{"id":3025,"date":"2013-11-05T20:35:41","date_gmt":"2013-11-05T20:35:41","guid":{"rendered":"http:\/\/shtc.biz\/?page_id=296"},"modified":"2013-11-05T20:35:41","modified_gmt":"2013-11-05T20:35:41","slug":"coop2","status":"publish","type":"page","link":"https:\/\/shnext.com\/coop2\/","title":{"rendered":"CO-OP2 Request"},"content":{"rendered":"<div id=\"vfb-form-4\" class=\"visual-form-builder-container\"><form id=\"birthday-anniversary-and-special-announcement-request-4\" class=\"visual-form-builder vfb-form-4  \" method=\"post\" enctype=\"multipart\/form-data\" action=\"\">\n\t\t<input type=\"hidden\" name=\"form_id\" value=\"4\" \/><fieldset class=\"vfb-fieldset vfb-fieldset-1 receipient-information    \" id=\"item-vfb-194\"><div class=\"vfb-legend\"><h3>Receipient Information<\/h3><\/div><ul class=\"vfb-section vfb-section-1\"><li class=\"vfb-item vfb-item-date   vfb-right-half  \" id=\"item-vfb-40\"><label for=\"vfb-40\" class=\"vfb-desc\">Date  <span class=\"vfb-required-asterisk\">*<\/span><\/label><span class=\"vfb-span\"><input type=\"text\" name=\"vfb-40\" id=\"vfb-40\" value=\"\" class=\"vfb-text vfb-date-picker  vfb-medium  required \" data-dp-dateFormat=\"mm\/dd\/yy\" \/><label>Enter actual date of Birthday, Anniversary or Special Announcement<\/label><\/span><\/li>\n<li class=\"vfb-item vfb-item-text   vfb-left-half  \" id=\"item-vfb-181\"><label for=\"vfb-181\" class=\"vfb-desc\">Name  <span class=\"vfb-required-asterisk\">*<\/span><\/label><input type=\"text\" name=\"vfb-181\" id=\"vfb-181\" value=\"\" class=\"vfb-text  vfb-medium  required  \" \/><\/li>\n<\/ul>&nbsp;<\/fieldset><fieldset class=\"vfb-fieldset vfb-fieldset-2 contact-information    \" id=\"item-vfb-43\"><div class=\"vfb-legend\"><h3>Contact Information<\/h3><\/div><ul class=\"vfb-section vfb-section-2\"><li class=\"vfb-item vfb-item-text    \" id=\"item-vfb-44\"><label for=\"vfb-44\" class=\"vfb-desc\">Name  <span class=\"vfb-required-asterisk\">*<\/span><\/label><input type=\"text\" name=\"vfb-44\" id=\"vfb-44\" value=\"\" class=\"vfb-text  vfb-medium  required  \" \/><\/li>\n<li class=\"vfb-item vfb-item-phone   vfb-left-third  \" id=\"item-vfb-46\"><label for=\"vfb-46\" class=\"vfb-desc\">Contact Phone Number  <span class=\"vfb-required-asterisk\">*<\/span><\/label><input type=\"tel\" name=\"vfb-46\" id=\"vfb-46\" value=\"\" class=\"vfb-text  vfb-medium  required  phone \" \/><\/li>\n<li class=\"vfb-item vfb-item-phone   vfb-middle-third  \" id=\"item-vfb-45\"><label for=\"vfb-45\" class=\"vfb-desc\">Alternate Contact Number <\/label><input type=\"tel\" name=\"vfb-45\" id=\"vfb-45\" value=\"\" class=\"vfb-text  vfb-medium   phone \" \/><\/li>\n<li class=\"vfb-item vfb-item-email   vfb-right-third  \" id=\"item-vfb-47\"><label for=\"vfb-47\" class=\"vfb-desc\">Email Address  <span class=\"vfb-required-asterisk\">*<\/span><\/label><input type=\"email\" name=\"vfb-47\" id=\"vfb-47\" value=\"\" class=\"vfb-text  vfb-medium  required  email \" \/><\/li>\n<\/ul>&nbsp;<\/fieldset><fieldset class=\"vfb-fieldset vfb-fieldset-3 advertising-type    \" id=\"item-vfb-48\"><div class=\"vfb-legend\"><h3>Advertising Type<\/h3><\/div><ul class=\"vfb-section vfb-section-3\"><div id=\"item-vfb-171\" class=\"vfb-section-div   \"><h4>Disclaimer<\/h4><\/div><div class=\"vfb-clear\"><\/div><li class=\"vfb-item vfb-item-instructions    \" id=\"item-vfb-166\"><label class=\"vfb-desc\">NOTE: <\/label><p>Sandhill Telephone Cooperative reserves the right to refuse or discontinue any advertising from the Cooperative Channel for any reason.  <\/p>\n<p>Sandhill Telephone reserves the right to modify any advertising deemed inappropriate or resulting in customer complaints.  Sandhill Telephone is not liable for any advertising by advertisers.\n\n<p>Birthday, Anniversary and Special Announcements are loaded once a week (Monday).  Therefore, <b><big>your birthday, anniversary, and special announcement must be received by us the Sunday before it is to be ran and payment must be confirmed,<\/b><\/big> otherwise we cannot guarantee that it will be loaded that week.<\/P>\n\n<p>Allow 72 hours before announcement is to air.  Announcements run for a week (Monday thru Monday).<\/P><\/li>\n<li class=\"vfb-item vfb-item-radio    \" id=\"item-vfb-197\"><label class=\"vfb-desc\">Agreement  <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><span><label>You must agree to the terms and conditions prior to proceed with this request.<\/label><\/span><span class=\"vfb-span\"><input type=\"radio\" name=\"vfb-197\" id=\"vfb-197-1\" value=\"Agree\" class=\"vfb-radio  required \" \/><label for=\"vfb-197-1\" class=\"vfb-choice\">Agree<\/label><\/span><span class=\"vfb-span\"><input type=\"radio\" name=\"vfb-197\" id=\"vfb-197-2\" value=\"Do Not Agree\" class=\"vfb-radio  required \" \/><label for=\"vfb-197-2\" class=\"vfb-choice\">Do Not Agree<\/label><\/span><div style=\"clear:both\"><\/div><\/div><\/li>\n<li class=\"vfb-item vfb-item-select   vfb-left-third  \" id=\"item-vfb-69\"><label for=\"vfb-69\" class=\"vfb-desc\">Choose Your Announcements Type  <span class=\"vfb-required-asterisk\">*<\/span><\/label><select name=\"vfb-69\" id=\"vfb-69\" class=\"vfb-select  vfb-medium  required \"><option value=\"Choose Announcements Type\">Choose Announcements Type<\/option><option value=\"Anniversary Announcement\">Anniversary Announcement<\/option><option value=\"Birthday Announcement\">Birthday Announcement<\/option><option value=\"Special Announcement\">Special Announcement<\/option><\/select><\/li>\n<li class=\"vfb-item vfb-item-date   vfb-middle-third  \" id=\"item-vfb-49\"><label for=\"vfb-49\" class=\"vfb-desc\">Beginning Run Date  <span class=\"vfb-required-asterisk\">*<\/span><\/label><input type=\"text\" name=\"vfb-49\" id=\"vfb-49\" value=\"\" class=\"vfb-text vfb-date-picker  vfb-medium  required \" data-dp-dateFormat=\"mm\/dd\/yy\" \/><\/li>\n<li class=\"vfb-item vfb-item-date   vfb-right-third  \" id=\"item-vfb-50\"><label for=\"vfb-50\" class=\"vfb-desc\">Ending Run Date  <span class=\"vfb-required-asterisk\">*<\/span><\/label><input type=\"text\" name=\"vfb-50\" id=\"vfb-50\" value=\"\" class=\"vfb-text vfb-date-picker  vfb-medium  required \" data-dp-dateFormat=\"mm\/dd\/yy\" \/><\/li>\n<li class=\"vfb-item vfb-item-number    vfb-conditional  vfb-conditional-hide\" id=\"item-vfb-183\"><label for=\"vfb-183\" class=\"vfb-desc\">Age (Optional) <\/label><input type=\"text\" name=\"vfb-183\" id=\"vfb-183\" value=\"\" class=\"vfb-text  vfb-medium   digits \" \/><\/li>\n<li class=\"vfb-item vfb-item-number    vfb-conditional  vfb-conditional-hide\" id=\"item-vfb-200\"><label for=\"vfb-200\" class=\"vfb-desc\">Years of Marriage <\/label><input type=\"text\" name=\"vfb-200\" id=\"vfb-200\" value=\"\" class=\"vfb-text  vfb-medium   digits \" \/><\/li>\n<li class=\"vfb-item vfb-item-textarea    vfb-conditional  vfb-conditional-hide\" id=\"item-vfb-198\"><label for=\"vfb-198\" class=\"vfb-desc\">Enter Your Text <\/label><div><span class='vfb-span'><label>Enter text description of your announcement.<\/label><\/span><textarea name=\"vfb-198\" id=\"vfb-198\" class=\"vfb-textarea  vfb-medium   \"><\/textarea> <\/div><\/li>\n<li class=\"vfb-item vfb-item-radio   vfb-left-half  \" id=\"item-vfb-62\"><label class=\"vfb-desc\">Picture  <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><span><label>1 slide per announcement.\nText Only $5 or \nText and Picture $8<\/label><\/span><span class=\"vfb-span\"><input type=\"radio\" name=\"vfb-62\" id=\"vfb-62-1\" value=\"Yes $8.00\" class=\"vfb-radio  required \" \/><label for=\"vfb-62-1\" class=\"vfb-choice\">Yes $8.00<\/label><\/span><span class=\"vfb-span\"><input type=\"radio\" name=\"vfb-62\" id=\"vfb-62-2\" value=\"No   $5.00\" class=\"vfb-radio  required \" \/><label for=\"vfb-62-2\" class=\"vfb-choice\">No   $5.00<\/label><\/span><div style=\"clear:both\"><\/div><\/div><\/li>\n<li class=\"vfb-item vfb-item-file-upload   vfb-middle-third  vfb-conditional  vfb-conditional-hide\" id=\"item-vfb-70\"><label for=\"vfb-70\" class=\"vfb-desc\">Upload Photo <\/label><span class=\"vfb-span\"><input type=\"file\" name=\"vfb-70\" id=\"vfb-70\" value=\"\" class=\"vfb-text  vfb-medium     {accept:'png|jpe?g|gif'}\" \/><label>For better quality file resolution must be 300DPI.\nClick here to see slide template layout.<\/label><\/span><\/li>\n<li class=\"vfb-item vfb-item-text    \" id=\"item-vfb-184\"><label for=\"vfb-184\" class=\"vfb-desc\">This Announcement Was Given By? <\/label><input type=\"text\" name=\"vfb-184\" id=\"vfb-184\" value=\"\" class=\"vfb-text  vfb-medium   \" \/><\/li>\n<li class=\"vfb-item vfb-item-page-break\" id=\"item-vfb-195\"><a href=\"#\" id=\"page-1\" class=\"vfb-page-next\">Next<\/a> <span class=\"vfb-page-counter\">1 \/ 2<\/span><\/li><\/ul>&nbsp;<\/fieldset><fieldset class=\"vfb-fieldset vfb-fieldset-4 billing   vfb-page page-1  \" id=\"item-vfb-190\"><div class=\"vfb-legend\"><h3>Billing<\/h3><\/div><ul class=\"vfb-section vfb-section-4\"><li class=\"vfb-item vfb-item-text   vfb-left-half  \" id=\"item-vfb-41\"><label for=\"vfb-41\" class=\"vfb-desc\">Name <\/label><input type=\"text\" name=\"vfb-41\" id=\"vfb-41\" value=\"\" class=\"vfb-text  vfb-medium   \" \/><\/li>\n<li class=\"vfb-item vfb-item-address    \" id=\"item-vfb-42\"><label class=\"vfb-desc\">Address <\/label><div><span class=\"vfb-full\"><input type=\"text\" name=\"vfb-42[address]\" id=\"vfb-42-address\" maxlength=\"150\" class=\"vfb-text vfb-medium  \" \/><label for=\"vfb-42-address\">Street Address<\/label><\/span><span class=\"vfb-full\"><input type=\"text\" name=\"vfb-42[address-2]\" id=\"vfb-42-address-2\" maxlength=\"150\" class=\"vfb-text vfb-medium  \" \/><label for=\"vfb-42-address-2\">Apt, Suite, Bldg. (optional)<\/label><\/span><span class=\"vfb-left\"><input type=\"text\" name=\"vfb-42[city]\" id=\"vfb-42-city\" maxlength=\"150\" class=\"vfb-text vfb-medium  \" \/><label for=\"vfb-42-city\">City<\/label><\/span><span class=\"vfb-right\"><input type=\"text\" name=\"vfb-42[state]\" id=\"vfb-42-state\" maxlength=\"150\" class=\"vfb-text vfb-medium  \" \/><label for=\"vfb-42-state\">State \/ Province \/ Region<\/label><\/span><span class=\"vfb-left\"><input type=\"text\" name=\"vfb-42[zip]\" id=\"vfb-42-zip\" maxlength=\"150\" class=\"vfb-text vfb-medium  \" \/><label for=\"vfb-42-zip\">Postal \/ Zip Code<\/label><\/span><span class=\"vfb-right\"><select name=\"vfb-42[country]\" class=\"vfb-select  \" id=\"vfb-42-country\"><option value=\"\"><\/option><option value=\"Afghanistan\">Afghanistan<\/option><option value=\"Albania\">Albania<\/option><option value=\"Algeria\">Algeria<\/option><option value=\"Andorra\">Andorra<\/option><option value=\"Angola\">Angola<\/option><option value=\"Antigua and Barbuda\">Antigua and Barbuda<\/option><option value=\"Argentina\">Argentina<\/option><option value=\"Armenia\">Armenia<\/option><option value=\"Australia\">Australia<\/option><option value=\"Austria\">Austria<\/option><option value=\"Azerbaijan\">Azerbaijan<\/option><option value=\"Bahamas\">Bahamas<\/option><option value=\"Bahrain\">Bahrain<\/option><option value=\"Bangladesh\">Bangladesh<\/option><option value=\"Barbados\">Barbados<\/option><option value=\"Belarus\">Belarus<\/option><option value=\"Belgium\">Belgium<\/option><option value=\"Belize\">Belize<\/option><option value=\"Benin\">Benin<\/option><option value=\"Bhutan\">Bhutan<\/option><option value=\"Bolivia\">Bolivia<\/option><option value=\"Bosnia and Herzegovina\">Bosnia and Herzegovina<\/option><option value=\"Botswana\">Botswana<\/option><option value=\"Brazil\">Brazil<\/option><option value=\"Brunei\">Brunei<\/option><option value=\"Bulgaria\">Bulgaria<\/option><option value=\"Burkina Faso\">Burkina Faso<\/option><option value=\"Burundi\">Burundi<\/option><option value=\"Cambodia\">Cambodia<\/option><option value=\"Cameroon\">Cameroon<\/option><option value=\"Canada\">Canada<\/option><option value=\"Cape Verde\">Cape Verde<\/option><option value=\"Central African Republic\">Central African Republic<\/option><option value=\"Chad\">Chad<\/option><option value=\"Chile\">Chile<\/option><option value=\"China\">China<\/option><option value=\"Colombi\">Colombi<\/option><option value=\"Comoros\">Comoros<\/option><option value=\"Congo (Brazzaville)\">Congo (Brazzaville)<\/option><option value=\"Congo\">Congo<\/option><option value=\"Costa Rica\">Costa Rica<\/option><option value=\"Cote d\\'Ivoire\">Cote d\\'Ivoire<\/option><option value=\"Croatia\">Croatia<\/option><option value=\"Cuba\">Cuba<\/option><option value=\"Cyprus\">Cyprus<\/option><option value=\"Czech Republic\">Czech Republic<\/option><option value=\"Denmark\">Denmark<\/option><option value=\"Djibouti\">Djibouti<\/option><option value=\"Dominica\">Dominica<\/option><option value=\"Dominican Republic\">Dominican Republic<\/option><option value=\"East Timor (Timor Timur)\">East Timor (Timor Timur)<\/option><option value=\"Ecuador\">Ecuador<\/option><option value=\"Egypt\">Egypt<\/option><option value=\"El Salvador\">El Salvador<\/option><option value=\"Equatorial Guinea\">Equatorial Guinea<\/option><option value=\"Eritrea\">Eritrea<\/option><option value=\"Estonia\">Estonia<\/option><option value=\"Ethiopia\">Ethiopia<\/option><option value=\"Fiji\">Fiji<\/option><option value=\"Finland\">Finland<\/option><option value=\"France\">France<\/option><option value=\"Gabon\">Gabon<\/option><option value=\"Gambia, The\">Gambia, The<\/option><option value=\"Georgia\">Georgia<\/option><option value=\"Germany\">Germany<\/option><option value=\"Ghana\">Ghana<\/option><option value=\"Greece\">Greece<\/option><option value=\"Grenada\">Grenada<\/option><option value=\"Guatemala\">Guatemala<\/option><option value=\"Guinea\">Guinea<\/option><option value=\"Guinea-Bissau\">Guinea-Bissau<\/option><option value=\"Guyana\">Guyana<\/option><option value=\"Haiti\">Haiti<\/option><option value=\"Honduras\">Honduras<\/option><option value=\"Hungary\">Hungary<\/option><option value=\"Iceland\">Iceland<\/option><option value=\"India\">India<\/option><option value=\"Indonesia\">Indonesia<\/option><option value=\"Iran\">Iran<\/option><option value=\"Iraq\">Iraq<\/option><option value=\"Ireland\">Ireland<\/option><option value=\"Israel\">Israel<\/option><option value=\"Italy\">Italy<\/option><option value=\"Jamaica\">Jamaica<\/option><option value=\"Japan\">Japan<\/option><option value=\"Jordan\">Jordan<\/option><option value=\"Kazakhstan\">Kazakhstan<\/option><option value=\"Kenya\">Kenya<\/option><option value=\"Kiribati\">Kiribati<\/option><option value=\"Korea, North\">Korea, North<\/option><option value=\"Korea, South\">Korea, South<\/option><option value=\"Kuwait\">Kuwait<\/option><option value=\"Kyrgyzstan\">Kyrgyzstan<\/option><option value=\"Laos\">Laos<\/option><option value=\"Latvia\">Latvia<\/option><option value=\"Lebanon\">Lebanon<\/option><option value=\"Lesotho\">Lesotho<\/option><option value=\"Liberia\">Liberia<\/option><option value=\"Libya\">Libya<\/option><option value=\"Liechtenstein\">Liechtenstein<\/option><option value=\"Lithuania\">Lithuania<\/option><option value=\"Luxembourg\">Luxembourg<\/option><option value=\"Macedonia\">Macedonia<\/option><option value=\"Madagascar\">Madagascar<\/option><option value=\"Malawi\">Malawi<\/option><option value=\"Malaysia\">Malaysia<\/option><option value=\"Maldives\">Maldives<\/option><option value=\"Mali\">Mali<\/option><option value=\"Malta\">Malta<\/option><option value=\"Marshall Islands\">Marshall Islands<\/option><option value=\"Mauritania\">Mauritania<\/option><option value=\"Mauritius\">Mauritius<\/option><option value=\"Mexico\">Mexico<\/option><option value=\"Micronesia\">Micronesia<\/option><option value=\"Moldova\">Moldova<\/option><option value=\"Monaco\">Monaco<\/option><option value=\"Mongolia\">Mongolia<\/option><option value=\"Montenegro\">Montenegro<\/option><option value=\"Morocco\">Morocco<\/option><option value=\"Mozambique\">Mozambique<\/option><option value=\"Myanmar\">Myanmar<\/option><option value=\"Namibia\">Namibia<\/option><option value=\"Nauru\">Nauru<\/option><option value=\"Nepa\">Nepa<\/option><option value=\"Netherlands\">Netherlands<\/option><option value=\"New Zealand\">New Zealand<\/option><option value=\"Nicaragua\">Nicaragua<\/option><option value=\"Niger\">Niger<\/option><option value=\"Nigeria\">Nigeria<\/option><option value=\"Norway\">Norway<\/option><option value=\"Oman\">Oman<\/option><option value=\"Pakistan\">Pakistan<\/option><option value=\"Palau\">Palau<\/option><option value=\"Panama\">Panama<\/option><option value=\"Papua New Guinea\">Papua New Guinea<\/option><option value=\"Paraguay\">Paraguay<\/option><option value=\"Peru\">Peru<\/option><option value=\"Philippines\">Philippines<\/option><option value=\"Poland\">Poland<\/option><option value=\"Portugal\">Portugal<\/option><option value=\"Qatar\">Qatar<\/option><option value=\"Romania\">Romania<\/option><option value=\"Russia\">Russia<\/option><option value=\"Rwanda\">Rwanda<\/option><option value=\"Saint Kitts and Nevis\">Saint Kitts and Nevis<\/option><option value=\"Saint Lucia\">Saint Lucia<\/option><option value=\"Saint Vincent\">Saint Vincent<\/option><option value=\"Samoa\">Samoa<\/option><option value=\"San Marino\">San Marino<\/option><option value=\"Sao Tome and Principe\">Sao Tome and Principe<\/option><option value=\"Saudi Arabia\">Saudi Arabia<\/option><option value=\"Senegal\">Senegal<\/option><option value=\"Serbia\">Serbia<\/option><option value=\"Seychelles\">Seychelles<\/option><option value=\"Sierra Leone\">Sierra Leone<\/option><option value=\"Singapore\">Singapore<\/option><option value=\"Slovakia\">Slovakia<\/option><option value=\"Slovenia\">Slovenia<\/option><option value=\"Solomon Islands\">Solomon Islands<\/option><option value=\"Somalia\">Somalia<\/option><option value=\"South Africa\">South Africa<\/option><option value=\"Spain\">Spain<\/option><option value=\"Sri Lanka\">Sri Lanka<\/option><option value=\"Sudan\">Sudan<\/option><option value=\"Suriname\">Suriname<\/option><option value=\"Swaziland\">Swaziland<\/option><option value=\"Sweden\">Sweden<\/option><option value=\"Switzerland\">Switzerland<\/option><option value=\"Syria\">Syria<\/option><option value=\"Taiwan\">Taiwan<\/option><option value=\"Tajikistan\">Tajikistan<\/option><option value=\"Tanzania\">Tanzania<\/option><option value=\"Thailand\">Thailand<\/option><option value=\"Togo\">Togo<\/option><option value=\"Tonga\">Tonga<\/option><option value=\"Trinidad and Tobago\">Trinidad and Tobago<\/option><option value=\"Tunisia\">Tunisia<\/option><option value=\"Turkey\">Turkey<\/option><option value=\"Turkmenistan\">Turkmenistan<\/option><option value=\"Tuvalu\">Tuvalu<\/option><option value=\"Uganda\">Uganda<\/option><option value=\"Ukraine\">Ukraine<\/option><option value=\"United Arab Emirates\">United Arab Emirates<\/option><option value=\"United Kingdom\">United Kingdom<\/option><option value=\"United States of America\" selected='selected'>United States of America<\/option><option value=\"Uruguay\">Uruguay<\/option><option value=\"Uzbekistan\">Uzbekistan<\/option><option value=\"Vanuatu\">Vanuatu<\/option><option value=\"Vatican City\">Vatican City<\/option><option value=\"Venezuela\">Venezuela<\/option><option value=\"Vietnam\">Vietnam<\/option><option value=\"Yemen\">Yemen<\/option><option value=\"Zambia\">Zambia<\/option><option value=\"Zimbabwe\">Zimbabwe<\/option><\/select><label for=\"vfb-42-country\">Country<\/label><\/span><\/div><\/li>\n<li class=\"vfb-item vfb-item-radio   vfb-left-half  \" id=\"item-vfb-185\"><label class=\"vfb-desc\">Payment  <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><span><label>Choose Payment Type<\/label><\/span><span class=\"vfb-span\"><input type=\"radio\" name=\"vfb-185\" id=\"vfb-185-1\" value=\"Bill charge on my bill\" class=\"vfb-radio  required \" \/><label for=\"vfb-185-1\" class=\"vfb-choice\">Bill charge on my bill<\/label><\/span><span class=\"vfb-span\"><input type=\"radio\" name=\"vfb-185\" id=\"vfb-185-2\" value=\"Pay in full with credit card\" class=\"vfb-radio  required \" \/><label for=\"vfb-185-2\" class=\"vfb-choice\">Pay in full with credit card<\/label><\/span><span class=\"vfb-span\"><input type=\"radio\" name=\"vfb-185\" id=\"vfb-185-3\" value=\"Pay in full with cash\/check\" class=\"vfb-radio  required \" \/><label for=\"vfb-185-3\" class=\"vfb-choice\">Pay in full with cash\/check<\/label><\/span><div style=\"clear:both\"><\/div><\/div><\/li>\n<li class=\"vfb-item vfb-item-text   vfb-right-half  vfb-conditional  vfb-conditional-hide\" id=\"item-vfb-215\"><label for=\"vfb-215\" class=\"vfb-desc\">Bill Account Number <\/label><span class=\"vfb-span\"><input type=\"text\" name=\"vfb-215\" id=\"vfb-215\" value=\"\" class=\"vfb-text  vfb-medium   \" \/><label>In order to bill the charge for this request please enter last five 5 digits of your account number.<br><br>\n\nAccount number can be found on the upper right hand corner of your billing statement.<\/label><\/span><\/li>\n<li class=\"vfb-item vfb-item-instructions   vfb-right-half  vfb-conditional  vfb-conditional-hide\" id=\"item-vfb-189\"><label class=\"vfb-desc\">To pay in full with credit card, <\/label>(MASTERCARD\/VISA) please call (843) 658-3434 Monday thru Friday from 8:30AM thru 5:00PM.<\/li>\n<li class=\"vfb-item vfb-item-instructions   vfb-right-half  vfb-conditional  vfb-conditional-hide\" id=\"item-vfb-199\"><label class=\"vfb-desc\">To pay in full with cash\/check, <\/label>after submitting the request to pay in full with cash\/check, please stop by one of our conveniently located business office in: <br> Chesterfield   |   Jefferson   |   McBee   |   Pageland.\n<p>Our offices are open Monday thru Friday from 8:30AM thru 5:00PM.<\/p><\/li>\n<\/ul>&nbsp;<\/fieldset><fieldset class=\"vfb-fieldset vfb-fieldset-5 verification   vfb-page page-1\" id=\"item-vfb-37\"><div class=\"vfb-legend\"><h3>Verification<\/h3><\/div><ul class=\"vfb-section vfb-section-5\"><li class=\"vfb-item vfb-item-secret\" ><label for=\"item-vfb-38\" class=\"vfb-desc\">Please Enter Any Two Digits Below <span class=\"vfb-required-asterisk\">*<\/span><\/label><input type=\"hidden\" name=\"_vfb-secret\" value=\"vfb-38\" \/><span class=\"vfb-span\"><input type=\"text\" name=\"vfb-38\" id=\"item-vfb-38\" value=\"\" class=\"vfb-text  vfb-medium  required {digits:true,maxlength:2,minlength:2} \" \/><label>Example: 12<\/label><\/span><li style=\"display:none;\"><label>This box is for spam protection - <strong>please leave it blank<\/strong><\/label><div><input name=\"vfb-spam\" \/><\/div><\/li><li class=\"vfb-item vfb-item-submit\" id=\"item-vfb-39\">\n\t\t\t\t\t<input type=\"submit\" name=\"vfb-submit\" id=\"vfb-39\" value=\"Submit\" class=\"vfb-submit \" \/>\n\t\t\t\t\t<\/li><span class=\"vfb-page-counter\">2 \/ 2<\/span><\/ul>\n\t\t &nbsp;\n\t\t <\/fieldset><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/wp-json\/wp\/v2\/pages\/3025\" \/><\/form><\/div> <!-- .visual-form-builder-container 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