{"id":4272,"date":"2017-12-06T12:35:48","date_gmt":"2017-12-05T23:35:48","guid":{"rendered":"https:\/\/www.nzautoglass.co.nz\/nzag\/?page_id=4272"},"modified":"2022-08-15T14:34:15","modified_gmt":"2022-08-15T02:34:15","slug":"job-request","status":"publish","type":"page","link":"https:\/\/www.nzautoglass.co.nz\/nzag\/job-request\/","title":{"rendered":"Job Request"},"content":{"rendered":"<div class=\"alert alert-warning\"><i class=\"fa fa-info-circle\" style=\"\"><\/i> This form is intended for use by <b>NEW ZEALAND AUTO GLASS account holders only.<\/b> [*] Denotes a required field.<\/div><!-- .alert (end) -->\n<div id=\"quform-649945\" class=\"quform quform-2 quform-theme-hollow quform-prevent-fouc quform-support-page-caching\"><form id=\"quform-form-649945\" class=\"quform-form quform-form-2\" action=\"\/nzag\/wp-json\/wp\/v2\/pages\/4272#quform-649945\" method=\"post\" enctype=\"multipart\/form-data\" novalidate=\"novalidate\" data-options=\"{&quot;id&quot;:2,&quot;uniqueId&quot;:&quot;649945&quot;,&quot;theme&quot;:&quot;hollow&quot;,&quot;ajax&quot;:true,&quot;logic&quot;:{&quot;logic&quot;:{&quot;84&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;83&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;1&quot;,&quot;value&quot;:&quot;Yes&quot;}]},&quot;78&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;14&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;15&quot;,&quot;value&quot;:&quot;Other&quot;}]},&quot;68&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;24&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;61&quot;,&quot;value&quot;:&quot;Other&quot;}]},&quot;69&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;30&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;26&quot;,&quot;value&quot;:&quot;Other&quot;}]},&quot;71&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;39&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;18&quot;,&quot;value&quot;:&quot;Other&quot;}]},&quot;70&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;35&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;5&quot;,&quot;value&quot;:&quot;Other&quot;}]},&quot;52&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;any&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;35&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;1&quot;,&quot;value&quot;:&quot;Front Windscreen Repair&quot;},{&quot;elementId&quot;:&quot;35&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;2&quot;,&quot;value&quot;:&quot;Front Windscreen Replacement&quot;}]},&quot;55&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;any&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;35&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;3&quot;,&quot;value&quot;:&quot;Rear Windscreen Replacement&quot;}]},&quot;59&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;any&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;35&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;6&quot;,&quot;value&quot;:&quot;Side \\\/ Door Glass Replacement&quot;}]}},&quot;dependents&quot;:{&quot;83&quot;:[84],&quot;14&quot;:[78],&quot;24&quot;:[68],&quot;30&quot;:[69],&quot;39&quot;:[71],&quot;35&quot;:[70,52,52,55,59]},&quot;elementIds&quot;:[84,78,68,69,71,70,52,55,59],&quot;dependentElementIds&quot;:[&quot;83&quot;,&quot;14&quot;,&quot;24&quot;,&quot;30&quot;,&quot;39&quot;,&quot;35&quot;],&quot;animate&quot;:true},&quot;currentPageId&quot;:1,&quot;errorsIcon&quot;:&quot;fa fa-exclamation-triangle&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 qtip-rounded&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-2\"><input type=\"hidden\" name=\"quform_form_id\" value=\"2\" \/><input type=\"hidden\" name=\"quform_form_uid\" value=\"649945\" \/><input type=\"hidden\" name=\"quform_count\" value=\"1\" \/><input type=\"hidden\" name=\"form_url\" value=\"https:\/\/www.nzautoglass.co.nz\/nzag\/wp-json\/wp\/v2\/pages\/4272\" \/><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_loaded\" value=\"1776601336|26991a0f3dee90ca4d4908976a12bb8f\" \/><input type=\"hidden\" name=\"quform_csrf_token\" value=\"RSdyYWwWtGG6D4FMqZwzRErxO4FYRsPmGvQhy3hu\" \/><div class=\"quform-elements quform-elements-2 quform-cf quform-responsive-elements-phone-landscape\"><div class=\"quform-element quform-element-page quform-page-1 quform-page-2_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-2_16 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><h3 class=\"quform-group-title\">\/\/ JOB DETAILS<\/h3><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-2_85 quform-1-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-2_86\"><div class=\"quform-element quform-element-radio quform-element-2_87 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-2_87\"><label class=\"quform-label-text\" id=\"quform_2_87_649945_label\">Are you an insurance broker or insurance company?<\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-2_87\"><div class=\"quform-input quform-input-radio quform-input-2_87 quform-cf\"><div class=\"quform-options quform-cf quform-options-inline quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_2_87_649945_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_2_87\" id=\"quform_2_87_649945_1\" class=\"quform-field quform-field-radio quform-field-2_87 quform-field-2_87_1\" value=\"\/\/www.nzautoglass.co.nz\/nzag\/job-request-insurance\/\" \/><label for=\"quform_2_87_649945_1\" class=\"quform-option-label quform-option-label-2_87_1\"><span class=\"quform-option-text\">Yes<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_2_87\" id=\"quform_2_87_649945_2\" class=\"quform-field quform-field-radio quform-field-2_87 quform-field-2_87_2\" value=\"No\" checked \/><label for=\"quform_2_87_649945_2\" class=\"quform-option-label quform-option-label-2_87_2\"><span class=\"quform-option-text\">No<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-2_80 quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-2_81\"><div class=\"quform-element quform-element-radio quform-element-2_83 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-2_83\"><label class=\"quform-label-text\" id=\"quform_2_83_649945_label\">Do you require a price before we proceed with the job?<\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-2_83\"><div class=\"quform-input quform-input-radio quform-input-2_83 quform-cf\"><div class=\"quform-options quform-cf quform-options-inline quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_2_83_649945_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_2_83\" id=\"quform_2_83_649945_1\" class=\"quform-field quform-field-radio quform-field-2_83 quform-field-2_83_1\" value=\"Yes\" \/><label for=\"quform_2_83_649945_1\" class=\"quform-option-label quform-option-label-2_83_1\"><span class=\"quform-option-text\">Yes<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_2_83\" id=\"quform_2_83_649945_2\" class=\"quform-field quform-field-radio quform-field-2_83 quform-field-2_83_2\" value=\"No\" checked \/><label for=\"quform_2_83_649945_2\" class=\"quform-option-label quform-option-label-2_83_2\"><span class=\"quform-option-text\">No<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-2_82\"><div class=\"quform-element quform-element-email quform-element-2_84 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-2_84\"><label class=\"quform-label-text\" for=\"quform_2_84_649945\">Contact Email Address<span class=\"quform-required\">[*]<\/span><\/label><\/div><div class=\"quform-inner quform-inner-email quform-inner-2_84\"><div class=\"quform-input quform-input-email quform-input-2_84 quform-cf\"><input type=\"email\" id=\"quform_2_84_649945\" name=\"quform_2_84\" class=\"quform-field quform-field-email quform-field-2_84\" maxlength=\"50\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-2_3 quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-2_4\"><div class=\"quform-element quform-element-text quform-element-2_6 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-2_6\"><label class=\"quform-label-text\" for=\"quform_2_6_649945\">Order #<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-2_6\"><div class=\"quform-input quform-input-text quform-input-2_6 quform-cf\"><input type=\"text\" id=\"quform_2_6_649945\" name=\"quform_2_6\" class=\"quform-field quform-field-text quform-field-2_6\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-2_5\"><div class=\"quform-element quform-element-select quform-element-2_13 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-2_13\"><label class=\"quform-label-text\" for=\"quform_2_13_649945\">Job Priority<span class=\"quform-required\">[*]<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-2_13\"><div class=\"quform-input quform-input-select quform-input-2_13 quform-cf\"><select id=\"quform_2_13_649945\" name=\"quform_2_13\" class=\"quform-field quform-field-select quform-field-2_13 quform-field-select-enhanced\" data-options=\"{&quot;rtl&quot;:false,&quot;search&quot;:true,&quot;noResultsFound&quot;:&quot;No results found.&quot;}\" style=\"width: 100%;\"><option value=\"\" selected=\"selected\">Please select<\/option><option value=\"At earliest convenience\">At earliest convenience<\/option><option value=\"ASAP (genuinely urgent request)\">ASAP (genuinely urgent request)<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-2_17 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><h3 class=\"quform-group-title\">\/\/ COMPANY DETAILS<\/h3><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-2_8 quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-2_9\"><div class=\"quform-element quform-element-text quform-element-2_11 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-2_11\"><label class=\"quform-label-text\" for=\"quform_2_11_649945\">Company Name<span class=\"quform-required\">[*]<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-2_11\"><div class=\"quform-input quform-input-text quform-input-2_11 quform-cf\"><input type=\"text\" id=\"quform_2_11_649945\" name=\"quform_2_11\" class=\"quform-field quform-field-text quform-field-2_11\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-2_10\"><div class=\"quform-element quform-element-select quform-element-2_14 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-2_14\"><label class=\"quform-label-text\" for=\"quform_2_14_649945\">Branch<span class=\"quform-required\">[*]<\/span><\/label><div class=\"quform-tooltip-icon quform-tooltip-icon-hover\"><i class=\"qicon-question-circle\"><\/i><div class=\"quform-tooltip-icon-content\">Select 'Other' if your Branch is not listed<\/div><\/div><\/div><div class=\"quform-inner quform-inner-select quform-inner-2_14\"><div class=\"quform-input quform-input-select quform-input-2_14 quform-cf\"><select id=\"quform_2_14_649945\" name=\"quform_2_14\" class=\"quform-field quform-field-select quform-field-2_14 quform-field-select-enhanced\" data-options=\"{&quot;rtl&quot;:false,&quot;search&quot;:true,&quot;noResultsFound&quot;:&quot;No results found.&quot;}\" style=\"width: 100%;\"><option value=\"\" selected=\"selected\">Please select<\/option><option value=\"Auckland\">Auckland<\/option><option value=\"Alexandra\">Alexandra<\/option><option value=\"Christchurch\">Christchurch<\/option><option value=\"Dunedin\">Dunedin<\/option><option value=\"Hamilton\">Hamilton<\/option><option value=\"Invercargill\">Invercargill<\/option><option value=\"New Plymouth\">New Plymouth<\/option><option value=\"Pukekohe\">Pukekohe<\/option><option value=\"Queenstown\">Queenstown<\/option><option value=\"Tauranga\">Tauranga<\/option><option value=\"Thames\">Thames<\/option><option value=\"Wanaka\">Wanaka<\/option><option value=\"Wellington\">Wellington<\/option><optgroup label=\"\"><option value=\"Other\">Other<\/option><\/optgroup><\/select><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-2_78 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-2_78\"><label class=\"quform-label-text\" for=\"quform_2_78_649945\">Branch (Other)<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-2_78\"><div class=\"quform-input quform-input-text quform-input-2_78 quform-cf\"><input type=\"text\" id=\"quform_2_78_649945\" name=\"quform_2_78\" class=\"quform-field quform-field-text quform-field-2_78\" placeholder=\"e.g. Whangarei\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-2_46 quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-2_47\"><div class=\"quform-element quform-element-text quform-element-2_49 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-2_49\"><label class=\"quform-label-text\" for=\"quform_2_49_649945\">Contact Name<span class=\"quform-required\">[*]<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-2_49\"><div class=\"quform-input quform-input-text quform-input-2_49 quform-cf\"><input type=\"text\" id=\"quform_2_49_649945\" name=\"quform_2_49\" class=\"quform-field quform-field-text quform-field-2_49\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-2_48\"><div class=\"quform-element quform-element-text quform-element-2_50 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-2_50\"><label class=\"quform-label-text\" for=\"quform_2_50_649945\">Contact Mobile or Landline Number<span class=\"quform-required\">[*]<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-2_50\"><div class=\"quform-input quform-input-text quform-input-2_50 quform-cf\"><input type=\"text\" id=\"quform_2_50_649945\" name=\"quform_2_50\" class=\"quform-field quform-field-text quform-field-2_50\" \/><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-2_20 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><h3 class=\"quform-group-title\">\/\/ VEHICLE DETAILS<\/h3><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-2_21 quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-2_22\"><div class=\"quform-element quform-element-select quform-element-2_24 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-2_24\"><label class=\"quform-label-text\" for=\"quform_2_24_649945\">Make<span class=\"quform-required\">[*]<\/span><\/label><div class=\"quform-tooltip-icon quform-tooltip-icon-hover\"><i class=\"qicon-question-circle\"><\/i><div class=\"quform-tooltip-icon-content\">Select 'Other' if your Make is not listed<\/div><\/div><\/div><div class=\"quform-inner quform-inner-select quform-inner-2_24\"><div class=\"quform-input quform-input-select quform-input-2_24 quform-cf\"><select id=\"quform_2_24_649945\" name=\"quform_2_24\" class=\"quform-field quform-field-select quform-field-2_24 quform-field-select-enhanced\" data-options=\"{&quot;rtl&quot;:false,&quot;search&quot;:true,&quot;noResultsFound&quot;:&quot;No results found.&quot;}\" style=\"width: 100%;\"><option value=\"\" selected=\"selected\">Please select<\/option><option value=\"Alfa Romeo\">Alfa Romeo<\/option><option value=\"Audi\">Audi<\/option><option value=\"Austin\">Austin<\/option><option value=\"Bentley\">Bentley<\/option><option value=\"BMW\">BMW<\/option><option value=\"Chevrolet\">Chevrolet<\/option><option value=\"Chrysler\">Chrysler<\/option><option value=\"Citroen\">Citroen<\/option><option value=\"Daewoo\">Daewoo<\/option><option value=\"DAF\">DAF<\/option><option value=\"Daihatsu\">Daihatsu<\/option><option value=\"Daimler\">Daimler<\/option><option value=\"Fiat\">Fiat<\/option><option value=\"Ford\">Ford<\/option><option value=\"Freightliner\">Freightliner<\/option><option value=\"Fuso\">Fuso<\/option><option value=\"Great Wall\">Great Wall<\/option><option value=\"Hino\">Hino<\/option><option value=\"Holden\">Holden<\/option><option value=\"Honda\">Honda<\/option><option value=\"Hyundai\">Hyundai<\/option><option value=\"Isuzu\">Isuzu<\/option><option value=\"Iveco\">Iveco<\/option><option value=\"Jaguar\">Jaguar<\/option><option value=\"Jeep \">Jeep <\/option><option value=\"Kenworth\">Kenworth<\/option><option value=\"Kia\">Kia<\/option><option value=\"Lada\">Lada<\/option><option value=\"Landrover\">Landrover<\/option><option value=\"Lexus\">Lexus<\/option><option value=\"Mack\">Mack<\/option><option value=\"MAN\">MAN<\/option><option value=\"Mazda\">Mazda<\/option><option value=\"Mercedes-Benz\">Mercedes-Benz<\/option><option value=\"MG\">MG<\/option><option value=\"Mitsubishi\">Mitsubishi<\/option><option value=\"Morris\">Morris<\/option><option value=\"Nissan\">Nissan<\/option><option value=\"Opel\">Opel<\/option><option value=\"Peugeot\">Peugeot<\/option><option value=\"Pontiac\">Pontiac<\/option><option value=\"Porsche\">Porsche<\/option><option value=\"Proton\">Proton<\/option><option value=\"Renault\">Renault<\/option><option value=\"Rolls-Royce\">Rolls-Royce<\/option><option value=\"Rover\">Rover<\/option><option value=\"Saab\">Saab<\/option><option value=\"Scania\">Scania<\/option><option value=\"Seat\">Seat<\/option><option value=\"Skoda\">Skoda<\/option><option value=\"SsangYong\">SsangYong<\/option><option value=\"Subaru\">Subaru<\/option><option value=\"Suzuki\">Suzuki<\/option><option value=\"Toyota\">Toyota<\/option><option value=\"Triumph\">Triumph<\/option><option value=\"UD\">UD<\/option><option value=\"Volkswagen\">Volkswagen<\/option><option value=\"Volvo\">Volvo<\/option><option value=\"Western Star\">Western Star<\/option><optgroup label=\"\"><option value=\"Other\">Other<\/option><\/optgroup><\/select><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-2_68 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-2_68\"><label class=\"quform-label-text\" for=\"quform_2_68_649945\">Make (Other)<span class=\"quform-required\">[*]<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-2_68\"><div class=\"quform-input quform-input-text quform-input-2_68 quform-cf\"><input type=\"text\" id=\"quform_2_68_649945\" name=\"quform_2_68\" class=\"quform-field quform-field-text quform-field-2_68\" placeholder=\"e.g. Lamborghini\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-2_23\"><div class=\"quform-element quform-element-text quform-element-2_25 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-2_25\"><label class=\"quform-label-text\" for=\"quform_2_25_649945\">Model<span class=\"quform-required\">[*]<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-2_25\"><div class=\"quform-input quform-input-text quform-input-2_25 quform-cf\"><input type=\"text\" id=\"quform_2_25_649945\" name=\"quform_2_25\" class=\"quform-field quform-field-text quform-field-2_25\" placeholder=\"e.g. VF Commodore\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-2_27 quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-2_28\"><div class=\"quform-element quform-element-select quform-element-2_30 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-2_30\"><label class=\"quform-label-text\" for=\"quform_2_30_649945\">Year<span class=\"quform-required\">[*]<\/span><\/label><div class=\"quform-tooltip-icon quform-tooltip-icon-hover\"><i class=\"qicon-question-circle\"><\/i><div class=\"quform-tooltip-icon-content\">Select 'Other' if your Year is not listed<\/div><\/div><\/div><div class=\"quform-inner quform-inner-select quform-inner-2_30\"><div class=\"quform-input quform-input-select quform-input-2_30 quform-cf\"><select id=\"quform_2_30_649945\" name=\"quform_2_30\" class=\"quform-field quform-field-select quform-field-2_30 quform-field-select-enhanced\" data-options=\"{&quot;rtl&quot;:false,&quot;search&quot;:true,&quot;noResultsFound&quot;:&quot;No results found.&quot;}\" style=\"width: 100%;\"><option value=\"\" selected=\"selected\">Please select<\/option><option value=\"2026\">2026<\/option><option value=\"2025\">2025<\/option><option value=\"2024\">2024<\/option><option value=\"2023\">2023<\/option><option value=\"2022\">2022<\/option><option value=\"2021\">2021<\/option><option value=\"2020\">2020<\/option><option value=\"2019\">2019<\/option><option value=\"2018\">2018<\/option><option value=\"2017\">2017<\/option><option value=\"2016\">2016<\/option><option value=\"2015\">2015<\/option><option value=\"2014\">2014<\/option><option value=\"2013\">2013<\/option><option value=\"2012\">2012<\/option><option value=\"2011\">2011<\/option><option value=\"2010\">2010<\/option><option value=\"2009\">2009<\/option><option value=\"2008\">2008<\/option><option value=\"2007\">2007<\/option><option value=\"2006\">2006<\/option><option value=\"2005\">2005<\/option><option value=\"2004\">2004<\/option><option value=\"2003\">2003<\/option><option value=\"2002\">2002<\/option><option value=\"2001\">2001<\/option><option value=\"2000\">2000<\/option><option value=\"1999\">1999<\/option><option value=\"1998\">1998<\/option><option value=\"1997\">1997<\/option><option value=\"1996\">1996<\/option><option value=\"1995\">1995<\/option><option value=\"1994\">1994<\/option><option value=\"1993\">1993<\/option><option value=\"1992\">1992<\/option><option value=\"1991\">1991<\/option><option value=\"1990\">1990<\/option><optgroup label=\"\"><option value=\"Other\">Other<\/option><\/optgroup><\/select><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-2_69 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-2_69\"><label class=\"quform-label-text\" for=\"quform_2_69_649945\">Year (Other)<span class=\"quform-required\">[*]<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-2_69\"><div class=\"quform-input quform-input-text quform-input-2_69 quform-cf\"><input type=\"text\" id=\"quform_2_69_649945\" name=\"quform_2_69\" class=\"quform-field quform-field-text quform-field-2_69\" placeholder=\"e.g. 1974\" maxlength=\"4\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-2_29\"><div class=\"quform-element quform-element-select quform-element-2_31 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-2_31\"><label class=\"quform-label-text\" for=\"quform_2_31_649945\">Door Type<span class=\"quform-required\">[*]<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-2_31\"><div class=\"quform-input quform-input-select quform-input-2_31 quform-cf\"><select id=\"quform_2_31_649945\" name=\"quform_2_31\" class=\"quform-field quform-field-select quform-field-2_31 quform-field-select-enhanced\" data-options=\"{&quot;rtl&quot;:false,&quot;search&quot;:true,&quot;noResultsFound&quot;:&quot;No results found.&quot;}\" style=\"width: 100%;\"><option value=\"\" selected=\"selected\">Please select<\/option><option value=\"2-Door\">2-Door<\/option><option value=\"3-Door\">3-Door<\/option><option value=\"4-Door\">4-Door<\/option><option value=\"5-Door\">5-Door<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-2_36 quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-2_37\"><div class=\"quform-element quform-element-select quform-element-2_39 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-2_39\"><label class=\"quform-label-text\" for=\"quform_2_39_649945\">Body Style<span class=\"quform-required\">[*]<\/span><\/label><div class=\"quform-tooltip-icon quform-tooltip-icon-hover\"><i class=\"qicon-question-circle\"><\/i><div class=\"quform-tooltip-icon-content\">Select 'Other' if your Body Style is not listed<\/div><\/div><\/div><div class=\"quform-inner quform-inner-select quform-inner-2_39\"><div class=\"quform-input quform-input-select quform-input-2_39 quform-cf\"><select id=\"quform_2_39_649945\" name=\"quform_2_39\" class=\"quform-field quform-field-select quform-field-2_39 quform-field-select-enhanced\" data-options=\"{&quot;rtl&quot;:false,&quot;search&quot;:true,&quot;noResultsFound&quot;:&quot;No results found.&quot;}\" style=\"width: 100%;\"><option value=\"\" selected=\"selected\">Please select<\/option><option value=\"4x4\">4x4<\/option><option value=\"Convertible\">Convertible<\/option><option value=\"Coup\u00e9\">Coup\u00e9<\/option><option value=\"Hatchback\">Hatchback<\/option><option value=\"Liftback\">Liftback<\/option><option value=\"People-mover \/ MPV\">People-mover \/ MPV<\/option><option value=\"Sedan \/ Saloon\">Sedan \/ Saloon<\/option><option value=\"SUV\">SUV<\/option><option value=\"Truck\">Truck<\/option><option value=\"Utility \/ Ute\">Utility \/ Ute<\/option><option value=\"Van \/ Minivan\">Van \/ Minivan<\/option><option value=\"Wagon \/ Station Wagon\">Wagon \/ Station Wagon<\/option><optgroup label=\"\"><option value=\"Other\">Other<\/option><\/optgroup><\/select><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-2_71 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-2_71\"><label class=\"quform-label-text\" for=\"quform_2_71_649945\">Body Style (Other)<span class=\"quform-required\">[*]<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-2_71\"><div class=\"quform-input quform-input-text quform-input-2_71 quform-cf\"><input type=\"text\" id=\"quform_2_71_649945\" name=\"quform_2_71\" class=\"quform-field quform-field-text quform-field-2_71\" placeholder=\"e.g. Bus\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-2_38\"><div class=\"quform-element quform-element-text quform-element-2_40 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-2_40\"><label class=\"quform-label-text\" for=\"quform_2_40_649945\">Number Plate<span class=\"quform-required\">[*]<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-2_40\"><div class=\"quform-input quform-input-text quform-input-2_40 quform-cf\"><input type=\"text\" id=\"quform_2_40_649945\" name=\"quform_2_40\" class=\"quform-field quform-field-text quform-field-2_40\" maxlength=\"6\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-2_32 quform-1-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-2_33\"><div class=\"quform-element quform-element-select quform-element-2_35 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-2_35\"><label class=\"quform-label-text\" for=\"quform_2_35_649945\">Work Required<span class=\"quform-required\">[*]<\/span><\/label><div class=\"quform-tooltip-icon quform-tooltip-icon-hover\"><i class=\"qicon-question-circle\"><\/i><div class=\"quform-tooltip-icon-content\">Select 'Other' if your Work Required is not listed<\/div><\/div><\/div><div class=\"quform-inner quform-inner-select quform-inner-2_35\"><div class=\"quform-input quform-input-select quform-input-2_35 quform-cf\"><select id=\"quform_2_35_649945\" name=\"quform_2_35\" class=\"quform-field quform-field-select quform-field-2_35 quform-field-select-enhanced\" data-options=\"{&quot;rtl&quot;:false,&quot;search&quot;:true,&quot;noResultsFound&quot;:&quot;No results found.&quot;}\" style=\"width: 100%;\"><option value=\"\" selected=\"selected\">Please select<\/option><option value=\"Front Windscreen Repair\">Front Windscreen Repair<\/option><option value=\"Front Windscreen Replacement\">Front Windscreen Replacement<\/option><option value=\"Rear Windscreen Replacement\">Rear Windscreen Replacement<\/option><option value=\"Side \/ Door Glass Replacement\">Side \/ Door Glass Replacement<\/option><optgroup label=\"\"><option value=\"Other\">Other<\/option><\/optgroup><\/select><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-textarea quform-element-2_70 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-2_70\"><label class=\"quform-label-text\" for=\"quform_2_70_649945\">Work Required (Other)<span class=\"quform-required\">[*]<\/span><\/label><\/div><div class=\"quform-inner quform-inner-textarea quform-inner-2_70\"><div class=\"quform-input quform-input-textarea quform-input-2_70 quform-cf\"><textarea id=\"quform_2_70_649945\" name=\"quform_2_70\" class=\"quform-field quform-field-textarea quform-field-2_70\" placeholder=\"e.g. Wing Mirror Glass\" maxlength=\"1000\"><\/textarea><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-2_52 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><h3 class=\"quform-group-title\">\/\/ FRONT WINDSCREEN FEATURE(S)<\/h3><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-checkbox quform-element-2_53 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-inner quform-inner-checkbox quform-inner-2_53\"><div class=\"quform-input quform-input-checkbox quform-input-2_53 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_53[]\" id=\"quform_2_53_649945_1\" class=\"quform-field quform-field-checkbox quform-field-2_53 quform-field-2_53_1\" value=\"Rain sensor\" \/><label for=\"quform_2_53_649945_1\" class=\"quform-option-label quform-option-label-2_53_1\"><span class=\"quform-option-text\">Rain sensor<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_53[]\" id=\"quform_2_53_649945_2\" class=\"quform-field quform-field-checkbox quform-field-2_53 quform-field-2_53_2\" value=\"Camera (Lane change warning system)\" \/><label for=\"quform_2_53_649945_2\" class=\"quform-option-label quform-option-label-2_53_2\"><span class=\"quform-option-text\">Camera (Lane change warning system)<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_53[]\" id=\"quform_2_53_649945_3\" class=\"quform-field quform-field-checkbox quform-field-2_53 quform-field-2_53_3\" value=\"Heated wiper system\" \/><label for=\"quform_2_53_649945_3\" class=\"quform-option-label quform-option-label-2_53_3\"><span class=\"quform-option-text\">Heated wiper system<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_53[]\" id=\"quform_2_53_649945_4\" class=\"quform-field quform-field-checkbox quform-field-2_53 quform-field-2_53_4\" value=\"Windscreen antenna (Radio and\/or GPS)\" \/><label for=\"quform_2_53_649945_4\" class=\"quform-option-label quform-option-label-2_53_4\"><span class=\"quform-option-text\">Windscreen antenna (Radio and\/or GPS)<\/span><\/label><\/div><\/div><\/div><p class=\"quform-description quform-description-below\">Check all that apply above<\/p><\/div><\/div><\/div><div class=\"quform-element quform-element-checkbox quform-element-2_54 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-inner quform-inner-checkbox quform-inner-2_54\"><div class=\"quform-input quform-input-checkbox quform-input-2_54 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_54[]\" id=\"quform_2_54_649945_1\" class=\"quform-field quform-field-checkbox quform-field-2_54 quform-field-2_54_1\" value=\"I have ensured that the information I have supplied in the front windscreen features section is accurate\" \/><label for=\"quform_2_54_649945_1\" class=\"quform-option-label quform-option-label-2_54_1\"><span class=\"quform-option-text\">I have ensured that the information I have supplied in the front windscreen features section is accurate<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-2_55 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><h3 class=\"quform-group-title\">\/\/ REAR WINDSCREEN FEATURE(S)<\/h3><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-checkbox quform-element-2_56 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-inner quform-inner-checkbox quform-inner-2_56\"><div class=\"quform-input quform-input-checkbox quform-input-2_56 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_56[]\" id=\"quform_2_56_649945_1\" class=\"quform-field quform-field-checkbox quform-field-2_56 quform-field-2_56_1\" value=\"Privacy tinted\" \/><label for=\"quform_2_56_649945_1\" class=\"quform-option-label quform-option-label-2_56_1\"><span class=\"quform-option-text\">Privacy tinted<\/span><\/label><\/div><\/div><\/div><p class=\"quform-description quform-description-below\">Check all that apply above<\/p><\/div><\/div><\/div><div class=\"quform-element quform-element-checkbox quform-element-2_58 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-inner quform-inner-checkbox quform-inner-2_58\"><div class=\"quform-input quform-input-checkbox quform-input-2_58 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_58[]\" id=\"quform_2_58_649945_1\" class=\"quform-field quform-field-checkbox quform-field-2_58 quform-field-2_58_1\" value=\"I have ensured that the information I have supplied in the rear windscreen features section is accurate\" \/><label for=\"quform_2_58_649945_1\" class=\"quform-option-label quform-option-label-2_58_1\"><span class=\"quform-option-text\">I have ensured that the information I have supplied in the rear windscreen features section is accurate<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-2_59 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><h3 class=\"quform-group-title\">\/\/ SIDE \/ DOOR GLASS PART(S)<\/h3><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-checkbox quform-element-2_60 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-inner quform-inner-checkbox quform-inner-2_60\"><div class=\"quform-input quform-input-checkbox quform-input-2_60 quform-cf\"><div class=\"quform-options quform-cf quform-options-columns quform-2-columns quform-responsive-columns-phone-portrait quform-options-style-input-hidden\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_60[]\" id=\"quform_2_60_649945_1\" class=\"quform-field quform-field-checkbox quform-field-2_60 quform-field-2_60_1\" value=\"Driver&#039;s Side \u00bc Glass in Front\" \/><label for=\"quform_2_60_649945_1\" class=\"quform-option-label quform-option-label-2_60_1\"><span class=\"quform-option-icon\"><i class=\"fa fa-circle-o\"><\/i><\/span><span class=\"quform-option-icon-selected\"><i class=\"fa fa-check-circle-o\"><\/i><\/span><span class=\"quform-option-text\">Driver's Side \u00bc Glass in Front<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_60[]\" id=\"quform_2_60_649945_17\" class=\"quform-field quform-field-checkbox quform-field-2_60 quform-field-2_60_17\" value=\"Passenger&#039;s Side \u00bc Glass in Front\" \/><label for=\"quform_2_60_649945_17\" class=\"quform-option-label quform-option-label-2_60_17\"><span class=\"quform-option-icon\"><i class=\"fa fa-circle-o\"><\/i><\/span><span class=\"quform-option-icon-selected\"><i class=\"fa fa-check-circle-o\"><\/i><\/span><span class=\"quform-option-text\">Passenger's Side \u00bc Glass in Front<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_60[]\" id=\"quform_2_60_649945_16\" class=\"quform-field quform-field-checkbox quform-field-2_60 quform-field-2_60_16\" value=\"Driver&#039;s Side Front Door Glass\" \/><label for=\"quform_2_60_649945_16\" class=\"quform-option-label quform-option-label-2_60_16\"><span class=\"quform-option-icon\"><i class=\"fa fa-circle-o\"><\/i><\/span><span class=\"quform-option-icon-selected\"><i class=\"fa fa-check-circle-o\"><\/i><\/span><span class=\"quform-option-text\">Driver's Side Front Door Glass<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_60[]\" id=\"quform_2_60_649945_12\" class=\"quform-field quform-field-checkbox quform-field-2_60 quform-field-2_60_12\" value=\"Passenger&#039;s Side Front Door Glass\" \/><label for=\"quform_2_60_649945_12\" class=\"quform-option-label quform-option-label-2_60_12\"><span class=\"quform-option-icon\"><i class=\"fa fa-circle-o\"><\/i><\/span><span class=\"quform-option-icon-selected\"><i class=\"fa fa-check-circle-o\"><\/i><\/span><span class=\"quform-option-text\">Passenger's Side Front Door Glass<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_60[]\" id=\"quform_2_60_649945_5\" class=\"quform-field quform-field-checkbox quform-field-2_60 quform-field-2_60_5\" value=\"Driver&#039;s Side Rear Door Glass\" \/><label for=\"quform_2_60_649945_5\" class=\"quform-option-label quform-option-label-2_60_5\"><span class=\"quform-option-icon\"><i class=\"fa fa-circle-o\"><\/i><\/span><span class=\"quform-option-icon-selected\"><i class=\"fa fa-check-circle-o\"><\/i><\/span><span class=\"quform-option-text\">Driver's Side Rear Door Glass<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_60[]\" id=\"quform_2_60_649945_13\" class=\"quform-field quform-field-checkbox quform-field-2_60 quform-field-2_60_13\" value=\"Passenger&#039;s Side Rear Door Glass\" \/><label for=\"quform_2_60_649945_13\" class=\"quform-option-label quform-option-label-2_60_13\"><span class=\"quform-option-icon\"><i class=\"fa fa-circle-o\"><\/i><\/span><span class=\"quform-option-icon-selected\"><i class=\"fa fa-check-circle-o\"><\/i><\/span><span class=\"quform-option-text\">Passenger's Side Rear Door Glass<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_60[]\" id=\"quform_2_60_649945_6\" class=\"quform-field quform-field-checkbox quform-field-2_60 quform-field-2_60_6\" value=\"Driver&#039;s Side \u00bc Glass in Rear Door\" \/><label for=\"quform_2_60_649945_6\" class=\"quform-option-label quform-option-label-2_60_6\"><span class=\"quform-option-icon\"><i class=\"fa fa-circle-o\"><\/i><\/span><span class=\"quform-option-icon-selected\"><i class=\"fa fa-check-circle-o\"><\/i><\/span><span class=\"quform-option-text\">Driver's Side \u00bc Glass in Rear Door<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_60[]\" id=\"quform_2_60_649945_14\" class=\"quform-field quform-field-checkbox quform-field-2_60 quform-field-2_60_14\" value=\"Passenger&#039;s Side \u00bc Glass in Rear Door\" \/><label for=\"quform_2_60_649945_14\" class=\"quform-option-label quform-option-label-2_60_14\"><span class=\"quform-option-icon\"><i class=\"fa fa-circle-o\"><\/i><\/span><span class=\"quform-option-icon-selected\"><i class=\"fa fa-check-circle-o\"><\/i><\/span><span class=\"quform-option-text\">Passenger's Side \u00bc Glass in Rear Door<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_60[]\" id=\"quform_2_60_649945_7\" class=\"quform-field quform-field-checkbox quform-field-2_60 quform-field-2_60_7\" value=\"Driver&#039;s Side \u00bc Glass in Body\" \/><label for=\"quform_2_60_649945_7\" class=\"quform-option-label quform-option-label-2_60_7\"><span class=\"quform-option-icon\"><i class=\"fa fa-circle-o\"><\/i><\/span><span class=\"quform-option-icon-selected\"><i class=\"fa fa-check-circle-o\"><\/i><\/span><span class=\"quform-option-text\">Driver's Side \u00bc Glass in Body<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_2_60[]\" id=\"quform_2_60_649945_15\" class=\"quform-field quform-field-checkbox quform-field-2_60 quform-field-2_60_15\" value=\"Passenger&#039;s Side \u00bc Glass in Body\" \/><label for=\"quform_2_60_649945_15\" class=\"quform-option-label quform-option-label-2_60_15\"><span class=\"quform-option-icon\"><i class=\"fa fa-circle-o\"><\/i><\/span><span class=\"quform-option-icon-selected\"><i class=\"fa fa-check-circle-o\"><\/i><\/span><span class=\"quform-option-text\">Passenger's Side \u00bc Glass in Body<\/span><\/label><\/div><\/div><\/div><p class=\"quform-description quform-description-below\">Check all that apply above<\/p><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-textarea quform-element-2_851706 quform-sr-only quform-cf\" style=\"clip: rect(1px, 1px, 1px, 1px); clip-path: inset(50%); position: absolute !important; height: 1px; width: 1px; overflow: hidden;\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-2_851706\"><label class=\"quform-label-text\" for=\"quform_2_851706_649945\">Website URL<span class=\"quform-required\">[*]<\/span><\/label><\/div><div class=\"quform-inner quform-inner-2_851706\"><textarea id=\"quform_2_851706_649945\" name=\"quform_2_851706\" class=\"quform-field quform-field-textarea quform-field-2_851706\" tabindex=\"-1\" autocomplete=\"new-password\"><\/textarea><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-2_18 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><h3 class=\"quform-group-title\">\/\/ IMAGE UPLOAD<\/h3><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-file quform-element-2_19 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-2_19\"><label class=\"quform-label-text\" for=\"quform_2_19_649945\">Upload an image of the damage<\/label><\/div><div class=\"quform-inner quform-inner-file quform-inner-2_19\"><div class=\"quform-input quform-input-file quform-input-2_19 quform-cf quform-button-style-theme\"><input type=\"file\" id=\"quform_2_19_649945\" name=\"quform_2_19[]\" class=\"quform-field quform-field-file quform-field-2_19 quform-field-file-enhanced\" data-config=\"{&quot;id&quot;:19,&quot;identifier&quot;:&quot;2_19&quot;,&quot;name&quot;:&quot;quform_2_19&quot;,&quot;max&quot;:1,&quot;size&quot;:10485760,&quot;allowedExtensions&quot;:[&quot;jpg&quot;,&quot;jpeg&quot;,&quot;png&quot;,&quot;gif&quot;,&quot;heic&quot;],&quot;notAllowedTypeWithFilename&quot;:&quot;File type of &#039;%filename%&#039; is not allowed&quot;,&quot;tooBigWithFilename&quot;:&quot;File &#039;%filename%&#039; exceeds the maximum allowed file size&quot;,&quot;tooMany&quot;:&quot;You cannot upload more than %max% file(s)&quot;,&quot;buttonType&quot;:&quot;dropzone&quot;,&quot;buttonText&quot;:&quot;Browse...&quot;,&quot;buttonIcon&quot;:&quot;qicon-file_upload&quot;,&quot;buttonIconPosition&quot;:&quot;right&quot;}\" \/><\/div><p class=\"quform-description quform-description-below\">Maximum filesize of 10 MB<\/p><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-2_41 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><h3 class=\"quform-group-title\">\/\/ COMMENTS \/ INFORMATION<\/h3><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-2_42 quform-1-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-2_43\"><div class=\"quform-element quform-element-textarea quform-element-2_45 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-inner quform-inner-textarea quform-inner-2_45\"><div class=\"quform-input quform-input-textarea quform-input-2_45 quform-cf\"><textarea id=\"quform_2_45_649945\" name=\"quform_2_45\" class=\"quform-field quform-field-textarea quform-field-2_45\" placeholder=\"Optional\" maxlength=\"1000\"><\/textarea><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-submit quform-element-2_2 quform-cf quform-button-style-blue-3d quform-button-size-medium quform-button-width-full\"><div class=\"quform-button-submit quform-button-submit-default quform-button-submit-2_2 quform-button-icon-right\" data-animation=\"one\"><button name=\"quform_submit\" type=\"submit\" class=\"quform-submit\" value=\"submit\"><span class=\"quform-button-text quform-button-submit-text\">SEND JOB REQUEST<\/span><span class=\"quform-button-icon quform-button-submit-icon\"><i class=\"qicon-send\"><\/i><\/span><\/button><\/div><div class=\"quform-loading quform-loading-position-over-button 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-upload-progress-wrap\"><div class=\"quform-upload-progress-bar-wrap\"><div class=\"quform-upload-progress-bar\"><\/div><\/div><div class=\"quform-upload-info quform-cf\"><div class=\"quform-upload-filename\"><\/div><\/div><\/div><\/div><\/form><\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-4272","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Job Request | New Zealand Auto Glass &amp; ADAS<\/title>\n<meta name=\"robots\" content=\"noindex, nofollow\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Job Request | New Zealand Auto Glass &amp; ADAS\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.nzautoglass.co.nz\/nzag\/job-request\/\" \/>\n<meta property=\"og:site_name\" content=\"New 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