{"id":2004,"date":"2023-05-30T23:16:08","date_gmt":"2023-05-30T21:16:08","guid":{"rendered":"https:\/\/h2oguru.co.za\/?page_id=2004"},"modified":"2025-01-15T01:29:10","modified_gmt":"2025-01-14T23:29:10","slug":"water-sample-analysis-request-cpt","status":"publish","type":"page","link":"https:\/\/h2oguru.co.za\/?page_id=2004","title":{"rendered":"Water Sample Analysis Request form Cape Town"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; custom_padding_last_edited=&#8221;on|phone&#8221; disabled_on=&#8221;on|on|on&#8221; _builder_version=&#8221;4.20.0&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;rgba(255,255,255,0.5)&#8221; background_image=&#8221;https:\/\/h2oguru.co.za\/wp-content\/uploads\/2022\/11\/packages_top_image.jpg&#8221; background_size=&#8221;contain&#8221; background_position=&#8221;top_center&#8221; background_blend=&#8221;lighten&#8221; custom_padding=&#8221;60px||60px||true|false&#8221; custom_padding_tablet=&#8221;0px||0px||true|false&#8221; custom_padding_phone=&#8221;0px||0px||true|false&#8221; background_last_edited=&#8221;on|desktop&#8221; background_image_tablet=&#8221;https:\/\/h2oguru.co.za\/wp-content\/uploads\/2022\/11\/top_image_mobile.jpg&#8221; background_image_phone=&#8221;https:\/\/h2oguru.co.za\/wp-content\/uploads\/2022\/11\/top_image_mobile_small.jpg&#8221; background_enable_image_tablet=&#8221;on&#8221; background_enable_image_phone=&#8221;on&#8221; background_size_tablet=&#8221;contain&#8221; disabled=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row _builder_version=&#8221;4.19.4&#8243; _module_preset=&#8221;default&#8221; width=&#8221;70%&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.18.0&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_image src=&#8221;https:\/\/h2oguru.co.za\/wp-content\/uploads\/2022\/11\/H20_Guru_Logo_Signature.png&#8221; alt=&#8221;H2Oguru Water Specialists&#8221; title_text=&#8221;H2Oguru Water Specialists&#8221; 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_builder_version=&#8221;4.18.0&#8243; _module_preset=&#8221;default&#8221; custom_padding=&#8221;5px|||||&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row column_structure=&#8221;1_2,1_2&#8243; make_equal=&#8221;on&#8221; disabled_on=&#8221;on|on|on&#8221; _builder_version=&#8221;4.19.4&#8243; _module_preset=&#8221;default&#8221; width=&#8221;70%&#8221; disabled=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;1_2&#8243; _builder_version=&#8221;4.18.0&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_cta title=&#8221;Download the form in PDF&#8221; button_url=&#8221;https:\/\/dev.h2oguru.co.za\/wp-content\/uploads\/2022\/11\/WATER-SAMPLING-ANALYSIS-WEB.pdf&#8221; url_new_window=&#8221;on&#8221; button_text=&#8221;DOWNLOAD&#8221; _builder_version=&#8221;4.19.4&#8243; _module_preset=&#8221;default&#8221; header_level=&#8221;h5&#8243; header_font=&#8221;||||||||&#8221; header_text_color=&#8221;gcid-284d51d8-70d2-434b-b042-f647d552aad1&#8243; header_font_size=&#8221;18px&#8221; body_font=&#8221;||||||||&#8221; body_text_color=&#8221;gcid-284d51d8-70d2-434b-b042-f647d552aad1&#8243; body_font_size=&#8221;9px&#8221; background_color=&#8221;#FFFFFF&#8221; custom_button=&#8221;on&#8221; button_text_size=&#8221;11px&#8221; button_text_color=&#8221;gcid-1b3d7de0-5c24-47f8-a501-1d0e897118e6&#8243; button_bg_color=&#8221;#FFFFFF&#8221; button_border_width=&#8221;1px&#8221; button_border_color=&#8221;gcid-1b3d7de0-5c24-47f8-a501-1d0e897118e6&#8243; button_border_radius=&#8221;100px&#8221; button_use_icon=&#8221;off&#8221; button_custom_padding=&#8221;12px|24px|12px|24px|true|true&#8221; background_layout=&#8221;light&#8221; link_option_url_new_window=&#8221;on&#8221; header_font_size_tablet=&#8221;16px&#8221; header_font_size_phone=&#8221;16px&#8221; header_font_size_last_edited=&#8221;on|phone&#8221; body_font_size_tablet=&#8221;9px&#8221; body_font_size_phone=&#8221;9px&#8221; body_font_size_last_edited=&#8221;on|desktop&#8221; border_width_all=&#8221;1px&#8221; 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custom_css_promo_button_last_edited=&#8221;on|phone&#8221; custom_css_promo_button_phone=&#8221;width: 100%;&#8221;]<\/p>\n<p style=\"text-align: center;\">Please complete the document and send it to <a href=\"mailto:sales@h2oguru.co.za\">sales@h2oguru.co.za<\/a><\/p>\n<div><\/div>\n<p>[\/et_pb_cta][\/et_pb_column][et_pb_column type=&#8221;1_2&#8243; _builder_version=&#8221;4.18.0&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_cta title=&#8221;Complete the form below&#8221; button_url=&#8221;#form&#8221; url_new_window=&#8221;on&#8221; button_text=&#8221;COMPLETE FORM ONLINE&#8221; _builder_version=&#8221;4.19.4&#8243; _module_preset=&#8221;default&#8221; header_level=&#8221;h4&#8243; header_text_color=&#8221;gcid-284d51d8-70d2-434b-b042-f647d552aad1&#8243; header_font_size=&#8221;18px&#8221; background_color=&#8221;#FFFFFF&#8221; custom_button=&#8221;on&#8221; button_text_size=&#8221;11px&#8221; button_text_color=&#8221;gcid-1b3d7de0-5c24-47f8-a501-1d0e897118e6&#8243; 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_module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h2>Water Sample Analysis Request<\/h2>\n<p>Complete the form below to schedule a water sample analysis test. Or <a href=\"https:\/\/h2oguru.co.za\/wp-content\/uploads\/2022\/11\/WATER-SAMPLING-ANALYSIS-WEB.pdf\" target=\"_blank\" rel=\"noopener\">download the form<\/a> and complete in your own time.<br \/>\n[\/et_pb_text][et_pb_code _builder_version=&#8221;4.21.0&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;]<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be 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action='\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F2004#gf_8' data-formid='8' novalidate><div class='gf_invisible ginput_recaptchav3' data-sitekey='6LcIld4pAAAAAOBOICtRMDiywrz-WiGMHbiMN_2P' data-tabindex='0'><input id=\"input_3f1b158930940546112d3662d483e257\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_3f1b158930940546112d3662d483e257\" value=\"\"\/><\/div>\n        <div id='gf_progressbar_wrapper_8' class='gf_progressbar_wrapper' data-start-at-zero=''>\n        \t<p class=\"gf_progressbar_title\">Step <span class='gf_step_current_page'>1<\/span> of <span class='gf_step_page_count'>5<\/span><span class='gf_step_page_name'><\/span>\n        \t<\/p>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_20' style='width:20%;'><span>20%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_8_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><div id='gform_fields_8' class='gform_fields top_label form_sublabel_below description_above validation_below'><div id=\"field_8_98\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_98'><span class='gform-field-label__text'>LinkedIn<\/span><\/label><div class='gfield_description' id='gfield_description_8_98'>This field is for validation purposes and should be left unchanged.<\/div><div class='ginput_container'><input name='input_98' id='input_8_98' type='text' value='' autocomplete='new-password'\/><\/div><\/div><fieldset id=\"field_8_51\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_hidden_label gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Name and Surname<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_8_51'>\n                            \n                            <span id='input_8_51_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_51.3' id='input_8_51_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_8_51_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_8_51_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_51.6' id='input_8_51_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_8_51_6' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_8_94\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><\/div><fieldset id=\"field_8_96\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Water Testing Package<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_8_96'>Please select the water testing package you are interested in<\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_96'>\n\t\t\t<div class='gchoice gchoice_8_96_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_96' type='radio' value='SANS241\u2013CM'  id='choice_8_96_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_8_96\"   \/>\n\t\t\t\t\t<label for='choice_8_96_0' id='label_8_96_0' class='gform-field-label gform-field-label--type-inline'>Drinking  Water \u2013 SANS241 \u2013 Chemistry + Microbiology<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_96_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_96' type='radio' value='SANS241\u2013C'  id='choice_8_96_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_96_1' id='label_8_96_1' class='gform-field-label gform-field-label--type-inline'>Drinking Water \u2013 SANS241 \u2013 Chemistry only<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_96_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_96' type='radio' value='SANS241\u2013M'  id='choice_8_96_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_96_2' id='label_8_96_2' class='gform-field-label gform-field-label--type-inline'>Drinking Water \u2013 SANS241 \u2013 Microbiology only<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_96_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_96' type='radio' value='SANS1657'  id='choice_8_96_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_96_3' id='label_8_96_3' class='gform-field-label gform-field-label--type-inline'>Bottled Water \u2013 SANS1657<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_96_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_96' type='radio' value='SANS241\u2013I'  id='choice_8_96_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_96_4' id='label_8_96_4' class='gform-field-label gform-field-label--type-inline'>Irrigation Water \u2013 SANS241<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_96_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_96' type='radio' value='SANS241\u2013W'  id='choice_8_96_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_96_5' id='label_8_96_5' class='gform-field-label gform-field-label--type-inline'>Waste\/Effluent Water \u2013 SANS241<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_96_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_96' type='radio' value='Other'  id='choice_8_96_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_96_6' id='label_8_96_6' class='gform-field-label gform-field-label--type-inline'>Other testing parameters<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_76\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_76'><span class='gform-field-label__text'>Other testing parameters<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_8_76'>Please specify<\/div><div class='ginput_container ginput_container_text'><input name='input_76' id='input_8_76' type='text' value='' class='large'  aria-describedby=\"gfield_description_8_76\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <button type='button' id='gform_next_button_8_74' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_8_2' class='gform_page' data-js='page-field-id-74' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_8_2' class='gform_fields top_label form_sublabel_below description_above validation_below'><div id=\"field_8_80\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Sample Address<\/h3><div class='gsection_description' id='gfield_description_8_80'>Where the water was sampled or where it must be sampled by H2oguru)<\/div><\/div><div id=\"field_8_81\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_81'><span class='gform-field-label__text'>Street Address \u2013 Sample Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_81' id='input_8_81' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_82\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_82'><span class='gform-field-label__text'>City \u2013 Sample Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_82' id='input_8_82' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_85\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_85'><span class='gform-field-label__text'>ZIP \/ Postal Code \u2013 Sample Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_85' id='input_8_85' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_84\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_84'><span class='gform-field-label__text'>Country \u2013 Sample Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_84' id='input_8_84' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='South Africa' >South Africa<\/option><option value='Mozambique' >Mozambique<\/option><option value='Eswatini' >Eswatini<\/option><option value='Lesotho' >Lesotho<\/option><option value='Botswana' >Botswana<\/option><\/select><\/div><\/div><div id=\"field_8_86\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_86'><span class='gform-field-label__text'>Province \u2013 Sample Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_86' id='input_8_86' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Eastern Cape' >Eastern Cape<\/option><option value='Free State' >Free State<\/option><option value='Gauteng' >Gauteng<\/option><option value='KwaZulu-Natal' >KwaZulu-Natal<\/option><option value='Limpopo' >Limpopo<\/option><option value='Mpumalanga' >Mpumalanga<\/option><option value='Northern Cape' >Northern Cape<\/option><option value='North West' >North West<\/option><option value='Western Cape' >Western Cape<\/option><\/select><\/div><\/div><fieldset id=\"field_8_63\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Please select one:<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_63'>\n\t\t\t<div class='gchoice gchoice_8_63_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_63' type='radio' value='Sampling'  id='choice_8_63_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_63_0' id='label_8_63_0' class='gform-field-label gform-field-label--type-inline'>Sampling<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_63_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_63' type='radio' value='Couriers'  id='choice_8_63_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_63_1' id='label_8_63_1' class='gform-field-label gform-field-label--type-inline'>Couriers<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_69\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><div style=\"padding:30px; background-color:#ecf0f7;\">If you are not located in the Pretoria Area, but still in the Gauteng Area an extra R400 will be added to your billing account. If located outside Gauteng Area, please enquire for sampling pricing.<\/div><\/div><fieldset id=\"field_8_70\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Collection Address for Couriers<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_70'>\n\t\t\t<div class='gchoice gchoice_8_70_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_70' type='radio' value='Same as sampling address'  id='choice_8_70_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_70_0' id='label_8_70_0' class='gform-field-label gform-field-label--type-inline'>Same as sampling address<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_70_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_70' type='radio' value='Different address'  id='choice_8_70_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_70_1' id='label_8_70_1' class='gform-field-label gform-field-label--type-inline'>Different address<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_87\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Collection Address for Couriers (if not the same Sample Address)<\/h3><div class='gsection_description' id='gfield_description_8_87'>Where the water was sampled or where it must be sampled by H2OGuru<\/div><\/div><div id=\"field_8_88\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_88'><span class='gform-field-label__text'>Street Address \u2013 Collection Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_88' id='input_8_88' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_89\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_89'><span class='gform-field-label__text'>City \u2013 Collection Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_89' id='input_8_89' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_90\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_90'><span class='gform-field-label__text'>ZIP \/ Postal Code \u2013 Collection Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_90' id='input_8_90' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_91\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_91'><span class='gform-field-label__text'>Country \u2013 Collection Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_91' id='input_8_91' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='South Africa' >South Africa<\/option><option value='Mozambique' >Mozambique<\/option><option value='Eswatini' >Eswatini<\/option><option value='Lesotho' >Lesotho<\/option><option value='Botswana' >Botswana<\/option><\/select><\/div><\/div><div id=\"field_8_92\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_92'><span class='gform-field-label__text'>Province \u2013 Collection Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_92' id='input_8_92' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Eastern Cape' >Eastern Cape<\/option><option value='Free State' >Free State<\/option><option value='Gauteng' >Gauteng<\/option><option value='KwaZulu-Natal' >KwaZulu-Natal<\/option><option value='Limpopo' >Limpopo<\/option><option value='Mpumalanga' >Mpumalanga<\/option><option value='Northern Cape' >Northern Cape<\/option><option value='North West' >North West<\/option><option value='Western Cape' >Western Cape<\/option><\/select><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_8_77' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='button' id='gform_next_button_8_77' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_8_3' class='gform_page' data-js='page-field-id-77' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_8_3' class='gform_fields top_label form_sublabel_below description_above validation_below'><div id=\"field_8_52\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_52'><span class='gform-field-label__text'>Invoice Name (If not the same)<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_52' id='input_8_52' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_54\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-standard gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_54'><span class='gform-field-label__text'>Telephone Number<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_54' id='input_8_54' type='tel' value='' class='large'  placeholder='(999) 999-9999' aria-required=\"true\" aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/div><div id=\"field_8_55\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_55'><span class='gform-field-label__text'>Email Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_55' id='input_8_55' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_8_56\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_56'><span class='gform-field-label__text'>Sample Name (Will appear on test results)<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_56' id='input_8_56' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_8_78' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='button' id='gform_next_button_8_78' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_8_4' class='gform_page' data-js='page-field-id-78' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_8_4' class='gform_fields top_label form_sublabel_below description_above validation_below'><fieldset id=\"field_8_64\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Water Sample Source<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_64'>\n\t\t\t<div class='gchoice gchoice_8_64_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='Borehole'  id='choice_8_64_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_64_0' id='label_8_64_0' class='gform-field-label gform-field-label--type-inline'>Borehole<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_64_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='Municipal'  id='choice_8_64_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_64_1' id='label_8_64_1' class='gform-field-label gform-field-label--type-inline'>Municipal<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_64_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='River'  id='choice_8_64_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_64_2' id='label_8_64_2' class='gform-field-label gform-field-label--type-inline'>River<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_64_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='Spring'  id='choice_8_64_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_64_3' id='label_8_64_3' class='gform-field-label gform-field-label--type-inline'>Spring<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_64_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='Dam'  id='choice_8_64_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_64_4' id='label_8_64_4' class='gform-field-label gform-field-label--type-inline'>Dam<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_64_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='Rain'  id='choice_8_64_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_64_5' id='label_8_64_5' class='gform-field-label gform-field-label--type-inline'>Rain<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_8_58\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Filtered<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_58'>\n\t\t\t<div class='gchoice gchoice_8_58_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_58' type='radio' value='Yes'  id='choice_8_58_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_58_0' id='label_8_58_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_58_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_58' type='radio' value='No'  id='choice_8_58_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_58_1' id='label_8_58_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_8_71\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>If Filtered<\/span><\/legend><div class='gfield_description' id='gfield_description_8_71'>Sample before or after the Tank\/Filtering System<\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_71'>\n\t\t\t<div class='gchoice gchoice_8_71_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_71' type='radio' value='Before the Tank\/Filtering System'  id='choice_8_71_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_8_71\"   \/>\n\t\t\t\t\t<label for='choice_8_71_0' id='label_8_71_0' class='gform-field-label gform-field-label--type-inline'>Before the Tank\/Filtering System<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_71_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_71' type='radio' value='After the Tank\/Filtering System'  id='choice_8_71_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_71_1' id='label_8_71_1' class='gform-field-label gform-field-label--type-inline'>After the Tank\/Filtering System<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_8_59\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Purpose<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_8_59'><div class='gchoice gchoice_8_59_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_59.1' type='checkbox'  value='Human Consumption'  id='choice_8_59_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_59_1' id='label_8_59_1' class='gform-field-label gform-field-label--type-inline'>Human Consumption<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_59_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_59.2' type='checkbox'  value='Household'  id='choice_8_59_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_59_2' id='label_8_59_2' class='gform-field-label gform-field-label--type-inline'>Household<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_59_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_59.3' type='checkbox'  value='Industrial'  id='choice_8_59_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_59_3' id='label_8_59_3' class='gform-field-label gform-field-label--type-inline'>Industrial<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_59_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_59.4' type='checkbox'  value='Irrigation'  id='choice_8_59_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_59_4' id='label_8_59_4' class='gform-field-label gform-field-label--type-inline'>Irrigation<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_59_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_59.5' type='checkbox'  value='Bottling Plant'  id='choice_8_59_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_59_5' id='label_8_59_5' class='gform-field-label gform-field-label--type-inline'>Bottling Plant<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_59_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_59.6' type='checkbox'  value='Food Preparation'  id='choice_8_59_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_59_6' id='label_8_59_6' class='gform-field-label gform-field-label--type-inline'>Food Preparation<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_59_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_59.7' type='checkbox'  value='Other'  id='choice_8_59_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_59_7' id='label_8_59_7' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_72\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_72'><span class='gform-field-label__text'>Purpose: Other<\/span><\/label><div class='gfield_description' id='gfield_description_8_72'>Please specify<\/div><div class='ginput_container ginput_container_text'><input name='input_72' id='input_8_72' type='text' value='' class='large'  aria-describedby=\"gfield_description_8_72\"    aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_8_79' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='button' id='gform_next_button_8_79' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_8_5' class='gform_page' data-js='page-field-id-79' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_8_5' class='gform_fields top_label form_sublabel_below description_above validation_below'><fieldset id=\"field_8_60\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Any Water Quality concerns<\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_8_60'><div class='gchoice gchoice_8_60_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_60.1' type='checkbox'  value='Hard'  id='choice_8_60_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_60_1' id='label_8_60_1' class='gform-field-label gform-field-label--type-inline'>Hard<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_60_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_60.2' type='checkbox'  value='Salty'  id='choice_8_60_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_60_2' id='label_8_60_2' class='gform-field-label gform-field-label--type-inline'>Salty<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_60_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_60.3' type='checkbox'  value='Colour'  id='choice_8_60_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_60_3' id='label_8_60_3' class='gform-field-label gform-field-label--type-inline'>Colour<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_60_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_60.4' type='checkbox'  value='Odours'  id='choice_8_60_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_60_4' id='label_8_60_4' class='gform-field-label gform-field-label--type-inline'>Odours<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_60_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_60.5' type='checkbox'  value='Iron'  id='choice_8_60_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_60_5' id='label_8_60_5' class='gform-field-label gform-field-label--type-inline'>Iron<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_60_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_60.6' type='checkbox'  value='Corrosion'  id='choice_8_60_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_60_6' id='label_8_60_6' class='gform-field-label gform-field-label--type-inline'>Corrosion<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_60_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_60.7' type='checkbox'  value='Other'  id='choice_8_60_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_60_7' id='label_8_60_7' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_73\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_73'><span class='gform-field-label__text'>Quality Concerns: Other<\/span><\/label><div class='gfield_description' id='gfield_description_8_73'>Please specify<\/div><div class='ginput_container ginput_container_text'><input name='input_73' id='input_8_73' type='text' value='' class='large'  aria-describedby=\"gfield_description_8_73\"    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_61\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_61'><span class='gform-field-label__text'>Any Special Requirements or Comments<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_61' id='input_8_61' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_8_97\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><script>\ngform.addFilter('gform_datepicker_options_pre_init', function(optionsObj, formId, fieldId) {\n\n    if (formId == 8 && fieldId == 62) {\n\n        optionsObj.firstDay = 1; \/\/ Start week on Monday\n\n        optionsObj.beforeShowDay = function(date) {\n\n            var day = date.getDay();\n\n            \/\/ --- Existing rules ---\n            var isWeekend = (day === 0 || day === 5 || day === 6); \/\/ Sun (0), Fri (5), Sat (6)\n\n            \/\/ --- Block out dates until 5 Jan 2026 ---\n            var blockStart = new Date(); \/\/ today\n            blockStart.setHours(0,0,0,0);\n\n            var reopenDate = new Date('2026-01-05');\n            reopenDate.setHours(0,0,0,0);\n\n            var isBlockedRange = (date >= blockStart && date < reopenDate);\n\n            \/\/ Final decision:\n            return [(!isWeekend && !isBlockedRange), ''];\n        };\n    }\n\n    return optionsObj;\n});\n<\/script><\/div><div id=\"field_8_62\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_62'><span class='gform-field-label__text'>Sampling or Courier Date<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='mm\/dd\/yyyy'\n\t\t\t\t\tid='input_8_62'\n\t\t\t\t\tclass='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_62'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\taria-required=\"true\"\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_8_62' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_8_62' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_8_62' aria-label='Sampling or Courier Date: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><fieldset id=\"field_8_65\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above hidden_label field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Terms and Conditions<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_8_65'><div class='gchoice gchoice_8_65_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_65.1' type='checkbox'  value='I accept the Terms and Conditions*'  id='choice_8_65_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_65_1' id='label_8_65_1' class='gform-field-label gform-field-label--type-inline'>I accept the Terms and Conditions*<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><\/div><\/div>\n        <div class='gform-page-footer gform_page_footer top_label'><button type='submit' id='gform_previous_button_8' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='submit' id='gform_submit_button_8' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' >Submit<\/button> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_8' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_8' id='gform_theme_8' value='gravity-theme' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_8' id='gform_style_settings_8' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_8' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='8' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='ZAR' value='tLXJxgkuqFAoH2IvRhQdIov3DQD9+6skbky6v9BjsIlW25+nrFy5outoOii5JLRR8UA9j1xAgDtE+0zDjYV6j1AWvCPgxUJ+TstdbzX2AxrMsn0=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_8' 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width_phone=&#8221;70%&#8221; width_last_edited=&#8221;on|desktop&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;3_5&#8243; _builder_version=&#8221;4.19.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.19.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221; custom_padding=&#8221;||10px|||&#8221;]<\/p>\n<p style=\"font-weight: 400;\"><strong>IMPORTANT:<\/strong> <span> If you would like to go ahead, please fill out the online form. Depending on where you are located we can arrange for our couriers to collect the water samples when you are ready. Courier fees applicable. If you want H2oGuru to come and sample the water, please select accordingly or enquire for pricing.<\/span><\/p>\n<p>[\/et_pb_text][\/et_pb_column][et_pb_column type=&#8221;2_5&#8243; _builder_version=&#8221;4.19.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_cta title=&#8221;NB: If we make use of our Couriers&#8221; button_url=&#8221;https:\/\/h2oguru.co.za\/water-sampling-procedures\/&#8221; url_new_window=&#8221;on&#8221; button_text=&#8221;READ MORE&#8221; _builder_version=&#8221;4.19.4&#8243; _module_preset=&#8221;default&#8221; header_level=&#8221;h4&#8243; header_text_color=&#8221;gcid-284d51d8-70d2-434b-b042-f647d552aad1&#8243; header_font_size=&#8221;18px&#8221; background_color=&#8221;#FFFFFF&#8221; custom_button=&#8221;on&#8221; button_text_size=&#8221;11px&#8221; button_text_color=&#8221;gcid-1b3d7de0-5c24-47f8-a501-1d0e897118e6&#8243; button_bg_color=&#8221;#FFFFFF&#8221; button_border_width=&#8221;1px&#8221; button_border_color=&#8221;gcid-1b3d7de0-5c24-47f8-a501-1d0e897118e6&#8243; button_border_radius=&#8221;100px&#8221; button_use_icon=&#8221;off&#8221; button_custom_padding=&#8221;12px|24px|12px|24px|true|true&#8221; background_layout=&#8221;light&#8221; header_font_size_tablet=&#8221;16px&#8221; header_font_size_phone=&#8221;16px&#8221; header_font_size_last_edited=&#8221;on|phone&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;gcid-284d51d8-70d2-434b-b042-f647d552aad1&#8243; locked=&#8221;off&#8221; global_colors_info=&#8221;{%22gcid-1b3d7de0-5c24-47f8-a501-1d0e897118e6%22:%91%22button_border_color%22,%22button_text_color%22,%22button_border_color%22,%22button_text_color%22%93,%22gcid-284d51d8-70d2-434b-b042-f647d552aad1%22:%91%22header_text_color%22,%22border_color_all%22,%22button_bg_color__hover%22,%22button_border_color__hover%22,%22header_text_color%22,%22border_color_all%22,%22button_bg_color__hover%22,%22button_border_color__hover%22%93}&#8221; button_text_color__hover_enabled=&#8221;on|hover&#8221; button_text_color__hover=&#8221;#FFFFFF&#8221; button_bg_color__hover_enabled=&#8221;on|hover&#8221; button_bg_color__hover=&#8221;#4972b8&#8243; button_bg_enable_color__hover=&#8221;on&#8221; button_border_color__hover_enabled=&#8221;on|hover&#8221; button_border_color__hover=&#8221;#4972b8&#8243; button_border_radius__hover_enabled=&#8221;on|hover&#8221; button_border_radius__hover=&#8221;100px&#8221; custom_css_promo_button_last_edited=&#8221;on|desktop&#8221; custom_css_promo_button_phone=&#8221;width: 100%;&#8221;]Read more about water sampling procedures<br \/>\n[\/et_pb_cta][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; admin_label=&#8221;Section&#8221; _builder_version=&#8221;4.19.4&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;#ecf0f7&#8243; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;50px||50px||false|false&#8221; global_module=&#8221;243&#8243; saved_tabs=&#8221;all&#8221; collapsed=&#8221;off&#8221; global_colors_info=&#8221;{%22gcid-2c338d08-4403-4ace-b301-7dee33fa09cc%22:%91%22background_color%22%93}&#8221;][et_pb_row column_structure=&#8221;1_2,1_2&#8243; make_equal=&#8221;on&#8221; _builder_version=&#8221;4.21.0&#8243; _module_preset=&#8221;default&#8221; width=&#8221;90%&#8221; custom_padding=&#8221;0px||30px||false|false&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;1_2&#8243; _builder_version=&#8221;4.18.0&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_image src=&#8221;https:\/\/h2oguru.co.za\/wp-content\/uploads\/2023\/09\/H20Guru-Water-Specialists.png&#8221; alt=&#8221;H20Guru Water Specialists&#8221; title_text=&#8221;H20Guru-Water-Specialists&#8221; _builder_version=&#8221;4.22.1&#8243; _module_preset=&#8221;default&#8221; width=&#8221;19%&#8221; width_tablet=&#8221;20%&#8221; width_phone=&#8221;20%&#8221; width_last_edited=&#8221;on|tablet&#8221; custom_margin=&#8221;||19px|||&#8221; global_colors_info=&#8221;{}&#8221;][\/et_pb_image][et_pb_text _builder_version=&#8221;4.22.1&#8243; _module_preset=&#8221;default&#8221; text_font_size=&#8221;12px&#8221; text_line_height=&#8221;1.5em&#8221; header_5_font_size=&#8221;14px&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h6><span><b>Book your Water Test today<\/b><\/span><\/h6>\n<p><span><br \/><\/span><span>Water Sampling &amp; Testing services includes: SANS241 + Microbiology Test (SANAS Accredited Laboratory). Sampling at your premises by one of our representatives. H<\/span><span>\u2082<\/span><span>Oguru also make use of Courier services where required. Kindly leave your number and we will get back to you within 24hours or alternatively contact us.<\/span><\/p>\n<p>[\/et_pb_text][et_pb_text _builder_version=&#8221;4.22.0&#8243; _module_preset=&#8221;default&#8221; text_font_size=&#8221;13px&#8221; text_line_height=&#8221;1.5em&#8221; header_5_font_size=&#8221;14px&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p><span><a href=\"\/privacy-policy\/\">PRIVACY POLICY<\/a><br \/><\/span><a href=\"\/terms-and-conditions\/\"><span style=\"margin-top: 6px;\">TERMS &amp; CONDITIONS<\/span><\/a><br \/><a href=\"https:\/\/h2oguru.co.za\/refund-and-returns-policy\/\">REFUND &amp; RETURN POLICY<\/a><span style=\"margin-top: 6px;\"><\/span><\/p>\n<p>[\/et_pb_text][\/et_pb_column][et_pb_column type=&#8221;1_2&#8243; _builder_version=&#8221;4.18.0&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Water Sample Analysis request Form Please complete the document and send it to sales@h2oguru.co.za Water Sample Analysis Request Complete the form below to schedule a water sample analysis test. Or download the form and complete in your own time. \n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_8' style='display:none'><div id='gf_8' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data'  id='gform_8'  action='\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F2004#gf_8' data-formid='8' novalidate><div class='gf_invisible ginput_recaptchav3' data-sitekey='6LcIld4pAAAAAOBOICtRMDiywrz-WiGMHbiMN_2P' data-tabindex='0'><input id=\"input_3f1b158930940546112d3662d483e257\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_3f1b158930940546112d3662d483e257\" value=\"\"\/><\/div>\n        <div id='gf_progressbar_wrapper_8' class='gf_progressbar_wrapper' data-start-at-zero=''>\n        \t<p class=\"gf_progressbar_title\">Step <span class='gf_step_current_page'>1<\/span> of <span class='gf_step_page_count'>5<\/span><span class='gf_step_page_name'><\/span>\n        \t<\/p>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_20' style='width:20%;'><span>20%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_8_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><div id='gform_fields_8' class='gform_fields top_label form_sublabel_below description_above validation_below'><div id=\"field_8_98\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_98'><span class='gform-field-label__text'>URL<\/span><\/label><div class='gfield_description' id='gfield_description_8_98'>This field is for validation purposes and should be left unchanged.<\/div><div class='ginput_container'><input name='input_98' id='input_8_98' type='text' value='' autocomplete='new-password'\/><\/div><\/div><fieldset id=\"field_8_51\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_hidden_label gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Name and Surname<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_8_51'>\n                            \n                            <span id='input_8_51_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_51.3' id='input_8_51_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_8_51_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_8_51_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_51.6' id='input_8_51_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_8_51_6' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_8_94\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><\/div><fieldset id=\"field_8_96\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Water Testing Package<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_8_96'>Please select the water testing package you are interested in<\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_96'>\n\t\t\t<div class='gchoice gchoice_8_96_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_96' type='radio' value='SANS241\u2013CM'  id='choice_8_96_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_8_96\"   \/>\n\t\t\t\t\t<label for='choice_8_96_0' id='label_8_96_0' class='gform-field-label gform-field-label--type-inline'>Drinking  Water \u2013 SANS241 \u2013 Chemistry + Microbiology<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_96_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_96' type='radio' value='SANS241\u2013C'  id='choice_8_96_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_96_1' id='label_8_96_1' class='gform-field-label gform-field-label--type-inline'>Drinking Water \u2013 SANS241 \u2013 Chemistry only<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_96_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_96' type='radio' value='SANS241\u2013M'  id='choice_8_96_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_96_2' id='label_8_96_2' class='gform-field-label gform-field-label--type-inline'>Drinking Water \u2013 SANS241 \u2013 Microbiology only<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_96_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_96' type='radio' value='SANS1657'  id='choice_8_96_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_96_3' id='label_8_96_3' class='gform-field-label gform-field-label--type-inline'>Bottled Water \u2013 SANS1657<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_96_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_96' type='radio' value='SANS241\u2013I'  id='choice_8_96_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_96_4' id='label_8_96_4' class='gform-field-label gform-field-label--type-inline'>Irrigation Water \u2013 SANS241<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_96_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_96' type='radio' value='SANS241\u2013W'  id='choice_8_96_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_96_5' id='label_8_96_5' class='gform-field-label gform-field-label--type-inline'>Waste\/Effluent Water \u2013 SANS241<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_96_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_96' type='radio' value='Other'  id='choice_8_96_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_96_6' id='label_8_96_6' class='gform-field-label gform-field-label--type-inline'>Other testing parameters<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_76\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_76'><span class='gform-field-label__text'>Other testing parameters<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_8_76'>Please specify<\/div><div class='ginput_container ginput_container_text'><input name='input_76' id='input_8_76' type='text' value='' class='large'  aria-describedby=\"gfield_description_8_76\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <button type='button' id='gform_next_button_8_74' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_8_2' class='gform_page' data-js='page-field-id-74' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_8_2' class='gform_fields top_label form_sublabel_below description_above validation_below'><div id=\"field_8_80\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Sample Address<\/h3><div class='gsection_description' id='gfield_description_8_80'>Where the water was sampled or where it must be sampled by H2oguru)<\/div><\/div><div id=\"field_8_81\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_81'><span class='gform-field-label__text'>Street Address \u2013 Sample Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_81' id='input_8_81' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_82\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_82'><span class='gform-field-label__text'>City \u2013 Sample Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_82' id='input_8_82' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_85\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_85'><span class='gform-field-label__text'>ZIP \/ Postal Code \u2013 Sample Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_85' id='input_8_85' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_84\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_84'><span class='gform-field-label__text'>Country \u2013 Sample Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_84' id='input_8_84' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='South Africa' >South Africa<\/option><option value='Mozambique' >Mozambique<\/option><option value='Eswatini' >Eswatini<\/option><option value='Lesotho' >Lesotho<\/option><option value='Botswana' >Botswana<\/option><\/select><\/div><\/div><div id=\"field_8_86\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_86'><span class='gform-field-label__text'>Province \u2013 Sample Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_86' id='input_8_86' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Eastern Cape' >Eastern Cape<\/option><option value='Free State' >Free State<\/option><option value='Gauteng' >Gauteng<\/option><option value='KwaZulu-Natal' >KwaZulu-Natal<\/option><option value='Limpopo' >Limpopo<\/option><option value='Mpumalanga' >Mpumalanga<\/option><option value='Northern Cape' >Northern Cape<\/option><option value='North West' >North West<\/option><option value='Western Cape' >Western Cape<\/option><\/select><\/div><\/div><fieldset id=\"field_8_63\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Please select one:<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_63'>\n\t\t\t<div class='gchoice gchoice_8_63_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_63' type='radio' value='Sampling'  id='choice_8_63_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_63_0' id='label_8_63_0' class='gform-field-label gform-field-label--type-inline'>Sampling<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_63_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_63' type='radio' value='Couriers'  id='choice_8_63_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_63_1' id='label_8_63_1' class='gform-field-label gform-field-label--type-inline'>Couriers<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_69\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><div style=\"padding:30px; background-color:#ecf0f7;\">If you are not located in the Pretoria Area, but still in the Gauteng Area an extra R400 will be added to your billing account. If located outside Gauteng Area, please enquire for sampling pricing.<\/div><\/div><fieldset id=\"field_8_70\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Collection Address for Couriers<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_70'>\n\t\t\t<div class='gchoice gchoice_8_70_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_70' type='radio' value='Same as sampling address'  id='choice_8_70_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_70_0' id='label_8_70_0' class='gform-field-label gform-field-label--type-inline'>Same as sampling address<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_70_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_70' type='radio' value='Different address'  id='choice_8_70_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_70_1' id='label_8_70_1' class='gform-field-label gform-field-label--type-inline'>Different address<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_87\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Collection Address for Couriers (if not the same Sample Address)<\/h3><div class='gsection_description' id='gfield_description_8_87'>Where the water was sampled or where it must be sampled by H2OGuru<\/div><\/div><div id=\"field_8_88\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_88'><span class='gform-field-label__text'>Street Address \u2013 Collection Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_88' id='input_8_88' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_89\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_89'><span class='gform-field-label__text'>City \u2013 Collection Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_89' id='input_8_89' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_90\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_90'><span class='gform-field-label__text'>ZIP \/ Postal Code \u2013 Collection Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_90' id='input_8_90' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_91\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_91'><span class='gform-field-label__text'>Country \u2013 Collection Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_91' id='input_8_91' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='South Africa' >South Africa<\/option><option value='Mozambique' >Mozambique<\/option><option value='Eswatini' >Eswatini<\/option><option value='Lesotho' >Lesotho<\/option><option value='Botswana' >Botswana<\/option><\/select><\/div><\/div><div id=\"field_8_92\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_92'><span class='gform-field-label__text'>Province \u2013 Collection Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_92' id='input_8_92' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Eastern Cape' >Eastern Cape<\/option><option value='Free State' >Free State<\/option><option value='Gauteng' >Gauteng<\/option><option value='KwaZulu-Natal' >KwaZulu-Natal<\/option><option value='Limpopo' >Limpopo<\/option><option value='Mpumalanga' >Mpumalanga<\/option><option value='Northern Cape' >Northern Cape<\/option><option value='North West' >North West<\/option><option value='Western Cape' >Western Cape<\/option><\/select><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_8_77' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='button' id='gform_next_button_8_77' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_8_3' class='gform_page' data-js='page-field-id-77' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_8_3' class='gform_fields top_label form_sublabel_below description_above validation_below'><div id=\"field_8_52\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_52'><span class='gform-field-label__text'>Invoice Name (If not the same)<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_52' id='input_8_52' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_54\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-standard gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_54'><span class='gform-field-label__text'>Telephone Number<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_54' id='input_8_54' type='tel' value='' class='large'  placeholder='(999) 999-9999' aria-required=\"true\" aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/div><div id=\"field_8_55\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_55'><span class='gform-field-label__text'>Email Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_55' id='input_8_55' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_8_56\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_56'><span class='gform-field-label__text'>Sample Name (Will appear on test results)<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_56' id='input_8_56' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_8_78' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='button' id='gform_next_button_8_78' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_8_4' class='gform_page' data-js='page-field-id-78' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_8_4' class='gform_fields top_label form_sublabel_below description_above validation_below'><fieldset id=\"field_8_64\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Water Sample Source<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_64'>\n\t\t\t<div class='gchoice gchoice_8_64_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='Borehole'  id='choice_8_64_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_64_0' id='label_8_64_0' class='gform-field-label gform-field-label--type-inline'>Borehole<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_64_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='Municipal'  id='choice_8_64_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_64_1' id='label_8_64_1' class='gform-field-label gform-field-label--type-inline'>Municipal<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_64_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='River'  id='choice_8_64_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_64_2' id='label_8_64_2' class='gform-field-label gform-field-label--type-inline'>River<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_64_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='Spring'  id='choice_8_64_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_64_3' id='label_8_64_3' class='gform-field-label gform-field-label--type-inline'>Spring<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_64_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='Dam'  id='choice_8_64_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_64_4' id='label_8_64_4' class='gform-field-label gform-field-label--type-inline'>Dam<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_64_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='Rain'  id='choice_8_64_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_64_5' id='label_8_64_5' class='gform-field-label gform-field-label--type-inline'>Rain<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_8_58\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Filtered<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_58'>\n\t\t\t<div class='gchoice gchoice_8_58_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_58' type='radio' value='Yes'  id='choice_8_58_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_58_0' id='label_8_58_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_58_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_58' type='radio' value='No'  id='choice_8_58_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_58_1' id='label_8_58_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_8_71\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>If Filtered<\/span><\/legend><div class='gfield_description' id='gfield_description_8_71'>Sample before or after the Tank\/Filtering System<\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_71'>\n\t\t\t<div class='gchoice gchoice_8_71_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_71' type='radio' value='Before the Tank\/Filtering System'  id='choice_8_71_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_8_71\"   \/>\n\t\t\t\t\t<label for='choice_8_71_0' id='label_8_71_0' class='gform-field-label gform-field-label--type-inline'>Before the Tank\/Filtering System<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_71_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_71' type='radio' value='After the Tank\/Filtering System'  id='choice_8_71_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_71_1' id='label_8_71_1' class='gform-field-label gform-field-label--type-inline'>After the Tank\/Filtering System<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_8_59\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Purpose<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_8_59'><div class='gchoice gchoice_8_59_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_59.1' type='checkbox'  value='Human Consumption'  id='choice_8_59_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_59_1' id='label_8_59_1' class='gform-field-label gform-field-label--type-inline'>Human Consumption<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_59_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_59.2' type='checkbox'  value='Household'  id='choice_8_59_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_59_2' id='label_8_59_2' class='gform-field-label gform-field-label--type-inline'>Household<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_59_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_59.3' type='checkbox'  value='Industrial'  id='choice_8_59_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_59_3' id='label_8_59_3' class='gform-field-label gform-field-label--type-inline'>Industrial<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_59_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_59.4' type='checkbox'  value='Irrigation'  id='choice_8_59_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_59_4' id='label_8_59_4' class='gform-field-label gform-field-label--type-inline'>Irrigation<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_59_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_59.5' type='checkbox'  value='Bottling Plant'  id='choice_8_59_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_59_5' id='label_8_59_5' class='gform-field-label gform-field-label--type-inline'>Bottling Plant<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_59_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_59.6' type='checkbox'  value='Food Preparation'  id='choice_8_59_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_59_6' id='label_8_59_6' class='gform-field-label gform-field-label--type-inline'>Food Preparation<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_59_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_59.7' type='checkbox'  value='Other'  id='choice_8_59_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_59_7' id='label_8_59_7' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_72\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_72'><span class='gform-field-label__text'>Purpose: Other<\/span><\/label><div class='gfield_description' id='gfield_description_8_72'>Please specify<\/div><div class='ginput_container ginput_container_text'><input name='input_72' id='input_8_72' type='text' value='' class='large'  aria-describedby=\"gfield_description_8_72\"    aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_8_79' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='button' id='gform_next_button_8_79' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_8_5' class='gform_page' data-js='page-field-id-79' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_8_5' class='gform_fields top_label form_sublabel_below description_above validation_below'><fieldset id=\"field_8_60\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Any Water Quality concerns<\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_8_60'><div class='gchoice gchoice_8_60_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_60.1' type='checkbox'  value='Hard'  id='choice_8_60_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_60_1' id='label_8_60_1' class='gform-field-label gform-field-label--type-inline'>Hard<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_60_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_60.2' type='checkbox'  value='Salty'  id='choice_8_60_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_60_2' id='label_8_60_2' class='gform-field-label gform-field-label--type-inline'>Salty<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_60_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_60.3' type='checkbox'  value='Colour'  id='choice_8_60_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_60_3' id='label_8_60_3' class='gform-field-label gform-field-label--type-inline'>Colour<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_60_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_60.4' type='checkbox'  value='Odours'  id='choice_8_60_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_60_4' id='label_8_60_4' class='gform-field-label gform-field-label--type-inline'>Odours<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_60_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_60.5' type='checkbox'  value='Iron'  id='choice_8_60_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_60_5' id='label_8_60_5' class='gform-field-label gform-field-label--type-inline'>Iron<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_60_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_60.6' type='checkbox'  value='Corrosion'  id='choice_8_60_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_60_6' id='label_8_60_6' class='gform-field-label gform-field-label--type-inline'>Corrosion<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_60_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_60.7' type='checkbox'  value='Other'  id='choice_8_60_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_60_7' id='label_8_60_7' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_73\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_73'><span class='gform-field-label__text'>Quality Concerns: Other<\/span><\/label><div class='gfield_description' id='gfield_description_8_73'>Please specify<\/div><div class='ginput_container ginput_container_text'><input name='input_73' id='input_8_73' type='text' value='' class='large'  aria-describedby=\"gfield_description_8_73\"    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_61\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_61'><span class='gform-field-label__text'>Any Special Requirements or Comments<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_61' id='input_8_61' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_8_97\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><script>\ngform.addFilter('gform_datepicker_options_pre_init', function(optionsObj, formId, fieldId) {\n\n    if (formId == 8 && fieldId == 62) {\n\n        optionsObj.firstDay = 1; \/\/ Start week on Monday\n\n        optionsObj.beforeShowDay = function(date) {\n\n            var day = date.getDay();\n\n            \/\/ --- Existing rules ---\n            var isWeekend = (day === 0 || day === 5 || day === 6); \/\/ Sun (0), Fri (5), Sat (6)\n\n            \/\/ --- Block out dates until 5 Jan 2026 ---\n            var blockStart = new Date(); \/\/ today\n            blockStart.setHours(0,0,0,0);\n\n            var reopenDate = new Date('2026-01-05');\n            reopenDate.setHours(0,0,0,0);\n\n            var isBlockedRange = (date >= blockStart && date < reopenDate);\n\n            \/\/ Final decision:\n            return [(!isWeekend && !isBlockedRange), ''];\n        };\n    }\n\n    return optionsObj;\n});\n<\/script><\/div><div id=\"field_8_62\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_62'><span class='gform-field-label__text'>Sampling or Courier Date<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='mm\/dd\/yyyy'\n\t\t\t\t\tid='input_8_62'\n\t\t\t\t\tclass='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_62'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\taria-required=\"true\"\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_8_62' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_8_62' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_8_62' aria-label='Sampling or Courier Date: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><fieldset id=\"field_8_65\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above hidden_label field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Terms and Conditions<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_8_65'><div class='gchoice gchoice_8_65_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_65.1' type='checkbox'  value='I accept the Terms and Conditions*'  id='choice_8_65_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_65_1' id='label_8_65_1' class='gform-field-label gform-field-label--type-inline'>I accept the Terms and Conditions*<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><\/div><\/div>\n        <div class='gform-page-footer gform_page_footer top_label'><button type='submit' id='gform_previous_button_8' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='submit' id='gform_submit_button_8' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' >Submit<\/button> \n            <input type='hidden' class='gform_hidden' 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