{"title":"Jewelry & Fine Arts Proposal Request","showQuestionNumbers":"onPage","questionErrorLocation":"bottom","checkErrorsMode":"onNextPage","completedHtml":"<div class=\"sir-thanks\"><h1>Thank you — your request is in.</h1><p>Thank you for your quote request. Please look for a response within 24-48 hours.</p></div>","pages":[{"name":"page__name","elements":[{"type":"text","name":"name","title":"Name","isRequired":true}]},{"name":"page__how_did_you_find_us","elements":[{"type":"radiogroup","choices":[{"value":"Search engines","text":"Search engines"},{"value":"Social media","text":"Social media"},{"value":"News story","text":"News story"},{"value":"Referral","text":"Referral"},{"value":"I am a current client of Susman Insurance","text":"I am a current client of Susman Insurance"}],"choicesOrder":"none","name":"how_did_you_find_us","title":"How did you find us?","isRequired":true}]},{"name":"page__name_of_referral","elements":[{"type":"text","name":"name_of_referral","title":"Name of Referral","isRequired":true,"visibleIf":"({how_did_you_find_us} = 'Referral')"}]},{"name":"page__phone","elements":[{"type":"text","inputType":"tel","validators":[{"type":"regex","regex":"^\\D*(\\d\\D*){10,}$","text":"Please enter a phone number with at least 10 digits."}],"name":"phone","title":"Phone","isRequired":true}]},{"name":"page__email","elements":[{"type":"text","inputType":"email","validators":[{"type":"email"}],"name":"email","title":"Email","isRequired":true}]},{"name":"page__address_where_items_are_stored","title":"Address where items are stored","elements":[{"type":"text","name":"address_where_items_are_stored__street_address","title":"Street Address","isRequired":true},{"type":"text","name":"address_where_items_are_stored__city","title":"City","isRequired":true},{"type":"text","name":"address_where_items_are_stored__state","title":"State","isRequired":true},{"type":"text","inputType":"number","name":"address_where_items_are_stored__zip_code","title":"ZIP Code","isRequired":true}]},{"name":"page__have_you_had_any_claims_in_the_last_5_years","elements":[{"type":"radiogroup","choices":["Yes","No"],"name":"have_you_had_any_claims_in_the_last_5_years","title":"Have you had any claims in the last 5 years?","isRequired":true}]},{"name":"page__please_tell_us_the_total_amount_of_each_category_below_you_wish_to_insur","title":"Please tell us the total amount of each category below you wish to insure:","elements":[{"type":"text","inputType":"number","name":"please_tell_us_the_total_amount_of_each_category_below_you_wish_to_insur__jewelry","title":"Jewelry","description":"$"},{"type":"text","inputType":"number","name":"please_tell_us_the_total_amount_of_each_category_below_you_wish_to_insur__fine_arts","title":"Fine Arts","description":"$"},{"type":"text","inputType":"number","name":"please_tell_us_the_total_amount_of_each_category_below_you_wish_to_insur__china","title":"China","description":"$"},{"type":"text","inputType":"number","name":"please_tell_us_the_total_amount_of_each_category_below_you_wish_to_insur__wine","title":"Wine","description":"$"},{"type":"text","inputType":"number","name":"please_tell_us_the_total_amount_of_each_category_below_you_wish_to_insur__other","title":"Other","description":"$"}]},{"name":"page__are_you_working_with_one_of_our_agents","elements":[{"type":"radiogroup","choices":["Yes","No"],"name":"are_you_working_with_one_of_our_agents","title":"Are you working with one of our Agents?","isRequired":true}]},{"name":"page__agent_s_name","elements":[{"type":"text","name":"agent_s_name","title":"Agent’s name","isRequired":true,"visibleIf":"({are_you_working_with_one_of_our_agents} = 'Yes')"}]}]}