phone Account PO Box<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-7_136\"><div class=\"quform-input quform-input-text quform-input-7_136 quform-cf\"><input type=\"text\" id=\"quform_7_136_d97b82\" name=\"quform_7_136\" class=\"quform-field quform-field-text quform-field-7_136\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-7_137 quform-3-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-7_138\"><div class=\"quform-element quform-element-text quform-element-7_139 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_139\"><label class=\"quform-label-text\" for=\"quform_7_139_d97b82\">Phone Acct City<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-7_139\"><div class=\"quform-input quform-input-text quform-input-7_139 quform-cf\"><input type=\"text\" id=\"quform_7_139_d97b82\" name=\"quform_7_139\" class=\"quform-field quform-field-text quform-field-7_139\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-7_140\"><div class=\"quform-element quform-element-select quform-element-7_141 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_141\"><label class=\"quform-label-text\" for=\"quform_7_141_d97b82\">Phone Acct Province<\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-7_141\"><div class=\"quform-input quform-input-select quform-input-7_141 quform-cf\"><select id=\"quform_7_141_d97b82\" name=\"quform_7_141\" class=\"quform-field quform-field-select quform-field-7_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-7_142\"><div class=\"quform-element quform-element-text quform-element-7_143 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_143\"><label class=\"quform-label-text\" for=\"quform_7_143_d97b82\">Phone Acct Postal Code<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-7_143\"><div class=\"quform-input quform-input-text quform-input-7_143 quform-cf\"><input type=\"text\" id=\"quform_7_143_d97b82\" name=\"quform_7_143\" class=\"quform-field quform-field-text quform-field-7_143\" \/><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-7_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-7_72 quform-3-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-7_73\"><div class=\"quform-element quform-element-select quform-element-7_75 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_75\"><label class=\"quform-label-text\" for=\"quform_7_75_d97b82\">Invoice Delivery<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-7_75\"><div class=\"quform-input quform-input-select quform-input-7_75 quform-cf\"><select id=\"quform_7_75_d97b82\" name=\"quform_7_75\" class=\"quform-field quform-field-select quform-field-7_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-7_74\"><div class=\"quform-element quform-element-select quform-element-7_76 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_76\"><label class=\"quform-label-text\" for=\"quform_7_76_d97b82\">Financial Institution<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-7_76\"><div class=\"quform-input quform-input-select quform-input-7_76 quform-cf\"><select id=\"quform_7_76_d97b82\" name=\"quform_7_76\" class=\"quform-field quform-field-select quform-field-7_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-7_243\"><div class=\"quform-element quform-element-select quform-element-7_242 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_242\"><label class=\"quform-label-text\" for=\"quform_7_242_d97b82\">Payment Option<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-7_242\"><div class=\"quform-input quform-input-select quform-input-7_242 quform-cf\"><select id=\"quform_7_242_d97b82\" name=\"quform_7_242\" class=\"quform-field quform-field-select quform-field-7_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-7_94 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_94\"><label class=\"quform-label-text\" id=\"quform_7_94_d97b82_label\">Billing Address Info<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-7_94\"><div class=\"quform-input quform-input-checkbox quform-input-7_94 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"group\" aria-labelledby=\"quform_7_94_d97b82_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_7_94[]\" id=\"quform_7_94_d97b82_1\" class=\"quform-field quform-field-checkbox quform-field-7_94 quform-field-7_94_1\" value=\"Same as Above\" checked \/><label for=\"quform_7_94_d97b82_1\" class=\"quform-option-label quform-option-label-7_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-7_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-7_103 quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-7_104\"><div class=\"quform-element quform-element-text quform-element-7_105 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_105\"><label class=\"quform-label-text\" for=\"quform_7_105_d97b82\">Billing Street<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-7_105\"><div class=\"quform-input quform-input-text quform-input-7_105 quform-cf\"><input type=\"text\" id=\"quform_7_105_d97b82\" name=\"quform_7_105\" class=\"quform-field quform-field-text quform-field-7_105\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-7_106\"><div class=\"quform-element quform-element-text quform-element-7_107 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_107\"><label class=\"quform-label-text\" for=\"quform_7_107_d97b82\">Billing PO Box<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-7_107\"><div class=\"quform-input quform-input-text quform-input-7_107 quform-cf\"><input type=\"text\" id=\"quform_7_107_d97b82\" name=\"quform_7_107\" class=\"quform-field quform-field-text quform-field-7_107\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-7_108 quform-3-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-7_109\"><div class=\"quform-element quform-element-text quform-element-7_110 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_110\"><label class=\"quform-label-text\" for=\"quform_7_110_d97b82\">Billing City<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-7_110\"><div class=\"quform-input quform-input-text quform-input-7_110 quform-cf\"><input type=\"text\" id=\"quform_7_110_d97b82\" name=\"quform_7_110\" class=\"quform-field quform-field-text quform-field-7_110\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-7_111\"><div class=\"quform-element quform-element-select quform-element-7_112 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_112\"><label class=\"quform-label-text\" for=\"quform_7_112_d97b82\">Billing Province<\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-7_112\"><div class=\"quform-input quform-input-select quform-input-7_112 quform-cf\"><select id=\"quform_7_112_d97b82\" name=\"quform_7_112\" class=\"quform-field quform-field-select quform-field-7_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-7_113\"><div class=\"quform-element quform-element-text quform-element-7_114 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_114\"><label class=\"quform-label-text\" for=\"quform_7_114_d97b82\">Billing Postal Code<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-7_114\"><div class=\"quform-input quform-input-text quform-input-7_114 quform-cf\"><input type=\"text\" id=\"quform_7_114_d97b82\" name=\"quform_7_114\" class=\"quform-field quform-field-text quform-field-7_114\" \/><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-7_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-7_70 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_70\"><label class=\"quform-label-text\" for=\"quform_7_70_d97b82\">Additional Information<\/label><\/div><div class=\"quform-inner quform-inner-textarea quform-inner-7_70\"><div class=\"quform-input quform-input-textarea quform-input-7_70 quform-cf\"><textarea id=\"quform_7_70_d97b82\" name=\"quform_7_70\" class=\"quform-field quform-field-textarea quform-field-7_70\"><\/textarea><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-7_252 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_252\"><span class=\"quform-label-icon\"><i class=\"fa fa-rss\"><\/i><\/span><label class=\"quform-label-text\" id=\"quform_7_252_d97b82_label\">Allow WCCT to send communications (bill information, notices, and newsletters) by email<\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-7_252\"><div class=\"quform-input quform-input-radio quform-input-7_252 quform-cf\"><div class=\"quform-options quform-cf quform-options-inline quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_7_252_d97b82_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_7_252\" id=\"quform_7_252_d97b82_1\" class=\"quform-field quform-field-radio quform-field-7_252 quform-field-7_252_1\" value=\"Yes\" checked \/><label for=\"quform_7_252_d97b82_1\" class=\"quform-option-label quform-option-label-7_252_1\"><span class=\"quform-option-text\">Yes<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_7_252\" id=\"quform_7_252_d97b82_2\" class=\"quform-field quform-field-radio quform-field-7_252 quform-field-7_252_2\" value=\"No\" \/><label for=\"quform_7_252_d97b82_2\" class=\"quform-option-label quform-option-label-7_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-7_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-7_257 quform-cf quform-element-required quform-recaptcha-no-size\"><div class=\"quform-spacer\"><div class=\"quform-inner quform-inner-recaptcha quform-inner-7_257\"><div class=\"quform-input quform-input-recaptcha quform-input-7_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-7_151 quform-cf quform-button-style-theme\"><div class=\"quform-button-submit quform-button-submit-default quform-button-submit-7_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_7_0_d97b82\">This field should be left blank<\/label><input type=\"text\" id=\"quform_7_0_d97b82\" name=\"quform_7_0\" class=\"quform-field quform-field-tree quform-field-7_0\" tabindex=\"-1\" autocomplete=\"off\" \/><\/div><\/div><\/div><\/div><\/div><\/form><\/div><br \/>\n[\/et_pb_text][et_pb_code _builder_version=&#8221;4.11.2&#8243; _module_preset=&#8221;default&#8221; hover_enabled=&#8221;0&#8243; sticky_enabled=&#8221;0&#8243;]<script><!-- [et_pb_line_break_holder] -->$( document ).ready(function() { <!-- [et_pb_line_break_holder] -->    $( \"a\" ).click(function( event ) {<!-- [et_pb_line_break_holder] -->        alert( \"Thanks for visiting!\" );<!-- [et_pb_line_break_holder] -->    }); <!-- [et_pb_line_break_holder] -->});<\/script>[\/et_pb_code][et_pb_code _builder_version=&#8221;4.11.2&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;]<script>jQuery(function ($) {<!-- [et_pb_line_break_holder] -->    var calculate = function () {<!-- [et_pb_line_break_holder] -->        var install=75;<!-- [et_pb_line_break_holder] -->        var mrc=0;<!-- [et_pb_line_break_holder] -->        var bundle=0;<!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] -->        \/\/ Add router rent<!-- [et_pb_line_break_holder] -->        mrc += 5;<!-- [et_pb_line_break_holder] -->        \/\/ Process internet choice<!-- [et_pb_line_break_holder] -->        var val1 = $('.quform-field-7_274').val();<!-- [et_pb_line_break_holder] -->        if (val1 == '5\/1') {<!-- [et_pb_line_break_holder] -->            mrc += 49;<!-- [et_pb_line_break_holder] -->        } else if (val1 == '10\/5') {<!-- [et_pb_line_break_holder] -->            mrc += 64;<!-- [et_pb_line_break_holder] -->        } else if (val1 == '25\/5') {<!-- [et_pb_line_break_holder] -->            mrc += 79;<!-- [et_pb_line_break_holder] -->        } else if (val1 == '50\/10') {<!-- [et_pb_line_break_holder] -->            mrc += 99;<!-- [et_pb_line_break_holder] -->        }<!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] -->        \/\/ Process phone choice<!-- [et_pb_line_break_holder] -->        var val2 = $('.quform-field-7_273').val();<!-- [et_pb_line_break_holder] -->        if (val2 == 'Yes') {<!-- [et_pb_line_break_holder] -->           mrc += 20;<!-- [et_pb_line_break_holder] -->           bundle += 1;<!-- [et_pb_line_break_holder] -->        }<!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] -->        \/\/ Process TV choice<!-- [et_pb_line_break_holder] -->        var val3 = $('.quform-field-7_275').val();<!-- [et_pb_line_break_holder] -->        if (val3 > 0) {<!-- [et_pb_line_break_holder] -->        \tmrc += 50 + (val3-1)*5;<!-- [et_pb_line_break_holder] -->                bundle += 1;<!-- [et_pb_line_break_holder] -->            }<!-- [et_pb_line_break_holder] -->        }<!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] -->        \/\/ Apply bundle savings<!-- [et_pb_line_break_holder] -->        mrc = mrc - (bundle*10);<!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] -->        \/\/ A text input field with numeric value<!-- [et_pb_line_break_holder] -->        \/\/var val4 = $('.quform-field-1_8').val();<!-- [et_pb_line_break_holder] -->        \/\/if (val4 && val4.length && $.isNumeric(val4)) {<!-- [et_pb_line_break_holder] -->        \/\/    total += parseFloat(val4);<!-- [et_pb_line_break_holder] -->        \/\/}<!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] -->        \/\/ Display the result to the user<!-- [et_pb_line_break_holder] -->        $('#cost-estimate').text('On-Time Installation Fee: $' + install + '  ' + 'Monthly Service Fee: $' + mrc);<!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] -->        \/\/ Set the value of the hidden field<!-- [et_pb_line_break_holder] -->        $('.quform-field-7_293').val('$' + mrc);<!-- [et_pb_line_break_holder] -->    };<!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] -->    \/\/ Calculate on page load<!-- [et_pb_line_break_holder] -->    calculate();<!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] -->    \/\/ Recalculate when these checkboxes\/radio buttons are clicked<!-- [et_pb_line_break_holder] -->    $('.quform-field-7_273, .quform-field-7_274, .quform-field-7_275').click(calculate);<!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] -->  });<\/script>[\/et_pb_code][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Sign Up Now<div id=\"quform-3d564b\" class=\"quform quform-7 quform-theme-light quform-support-page-caching\"><form id=\"quform-form-3d564b\" class=\"quform-form quform-form-7\" action=\"\/home\/wp-json\/wp\/v2\/pages\/194#quform-3d564b\" method=\"post\" enctype=\"multipart\/form-data\" novalidate=\"novalidate\" data-options=\"{&quot;id&quot;:7,&quot;uniqueId&quot;:&quot;3d564b&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-7\"><input type=\"hidden\" name=\"quform_form_id\" value=\"7\" \/><input type=\"hidden\" name=\"quform_form_uid\" value=\"3d564b\" \/><input type=\"hidden\" name=\"quform_count\" value=\"2\" \/><input type=\"hidden\" name=\"form_url\" value=\"https:\/\/wcc-tech.ca\/home\/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=\"JqcmYeY9GX1QRCA4afK21DUHp3bQLMlNwnK7XFtv\" \/><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-7 quform-cf quform-responsive-elements-phone-landscape\"><div class=\"quform-element quform-element-page quform-page-1 quform-page-7_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-7_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-7_260 quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-7_261\"><div class=\"quform-element quform-element-text quform-element-7_97 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_97\"><label class=\"quform-label-text\" for=\"quform_7_97_3d564b\">First Name<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-7_97\"><div class=\"quform-input quform-input-text quform-input-7_97 quform-cf\"><input type=\"text\" id=\"quform_7_97_3d564b\" name=\"quform_7_97\" class=\"quform-field quform-field-text quform-field-7_97\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-7_262\"><div class=\"quform-element quform-element-text quform-element-7_101 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_101\"><label class=\"quform-label-text\" for=\"quform_7_101_3d564b\">Last Name<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-7_101\"><div class=\"quform-input quform-input-text quform-input-7_101 quform-cf\"><input type=\"text\" id=\"quform_7_101_3d564b\" name=\"quform_7_101\" class=\"quform-field quform-field-text quform-field-7_101\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-7_263 quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-7_264\"><div class=\"quform-element quform-element-text quform-element-7_98 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_98\"><label class=\"quform-label-text\" for=\"quform_7_98_3d564b\">Primary Phone Number<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-7_98\"><div class=\"quform-input quform-input-text quform-input-7_98 quform-cf\"><input type=\"text\" id=\"quform_7_98_3d564b\" name=\"quform_7_98\" class=\"quform-field quform-field-text quform-field-7_98\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-7_265\"><div class=\"quform-element quform-element-text quform-element-7_102 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_102\"><label class=\"quform-label-text\" for=\"quform_7_102_3d564b\">Other Phone Number<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-7_102\"><div class=\"quform-input quform-input-text quform-input-7_102 quform-cf\"><input type=\"text\" id=\"quform_7_102_3d564b\" name=\"quform_7_102\" class=\"quform-field quform-field-text quform-field-7_102\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-7_95 quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-7_96\"><div class=\"quform-element quform-element-text quform-element-7_99 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_99\"><label class=\"quform-label-text\" for=\"quform_7_99_3d564b\">Email<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-7_99\"><div class=\"quform-input quform-input-text quform-input-7_99 quform-cf\"><input type=\"text\" id=\"quform_7_99_3d564b\" name=\"quform_7_99\" class=\"quform-field quform-field-text quform-field-7_99\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-7_100\"><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-7_38 quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-7_39\"><div class=\"quform-element quform-element-text quform-element-7_37 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_37\"><label class=\"quform-label-text\" for=\"quform_7_37_3d564b\">Street<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-7_37\"><div class=\"quform-input quform-input-text quform-input-7_37 quform-cf\"><input type=\"text\" id=\"quform_7_37_3d564b\" name=\"quform_7_37\" class=\"quform-field quform-field-text quform-field-7_37\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-7_40\"><div class=\"quform-element quform-element-text quform-element-7_41 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_41\"><label class=\"quform-label-text\" for=\"quform_7_41_3d564b\">PO Box \/ RR#<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-7_41\"><div class=\"quform-input quform-input-text quform-input-7_41 quform-cf\"><input type=\"text\" id=\"quform_7_41_3d564b\" name=\"quform_7_41\" class=\"quform-field quform-field-text quform-field-7_41\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-7_42 quform-3-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-7_43\"><div class=\"quform-element quform-element-text quform-element-7_44 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_44\"><label class=\"quform-label-text\" for=\"quform_7_44_3d564b\">City<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-7_44\"><div class=\"quform-input quform-input-text quform-input-7_44 quform-cf\"><input type=\"text\" id=\"quform_7_44_3d564b\" name=\"quform_7_44\" class=\"quform-field quform-field-text quform-field-7_44\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-7_45\"><div class=\"quform-element quform-element-select quform-element-7_4 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_4\"><label class=\"quform-label-text\" for=\"quform_7_4_3d564b\">Province<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-7_4\"><div class=\"quform-input quform-input-select quform-input-7_4 quform-cf\"><select id=\"quform_7_4_3d564b\" name=\"quform_7_4\" class=\"quform-field quform-field-select quform-field-7_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-7_47\"><div class=\"quform-element quform-element-text quform-element-7_46 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_46\"><label class=\"quform-label-text\" for=\"quform_7_46_3d564b\">Postal Code<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-7_46\"><div class=\"quform-input quform-input-text quform-input-7_46 quform-cf\"><input type=\"text\" id=\"quform_7_46_3d564b\" name=\"quform_7_46\" class=\"quform-field quform-field-text quform-field-7_46\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-7_250 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_250\"><span class=\"quform-label-icon\"><i class=\"fa fa-rss\"><\/i><\/span><label class=\"quform-label-text\" id=\"quform_7_250_3d564b_label\">Do you currently have internet service at this location?<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-7_250\"><div class=\"quform-input quform-input-radio quform-input-7_250 quform-cf\"><div class=\"quform-options quform-cf quform-options-inline quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_7_250_3d564b_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_7_250\" id=\"quform_7_250_3d564b_1\" class=\"quform-field quform-field-radio quform-field-7_250 quform-field-7_250_1\" value=\"Yes\" checked \/><label for=\"quform_7_250_3d564b_1\" class=\"quform-option-label quform-option-label-7_250_1\"><span class=\"quform-option-text\">Yes<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_7_250\" id=\"quform_7_250_3d564b_2\" class=\"quform-field quform-field-radio quform-field-7_250 quform-field-7_250_2\" value=\"No\" \/><label for=\"quform_7_250_3d564b_2\" class=\"quform-option-label quform-option-label-7_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-7_292 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_292\"><span class=\"quform-label-icon\"><i class=\"fa fa-rss\"><\/i><\/span><label class=\"quform-label-text\" id=\"quform_7_292_3d564b_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-7_292\"><div class=\"quform-input quform-input-radio quform-input-7_292 quform-cf\"><div class=\"quform-options quform-cf quform-options-inline quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_7_292_3d564b_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_7_292\" id=\"quform_7_292_3d564b_1\" class=\"quform-field quform-field-radio quform-field-7_292 quform-field-7_292_1\" value=\"Yes\" checked \/><label for=\"quform_7_292_3d564b_1\" class=\"quform-option-label quform-option-label-7_292_1\"><span class=\"quform-option-text\">Yes<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_7_292\" id=\"quform_7_292_3d564b_2\" class=\"quform-field quform-field-radio quform-field-7_292 quform-field-7_292_2\" value=\"No\" \/><label for=\"quform_7_292_3d564b_2\" class=\"quform-option-label quform-option-label-7_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-7_49 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><h4 class=\"quform-group-title\">Requested Service<\/h4><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-7_53 quform-4-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-7_55\"><div class=\"quform-element quform-element-radio quform-element-7_274 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_274\"><label class=\"quform-label-text\" id=\"quform_7_274_3d564b_label\">Internet<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-7_274\"><div class=\"quform-input quform-input-radio quform-input-7_274 quform-cf\"><div class=\"quform-options quform-cf quform-options-columns quform-4-columns quform-responsive-columns-phone-landscape quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_7_274_3d564b_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_7_274\" id=\"quform_7_274_3d564b_1\" class=\"quform-field quform-field-radio quform-field-7_274 quform-field-7_274_1\" value=\"5\/1\" \/><label for=\"quform_7_274_3d564b_1\" class=\"quform-option-label quform-option-label-7_274_1\"><span class=\"quform-option-text\">5\/1<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_7_274\" id=\"quform_7_274_3d564b_2\" class=\"quform-field quform-field-radio quform-field-7_274 quform-field-7_274_2\" value=\"10\/5\" checked \/><label for=\"quform_7_274_3d564b_2\" class=\"quform-option-label quform-option-label-7_274_2\"><span class=\"quform-option-text\">10\/5<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_7_274\" id=\"quform_7_274_3d564b_4\" class=\"quform-field quform-field-radio quform-field-7_274 quform-field-7_274_4\" value=\"25\/10\" \/><label for=\"quform_7_274_3d564b_4\" class=\"quform-option-label quform-option-label-7_274_4\"><span class=\"quform-option-text\">25\/10<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_7_274\" id=\"quform_7_274_3d564b_8\" class=\"quform-field quform-field-radio quform-field-7_274 quform-field-7_274_8\" value=\"50\/15\" \/><label for=\"quform_7_274_3d564b_8\" class=\"quform-option-label quform-option-label-7_274_8\"><span class=\"quform-option-text\">50\/15<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_7_274\" id=\"quform_7_274_3d564b_9\" class=\"quform-field quform-field-radio quform-field-7_274 quform-field-7_274_9\" value=\"75\/20\" \/><label for=\"quform_7_274_3d564b_9\" class=\"quform-option-label quform-option-label-7_274_9\"><span class=\"quform-option-text\">75\/20<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_7_274\" id=\"quform_7_274_3d564b_10\" class=\"quform-field quform-field-radio quform-field-7_274 quform-field-7_274_10\" value=\"100\/35\" \/><label for=\"quform_7_274_3d564b_10\" class=\"quform-option-label quform-option-label-7_274_10\"><span class=\"quform-option-text\">100\/35<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-7_270\"><div class=\"quform-element quform-element-radio quform-element-7_296 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_296\"><label class=\"quform-label-text\" id=\"quform_7_296_3d564b_label\">Router<\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-7_296\"><div class=\"quform-input quform-input-radio quform-input-7_296 quform-cf\"><div class=\"quform-options quform-cf quform-options-inline quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_7_296_3d564b_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_7_296\" id=\"quform_7_296_3d564b_1\" class=\"quform-field quform-field-radio quform-field-7_296 quform-field-7_296_1\" value=\"Purchase ($50 +hst)\" checked \/><label for=\"quform_7_296_3d564b_1\" class=\"quform-option-label quform-option-label-7_296_1\"><span class=\"quform-option-text\">Purchase ($50 +hst)<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_7_296\" id=\"quform_7_296_3d564b_2\" class=\"quform-field quform-field-radio quform-field-7_296 quform-field-7_296_2\" value=\"Rent ($5 +hst \/mon)\" \/><label for=\"quform_7_296_3d564b_2\" class=\"quform-option-label quform-option-label-7_296_2\"><span class=\"quform-option-text\">Rent ($5 +hst \/mon)<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_7_296\" id=\"quform_7_296_3d564b_3\" class=\"quform-field quform-field-radio quform-field-7_296 quform-field-7_296_3\" value=\"Providing Own\" \/><label for=\"quform_7_296_3d564b_3\" class=\"quform-option-label quform-option-label-7_296_3\"><span class=\"quform-option-text\">Providing Own<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-7_268\"><div class=\"quform-element quform-element-radio quform-element-7_593 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_593\"><label class=\"quform-label-text\" id=\"quform_7_593_3d564b_label\">TV<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-7_593\"><div class=\"quform-input quform-input-radio quform-input-7_593 quform-cf\"><div class=\"quform-options quform-cf quform-options-inline quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_7_593_3d564b_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_7_593\" id=\"quform_7_593_3d564b_1\" class=\"quform-field quform-field-radio quform-field-7_593 quform-field-7_593_1\" value=\"No\" checked \/><label for=\"quform_7_593_3d564b_1\" class=\"quform-option-label quform-option-label-7_593_1\"><span class=\"quform-option-text\">No<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_7_593\" id=\"quform_7_593_3d564b_2\" class=\"quform-field quform-field-radio quform-field-7_593 quform-field-7_593_2\" value=\"Yes\" \/><label for=\"quform_7_593_3d564b_2\" class=\"quform-option-label quform-option-label-7_593_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-7_592\"><div class=\"quform-element quform-element-radio quform-element-7_273 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_273\"><label class=\"quform-label-text\" id=\"quform_7_273_3d564b_label\">Phone<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-7_273\"><div class=\"quform-input quform-input-radio quform-input-7_273 quform-cf\"><div class=\"quform-options quform-cf quform-options-inline quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_7_273_3d564b_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_7_273\" id=\"quform_7_273_3d564b_1\" class=\"quform-field quform-field-radio quform-field-7_273 quform-field-7_273_1\" value=\"No\" checked \/><label for=\"quform_7_273_3d564b_1\" class=\"quform-option-label quform-option-label-7_273_1\"><span class=\"quform-option-text\">No<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_7_273\" id=\"quform_7_273_3d564b_2\" class=\"quform-field quform-field-radio quform-field-7_273 quform-field-7_273_2\" value=\"Yes\" \/><label for=\"quform_7_273_3d564b_2\" class=\"quform-option-label quform-option-label-7_273_2\"><span class=\"quform-option-text\">Yes<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-7_284 quform-1-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-7_285\"><input type=\"hidden\" name=\"quform_7_293\" class=\"quform-field quform-field-hidden quform-field-7_293\" data-default=\"\" \/><div class=\"quform-element quform-element-html quform-element-7_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-7_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-7_57 quform-4-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-7_58\"><div class=\"quform-element quform-element-select quform-element-7_279 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_279\"><label class=\"quform-label-text\" for=\"quform_7_279_3d564b\">Current Provider<\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-7_279\"><div class=\"quform-input quform-input-select quform-input-7_279 quform-cf\"><select id=\"quform_7_279_3d564b\" name=\"quform_7_279\" class=\"quform-field quform-field-select quform-field-7_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-7_276\"><div class=\"quform-element quform-element-text quform-element-7_278 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_278\"><label class=\"quform-label-text\" for=\"quform_7_278_3d564b\">Phone Number<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-7_278 quform-field-width-small\"><div class=\"quform-input quform-input-text quform-input-7_278 quform-cf\"><input type=\"text\" id=\"quform_7_278_3d564b\" name=\"quform_7_278\" class=\"quform-field quform-field-text quform-field-7_278\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-7_59\"><div class=\"quform-element quform-element-text quform-element-7_61 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_61\"><label class=\"quform-label-text\" for=\"quform_7_61_3d564b\">Account Owner<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-7_61 quform-field-width-medium\"><div class=\"quform-input quform-input-text quform-input-7_61 quform-cf\"><input type=\"text\" id=\"quform_7_61_3d564b\" name=\"quform_7_61\" class=\"quform-field quform-field-text quform-field-7_61\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-7_63\"><div class=\"quform-element quform-element-text quform-element-7_64 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_64\"><label class=\"quform-label-text\" for=\"quform_7_64_3d564b\">Account Number<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-7_64\"><div class=\"quform-input quform-input-text quform-input-7_64 quform-cf\"><input type=\"text\" id=\"quform_7_64_3d564b\" name=\"quform_7_64\" class=\"quform-field quform-field-text quform-field-7_64\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-7_145 quform-1-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-7_146\"><div class=\"quform-element quform-element-checkbox quform-element-7_130 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_130\"><label class=\"quform-label-text\" id=\"quform_7_130_3d564b_label\">Phone Address Info<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-7_130\"><div class=\"quform-input quform-input-checkbox quform-input-7_130 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"group\" aria-labelledby=\"quform_7_130_3d564b_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_7_130[]\" id=\"quform_7_130_3d564b_1\" class=\"quform-field quform-field-checkbox quform-field-7_130 quform-field-7_130_1\" value=\"Same as Above\" checked \/><label for=\"quform_7_130_3d564b_1\" class=\"quform-option-label quform-option-label-7_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-7_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-7_132 quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-7_133\"><div class=\"quform-element quform-element-text quform-element-7_134 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_134\"><label class=\"quform-label-text\" for=\"quform_7_134_3d564b\">Phone Account Street<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-7_134\"><div class=\"quform-input quform-input-text quform-input-7_134 quform-cf\"><input type=\"text\" id=\"quform_7_134_3d564b\" name=\"quform_7_134\" class=\"quform-field quform-field-text quform-field-7_134\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-7_135\"><div class=\"quform-element quform-element-text quform-element-7_136 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_136\"><label class=\"quform-label-text\" for=\"quform_7_136_3d564b\">Phone Account PO Box<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-7_136\"><div class=\"quform-input quform-input-text quform-input-7_136 quform-cf\"><input type=\"text\" id=\"quform_7_136_3d564b\" name=\"quform_7_136\" class=\"quform-field quform-field-text quform-field-7_136\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-7_137 quform-3-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-7_138\"><div class=\"quform-element quform-element-text quform-element-7_139 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_139\"><label class=\"quform-label-text\" for=\"quform_7_139_3d564b\">Phone Acct City<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-7_139\"><div class=\"quform-input quform-input-text quform-input-7_139 quform-cf\"><input type=\"text\" id=\"quform_7_139_3d564b\" name=\"quform_7_139\" class=\"quform-field quform-field-text quform-field-7_139\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-7_140\"><div class=\"quform-element quform-element-select quform-element-7_141 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_141\"><label class=\"quform-label-text\" for=\"quform_7_141_3d564b\">Phone Acct Province<\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-7_141\"><div class=\"quform-input quform-input-select quform-input-7_141 quform-cf\"><select id=\"quform_7_141_3d564b\" name=\"quform_7_141\" class=\"quform-field quform-field-select quform-field-7_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-7_142\"><div class=\"quform-element quform-element-text quform-element-7_143 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_143\"><label class=\"quform-label-text\" for=\"quform_7_143_3d564b\">Phone Acct Postal Code<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-7_143\"><div class=\"quform-input quform-input-text quform-input-7_143 quform-cf\"><input type=\"text\" id=\"quform_7_143_3d564b\" name=\"quform_7_143\" class=\"quform-field quform-field-text quform-field-7_143\" \/><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-7_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-7_72 quform-3-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-7_73\"><div class=\"quform-element quform-element-select quform-element-7_75 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_75\"><label class=\"quform-label-text\" for=\"quform_7_75_3d564b\">Invoice Delivery<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-7_75\"><div class=\"quform-input quform-input-select quform-input-7_75 quform-cf\"><select id=\"quform_7_75_3d564b\" name=\"quform_7_75\" class=\"quform-field quform-field-select quform-field-7_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-7_74\"><div class=\"quform-element quform-element-select quform-element-7_76 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_76\"><label class=\"quform-label-text\" for=\"quform_7_76_3d564b\">Financial Institution<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-7_76\"><div class=\"quform-input quform-input-select quform-input-7_76 quform-cf\"><select id=\"quform_7_76_3d564b\" name=\"quform_7_76\" class=\"quform-field quform-field-select quform-field-7_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-7_243\"><div class=\"quform-element quform-element-select quform-element-7_242 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_242\"><label class=\"quform-label-text\" for=\"quform_7_242_3d564b\">Payment Option<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-7_242\"><div class=\"quform-input quform-input-select quform-input-7_242 quform-cf\"><select id=\"quform_7_242_3d564b\" name=\"quform_7_242\" class=\"quform-field quform-field-select quform-field-7_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-7_94 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_94\"><label class=\"quform-label-text\" id=\"quform_7_94_3d564b_label\">Billing Address Info<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-7_94\"><div class=\"quform-input quform-input-checkbox quform-input-7_94 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"group\" aria-labelledby=\"quform_7_94_3d564b_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_7_94[]\" id=\"quform_7_94_3d564b_1\" class=\"quform-field quform-field-checkbox quform-field-7_94 quform-field-7_94_1\" value=\"Same as Above\" checked \/><label for=\"quform_7_94_3d564b_1\" class=\"quform-option-label quform-option-label-7_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-7_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-7_103 quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-7_104\"><div class=\"quform-element quform-element-text quform-element-7_105 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_105\"><label class=\"quform-label-text\" for=\"quform_7_105_3d564b\">Billing Street<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-7_105\"><div class=\"quform-input quform-input-text quform-input-7_105 quform-cf\"><input type=\"text\" id=\"quform_7_105_3d564b\" name=\"quform_7_105\" class=\"quform-field quform-field-text quform-field-7_105\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-7_106\"><div class=\"quform-element quform-element-text quform-element-7_107 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_107\"><label class=\"quform-label-text\" for=\"quform_7_107_3d564b\">Billing PO Box<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-7_107\"><div class=\"quform-input quform-input-text quform-input-7_107 quform-cf\"><input type=\"text\" id=\"quform_7_107_3d564b\" name=\"quform_7_107\" class=\"quform-field quform-field-text quform-field-7_107\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-7_108 quform-3-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-7_109\"><div class=\"quform-element quform-element-text quform-element-7_110 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_110\"><label class=\"quform-label-text\" for=\"quform_7_110_3d564b\">Billing City<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-7_110\"><div class=\"quform-input quform-input-text quform-input-7_110 quform-cf\"><input type=\"text\" id=\"quform_7_110_3d564b\" name=\"quform_7_110\" class=\"quform-field quform-field-text quform-field-7_110\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-7_111\"><div class=\"quform-element quform-element-select quform-element-7_112 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_112\"><label class=\"quform-label-text\" for=\"quform_7_112_3d564b\">Billing Province<\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-7_112\"><div class=\"quform-input quform-input-select quform-input-7_112 quform-cf\"><select id=\"quform_7_112_3d564b\" name=\"quform_7_112\" class=\"quform-field quform-field-select quform-field-7_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-7_113\"><div class=\"quform-element quform-element-text quform-element-7_114 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_114\"><label class=\"quform-label-text\" for=\"quform_7_114_3d564b\">Billing Postal Code<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-7_114\"><div class=\"quform-input quform-input-text quform-input-7_114 quform-cf\"><input type=\"text\" id=\"quform_7_114_3d564b\" name=\"quform_7_114\" class=\"quform-field quform-field-text quform-field-7_114\" \/><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-7_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-7_70 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_70\"><label class=\"quform-label-text\" for=\"quform_7_70_3d564b\">Additional Information<\/label><\/div><div class=\"quform-inner quform-inner-textarea quform-inner-7_70\"><div class=\"quform-input quform-input-textarea quform-input-7_70 quform-cf\"><textarea id=\"quform_7_70_3d564b\" name=\"quform_7_70\" class=\"quform-field quform-field-textarea quform-field-7_70\"><\/textarea><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-7_252 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-7_252\"><span class=\"quform-label-icon\"><i class=\"fa fa-rss\"><\/i><\/span><label class=\"quform-label-text\" id=\"quform_7_252_3d564b_label\">Allow WCCT to send communications (bill information, notices, and newsletters) by email<\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-7_252\"><div class=\"quform-input quform-input-radio quform-input-7_252 quform-cf\"><div class=\"quform-options quform-cf quform-options-inline quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_7_252_3d564b_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_7_252\" id=\"quform_7_252_3d564b_1\" class=\"quform-field quform-field-radio quform-field-7_252 quform-field-7_252_1\" value=\"Yes\" checked \/><label for=\"quform_7_252_3d564b_1\" class=\"quform-option-label quform-option-label-7_252_1\"><span class=\"quform-option-text\">Yes<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_7_252\" id=\"quform_7_252_3d564b_2\" class=\"quform-field quform-field-radio quform-field-7_252 quform-field-7_252_2\" value=\"No\" \/><label for=\"quform_7_252_3d564b_2\" class=\"quform-option-label quform-option-label-7_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-7_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-7_257 quform-cf quform-element-required quform-recaptcha-no-size\"><div class=\"quform-spacer\"><div class=\"quform-inner quform-inner-recaptcha quform-inner-7_257\"><div class=\"quform-input quform-input-recaptcha quform-input-7_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-7_151 quform-cf quform-button-style-theme\"><div class=\"quform-button-submit quform-button-submit-default quform-button-submit-7_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_7_0_3d564b\">This field should be left blank<\/label><input type=\"text\" id=\"quform_7_0_3d564b\" name=\"quform_7_0\" class=\"quform-field quform-field-tree quform-field-7_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":""},"class_list":["post-194","page","type-page","status-publish","hentry"],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/wcc-tech.ca\/home\/wp-json\/wp\/v2\/pages\/194","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/wcc-tech.ca\/home\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/wcc-tech.ca\/home\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/wcc-tech.ca\/home\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/wcc-tech.ca\/home\/wp-json\/wp\/v2\/comments?post=194"}],"version-history":[{"count":17,"href":"https:\/\/wcc-tech.ca\/home\/wp-json\/wp\/v2\/pages\/194\/revisions"}],"predecessor-version":[{"id":235651,"href":"https:\/\/wcc-tech.ca\/home\/wp-json\/wp\/v2\/pages\/194\/revisions\/235651"}],"wp:attachment":[{"href":"https:\/\/wcc-tech.ca\/home\/wp-json\/wp\/v2\/media?parent=194"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}