{"id":37449,"date":"2022-02-16T10:20:07","date_gmt":"2022-02-16T15:20:07","guid":{"rendered":"https:\/\/ure.com\/?page_id=37449"},"modified":"2022-06-23T15:27:36","modified_gmt":"2022-06-23T19:27:36","slug":"new-home-construction","status":"publish","type":"page","link":"https:\/\/ure.com\/services\/electric\/residential-service\/new-home-construction\/","title":{"rendered":"New Home Construction &#8211; Electric Service"},"content":{"rendered":"<h2>New Home Construction Questionnaire<\/h2>\n<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_safari gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_21' style='display:none'><div id='gf_21' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data'  id='gform_21'  action='\/wp-json\/wp\/v2\/pages\/37449#gf_21' data-formid='21' novalidate>\n        <div id='gf_progressbar_wrapper_21' class='gf_progressbar_wrapper'>\n        \t<p class=\"gf_progressbar_title\">Step <span class='gf_step_current_page'>1<\/span> of <span class='gf_step_page_count'>4<\/span>\n        \t<\/p>\n            <div class='gf_progressbar gf_progressbar_custom' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_custom percentbar_0' style='width:0%; color:#211f1d; background-color:#f5d896;'><span>0%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_21_1' class='gform_page ' data-js='page-field-id-1' >\n                                    <div class='gform_page_fields'><div id='gform_fields_21' class='gform_fields top_label form_sublabel_above description_above'><fieldset id=\"field_21_78\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_78\"><legend class='gfield_label gform-field-label'  >** NOTE TO APPLICANT: If your deed information is not available at this time, you may submit your application to begin the new service process. HOWEVER, this information MUST be submitted to URE and an easement created and signed by the homeowners BEFORE any URE facilities will be installed.**<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_21_78'>\n\t\t\t<div class='gchoice gchoice_21_78_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_78' type='radio' value='I AGREE to provide all necessary documents'  id='choice_21_78_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_78_0' id='label_21_78_0' class='gform-field-label gform-field-label--type-inline'>I AGREE to provide all necessary documents<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_21_1\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_1\"><legend class='gfield_label gform-field-label'  >I am the:<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_21_1'>\n\t\t\t<div class='gchoice gchoice_21_1_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_1' type='radio' value='Homeowner'  id='choice_21_1_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_1_0' id='label_21_1_0' class='gform-field-label gform-field-label--type-inline'>Homeowner<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_21_1_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_1' type='radio' value='Builder\/Contractor'  id='choice_21_1_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_1_1' id='label_21_1_1' class='gform-field-label gform-field-label--type-inline'>Builder\/Contractor<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_21_1_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_1' type='radio' value='gf_other_choice'  id='choice_21_1_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_1_2' id='label_21_1_2' class='gform-field-label gform-field-label--type-inline'>Other<\/label><br \/><input id='input_21_1_other' class='gchoice_other_control' name='input_1_other' type='text' value='Other' aria-label='Other Choice, please specify'  disabled='disabled' \/>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_21_2\"  class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_2\"><h3>Contact Information<\/h3><\/div><fieldset id=\"field_21_3\"  class=\"gfield gfield--type-name gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_3\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Name<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_21_3'>\n                            \n                            <span id='input_21_3_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_21_3_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                    <input type='text' name='input_3.3' id='input_21_3_3' value=''   aria-required='true'     \/>\n                                                <\/span>\n                            \n                            <span id='input_21_3_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_21_3_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                            <input type='text' name='input_3.6' id='input_21_3_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_21_6\"  class=\"gfield gfield--type-email gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_6\"><label class='gfield_label gform-field-label' for='input_21_6' >Email<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_6' id='input_21_6' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_21_7\"  class=\"gfield gfield--type-phone gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_7\"><label class='gfield_label gform-field-label' for='input_21_7' >Best Contact Phone<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_7' id='input_21_7' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_21_4\"  class=\"gfield gfield--type-address gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_4\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Service Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_state has_zip ginput_container_address gform-grid-row' id='input_21_4' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_21_4_1_container' >\n                                        <label for='input_21_4_1' id='input_21_4_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                        <input type='text' name='input_4.1' id='input_21_4_1' value=''    aria-required='true'    \/>\n                                   <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_21_4_3_container' >\n                                    <label for='input_21_4_3' id='input_21_4_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                    <input type='text' name='input_4.3' id='input_21_4_3' value=''    aria-required='true'    \/>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_21_4_4_container' >\n                                        <label for='input_21_4_4' id='input_21_4_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                        <select name='input_4.4' id='input_21_4_4'     aria-required='true'    ><option value='' ><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' selected='selected'>Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_21_4_5_container' >\n                                    <label for='input_21_4_5' id='input_21_4_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                    <input type='text' name='input_4.5' id='input_21_4_5' value=''    aria-required='true'    \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_4.6' id='input_21_4_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><fieldset id=\"field_21_5\"  class=\"gfield gfield--type-address gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_5\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Mailing Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    <div id='input_21_5_copy_values_option_container' class='copy_values_option_container' >\n                                        <input type='checkbox' id='input_21_5_copy_values_activated' class='copy_values_activated' value='1' data-source_field_id='4' name='input_5_copy_values_activated'  \/>\n                                        <label for='input_21_5_copy_values_activated' id='input_21_5_copy_values_option_label' class='copy_values_option_label inline gform-field-label gform-field-label--type-inline'>Same as Service Address<\/label>\n                                    <\/div>\n                    <div class='ginput_complex ginput_container has_street has_city has_state has_zip ginput_container_address gform-grid-row' id='input_21_5' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_21_5_1_container' >\n                                        <label for='input_21_5_1' id='input_21_5_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                        <input type='text' name='input_5.1' id='input_21_5_1' value=''    aria-required='true'    \/>\n                                   <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_21_5_3_container' >\n                                    <label for='input_21_5_3' id='input_21_5_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                    <input type='text' name='input_5.3' id='input_21_5_3' value=''    aria-required='true'    \/>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_21_5_4_container' >\n                                        <label for='input_21_5_4' id='input_21_5_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                        <select name='input_5.4' id='input_21_5_4'     aria-required='true'    ><option value='' ><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' selected='selected'>Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_21_5_5_container' >\n                                    <label for='input_21_5_5' id='input_21_5_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                    <input type='text' name='input_5.5' id='input_21_5_5' value=''    aria-required='true'    \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_5.6' id='input_21_5_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_21_8\"  class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_8\"><h3>Builder\/Contractor Information<\/h3><\/div><div id=\"field_21_73\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_73\"><label class='gfield_label gform-field-label' for='input_21_73' >Builder\/Contractor Name<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_73' id='input_21_73' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_21_11\"  class=\"gfield gfield--type-email gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_11\"><label class='gfield_label gform-field-label' for='input_21_11' >Builder\/Contractor Email<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_11' id='input_21_11' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_21_12\"  class=\"gfield gfield--type-phone gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_12\"><label class='gfield_label gform-field-label' for='input_21_12' >Builder\/Contractor Phone<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_12' id='input_21_12' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_21_10\"  class=\"gfield gfield--type-address gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_10\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Builder\/Contractor Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_state has_zip ginput_container_address gform-grid-row' id='input_21_10' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_21_10_1_container' >\n                                        <label for='input_21_10_1' id='input_21_10_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                        <input type='text' name='input_10.1' id='input_21_10_1' value=''    aria-required='true'    \/>\n                                   <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_21_10_3_container' >\n                                    <label for='input_21_10_3' id='input_21_10_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                    <input type='text' name='input_10.3' id='input_21_10_3' value=''    aria-required='true'    \/>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_21_10_4_container' >\n                                        <label for='input_21_10_4' id='input_21_10_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                        <select name='input_10.4' id='input_21_10_4'     aria-required='true'    ><option value='' ><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' selected='selected'>Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_21_10_5_container' >\n                                    <label for='input_21_10_5' id='input_21_10_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                    <input type='text' name='input_10.5' id='input_21_10_5' value=''    aria-required='true'    \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_10.6' id='input_21_10_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_21_65' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_21\").val(\"2\");  jQuery(\"#gform_21\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_21\").val(\"2\");  jQuery(\"#gform_21\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_21_2' class='gform_page' data-js='page-field-id-65' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_21_2' class='gform_fields top_label form_sublabel_above description_above'><fieldset id=\"field_21_13\"  class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_13\"><legend class='gfield_label gform-field-label'  >Will the home be built in a subdivision?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_21_13'>\n\t\t\t<div class='gchoice gchoice_21_13_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='Yes'  id='choice_21_13_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_13_0' id='label_21_13_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_21_13_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='No'  id='choice_21_13_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_13_1' id='label_21_13_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_21_14\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_14\"><h3>Subdivision Information<\/h3><\/div><div id=\"field_21_15\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_15\"><label class='gfield_label gform-field-label' for='input_21_15' >Name of Subdivision<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_15' id='input_21_15' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_21_16\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_16\"><label class='gfield_label gform-field-label' for='input_21_16' >Lot Number<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_16' id='input_21_16' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_21_21\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_21\">These items must be checked <strong>before<\/strong> a site meeting can be scheduled.<\/div><fieldset id=\"field_21_18\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_18\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Site plan was filed with the county\/township<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_21_18'><div class='gchoice gchoice_21_18_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.1' type='checkbox'  value='Yes'  id='choice_21_18_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_18_1' id='label_21_18_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_21_19\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_19\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >House must be professionally staked<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_21_19'><div class='gchoice gchoice_21_19_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_19.1' type='checkbox'  value='Yes'  id='choice_21_19_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_19_1' id='label_21_19_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_21_20\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_20\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >House property must be accessible - URE employee must be able to take measurements and located stakes (area and terrain cleared)<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_21_20'><div class='gchoice gchoice_21_20_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.1' type='checkbox'  value='Yes'  id='choice_21_20_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_20_1' id='label_21_20_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_21_17\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_17\"><h3>Non-Subdivision Home<\/h3><\/div><div id=\"field_21_22\"  class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_22\"><p>Please provide the following information so URE can prepare your electric easement.<\/p>\n<p>Much of the information will be on the grantor\u2019s deed\/general warranty deed.<\/p>\n<p>Your County agency (most likely the Auditor\u2019s office or Recorder\u2019s office) should be able to help you obtain any missing information.<\/p><\/div><div id=\"field_21_23\"  class=\"gfield gfield--type-fileupload field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_23\"><label class='gfield_label gform-field-label' for='input_21_23' >Upload the Grantor\u2019s Deed\/General Warranty Deed<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='536870912' \/><input name='input_23' id='input_21_23' type='file' class='large' aria-describedby=\"gfield_upload_rules_21_23\" onchange='javascript:gformValidateFileSize( this, 536870912 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_21_23'>Max. file size: 512 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_21_23'><\/div><\/div><\/div><div id=\"field_21_24\"  class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_24\">The Grantor\u2019s Deed\/General Warranty Deed file upload must include the following:<\/div><div id=\"field_21_25\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_25\"><label class='gfield_label gform-field-label' for='input_21_25' >Official Names on the Deed<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_25' id='input_21_25' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_21_26\"  class=\"gfield gfield--type-text field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_26\"><label class='gfield_label gform-field-label' for='input_21_26' >Recorded Instrument number on Grantor&#039;s deed\/General warranty Deed<\/label><div class='ginput_container ginput_container_text'><input name='input_26' id='input_21_26' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_21_27\"  class=\"gfield gfield--type-text field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_27\"><label class='gfield_label gform-field-label' for='input_21_27' >Parcel Number where the easement will reside (not the parent parcel)<\/label><div class='ginput_container ginput_container_text'><input name='input_27' id='input_21_27' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_21_28\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_28\"><label class='gfield_label gform-field-label' for='input_21_28' >Number of Acres of the Parcel<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_28' id='input_21_28' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_21_29\"  class=\"gfield gfield--type-fileupload gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_29\"><label class='gfield_label gform-field-label' for='input_21_29' >Upload written legal description. URE will prepare an easement document on the property<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='536870912' \/><input name='input_29' id='input_21_29' type='file' class='large' aria-describedby=\"gfield_upload_rules_21_29\" onchange='javascript:gformValidateFileSize( this, 536870912 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_21_29'>Max. file size: 512 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_21_29'><\/div><\/div><\/div><div id=\"field_21_31\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_31\"><label class='gfield_label gform-field-label' for='input_21_31' >Virginia Military Survey Number (VMS)<\/label><div class='ginput_container ginput_container_text'><input name='input_31' id='input_21_31' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_21_30\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_30\"><label class='gfield_label gform-field-label' for='input_21_30' >Parcel is located in what County?<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_30' id='input_21_30' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_21_32\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_32\"><label class='gfield_label gform-field-label' for='input_21_32' >Parcel is located in what Township?<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_32' id='input_21_32' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_21_33\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_33\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Site plan was filed with the county\/township (this shows well, septic, driveway, house etc.)<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_21_33'><div class='gchoice gchoice_21_33_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.1' type='checkbox'  value='Yes'  id='choice_21_33_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_33_1' id='label_21_33_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_21_34\"  class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_34\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >All items must be checked before a site meeting can be scheduled<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_21_34'><div class='gchoice gchoice_21_34_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_34.1' type='checkbox'  value='Are you a URE member? If not- please fill out the New Member Application'  id='choice_21_34_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_34_1' id='label_21_34_1' class='gform-field-label gform-field-label--type-inline'>Are you a URE member? If not- please fill out the New Member Application<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_21_34_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_34.2' type='checkbox'  value='Property pins must be located'  id='choice_21_34_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_34_2' id='label_21_34_2' class='gform-field-label gform-field-label--type-inline'>Property pins must be located<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_21_34_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_34.3' type='checkbox'  value='Driveway must be staked\/known'  id='choice_21_34_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_34_3' id='label_21_34_3' class='gform-field-label gform-field-label--type-inline'>Driveway must be staked\/known<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_21_34_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_34.4' type='checkbox'  value='Septic must be staked\/known'  id='choice_21_34_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_34_4' id='label_21_34_4' class='gform-field-label gform-field-label--type-inline'>Septic must be staked\/known<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_21_34_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_34.5' type='checkbox'  value='Well location must be known'  id='choice_21_34_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_34_5' id='label_21_34_5' class='gform-field-label gform-field-label--type-inline'>Well location must be known<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_21_34_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_34.6' type='checkbox'  value='Property must be professionally staked'  id='choice_21_34_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_34_6' id='label_21_34_6' class='gform-field-label gform-field-label--type-inline'>Property must be professionally staked<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_21_34_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_34.7' type='checkbox'  value='Property must be accessible - URE employee must be able to take measurements and located stakes (area and terrain cleared)'  id='choice_21_34_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_34_7' id='label_21_34_7' class='gform-field-label gform-field-label--type-inline'>Property must be accessible - URE employee must be able to take measurements and located stakes (area and terrain cleared)<\/label>\n\t\t\t\t\t\t\t<\/div><button type=\"button\" id=\"button_34_select_all\" class=\"gfield_choice_all_toggle gform-theme-button--size-sm\" onclick=\"gformToggleCheckboxes( this )\" data-checked=\"0\" data-label-select=\"Select All\" data-label-deselect=\"Deselect All\">Select All<\/button><\/div><\/div><\/fieldset><div id=\"field_21_35\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_35\"><h4>Site Meeting Information<\/h4><\/div><div id=\"field_21_36\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_36\"><label class='gfield_label gform-field-label' for='input_21_36' >Who will be at this meeting?<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_36' id='input_21_36' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_21_37\"  class=\"gfield gfield--type-phone gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_37\"><label class='gfield_label gform-field-label' for='input_21_37' >Best Contact Phone- in the event the meeting needs to be rescheduled<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_37' id='input_21_37' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_21_66' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_21\").val(\"1\");  jQuery(\"#gform_21\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_21\").val(\"1\");  jQuery(\"#gform_21\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_21_66' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_21\").val(\"3\");  jQuery(\"#gform_21\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_21\").val(\"3\");  jQuery(\"#gform_21\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_21_3' class='gform_page' data-js='page-field-id-66' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_21_3' class='gform_fields top_label form_sublabel_above description_above'><div id=\"field_21_46\"  class=\"gfield gfield--type-html gfield--width-full gf_list_2col gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_46\"><h3>New Home Information<\/h3><\/div><fieldset id=\"field_21_38\"  class=\"gfield gfield--type-checkbox gfield--type-choice gf_list_2col gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_38\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >New Home Services - please check all that apply to your home<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_21_38'><div class='gchoice gchoice_21_38_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_38.1' type='checkbox'  value='Multi-Level'  id='choice_21_38_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_38_1' id='label_21_38_1' class='gform-field-label gform-field-label--type-inline'>Multi-Level<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_21_38_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_38.2' type='checkbox'  value='Single Familly'  id='choice_21_38_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_38_2' id='label_21_38_2' class='gform-field-label gform-field-label--type-inline'>Single Familly<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_21_38_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_38.3' type='checkbox'  value='Duplex'  id='choice_21_38_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_38_3' id='label_21_38_3' class='gform-field-label gform-field-label--type-inline'>Duplex<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_21_38_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_38.4' type='checkbox'  value='Multi-Family'  id='choice_21_38_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_38_4' id='label_21_38_4' class='gform-field-label gform-field-label--type-inline'>Multi-Family<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_21_38_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_38.5' type='checkbox'  value='Mobile Home'  id='choice_21_38_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_38_5' id='label_21_38_5' class='gform-field-label gform-field-label--type-inline'>Mobile Home<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_21_39\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_39\"><label class='gfield_label gform-field-label' for='input_21_39' >What is the square feet of your new home?<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_39' id='input_21_39' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_21_40\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_40\"><legend class='gfield_label gform-field-label'  >Service Installation type:<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_21_40'>\n\t\t\t<div class='gchoice gchoice_21_40_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_40' type='radio' value='Overhead'  id='choice_21_40_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_40_0' id='label_21_40_0' class='gform-field-label gform-field-label--type-inline'>Overhead<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_21_40_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_40' type='radio' value='Underground'  id='choice_21_40_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_40_1' id='label_21_40_1' class='gform-field-label gform-field-label--type-inline'>Underground<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_21_41\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_41\"><legend class='gfield_label gform-field-label'  >Service type (Amps)<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_21_41'>\n\t\t\t<div class='gchoice gchoice_21_41_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_41' type='radio' value='100'  id='choice_21_41_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_41_0' id='label_21_41_0' class='gform-field-label gform-field-label--type-inline'>100<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_21_41_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_41' type='radio' value='200'  id='choice_21_41_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_41_1' id='label_21_41_1' class='gform-field-label gform-field-label--type-inline'>200<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_21_41_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_41' type='radio' value='320'  id='choice_21_41_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_41_2' id='label_21_41_2' class='gform-field-label gform-field-label--type-inline'>320<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_21_41_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_41' type='radio' value='gf_other_choice'  id='choice_21_41_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_41_3' id='label_21_41_3' class='gform-field-label gform-field-label--type-inline'>Other<\/label><br \/><input id='input_21_41_other' class='gchoice_other_control' name='input_41_other' type='text' value='Other' aria-label='Other Choice, please specify'  disabled='disabled' \/>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_21_42\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_42\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Type of water heater<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_21_42'><div class='gchoice gchoice_21_42_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_42.1' type='checkbox'  value='Electric'  id='choice_21_42_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_42_1' id='label_21_42_1' class='gform-field-label gform-field-label--type-inline'>Electric<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_21_42_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_42.2' type='checkbox'  value='Natural Gas'  id='choice_21_42_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_42_2' id='label_21_42_2' class='gform-field-label gform-field-label--type-inline'>Natural Gas<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_21_42_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_42.3' type='checkbox'  value='Propane'  id='choice_21_42_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_42_3' id='label_21_42_3' class='gform-field-label gform-field-label--type-inline'>Propane<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_21_42_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_42.4' type='checkbox'  value='Tankless - electric'  id='choice_21_42_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_42_4' id='label_21_42_4' class='gform-field-label gform-field-label--type-inline'>Tankless - electric<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_21_42_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_42.5' type='checkbox'  value='Tankless - natural gas'  id='choice_21_42_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_42_5' id='label_21_42_5' class='gform-field-label gform-field-label--type-inline'>Tankless - natural gas<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_21_43\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_43\"><label class='gfield_label gform-field-label' for='input_21_43' >Size of Water Heater (gallons)<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_43' id='input_21_43' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_21_44\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_44\"><label class='gfield_label gform-field-label' for='input_21_44' >How many water heaters\/tankless units will this home have?<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_44' id='input_21_44' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_21_45\"  class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_45\"><legend class='gfield_label gform-field-label'  >What will be the main source of heat for the home?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_21_45'>\n\t\t\t<div class='gchoice gchoice_21_45_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_45' type='radio' value='Electric'  id='choice_21_45_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_45_0' id='label_21_45_0' class='gform-field-label gform-field-label--type-inline'>Electric<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_21_45_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_45' type='radio' value='Natural Gas'  id='choice_21_45_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_45_1' id='label_21_45_1' class='gform-field-label gform-field-label--type-inline'>Natural Gas<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_21_45_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_45' type='radio' value='Propane'  id='choice_21_45_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_45_2' id='label_21_45_2' class='gform-field-label gform-field-label--type-inline'>Propane<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_21_45_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_45' type='radio' value='Geothermal'  id='choice_21_45_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_45_3' id='label_21_45_3' class='gform-field-label gform-field-label--type-inline'>Geothermal<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_21_45_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_45' type='radio' value='gf_other_choice'  id='choice_21_45_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_45_4' id='label_21_45_4' class='gform-field-label gform-field-label--type-inline'>Other<\/label><br \/><input id='input_21_45_other' class='gchoice_other_control' name='input_45_other' type='text' value='Other' aria-label='Other Choice, please specify'  disabled='disabled' \/>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_21_47\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_47\"><label class='gfield_label gform-field-label' for='input_21_47' >*If you are using geothermal or air-to-air heat pump, what is your backup heating source?<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_47' id='input_21_47' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_21_48\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_48\"><label class='gfield_label gform-field-label' for='input_21_48' >What is the size (in tons) of your air conditioning\/heat pump?<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_48' id='input_21_48' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_21_67\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_67\"><h3>Temporary Power<\/h3><\/div><fieldset id=\"field_21_71\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_71\"><legend class='gfield_label gform-field-label'  >Temporary power for construction provided by?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_21_71'>\n\t\t\t<div class='gchoice gchoice_21_71_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_71' type='radio' value='Member'  id='choice_21_71_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_71_0' id='label_21_71_0' class='gform-field-label gform-field-label--type-inline'>Member<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_21_71_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_71' type='radio' value='URE'  id='choice_21_71_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_71_1' id='label_21_71_1' class='gform-field-label gform-field-label--type-inline'>URE<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_21_50\"  class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_50\">Who will pay for temporary electric usage?<\/div><fieldset id=\"field_21_51\"  class=\"gfield gfield--type-name gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_51\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Name<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_21_51'>\n                            \n                            <span id='input_21_51_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_21_51_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                    <input type='text' name='input_51.3' id='input_21_51_3' value=''   aria-required='true'     \/>\n                                                <\/span>\n                            \n                            <span id='input_21_51_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_21_51_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                            <input type='text' name='input_51.6' id='input_21_51_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_21_52\"  class=\"gfield gfield--type-phone gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_52\"><label class='gfield_label gform-field-label' for='input_21_52' >Phone<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_52' id='input_21_52' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_21_53\"  class=\"gfield gfield--type-email gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_53\"><label class='gfield_label gform-field-label' for='input_21_53' >Email<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_53' id='input_21_53' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><fieldset id=\"field_21_54\"  class=\"gfield gfield--type-address gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_54\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_state has_zip ginput_container_address gform-grid-row' id='input_21_54' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_21_54_1_container' >\n                                        <label for='input_21_54_1' id='input_21_54_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                        <input type='text' name='input_54.1' id='input_21_54_1' value=''    aria-required='true'    \/>\n                                   <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_21_54_3_container' >\n                                    <label for='input_21_54_3' id='input_21_54_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                    <input type='text' name='input_54.3' id='input_21_54_3' value=''    aria-required='true'    \/>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_21_54_4_container' >\n                                        <label for='input_21_54_4' id='input_21_54_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                        <select name='input_54.4' id='input_21_54_4'     aria-required='true'    ><option value='' ><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' selected='selected'>Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_21_54_5_container' >\n                                    <label for='input_21_54_5' id='input_21_54_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                    <input type='text' name='input_54.5' id='input_21_54_5' value=''    aria-required='true'    \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_54.6' id='input_21_54_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_21_69' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_21\").val(\"2\");  jQuery(\"#gform_21\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_21\").val(\"2\");  jQuery(\"#gform_21\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_21_69' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_21\").val(\"4\");  jQuery(\"#gform_21\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_21\").val(\"4\");  jQuery(\"#gform_21\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_21_4' class='gform_page' data-js='page-field-id-69' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_21_4' class='gform_fields top_label form_sublabel_above description_above'><div id=\"field_21_68\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_68\"><h3>Property Information<\/h3><\/div><fieldset id=\"field_21_55\"  class=\"gfield gfield--type-checkbox gfield--type-choice gf_list_2col gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_55\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Will your property contain any of these items? Please check all that apply<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_21_55'><div class='gchoice gchoice_21_55_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.1' type='checkbox'  value='Back-up generator'  id='choice_21_55_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_55_1' id='label_21_55_1' class='gform-field-label gform-field-label--type-inline'>Back-up generator<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_21_55_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.2' type='checkbox'  value='Barn\/Out building'  id='choice_21_55_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_55_2' id='label_21_55_2' class='gform-field-label gform-field-label--type-inline'>Barn\/Out building<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_21_55_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.3' type='checkbox'  value='Workshop'  id='choice_21_55_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_55_3' id='label_21_55_3' class='gform-field-label gform-field-label--type-inline'>Workshop<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_21_55_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.4' type='checkbox'  value='Motors'  id='choice_21_55_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_55_4' id='label_21_55_4' class='gform-field-label gform-field-label--type-inline'>Motors<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_21_55_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.5' type='checkbox'  value='Welding equipment'  id='choice_21_55_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_55_5' id='label_21_55_5' class='gform-field-label gform-field-label--type-inline'>Welding equipment<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_21_55_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.6' type='checkbox'  value='Pool'  id='choice_21_55_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_55_6' id='label_21_55_6' class='gform-field-label gform-field-label--type-inline'>Pool<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_21_55_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.7' type='checkbox'  value='Hot tub'  id='choice_21_55_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_55_7' id='label_21_55_7' class='gform-field-label gform-field-label--type-inline'>Hot tub<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_21_55_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.8' type='checkbox'  value='Pond, Pump, Aerator'  id='choice_21_55_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_55_8' id='label_21_55_8' class='gform-field-label gform-field-label--type-inline'>Pond, Pump, Aerator<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_21_55_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.9' type='checkbox'  value='Electric vehicle charging station'  id='choice_21_55_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_55_9' id='label_21_55_9' class='gform-field-label gform-field-label--type-inline'>Electric vehicle charging station<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_21_55_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.11' type='checkbox'  value='Solar\/Wind turbine interconnection'  id='choice_21_55_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_55_11' id='label_21_55_11' class='gform-field-label gform-field-label--type-inline'>Solar\/Wind turbine interconnection<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_21_55_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.12' type='checkbox'  value='Not Applicable'  id='choice_21_55_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_55_12' id='label_21_55_12' class='gform-field-label gform-field-label--type-inline'>Not Applicable<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_21_55_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.13' type='checkbox'  value='Other'  id='choice_21_55_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_55_13' id='label_21_55_13' 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_21_56\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_56\"><label class='gfield_label gform-field-label' for='input_21_56' >Please explain<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_21_56' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_21_57\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_57\"><legend class='gfield_label gform-field-label'  >Is your generator:<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_21_57'>\n\t\t\t<div class='gchoice gchoice_21_57_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_57' type='radio' value='Whole House'  id='choice_21_57_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_57_0' id='label_21_57_0' class='gform-field-label gform-field-label--type-inline'>Whole House<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_21_57_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_57' type='radio' value='Portable'  id='choice_21_57_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_57_1' id='label_21_57_1' class='gform-field-label gform-field-label--type-inline'>Portable<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_21_58\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_58\"><legend class='gfield_label gform-field-label'  >Will you need a GenerLink transfer switch? For more information about GenerLinks go to https:\/\/ure.com\/generlink\/<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_21_58'>\n\t\t\t<div class='gchoice gchoice_21_58_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_58' type='radio' value='Yes'  id='choice_21_58_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_58_0' id='label_21_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_21_58_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_58' type='radio' value='No'  id='choice_21_58_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_58_1' id='label_21_58_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_21_59\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_59\"><legend class='gfield_label gform-field-label'  >Amp?<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_21_59'>\n\t\t\t<div class='gchoice gchoice_21_59_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_59' type='radio' value='30 Amp'  id='choice_21_59_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_59_0' id='label_21_59_0' class='gform-field-label gform-field-label--type-inline'>30 Amp<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_21_59_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_59' type='radio' value='50 Amp'  id='choice_21_59_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_59_1' id='label_21_59_1' class='gform-field-label gform-field-label--type-inline'>50 Amp<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_21_60\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_60\"><label class='gfield_label gform-field-label' for='input_21_60' >Motor Rating in Horsepower<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_60' id='input_21_60' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_21_61\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_61\"><label class='gfield_label gform-field-label' for='input_21_61' >Welding Equipment Amps?<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_61' id='input_21_61' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_21_62\"  class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_62\"><h3>Member Agreement & Consent<\/h3><\/div><fieldset id=\"field_21_63\"  class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_21_63\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Member Consent<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_63.1' id='input_21_63_1' type='checkbox' value='1'   aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_21_63_1' >I agree to the I hereby verify the information to be true and complete and agree to the terms and conditions. I understand that by typing my full name and pressing the Submit button, this form submission will be stamped with today\u2019s date and authorized by me as if I had signed my signature.privacy policy.<\/label><input type='hidden' name='input_63.2' value='I agree to the I hereby verify the information to be true and complete and agree to the terms and conditions. I understand that by typing my full name and pressing the Submit button, this form submission will be stamped with today\u2019s date and authorized by me as if I had signed my signature.privacy policy.' class='gform_hidden' \/><input type='hidden' name='input_63.3' value='10' class='gform_hidden' \/><\/div><\/fieldset><div id=\"field_21_64\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_64\"><label class='gfield_label gform-field-label' for='input_21_64' >Member Electronic Signature (Full Name)<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_64' id='input_21_64' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_21_79\"  class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_above gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_21_79\"><label class='gfield_label gform-field-label' for='input_21_79' >Comments<\/label><div class='gfield_description' id='gfield_description_21_79'>This field is for validation purposes and should be left unchanged.<\/div><div class='ginput_container'><input name='input_79' id='input_21_79' type='text' value='' autocomplete='new-password'\/><\/div><\/div><\/div><\/div>\n        <div class='gform_page_footer top_label'><input type='submit' id='gform_previous_button_21' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='if(window[\"gf_submitting_21\"]){return false;}  if( !jQuery(\"#gform_21\")[0].checkValidity || jQuery(\"#gform_21\")[0].checkValidity()){window[\"gf_submitting_21\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_21\"]){return false;} if( !jQuery(\"#gform_21\")[0].checkValidity || jQuery(\"#gform_21\")[0].checkValidity()){window[\"gf_submitting_21\"]=true;}  jQuery(\"#gform_21\").trigger(\"submit\",[true]); 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