I have an existing form that was built at http://www.formassembly.com. I am new to all of this and just need to know if there is a way to convert this form with Chronoforms so it can be used on my Joomla site. I am assuming that how it post will have to be changed in the html??? Any help would be greatly appreciated. I will post the code here. If anyone can give me some guidance on if and how I can make this work I would be greatful!
Thanks,
Skip
Thanks,
Skip
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<title>Current Insurance</title>
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<div id="tfaContent">
<div class="wFormContainer">
<h3 class="wFormTitle"><span>Current Insurance</span></h3>
<div class="wForm wFormdefaultWidth"><form method="post" action="http://www.tfaforms.com/responses/processor" id="id2423014" class="labelsLeftAligned hintsTooltip">
<div class="wfPage " id="wfPgIndex-1">
<h3>Account Info</h3>
<fieldset id="tfa_AccountInfo1" class="repeat wfSection">
<legend>Account Info</legend>
<div id="tfa_FullName1" class="inlineSection required">
<label class="preField">Full Name: <span class="reqMark">*</span></label><div id="tfa_8431692890939-D" class="oneField"> <input type="text" id="tfa_8431692890939" name="tfa_8431692890939" value="" size="12" class=""> </div>
<div id="tfa_8431692219275-D" class="oneField"> <input type="text" id="tfa_8431692219275" name="tfa_8431692219275" value="" size="2" class=""> </div>
<div id="tfa_8431693188199-D" class="oneField"> <input type="text" id="tfa_8431693188199" name="tfa_8431693188199" value="" size="15" class=""> </div>
<div id="tfa_Alreadyhavelogin-D" class="oneField">
<label class="inlineLabel">Already have login?</label> <span id="tfa_Alreadyhavelogin" class="choices"><span class="oneChoice"><input type="radio" value="tfa_Yes5" class="" id="tfa_Yes5" name="tfa_Alreadyhavelogin"><label for="tfa_Yes5" class="postField">Yes</label></span><span class="oneChoice"><input type="radio" value="tfa_No5" class="switch-f" id="tfa_No5" name="tfa_Alreadyhavelogin"><label for="tfa_No5" class="postField">No</label></span></span> </div>
<div id="tfa_EnterEmailAddres-D" class="offstate-f oneField">
<label class="inlineLabel" for="tfa_EnterEmailAddres">Enter Email Address</label> <input type="text" id="tfa_EnterEmailAddres" name="tfa_EnterEmailAddres" value="" size="40" class=""> </div>
<div id="tfa_CreatePassword-D" class="offstate-f oneField">
<label class="inlineLabel" for="tfa_CreatePassword">Create Password</label> <input type="text" id="tfa_CreatePassword" name="tfa_CreatePassword" value="" size="40" class=""> </div>
</div>
<div id="tfa_PhoneNumber-D" class="oneField">
<label class="preField" for="tfa_PhoneNumber">Phone Number</label> <input type="text" id="tfa_PhoneNumber" name="tfa_PhoneNumber" value="" size="40" class="validate-phone"> <br>
</div>
<div id="tfa_EmailAddress1-D" class="oneField">
<label class="preField" for="tfa_EmailAddress1">Email Address</label> <input type="text" id="tfa_EmailAddress1" name="tfa_EmailAddress1" value="" size="40" class="validate-email"> <br>
</div>
<div id="tfa_MaritalStatus1-D" class="oneField">
<label class="preField" for="tfa_MaritalStatus1">Marital Status</label> <select id="tfa_MaritalStatus1" name="tfa_MaritalStatus1" class=""><option value="">Please select...</option>
<option value="tfa_Single1" class="">Single</option>
<option value="tfa_Married1" class="">Married</option>
<option value="tfa_Divorced" class="">Divorced</option>
<option value="tfa_Seperated1" class="">Seperated</option>
<option value="tfa_Widowed1" class="">Widowed</option></select> <br>
</div>
<div id="tfa_HighestLevelofEd-D" class="oneField">
<label class="preField" for="tfa_HighestLevelofEd">Highest Level of Education</label> <select id="tfa_HighestLevelofEd" name="tfa_HighestLevelofEd" class=""><option value="">Please select...</option>
<option value="tfa_HighSchoolorEqui" class="">High School or Equiveland</option>
<option value="tfa_AssocSomeCollege" class="">Assoc./Some College</option>
<option value="tfa_Bachelors" class="">Bachelors</option>
<option value="tfa_MD" class="">MD</option>
<option value="tfa_LLDJD" class="">LLD/JD</option>
<option value="tfa_Masters" class="">Masters</option>
<option value="tfa_PhD" class="">Ph.D</option>
<option value="tfa_Vocational" class="">Vocational</option>
<option value="tfa_Other1" class="">Other</option></select> <br>
</div>
<div id="tfa_DateofBirth-D" class="oneField">
<label class="preField" for="tfa_DateofBirth">Date of Birth</label> <input type="text" id="tfa_DateofBirth" name="tfa_DateofBirth" value="" size="10" class="validate-date"> <br>
</div>
<div id="tfa_Gender-D" class="oneField">
<label class="preField" for="tfa_Gender">Gender</label> <select id="tfa_Gender" name="tfa_Gender" class=""><option value="">Please select...</option>
<option value="tfa_Male" class="">Male</option>
<option value="tfa_Female" class="">Female</option></select> <br>
</div>
<fieldset id="tfa_Address" class="wfSection">
<legend>Address</legend>
<div id="tfa_StreetAddress-D" class="oneField">
<label class="preField" for="tfa_StreetAddress">Street Address</label> <input type="text" id="tfa_StreetAddress" name="tfa_StreetAddress" value="" size="50" class=""> <br>
</div>
<div id="tfa_Addresscontinued-D" class="oneField">
<label class="preField" for="tfa_Addresscontinued">Address continued</label> <input type="text" id="tfa_Addresscontinued" name="tfa_Addresscontinued" value="" size="50" class=""> <br>
</div>
<div id="id-1250047472446" class="inlineSection">
<div id="tfa_City-D" class="oneField">
<label class="inlineLabel" for="tfa_City">City</label> <input type="text" id="tfa_City" name="tfa_City" value="" size="" class=""> </div>
<div id="tfa_State-D" class="oneField">
<label class="inlineLabel" for="tfa_State">State</label> <select id="tfa_State" name="tfa_State" class=""><option value="">Please select...</option>
<option value="tfa_Pleaseselect" class="" selected>Please select</option>
<option value="tfa_Alabama" class="">Alabama</option>
<option value="tfa_Alaska" class="">Alaska</option>
<option value="tfa_Arizona" class="">Arizona</option>
<option value="tfa_Arkansas" class="">Arkansas</option>
<option value="tfa_California" class="">California</option>
<option value="tfa_Colorado" class="">Colorado</option>
<option value="tfa_Connecticut" class="">Connecticut</option>
<option value="tfa_Delaware" class="">Delaware</option>
<option value="tfa_DistrictOfColumb" class="">District Of Columbia</option>
<option value="tfa_Florida" class="">Florida</option>
<option value="tfa_Georgia" class="">Georgia</option>
<option value="tfa_Hawaii" class="">Hawaii</option>
<option value="tfa_Idaho" class="">Idaho</option>
<option value="tfa_Illinois" class="">Illinois</option>
<option value="tfa_Indiana" class="">Indiana</option>
<option value="tfa_Iowa" class="">Iowa</option>
<option value="tfa_Kansas" class="">Kansas</option>
<option value="tfa_Kentucky" class="">Kentucky</option>
<option value="tfa_Louisiana" class="">Louisiana</option>
<option value="tfa_Maine" class="">Maine</option>
<option value="tfa_Maryland" class="">Maryland</option>
<option value="tfa_Massachusetts" class="">Massachusetts</option>
<option value="tfa_Michigan" class="">Michigan</option>
<option value="tfa_Minnesota" class="">Minnesota</option>
<option value="tfa_Mississippi" class="">Mississippi</option>
<option value="tfa_Missouri" class="">Missouri</option>
<option value="tfa_Montana" class="">Montana</option>
<option value="tfa_Nebraska" class="">Nebraska</option>
<option value="tfa_Nevada" class="">Nevada</option>
<option value="tfa_NewHampshire" class="">New Hampshire</option>
<option value="tfa_NewJersey" class="">New Jersey</option>
<option value="tfa_NewMexico" class="">New Mexico</option>
<option value="tfa_NewYork" class="">New York</option>
<option value="tfa_NorthCarolina" class="">North Carolina</option>
<option value="tfa_NorthDakota" class="">North Dakota</option>
<option value="tfa_Ohio" class="">Ohio</option>
<option value="tfa_Oklahoma" class="">Oklahoma</option>
<option value="tfa_Oregon" class="">Oregon</option>
<option value="tfa_Pennsylvania" class="">Pennsylvania</option>
<option value="tfa_RhodeIsland" class="">Rhode Island</option>
<option value="tfa_SouthCarolina" class="">South Carolina</option>
<option value="tfa_SouthDakota" class="">South Dakota</option>
<option value="tfa_Tennessee" class="">Tennessee</option>
<option value="tfa_Texas" class="">Texas</option>
<option value="tfa_Utah" class="">Utah</option>
<option value="tfa_Vermont" class="">Vermont</option>
<option value="tfa_Virginia" class="">Virginia</option>
<option value="tfa_Washington" class="">Washington</option>
<option value="tfa_WestVirginia" class="">West Virginia</option>
<option value="tfa_Wisconsin" class="">Wisconsin</option>
<option value="tfa_Wyoming" class="">Wyoming</option>
<option value="tfa_PuertoRico" class="">Puerto Rico</option>
<option value="tfa_VirginIsland" class="">Virgin Island</option>
<option value="tfa_NorthernMarianaI" class="">Northern Mariana Islands</option>
<option value="tfa_Guam" class="">Guam</option>
<option value="tfa_AmericanSamoa" class="">American Samoa</option>
<option value="tfa_Palau" class="">Palau</option></select> </div>
<div id="tfa_Zip-D" class="oneField">
<label class="inlineLabel" for="tfa_Zip">Zip</label> <input type="text" id="tfa_Zip" name="tfa_Zip" value="" size="6" class=""> </div>
</div>
</fieldset>
</fieldset>
</div>
<div class="wfPage " id="wfPgIndex-2">
<h3>Current Insurance Info</h3>
<fieldset id="tfa_CurrentInsurance" class="wfSection">
<legend>Current Insurance</legend>
<div id="tfa_Doyoucurrentlyha-D" class="oneField labelsLeftAligned">
<label class="preField" for="tfa_Doyoucurrentlyha">Do you currently have home (not condo or renters) insurance? <span class="reqMark">*</span></label> <select id="tfa_Doyoucurrentlyha" name="tfa_Doyoucurrentlyha" class="required"><option value="">Please select...</option>
<option value="tfa_YeswithAnotherIn" class="switch-a">Yes, with Another Insurance Company</option>
<option value="tfa_NoFirstTimeHomeB" class="">No, First Time Home Buyer</option>
<option value="tfa_NoRenter" class="">No, Renter</option>
<option value="tfa_NoCondoOwner" class="">No, Condo Owner</option>
<option value="tfa_NoLivewithRelati" class="">No, Live with Relatives or Friends</option>
<option value="tfa_NoWasonActiveMil" class="">No, Was on Active Military Duty</option>
<option value="tfa_NoOwnaHomeButPri" class="switch-e">No, Own a Home, But Prior Policy Cancelled</option>
<option value="tfa_NoOwnaHomeButNot" class="">No, Own a Home, But Not Currently Insured</option></select> <br>
</div>
<div id="tfa_Whoisyourcurrent-D" class="offstate-a oneField">
<label class="preField" for="tfa_Whoisyourcurrent">Who is your current home insurance company? <span class="reqMark">*</span></label> <select id="tfa_Whoisyourcurrent" name="tfa_Whoisyourcurrent" class="required"><option value="">Please select...</option>
<option value="tfa_AlfaInsGrp" class="">Alfa Ins Grp</option>
<option value="tfa_AllianzinclFirem" class="">Allianz (incl Firemans Fund)</option>
<option value="tfa_AllmericaPampCCo" class="">Allmerica P&C Cos (Citizens; Hanover)Allstate Ins Grp</option>
<option value="tfa_AmerBankersInsGr" class="">Amer Bankers Ins Grp (incl Voyager)</option>
<option value="tfa_AmericanFamily" class="">American Family</option>
<option value="tfa_AmericanMutual" class="">American Mutual</option>
<option value="tfa_AmicaMutualInsCo" class="">Amica Mutual Ins Co</option>
<option value="tfa_AutoClubMichigan" class="">Auto Club - Michigan</option>
<option value="tfa_AutoOwnersGrp" class="">Auto-Owners Grp</option>
<option value="tfa_CalifStAutoGrpin" class="">Calif St Auto Grp (incl AAA)</option>
<option value="tfa_CGUGrpinclCUampY" class="">CGU Grp (incl CU York)</option>
<option value="tfa_ChubbGrp" class="">Chubb Grp</option>
<option value="tfa_CIGNAGrpClarendo" class="">CIGNA GrpClarendon Ins Grp</option>
<option value="tfa_CNAInsCosinclCon" class="">CNA Ins Cos (incl Continental)</option>
<option value="tfa_ColonialPenn" class="">Colonial Penn</option>
<option value="tfa_CountryCompanies" class="">Country Companies</option>
<option value="tfa_ErieInsGrp" class="">Erie Ins Grp</option>
<option value="tfa_FarmersInsGrp" class="">Farmers Ins Grp</option>
<option value="tfa_GEICOBerkshireHa" class="">GEICO (Berkshire Hathaway)</option>
<option value="tfa_GrangeMutualCasG" class="">Grange Mutual Cas Grp</option>
<option value="tfa_HarleysvilleInsC" class="">Harleysville Ins Cos</option>
<option value="tfa_HartfordInsGrp" class="">Hartford Ins Grp</option>
<option value="tfa_HoraceMannInsGrp" class="">Horace Mann Ins Grp</option>
<option value="tfa_KemperInsGrp" class="">Kemper Ins Grp</option>
<option value="tfa_LibertyMutual" class="">Liberty Mutual</option>
<option value="tfa_MetropolitanGrp" class="">Metropolitan Grp</option>
<option value="tfa_MotoristsAmHrdwr" class="">Motorists - Am Hrdwr Grp</option>
<option value="tfa_NationwideGrp" class="">Nationwide Grp</option>
<option value="tfa_OhioCasualtyGrpi" class="">Ohio Casualty Grp (incl Avomark)</option>
<option value="tfa_PrudentialofAmGr" class="">Prudential of Am Grp</option>
<option value="tfa_SafecoInsCosincl" class="">Safeco Ins Cos (incl Amer States)</option>
<option value="tfa_SentryInsGrpincl" class="">Sentry Ins Grp (incl Dairyland)</option>
<option value="tfa_ShelterInsCos" class="">Shelter Ins Cos</option>
<option value="tfa_SouthernFBGrpinc" class="">Southern FB Grp (incl Farm Bureaus)</option>
<option value="tfa_StPaulCosinclUSF" class="">St Paul Cos (incl USF&G)</option>
<option value="tfa_StateAutoInsCos" class="">State Auto Ins Cos</option>
<option value="tfa_StateFarmGrp" class="">State Farm Grp</option>
<option value="tfa_TIGHoldingsGrp" class="">TIG Holdings Grp</option>
<option value="tfa_TravelersInsGrp" class="">Travelers Ins Grp</option>
<option value="tfa_Unknown" class="">Unknown</option>
<option value="tfa_USAA" class="">USAA</option>
<option value="tfa_VestaInsGrpinclS" class="">Vesta Ins Grp (incl Shelby)</option>
<option value="tfa_WawanesaMutual" class="">Wawanesa Mutual</option>
<option value="tfa_WinterthurSwissG" class="">Winterthur Swiss Grp (incl Republic)</option>
<option value="tfa_WRBerkleyGrpincl" class="">WR Berkley Grp (incl Acadia)</option>
<option value="tfa_ZurichGrpMaineBo" class="">Zurich Grp (Maine Bonding Maryland Cas)</option>
<option value="tfa_Other" class="">Other</option></select> <br>
</div>
<div id="tfa_Whendoesyourcurr-D" class="offstate-a oneField labelsAbove">
<label class="preField" for="tfa_Whendoesyourcurr">When does your current policy expire?</label> <input type="text" id="tfa_Whendoesyourcurr" name="tfa_Whendoesyourcurr" value="" size="10" class="validate-datecal"> <br>
</div>
<div id="tfa_Whatyeardidyoube-D" class="offstate-a oneField">
<label class="preField" for="tfa_Whatyeardidyoube">What year did you begin your home insurance policy with this company? </label> <select id="tfa_Whatyeardidyoube" name="tfa_Whatyeardidyoube" class=""><option value="">Please select...</option>
<option value="tfa_2010" class="">2010</option>
<option value="tfa_2009" class="">2009</option>
<option value="tfa_2008" class="">2008</option>
<option value="tfa_2007" class="">2007</option>
<option value="tfa_2006" class="">2006</option>
<option value="tfa_2005" class="">2005</option>
<option value="tfa_2004" class="">2004</option>
<option value="tfa_2003" class="">2003</option>
<option value="tfa_2002" class="">2002</option>
<option value="tfa_2001" class="">2001</option>
<option value="tfa_2000" class="">2000</option>
<option value="tfa_1999" class="">1999</option>
<option value="tfa_1998" class="">1998</option>
<option value="tfa_1997" class="">1997</option>
<option value="tfa_1996" class="">1996</option>
<option value="tfa_1995" class="">1995</option>
<option value="tfa_1994" class="">1994</option>
<option value="tfa_1993" class="">1993</option>
<option value="tfa_1992" class="">1992</option>
<option value="tfa_1991" class="">1991</option>
<option value="tfa_1990" class="">1990</option>
<option value="tfa_1989" class="">1989</option>
<option value="tfa_1988" class="">1988</option>
<option value="tfa_1987" class="">1987</option>
<option value="tfa_1986" class="">1986</option>
<option value="tfa_1985" class="">1985</option>
<option value="tfa_1984" class="">1984</option>
<option value="tfa_1983" class="">1983</option>
<option value="tfa_1982" class="">1982</option>
<option value="tfa_1981" class="">1981</option>
<option value="tfa_1980orPrior" class="">1980 or Prior</option></select> <br>
</div>
<div id="tfa_Haveyouhadahomec-D" class="offstate-e oneField">
<label class="preField">Have you had a home, condo, or renters policy cancelled or non-renewed in the past 12 months? </label> <span id="tfa_Haveyouhadahomec" class="choices"><span class="oneChoice"><input type="radio" value="tfa_Yes4" class="switch-d" id="tfa_Yes4" name="tfa_Haveyouhadahomec"><label for="tfa_Yes4" class="postField">Yes</label></span><span class="oneChoice"><input type="radio" value="tfa_No4" class="" id="tfa_No4" name="tfa_Haveyouhadahomec"><label for="tfa_No4" class="postField">No</label></span></span> <br>
</div>
<div id="tfa_Pleaseselectthen-D" class="offstate-d oneField">
<label class="preField" for="tfa_Pleaseselectthen">Please select the name of the insurance company who cancelled or non-renewed your policy. </label> <input type="text" id="tfa_Pleaseselectthen" name="tfa_Pleaseselectthen" value="" size="40" class=""> <br>
</div>
<div id="tfa_ReasonforCancell-D" class="offstate-d oneField">
<label class="preField" for="tfa_ReasonforCancell">Reason for Cancellation </label> <select id="tfa_ReasonforCancell" name="tfa_ReasonforCancell" class=""><option value="">Please select...</option>
<option value="tfa_UnderwritingReas" class="">Underwriting Reasons</option>
<option value="tfa_NonPayment" class="">Non Payment</option>
<option value="tfa_CarrierLeftState" class="">Carrier Left State</option></select> <br>
</div>
<div id="tfa_Duringthepastfiv-D" class="oneField">
<label class="preField">During the past five years, have you had a claim or loss? </label> <span id="tfa_Duringthepastfiv" class="choices"><span class="oneChoice"><input type="radio" value="tfa_Yes" class="switch-b" id="tfa_Yes" name="tfa_Duringthepastfiv"><label for="tfa_Yes" class="postField">Yes</label></span><span class="oneChoice"><input type="radio" value="tfa_No" class="" id="tfa_No" name="tfa_Duringthepastfiv"><label for="tfa_No" class="postField">No</label></span></span> <br>
</div>
<div id="tfa_BriefExplanation-D" class="offstate-b oneField">
<label class="preField" for="tfa_BriefExplanation">Brief Explanation: <span class="reqMark">*</span></label> <textarea cols="40" rows="4" id="tfa_BriefExplanation" name="tfa_BriefExplanation" class="required"></textarea> <br>
</div>
<div id="tfa_TotalAmountofCla-D" class="offstate-b oneField">
<label class="preField" for="tfa_TotalAmountofCla">Total Amount of Claims: <span class="reqMark">*</span></label> <input type="text" id="tfa_TotalAmountofCla" name="tfa_TotalAmountofCla" value="" size="40" class="validate-float required"> <br>
</div>
</fieldset>
<fieldset id="tfa_OtherInsurance" class="wfSection">
<legend>Other Insurance</legend>
<div id="tfa_Doyoucurrentlyha1-D" class="oneField">
<label class="preField">Do you currently have an auto policy with Liberty Mutual?</label> <span id="tfa_Doyoucurrentlyha1" class="choices"><span class="oneChoice"><input type="radio" value="tfa_Yes1" class="" id="tfa_Yes1" name="tfa_Doyoucurrentlyha1"><label for="tfa_Yes1" class="postField">Yes</label></span><span class="oneChoice"><input type="radio" value="tfa_No1" class="switch-c" id="tfa_No1" name="tfa_Doyoucurrentlyha1"><label for="tfa_No1" class="postField">No</label></span></span> <br>
</div>
<div id="tfa_Saveupto10onyour-D" class="offstate-c oneField labelsAbove">
<label class="preField">Save up to 10% on your Home Insurance when you buy Liberty Mutual Auto Insurance.
</label> <span id="tfa_Saveupto10onyour" class="choices"><span class="oneChoice"><input type="checkbox" value="tfa_Getmeaquote" class="" id="tfa_Getmeaquote" name="tfa_Getmeaquote"><label for="tfa_Getmeaquote" class="postField">Get me a quote</label></span></span> <br>
</div>
<div id="tfa_Doesanyoneintheh-D" class="oneField labelsAbove">
<label class="preField">Does anyone in the household have an active Life Insurance policy with Liberty Mutual? </label> <span id="tfa_Doesanyoneintheh" class="choices"><span class="oneChoice"><input type="radio" value="tfa_Yes2" class="" id="tfa_Yes2" name="tfa_Doesanyoneintheh"><label for="tfa_Yes2" class="postField">Yes</label></span><span class="oneChoice"><input type="radio" value="tfa_No2" class="" id="tfa_No2" name="tfa_Doesanyoneintheh"><label for="tfa_No2" class="postField">No</label></span></span> <br>
</div>
<div id="tfa_Doyoucurrentlyha2-D" class="oneField labelsAbove">
<label class="preField">Do you currently have a Personal Liability (Umbrella) policy with Liberty Mutual? </label> <span id="tfa_Doyoucurrentlyha2" class="choices"><span class="oneChoice"><input type="radio" value="tfa_Yes3" class="" id="tfa_Yes3" name="tfa_Doyoucurrentlyha2"><label for="tfa_Yes3" class="postField">Yes</label></span><span class="oneChoice"><input type="radio" value="tfa_No3" class="" id="tfa_No3" name="tfa_Doyoucurrentlyha2"><label for="tfa_No3" class="postField">No</label></span></span> <br>
</div>
</fieldset>
</div>
<div class="wfPage " id="wfPgIndex-3">
<h3>Property Info</h3>
<fieldset id="tfa_PolicyStartDate" class="wfSection">
<legend>Policy Start Date</legend>
<div id="tfa_NewPolicyDesired-D" class="oneField">
<label class="preField" for="tfa_NewPolicyDesired">New Policy Desired Start Date</label> <input type="text" id="tfa_NewPolicyDesired" name="tfa_NewPolicyDesired" value="" size="40" class="validate-datecal"> <br>
</div>
</fieldset>
<fieldset id="tfa_PropertyInformat" class="wfSection">
<legend>Property Information</legend>
<div id="tfa_ApproximateYearB-D" class="oneField">
<label class="preField" for="tfa_ApproximateYearB"> Approximate Year Built</label> <input type="text" id="tfa_ApproximateYearB" name="tfa_ApproximateYearB" value="" size="40" class="validate-integer"> <br>
</div>
<div id="tfa_3111297785689-D" class="oneField"> <input type="text" id="tfa_3111297785689" name="tfa_3111297785689" value="" size="40" class=""> <br>
</div>
<div id="tfa_3111301587565" class="inlineSection">
<div id="tfa_Month-D" class="oneField">
<label class="inlineLabel" for="tfa_Month">Month</label> <select id="tfa_Month" name="tfa_Month" class=""><option value="">Please select...</option>
<option value="tfa_Jan" class="">Jan</option>
<option value="tfa_Feb" class="">Feb</option>
<option value="tfa_Mar" class="">Mar</option>
<option value="tfa_Apr" class="">Apr</option>
<option value="tfa_May" class="">May</option>
<option value="tfa_Jun" class="">Jun</option>
<option value="tfa_Jul" class="">Jul</option>
<option value="tfa_Aug" class="">Aug</option>
<option value="tfa_Sep" class="">Sep</option>
<option value="tfa_Oct" class="">Oct</option>
<option value="tfa_Nov" class="">Nov</option>
<option value="tfa_Dec" class="">Dec</option></select> </div>
<div id="tfa_Year-D" class="oneField">
<label class="inlineLabel" for="tfa_Year">Year</label> <input type="text" id="tfa_Year" name="tfa_Year" value="" size="5" class=""> </div>
</div>
<div id="tfa_TypeofHome-D" class="oneField">
<label class="preField" for="tfa_TypeofHome">Type of Home</label> <select id="tfa_TypeofHome" name="tfa_TypeofHome" class=""><option value="">Please select...</option>
<option value="tfa_SingleFamily" class="">Single Family</option>
<option value="tfa_TwoFamily" class="">Two Family</option>
<option value="tfa_3111331065626" class=""></option></select> <br>
</div>
<div id="tfa_PrimaryMaterialo-D" class="oneField">
<label class="preField" for="tfa_PrimaryMaterialo">Primary Material on Outside Walls</label> <select id="tfa_PrimaryMaterialo" name="tfa_PrimaryMaterialo" class=""><option value="">Please select...</option>
<option value="tfa_3111334146705" class=""></option></select> <br>
</div>
<div id="tfa_MaterialCovering-D" class="oneField">
<label class="preField" for="tfa_MaterialCovering">Material Covering Roof</label> <select id="tfa_MaterialCovering" name="tfa_MaterialCovering" class=""><option value="">Please select...</option>
<option value="tfa_3111336166144" class=""></option></select> <br>
</div>
<div id="tfa_AgeofRoof-D" class="oneField">
<label class="preField" for="tfa_AgeofRoof">Age of Roof</label> <select id="tfa_AgeofRoof" name="tfa_AgeofRoof" class=""><option value="">Please select...</option>
<option value="tfa_3111339588438" class=""></option></select> <br>
</div>
<div class="htmlsection" id="html-tmp-1590787801669"><p>Estimate the cost to replace your home, including attached structures. Do not include land, foundation or detached structures in your estimate.</p></div>
<div id="tfa_EstimatedReplace-D" class="oneField">
<label class="preField" for="tfa_EstimatedReplace">Estimated Replacement Cost:</label> <input type="text" id="tfa_EstimatedReplace" name="tfa_EstimatedReplace" value="" size="40" class=""> <br>
</div>
<fieldset id="tfa_SafetyInformatio" class="wfSection">
<legend>Safety Information</legend>
<div id="tfa_3111345900946" class="inlineSection"><div id="tfa_HomeSafetyDevice-D" class="oneField labelsLeftAligned">
<label class="inlineLabel">Home Safety Devices (check all that apply)
</label> <span id="tfa_HomeSafetyDevice" class="choices"><br><span class="oneChoice"><input type="checkbox" value="tfa_BurglarAlarm" class="" id="tfa_BurglarAlarm" name="tfa_BurglarAlarm"><label for="tfa_BurglarAlarm" class="postField">Burglar Alarm</label></span><br><span class="oneChoice"><input type="checkbox" value="tfa_Deadboltlocksone" class="" id="tfa_Deadboltlocksone" name="tfa_Deadboltlocksone"><label for="tfa_Deadboltlocksone" class="postField">Dead bolt locks on exterior doors</label></span><br><span class="oneChoice"><input type="checkbox" value="tfa_Smokealarmsonall" class="" id="tfa_Smokealarmsonall" name="tfa_Smokealarmsonall"><label for="tfa_Smokealarmsonall" class="postField">Smoke alarms on all floors </label></span><br><span class="oneChoice"><input type="checkbox" value="tfa_Oneormorefireext" class="" id="tfa_Oneormorefireext" name="tfa_Oneormorefireext"><label for="tfa_Oneormorefireext" class="postField">One or more fire extinguishers</label></span><br><span class="oneChoice"><input type="checkbox" value="tfa_Firealarmreporti" class="" id="tfa_Firealarmreporti" name="tfa_Firealarmreporti"><label for="tfa_Firealarmreporti" class="postField">Fire alarm reporting to a monitoring center</label></span><br><span class="oneChoice"><input type="checkbox" value="tfa_Sprinklersystemo" class="" id="tfa_Sprinklersystemo" name="tfa_Sprinklersystemo"><label for="tfa_Sprinklersystemo" class="postField">Sprinkler system on all floors </label></span></span> </div></div>
</fieldset>
</fieldset>
</div>
<div class="wfPage " id="wfPgIndex-4">
<h3>Additional Info</h3>
<fieldset id="tfa_AdditionalHomeIn" class="wfSection">
<legend>Additional Home Information</legend>
<div class="htmlsection" id="html-tmp-2539693602936"><p>Since the home was built, have any of the following been upgraded?</p></div>
<div id="tfa_ElectricSystem-D" class="oneField">
<label class="preField">Electric System</label> <span id="tfa_ElectricSystem" class="choices"><span class="oneChoice"><input type="radio" value="tfa_Yes6" class="switch-g" id="tfa_Yes6" name="tfa_ElectricSystem"><label for="tfa_Yes6" class="postField">Yes</label></span><span class="oneChoice"><input type="radio" value="tfa_No6" class="" id="tfa_No6" name="tfa_ElectricSystem"><label for="tfa_No6" class="postField">No</label></span></span> <br>
</div>
<div id="tfa_YearElectricUpda-D" class="offstate-g oneField">
<label class="preField" for="tfa_YearElectricUpda">Year Electric Updated</label> <input type="text" id="tfa_YearElectricUpda" name="tfa_YearElectricUpda" value="" size="5" class=""> <br>
</div>
<div id="tfa_PlumbingSystem-D" class="oneField">
<label class="preField">Plumbing System</label> <span id="tfa_PlumbingSystem" class="choices"><span class="oneChoice"><input type="radio" value="tfa_Yes7" class="switch-h" id="tfa_Yes7" name="tfa_PlumbingSystem"><label for="tfa_Yes7" class="postField">Yes</label></span><span class="oneChoice"><input type="radio" value="tfa_No7" class="" id="tfa_No7" name="tfa_PlumbingSystem"><label for="tfa_No7" class="postField">No</label></span></span> <br>
</div>
<div id="tfa_YearPlumbingUpda-D" class="offstate-h oneField">
<label class="preField" for="tfa_YearPlumbingUpda">Year Plumbing Updated</label> <input type="text" id="tfa_YearPlumbingUpda" name="tfa_YearPlumbingUpda" value="" size="5" class=""> <br>
</div>
<div id="tfa_HeatingandorCool-D" class="oneField">
<label class="preField">Heating and/or Cooling System</label> <span id="tfa_HeatingandorCool" class="choices"><span class="oneChoice"><input type="radio" value="tfa_Yes8" class="switch-i" id="tfa_Yes8" name="tfa_HeatingandorCool"><label for="tfa_Yes8" class="postField">Yes </label></span><span class="oneChoice"><input type="radio" value="tfa_No8" class="" id="tfa_No8" name="tfa_HeatingandorCool"><label for="tfa_No8" class="postField">No</label></span></span> <br>
</div>
<div id="tfa_YearHeatingandCo-D" class="offstate-i oneField">
<label class="preField" for="tfa_YearHeatingandCo">Year Heating and Cooling Updated</label> <input type="text" id="tfa_YearHeatingandCo" name="tfa_YearHeatingandCo" value="" size="5" class=""> <br>
</div>
<div id="tfa_NumberofPeopleli-D" class="oneField">
<label class="preField" for="tfa_NumberofPeopleli">Number of People living in home</label> <select id="tfa_NumberofPeopleli" name="tfa_NumberofPeopleli" class=""><option value="">Please select...</option>
<option value="tfa_1" class="">1</option>
<option value="tfa_2" class="">2</option>
<option value="tfa_3" class="">3</option>
<option value="tfa_4" class="">4</option>
<option value="tfa_5" class="">5</option>
<option value="tfa_6" class="">6</option>
<option value="tfa_7" class="">7</option>
<option value="tfa_8" class="">8</option>
<option value="tfa_9" class="">9</option>
<option value="tfa_10" class="">10+</option></select> <br>
</div>
<div id="tfa_NumberOvertheAge-D" class="oneField">
<label class="preField" for="tfa_NumberOvertheAge">Number Over the Age 18</label> <select id="tfa_NumberOvertheAge" name="tfa_NumberOvertheAge" class=""><option value="">Please select...</option>
<option value="tfa_11" class="">1</option>
<option value="tfa_21" class="">2</option>
<option value="tfa_31" class="">3</option>
<option value="tfa_41" class="">4</option>
<option value="tfa_51" class="">5</option>
<option value="tfa_61" class="">6</option>
<option value="tfa_71" class="">7</option>
<option value="tfa_81" class="">8</option>
<option value="tfa_91" class="">9</option>
<option value="tfa_101" class="">10+</option>
<option value="tfa_4122643170745" class=""></option></select> <br>
</div>
<div id="tfa_NumberofSmokers-D" class="oneField">
<label class="preField" for="tfa_NumberofSmokers">Number of Smokers</label> <select id="tfa_NumberofSmokers" name="tfa_NumberofSmokers" class=""><option value="">Please select...</option>
<option value="tfa_12" class="">1</option>
<option value="tfa_22" class="">2</option>
<option value="tfa_32" class="">3</option>
<option value="tfa_42" class="">4</option>
<option value="tfa_52" class="">5</option>
<option value="tfa_62" class="">6</option>
<option value="tfa_72" class="">7</option>
<option value="tfa_82" class="">8</option>
<option value="tfa_92" class="">9</option>
<option value="tfa_102" class="">10+</option>
<option value="tfa_4122666032560" class=""></option></select> <br>
</div>
<div id="tfa_Isthereanundergr-D" class="oneField">
<label class="preField" for="tfa_Isthereanundergr">Is there an underground fuel storage tank on the property? </label> <select id="tfa_Isthereanundergr" name="tfa_Isthereanundergr" class=""><option value="">Please select...</option>
<option value="tfa_Yes9" class="">Yes</option>
<option value="tfa_No9" class="">No</option></select> <br>
</div>
<div id="tfa_Arethereanydogso-D" class="oneField">
<label class="preField" for="tfa_Arethereanydogso">Are there any dogs on the property? </label> <select id="tfa_Arethereanydogso" name="tfa_Arethereanydogso" class=""><option value="">Please select...</option>
<option value="tfa_Yes10" class="">Yes</option>
<option value="tfa_No10" class="">No</option></select> <br>
</div>
</fieldset>
<fieldset id="tfa_ApplicantSavings" class="wfSection">
<legend>Applicant Savings</legend>
<div id="tfa_HighestLevelofEd1-D" class="oneField">
<label class="preField" for="tfa_HighestLevelofEd1"> Highest Level of Education Completed</label> <select id="tfa_HighestLevelofEd1" name="tfa_HighestLevelofEd1" class=""><option value="">Please select...</option>
<option value="tfa_4122686522982" class=""></option></select> <br>
</div>
<div id="tfa_CurrentOccupatio-D" class="oneField">
<label class="preField" for="tfa_CurrentOccupatio">Current Occupation</label> <select id="tfa_CurrentOccupatio" name="tfa_CurrentOccupatio" class=""><option value="">Please select...</option>
<option value="tfa_4122689371789" class=""></option></select> <br>
</div>
<div id="tfa_CurrentEmployero-D" class="oneField">
<label class="preField" for="tfa_CurrentEmployero">Current Employer (optional)</label> <input type="text" id="tfa_CurrentEmployero" name="tfa_CurrentEmployero" value="" size="40" class=""> <br>
</div>
</fieldset>
</div>
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