{"id":39434,"date":"2023-06-23T09:41:05","date_gmt":"2023-06-23T16:41:05","guid":{"rendered":"https:\/\/www.skamaniapud.com\/?page_id=39434"},"modified":"2023-06-23T09:41:05","modified_gmt":"2023-06-23T16:41:05","slug":"application-for-vendor-list","status":"publish","type":"page","link":"https:\/\/www.skamaniapud.com\/about-us\/contracting-bidding\/application-for-vendor-list\/","title":{"rendered":"Application for Vendor List"},"content":{"rendered":"<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var 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class='gform-body gform_body'><div id='gform_fields_28' class='gform_fields top_label form_sublabel_above description_above'><div id=\"field_28_1\"  class=\"gfield gfield--type-text gfield--width-half field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_28_1\"><label class='gfield_label gform-field-label' for='input_28_1' >Company Name<\/label><div class='ginput_container ginput_container_text'><input name='input_1' id='input_28_1' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_28_3\"  class=\"gfield gfield--type-number gfield--width-half field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_28_3\"><label class='gfield_label gform-field-label' for='input_28_3' >Tax Identification Number<\/label><div class='ginput_container ginput_container_number'><input name='input_3' id='input_28_3' type='number' step='any'   value='' class='large'      aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_28_4\"  class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_28_4\"><legend class='gfield_label gform-field-label'  >Company Type<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_4'>\n\t\t\t<div class='gchoice gchoice_28_4_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_4' type='radio' value='Corporation'  id='choice_28_4_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_4_0' id='label_28_4_0' class='gform-field-label gform-field-label--type-inline'>Corporation<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_4_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_4' type='radio' value='Partnership'  id='choice_28_4_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_4_1' id='label_28_4_1' class='gform-field-label gform-field-label--type-inline'>Partnership<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_4_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_4' type='radio' value='Sole Proprietorship'  id='choice_28_4_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_4_2' id='label_28_4_2' class='gform-field-label gform-field-label--type-inline'>Sole Proprietorship<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_4_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_4' type='radio' value='gf_other_choice'  id='choice_28_4_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_4_3' id='label_28_4_3' class='gform-field-label gform-field-label--type-inline'>Other<\/label><br \/><input id='input_28_4_other' class='gchoice_other_control' name='input_4_other' type='text' value='Other' aria-label='Other Choice, please specify'  disabled='disabled' \/>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_28_13\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_28_13\"><label class='gfield_label gform-field-label' for='input_28_13' >State of incorporation<\/label><div class='ginput_container ginput_container_text'><input name='input_13' id='input_28_13' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_28_15\"  class=\"gfield gfield--type-name gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_28_15\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Name of registered agent<\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_28_15'>\n                            \n                            <span id='input_28_15_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_28_15_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                    <input type='text' name='input_15.3' id='input_28_15_3' value=''   aria-required='false'     \/>\n                                                <\/span>\n                            \n                            <span id='input_28_15_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_28_15_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                            <input type='text' name='input_15.6' id='input_28_15_6' value=''   aria-required='false'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_28_6\"  class=\"gfield gfield--type-address gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_28_6\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Address of registered agent<\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_28_6' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_28_6_1_container' >\n                                        <label for='input_28_6_1' id='input_28_6_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                        <input type='text' name='input_6.1' id='input_28_6_1' value=''    aria-required='false'    \/>\n                                   <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_28_6_2_container' >\n                                        <label for='input_28_6_2' id='input_28_6_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                        <input type='text' name='input_6.2' id='input_28_6_2' value=''     aria-required='false'   \/>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_28_6_3_container' >\n                                    <label for='input_28_6_3' id='input_28_6_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                    <input type='text' name='input_6.3' id='input_28_6_3' value=''    aria-required='false'    \/>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_28_6_4_container' >\n                                        <label for='input_28_6_4' id='input_28_6_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                        <select name='input_6.4' id='input_28_6_4'     aria-required='false'    ><option value='' ><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' selected='selected'>Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_28_6_5_container' >\n                                    <label for='input_28_6_5' id='input_28_6_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                    <input type='text' name='input_6.5' id='input_28_6_5' value=''    aria-required='false'    \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_6.6' id='input_28_6_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><fieldset id=\"field_28_16\"  class=\"gfield gfield--type-name gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_28_16\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Name of the managing partner<\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_28_16'>\n                            \n                            <span id='input_28_16_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_28_16_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                    <input type='text' name='input_16.3' id='input_28_16_3' value=''   aria-required='false'     \/>\n                                                <\/span>\n                            \n                            <span id='input_28_16_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_28_16_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                            <input type='text' name='input_16.6' id='input_28_16_6' value=''   aria-required='false'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_28_17\"  class=\"gfield gfield--type-address gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_28_17\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Address of the managing partner<\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_28_17' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_28_17_1_container' >\n                                        <label for='input_28_17_1' id='input_28_17_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                        <input type='text' name='input_17.1' id='input_28_17_1' value=''    aria-required='false'    \/>\n                                   <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_28_17_2_container' >\n                                        <label for='input_28_17_2' id='input_28_17_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                        <input type='text' name='input_17.2' id='input_28_17_2' value=''     aria-required='false'   \/>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_28_17_3_container' >\n                                    <label for='input_28_17_3' id='input_28_17_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                    <input type='text' name='input_17.3' id='input_28_17_3' value=''    aria-required='false'    \/>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_28_17_4_container' >\n                                        <label for='input_28_17_4' id='input_28_17_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                        <select name='input_17.4' id='input_28_17_4'     aria-required='false'    ><option value='' ><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' selected='selected'>Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_28_17_5_container' >\n                                    <label for='input_28_17_5' id='input_28_17_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                    <input type='text' name='input_17.5' id='input_28_17_5' value=''    aria-required='false'    \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_17.6' id='input_28_17_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_28_21\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_28_21\"><label class='gfield_label gform-field-label' for='input_28_21' >Year the business was established<\/label><div class='ginput_container ginput_container_text'><input name='input_21' id='input_28_21' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_28_12\"  class=\"gfield gfield--type-address gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_28_12\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Address<\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_28_12' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_28_12_1_container' >\n                                        <label for='input_28_12_1' id='input_28_12_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                        <input type='text' name='input_12.1' id='input_28_12_1' value=''    aria-required='false'    \/>\n                                   <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_28_12_2_container' >\n                                        <label for='input_28_12_2' id='input_28_12_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                        <input type='text' name='input_12.2' id='input_28_12_2' value=''     aria-required='false'   \/>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_28_12_3_container' >\n                                    <label for='input_28_12_3' id='input_28_12_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                    <input type='text' name='input_12.3' id='input_28_12_3' value=''    aria-required='false'    \/>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_28_12_4_container' >\n                                        <label for='input_28_12_4' id='input_28_12_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                        <select name='input_12.4' id='input_28_12_4'     aria-required='false'    ><option value='' ><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' selected='selected'>Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_28_12_5_container' >\n                                    <label for='input_28_12_5' id='input_28_12_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                    <input type='text' name='input_12.5' id='input_28_12_5' value=''    aria-required='false'    \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_12.6' id='input_28_12_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><fieldset id=\"field_28_22\"  class=\"gfield gfield--type-address gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_28_22\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Mailing Address<\/legend>    <div id='input_28_22_copy_values_option_container' class='copy_values_option_container' >\n                                        <input type='checkbox' id='input_28_22_copy_values_activated' class='copy_values_activated' value='1' data-source_field_id='12' name='input_22_copy_values_activated'  \/>\n                                        <label for='input_28_22_copy_values_activated' id='input_28_22_copy_values_option_label' class='copy_values_option_label inline gform-field-label gform-field-label--type-inline'>Same as previous<\/label>\n                                    <\/div>\n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_28_22' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_28_22_1_container' >\n                                        <label for='input_28_22_1' id='input_28_22_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                        <input type='text' name='input_22.1' id='input_28_22_1' value=''    aria-required='false'    \/>\n                                   <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_28_22_2_container' >\n                                        <label for='input_28_22_2' id='input_28_22_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                        <input type='text' name='input_22.2' id='input_28_22_2' value=''     aria-required='false'   \/>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_28_22_3_container' >\n                                    <label for='input_28_22_3' id='input_28_22_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                    <input type='text' name='input_22.3' id='input_28_22_3' value=''    aria-required='false'    \/>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_28_22_4_container' >\n                                        <label for='input_28_22_4' id='input_28_22_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                        <select name='input_22.4' id='input_28_22_4'     aria-required='false'    ><option value='' ><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' selected='selected'>Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_28_22_5_container' >\n                                    <label for='input_28_22_5' id='input_28_22_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                    <input type='text' name='input_22.5' id='input_28_22_5' value=''    aria-required='false'    \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_22.6' id='input_28_22_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><fieldset id=\"field_28_7\"  class=\"gfield gfield--type-name field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_28_7\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Contact Name<\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_28_7'>\n                            \n                            <span id='input_28_7_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_28_7_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                    <input type='text' name='input_7.3' id='input_28_7_3' value=''   aria-required='false'     \/>\n                                                <\/span>\n                            \n                            <span id='input_28_7_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_28_7_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                            <input type='text' name='input_7.6' id='input_28_7_6' value=''   aria-required='false'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_28_8\"  class=\"gfield gfield--type-text field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_28_8\"><label class='gfield_label gform-field-label' for='input_28_8' >Contact Title<\/label><div class='ginput_container ginput_container_text'><input name='input_8' id='input_28_8' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_28_9\"  class=\"gfield gfield--type-phone field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_28_9\"><label class='gfield_label gform-field-label' for='input_28_9' >Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_9' id='input_28_9' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_28_10\"  class=\"gfield gfield--type-number field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_28_10\"><label class='gfield_label gform-field-label' for='input_28_10' >Fax Number<\/label><div class='ginput_container ginput_container_number'><input name='input_10' id='input_28_10' type='number' step='any'   value='' class='large'      aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_28_11\"  class=\"gfield gfield--type-email field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_28_11\"><label class='gfield_label gform-field-label' for='input_28_11' >Email<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_11' id='input_28_11' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><fieldset id=\"field_28_18\"  class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_above gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_28_18\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Materials, Equipment, and Supplies<\/legend><div class='gfield_description' id='gfield_description_28_18'>Check appropriate box for the materials, equipment, or supplies you are willing to supply and for which you would like to receive requests for quotes.<\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_28_18'><div class='gchoice gchoice_28_18_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.1' type='checkbox'  value='Arrestors'  id='choice_28_18_1'   aria-describedby=\"gfield_description_28_18\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_28_18_1' id='label_28_18_1' class='gform-field-label gform-field-label--type-inline'>Arrestors<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_18_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.2' type='checkbox'  value='Cable &amp; Conductor'  id='choice_28_18_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_18_2' id='label_28_18_2' class='gform-field-label gform-field-label--type-inline'>Cable &amp; Conductor<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_18_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.3' type='checkbox'  value='Capacitors'  id='choice_28_18_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_18_3' id='label_28_18_3' class='gform-field-label gform-field-label--type-inline'>Capacitors<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_18_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.4' type='checkbox'  value='Circuit Breakers'  id='choice_28_18_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_18_4' id='label_28_18_4' class='gform-field-label gform-field-label--type-inline'>Circuit Breakers<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_18_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.5' type='checkbox'  value='Circuit Interrupters'  id='choice_28_18_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_18_5' id='label_28_18_5' class='gform-field-label gform-field-label--type-inline'>Circuit Interrupters<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_18_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.6' type='checkbox'  value='Circuit Reclosers'  id='choice_28_18_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_18_6' id='label_28_18_6' class='gform-field-label gform-field-label--type-inline'>Circuit Reclosers<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_18_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.7' type='checkbox'  value='Computer Equipment'  id='choice_28_18_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_18_7' id='label_28_18_7' class='gform-field-label gform-field-label--type-inline'>Computer Equipment<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_18_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.8' type='checkbox'  value='Concrete Products'  id='choice_28_18_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_18_8' id='label_28_18_8' class='gform-field-label gform-field-label--type-inline'>Concrete Products<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_18_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.9' type='checkbox'  value='Conduit'  id='choice_28_18_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_18_9' id='label_28_18_9' class='gform-field-label gform-field-label--type-inline'>Conduit<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_18_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.11' type='checkbox'  value='Construction Equipment'  id='choice_28_18_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_18_11' id='label_28_18_11' class='gform-field-label gform-field-label--type-inline'>Construction Equipment<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_18_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.12' type='checkbox'  value='Custodial\/Cleaning Supplies'  id='choice_28_18_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_18_12' id='label_28_18_12' class='gform-field-label gform-field-label--type-inline'>Custodial\/Cleaning Supplies<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_18_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.13' type='checkbox'  value='Digger Derricks'  id='choice_28_18_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_18_13' id='label_28_18_13' class='gform-field-label gform-field-label--type-inline'>Digger Derricks<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_18_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.14' type='checkbox'  value='Electronics'  id='choice_28_18_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_18_14' id='label_28_18_14' class='gform-field-label gform-field-label--type-inline'>Electronics<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_18_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.15' type='checkbox'  value='Envelopes'  id='choice_28_18_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_18_15' id='label_28_18_15' class='gform-field-label gform-field-label--type-inline'>Envelopes<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_18_16'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.16' type='checkbox'  value='Fasteners'  id='choice_28_18_16'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_18_16' id='label_28_18_16' class='gform-field-label gform-field-label--type-inline'>Fasteners<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_18_17'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.17' type='checkbox'  value='Forklifts'  id='choice_28_18_17'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_18_17' id='label_28_18_17' class='gform-field-label gform-field-label--type-inline'>Forklifts<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_18_18'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.18' type='checkbox'  value='Fuel-Lubes'  id='choice_28_18_18'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_18_18' id='label_28_18_18' class='gform-field-label gform-field-label--type-inline'>Fuel-Lubes<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_18_19'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.19' type='checkbox'  value='Hardware Distribution'  id='choice_28_18_19'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_18_19' id='label_28_18_19' class='gform-field-label gform-field-label--type-inline'>Hardware Distribution<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_18_21'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.21' type='checkbox'  value='Hardware-Industrial'  id='choice_28_18_21'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_18_21' id='label_28_18_21' class='gform-field-label gform-field-label--type-inline'>Hardware-Industrial<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_18_22'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.22' type='checkbox'  value='Hardware-Transmission'  id='choice_28_18_22'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_18_22' id='label_28_18_22' class='gform-field-label gform-field-label--type-inline'>Hardware-Transmission<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_18_23'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.23' type='checkbox'  value='Hydraulic Tools'  id='choice_28_18_23'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_18_23' id='label_28_18_23' class='gform-field-label gform-field-label--type-inline'>Hydraulic Tools<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_18_24'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.24' type='checkbox'  value='Insulators'  id='choice_28_18_24'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_18_24' id='label_28_18_24' class='gform-field-label gform-field-label--type-inline'>Insulators<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_18_25'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.25' type='checkbox'  value='Meter Accessories'  id='choice_28_18_25'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_18_25' id='label_28_18_25' class='gform-field-label gform-field-label--type-inline'>Meter Accessories<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_18_26'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.26' type='checkbox'  value='Meter Reading Equipment'  id='choice_28_18_26'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_18_26' id='label_28_18_26' class='gform-field-label gform-field-label--type-inline'>Meter Reading Equipment<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_18_27'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.27' type='checkbox'  value='Meter Test Equipment'  id='choice_28_18_27'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_18_27' id='label_28_18_27' class='gform-field-label gform-field-label--type-inline'>Meter Test Equipment<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_18_28'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.28' type='checkbox'  value='Paper Products'  id='choice_28_18_28'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_18_28' id='label_28_18_28' class='gform-field-label gform-field-label--type-inline'>Paper Products<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_18_29'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.29' type='checkbox'  value='Plan Centers'  id='choice_28_18_29'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_18_29' id='label_28_18_29' class='gform-field-label gform-field-label--type-inline'>Plan Centers<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_18_31'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.31' type='checkbox'  value='Pole-Steel'  id='choice_28_18_31'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_18_31' id='label_28_18_31' class='gform-field-label gform-field-label--type-inline'>Pole-Steel<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_18_32'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.32' type='checkbox'  value='Poles-Wood'  id='choice_28_18_32'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_18_32' id='label_28_18_32' class='gform-field-label gform-field-label--type-inline'>Poles-Wood<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_18_33'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.33' type='checkbox'  value='Polyethylene Pipe'  id='choice_28_18_33'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_18_33' id='label_28_18_33' class='gform-field-label gform-field-label--type-inline'>Polyethylene Pipe<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_18_34'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.34' type='checkbox'  value='Radio Frequency Transponder'  id='choice_28_18_34'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_18_34' id='label_28_18_34' class='gform-field-label gform-field-label--type-inline'>Radio Frequency Transponder<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_18_35'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.35' type='checkbox'  value='Regulators'  id='choice_28_18_35'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_18_35' id='label_28_18_35' class='gform-field-label gform-field-label--type-inline'>Regulators<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_18_36'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.36' type='checkbox'  value='RTU\u2019s'  id='choice_28_18_36'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_18_36' id='label_28_18_36' class='gform-field-label gform-field-label--type-inline'>RTU\u2019s<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_18_37'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.37' type='checkbox'  value='Safety-Materials'  id='choice_28_18_37'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_18_37' id='label_28_18_37' class='gform-field-label gform-field-label--type-inline'>Safety-Materials<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_18_38'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.38' type='checkbox'  value='Scaffolding'  id='choice_28_18_38'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_18_38' id='label_28_18_38' class='gform-field-label gform-field-label--type-inline'>Scaffolding<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_18_39'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.39' type='checkbox'  value='Software'  id='choice_28_18_39'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_18_39' id='label_28_18_39' class='gform-field-label gform-field-label--type-inline'>Software<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_18_41'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.41' type='checkbox'  value='Steel &amp; Metals'  id='choice_28_18_41'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_18_41' id='label_28_18_41' class='gform-field-label gform-field-label--type-inline'>Steel &amp; Metals<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_18_42'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.42' type='checkbox'  value='Steel Structures'  id='choice_28_18_42'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_18_42' id='label_28_18_42' class='gform-field-label gform-field-label--type-inline'>Steel Structures<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_18_43'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.43' type='checkbox'  value='Substation Batteries'  id='choice_28_18_43'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_18_43' id='label_28_18_43' class='gform-field-label gform-field-label--type-inline'>Substation Batteries<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_18_44'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.44' type='checkbox'  value='Substation Test Equipment'  id='choice_28_18_44'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_18_44' id='label_28_18_44' class='gform-field-label gform-field-label--type-inline'>Substation Test Equipment<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_18_45'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.45' type='checkbox'  value='Surplus Computer Equipment'  id='choice_28_18_45'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_18_45' id='label_28_18_45' class='gform-field-label gform-field-label--type-inline'>Surplus Computer Equipment<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_18_46'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.46' type='checkbox'  value='Surplus Scrap'  id='choice_28_18_46'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_18_46' id='label_28_18_46' class='gform-field-label gform-field-label--type-inline'>Surplus Scrap<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_18_47'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.47' type='checkbox'  value='Switches'  id='choice_28_18_47'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_18_47' id='label_28_18_47' class='gform-field-label gform-field-label--type-inline'>Switches<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_18_48'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.48' type='checkbox'  value='Telecom Equipment'  id='choice_28_18_48'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_18_48' id='label_28_18_48' class='gform-field-label gform-field-label--type-inline'>Telecom Equipment<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_18_49'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.49' type='checkbox'  value='Tools'  id='choice_28_18_49'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_18_49' id='label_28_18_49' class='gform-field-label gform-field-label--type-inline'>Tools<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_18_51'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.51' type='checkbox'  value='Transformers-Distribution'  id='choice_28_18_51'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_18_51' id='label_28_18_51' class='gform-field-label gform-field-label--type-inline'>Transformers-Distribution<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_18_52'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.52' type='checkbox'  value='Transformers-Power'  id='choice_28_18_52'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_18_52' id='label_28_18_52' class='gform-field-label gform-field-label--type-inline'>Transformers-Power<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_18_53'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.53' type='checkbox'  value='Trucks-Boom'  id='choice_28_18_53'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_18_53' id='label_28_18_53' class='gform-field-label gform-field-label--type-inline'>Trucks-Boom<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_18_54'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.54' type='checkbox'  value='Trucks-Crane'  id='choice_28_18_54'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_18_54' id='label_28_18_54' class='gform-field-label gform-field-label--type-inline'>Trucks-Crane<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_18_55'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.55' type='checkbox'  value='Other'  id='choice_28_18_55'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_18_55' id='label_28_18_55' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_28_19\"  class=\"gfield gfield--type-text field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_28_19\"><label class='gfield_label gform-field-label' for='input_28_19' >Other<\/label><div class='ginput_container ginput_container_text'><input name='input_19' id='input_28_19' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_28_20\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_28_20\"><label class='gfield_label gform-field-label' for='input_28_20' >Applicant Electronic Signature (Full Name)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_20' id='input_28_20' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_28_23\"  class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_above gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_28_23\"><label class='gfield_label gform-field-label' for='input_28_23' >Phone<\/label><div class='gfield_description' id='gfield_description_28_23'>This field is for validation purposes and should be left unchanged.<\/div><div class='ginput_container'><input name='input_23' 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