{"id":1858,"date":"2021-03-11T02:28:05","date_gmt":"2021-03-11T02:28:05","guid":{"rendered":"https:\/\/nilsonvan.splashclients.com\/?page_id=1858"},"modified":"2021-05-19T15:02:34","modified_gmt":"2021-05-19T15:02:34","slug":"customer-service","status":"publish","type":"page","link":"https:\/\/nilsonvan.com\/customer-service","title":{"rendered":"Customer Service"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\">Claim Service Form<\/h2>\n\n\n<div class=\"frm_forms \" id=\"frm_form_4_container\" data-token=\"9d8ffdeeb3dae3664949553d38d39495\">\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_pro_form \" id=\"form_customerserviceclaimform\"  data-token=\"9d8ffdeeb3dae3664949553d38d39495\">\n<div class=\"frm_form_fields \">\n<fieldset>\n<div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"4\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_4\" id=\"frm_hide_fields_4\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"customerserviceclaimform\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_4\" name=\"frm_submit_entry_4\" value=\"b2d639ab19\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/wp-json\/wp\/v2\/pages\/1858\" \/><div class=\"contact-form\">\r\n    <table width=\"100%\" cellspacing=\"0\" cellpadding=\"0\" border=\"0\">\r\n        <tbody>\r\n            <tr>\r\n                <td colspan=\"2\">\r\n                    <!-- <input type=\"text\" class=\"cat_textbox order-number\" id=\"CAT_Custom_1110510\" name=\"CAT_Custom_1110510\" maxlength=\"4000\" placeholder=\"order number\" \/> -->\r\n                    <div id=\"frm_field_18_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n                        <label for=\"field_kw8oj\" id=\"field_kw8oj_label\" class=\"frm_primary_label\">Order Number\r\n                            <span class=\"frm_required\">*<\/span>\r\n                        <\/label>\r\n                        <input type=\"text\" id=\"field_kw8oj\" name=\"item_meta[18]\" value=\"\"  placeholder=\"order number\" data-reqmsg=\"Order Number cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" class=\"order-number\" aria-invalid=\"false\"  \/>\r\n                        \r\n                        \r\n                    <\/div>\r\n                <\/td>\r\n            <\/tr>\n            <tr>\r\n                <td colspan=\"2\">\r\n                    <div id=\"frm_field_19_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n                        <label for=\"field_z38in\" id=\"field_z38in_label\" class=\"frm_primary_label\">First Name\r\n                            <span class=\"frm_required\">*<\/span>\r\n                        <\/label>\r\n                        <input type=\"text\" id=\"field_z38in\" name=\"item_meta[19]\" value=\"\"  placeholder=\"first name\" data-reqmsg=\"First Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" class=\"first-input\" aria-invalid=\"false\"  \/>\r\n                        \r\n                        \r\n                    <\/div>\n    <div id=\"frm_field_20_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n                        <label for=\"field_nuo1x\" id=\"field_nuo1x_label\" class=\"frm_primary_label\">Last Name\r\n                            <span class=\"frm_required\">*<\/span>\r\n                        <\/label>\r\n                        <input type=\"text\" id=\"field_nuo1x\" name=\"item_meta[20]\" value=\"\"  placeholder=\"last name\" data-reqmsg=\"Last Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n                        \r\n                        \r\n                    <\/div>\r\n                <\/td>\r\n            <\/tr>\n     <tr>\r\n                <td colspan=\"2\">\r\n                    <div id=\"frm_field_21_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n                        <label for=\"field_2ru6z\" id=\"field_2ru6z_label\" class=\"frm_primary_label\">Phone\r\n                            <span class=\"frm_required\">*<\/span>\r\n                        <\/label>\r\n                        <input type=\"text\" id=\"field_2ru6z\" name=\"item_meta[21]\" value=\"\"  placeholder=\"phone\" data-reqmsg=\"Phone cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" class=\"phone-input\" aria-invalid=\"false\"  \/>\r\n                        \r\n                        \r\n                    <\/div>\n  <div id=\"frm_field_22_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n                        <label for=\"field_fpxen\" id=\"field_fpxen_label\" class=\"frm_primary_label\">Email\r\n                            <span class=\"frm_required\">*<\/span>\r\n                        <\/label>\r\n                        <input type=\"email\" id=\"field_fpxen\" name=\"item_meta[22]\" value=\"\"  placeholder=\"email\" data-reqmsg=\"Email cannot be blank.\" aria-required=\"true\" data-invmsg=\"Email is invalid\" class=\"email-input\" aria-invalid=\"false\"  \/>\r\n                        \r\n                        \r\n                    <\/div>\r\n                <\/td>\r\n            <\/tr>\n<div id=\"frm_field_37_container\" class=\"frm_form_field hide hidden none frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Original Address<\/h3>\r\n\r\n\r\n  <tr>\r\n                <td colspan=\"2\">\r\n                    <div class=\"title-form\">Original address<\/div>\r\n                <\/td>\r\n            <\/tr>\r\n            <tr>\r\n                <td colspan=\"2\">\r\n                    <div id=\"frm_field_39_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n                        <label for=\"field_ptcj4\" id=\"field_ptcj4_label\" class=\"frm_primary_label\">Street\r\n                            <span class=\"frm_required\"><\/span>\r\n                        <\/label>\r\n                        <input type=\"text\" id=\"field_ptcj4\" name=\"item_meta[39]\" value=\"\"  data-sectionid=\"37\" placeholder=\"street\" data-invmsg=\"Text is invalid\" class=\"street-input\" aria-invalid=\"false\"  \/>\r\n                        \r\n                        \r\n                    <\/div>\r\n                <\/td>\r\n            <\/tr>\n         <tr>\r\n                <td colspan=\"2\">\r\n                    <div id=\"frm_field_40_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n                        <label for=\"field_gc26g\" id=\"field_gc26g_label\" class=\"frm_primary_label\">City\r\n                            <span class=\"frm_required\"><\/span>\r\n                        <\/label>\r\n                        <input type=\"text\" id=\"field_gc26g\" name=\"item_meta[40]\" value=\"\"  data-sectionid=\"37\" placeholder=\"city\" data-invmsg=\"Text is invalid\" class=\"city-input\" aria-invalid=\"false\"  \/>\r\n                        \r\n                        \r\n                    <\/div>\n<div class=\"styled-select s-select2 left\">\r\n                        <select name=\"CAT_Custom_1110584\" id=\"CAT_Custom_1110583\" onchange=\"$('.txtOriginalState input').val(this.value);\" class=\"cat_dropdown category2\">\r\n                            <option value=\" \">state<\/option>\r\n                            <option value=\"AL\">AL<\/option>\r\n                            <option value=\"AK\">AK<\/option>\r\n                            <option value=\"AZ\">AZ<\/option>\r\n                            <option value=\"AR\">AR<\/option>\r\n                            <option value=\"CA\">CA<\/option>\r\n                            <option value=\"CO\">CO<\/option>\r\n                            <option value=\"CT\">CT<\/option>\r\n                            <option value=\"DE\">DE<\/option>\r\n                            <option value=\"FL\">FL<\/option>\r\n                            <option value=\"GA\">GA<\/option>\r\n                            <option value=\"HI\">HI<\/option>\r\n                            <option value=\"ID\">ID<\/option>\r\n                            <option value=\"IL\">IL<\/option>\r\n                            <option value=\"IN\">IN<\/option>\r\n                            <option value=\"IA\">IA<\/option>\r\n                            <option value=\"KS\">KS<\/option>\r\n                            <option value=\"KY\">KY<\/option>\r\n                            <option value=\"LA\">LA<\/option>\r\n                            <option value=\"ME\">ME<\/option>\r\n                            <option value=\"MD\">MD<\/option>\r\n                            <option value=\"MA\">MA<\/option>\r\n                            <option value=\"MI\">MI<\/option>\r\n                            <option value=\"MN\">MN<\/option>\r\n                            <option value=\"MS\">MS<\/option>\r\n                            <option value=\"MO\">MO<\/option>\r\n                            <option value=\"MT\">MT<\/option>\r\n                            <option value=\"NE\">NE<\/option>\r\n                            <option value=\"NV\">NV<\/option>\r\n                            <option value=\"NH\">NH<\/option>\r\n                            <option value=\"NJ\">NJ<\/option>\r\n                            <option value=\"NM\">NM<\/option>\r\n                            <option value=\"NY\">NY<\/option>\r\n                            <option value=\"NC\">NC<\/option>\r\n                            <option value=\"ND\">ND<\/option>\r\n                            <option value=\"OH\">OH<\/option>\r\n                            <option value=\"OK\">OK<\/option>\r\n                            <option value=\"OR\">OR<\/option>\r\n                            <option value=\"PA\">PA<\/option>\r\n                            <option value=\"RI\">RI<\/option>\r\n                            <option value=\"SC\">SC<\/option>\r\n                            <option value=\"SD\">SD<\/option>\r\n                            <option value=\"TN\">TN<\/option>\r\n                            <option value=\"TX\">TX<\/option>\r\n                            <option value=\"UT\">UT<\/option>\r\n                            <option value=\"VT\">VT<\/option>\r\n                            <option value=\"VA\">VA<\/option>\r\n                            <option value=\"WA\">WA<\/option>\r\n                            <option value=\"WV\">WV<\/option>\r\n                            <option value=\"WI\">WI<\/option>\r\n                            <option value=\"WY\">WY<\/option>\r\n                        <\/select>\r\n                        <div id=\"frm_field_41_container\" class=\"frm_form_field hide hidden none txtOriginalState form-field  frm_top_container\">\r\n                            <label for=\"field_g60r2\" id=\"field_g60r2_label\" class=\"frm_primary_label\">State\r\n                                <span class=\"frm_required\"><\/span>\r\n                            <\/label>\r\n                            <input type=\"text\" id=\"field_g60r2\" name=\"item_meta[41]\" value=\"\"  data-sectionid=\"37\" placeholder=\"state\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n                            \r\n                            \r\n                        <\/div>\r\n                    <\/div>\n                    <div id=\"frm_field_42_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n                        <label for=\"field_ueuwr\" id=\"field_ueuwr_label\" class=\"frm_primary_label\">Zip\r\n                            <span class=\"frm_required\"><\/span>\r\n                        <\/label>\r\n                        <input type=\"text\" id=\"field_ueuwr\" name=\"item_meta[42]\" value=\"\"  data-sectionid=\"37\" placeholder=\"zip\" data-invmsg=\"Text is invalid\" class=\"zip-input\" aria-invalid=\"false\"  \/>\r\n                        \r\n                        \r\n                    <\/div>\r\n                    <div class=\"clear\"><\/div>\r\n                <\/td>\r\n            <\/tr>\n<tr>\r\n                <td colspan=\"2\">\r\n                    <div id=\"frm_field_43_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n                        <label for=\"field_23u1u\" id=\"field_23u1u_label\" class=\"frm_primary_label\">Phone\r\n                            <span class=\"frm_required\"><\/span>\r\n                        <\/label>\r\n                        <input type=\"text\" id=\"field_23u1u\" name=\"item_meta[43]\" value=\"\"  data-sectionid=\"37\" placeholder=\"phone\" data-invmsg=\"Text is invalid\" class=\"phone-input\" aria-invalid=\"false\"  \/>\r\n                        \r\n                        \r\n                    <\/div>\r\n                <\/td>\r\n            <\/tr>\n<\/div>\n<div id=\"frm_field_44_container\" class=\"frm_form_field hide hidden none frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Destination Address<\/h3>\r\n\r\n\r\n<tr>\r\n                <td colspan=\"2\">\r\n                    <div class=\"title-form\">Destination address<\/div>\r\n                <\/td>\r\n            <\/tr>\r\n            <tr>\r\n                <td colspan=\"2\">\r\n                    <div id=\"frm_field_46_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n                        <label for=\"field_n2ouk\" id=\"field_n2ouk_label\" class=\"frm_primary_label\">Street\r\n                            <span class=\"frm_required\"><\/span>\r\n                        <\/label>\r\n                        <input type=\"text\" id=\"field_n2ouk\" name=\"item_meta[46]\" value=\"\"  data-sectionid=\"44\" placeholder=\"street\" data-invmsg=\"Text is invalid\" class=\"street-input\" aria-invalid=\"false\"  \/>\r\n                        \r\n                        \r\n                    <\/div>\r\n                <\/td>\r\n            <\/tr>\n <tr>\r\n                <td colspan=\"2\">\r\n                  \r\n                    <div id=\"frm_field_47_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n                        <label for=\"field_r9y2a\" id=\"field_r9y2a_label\" class=\"frm_primary_label\">City\r\n                            <span class=\"frm_required\"><\/span>\r\n                        <\/label>\r\n                        <input type=\"text\" id=\"field_r9y2a\" name=\"item_meta[47]\" value=\"\"  data-sectionid=\"44\" placeholder=\"city\" data-invmsg=\"Text is invalid\" class=\"city-input\" aria-invalid=\"false\"  \/>\r\n                        \r\n                        \r\n                    <\/div>\n<\/div>\n <div class=\"styled-select s-select2 left\">\r\n                        <select name=\"CAT_Custom_1110584\" id=\"CAT_Custom_1110584\" onchange=\"$('.txtDestoState input').val(this.value);\" class=\"cat_dropdown category2\">\r\n                            <option value=\" \">state<\/option>\r\n                            <option value=\"AL\">AL<\/option>\r\n                            <option value=\"AK\">AK<\/option>\r\n                            <option value=\"AZ\">AZ<\/option>\r\n                            <option value=\"AR\">AR<\/option>\r\n                            <option value=\"CA\">CA<\/option>\r\n                            <option value=\"CO\">CO<\/option>\r\n                            <option value=\"CT\">CT<\/option>\r\n                            <option value=\"DE\">DE<\/option>\r\n                            <option value=\"FL\">FL<\/option>\r\n                            <option value=\"GA\">GA<\/option>\r\n                            <option value=\"HI\">HI<\/option>\r\n                            <option value=\"ID\">ID<\/option>\r\n                            <option value=\"IL\">IL<\/option>\r\n                            <option value=\"IN\">IN<\/option>\r\n                            <option value=\"IA\">IA<\/option>\r\n                            <option value=\"KS\">KS<\/option>\r\n                            <option value=\"KY\">KY<\/option>\r\n                            <option value=\"LA\">LA<\/option>\r\n                            <option value=\"ME\">ME<\/option>\r\n                            <option value=\"MD\">MD<\/option>\r\n                            <option value=\"MA\">MA<\/option>\r\n                            <option value=\"MI\">MI<\/option>\r\n                            <option value=\"MN\">MN<\/option>\r\n                            <option value=\"MS\">MS<\/option>\r\n                            <option value=\"MO\">MO<\/option>\r\n                            <option value=\"MT\">MT<\/option>\r\n                            <option value=\"NE\">NE<\/option>\r\n                            <option value=\"NV\">NV<\/option>\r\n                            <option value=\"NH\">NH<\/option>\r\n                            <option value=\"NJ\">NJ<\/option>\r\n                            <option value=\"NM\">NM<\/option>\r\n                            <option value=\"NY\">NY<\/option>\r\n                            <option value=\"NC\">NC<\/option>\r\n                            <option value=\"ND\">ND<\/option>\r\n                            <option value=\"OH\">OH<\/option>\r\n                            <option value=\"OK\">OK<\/option>\r\n                            <option value=\"OR\">OR<\/option>\r\n                            <option value=\"PA\">PA<\/option>\r\n                            <option value=\"RI\">RI<\/option>\r\n                            <option value=\"SC\">SC<\/option>\r\n                            <option value=\"SD\">SD<\/option>\r\n                            <option value=\"TN\">TN<\/option>\r\n                            <option value=\"TX\">TX<\/option>\r\n                            <option value=\"UT\">UT<\/option>\r\n                            <option value=\"VT\">VT<\/option>\r\n                            <option value=\"VA\">VA<\/option>\r\n                            <option value=\"WA\">WA<\/option>\r\n                            <option value=\"WV\">WV<\/option>\r\n                            <option value=\"WI\">WI<\/option>\r\n                            <option value=\"WY\">WY<\/option>\r\n                        <\/select>\r\n                        <div id=\"frm_field_48_container\" class=\"frm_form_field txtDestoState form-field  frm_top_container\">\r\n                            <label for=\"field_aaln2\" id=\"field_aaln2_label\" class=\"frm_primary_label\">State\r\n                                <span class=\"frm_required\"><\/span>\r\n                            <\/label>\r\n                            \r\n                            \r\n                        <\/div>\r\n                    <\/div>\n<div id=\"frm_field_49_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n                        <label for=\"field_su3jc\" id=\"field_su3jc_label\" class=\"frm_primary_label\">Zip\r\n                            <span class=\"frm_required\"><\/span>\r\n                        <\/label>\r\n                        <input type=\"text\" id=\"field_su3jc\" name=\"item_meta[49]\" value=\"\"  placeholder=\"zip\" data-invmsg=\"Text is invalid\" class=\"zip-input\" aria-invalid=\"false\"  \/>\r\n                        \r\n                        \r\n                    <\/div>  \r\n                    <div class=\"clear\"><\/div>\r\n                <\/td>\r\n            <\/tr>\n <tr>\r\n                <td colspan=\"2\">\r\n                    <div id=\"frm_field_50_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n                        <label for=\"field_40pqq\" id=\"field_40pqq_label\" class=\"frm_primary_label\">Phone\r\n                            <span class=\"frm_required\"><\/span>\r\n                        <\/label>\r\n                        <input type=\"text\" id=\"field_40pqq\" name=\"item_meta[50]\" value=\"\"  placeholder=\"phone\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n                        \r\n                        \r\n                    <\/div>\r\n                <\/td>\r\n            <\/tr>\n<div id=\"frm_field_51_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Claim Information<\/h3>\r\n\r\n\r\n<tr>\r\n                <td colspan=\"2\">\r\n                    <div class=\"title-form\">Claim information<\/div>\r\n                <\/td>\r\n            <\/tr>\r\n            <tr>\r\n                <td>\r\n                    <div class=\"styled-select s-select3\">\r\n                        <select name=\"CAT_Custom_1110519\" id=\"CAT_Custom_1110519\" onchange=\"$('.txtTypeClaim input').val(this.value);\" class=\"cat_dropdown category3\">\r\n                            <option value=\" \">type of claim<\/option>\r\n                            <option value=\"Damage\">Damage<\/option>\r\n                            <option value=\"Delay\">Delay<\/option>\r\n                            <option value=\"Auto\">Auto<\/option>\r\n                        <\/select>\r\n                        <div id=\"frm_field_53_container\" class=\"frm_form_field hide hidden none txtTypeClaim form-field  frm_top_container\">\r\n                            <label for=\"field_s7o2m\" id=\"field_s7o2m_label\" class=\"frm_primary_label\">Type of Claim\r\n                                <span class=\"frm_required\"><\/span>\r\n                            <\/label>\r\n                            <input type=\"text\" id=\"field_s7o2m\" name=\"item_meta[53]\" value=\"\"  data-sectionid=\"51\" placeholder=\"type of claim\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n                            \r\n                            \r\n                        <\/div>\r\n                    <\/div>\r\n                <\/td>\n<td>\r\n                    <div class=\"styled-select s-select3 right\">\r\n                        <select name=\"CAT_Custom_1110520\" id=\"CAT_Custom_1110520\" onchange=\"$('.txtLevelValue input').val(this.value);\" class=\"cat_dropdown category4 level-of-value\">\r\n                            <option value=\"cat1\">level of value<\/option>\r\n                            <option class=\"option-label\">Full Valuation Coverage<\/option>\r\n                            <option value=\"$250.00 deductible\">$250.00 deductible<\/option>\r\n                            <option value=\"$500.00 deductible\">$500.00 deductible<\/option>\r\n                            <option value=\"$750.00 deductible\">$750.00 deductible<\/option>\r\n                            <option value=\"$1,000.00 deductible\">$1,000.00 deductible<\/option>\r\n                            <option class=\"option-label\">Released Liability<\/option>\r\n                            <option value=\"$.60 cents per pound per item\">$.60 cents per pound per item<\/option>\r\n                        <\/select>\r\n                        <div id=\"frm_field_54_container\" class=\"frm_form_field hide hidden none txtLevelValue form-field  frm_top_container\">\r\n                            <label for=\"field_r7uoh\" id=\"field_r7uoh_label\" class=\"frm_primary_label\">Level of Value\r\n                                <span class=\"frm_required\"><\/span>\r\n                            <\/label>\r\n                            <input type=\"text\" id=\"field_r7uoh\" name=\"item_meta[54]\" value=\"\"  data-sectionid=\"51\" placeholder=\"level of value\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n                            \r\n                            \r\n                        <\/div>\r\n                    <\/div>\r\n                <\/td>\r\n            <\/tr>\n<tr>\r\n                <td colspan=\"2\">\r\n                    <div id=\"frm_field_56_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n                        <label for=\"field_lwrbb\" id=\"field_lwrbb_label\" class=\"frm_primary_label\">Description of Claim\r\n                            <span class=\"frm_required\"><\/span>\r\n                        <\/label>\r\n                        <textarea name=\"item_meta[56]\" id=\"field_lwrbb\" rows=\"5\"  data-sectionid=\"51\" placeholder=\"description of claim\" data-invmsg=\"Description of Claim is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n                        \r\n                        \r\n                    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