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	                	<h1 class="pagetitle">Contact Us Form</h1>
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			<p class="form-instructions"><p>If you would like additional information about ANAC, or if you have a questions, please complete and submit this form.&nbsp; You may also email us at <a href="mailto:anac@anacnet.org">anac@anacnet.org</a> or call us at 1-800-260-6780.&nbsp; Thank you for your interest in ANAC.</p>
</p>
		

	<form action="index.cfm?id=53&popup=false" method="POST" id="iform" name="iform" enctype="multipart/form-data">
		
		<input type="hidden" id="num_questions" name="num_questions" value="10">
		<input type="hidden" name="form_id" value="53">
		<input type="hidden" name="report_id" value="">
		<input type="hidden" name="AllowedUploads" value="doc,docx,docm,dotx,dotm,eps,epub,htm,ics,lit,mobi,msg,pdf,potx,potm,ppam,ppsx,ppsm,pps,ppt,pptm,pptx,pub,txt,xls,zip,xlsx,xlsm,xltx,xltm,xlsb,xlam,vcf,sgf,gif,jpg,jpeg,jpe,png">
		
		
<script>
	$(function () {
		// reset payment token in case user clicked Back button in browser
		$('#paymentToken').val('');
		
		//$('#business_radio').trigger('change');
		
		
			$('#formsPayment :input').each(function() {
				if ($(this).attr('id') != 'savePaymentProfile_yes' && $(this).attr('id') != 'usePaymentProfile_yes') {
					$(this).addClass('form-control').css('margin-bottom', '10px').css('margin-left', '2px');
				}
			});
			$('#formsPayment').css('max-width', '100%');
		
	});
	
	function limitText(limitField, limitCount, limitNum) {
		if (limitField.value.length > limitNum) {
			limitField.value = limitField.value.substring(0, limitNum);
		} else {
			limitCount.value = limitNum - limitField.value.length;
		}
	}

	function enable(obj) {
		obj.disabled = false;
		obj.style.backgroundColor = "white";
		obj.style.color = "black";
	}

	var validForm = false;
	var sent = 0;
	
	// Thibault 2/11/06 added init function called at page load, plus validation that required fields are completed before submit.  should help with problems with the back button and credit cards,  issue 30102
	function init() {
		frm = document.iform;

		
	}

	window.onload = new Function("init()"); //set init function to run at page load

	function lcase(mystring)  {
		return mystring.toLowerCase()
	}

	function listfind(list,value,delimiters) {
		if(!delimiters){var delimiters=','}
		_TempListSplitArray = list.split(delimiters)
		FoundIdx = 0;
		for(i=0;i<_TempListSplitArray.length;i++) {
			if(_TempListSplitArray[i]==value){
				FoundIdx= i+1;
				break
			}
		}
		return FoundIdx;
	}

	function startValidate() {
		// this will kick off validation, but since we need to validate the captcha
		// we have to wait for that to finish first...
		var iForm = document.getElementById('iform');
		var fld_ss_form_testid = document.getElementById('fld_ss_form_testid');
		var mainV = validateFrm();
		fld_ss_form_testid.value = 1;
		if (mainV) {
			
				iForm.submit();
			
		}
	}

	function validateFrm() {
		if(!sent) sent = 0;  //make sure we have this!
		if (!validForm) validForm = false;
		arrReqMissing = new Array();
		
			
			var jsDesc = "Contact Us Form";
			
			
			var jsDesc = "\n\nIf you would like additional information about ANAC, or if you have a questions, please complete and submit this form.&nbsp; You may also email us at anac@anacnet.org or call us at 1-800-260-6780.&nbsp; Thank you for your interest in ANAC. ";
			
			
			var jsDesc = "Title";
			
			
			var jsDesc = "Name";
			
				obj = document.iform.response_4;
				val = "";
				
				val = obj.value;
				if (obj.value == "") {
					arrReqMissing[arrReqMissing.length] = jsDesc;
				}
				
			
			var jsDesc = "Company";
			
			
			var jsDesc = "Address";
			
			
			var jsDesc = "City, State, Zip";
			
			
			var jsDesc = "Phone";
			
			
			var jsDesc = "Email";
			
				obj = document.iform.response_9;
				val = "";
				
				val = obj.value;
				if (obj.value == "") {
					arrReqMissing[arrReqMissing.length] = jsDesc;
				}
				
			
			var jsDesc = "Comments/Questions";
			
			
		if(arrReqMissing.length > 0) {
			//errStr = "We're sorry, but the following fields are required before you can submit this form. Please click OK, then correct these entries.<br>";
			errStr = "";
			for(i=0; i<arrReqMissing.length; i++) {
				errStr += arrReqMissing[i] + "<br>";
			}
			swal({
	  			title: 'Missing required fields',
	  			html: true,
	  			text: errStr,
	  			animation: 'slide-from-top',
	  			type: 'info',
	  			confirmButtonText: 'Ok',
	  			confirmButtonColor: '#337ab7'
	  		});
			return false;
		}

		for(i=0; i<document.iform.elements.length; i++) {
		 	if (document.iform.elements[i].type == 'textarea' || document.iform.elements[i].type == 'text') {
		 		if (document.iform.elements[i].value.length > 2147483647) {
		 			swal({
			  			title: 'Maximum allowable length',
			  			html: true,
			  			text: "One or more field responses exceeds the maximum allowable length of 2147483647 characters. Please adjust your responses and re-submit.",
			  			animation: 'slide-from-top',
			  			type: 'info',
			  			confirmButtonText: 'Ok',
			  			confirmButtonColor: '#337ab7'
			  		});
		 			return false;
		 		}
		 	}
		}

		if (sent == 1) {
	          swal({
	  			title: 'Processing..',
	  			html: true,
	  			text: "Your request is processing. Please do not click Submit more than once.",
	  			animation: 'slide-from-top',
	  			type: 'info',
	  			confirmButtonText: 'Ok',
	  			confirmButtonColor: '#337ab7'
	  		  });
	          return false;
	    }
		
			bOK = true;
		
		if (bOK) {
			var btn = $('#submitBtn');
			btn.button('loading');
			btn.prop('disabled', true);
			sent = 1;
			validForm = true;
			return true;
		}
		else {
			return false;
		}
	}

	function IsNumeric(sText) {
	   var ValidChars = "0123456789.";
	   var IsNumber=true;
	   var Char;

	   for (i = 0; i < sText.length && IsNumber == true; i++) {
	      Char = sText.charAt(i);
	      if (ValidChars.indexOf(Char) == -1) {
	         IsNumber = false;
	      }
	   }
	   return IsNumber;
	}

	function setButtonVal(el, itemID, price) {
		// first set the price attribute on the element
		el.price = price;
		// now set the value of a hidden field for the associated radio button
		document.getElementById(itemID).price = price;
		document.getElementById(itemID).value = 1;
		// now call the calcTotalFix function to recaculate the total amount due
		calcTotalFix();
	}

	function getRadioButtonValForTotal(radioName){
		var rads = document.getElementsByName(radioName);
		var selectedPrice = 0;
		for(i=0; i < rads.length; i++) {
		  if(rads[i].checked == true){
		    selectedPrice = rads[i].getAttribute('price');
		  }
		}

		selectedPrice = parseFloat(selectedPrice);
		return selectedPrice;
	}

	function calcTotalFix() {
		var priceFields = $(".calculateTotal");
		// console.log('priceFields length: ' + priceFields.length);
		var updateTotal = 0; // initialize total before looping over array
		var processedRadioButtons = [];	/// reset array every time this function is called
		for (var i=0; i < priceFields.length; i++) {
			myFieldObj = priceFields[i];
			if (myFieldObj.value == '') { myFieldObj.value = 0; }
			fieldName = myFieldObj.name;
			value = myFieldObj.value;
			fieldID = myFieldObj.getAttribute('id');
			price = myFieldObj.getAttribute('price');

			// check to see if this is a radioVal by the item id
			if(fieldID != undefined){
				var nRadioVal = fieldID.indexOf("radioVal");
				if(nRadioVal > -1){
					fieldtype = 'radioval';
				} else {
					fieldtype = 'notradioval';
				}
			} else {
				fieldtype = 'nofieldid';
			}

			// if this is just an open price field, there is no notion of quantity times price, so the price to the value of the field
			if(fieldtype === 'radioval'){
				// radio price field - use "price" attribute since we have funky stuff in the "value" attribute that we can't parse easily
				arrNum = $.inArray(fieldName, processedRadioButtons);
				if(arrNum > -1) {
					// set price and calcualted value to zero for the rest of the checkboxes in this array because don't want to keep adding to price
					price = 0;
					calculatedValue = parseFloat(0);
				} else {
					price = getRadioButtonValForTotal(fieldName);
					calculatedValue = parseFloat(price);
					// add radio button field name to array of radio fields processed so we don't check again
					processedRadioButtons.push(fieldName);
				}
				// console.log('fieldName: ' + fieldName + ' / value: ' + value + ' fieldID: ' + fieldID + ' / price: ' + price + ' / calculatedValue: ' + calculatedValue);
			} else {
				if (price === undefined || price === null) {
				// check to see if it's a radio price field first
					// open price field - use "value" attribute
					if (!IsNumeric(value)) {
						//alert("Open Prices must be numbers only, no formatting is allowed.");
						swal({
				  			title: 'Numbers only',
				  			html: true,
				  			text: "Open Prices must be numbers only, no formatting is allowed.",
				  			animation: 'slide-from-top',
				  			type: 'info',
				  			confirmButtonText: 'Ok',
				  			confirmButtonColor: '#337ab7'
				  		});
						myFieldObj.value = 0;
						return;
					}
					calculatedValue = parseFloat(value);
					// console.log('fieldName: ' + fieldName + ' / value: ' + value + ' fieldID: ' + fieldID + ' / price: ' + price + ' / calculatedValue: ' + calculatedValue);
				} else {
					if (!IsNumeric(value)) {
						//alert("Price fields only allow numbers.");
						swal({
				  			title: 'Price fields',
				  			html: true,
				  			text: "Price fields only allow numbers.",
				  			animation: 'slide-from-top',
				  			type: 'info',
				  			confirmButtonText: 'Ok',
				  			confirmButtonColor: '#337ab7'
				  		});
						myFieldObj.value = 0;
						return;
					}
					myVal = parseFloat(value);
					// console.log('in parseint with 10 - fieldName: ' + fieldName + ' / value: ' + value + ' fieldID: ' + fieldID + ' / price: ' + price + ' / myVal: ' + myVal);
					calculatedValue = myVal * parseFloat(price);

				}
			}


			// console.log('Field id: ' + fieldID + ' / Fieldtype: ' + fieldtype + ' / Field name: ' + fieldName + ' / value: ' + value + ' / Price: ' + price + ' / Calculated Field Total: ' + calculatedValue);
			updateTotal = updateTotal + calculatedValue;
		}

		// update hidden total amount
		if (document.iform.hiddentotal) { document.iform.hiddentotal.value = updateTotal; }
		// console.log('The updateTotal is now: ' + updateTotal);
		
		
		// update total value with formatted amount
		if (typeof(formatCurrency) == "function") { document.iform.total.value = formatCurrency(updateTotal); }
		
		if ($('#ordertotal_work').length > 0) {
            $('#ordertotal_work').val(updateTotal.toFixed(2));
        }
        
        if ($('#pmt_method').length > 0) {
        	$('#pmt_method').val('');
        }
        $('.paymentProfileRadio').prop('checked', false);
        $('.card').removeClass('active');
        
		// need to update the cc_info tag fields...
		if (typeof(checkTotal) == "function") { checkTotal(); }
	}

	/* remove after confirming ok without it - 8/8/13 CJV */
	function calcTotal(myField){
		thisVal = myField.value;
		// alert(thisVal);
		if (thisVal == '') {
			thisVal = 0;
			myField.value = 0;
			}
			if (!IsNumeric(myField.value)) {
				//alert('Please enter only numbers or decimal points in a price field');
				swal({
		  			title: 'Price field',
		  			html: true,
		  			text: "Please enter only numbers or decimal points in a price field.",
		  			animation: 'slide-from-top',
		  			type: 'info',
		  			confirmButtonText: 'Ok',
		  			confirmButtonColor: '#337ab7'
		  		});
				myField.value = 0;
				thisVal = 0;
				}
				// get the current total
				var origTotal = document.iform.hiddentotal.value;
				// now backout the prior value from the total
				var priorTotal = origTotal - myField.priorval;
				if(priorTotal == ''){
					priorTotal = 0;
					}
				// add the open price to the total
				updateTotal = parseFloat(eval(priorTotal)) + parseFloat(eval(thisVal));
				// update hidden total amount
				document.iform.hiddentotal.value = updateTotal;
				
					
				// update total value with formatted amount
				document.iform.total.value = formatCurrency(updateTotal);
		checkTotal(); // need to update the cc_info tag fields...
	}
	/* */

	function setOpenPriceInput(thisField,thisPrice){
		if(thisPrice == ''){
			thisField.priorval = 0;
		} else {
			thisField.priorval = thisPrice;
		}
	}

	
		var div_bottom_moved = false;

		function addLoadEvent(func) {
 			var oldonload = window.onload;
  			if (typeof window.onload != 'function') {
    			window.onload = func;
  			}
  			else {
    			window.onload = function() {
      				if (oldonload) {
        				oldonload();
      				}
      				func();
    			}
  			}
 		}

		addLoadEvent(calcTotalFix);
	
</script>

	
<style>
.has-error {
	color: #f70404 !important;
}
.has-error input {
	border: 1px solid #f70404 !important;
}
</style>


<script>
	function checkInvalidCharacter(objName){
		var obj = document.iform[objName];
		var strFileName = obj.value.replace('C:\\fakepath\\','');
		iTemp = strFileName.indexOf(":");
		
		if (iTemp > -1) {
			swal({
	  			title: 'Invalid character',
	  			html: true,
	  			text: "Invalid character ':' found in file name. Please change the file name before attempting to upload this file.",
	  			animation: 'slide-from-top',
	  			type: 'info',
	  			confirmButtonText: 'Ok',
	  			confirmButtonColor: '#337ab7'
	  		});
			obj.value = '';
			return false;
		}
		else {
			iTemp = obj.value.indexOf(",");
			if (iTemp > -1) {
				swal({
		  			title: 'Invalid character',
		  			html: true,
		  			text: "Invalid character ',' found in file name. Please change the file name before attempting to upload this file.",
		  			animation: 'slide-from-top',
		  			type: 'info',
		  			confirmButtonText: 'Ok',
		  			confirmButtonColor: '#337ab7'
		  		});
				obj.value = '';
				return false;
			}
		}
	}
	function clearRadio(rd) {
		if (document.iform) {
			var v;
			var ln;
			var ev;
			submitted = 0;
			v = "document.iform." + rd + ".length";
			ln = eval(v);
			// This will ensure we uncheck if there is only 1 radio button..
			v = "document.iform." + rd + ".checked = false;";
			ev = eval(v);
			// Now loop through the list of radio buttons and uncheck them all
			for (i=0;i<ln;i++) {
				v = "document.iform." + rd + "[" + i + "].checked = false;";
				//console.log(v);
				ev = eval(v);
			}
			calcTotalFix();
		}
	}
</script>


<div class="form_layout_wrapper" style="max-width:940px;" >

	
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

		<div id="form-item-884" class="layout form item outer row-1 item-884 row_num-20 row_pos-1024 rowlength-1 type-None" style="clear:both;width:100%;position:relative;">

			<div class="inner">

				
						<span style="font-size:18pt;font-weight:bold">Contact Us Form</span>
					

				<input type="hidden" name="question_1" value="&lt;span style=&quot;font-size:18pt;font-weight:bold&quot;&gt;Contact Us Form&lt;/span&gt;">
				<INPUT TYPE="hidden" NAME="response_1_question_id" VALUE="884">
				<INPUT TYPE="hidden" NAME="question_type_1" value="None">
				<INPUT TYPE="hidden" NAME="label_1" value="">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
				</div> <!-- /The inner div, for the sake of IE -->
			
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

		<div id="form-item-885" class="layout form item outer row-2 item-885 row_num-40 row_pos-1024 rowlength-1 type-None" style="clear:both;width:100%;position:relative;">

			<div class="inner">

				
						<p>If you would like additional information about ANAC, or if you have a questions, please complete and submit this form.&nbsp; You may also email us at <a href="mailto:anac@anacnet.org">anac@anacnet.org</a> or call us at 1-800-260-6780.&nbsp; Thank you for your interest in ANAC.</p> 
					

				<input type="hidden" name="question_2" value="&lt;p&gt;If you would like additional information about ANAC, or if you have a questions, please complete and submit this form.&amp;nbsp; You may also email us at &lt;a href=&quot;mailto:anac@anacnet.org&quot;&gt;anac@anacnet.org&lt;/a&gt; or call us at 1-800-260-6780.&amp;nbsp; Thank you for your interest in ANAC.&lt;/p&gt; &lt;P&gt;">
				<INPUT TYPE="hidden" NAME="response_2_question_id" VALUE="885">
				<INPUT TYPE="hidden" NAME="question_type_2" value="None">
				<INPUT TYPE="hidden" NAME="label_2" value="">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
				</div> <!-- /The inner div, for the sake of IE -->
			
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

		<div id="form-item-888" class="layout form item outer row-3 item-888 row_num-60 row_pos-1024 rowlength-2 type-Text" style="clear:both;;position:relative;">

			<div class="inner">

				
							Title
					

							<input type="text"
								
									id="response_3"
									name="response_3"
								
								
								 style="width:80px;"
								
									
                                            value=""
									    
										
								class="form-control type-Text row-3 item-888"
							><!-- input -->

							
				<input type="hidden" name="question_3" value="Title">
				<INPUT TYPE="hidden" NAME="response_3_question_id" VALUE="888">
				<INPUT TYPE="hidden" NAME="question_type_3" value="Text">
				<INPUT TYPE="hidden" NAME="label_3" value="Title">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
		<div id="form-item-886" class="layout form item outer row-4 item-886 row_num-60 row_pos-1152 rowlength-2 type-Text" style=";position:relative;">

			<div class="inner">

				
							Name<span class="text-danger"> *</span>
					

							<input type="text"
								
									id="response_4"
									name="response_4"
								
								
								 style="width:156px;"
								
									
                                            value=""
									    
										
								class="form-control type-Text row-4 item-886"
							><!-- input -->

							
						<INPUT
							TYPE="hidden"
							NAME="response_4_required"
							VALUE="The field Name is required. Please click your browser's back button and provide this value.">
					

				<input type="hidden" name="question_4" value="Name">
				<INPUT TYPE="hidden" NAME="response_4_question_id" VALUE="886">
				<INPUT TYPE="hidden" NAME="question_type_4" value="Text">
				<INPUT TYPE="hidden" NAME="label_4" value="Name">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
				</div> <!-- /The inner div, for the sake of IE -->
			
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

		<div id="form-item-889" class="layout form item outer row-5 item-889 row_num-80 row_pos-1024 rowlength-1 type-Text" style="clear:both;;position:relative;">

			<div class="inner">

				
							Company
					

							<input type="text"
								
									id="response_5"
									name="response_5"
								
								
								 style="width:80px;"
								
									
                                            value=""
									    
										
								class="form-control type-Text row-5 item-889"
							><!-- input -->

							
				<input type="hidden" name="question_5" value="Company">
				<INPUT TYPE="hidden" NAME="response_5_question_id" VALUE="889">
				<INPUT TYPE="hidden" NAME="question_type_5" value="Text">
				<INPUT TYPE="hidden" NAME="label_5" value="Company">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
				</div> <!-- /The inner div, for the sake of IE -->
			
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

		<div id="form-item-890" class="layout form item outer row-6 item-890 row_num-100 row_pos-1024 rowlength-2 type-Text" style="clear:both;;position:relative;">

			<div class="inner">

				
							Address
					

							<input type="text"
								
									id="response_6"
									name="response_6"
								
								
								 style="width:104px;"
								
									
                                            value=""
									    
										
								class="form-control type-Text row-6 item-890"
							><!-- input -->

							
				<input type="hidden" name="question_6" value="Address">
				<INPUT TYPE="hidden" NAME="response_6_question_id" VALUE="890">
				<INPUT TYPE="hidden" NAME="question_type_6" value="Text">
				<INPUT TYPE="hidden" NAME="label_6" value="Address">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
		<div id="form-item-891" class="layout form item outer row-7 item-891 row_num-100 row_pos-1040 rowlength-2 type-Text" style=";position:relative;">

			<div class="inner">

				
							City, State, Zip
					

							<input type="text"
								
									id="response_7"
									name="response_7"
								
								
								 style="width:156px;"
								
									
                                            value=""
									    
										
								class="form-control type-Text row-7 item-891"
							><!-- input -->

							
				<input type="hidden" name="question_7" value="City, State, Zip">
				<INPUT TYPE="hidden" NAME="response_7_question_id" VALUE="891">
				<INPUT TYPE="hidden" NAME="question_type_7" value="Text">
				<INPUT TYPE="hidden" NAME="label_7" value="City, State">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
				</div> <!-- /The inner div, for the sake of IE -->
			
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

		<div id="form-item-892" class="layout form item outer row-8 item-892 row_num-120 row_pos-1024 rowlength-2 type-Text" style="clear:both;;position:relative;">

			<div class="inner">

				
							Phone
					

							<input type="text"
								
									id="response_8"
									name="response_8"
								
								
								 style="width:80px;"
								
									
                                            value=""
									    
										
								class="form-control type-Text row-8 item-892"
							><!-- input -->

							
				<input type="hidden" name="question_8" value="Phone">
				<INPUT TYPE="hidden" NAME="response_8_question_id" VALUE="892">
				<INPUT TYPE="hidden" NAME="question_type_8" value="Text">
				<INPUT TYPE="hidden" NAME="label_8" value="Phone">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
		<div id="form-item-887" class="layout form item outer row-9 item-887 row_num-120 row_pos-1028 rowlength-2 type-Text" style=";position:relative;">

			<div class="inner">

				
							Email<span class="text-danger"> *</span>
					

							<input type="text"
								
									id="response_9"
									name="response_9"
								
								
								 style="width:104px;"
								
									
                                            value=""
									    
										
								class="form-control type-Text row-9 item-887"
							><!-- input -->

							
						<INPUT
							TYPE="hidden"
							NAME="response_9_required"
							VALUE="The field Email is required. Please click your browser's back button and provide this value.">
					

				<input type="hidden" name="question_9" value="Email">
				<INPUT TYPE="hidden" NAME="response_9_question_id" VALUE="887">
				<INPUT TYPE="hidden" NAME="question_type_9" value="Text">
				<INPUT TYPE="hidden" NAME="label_9" value="Email">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
				</div> <!-- /The inner div, for the sake of IE -->
			
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

		<div id="form-item-894" class="layout form item outer row-10 item-894 row_num-140 row_pos-1024 rowlength-1 type-Textarea" style="clear:both;;position:relative;">

			<div class="inner">

				
							Comments/Questions
					

							<textarea
								
								id="response_10"
								name="response_10"
								rows="5"
								class="form-control type-Textarea row-10 item-894"
								
								
									style="width:218px;"
								

								></textarea>
								
						
				<input type="hidden" name="question_10" value="Comments/Questions">
				<INPUT TYPE="hidden" NAME="response_10_question_id" VALUE="894">
				<INPUT TYPE="hidden" NAME="question_type_10" value="Textarea">
				<INPUT TYPE="hidden" NAME="label_10" value="Comments/Questions">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
	</div><!-- /The inner div, for the sake of IE -->

	
	<input type="hidden" id="hasOpenPriceField" name="hasOpenPriceField" value="0">

	
</div><!-- /form_layout_wrapper -->


		<div id="_ssdiv2" style="display:none">
			<input type="hidden" id="fld_uploadfields" name="UploadFields" value="">
			<input type="hidden" id="fld_id_column" name="id_column" value="ID">
			<input type="hidden" id="fld_id_value" name="id_value" value="">
			<input type="hidden" id="fld_form_overrideid" name="form_overrideID" value="0">
			
			<input type="hidden" id="fld_ss_form_testid" name="ss_form_testid" value="0" />
			<div id="_ssdiv">
				<p style="background-color: blue"><input type="text" name="ss_zipcode" value="" /></p>
			</div>
		</div>
		
			<input type="hidden" name="form_isEdit" value="0">
		
	
		<div id="div_bottom" style="clear:both;">
			
			
				<input type="hidden" name="useCaptcha" value="0">
			
			
				<INPUT TYPE="hidden" NAME="send_mail_ind" VALUE="0">
				<INPUT TYPE="hidden" NAME="no_opt_out" VALUE="1">
			
	
			<div id="frm_submit_button">
				<br />
				<button class="btn btn-primary" type="button" data-loading-text="Please wait..." id="submitBtn"
					
						onclick="startValidate();"
					
				>Submit Form</button>
				<br /><br />
			</div>
	
			
			<div id="frm_verisign_seal_box">
				
				
			</div>
			
	
				<div id="frm_required_copy_bottom">
					<p>Fields marked with <span class="text-danger">*</span> are required.</p>
				</div>
			
	
				<div id="frm_ssl_copy_bottom"><p>Your form submission WILL be encrypted using SSL to ensure your privacy.</p></div>
			
	
		</div><!-- div_bottom -->
	
		
	</form>
</div>


	</div>


					</div> 
		
        <div class="col-md-4 i4a_right_sidebar widgets" id="right_sidebar"></div>
    </div> 
</div>


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<title></title>
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<div style=" margin-top:15px; text-weight:400; float:left; margin-left:auto; margin-right:auto; text-align:left; color:#fff; font-size:14px; font-family:'droid sans',arial, sans-serif;">Mailing: 1319 F Street NW, Suite 301, #187, Washington, D.C. 20004&nbsp;<br />
tel: 800.260.6780 (toll free) &bull; 330.670.0101 (phone) &bull; fax: 330.670.0109 &bull; email: <a href="mailto:anac@anacnet.org" style="color:#fff;">anac@anacnet.org</a><br />
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