{"id":105,"date":"2019-08-19T06:59:04","date_gmt":"2019-08-19T06:59:04","guid":{"rendered":"https:\/\/pipalinsurance.com\/?page_id=105"},"modified":"2024-01-08T10:53:25","modified_gmt":"2024-01-08T10:53:25","slug":"contact-4","status":"publish","type":"page","link":"https:\/\/pipalinsurance.com\/?page_id=105","title":{"rendered":"Contact"},"content":{"rendered":"<div id=\"mauticform_wrapper_websiteregistrationform\" class=\"mauticform_wrapper\"><\/div>\n\n\n<div id=\"content\">\n    <!--<h3 text-align:center>GET IN TOUCH<\/h3>-->\n    <\/div>\n    <!--<center><h3><pre>GET IN TOUCH<\/pre><\/h3><\/center>-->\n    <script type=\"text\/javascript\">\n        \/** This section is only needed once per page if manually copying **\/\n        if (typeof MauticSDKLoaded == 'undefined') {\n            var MauticSDKLoaded = true;\n            var head            = document.getElementsByTagName('head')[0];\n            var script          = document.createElement('script');\n            script.type         = 'text\/javascript';\n            script.src          = 'https:\/\/pipalinsurancemarketingphp80.simplecrmdemo.com\/media\/js\/mautic-form.js?v7f87c9ec';\n            script.onload       = function() {\n                MauticSDK.onLoad();\n            };\n            head.appendChild(script);\n            var MauticDomain = 'https:\/\/pipalinsurancemarketingphp80.simplecrmdemo.com';\n            var MauticLang   = {\n                'submittingMessage': \"Please wait...\"\n            }\n        }else if (typeof MauticSDK != 'undefined') {\n            MauticSDK.onLoad();\n        }\n    <\/script>\n     <style>\n         .mauticform-errormsg { display: block; color: red; margin-top: 2px; }\n            * {\n                box-sizing: border-box;\n            }\n    \n            input[type=text],\n            select,\n            textarea {\n                width: 50%;\n                padding: 6px;\n                border: 1px solid #ccc;\n                border-radius: 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class=\"mauticform-errormsg\" style=\"display: none;\"><\/span>\n    \n    <\/style>\n                    <\/div>\n                <\/div>\n                \n                <div class=\"row\">\n                    <div class=\"col-25\">\n                        <label class= \"required\" for=\"lname\"><b>Last Name<\/b><\/label>\n                        \n                    <\/div>\n                    <div class=\"col-75\">\n                        <input type=\"text\" id=\"lname\" name=\"mauticform[last_name]\"required \/>\n    <span class=\"mauticform-errormsg\" style=\"display: none;\"><\/span>\n    <style>\n      .required:after {\n        content:\" *\";\n        color: red;\n      }\n    <\/style>                    \n                    <\/div>\n                <\/div>\n                \n                <div class=\"row\">\n                    <div class=\"col-25\">\n                        <label class= \"required\" for=\"Email\"><b>Email<\/b><\/label>\n                    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color: red;\n      }\n    <\/style>\n                    <\/div>\n                <\/div>\n    \n                <div class=\"row\">\n                    <div class=\"col-25\">\n                        <label for=\"category1\"><b>Category<\/b><\/label>\n                    <\/div>\n                    <div class=\"col-75\">\n                        <select id=\"category1\" name=\"mauticform[category1]\">\n                            <option selected=\"selected\"value=\"\"><\/option>\n    <option value=\"Individual\">Individual<\/option>                    \n    <option value=\"Corporate\">Corporate<\/option>                   \n                        <\/select>\n    <span class=\"mauticform-errormsg\" style=\"display: none;\"><\/span>\n                    <\/div>\n                <\/div>\n\n                <div class=\"row\">\n                    <div class=\"col-25\">\n                        <label for=\"insurancecategory\"><b>Insurance Category<\/b><\/label>\n                    <\/div>\n                    <div class=\"col-75\">\n                        <select id=\"insurancecategory\" name=\"mauticform[insurancecategory]\">\n                            <option selected=\"selected\"value=\"\"><\/option>\n    <option value=\"Life_Insurance\">Life Insurance<\/option>                    \n<option value=\"General_Insurance\">General Insurance<\/option>\n<option value=\"Term_Insurance_Plans\">Term Insurance Plans<\/option>\n<option value=\"Savings_Plans\">Savings Plans<\/option>\n<option value=\"Retirement_Plans\">Retirement Plans<\/option>\n<option value=\"ULIP_Plans\">ULIP Plans<\/option>                          \n                        <\/select>\n    <span class=\"mauticform-errormsg\" style=\"display: none;\"><\/span>\n                    <\/div>\n                <\/div>\n    \n                <div class=\"row\">\n                    <div class=\"col-25\">\n                        <label for=\"product_type1\"><b>Product Type<\/b><\/label>\n                  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none;\"><\/span>\n                    <\/div>\n                <\/div>\n\n     \n    <div class=\"row\">\n                    <div class=\"col-25\">\n                        <label class= \"required\" for=\"phone\"><b>Captcha (1+2=?)<\/b><\/label>\n                    <\/div>\n                    <div class=\"col-75\">\n                        <input id=\"mauticform_input_websiteregistrationform_captcha\" name=\"mauticform[captcha]\" value=\"\" class=\"mauticform-input\" type=\"text\">\n                    <span class=\"mauticform-errormsg\" style=\"display: none;\">This is required.<\/span>\n                    <\/div>\n                <\/div>\n                    <div class=\"row\">\n    <button type=\"submit\" name=\"mauticform[submit]\" id=\"mauticform_input_websiteregistrationform_submit\" value=\"\" class=\"mauticform-button btn btn-default\">Submit<\/button>\n                <\/div>  \n                <\/div>\n            \n    \n            <input type=\"hidden\" 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