Execute HTML

About

Execute HTML is a service which generates forms in HTML and is highly configurable with your own settings.

Hosting HTML Forms

The Execute HTML endpoint displays forms that can serve either of the following purposes:

Output the HTML which can be used to display forms (if the property HostFormOnQuik is set to false).
Display forms in HTML using the Quik! Form Viewer (if the property HostFormOnQuik is set to true).

NOTE: The HostFormOnQuik property should only be set to TRUE for testing and should never include actual client data as this method is not a safe place to host real private data.

You can find more information about the HostFormOnQuik property on this page.

Service Name	Endpoint URL	Type	Service Description	Parameters

Service Name	Endpoint URL	Type	Service Description	Parameters
Execute HTML	https://websvcs.quikforms.com/rest/quikformsengine/qfe/execute/html	POST	Execute the Quik! Forms Engine for HTML form output	`HTMLSettings` (Object with properties to be set in the QuikFormsEngine)

How to Use

Before sending a request, be sure to Obtain a Quik! OAuth Token first.

Sample JSON Request Body:

{
   "HostFormOnQuik":true,
   "FormFields":[
      {
         "FieldName":"1own.FName",
         "FieldValue":"Joe"
      },
      {
         "FieldName":"1own.LName",
         "FieldValue":"Smith"
      }
   ],
   "QuikFormID":"12"
}

Example Responses

Example Response when HostFormOnQuik is set to false, we provide the HTML for you to host yourself (recommended):

{
    "ResultData": {
        "UNID": "Iv0B%2bkfgnWQlobJH%2bSlZsdrTi2H3gkhYSxu3gwMQZEXhJ%2bJFadr0iO%2bzEozc1Xpm",
        "HTML": "<!--[if lte IE 9]><!DOCTYPE html><html class=\"ie8\"><![endif]--> <!--[if !IE]><!--> <html class=\"nonIE8\">  <!--<![endif]--> <!-- saved from url=(0014)about:internet --> <head>     <title>Quik! Form Viewer</title>     <meta http-equiv=\"Content-Type\" content=\"text/html; charset=utf-8\"/>     <meta name=\"COPYRIGHT\" content=\"&copy; Efficient Technology, Inc. 2022\" />     <meta http-equiv=\"EXPIRES\" content=\"6/16/2022 3:52:44 PM\" />     <meta name=\"viewport\" content=\"width=device-width, initial-scale=1.0, user-scalable=yes, minimum-scale=1.0, maximum-scale=1.0\" /><!--[if gte IE 9]><meta http-equiv=\"X-UA-Compatible\" content=\"IE=Edge\"><![endif]--><!--[if IE 8]><meta http-equiv=\"X-UA-Compatible\" content=\"IE=8\"><![endif]--><meta name=\"apple-mobile-web-app-capable\" content=\"yes\" /><meta name=\"apple-mobile-web-app-status-bar-style\" content=\"black\" />     <link rel=\"stylesheet\" href=\"https://quikforms.com/shared/styles/jqueryui-1.11.4.css\">     <style type=\"text/css\" media=\"all\"> input.itemRequired{border-color:#FF0000 !important;border-width:1pt 1pt 1pt 1pt !important;} .itemRequired{border-color:#FF0000 !important;border-width:1pt 1pt 1pt 1pt !important;} .cbrequired{border:#FF0000 1px solid !important;} body,ul,li,p  {     padding:0;     margin:0;     border:0; }  body  {     font-size:12px;     font-family:helvetica; }  span a  {     text-decoration:none;     color:#aa0000; }  #header  {     position:absolute;     z-index:1;     top:0;     left:0;     width:100%;     min-width:768px;     height:88px;     line-height:38px;     padding-left:10px;     color:#000;     font-size:20px;     text-align:left;     border-bottom:2px solid #ccc; }  #header a  {     color:#000;     text-decoration:none;     font-weight:bold;     text-shadow:0 -1px 0 rgba(0,0,0,0.5); }  #footer  {     position:absolute;     z-index:2;     bottom:0;     left:0;     width:100%;     min-width:768px;     height:30px;     background-color:#fff;     padding-left:10px;     border-top:2px solid #ccc; }  .tableheader  {     height: 90px; }  #wrapper  {     position:absolute;     z-index:1;     top:90px;     bottom:31px;     left:0px;     background:#ccc;     overflow:auto; }  #scroller  {     position:absolute;     z-index:1;     width:100%;     padding:0;     background:#ccc;     -ms-touch-action:none; }  #scroller ul  {     list-style:none;     padding:0px;     margin:0px;     width:100%;     text-align:left;     border-bottom:0px solid #ccc;     border-top:0px solid #ccc;     border-left:3px solid #ccc; }  .ie8 #scroller ul  {     list-style:none;     padding:0px;     margin:0px;     width:100%;     text-align:left;     border-bottom:0px solid #ccc;     border-top:0px solid #ccc;     border-left:1px solid #ccc; }  #scroller li  {     padding:0px;     border-bottom:0px solid #ccc;     border-top:2px solid #ccc;     background-color:#ccc; }  #navWrapper  {     position:absolute;     z-index:3;     top: 90px;     left:625pt;     -ms-touch-action:none;     height:500px;     width:150px; }  #navPage {     position:absolute;     z-index:100;     top:25px;     overflow:auto;     background-color:#cccccc;     width:80pt;     height:175pt;     vertical-align:top;     text-align:center;     padding:1pt;     clear:left;     border-style:inset;     border-width:1pt;     border-color:#cccccc; }  .ie8 #navPage {     position:absolute;     z-index:4;     top:25px;     overflow:auto;     background-color:#cccccc;     width:80pt;     height:175pt;     vertical-align:top;     text-align:center;     padding:0pt;     clear:left;     border-style:inset;     border-width:1pt;     border-color:#cccccc; }  #navPage ul  {     list-style:none;     padding:3px;     margin:0px 0px 0px 10px;     width:63pt;     text-align:center; }  .ie8 #navPage ul  {     list-style:none;     padding:0px;     margin:0px 0px 0px 10px;     width:63pt;     text-align:center; }  #navPage a  {     text-decoration:none;    }  #navFormHeader {     position:absolute;     z-index:5;     top:250px; }  #navForm {     position:absolute;     z-index:100;     top:298px;     overflow:auto;     background-color:#cccccc;     width: 80pt;     height:135pt;     vertical-align:top;     text-align: left;     padding:1pt;     clear:left;     font-family:sans-serif;     font-size:8pt;     border-style:inset;     border-width:1pt;     border-color:#cccccc;     -ms-touch-action: none; }  #navAttachments  {     z-index:100;     overflow:auto;     background-color:#cccccc;     width: 80pt;     height:100pt;     vertical-align:top;     text-align: left;     padding:1pt;     clear:left;     font-family:sans-serif;     font-size:8pt;     border-style:inset;     border-width:1pt;     border-color:#cccccc;     -ms-touch-action: none; }   #navAttachmentsHeader  {     position:absolute;     z-index:100;     top:470px;     overflow:auto;     width: 100pt;     height: 240px;     }  .ie8 #navForm {     position:absolute;     z-index:6;     top:298px;     overflow:auto;     background-color:#cccccc;     width: 80pt;     height:135pt;     vertical-align:top;     text-align: left;     padding:0pt;     clear:left;     font-family:sans-serif;     font-size:8pt;     border-style:inset;     border-width:1pt;     border-color:#cccccc;     -ms-touch-action: none; }  #navForm ul  {     list-style:none;     padding:3px;     margin:0px;     width:80pt;     text-align:left; }  .nonIE8 #QFVFormPage input[type=\"checkbox\"]  {     display:none; }  .nonIE8 #QFVFormPage input[type=\"checkbox\"] + label span  {     display:inline-block;     width:20px;     height:20px;     margin:-1px 4px 0 0;     vertical-align:middle;     cursor:pointer; }  .nonIE8 input[type=\"checkbox\"]:checked + label span  {     background:url(https://www.quikforms.com/shared/images/quikformviewer/check_mark_black.gif) left top no-repeat; }  .nonIE8 #QFVFormPage input[type=\"radio\"]  {     display:none; }  .nonIE8 #QFVFormPage input[type=\"radio\"] + label span  {     display:inline-block;     width:20px;     height:20px;     margin:-1px 4px 0 0;     vertical-align:middle;     cursor:pointer; }  .nonIE8 input[type=\"radio\"]:checked + label span  {     background:url(https://www.quikforms.com/shared/images/quikformviewer/check_mark_black.gif) left top no-repeat; }  input.itemBackgroundTransparent {     background:url(https://www.quikforms.com/shared/images/quikformviewer/trans.gif) repeat; }  input.itemPositionAbsolute {     position:absolute; }  input.itemBorderNone {     border:none; }  input.itemBorderSolid {     border-style:solid; }  input.itemBorderTransparent {     border-color:transparent; }  input.itemBorderWidth1 {     border-width:1pt; }  input.itemVisible {     visibility:visible; }  input.itemHidden {     visibility:hidden; }  label.itemHidden {     visibility:hidden; }  .itemBlue {     color:Blue; }  .itemBackgroundWhite {     background:#FFFFFF; }  .itemBackgroundTransparent {     background:url(https://www.quikforms.com/shared/images/quikformviewer/trans.gif) repeat; }  .itemPositionAbsolute {     position:absolute; }  .itemBorderNone {     border:none; }  .itemBorderSolid {     border-style:solid; }  .itemBorderTransparent {     border-color:transparent; }  .itemBorderWidth1 {     border-width:1pt; }  .itemVisible {     visibility:visible; }  .itemHidden {     visibility:hidden; }  .itemBlue {     color:Blue; }  .itemBackgroundWhite {     background:#FFFFFF; }  span.MinorInstr {     font:bold 10px Arial, sans-serif;     vertical-align:top;     padding-left:10px; }      span.InstrError {     font:bold 14px Arial, sans-serif;     color:Red;     vertical-align:top; }  span.ItemError  {     font:bold 11px Arial, sans-serif;     line-height: 1em;     color:#FF0000;     text-shadow: 1px 1px 1px #000000;     background: url(https://www.quikforms.com/shared/images/quikformviewer/error.png) no-repeat 0 center;     background-size: 15px 15px;     padding:10px;     display:none;     top:3px;     right:0;     padding-right: 0px;     padding-bottom: 0px;      }  </style>      <style type=\"text/css\">     .maxWH  {     width:100%;      height:100%; }   table td  {     width:100px; }   #signTable tr.odd {     background-color:white; }   #signTable tr.even   {     background-color:rgb(223, 223, 224); }   #signTable  {     border-collapse: collapse }   #mask  {      position:absolute;      z-index:2000;      display:none;      top: -60px;      width: 1425px;      height: 1000px;      display: block;      opacity: 0.8;  }   #modalBoxes .prepareToSignWindow  {      width:440px;      position:absolute;      left:0;      right:0;      margin-left: auto;      margin-right: auto;      height:200px;      display:none;      z-index:9999;      padding:20px;  }   #modalBoxes #prepareToSignDialog  {      position:absolute;      left:0;      right:0;      width:950px;      margin-left: auto;      margin-right: auto;      height:auto;      background:white;      border: 5px solid #557db8;      -webkit-border-radius: 5px;      -moz-border-radius: 5px;      border-radius: 5px;      align: center 5px;      overflow-y:scroll;      height:400px;  }  .customFieldsButtons {     width:auto;      min-width:45pt;      left: 30px;     text-align:center;      font-family:sans-serif;      font-size:small;      font-weight:bold;    }  .ui-dialog { \toverflow: hidden; }  .ui-dialog .ui-dialog-titlebar-close {     width: 21px; }  .ui-widget-overlay  {      background-color: grey;  }    .ui-widget-header  {      background: #cccccc;  }    .ui-state-default,  .ui-widget-content .ui-state-default,  .ui-widget-header .ui-state-default {      background: #e6e6e6;  }  .ui-state-hover,  .ui-widget-content .ui-state-hover,  .ui-widget-header .ui-state-hover,  .ui-state-focus,  .ui-widget-content .ui-state-focus,  .ui-widget-header .ui-state-focus {      background: #dadada;  }  .ui-widget-content .ui-state-active, .ui-widget-header .ui-state-active  {      background: #ffffff;  }  .ui-state-highlight, .ui-widget-content .ui-state-highlight, .ui-widget-header .ui-state-highlight  {      background: #fbf9ee;  }   .ui-state-error, .ui-widget-content .ui-state-error, .ui-widget-header .ui-state-error  {      background: #fef1ec;  }  .ui-resizable-se{     width: 9px;     height: 9px;     right: -5px;     bottom: -5px; }  /*.ui-front  {      z-index: 100;  }                         .ui-button  {      display: inline-block;      position: relative;      padding: 0;      line-height: normal;      margin-right: .1em;      cursor: pointer;      vertical-align: middle;      text-align: center;      overflow: visible;   }   .ui-helper-clearfix:before,.ui-helper-clearfix:after  {      content: \"\";      display: table;      border-collapse: collapse;  }   .ui-helper-clearfix:after  {      clear: both;  }   .ui-icon-closethick  {      background-position: -96px -128px;  }   .ui-helper-clearfix {      min-height: 0;   }   .ui-button,.ui-button:link,.ui-button:visited,.ui-button:hover,.ui-button:active  {     text-decoration: none;  }                         .ui-button-icon-only  {      width: 2.2em;  }                         .ui-button-icons-only  {      width: 3.4em;  }   button.ui-button-icons-only  {      width: 3.7em;  }                         .ui-button .ui-button-text  {      display: block;      line-height: normal;  }   .ui-button-icons-only .ui-button-text  {      padding: .4em;      text-indent: -9999999px;  }   input.ui-button  {      padding: .4em 1em;  }                         .ui-button-icon-only .ui-icon,  .ui-button-text-icon-primary .ui-icon,  .ui-button-text-icon-secondary .ui-icon,  .ui-button-text-icons .ui-icon,  .ui-button-icons-only .ui-icon {      position: absolute;      top: 50%;      margin-top: -8px;  }   .ui-button-icon-only .ui-icon  {      left: 50%;      margin-left: -8px;  }       .ui-button-text-icon-primary .ui-button-icon-primary, .ui-button-text-icons .ui-button-icon-primary,  .ui-button-icons-only .ui-button-icon-primary  {      left: .5em;  }   .ui-button-icons-only .ui-button-icon-secondary  {      right: .5em;  }                         .ui-buttonset .ui-button  {      margin-left: 0;      margin-right: -.3em;  }                         input.ui-button::-moz-focus-inner, button.ui-button::-moz-focus-inner  {      border: 0;      padding: 0;  }       .ui-dialog  {      position: absolute;      top: 0;      left: 0;      padding: .2em;      outline: 0;  }   .ui-dialog .ui-dialog-titlebar  {      padding: .4em 1em;      position: relative;  }       .ui-dialog .ui-dialog-title  {      float: left;      margin: .1em 0;      white-space: nowrap;      width: 90%;      overflow: hidden;      text-overflow: ellipsis;  }   .ui-dialog .ui-dialog-titlebar-close  {      position: absolute;      right: .3em;      top: 50%;      width: 21px;      margin: -10px 0 0 0;      padding: 1px;      height: 20px;  }   .ui-dialog .ui-dialog-content  {      position: relative;      border: 0;      padding: .5em 1em;      background: none;      overflow: auto;  }   .ui-dialog .ui-dialog-buttonpane  {      text-align: left;      border-width: 1px 0 0 0;      background-image: none;      margin-top: .5em;      padding: .3em 1em .5em .4em;  }   .ui-dialog .ui-dialog-buttonpane .ui-dialog-buttonset  {      float: right;  }   .ui-dialog .ui-dialog-buttonpane button  {      margin: .5em .4em .5em 0;      cursor: pointer;  }   .ui-dialog .ui-resizable-se  {      width: 12px;      height: 12px;      right: -5px;      bottom: -5px;      background-position: 16px 16px;  }   .ui-draggable .ui-dialog-titlebar  {      cursor: move;  }   .ui-widget  {      font-family: Verdana,Arial,sans-serif;      font-size: 1.1em;  }   .ui-widget .ui-widget  {      font-size: 1em;  }   .ui-widget input,  .ui-widget select,  .ui-widget textarea,  .ui-widget button {      font-family: Verdana,Arial,sans-serif;      font-size: 1em;  }   .ui-widget-content  {      border: 1px solid #aaaaaa;      background: #ffffff;      color: #222222;  }   .ui-widget-content a  {      color: #222222;  }   .ui-widget-header  {      border: 1px solid #aaaaaa;      background: #cccccc;      color: #222222;      font-weight: bold;  }   .ui-widget-header a  {      color: #222222;  }                        .ui-state-default,  .ui-widget-content .ui-state-default,  .ui-widget-header .ui-state-default {      border: 1px solid #d3d3d3;      background: #e6e6e6;      font-weight: normal;      color: #555555;  }   .ui-state-hover,  .ui-widget-content .ui-state-hover,  .ui-widget-header .ui-state-hover,  .ui-state-focus,  .ui-widget-content .ui-state-focus,  .ui-widget-header .ui-state-focus {      border: 1px solid #999999;      background: #dadada;      font-weight: normal;      color: #212121;  }   .ui-widget-content .ui-state-active, .ui-widget-header .ui-state-active  {      border: 1px solid #aaaaaa;      background: #ffffff;      font-weight: normal;      color: #212121;  }                         .ui-state-highlight, .ui-widget-content .ui-state-highlight, .ui-widget-header .ui-state-highlight  {      border: 1px solid #fcefa1;      background: #fbf9ee;      color: #363636;  }   .ui-state-highlight a,.ui-widget-content .ui-state-highlight a,.ui-widget-header .ui-state-highlight a  {      color: #363636;  }   .ui-state-error, .ui-widget-content .ui-state-error, .ui-widget-header .ui-state-error  {      border: 1px solid #cd0a0a;      background: #fef1ec;      color: #cd0a0a;  }   .ui-state-error a, .ui-widget-content .ui-state-error a, .ui-widget-header .ui-state-error a  {      color: #cd0a0a;  }   .ui-state-error-text, .ui-widget-content .ui-state-error-text, .ui-widget-header .ui-state-error-text  {      color: #cd0a0a;  }   .ui-priority-primary, .ui-widget-content .ui-priority-primary, .ui-widget-header .ui-priority-primary  {      font-weight: bold;  }   .ui-priority-secondary, .ui-widget-content .ui-priority-secondary, .ui-widget-header .ui-priority-secondary  {      opacity: .7;      filter:Alpha(Opacity=70);      font-weight: normal;  }   .ui-state-disabled, .ui-widget-content .ui-state-disabled, .ui-widget-header .ui-state-disabled  {      opacity: .35;      filter:Alpha(Opacity=35);      background-image: none;  }                         .ui-corner-all, .ui-corner-top, .ui-corner-left, .ui-corner-tl  {      border-top-left-radius: 4px;  }   .ui-corner-all, .ui-corner-top, .ui-corner-right, .ui-corner-tr  {      border-top-right-radius: 4px;  }   .ui-corner-all, .ui-corner-bottom, .ui-corner-left, .ui-corner-bl  {      border-bottom-left-radius: 4px;  }   .ui-corner-all, .ui-corner-bottom, .ui-corner-right, .ui-corner-br  {      border-bottom-right-radius: 4px;  }                         .ui-icon  {      display: block;      text-indent: -99999px;      overflow: hidden;      background-repeat: no-repeat;  }   .ui-button-icon-only .ui-icon,  .ui-button-text-icon-primary .ui-icon,  .ui-button-text-icon-secondary .ui-icon,  .ui-button-text-icons .ui-icon,  .ui-button-icons-only .ui-icon  {      position: absolute;      top: 50%;      margin-top: -8px;  }   .ui-button-icon-only .ui-icon  {      left: 50%;      margin-left: -8px;  }   .ui-menu .ui-icon  {      position: absolute;      top: .2em;      left: .2em;  }   .ui-spinner .ui-icon  {      position: absolute;      margin-top: -8px;      top: 50%;      left: 0;  }   .ui-state-disabled .ui-icon  {      filter:Alpha(Opacity=35);  }   .ui-icon {      width: 16px;      height: 16px;  }   .ui-state-error .ui-icon, .ui-button .ui-button-text  {      display: none;      line-height: normal;  }   .ui-button-text-only .ui-button-text  {      padding: .4em 1em;  }   .ui-button-icon-only .ui-button-text, .ui-button-icons-only .ui-button-text  {      padding: .4em;      text-indent: -9999999px;  }   .ui-button-text-icon-primary .ui-button-text,  .ui-button-text-icons .ui-button-text  {      padding: .4em 1em .4em 2.1em;  }   .ui-button-text-icon-secondary .ui-button-text, .ui-button-text-icons .ui-button-text  {      padding: .4em 2.1em .4em 1em;  }   .ui-button-text-icons .ui-button-text  {      padding-left: 2.1em;      padding-right: 2.1em;  }   input.ui-button  {      padding: .4em 1em;  }                         .ui-button-icon-only .ui-icon,  .ui-button-text-icon-primary .ui-icon,  .ui-button-text-icon-secondary .ui-icon,  .ui-button-text-icons .ui-icon,  .ui-button-icons-only .ui-icon  {      position: absolute;      top: 50%;      margin-top: -8px;  }   .ui-button-icon-only .ui-icon  {      left: 50%;      margin-left: -8px;  }   .ui-button-text-icon-primary .ui-button-icon-primary,  .ui-button-text-icons .ui-button-icon-primary,  .ui-button-icons-only .ui-button-icon-primary  {      left: .5em;  }   .ui-button-text-icon-secondary .ui-button-icon-secondary,  .ui-button-text-icons .ui-button-icon-secondary,  .ui-button-icons-only .ui-button-icon-secondary  {      right: .5em;  }   .ui-widget-overlay  {      position: fixed;      top: 0;      left: 0;      width: 100%;      height: 100%;      background-color: grey;  }   .ui-widget-overlay  {      opacity: .3;      filter: Alpha(Opacity=30);  }*/   .popupButton {      font-size:9px;      height:15px;      opacity:0.6;      padding:0px;      width:15px;      z-index: 1001; }                        .popupButton:hover {      opacity:1;  }  .attachFile {   opacity:0.6;    padding:0px;    background-image: url(https://quikforms.com/shared/images/quikformviewer/paperclip.png);   height: 16px;   width: 16px;   background-size: 12px 12px;   z-index: 1001; }  .imgSignature {     position: absolute;     z-index: 900;         }  input:invalid {     border: solid 1px #aa0000; }  .btnBold{ \tfont-weight:bold; } .btnmr5{ margin-right:5px; }  .multiline {     resize: none; }  #btnSign {     width:auto;      min-width:40pt;      text-align:center;      font-family:sans-serif;      font-size:small;      font-weight:bold;      color:#FF0000;      visibility:visible; }  .ctn-sign-btn img{     display: none;     position: absolute;     width: 15px;     margin-left: 20px;     margin-top: 4px; }  .ctn-sign-btn {     display: inline; }           .custom-button-popup {     width: 323px;     max-width: 323px;     margin: 0;     font-size: 0.7em;   }  .custom-button-popup h1 {     font-weight: bold;     font-size: 1.5em;     margin: .6em 0;     color: #BD061E;     word-wrap: break-word; }  .custom-button-popup .subtitle {     font-size: 0.8em;     font-weight: normal;     color: #000; }   .custom-button-popup table {      margin: 1em 0;      border-collapse: collapse;      width: 100%;  }  .custom-button-popup table td, .custom-button-popup table th {     border: 1px solid #eee;     padding: .6em 10px;     text-align: left; }  .custom-button-img {     position:absolute;      cursor: pointer;  }  .custom-button-popup select {     height: 20px;     margin-top: 15px;     min-width: 189px;     width: 322px;     max-width: 322px; }      .btnSave {     float: right;     position: relative;     width: 47.78px; }  .btnCancel {     float: right;     position:relative;      margin-right:15px; }  .divButtons {     clear: both;     height: auto;      float:right;      margin-right:15px;      width:auto;      display:inline; }  .imgLoading {     position: absolute;     right:36px;      top: 8px;     z-index:1;      display:none;      width:16px;      height:16px; }  .pError {     font-size: 13px;     color: red;     float: left;     word-wrap:break-word;     width:500px; }  .multilineText {     -moz-resize: none;     -ms-resize: none;     -o-resize: none;     resize: none;     font-size:12px; }  .boldSpan {     color: #aa0000;     font-size: 20px;      margin-right:10px; }  .span {     font-size: 13px; }  .divClear {     clear: both;     height:10px; }  .divBottomWrapper {     float: left;     height:auto;      display:inline-block;      width:100%;      position:relative;      padding:5px; }  .divMultilineBody {     margin-bottom:5px;     text-align:left }  .divTitle {     margin-bottom: 5px; }  .divContainer {     margin-bottom:5px;     text-align:left;     font-family: Arial; }  .divContainerFonts {     position:absolute;     left: 0px; }  .labelFonts {     color:#aa0000;     font-size:13px;     font-weight: bold; }  .multilineDialog {     padding-bottom:0px; }      </style> </head> <body onload=\"init()\"><div> <div id=\"header\"> <table> <tr> <td> <img id=\"headerlogo\" src=\"https://www.quikforms.com/shared/images/quikformviewer/logo.png\" alt=\"Quik! Forms\"/> </td> <td> <table style=\"margin-top: 12px; width:782px;\"> <tr> <td> <span id=\"majortitle\" style=\"font-family:sans-serif; font-size:large; font-weight:bold;vertical-align:bottom; padding-left:10px; width:100\">Complete Your Forms</span> </td> <td style=\"text-align:right; padding-left:20px; width:250\"> <input type=\"button\" id=\"btnClear\" name=\"btnClear\" value=\"Clear\" title=\"Clear all fields of form data.\" style=\"width:auto; min-width:45pt; text-align:center; font-family:sans-serif; font-size:small; font-weight:bold; color:#0000ff; visibility:visible;\" /> <input type=\"button\" id=\"btnReset\" name=\"btnReset\" value=\"Reset\" title=\"Reset all fields to their original state and data.\" style=\"width:auto; min-width:45pt; text-align:center; font-family:sans-serif; font-size:small; font-weight:bold; color:#0000ff; visibility:visible;\" /> <input type=\"button\" id=\"btnSave\" name=\"btnSave\" value=\"Save\" title=\"Save your form data for use with this set of forms.\" style=\"width:auto; min-width:40pt; text-align:center; font-family:sans-serif; font-size:small; font-weight:bold; color:#009999; visibility:visible;\"/> <input type=\"button\" id=\"btnLoad\" name=\"btnLoad\" value=\"Load\" title=\"Load your saved data for this set of forms.\" style=\"width:auto; min-width:40pt; text-align:center; font-family:sans-serif; font-size:small; font-weight:bold; color:#009999; visibility:visible;\"/> <input type=\"button\" id=\"btnPrint\" name=\"btnPrint\" value=\"Print\" title=\"Create a PDF of your form for printing.\" style=\"width:auto; min-width:40pt; text-align:center; font-family:sans-serif; font-size:small; font-weight:bold; color:#000000;\"/>   </td> </tr> <tr> <td colspan=\"2\"> <span id=\"MinorInstructions\" style=\"font-family:sans-serif; font-size:8pt; vertical-align:top; padding-left:10px;\">Review and complete your forms below. When done, print, submit and/or save for your records.</span> </td> </tr> </table> </td> </tr> </table> </div> <table> <tr> <td style=\"width:618pt;\" rowspan=\"2\"> <form name=\"QFVFormPage\" id=\"QFVFormPage\" action=\"\" method=\"post\"> <input type=\"hidden\" id=\"QFECompany\" name=\"QFECompany\" value=\"Efficient Technology, Inc.\" /> <input type=\"hidden\" id=\"QFEProduct\" name=\"QFEProduct\" value=\"QuikFormsEngine\" /> <input type=\"hidden\" id=\"QFEVersion\" name=\"QFEVersion\" value=\"5.5.8131.34638\" /> <input type=\"hidden\" id=\"QFETrademark\" name=\"QFETrademark\" value=\"Efficient Technology Inc, Quik! and Take The Work Out Of Paperwork are either trademarks or registered trademarks of Efficient Technology, Inc.\" /> <input type=\"hidden\" id=\"QFECopyright\" name=\"QFECopyright\" value=\"Copyright © 2022, Efficient Technology, Inc.\" /> <input type=\"hidden\" id=\"QFECustomerID\" name=\"QFECustomerID\" value=\"10013741\" /> <input type=\"hidden\" 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onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:36.58pt;top: 1181.85pt;;height:14.560pt;;width:287.350pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"1own-M-Addr123-179070337\" name=\"1own.M.Addr123\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:38.08pt;top: 1184.25pt;;height:14.560pt;line-height: 14.560pt;width:287.350pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"1own-M-City-179070338\" name=\"1own.M.City\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:334.05pt;top: 1181.85pt;;height:14.560pt;;width:149.370pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"1own-M-City-179070338\" name=\"1own.M.City\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:335.55pt;top: 1184.25pt;;height:14.560pt;line-height: 14.560pt;width:149.370pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"1own-M-State-179070339\" name=\"1own.M.State\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:492.91pt;top: 1181.85pt;;height:14.560pt;;width:29.750pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"1own-M-State-179070339\" name=\"1own.M.State\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:494.41pt;top: 1184.25pt;;height:14.560pt;line-height: 14.560pt;width:29.750pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"1own-M-Zip-179070340\" name=\"1own.M.Zip\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:531.52pt;top: 1181.85pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:45.570pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"1own-M-Zip-179070340\" name=\"1own.M.Zip\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:533.02pt;top: 1184.25pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:45.570pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"1own-H-Email-179070341\" name=\"1own.H.Email\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:36.27pt;top: 1213.74pt;;height:14.630pt;;width:378.050pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"1own-H-Email-179070341\" name=\"1own.H.Email\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:37.77pt;top: 1216.14pt;;height:14.630pt;line-height: 14.630pt;width:378.050pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"1own-O-Phone-179070342\" name=\"1own.O.Phone\"  type=\"text\"  class=\" itemPositionAbsolute itemBlue itemBorderSolid itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:424.07pt;top: 1213.74pt;;background:rgba(255,255,255,1);border-color:#000000;border-width:0pt 0pt 1pt 0pt;height:14.630pt;;width:152.840pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"1own-O-Phone-179070342\" name=\"1own.O.Phone\"  type=\"text\"  class=\" itemPositionAbsolute itemBlue itemBorderSolid itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:425.57pt;top: 1216.14pt;;background:rgba(255,255,255,1);border-color:#000000;border-width:0pt 0pt 1pt 0pt;height:14.630pt;line-height: 14.630pt;width:152.840pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"2own-FName-179070343\" name=\"2own.FName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:36.27pt;top: 1245.44pt;;height:14.630pt;;width:246.340pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"2own-FName-179070343\" name=\"2own.FName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:37.77pt;top: 1247.84pt;;height:14.630pt;line-height: 14.630pt;width:246.340pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"2own-MName-179070344\" name=\"2own.MName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:291.56pt;top: 1245.44pt;;height:14.630pt;;width:30.080pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"2own-MName-179070344\" name=\"2own.MName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:293.06pt;top: 1247.84pt;;height:14.630pt;line-height: 14.630pt;width:30.080pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"2own-LName-179070345\" name=\"2own.LName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:330.58pt;top: 1245.44pt;;height:14.630pt;;width:246.340pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"2own-LName-179070345\" name=\"2own.LName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:332.08pt;top: 1247.84pt;;height:14.630pt;line-height: 14.630pt;width:246.340pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"2own-H-Addr123-179070346\" name=\"2own.H.Addr123\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:36.27pt;top: 1277.15pt;;height:14.630pt;;width:287.800pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"2own-H-Addr123-179070346\" name=\"2own.H.Addr123\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:37.77pt;top: 1279.55pt;;height:14.630pt;line-height: 14.630pt;width:287.800pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"2own-H-City-179070347\" name=\"2own.H.City\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:334.64pt;top: 1277.15pt;;height:14.630pt;;width:148.780pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"2own-H-City-179070347\" name=\"2own.H.City\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:336.14pt;top: 1279.55pt;;height:14.630pt;line-height: 14.630pt;width:148.780pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"2own-H-State-179070348\" name=\"2own.H.State\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:493.18pt;top: 1277.15pt;;height:14.630pt;;width:29.270pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"2own-H-State-179070348\" name=\"2own.H.State\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:494.68pt;top: 1279.55pt;;height:14.630pt;line-height: 14.630pt;width:29.270pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"2own-H-Zip-179070349\" name=\"2own.H.Zip\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:531.39pt;top: 1277.15pt;;border-width:0pt 0pt 1pt 0pt;height:14.630pt;;width:45.530pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"2own-H-Zip-179070349\" name=\"2own.H.Zip\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:532.89pt;top: 1279.55pt;;border-width:0pt 0pt 1pt 0pt;height:14.630pt;line-height: 14.630pt;width:45.530pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"2own-H-Email-179070350\" name=\"2own.H.Email\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:36.27pt;top: 1309.67pt;;height:14.630pt;;width:378.050pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"2own-H-Email-179070350\" name=\"2own.H.Email\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:37.77pt;top: 1312.07pt;;height:14.630pt;line-height: 14.630pt;width:378.050pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"2own-O-Phone-179070351\" name=\"2own.O.Phone\"  type=\"text\"  class=\" itemPositionAbsolute itemBlue itemBorderSolid itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:424.07pt;top: 1309.67pt;;background:rgba(255,255,255,1);border-color:#000000;border-width:0pt 0pt 1pt 0pt;height:14.630pt;;width:152.840pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"2own-O-Phone-179070351\" name=\"2own.O.Phone\"  type=\"text\"  class=\" itemPositionAbsolute itemBlue itemBorderSolid itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:425.57pt;top: 1312.07pt;;background:rgba(255,255,255,1);border-color:#000000;border-width:0pt 0pt 1pt 0pt;height:14.630pt;line-height: 14.630pt;width:152.840pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"2own-SSN-179070352\" name=\"2own.SSN\"  type=\"text\"  class=\" itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:37.21pt;top: 1338.18pt;;background:rgba(255,255,255,1);border-color:#C0C0C0;height:18.350pt;;width:166.460pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"2own-SSN-179070352\" name=\"2own.SSN\"  type=\"text\"  class=\" itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:38.71pt;top: 1340.58pt;;background:rgba(255,255,255,1);border-color:#C0C0C0;height:18.350pt;line-height: 18.350pt;width:166.460pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"2own-DOB-179070353\" name=\"2own.DOB\"  type=\"text\"  class=\" itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:228.35pt;top: 1338.18pt;;background:rgba(255,255,255,1);border-color:#C0C0C0;height:18.350pt;;width:162.660pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"2own-DOB-179070353\" name=\"2own.DOB\"  type=\"text\"  class=\" itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:229.85pt;top: 1340.58pt;;background:rgba(255,255,255,1);border-color:#C0C0C0;height:18.350pt;line-height: 18.350pt;width:162.660pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"2own-Citizenship-179070354\" name=\"2own.Citizenship\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:423.26pt;top: 1341.38pt;;height:14.630pt;;width:153.660pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"2own-Citizenship-179070354\" name=\"2own.Citizenship\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:424.76pt;top: 1343.78pt;;height:14.630pt;line-height: 14.630pt;width:153.660pt\" /><!-- <![endif]--></div> </li> <li id=\"FID12p3\"> <!--[if lte IE 8]><a id=\"FID12p3\"></a><![endif]--><div style=\"float:none; clear:both; background-color:#ffffff; height:792pt; width:612pt;\"><div id=\"ID12p3\" style=\"background-color: Gray; margin:0pt; padding:0pt; height:792pt; width:612pt; \"> <img src='https://dq6apn6hy8vc6.cloudfront.net/prod/forms/publish/current/12_3_38.png?Expires=1655394765&Signature=WUiiFPAD7blev9VVMXjFWhV4XB762HUjfkqcDeUOjnHHSanWge8ecsN9guH~Z6nxBithlHLd9n7AX5lpq3DwooVj44AULOGH1~XwxnveqXxgZq5E8MVVXCRgVqbiGt6X2-NJOEQlcPqGyxw6VN8Fa0u12LslbQ1P1jhuQKzB494_&Key-Pair-Id=APKAIO63VAHYK7C5DQRQ' alt=\"FormID12p3\" /></div> <!--[if lte IE 9]><input id=\"1prd-ShareType-179070356\" name=\"QuikRadio12.1prd.ShareType\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"1\"  style=\"left:146.04pt;top: 1765.85pt;\" /><label for=\"1prd-ShareType-179070356\" class=\"\" \" style=\"position:absolute;left: 146.04pt;top: 1765.85pt;width:14.560pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"1prd-ShareType-179070356\" name=\"QuikRadio12.1prd.ShareType\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"1\"  style=\"left:148.84pt;top: 1767.85pt;\" /><label for=\"1prd-ShareType-179070356\" class=\"\" \" style=\"position:absolute;left: 148.84pt;top: 1767.85pt;width:14.560pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"1prd-ShareType-179070357\" name=\"QuikRadio12.1prd.ShareType\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"2\"  style=\"left:235.28pt;top: 1765.85pt;\" /><label for=\"1prd-ShareType-179070357\" class=\"\" \" style=\"position:absolute;left: 235.28pt;top: 1765.85pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"1prd-ShareType-179070357\" name=\"QuikRadio12.1prd.ShareType\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"2\"  style=\"left:238.08pt;top: 1767.85pt;\" /><label for=\"1prd-ShareType-179070357\" class=\"\" \" style=\"position:absolute;left: 238.08pt;top: 1767.85pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-chk1-02-179070358\" name=\"QuikRadio12.AMFDS0012.chk1.02\"  type=\"checkbox\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"1\"  style=\"left:57.43pt;top: 1801.93pt;\" /><label for=\"AMFDS0012-chk1-02-179070358\" class=\"\" \" style=\"position:absolute;left: 57.43pt;top: 1801.93pt;width:14.560pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-chk1-02-179070358\" name=\"QuikRadio12.AMFDS0012.chk1.02\"  type=\"checkbox\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"1\"  style=\"left:60.23pt;top: 1803.93pt;\" /><label for=\"AMFDS0012-chk1-02-179070358\" class=\"\" \" style=\"position:absolute;left: 60.23pt;top: 1803.93pt;width:14.560pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-chk1-00-179070359\" name=\"QuikRadio12.AMFDS0012.chk1.00\"  type=\"checkbox\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"1\"  style=\"left:57.43pt;top: 1831.67pt;\" /><label for=\"AMFDS0012-chk1-00-179070359\" class=\"\" \" style=\"position:absolute;left: 57.43pt;top: 1831.67pt;width:14.560pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-chk1-00-179070359\" name=\"QuikRadio12.AMFDS0012.chk1.00\"  type=\"checkbox\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"1\"  style=\"left:60.23pt;top: 1833.67pt;\" /><label for=\"AMFDS0012-chk1-00-179070359\" class=\"\" \" style=\"position:absolute;left: 60.23pt;top: 1833.67pt;width:14.560pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-txt1-06-1-179070360\" name=\"AMFDS0012.txt1.06.1\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:81.51pt;top: 1850.66pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:87.980pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-txt1-06-1-179070360\" name=\"AMFDS0012.txt1.06.1\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:83.01pt;top: 1853.06pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:87.980pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-chk1-01-0-179070361\" name=\"QuikRadio12.AMFDS0012.chk1.01.0\"  type=\"checkbox\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"1\"  style=\"left:57.43pt;top: 1929.78pt;\" /><label for=\"AMFDS0012-chk1-01-0-179070361\" class=\"\" \" style=\"position:absolute;left: 57.43pt;top: 1929.78pt;width:14.560pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-chk1-01-0-179070361\" name=\"QuikRadio12.AMFDS0012.chk1.01.0\"  type=\"checkbox\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"1\"  style=\"left:60.23pt;top: 1931.78pt;\" /><label for=\"AMFDS0012-chk1-01-0-179070361\" class=\"\" \" style=\"position:absolute;left: 60.23pt;top: 1931.78pt;width:14.560pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-txt1-01-179070362\" name=\"AMFDS0012.txt1.01\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:253.67pt;top: 2005.09pt;;border-width:0pt 0pt 1pt 0pt;height:15.190pt;;width:120.890pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-txt1-01-179070362\" name=\"AMFDS0012.txt1.01\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:255.17pt;top: 2007.49pt;;border-width:0pt 0pt 1pt 0pt;height:15.190pt;line-height: 15.190pt;width:120.890pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-txt1-02-179070363\" name=\"AMFDS0012.txt1.02\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:318.23pt;top: 2029.78pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:72.790pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-txt1-02-179070363\" name=\"AMFDS0012.txt1.02\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:319.73pt;top: 2032.18pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:72.790pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-txt1-06-0-179070364\" name=\"AMFDS0012.txt1.06.0\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:397.97pt;top: 2029.78pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:71.520pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-txt1-06-0-179070364\" name=\"AMFDS0012.txt1.06.0\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:399.47pt;top: 2032.18pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:71.520pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-chk1-03-179070365\" name=\"QuikRadio12.AMFDS0012.chk1.03\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"1\"  style=\"left:130.21pt;top: 2058.89pt;\" /><label for=\"AMFDS0012-chk1-03-179070365\" class=\"\" \" style=\"position:absolute;left: 130.21pt;top: 2058.89pt;width:15.820pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-chk1-03-179070365\" name=\"QuikRadio12.AMFDS0012.chk1.03\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"1\"  style=\"left:133.01pt;top: 2060.89pt;\" /><label for=\"AMFDS0012-chk1-03-179070365\" class=\"\" \" style=\"position:absolute;left: 133.01pt;top: 2060.89pt;width:15.820pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-chk1-03-179070366\" name=\"QuikRadio12.AMFDS0012.chk1.03\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"2\"  style=\"left:190.34pt;top: 2058.89pt;\" /><label for=\"AMFDS0012-chk1-03-179070366\" class=\"\" \" style=\"position:absolute;left: 190.34pt;top: 2058.89pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-chk1-03-179070366\" name=\"QuikRadio12.AMFDS0012.chk1.03\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"2\"  style=\"left:193.14pt;top: 2060.89pt;\" /><label for=\"AMFDS0012-chk1-03-179070366\" class=\"\" \" style=\"position:absolute;left: 193.14pt;top: 2060.89pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-chk1-03-179070367\" name=\"QuikRadio12.AMFDS0012.chk1.03\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"3\"  style=\"left:290.98pt;top: 2058.89pt;\" /><label for=\"AMFDS0012-chk1-03-179070367\" class=\"\" \" style=\"position:absolute;left: 290.98pt;top: 2058.89pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-chk1-03-179070367\" name=\"QuikRadio12.AMFDS0012.chk1.03\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"3\"  style=\"left:293.78pt;top: 2060.89pt;\" 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value=\"4\"  style=\"left:359.6pt;top: 2060.89pt;\" /><label for=\"AMFDS0012-chk1-03-179070368\" class=\"\" \" style=\"position:absolute;left: 359.6pt;top: 2060.89pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-chk1-01-1-179070369\" name=\"QuikRadio12.AMFDS0012.chk1.01.1\"  type=\"checkbox\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"1\"  style=\"left:57.43pt;top: 2079.78pt;\" /><label for=\"AMFDS0012-chk1-01-1-179070369\" class=\"\" \" style=\"position:absolute;left: 57.43pt;top: 2079.78pt;width:14.560pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-chk1-01-1-179070369\" name=\"QuikRadio12.AMFDS0012.chk1.01.1\"  type=\"checkbox\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"1\"  style=\"left:60.23pt;top: 2081.78pt;\" /><label for=\"AMFDS0012-chk1-01-1-179070369\" class=\"\" \" style=\"position:absolute;left: 60.23pt;top: 2081.78pt;width:14.560pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"1prd-Name-179070370\" name=\"1prd.Name\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:47.97pt;top: 2158.89pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:227.220pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"1prd-Name-179070370\" name=\"1prd.Name\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:49.47pt;top: 2161.29pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:227.220pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-txt1-11-0-179070371\" name=\"AMFDS0012.txt1.11.0\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:289.11pt;top: 2158.89pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:87.340pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-txt1-11-0-179070371\" name=\"AMFDS0012.txt1.11.0\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:290.61pt;top: 2161.29pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:87.340pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-txt1-12-0-179070372\" name=\"AMFDS0012.txt1.12.0\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:406.83pt;top: 2158.89pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:45.570pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-txt1-12-0-179070372\" name=\"AMFDS0012.txt1.12.0\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:408.33pt;top: 2161.29pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:45.570pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-txt1-16-0-179070373\" name=\"AMFDS0012.txt1.16.0\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:473.29pt;top: 2158.89pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:87.980pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-txt1-16-0-179070373\" name=\"AMFDS0012.txt1.16.0\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:474.79pt;top: 2161.29pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:87.980pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"2prd-Name-179070374\" name=\"2prd.Name\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:47.97pt;top: 2182.31pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:227.220pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"2prd-Name-179070374\" name=\"2prd.Name\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:49.47pt;top: 2184.71pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:227.220pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-txt1-11-2-179070375\" name=\"AMFDS0012.txt1.11.2\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:289.11pt;top: 2182.31pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:87.340pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-txt1-11-2-179070375\" name=\"AMFDS0012.txt1.11.2\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:290.61pt;top: 2184.71pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:87.340pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-txt1-12-2-179070376\" name=\"AMFDS0012.txt1.12.2\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:406.83pt;top: 2182.31pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:45.570pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-txt1-12-2-179070376\" name=\"AMFDS0012.txt1.12.2\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:408.33pt;top: 2184.71pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:45.570pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-txt1-16-2-179070377\" name=\"AMFDS0012.txt1.16.2\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:473.29pt;top: 2182.31pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:87.980pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-txt1-16-2-179070377\" name=\"AMFDS0012.txt1.16.2\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:474.79pt;top: 2184.71pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:87.980pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"3prd-Name-179070378\" name=\"3prd.Name\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:47.97pt;top: 2206.36pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:227.220pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"3prd-Name-179070378\" name=\"3prd.Name\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:49.47pt;top: 2208.76pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:227.220pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-txt1-11-4-179070379\" name=\"AMFDS0012.txt1.11.4\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:289.11pt;top: 2206.36pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:87.340pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-txt1-11-4-179070379\" name=\"AMFDS0012.txt1.11.4\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:290.61pt;top: 2208.76pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:87.340pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-txt1-12-4-179070380\" name=\"AMFDS0012.txt1.12.4\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:406.83pt;top: 2206.36pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:45.570pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-txt1-12-4-179070380\" name=\"AMFDS0012.txt1.12.4\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:408.33pt;top: 2208.76pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:45.570pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-txt1-16-4-179070381\" name=\"AMFDS0012.txt1.16.4\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:473.29pt;top: 2206.36pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:87.980pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-txt1-16-4-179070381\" name=\"AMFDS0012.txt1.16.4\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:474.79pt;top: 2208.76pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:87.980pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"4prd-Name-179070382\" name=\"4prd.Name\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:47.97pt;top: 2229.78pt;;border-width:0pt 0pt 1pt 0pt;height:15.190pt;;width:227.220pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"4prd-Name-179070382\" name=\"4prd.Name\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:49.47pt;top: 2232.18pt;;border-width:0pt 0pt 1pt 0pt;height:15.190pt;line-height: 15.190pt;width:227.220pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-txt1-11-6-179070383\" name=\"AMFDS0012.txt1.11.6\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:289.11pt;top: 2229.78pt;;border-width:0pt 0pt 1pt 0pt;height:15.190pt;;width:87.340pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-txt1-11-6-179070383\" name=\"AMFDS0012.txt1.11.6\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:290.61pt;top: 2232.18pt;;border-width:0pt 0pt 1pt 0pt;height:15.190pt;line-height: 15.190pt;width:87.340pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-txt1-12-6-179070384\" name=\"AMFDS0012.txt1.12.6\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:406.83pt;top: 2229.78pt;;border-width:0pt 0pt 1pt 0pt;height:15.190pt;;width:45.570pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-txt1-12-6-179070384\" name=\"AMFDS0012.txt1.12.6\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:408.33pt;top: 2232.18pt;;border-width:0pt 0pt 1pt 0pt;height:15.190pt;line-height: 15.190pt;width:45.570pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-txt1-16-6-179070385\" name=\"AMFDS0012.txt1.16.6\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:473.29pt;top: 2229.78pt;;border-width:0pt 0pt 1pt 0pt;height:15.190pt;;width:87.980pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-txt1-16-6-179070385\" name=\"AMFDS0012.txt1.16.6\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:474.79pt;top: 2232.18pt;;border-width:0pt 0pt 1pt 0pt;height:15.190pt;line-height: 15.190pt;width:87.980pt\" /><!-- <![endif]--></div> </li> <li id=\"FID12p4\"> <!--[if lte IE 8]><a id=\"FID12p4\"></a><![endif]--><div style=\"float:none; clear:both; background-color:#ffffff; height:792pt; width:612pt;\"><div id=\"ID12p4\" style=\"background-color: Gray; margin:0pt; padding:0pt; height:792pt; width:612pt; \"> <img src='https://dq6apn6hy8vc6.cloudfront.net/prod/forms/publish/current/12_4_38.png?Expires=1655394765&Signature=bgNxRSctfNJNK~BzYCB7DIk8ldxqUDtIbKNnMIt5bsdSOWwhf-KiNAoBIPIrGQxrJ~1r3yjN-Y~Rt9fAX-vjGoiZO4xMh~Fo~46S50E43~4z9gNcADhIG~oCjEIEwKRj34ZmYmAwsZHQ-~4oN3Dy8~OeCj4WWCKNydkcmK8bkYI_&Key-Pair-Id=APKAIO63VAHYK7C5DQRQ' alt=\"FormID12p4\" /></div> <!--[if lte IE 9]><input id=\"1bnk-Company-179070386\" name=\"1bnk.Company\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:35.94pt;top: 2890.37pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:372.160pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"1bnk-Company-179070386\" name=\"1bnk.Company\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:37.44pt;top: 2892.77pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:372.160pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"1bnk-ABANum-179070387\" name=\"1bnk.ABANum\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:417.59pt;top: 2890.37pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:159.500pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"1bnk-ABANum-179070387\" name=\"1bnk.ABANum\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:419.09pt;top: 2892.77pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:159.500pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"1bnk-AcctNum-179070388\" name=\"1bnk.AcctNum\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:35.94pt;top: 2921.38pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:182.910pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"1bnk-AcctNum-179070388\" name=\"1bnk.AcctNum\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:37.44pt;top: 2923.78pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:182.910pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"1bnk-Reg-179070389\" name=\"1bnk.Reg\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:228.35pt;top: 2921.38pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:198.100pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"1bnk-Reg-179070389\" name=\"1bnk.Reg\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:229.85pt;top: 2923.78pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:198.100pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-chk2-01-179070390\" name=\"QuikRadio12.AMFDS0012.chk2.01\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"1\"  style=\"left:430.85pt;top: 2921.38pt;\" /><label for=\"AMFDS0012-chk2-01-179070390\" class=\"\" \" style=\"position:absolute;left: 430.85pt;top: 2921.38pt;width:14.560pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-chk2-01-179070390\" name=\"QuikRadio12.AMFDS0012.chk2.01\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"1\"  style=\"left:433.65pt;top: 2923.38pt;\" /><label for=\"AMFDS0012-chk2-01-179070390\" class=\"\" \" style=\"position:absolute;left: 433.65pt;top: 2923.38pt;width:14.560pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-chk2-01-179070391\" name=\"QuikRadio12.AMFDS0012.chk2.01\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"2\"  style=\"left:527.05pt;top: 2921.38pt;\" /><label for=\"AMFDS0012-chk2-01-179070391\" class=\"\" \" style=\"position:absolute;left: 527.05pt;top: 2921.38pt;width:14.560pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-chk2-01-179070391\" name=\"QuikRadio12.AMFDS0012.chk2.01\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"2\"  style=\"left:529.85pt;top: 2923.38pt;\" /><label for=\"AMFDS0012-chk2-01-179070391\" class=\"\" \" style=\"position:absolute;left: 529.85pt;top: 2923.38pt;width:14.560pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-chk1-05-179070392\" name=\"QuikRadio12.AMFDS0012.chk1.05\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"1\"  style=\"left:34.01pt;top: 2982.14pt;\" /><label for=\"AMFDS0012-chk1-05-179070392\" class=\"\" \" style=\"position:absolute;left: 34.01pt;top: 2982.14pt;width:15.820pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-chk1-05-179070392\" name=\"QuikRadio12.AMFDS0012.chk1.05\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"1\"  style=\"left:36.81pt;top: 2984.14pt;\" /><label for=\"AMFDS0012-chk1-05-179070392\" class=\"\" \" style=\"position:absolute;left: 36.81pt;top: 2984.14pt;width:15.820pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-chk1-05-179070393\" name=\"QuikRadio12.AMFDS0012.chk1.05\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"2\"  style=\"left:100.47pt;top: 2982.14pt;\" /><label for=\"AMFDS0012-chk1-05-179070393\" class=\"\" \" style=\"position:absolute;left: 100.47pt;top: 2982.14pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-chk1-05-179070393\" name=\"QuikRadio12.AMFDS0012.chk1.05\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"2\"  style=\"left:103.27pt;top: 2984.14pt;\" /><label for=\"AMFDS0012-chk1-05-179070393\" class=\"\" \" style=\"position:absolute;left: 103.27pt;top: 2984.14pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-chk1-05-179070394\" name=\"QuikRadio12.AMFDS0012.chk1.05\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"3\"  style=\"left:145.4pt;top: 2982.14pt;\" /><label for=\"AMFDS0012-chk1-05-179070394\" class=\"\" \" style=\"position:absolute;left: 145.4pt;top: 2982.14pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-chk1-05-179070394\" name=\"QuikRadio12.AMFDS0012.chk1.05\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"3\"  style=\"left:148.2pt;top: 2984.14pt;\" /><label for=\"AMFDS0012-chk1-05-179070394\" class=\"\" \" style=\"position:absolute;left: 148.2pt;top: 2984.14pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--></div> </li> <li id=\"FID12p5\"> <!--[if lte IE 8]><a id=\"FID12p5\"></a><![endif]--><div style=\"float:none; clear:both; background-color:#ffffff; height:792pt; width:612pt;\"><div id=\"ID12p5\" style=\"background-color: Gray; margin:0pt; padding:0pt; height:792pt; width:612pt; \"> <img src='https://dq6apn6hy8vc6.cloudfront.net/prod/forms/publish/current/12_5_38.png?Expires=1655394765&Signature=GGBaP8L2YS65djN16dJkxXPPC6Eo~ZHzXkrVX6jHsooj6ozJIEEcXPj1Nv4HrTcYQ5QtxIBAkBXLzLAc~1F887ZBtvy~BAFr0Rr99Dj62oFH~Jcw8A1a7O-~Xm-wk5msROy4ag0YTgPag~BanJgZNyIqwUd6Uc10D~wiAuUdppA_&Key-Pair-Id=APKAIO63VAHYK7C5DQRQ' alt=\"FormID12p5\" /></div> <!--[if lte IE 9]><input id=\"AMFDS0012-chk1-06-179070395\" name=\"QuikRadio12.AMFDS0012.chk1.06\"  type=\"checkbox\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"1\"  style=\"left:397.94pt;top: 3366.14pt;\" /><label for=\"AMFDS0012-chk1-06-179070395\" class=\"\" \" style=\"position:absolute;left: 397.94pt;top: 3366.14pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-chk1-06-179070395\" name=\"QuikRadio12.AMFDS0012.chk1.06\"  type=\"checkbox\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"1\"  style=\"left:400.74pt;top: 3368.14pt;\" /><label for=\"AMFDS0012-chk1-06-179070395\" class=\"\" \" style=\"position:absolute;left: 400.74pt;top: 3368.14pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-chk1-07-179070396\" name=\"QuikRadio12.AMFDS0012.chk1.07\"  type=\"checkbox\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"1\"  style=\"left:413.13pt;top: 3383.86pt;\" /><label for=\"AMFDS0012-chk1-07-179070396\" class=\"\" \" style=\"position:absolute;left: 413.13pt;top: 3383.86pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-chk1-07-179070396\" name=\"QuikRadio12.AMFDS0012.chk1.07\"  type=\"checkbox\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"1\"  style=\"left:415.93pt;top: 3385.86pt;\" /><label for=\"AMFDS0012-chk1-07-179070396\" class=\"\" \" style=\"position:absolute;left: 415.93pt;top: 3385.86pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-txt1-27-179070397\" name=\"AMFDS0012.txt1.27\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:35.94pt;top: 3493.36pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:174.050pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-txt1-27-179070397\" name=\"AMFDS0012.txt1.27\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:37.44pt;top: 3495.76pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:174.050pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-txt1-31-0-179070398\" name=\"AMFDS0012.txt1.31.0\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:218.86pt;top: 3493.36pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:174.050pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-txt1-31-0-179070398\" name=\"AMFDS0012.txt1.31.0\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:220.36pt;top: 3495.76pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:174.050pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-txt1-32-0-179070399\" name=\"AMFDS0012.txt1.32.0\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:402.4pt;top: 3493.36pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:174.690pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-txt1-32-0-179070399\" name=\"AMFDS0012.txt1.32.0\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:403.9pt;top: 3495.76pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:174.690pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-chk1-09-179070400\" name=\"QuikRadio12.AMFDS0012.chk1.09\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"1\"  style=\"left:34.01pt;top: 3547.16pt;\" /><label for=\"AMFDS0012-chk1-09-179070400\" class=\"\" \" style=\"position:absolute;left: 34.01pt;top: 3547.16pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-chk1-09-179070400\" name=\"QuikRadio12.AMFDS0012.chk1.09\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"1\"  style=\"left:36.81pt;top: 3549.16pt;\" /><label for=\"AMFDS0012-chk1-09-179070400\" class=\"\" \" style=\"position:absolute;left: 36.81pt;top: 3549.16pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-chk1-09-179070401\" name=\"QuikRadio12.AMFDS0012.chk1.09\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"2\"  style=\"left:95.4pt;top: 3547.16pt;\" /><label for=\"AMFDS0012-chk1-09-179070401\" class=\"\" \" style=\"position:absolute;left: 95.4pt;top: 3547.16pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-chk1-09-179070401\" name=\"QuikRadio12.AMFDS0012.chk1.09\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"2\"  style=\"left:98.2pt;top: 3549.16pt;\" /><label for=\"AMFDS0012-chk1-09-179070401\" class=\"\" \" style=\"position:absolute;left: 98.2pt;top: 3549.16pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-chk1-09-179070402\" name=\"QuikRadio12.AMFDS0012.chk1.09\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"3\"  style=\"left:156.8pt;top: 3547.16pt;\" /><label for=\"AMFDS0012-chk1-09-179070402\" class=\"\" \" style=\"position:absolute;left: 156.8pt;top: 3547.16pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-chk1-09-179070402\" name=\"QuikRadio12.AMFDS0012.chk1.09\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"3\"  style=\"left:159.6pt;top: 3549.16pt;\" /><label for=\"AMFDS0012-chk1-09-179070402\" class=\"\" \" style=\"position:absolute;left: 159.6pt;top: 3549.16pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-chk1-09-179070403\" name=\"QuikRadio12.AMFDS0012.chk1.09\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"4\"  style=\"left:222.62pt;top: 3547.16pt;\" /><label for=\"AMFDS0012-chk1-09-179070403\" class=\"\" \" style=\"position:absolute;left: 222.62pt;top: 3547.16pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-chk1-09-179070403\" name=\"QuikRadio12.AMFDS0012.chk1.09\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"4\"  style=\"left:225.42pt;top: 3549.16pt;\" /><label for=\"AMFDS0012-chk1-09-179070403\" class=\"\" \" style=\"position:absolute;left: 225.42pt;top: 3549.16pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-chk1-09-179070404\" name=\"QuikRadio12.AMFDS0012.chk1.09\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"5\"  style=\"left:288.44pt;top: 3547.16pt;\" /><label for=\"AMFDS0012-chk1-09-179070404\" class=\"\" \" style=\"position:absolute;left: 288.44pt;top: 3547.16pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-chk1-09-179070404\" name=\"QuikRadio12.AMFDS0012.chk1.09\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"5\"  style=\"left:291.24pt;top: 3549.16pt;\" /><label for=\"AMFDS0012-chk1-09-179070404\" class=\"\" \" style=\"position:absolute;left: 291.24pt;top: 3549.16pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-chk1-09-179070405\" name=\"QuikRadio12.AMFDS0012.chk1.09\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"6\"  style=\"left:354.9pt;top: 3547.16pt;\" /><label for=\"AMFDS0012-chk1-09-179070405\" class=\"\" \" style=\"position:absolute;left: 354.9pt;top: 3547.16pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-chk1-09-179070405\" name=\"QuikRadio12.AMFDS0012.chk1.09\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"6\"  style=\"left:357.7pt;top: 3549.16pt;\" /><label for=\"AMFDS0012-chk1-09-179070405\" class=\"\" \" style=\"position:absolute;left: 357.7pt;top: 3549.16pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-chk1-09-179070406\" name=\"QuikRadio12.AMFDS0012.chk1.09\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"7\"  style=\"left:421.36pt;top: 3547.16pt;\" /><label for=\"AMFDS0012-chk1-09-179070406\" class=\"\" \" style=\"position:absolute;left: 421.36pt;top: 3547.16pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-chk1-09-179070406\" name=\"QuikRadio12.AMFDS0012.chk1.09\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"7\"  style=\"left:424.16pt;top: 3549.16pt;\" /><label for=\"AMFDS0012-chk1-09-179070406\" class=\"\" \" style=\"position:absolute;left: 424.16pt;top: 3549.16pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-chk1-08-0-179070407\" name=\"QuikRadio12.AMFDS0012.chk1.08.0\"  type=\"checkbox\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"1\"  style=\"left:256.17pt;top: 3709.82pt;\" /><label for=\"AMFDS0012-chk1-08-0-179070407\" class=\"\" \" style=\"position:absolute;left: 256.17pt;top: 3709.82pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-chk1-08-0-179070407\" name=\"QuikRadio12.AMFDS0012.chk1.08.0\"  type=\"checkbox\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"1\"  style=\"left:258.97pt;top: 3711.82pt;\" /><label for=\"AMFDS0012-chk1-08-0-179070407\" class=\"\" \" style=\"position:absolute;left: 258.97pt;top: 3711.82pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-txt1-31-3-179070408\" name=\"AMFDS0012.txt1.31.3\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:47.97pt;top: 3795.26pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:72.790pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-txt1-31-3-179070408\" name=\"AMFDS0012.txt1.31.3\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:49.47pt;top: 3797.66pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:72.790pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-chk1-08-1-179070409\" name=\"QuikRadio12.AMFDS0012.chk1.08.1\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"1\"  style=\"left:151.1pt;top: 3780.7pt;\" /><label for=\"AMFDS0012-chk1-08-1-179070409\" class=\"\" \" style=\"position:absolute;left: 151.1pt;top: 3780.7pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-chk1-08-1-179070409\" name=\"QuikRadio12.AMFDS0012.chk1.08.1\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"1\"  style=\"left:153.9pt;top: 3782.7pt;\" /><label for=\"AMFDS0012-chk1-08-1-179070409\" class=\"\" \" style=\"position:absolute;left: 153.9pt;top: 3782.7pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-chk1-08-1-179070410\" name=\"QuikRadio12.AMFDS0012.chk1.08.1\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"2\"  style=\"left:151.1pt;top: 3799.06pt;\" /><label for=\"AMFDS0012-chk1-08-1-179070410\" class=\"\" \" style=\"position:absolute;left: 151.1pt;top: 3799.06pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-chk1-08-1-179070410\" name=\"QuikRadio12.AMFDS0012.chk1.08.1\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"2\"  style=\"left:153.9pt;top: 3801.06pt;\" /><label for=\"AMFDS0012-chk1-08-1-179070410\" class=\"\" \" style=\"position:absolute;left: 153.9pt;top: 3801.06pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-chk1-08-2-179070411\" name=\"QuikRadio12.AMFDS0012.chk1.08.2\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"1\"  style=\"left:270.72pt;top: 3780.7pt;\" /><label for=\"AMFDS0012-chk1-08-2-179070411\" class=\"\" \" style=\"position:absolute;left: 270.72pt;top: 3780.7pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-chk1-08-2-179070411\" name=\"QuikRadio12.AMFDS0012.chk1.08.2\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"1\"  style=\"left:273.52pt;top: 3782.7pt;\" /><label for=\"AMFDS0012-chk1-08-2-179070411\" class=\"\" \" style=\"position:absolute;left: 273.52pt;top: 3782.7pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-chk1-08-2-179070412\" name=\"QuikRadio12.AMFDS0012.chk1.08.2\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"2\"  style=\"left:270.72pt;top: 3799.06pt;\" /><label for=\"AMFDS0012-chk1-08-2-179070412\" class=\"\" \" style=\"position:absolute;left: 270.72pt;top: 3799.06pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-chk1-08-2-179070412\" name=\"QuikRadio12.AMFDS0012.chk1.08.2\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"2\"  style=\"left:273.52pt;top: 3801.06pt;\" /><label for=\"AMFDS0012-chk1-08-2-179070412\" class=\"\" \" style=\"position:absolute;left: 273.52pt;top: 3801.06pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-txt1-32-3-179070413\" name=\"AMFDS0012.txt1.32.3\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:404.94pt;top: 3795.26pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:72.790pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-txt1-32-3-179070413\" name=\"AMFDS0012.txt1.32.3\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:406.44pt;top: 3797.66pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:72.790pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-txt1-31-2-179070414\" name=\"AMFDS0012.txt1.31.2\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:47.97pt;top: 3836.4pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:72.790pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-txt1-31-2-179070414\" name=\"AMFDS0012.txt1.31.2\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:49.47pt;top: 3838.8pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:72.790pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-chk1-08-3-179070415\" name=\"QuikRadio12.AMFDS0012.chk1.08.3\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"1\"  style=\"left:151.1pt;top: 3822.48pt;\" /><label for=\"AMFDS0012-chk1-08-3-179070415\" class=\"\" \" style=\"position:absolute;left: 151.1pt;top: 3822.48pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-chk1-08-3-179070415\" name=\"QuikRadio12.AMFDS0012.chk1.08.3\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"1\"  style=\"left:153.9pt;top: 3824.48pt;\" /><label for=\"AMFDS0012-chk1-08-3-179070415\" class=\"\" \" style=\"position:absolute;left: 153.9pt;top: 3824.48pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-chk1-08-3-179070416\" name=\"QuikRadio12.AMFDS0012.chk1.08.3\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"2\"  style=\"left:151.1pt;top: 3840.2pt;\" /><label for=\"AMFDS0012-chk1-08-3-179070416\" class=\"\" \" style=\"position:absolute;left: 151.1pt;top: 3840.2pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-chk1-08-3-179070416\" name=\"QuikRadio12.AMFDS0012.chk1.08.3\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"2\"  style=\"left:153.9pt;top: 3842.2pt;\" /><label for=\"AMFDS0012-chk1-08-3-179070416\" class=\"\" \" style=\"position:absolute;left: 153.9pt;top: 3842.2pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-chk1-08-4-179070417\" name=\"QuikRadio12.AMFDS0012.chk1.08.4\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"1\"  style=\"left:270.72pt;top: 3822.48pt;\" /><label for=\"AMFDS0012-chk1-08-4-179070417\" class=\"\" \" style=\"position:absolute;left: 270.72pt;top: 3822.48pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-chk1-08-4-179070417\" name=\"QuikRadio12.AMFDS0012.chk1.08.4\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"1\"  style=\"left:273.52pt;top: 3824.48pt;\" /><label for=\"AMFDS0012-chk1-08-4-179070417\" class=\"\" \" style=\"position:absolute;left: 273.52pt;top: 3824.48pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-chk1-08-4-179070418\" name=\"QuikRadio12.AMFDS0012.chk1.08.4\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"2\"  style=\"left:270.72pt;top: 3840.2pt;\" /><label for=\"AMFDS0012-chk1-08-4-179070418\" class=\"\" \" style=\"position:absolute;left: 270.72pt;top: 3840.2pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-chk1-08-4-179070418\" name=\"QuikRadio12.AMFDS0012.chk1.08.4\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"2\"  style=\"left:273.52pt;top: 3842.2pt;\" /><label for=\"AMFDS0012-chk1-08-4-179070418\" class=\"\" \" style=\"position:absolute;left: 273.52pt;top: 3842.2pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-txt1-32-2-179070419\" name=\"AMFDS0012.txt1.32.2\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:404.94pt;top: 3837.03pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:72.790pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-txt1-32-2-179070419\" name=\"AMFDS0012.txt1.32.2\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:406.44pt;top: 3839.43pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:72.790pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-txt1-31-1-179070420\" name=\"AMFDS0012.txt1.31.1\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:47.97pt;top: 3884.5pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:72.790pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-txt1-31-1-179070420\" name=\"AMFDS0012.txt1.31.1\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:49.47pt;top: 3886.9pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:72.790pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-chk1-08-5-179070421\" name=\"QuikRadio12.AMFDS0012.chk1.08.5\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"1\"  style=\"left:151.1pt;top: 3870.58pt;\" /><label for=\"AMFDS0012-chk1-08-5-179070421\" class=\"\" \" style=\"position:absolute;left: 151.1pt;top: 3870.58pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-chk1-08-5-179070421\" name=\"QuikRadio12.AMFDS0012.chk1.08.5\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"1\"  style=\"left:153.9pt;top: 3872.58pt;\" /><label for=\"AMFDS0012-chk1-08-5-179070421\" class=\"\" \" style=\"position:absolute;left: 153.9pt;top: 3872.58pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-chk1-08-5-179070422\" name=\"QuikRadio12.AMFDS0012.chk1.08.5\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"2\"  style=\"left:151.1pt;top: 3888.3pt;\" /><label for=\"AMFDS0012-chk1-08-5-179070422\" class=\"\" \" style=\"position:absolute;left: 151.1pt;top: 3888.3pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-chk1-08-5-179070422\" name=\"QuikRadio12.AMFDS0012.chk1.08.5\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"2\"  style=\"left:153.9pt;top: 3890.3pt;\" /><label for=\"AMFDS0012-chk1-08-5-179070422\" class=\"\" \" style=\"position:absolute;left: 153.9pt;top: 3890.3pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-chk1-08-6-179070423\" name=\"QuikRadio12.AMFDS0012.chk1.08.6\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"1\"  style=\"left:270.72pt;top: 3870.58pt;\" /><label for=\"AMFDS0012-chk1-08-6-179070423\" class=\"\" \" style=\"position:absolute;left: 270.72pt;top: 3870.58pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-chk1-08-6-179070423\" name=\"QuikRadio12.AMFDS0012.chk1.08.6\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"1\"  style=\"left:273.52pt;top: 3872.58pt;\" /><label for=\"AMFDS0012-chk1-08-6-179070423\" class=\"\" \" style=\"position:absolute;left: 273.52pt;top: 3872.58pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-chk1-08-6-179070424\" name=\"QuikRadio12.AMFDS0012.chk1.08.6\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"2\"  style=\"left:270.72pt;top: 3888.3pt;\" /><label for=\"AMFDS0012-chk1-08-6-179070424\" class=\"\" \" style=\"position:absolute;left: 270.72pt;top: 3888.3pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-chk1-08-6-179070424\" name=\"QuikRadio12.AMFDS0012.chk1.08.6\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"2\"  style=\"left:273.52pt;top: 3890.3pt;\" /><label for=\"AMFDS0012-chk1-08-6-179070424\" class=\"\" \" style=\"position:absolute;left: 273.52pt;top: 3890.3pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"AMFDS0012-txt1-32-1-179070425\" name=\"AMFDS0012.txt1.32.1\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:404.94pt;top: 3885.13pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:72.790pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-txt1-32-1-179070425\" name=\"AMFDS0012.txt1.32.1\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:406.44pt;top: 3887.53pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:72.790pt\" /><!-- <![endif]--></div> </li> <li id=\"FID12p6\"> <!--[if lte IE 8]><a id=\"FID12p6\"></a><![endif]--><div style=\"float:none; clear:both; background-color:#ffffff; height:792pt; width:612pt;\"><div id=\"ID12p6\" style=\"background-color: Gray; margin:0pt; padding:0pt; height:792pt; width:612pt; \"> <img src='https://dq6apn6hy8vc6.cloudfront.net/prod/forms/publish/current/12_6_38.png?Expires=1655394765&Signature=Z5qPC5LUwJ9xP26KU6xm19k6x7pUq3Bn1MJYZql8-oYDZqcvWo-KkwV3EE3I5GiAKhxadpuXcx8s16AU0NNrFRnL2OJ8G4mvm7NN2UEcaTnI6fCyshixA6bLkT42VOqxEWlXucgSIIsN-2onWNQPuJ4k8McfRoWpRWnKaEFkHZ8_&Key-Pair-Id=APKAIO63VAHYK7C5DQRQ' alt=\"FormID12p6\" /></div> <!--[if lte IE 9]><input id=\"1ben-FName-179070426\" name=\"1ben.FName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:59.99pt;top: 4336.86pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:206.960pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"1ben-FName-179070426\" name=\"1ben.FName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:61.49pt;top: 4339.26pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:206.960pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"1ben-MName-179070427\" name=\"1ben.MName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:277.09pt;top: 4336.86pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:29.110pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"1ben-MName-179070427\" name=\"1ben.MName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:278.59pt;top: 4339.26pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:29.110pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"1ben-LName-179070428\" name=\"1ben.LName\"  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<![endif]--><!--[if lte IE 9]><input id=\"2ben-MName-179070445\" name=\"2ben.MName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:277.09pt;top: 4462.81pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:29.110pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"2ben-MName-179070445\" name=\"2ben.MName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:278.59pt;top: 4465.21pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:29.110pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"2ben-LName-179070446\" name=\"2ben.LName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\" 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id=\"2ben-Suffix-179070447\" name=\"2ben.Suffix\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:533.02pt;top: 4465.21pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:45.570pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"2ben-H-Addr123-179070448\" name=\"2ben.H.Addr123\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:59.99pt;top: 4495.72pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:263.930pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"2ben-H-Addr123-179070448\" name=\"2ben.H.Addr123\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  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9]><input id=\"2ben-H-State-179070450\" name=\"2ben.H.State\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:492.91pt;top: 4495.72pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:29.110pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"2ben-H-State-179070450\" name=\"2ben.H.State\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:494.41pt;top: 4498.12pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:29.110pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"2ben-H-Zip-179070451\" name=\"2ben.H.Zip\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:531.52pt;top: 4495.72pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:45.570pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"2ben-H-Zip-179070451\" name=\"2ben.H.Zip\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:533.02pt;top: 4498.12pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:45.570pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"2ben-BeneRelation-179070452\" name=\"QuikRadio12.2ben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"8\"  style=\"left:58.06pt;top: 4530.53pt;\" /><label for=\"2ben-BeneRelation-179070452\" class=\"\" \" style=\"position:absolute;left: 58.06pt;top: 4530.53pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"2ben-BeneRelation-179070452\" name=\"QuikRadio12.2ben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"8\"  style=\"left:60.86pt;top: 4532.53pt;\" /><label for=\"2ben-BeneRelation-179070452\" class=\"\" \" style=\"position:absolute;left: 60.86pt;top: 4532.53pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"2ben-BeneRelation-179070453\" name=\"QuikRadio12.2ben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"9\"  style=\"left:87.81pt;top: 4530.53pt;\" /><label for=\"2ben-BeneRelation-179070453\" class=\"\" \" style=\"position:absolute;left: 87.81pt;top: 4530.53pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"2ben-BeneRelation-179070453\" name=\"QuikRadio12.2ben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"9\"  style=\"left:90.61pt;top: 4532.53pt;\" /><label for=\"2ben-BeneRelation-179070453\" class=\"\" \" style=\"position:absolute;left: 90.61pt;top: 4532.53pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"2ben-BeneRelation-179070454\" name=\"QuikRadio12.2ben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"1\"  style=\"left:118.19pt;top: 4530.53pt;\" /><label for=\"2ben-BeneRelation-179070454\" class=\"\" \" style=\"position:absolute;left: 118.19pt;top: 4530.53pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"2ben-BeneRelation-179070454\" name=\"QuikRadio12.2ben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"1\"  style=\"left:120.99pt;top: 4532.53pt;\" /><label for=\"2ben-BeneRelation-179070454\" class=\"\" \" style=\"position:absolute;left: 120.99pt;top: 4532.53pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"2ben-BeneRelation-179070455\" name=\"QuikRadio12.2ben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"11\"  style=\"left:151.1pt;top: 4530.53pt;\" /><label for=\"2ben-BeneRelation-179070455\" class=\"\" \" style=\"position:absolute;left: 151.1pt;top: 4530.53pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"2ben-BeneRelation-179070455\" name=\"QuikRadio12.2ben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"11\"  style=\"left:153.9pt;top: 4532.53pt;\" /><label for=\"2ben-BeneRelation-179070455\" class=\"\" \" style=\"position:absolute;left: 153.9pt;top: 4532.53pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"2ben-BeneRelation-179070456\" name=\"QuikRadio12.2ben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"0\"  style=\"left:184.01pt;top: 4530.53pt;\" /><label for=\"2ben-BeneRelation-179070456\" class=\"\" \" style=\"position:absolute;left: 184.01pt;top: 4530.53pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"2ben-BeneRelation-179070456\" name=\"QuikRadio12.2ben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"0\"  style=\"left:186.81pt;top: 4532.53pt;\" /><label for=\"2ben-BeneRelation-179070456\" class=\"\" \" style=\"position:absolute;left: 186.81pt;top: 4532.53pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"2ben-DOB-179070457\" name=\"2ben.DOB\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:216.33pt;top: 4527.37pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:143.670pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"2ben-DOB-179070457\" name=\"2ben.DOB\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:217.83pt;top: 4529.77pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:143.670pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"2ben-SSN-179070458\" name=\"2ben.SSN\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:369.49pt;top: 4527.37pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:143.670pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"2ben-SSN-179070458\" name=\"2ben.SSN\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:370.99pt;top: 4529.77pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:143.670pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"2ben-BenePerc-179070459\" name=\"2ben.BenePerc\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:522.03pt;top: 4527.37pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:46.840pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"2ben-BenePerc-179070459\" name=\"2ben.BenePerc\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:523.53pt;top: 4529.77pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:46.840pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"3ben-FName-179070460\" name=\"3ben.FName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:59.99pt;top: 4558.38pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:206.960pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"3ben-FName-179070460\" name=\"3ben.FName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:61.49pt;top: 4560.78pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:206.960pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"3ben-MName-179070461\" name=\"3ben.MName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:277.09pt;top: 4558.38pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:29.110pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"3ben-MName-179070461\" name=\"3ben.MName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:278.59pt;top: 4560.78pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:29.110pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"3ben-LName-179070462\" name=\"3ben.LName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:315.69pt;top: 4558.38pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:206.330pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"3ben-LName-179070462\" name=\"3ben.LName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:317.19pt;top: 4560.78pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:206.330pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"3ben-Suffix-179070463\" name=\"3ben.Suffix\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:531.52pt;top: 4558.38pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:45.570pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"3ben-Suffix-179070463\" name=\"3ben.Suffix\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:533.02pt;top: 4560.78pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:45.570pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"3ben-H-Addr123-179070464\" name=\"3ben.H.Addr123\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:59.99pt;top: 4590.66pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:263.930pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"3ben-H-Addr123-179070464\" name=\"3ben.H.Addr123\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:61.49pt;top: 4593.06pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:263.930pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"3ben-H-City-179070465\" name=\"3ben.H.City\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:334.05pt;top: 4590.66pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:149.370pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"3ben-H-City-179070465\" name=\"3ben.H.City\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:335.55pt;top: 4593.06pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:149.370pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"3ben-H-State-179070466\" name=\"3ben.H.State\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:492.91pt;top: 4590.66pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:29.110pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"3ben-H-State-179070466\" name=\"3ben.H.State\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:494.41pt;top: 4593.06pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:29.110pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"3ben-H-Zip-179070467\" name=\"3ben.H.Zip\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:531.52pt;top: 4590.66pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:45.570pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"3ben-H-Zip-179070467\" name=\"3ben.H.Zip\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:533.02pt;top: 4593.06pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:45.570pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"3ben-BeneRelation-179070468\" name=\"QuikRadio12.3ben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"8\"  style=\"left:58.06pt;top: 4625.47pt;\" /><label for=\"3ben-BeneRelation-179070468\" class=\"\" \" style=\"position:absolute;left: 58.06pt;top: 4625.47pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"3ben-BeneRelation-179070468\" name=\"QuikRadio12.3ben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"8\"  style=\"left:60.86pt;top: 4627.47pt;\" /><label for=\"3ben-BeneRelation-179070468\" class=\"\" \" style=\"position:absolute;left: 60.86pt;top: 4627.47pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"3ben-BeneRelation-179070469\" name=\"QuikRadio12.3ben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"9\"  style=\"left:87.81pt;top: 4625.47pt;\" /><label for=\"3ben-BeneRelation-179070469\" class=\"\" \" style=\"position:absolute;left: 87.81pt;top: 4625.47pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"3ben-BeneRelation-179070469\" name=\"QuikRadio12.3ben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"9\"  style=\"left:90.61pt;top: 4627.47pt;\" /><label for=\"3ben-BeneRelation-179070469\" class=\"\" \" style=\"position:absolute;left: 90.61pt;top: 4627.47pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"3ben-BeneRelation-179070470\" name=\"QuikRadio12.3ben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"1\"  style=\"left:118.19pt;top: 4625.47pt;\" /><label for=\"3ben-BeneRelation-179070470\" class=\"\" \" style=\"position:absolute;left: 118.19pt;top: 4625.47pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"3ben-BeneRelation-179070470\" name=\"QuikRadio12.3ben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"1\"  style=\"left:120.99pt;top: 4627.47pt;\" /><label for=\"3ben-BeneRelation-179070470\" class=\"\" \" style=\"position:absolute;left: 120.99pt;top: 4627.47pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"3ben-BeneRelation-179070471\" name=\"QuikRadio12.3ben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"11\"  style=\"left:151.1pt;top: 4625.47pt;\" /><label for=\"3ben-BeneRelation-179070471\" class=\"\" \" style=\"position:absolute;left: 151.1pt;top: 4625.47pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"3ben-BeneRelation-179070471\" name=\"QuikRadio12.3ben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"11\"  style=\"left:153.9pt;top: 4627.47pt;\" /><label for=\"3ben-BeneRelation-179070471\" class=\"\" \" style=\"position:absolute;left: 153.9pt;top: 4627.47pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"3ben-BeneRelation-179070472\" name=\"QuikRadio12.3ben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"0\"  style=\"left:184.01pt;top: 4625.47pt;\" /><label for=\"3ben-BeneRelation-179070472\" class=\"\" \" style=\"position:absolute;left: 184.01pt;top: 4625.47pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"3ben-BeneRelation-179070472\" name=\"QuikRadio12.3ben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"0\"  style=\"left:186.81pt;top: 4627.47pt;\" /><label for=\"3ben-BeneRelation-179070472\" class=\"\" \" style=\"position:absolute;left: 186.81pt;top: 4627.47pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"3ben-DOB-179070473\" name=\"3ben.DOB\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:216.33pt;top: 4622.3pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:143.670pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"3ben-DOB-179070473\" name=\"3ben.DOB\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:217.83pt;top: 4624.7pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:143.670pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"3ben-SSN-179070474\" name=\"3ben.SSN\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:369.49pt;top: 4622.3pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:143.670pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"3ben-SSN-179070474\" name=\"3ben.SSN\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:370.99pt;top: 4624.7pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:143.670pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"3ben-BenePerc-179070475\" name=\"3ben.BenePerc\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:522.03pt;top: 4622.3pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:46.840pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"3ben-BenePerc-179070475\" name=\"3ben.BenePerc\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:523.53pt;top: 4624.7pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:46.840pt\" /><!-- <![endif]--></div> </li> <li id=\"FID12p7\"> <!--[if lte IE 8]><a id=\"FID12p7\"></a><![endif]--><div style=\"float:none; clear:both; background-color:#ffffff; height:792pt; width:612pt;\"><div id=\"ID12p7\" style=\"background-color: Gray; margin:0pt; padding:0pt; height:792pt; width:612pt; \"> <img src='https://dq6apn6hy8vc6.cloudfront.net/prod/forms/publish/current/12_7_38.png?Expires=1655394765&Signature=ZRSMj7omWRQPW46Ktl6miD8-XfTS~Azkw-ea0dg5afKui4-6J5Z0Mdb6~4GMOYK~cu0gRXJPZIn3xJx37GCoU~XFZMu9xNzdd~gKrSjdrM-BJv2q9PY1uQyRDmNyCKuNQmDNKyzN7Ma0UktY~kmqkfXpNDrwBC-KxycolzfuvrI_&Key-Pair-Id=APKAIO63VAHYK7C5DQRQ' alt=\"FormID12p7\" /></div> <!--[if lte IE 9]><input id=\"1cben-FName-179070476\" name=\"1cben.FName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:59.99pt;top: 4963.9pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:206.960pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"1cben-FName-179070476\" name=\"1cben.FName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:61.49pt;top: 4966.3pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:206.960pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"1cben-MName-179070477\" name=\"1cben.MName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:277.09pt;top: 4963.9pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:29.110pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"1cben-MName-179070477\" name=\"1cben.MName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:278.59pt;top: 4966.3pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:29.110pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"1cben-LName-179070478\" name=\"1cben.LName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:315.69pt;top: 4963.9pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:206.330pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"1cben-LName-179070478\" name=\"1cben.LName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  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9]><input id=\"1cben-EntityName-179070480\" name=\"1cben.EntityName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:59.99pt;top: 4995.55pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:517.100pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"1cben-EntityName-179070480\" name=\"1cben.EntityName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:61.49pt;top: 4997.95pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:517.100pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"1cben-H-Addr123-179070481\" name=\"1cben.H.Addr123\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent 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!IE]> --><input id=\"1cben-H-City-179070482\" name=\"1cben.H.City\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:335.55pt;top: 5029.59pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:149.370pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"1cben-H-State-179070483\" name=\"1cben.H.State\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:492.91pt;top: 5027.19pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:29.110pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"1cben-H-State-179070483\" name=\"1cben.H.State\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  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9]><input id=\"1cben-BeneRelation-179070485\" name=\"QuikRadio12.1cben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"8\"  style=\"left:58.06pt;top: 5062.64pt;\" /><label for=\"1cben-BeneRelation-179070485\" class=\"\" \" style=\"position:absolute;left: 58.06pt;top: 5062.64pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"1cben-BeneRelation-179070485\" name=\"QuikRadio12.1cben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"8\"  style=\"left:60.86pt;top: 5064.64pt;\" /><label for=\"1cben-BeneRelation-179070485\" class=\"\" \" style=\"position:absolute;left: 60.86pt;top: 5064.64pt;width:15.190pt;cursor: 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for=\"1cben-BeneRelation-179070487\" class=\"\" \" style=\"position:absolute;left: 120.99pt;top: 5064.64pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"1cben-BeneRelation-179070488\" name=\"QuikRadio12.1cben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"11\"  style=\"left:151.1pt;top: 5062.64pt;\" /><label for=\"1cben-BeneRelation-179070488\" class=\"\" \" style=\"position:absolute;left: 151.1pt;top: 5062.64pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"1cben-BeneRelation-179070488\" name=\"QuikRadio12.1cben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  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itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"4\"  style=\"left:216.56pt;top: 5064.64pt;\" /><label for=\"1cben-BeneRelation-179070490\" class=\"\" \" style=\"position:absolute;left: 216.56pt;top: 5064.64pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"1cben-DOB-179070491\" name=\"1cben.DOB\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:273.29pt;top: 5059.47pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:107.600pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"1cben-DOB-179070491\" name=\"1cben.DOB\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:274.79pt;top: 5061.87pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:107.600pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"1cben-SSN-179070492\" name=\"1cben.SSN\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:390.38pt;top: 5059.47pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:122.790pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"1cben-SSN-179070492\" name=\"1cben.SSN\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:391.88pt;top: 5061.87pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:122.790pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"1cben-BenePerc-179070493\" name=\"1cben.BenePerc\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:522.03pt;top: 5059.47pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:46.840pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"1cben-BenePerc-179070493\" name=\"1cben.BenePerc\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:523.53pt;top: 5061.87pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:46.840pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"2cben-FName-179070494\" name=\"2cben.FName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:59.99pt;top: 5089.85pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:206.960pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"2cben-FName-179070494\" name=\"2cben.FName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:61.49pt;top: 5092.25pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:206.960pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"2cben-MName-179070495\" name=\"2cben.MName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:277.09pt;top: 5089.85pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:29.110pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"2cben-MName-179070495\" name=\"2cben.MName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:278.59pt;top: 5092.25pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:29.110pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"2cben-LName-179070496\" name=\"2cben.LName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:315.69pt;top: 5089.85pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:206.330pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"2cben-LName-179070496\" name=\"2cben.LName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:317.19pt;top: 5092.25pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:206.330pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"2cben-Suffix-179070497\" name=\"2cben.Suffix\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:531.52pt;top: 5089.85pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:45.570pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"2cben-Suffix-179070497\" name=\"2cben.Suffix\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:533.02pt;top: 5092.25pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:45.570pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"2cben-H-Addr123-179070498\" name=\"2cben.H.Addr123\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:59.99pt;top: 5122.13pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:263.930pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"2cben-H-Addr123-179070498\" name=\"2cben.H.Addr123\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:61.49pt;top: 5124.53pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:263.930pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"2cben-H-City-179070499\" name=\"2cben.H.City\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:334.05pt;top: 5122.13pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:149.370pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"2cben-H-City-179070499\" name=\"2cben.H.City\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:335.55pt;top: 5124.53pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:149.370pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"2cben-H-State-179070500\" name=\"2cben.H.State\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:492.91pt;top: 5122.13pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:29.110pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"2cben-H-State-179070500\" name=\"2cben.H.State\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:494.41pt;top: 5124.53pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:29.110pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"2cben-H-Zip-179070501\" name=\"2cben.H.Zip\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:531.52pt;top: 5122.13pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:45.570pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"2cben-H-Zip-179070501\" name=\"2cben.H.Zip\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:533.02pt;top: 5124.53pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:45.570pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"2cben-BeneRelation-179070502\" name=\"QuikRadio12.2cben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"8\"  style=\"left:58.06pt;top: 5157.57pt;\" /><label for=\"2cben-BeneRelation-179070502\" class=\"\" \" style=\"position:absolute;left: 58.06pt;top: 5157.57pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"2cben-BeneRelation-179070502\" name=\"QuikRadio12.2cben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"8\"  style=\"left:60.86pt;top: 5159.57pt;\" /><label for=\"2cben-BeneRelation-179070502\" class=\"\" \" style=\"position:absolute;left: 60.86pt;top: 5159.57pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"2cben-BeneRelation-179070503\" name=\"QuikRadio12.2cben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"9\"  style=\"left:87.81pt;top: 5157.57pt;\" /><label for=\"2cben-BeneRelation-179070503\" class=\"\" \" style=\"position:absolute;left: 87.81pt;top: 5157.57pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"2cben-BeneRelation-179070503\" name=\"QuikRadio12.2cben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"9\"  style=\"left:90.61pt;top: 5159.57pt;\" /><label for=\"2cben-BeneRelation-179070503\" class=\"\" \" style=\"position:absolute;left: 90.61pt;top: 5159.57pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"2cben-BeneRelation-179070504\" name=\"QuikRadio12.2cben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"1\"  style=\"left:118.19pt;top: 5157.57pt;\" /><label for=\"2cben-BeneRelation-179070504\" class=\"\" \" style=\"position:absolute;left: 118.19pt;top: 5157.57pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"2cben-BeneRelation-179070504\" name=\"QuikRadio12.2cben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"1\"  style=\"left:120.99pt;top: 5159.57pt;\" /><label for=\"2cben-BeneRelation-179070504\" class=\"\" \" style=\"position:absolute;left: 120.99pt;top: 5159.57pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"2cben-BeneRelation-179070505\" name=\"QuikRadio12.2cben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"11\"  style=\"left:151.1pt;top: 5157.57pt;\" /><label for=\"2cben-BeneRelation-179070505\" class=\"\" \" style=\"position:absolute;left: 151.1pt;top: 5157.57pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"2cben-BeneRelation-179070505\" name=\"QuikRadio12.2cben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"11\"  style=\"left:153.9pt;top: 5159.57pt;\" /><label for=\"2cben-BeneRelation-179070505\" class=\"\" \" style=\"position:absolute;left: 153.9pt;top: 5159.57pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"2cben-BeneRelation-179070506\" name=\"QuikRadio12.2cben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"0\"  style=\"left:184.01pt;top: 5157.57pt;\" /><label for=\"2cben-BeneRelation-179070506\" class=\"\" \" style=\"position:absolute;left: 184.01pt;top: 5157.57pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"2cben-BeneRelation-179070506\" name=\"QuikRadio12.2cben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"0\"  style=\"left:186.81pt;top: 5159.57pt;\" /><label for=\"2cben-BeneRelation-179070506\" class=\"\" \" style=\"position:absolute;left: 186.81pt;top: 5159.57pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"2cben-DOB-179070507\" name=\"2cben.DOB\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:216.33pt;top: 5154.41pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:143.670pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"2cben-DOB-179070507\" name=\"2cben.DOB\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:217.83pt;top: 5156.81pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:143.670pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"2cben-SSN-179070508\" name=\"2cben.SSN\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:369.49pt;top: 5154.41pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:143.670pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"2cben-SSN-179070508\" name=\"2cben.SSN\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:370.99pt;top: 5156.81pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:143.670pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"2cben-BenePerc-179070509\" name=\"2cben.BenePerc\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:522.03pt;top: 5154.41pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:46.840pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"2cben-BenePerc-179070509\" name=\"2cben.BenePerc\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:523.53pt;top: 5156.81pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:46.840pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"3cben-FName-179070510\" name=\"3cben.FName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:59.99pt;top: 5184.79pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:206.960pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"3cben-FName-179070510\" name=\"3cben.FName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:61.49pt;top: 5187.19pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:206.960pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"3cben-MName-179070511\" name=\"3cben.MName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:277.09pt;top: 5184.79pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:29.110pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"3cben-MName-179070511\" name=\"3cben.MName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:278.59pt;top: 5187.19pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:29.110pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"3cben-LName-179070512\" name=\"3cben.LName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:315.69pt;top: 5184.79pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:206.330pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"3cben-LName-179070512\" name=\"3cben.LName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:317.19pt;top: 5187.19pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:206.330pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"3cben-Suffix-179070513\" name=\"3cben.Suffix\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:531.52pt;top: 5184.79pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:45.570pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"3cben-Suffix-179070513\" name=\"3cben.Suffix\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:533.02pt;top: 5187.19pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:45.570pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"3cben-H-Addr123-179070514\" name=\"3cben.H.Addr123\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:59.99pt;top: 5217.07pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:263.930pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"3cben-H-Addr123-179070514\" name=\"3cben.H.Addr123\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:61.49pt;top: 5219.47pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:263.930pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"3cben-H-City-179070515\" name=\"3cben.H.City\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:334.05pt;top: 5217.07pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:149.370pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"3cben-H-City-179070515\" name=\"3cben.H.City\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:335.55pt;top: 5219.47pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:149.370pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"3cben-H-State-179070516\" name=\"3cben.H.State\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:492.91pt;top: 5217.07pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:29.110pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"3cben-H-State-179070516\" name=\"3cben.H.State\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:494.41pt;top: 5219.47pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:29.110pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"3cben-H-Zip-179070517\" name=\"3cben.H.Zip\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:531.52pt;top: 5217.07pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:45.570pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"3cben-H-Zip-179070517\" name=\"3cben.H.Zip\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:533.02pt;top: 5219.47pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:45.570pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"3cben-BeneRelation-179070518\" name=\"QuikRadio12.3cben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"8\"  style=\"left:58.06pt;top: 5252.51pt;\" /><label for=\"3cben-BeneRelation-179070518\" class=\"\" \" style=\"position:absolute;left: 58.06pt;top: 5252.51pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"3cben-BeneRelation-179070518\" name=\"QuikRadio12.3cben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"8\"  style=\"left:60.86pt;top: 5254.51pt;\" /><label for=\"3cben-BeneRelation-179070518\" class=\"\" \" style=\"position:absolute;left: 60.86pt;top: 5254.51pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"3cben-BeneRelation-179070519\" name=\"QuikRadio12.3cben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"9\"  style=\"left:87.81pt;top: 5252.51pt;\" /><label for=\"3cben-BeneRelation-179070519\" class=\"\" \" style=\"position:absolute;left: 87.81pt;top: 5252.51pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"3cben-BeneRelation-179070519\" name=\"QuikRadio12.3cben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"9\"  style=\"left:90.61pt;top: 5254.51pt;\" /><label for=\"3cben-BeneRelation-179070519\" class=\"\" \" style=\"position:absolute;left: 90.61pt;top: 5254.51pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"3cben-BeneRelation-179070520\" name=\"QuikRadio12.3cben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"1\"  style=\"left:118.19pt;top: 5252.51pt;\" /><label for=\"3cben-BeneRelation-179070520\" class=\"\" \" style=\"position:absolute;left: 118.19pt;top: 5252.51pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"3cben-BeneRelation-179070520\" name=\"QuikRadio12.3cben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"1\"  style=\"left:120.99pt;top: 5254.51pt;\" /><label for=\"3cben-BeneRelation-179070520\" class=\"\" \" style=\"position:absolute;left: 120.99pt;top: 5254.51pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"3cben-BeneRelation-179070521\" name=\"QuikRadio12.3cben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"11\"  style=\"left:151.1pt;top: 5252.51pt;\" /><label for=\"3cben-BeneRelation-179070521\" class=\"\" \" style=\"position:absolute;left: 151.1pt;top: 5252.51pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"3cben-BeneRelation-179070521\" name=\"QuikRadio12.3cben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"11\"  style=\"left:153.9pt;top: 5254.51pt;\" /><label for=\"3cben-BeneRelation-179070521\" class=\"\" \" style=\"position:absolute;left: 153.9pt;top: 5254.51pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"3cben-BeneRelation-179070522\" name=\"QuikRadio12.3cben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"0\"  style=\"left:184.01pt;top: 5252.51pt;\" /><label for=\"3cben-BeneRelation-179070522\" class=\"\" \" style=\"position:absolute;left: 184.01pt;top: 5252.51pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"3cben-BeneRelation-179070522\" name=\"QuikRadio12.3cben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"0\"  style=\"left:186.81pt;top: 5254.51pt;\" /><label for=\"3cben-BeneRelation-179070522\" class=\"\" \" style=\"position:absolute;left: 186.81pt;top: 5254.51pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"3cben-DOB-179070523\" name=\"3cben.DOB\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:216.33pt;top: 5249.35pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:143.670pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"3cben-DOB-179070523\" name=\"3cben.DOB\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:217.83pt;top: 5251.75pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:143.670pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"3cben-SSN-179070524\" name=\"3cben.SSN\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:369.49pt;top: 5249.35pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:143.670pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"3cben-SSN-179070524\" name=\"3cben.SSN\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:370.99pt;top: 5251.75pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:143.670pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"3cben-BenePerc-179070525\" name=\"3cben.BenePerc\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:522.03pt;top: 5249.35pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:46.840pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"3cben-BenePerc-179070525\" name=\"3cben.BenePerc\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:523.53pt;top: 5251.75pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:46.840pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"4cben-FName-179070526\" name=\"4cben.FName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:59.99pt;top: 5285.42pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:206.960pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"4cben-FName-179070526\" name=\"4cben.FName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:61.49pt;top: 5287.82pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:206.960pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"4cben-MName-179070527\" name=\"4cben.MName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:277.09pt;top: 5285.42pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:29.110pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"4cben-MName-179070527\" name=\"4cben.MName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:278.59pt;top: 5287.82pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:29.110pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"4cben-LName-179070528\" name=\"4cben.LName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:315.69pt;top: 5285.42pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:206.330pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"4cben-LName-179070528\" name=\"4cben.LName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:317.19pt;top: 5287.82pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:206.330pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"4cben-Suffix-179070529\" name=\"4cben.Suffix\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:531.52pt;top: 5285.42pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:45.570pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"4cben-Suffix-179070529\" name=\"4cben.Suffix\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:533.02pt;top: 5287.82pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:45.570pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"4cben-H-Addr123-179070530\" name=\"4cben.H.Addr123\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:59.99pt;top: 5318.33pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:263.930pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"4cben-H-Addr123-179070530\" name=\"4cben.H.Addr123\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:61.49pt;top: 5320.73pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:263.930pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"4cben-H-City-179070531\" name=\"4cben.H.City\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:334.05pt;top: 5318.33pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:149.370pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"4cben-H-City-179070531\" name=\"4cben.H.City\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:335.55pt;top: 5320.73pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:149.370pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"4cben-H-State-179070532\" name=\"4cben.H.State\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:492.91pt;top: 5318.33pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:29.110pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"4cben-H-State-179070532\" name=\"4cben.H.State\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:494.41pt;top: 5320.73pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:29.110pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"4cben-H-Zip-179070533\" name=\"4cben.H.Zip\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:531.52pt;top: 5318.33pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:45.570pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"4cben-H-Zip-179070533\" name=\"4cben.H.Zip\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:533.02pt;top: 5320.73pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:45.570pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"4cben-BeneRelation-179070534\" name=\"QuikRadio12.4cben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"8\"  style=\"left:58.06pt;top: 5353.15pt;\" /><label for=\"4cben-BeneRelation-179070534\" class=\"\" \" style=\"position:absolute;left: 58.06pt;top: 5353.15pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"4cben-BeneRelation-179070534\" name=\"QuikRadio12.4cben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"8\"  style=\"left:60.86pt;top: 5355.15pt;\" /><label for=\"4cben-BeneRelation-179070534\" class=\"\" \" style=\"position:absolute;left: 60.86pt;top: 5355.15pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"4cben-BeneRelation-179070535\" name=\"QuikRadio12.4cben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"9\"  style=\"left:87.81pt;top: 5353.15pt;\" /><label for=\"4cben-BeneRelation-179070535\" class=\"\" \" style=\"position:absolute;left: 87.81pt;top: 5353.15pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"4cben-BeneRelation-179070535\" name=\"QuikRadio12.4cben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"9\"  style=\"left:90.61pt;top: 5355.15pt;\" /><label for=\"4cben-BeneRelation-179070535\" class=\"\" \" style=\"position:absolute;left: 90.61pt;top: 5355.15pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"4cben-BeneRelation-179070536\" name=\"QuikRadio12.4cben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"1\"  style=\"left:118.19pt;top: 5353.15pt;\" /><label for=\"4cben-BeneRelation-179070536\" class=\"\" \" style=\"position:absolute;left: 118.19pt;top: 5353.15pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"4cben-BeneRelation-179070536\" name=\"QuikRadio12.4cben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"1\"  style=\"left:120.99pt;top: 5355.15pt;\" /><label for=\"4cben-BeneRelation-179070536\" class=\"\" \" style=\"position:absolute;left: 120.99pt;top: 5355.15pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"4cben-BeneRelation-179070537\" name=\"QuikRadio12.4cben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"11\"  style=\"left:151.1pt;top: 5353.15pt;\" /><label for=\"4cben-BeneRelation-179070537\" class=\"\" \" style=\"position:absolute;left: 151.1pt;top: 5353.15pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"4cben-BeneRelation-179070537\" name=\"QuikRadio12.4cben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"11\"  style=\"left:153.9pt;top: 5355.15pt;\" /><label for=\"4cben-BeneRelation-179070537\" class=\"\" \" style=\"position:absolute;left: 153.9pt;top: 5355.15pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"4cben-BeneRelation-179070538\" name=\"QuikRadio12.4cben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"0\"  style=\"left:184.01pt;top: 5353.15pt;\" /><label for=\"4cben-BeneRelation-179070538\" class=\"\" \" style=\"position:absolute;left: 184.01pt;top: 5353.15pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"4cben-BeneRelation-179070538\" name=\"QuikRadio12.4cben.BeneRelation\"  type=\"radio\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"0\"  style=\"left:186.81pt;top: 5355.15pt;\" /><label for=\"4cben-BeneRelation-179070538\" class=\"\" \" style=\"position:absolute;left: 186.81pt;top: 5355.15pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"4cben-DOB-179070539\" name=\"4cben.DOB\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:216.33pt;top: 5349.35pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:143.670pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"4cben-DOB-179070539\" name=\"4cben.DOB\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:217.83pt;top: 5351.75pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:143.670pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"4cben-SSN-179070540\" name=\"4cben.SSN\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:369.49pt;top: 5349.35pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:143.670pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"4cben-SSN-179070540\" name=\"4cben.SSN\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:370.99pt;top: 5351.75pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:143.670pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"4cben-BenePerc-179070541\" name=\"4cben.BenePerc\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:522.03pt;top: 5349.35pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:46.840pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"4cben-BenePerc-179070541\" name=\"4cben.BenePerc\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:523.53pt;top: 5351.75pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:46.840pt\" /><!-- <![endif]--></div> </li> <li id=\"FID12p8\"> <!--[if lte IE 8]><a id=\"FID12p8\"></a><![endif]--><div style=\"float:none; clear:both; background-color:#ffffff; height:792pt; width:612pt;\"><div id=\"ID12p8\" style=\"background-color: Gray; margin:0pt; padding:0pt; height:792pt; width:612pt; \"> <img src='https://dq6apn6hy8vc6.cloudfront.net/prod/forms/publish/current/12_8_38.png?Expires=1655394765&Signature=HxiqaUQ5Zji367Z1VofxAIqKRvQi3GXG8U18th2s2CVZnmwRTnwjTI4NDw9HLkzrRAdRIB3MlhELl-D0H6H7F0XTd2y9nN1dBQBKEX7TvwVHlV2DmDOe4bsriXuVcgAhfS6HVAcyJOxWLXcNo4WaHY8mAat7zr8FJjN5iVEl7D0_&Key-Pair-Id=APKAIO63VAHYK7C5DQRQ' alt=\"FormID12p8\" /></div> <!--[if lte IE 9]><input id=\"1own-12-1-SignDate-179070542\" name=\"1own.12.1.SignDate\"  type=\"text\"  class=\" itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:460pt;top: 5720.69pt;;background:rgba(255,255,255,1);height:14.560pt;;width:117.090pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"1own-12-1-SignDate-179070542\" name=\"1own.12.1.SignDate\"  type=\"text\"  class=\" itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:461.5pt;top: 5723.09pt;;background:rgba(255,255,255,1);height:14.560pt;line-height: 14.560pt;width:117.090pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"1ntry-12-1-SignDateDD-179070543\" name=\"1ntry.12.1.SignDateDD\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:192.91pt;top: 5749.8pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:72.790pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"1ntry-12-1-SignDateDD-179070543\" name=\"1ntry.12.1.SignDateDD\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:194.41pt;top: 5752.2pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:72.790pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"1ntry-12-1-SignDateMM-179070544\" name=\"1ntry.12.1.SignDateMM\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:292.91pt;top: 5749.8pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:120.890pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"1ntry-12-1-SignDateMM-179070544\" name=\"1ntry.12.1.SignDateMM\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:294.41pt;top: 5752.2pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:120.890pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"1ntry-12-1-SignDateYY-179070545\" name=\"1ntry.12.1.SignDateYY\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:419.49pt;top: 5749.8pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:51.270pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"1ntry-12-1-SignDateYY-179070545\" name=\"1ntry.12.1.SignDateYY\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:420.99pt;top: 5752.2pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:51.270pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"1ntry-SignAddr-County-179070546\" name=\"1ntry.SignAddr.County\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:98.6pt;top: 5781.45pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:217.720pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"1ntry-SignAddr-County-179070546\" name=\"1ntry.SignAddr.County\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:100.1pt;top: 5783.85pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:217.720pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"1ntry-SignAddr-State-179070547\" name=\"1ntry.SignAddr.State\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:359.37pt;top: 5781.45pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:215.830pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"1ntry-SignAddr-State-179070547\" name=\"1ntry.SignAddr.State\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:360.87pt;top: 5783.85pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:215.830pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"1ntry-LicenseExpiry-179070548\" name=\"1ntry.LicenseExpiry\"  type=\"text\"  class=\" itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:450.51pt;top: 5811.2pt;;background:rgba(255,255,255,1);border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:126.580pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"1ntry-LicenseExpiry-179070548\" name=\"1ntry.LicenseExpiry\"  type=\"text\"  class=\" itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:452.01pt;top: 5813.6pt;;background:rgba(255,255,255,1);border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:126.580pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"1wit-FullName-179070549\" name=\"1wit.FullName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:35.94pt;top: 5959.93pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:267.090pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"1wit-FullName-179070549\" name=\"1wit.FullName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:37.44pt;top: 5962.33pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:267.090pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"2wit-FullName-179070550\" name=\"2wit.FullName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:35.94pt;top: 5994.74pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:267.090pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"2wit-FullName-179070550\" name=\"2wit.FullName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:37.44pt;top: 5997.14pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:267.090pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"1own-12-1-Sign-179070551\" name=\"1own.12.1.Sign\"  type=\"sign\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemHidden\"  value=\"\" readonly=\"readonly\" style=\"left:44.17pt;top: 5711.83pt;;height:27.220pt;;width:405.700pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"1own-12-1-Sign-179070551\" name=\"1own.12.1.Sign\"  type=\"sign\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemHidden\"  value=\"\" readonly=\"readonly\" style=\"left:45.67pt;top: 5714.23pt;;height:27.220pt;line-height: 27.220pt;width:405.700pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"1ntry-12-1-Sign-179070552\" name=\"1ntry.12.1.Sign\"  type=\"sign\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemHidden\"  value=\"\" readonly=\"readonly\" style=\"left:44.17pt;top: 5799.17pt;;height:27.220pt;;width:396.840pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"1ntry-12-1-Sign-179070552\" name=\"1ntry.12.1.Sign\"  type=\"sign\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemHidden\"  value=\"\" readonly=\"readonly\" style=\"left:45.67pt;top: 5801.57pt;;height:27.220pt;line-height: 27.220pt;width:396.840pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"1wit-12-1-Sign-179070553\" name=\"1wit.12.1.Sign\"  type=\"sign\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemHidden\"  value=\"\" readonly=\"readonly\" style=\"left:320.76pt;top: 5947.28pt;;height:27.220pt;;width:256.330pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"1wit-12-1-Sign-179070553\" name=\"1wit.12.1.Sign\"  type=\"sign\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemHidden\"  value=\"\" readonly=\"readonly\" style=\"left:322.26pt;top: 5949.68pt;;height:27.220pt;line-height: 27.220pt;width:256.330pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"2wit-12-1-Sign-179070554\" name=\"2wit.12.1.Sign\"  type=\"sign\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemHidden\"  value=\"\" readonly=\"readonly\" style=\"left:320.76pt;top: 5982.09pt;;height:27.220pt;;width:256.330pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"2wit-12-1-Sign-179070554\" name=\"2wit.12.1.Sign\"  type=\"sign\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemHidden\"  value=\"\" readonly=\"readonly\" style=\"left:322.26pt;top: 5984.49pt;;height:27.220pt;line-height: 27.220pt;width:256.330pt\" /><!-- <![endif]--></div> </li> <li id=\"FID12p9\"> <!--[if lte IE 8]><a id=\"FID12p9\"></a><![endif]--><div style=\"float:none; clear:both; background-color:#ffffff; height:792pt; width:612pt;\"><div id=\"ID12p9\" style=\"background-color: Gray; margin:0pt; padding:0pt; height:792pt; width:612pt; \"> <img src='https://dq6apn6hy8vc6.cloudfront.net/prod/forms/publish/current/12_9_38.png?Expires=1655394765&Signature=P1-7dc4b6vxZMfOgqBIIdtOoxUyBL6lHe5Btn2M0iKq5mu79SitbOOIOCW7727V7XmTHiErmiEoY7SQ7dEbBbSdleuEm75BMAJiT~3Emc4YbURvmdfGgZveuWNVPOCEDkv4TDSskphaMJVIKc1vkSRMJDm5H97KrVO0RP7xn12E_&Key-Pair-Id=APKAIO63VAHYK7C5DQRQ' alt=\"FormID12p9\" /></div> <!--[if lte IE 9]><input id=\"1rep-FullName-179070555\" name=\"1rep.FullName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:35.94pt;top: 6530.01pt;;height:14.560pt;;width:180.380pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"1rep-FullName-179070555\" name=\"1rep.FullName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:37.44pt;top: 6532.41pt;;height:14.560pt;line-height: 14.560pt;width:180.380pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"1rep-RepNum-179070556\" name=\"1rep.RepNum\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:225.82pt;top: 6530.01pt;;height:14.560pt;;width:77.220pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"1rep-RepNum-179070556\" name=\"1rep.RepNum\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:227.32pt;top: 6532.41pt;;height:14.560pt;line-height: 14.560pt;width:77.220pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"1rep-BrNum-179070557\" name=\"1rep.BrNum\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:312.53pt;top: 6530.01pt;;height:14.560pt;;width:101.900pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"1rep-BrNum-179070557\" name=\"1rep.BrNum\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:314.03pt;top: 6532.41pt;;height:14.560pt;line-height: 14.560pt;width:101.900pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"1rep-P-Phone-179070558\" name=\"1rep.P.Phone\"  type=\"text\"  class=\" itemPositionAbsolute itemBlue itemBorderSolid itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:423.92pt;top: 6529.38pt;;background:rgba(255,255,255,1);border-color:#000000;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:91.140pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"1rep-P-Phone-179070558\" name=\"1rep.P.Phone\"  type=\"text\"  class=\" itemPositionAbsolute itemBlue itemBorderSolid itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:425.42pt;top: 6531.78pt;;background:rgba(255,255,255,1);border-color:#000000;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:91.140pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"1rep-P-PhoneExt-179070559\" name=\"1rep.P.PhoneExt\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:527.72pt;top: 6530.01pt;;height:14.560pt;;width:49.370pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"1rep-P-PhoneExt-179070559\" name=\"1rep.P.PhoneExt\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:529.22pt;top: 6532.41pt;;height:14.560pt;line-height: 14.560pt;width:49.370pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"1rep-BR-Addr123-179070560\" name=\"1rep.BR.Addr123\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:35.94pt;top: 6562.29pt;;height:14.560pt;;width:287.980pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"1rep-BR-Addr123-179070560\" name=\"1rep.BR.Addr123\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:37.44pt;top: 6564.69pt;;height:14.560pt;line-height: 14.560pt;width:287.980pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"1rep-BR-City-179070561\" name=\"1rep.BR.City\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:334.05pt;top: 6562.29pt;;height:14.560pt;;width:149.370pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"1rep-BR-City-179070561\" name=\"1rep.BR.City\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:335.55pt;top: 6564.69pt;;height:14.560pt;line-height: 14.560pt;width:149.370pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"1rep-BR-State-179070562\" name=\"1rep.BR.State\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:492.91pt;top: 6562.29pt;;height:14.560pt;;width:29.110pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"1rep-BR-State-179070562\" name=\"1rep.BR.State\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:494.41pt;top: 6564.69pt;;height:14.560pt;line-height: 14.560pt;width:29.110pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"1rep-BR-Zip-179070563\" name=\"1rep.BR.Zip\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:531.52pt;top: 6562.29pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:45.570pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"1rep-BR-Zip-179070563\" name=\"1rep.BR.Zip\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:533.02pt;top: 6564.69pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:45.570pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"1rep-BDCompany-179070564\" name=\"1rep.BDCompany\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:35.94pt;top: 6593.94pt;;height:14.560pt;;width:265.830pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"1rep-BDCompany-179070564\" name=\"1rep.BDCompany\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:37.44pt;top: 6596.34pt;;height:14.560pt;line-height: 14.560pt;width:265.830pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"1spou-FullName-179070565\" name=\"1spou.FullName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:35.94pt;top: 6752.8pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:202.530pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"1spou-FullName-179070565\" name=\"1spou.FullName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:37.44pt;top: 6755.2pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:202.530pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"1spou-12-1-SignDate-179070566\" name=\"1spou.12.1.SignDate\"  type=\"text\"  class=\" itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:460pt;top: 6752.17pt;;background:rgba(255,255,255,1);border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:117.090pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"1spou-12-1-SignDate-179070566\" name=\"1spou.12.1.SignDate\"  type=\"text\"  class=\" itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:461.5pt;top: 6754.57pt;;background:rgba(255,255,255,1);border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:117.090pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"2spou-FullName-179070567\" name=\"2spou.FullName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:35.94pt;top: 6788.24pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:202.530pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"2spou-FullName-179070567\" name=\"2spou.FullName\"  type=\"text\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:37.44pt;top: 6790.64pt;;border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:202.530pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"2spou-12-1-SignDate-179070568\" name=\"2spou.12.1.SignDate\"  type=\"text\"  class=\" itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:460pt;top: 6787.61pt;;background:rgba(255,255,255,1);border-width:0pt 0pt 1pt 0pt;height:14.560pt;;width:117.090pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"2spou-12-1-SignDate-179070568\" name=\"2spou.12.1.SignDate\"  type=\"text\"  class=\" itemPositionAbsolute itemBlue itemBorderSolid itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:461.5pt;top: 6790.01pt;;background:rgba(255,255,255,1);border-width:0pt 0pt 1pt 0pt;height:14.560pt;line-height: 14.560pt;width:117.090pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"1rep-12-1-Sign-179070569\" name=\"1rep.12.1.Sign\"  type=\"sign\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemHidden\"  value=\"\" readonly=\"readonly\" style=\"left:318.23pt;top: 6583.81pt;;height:27.220pt;;width:259.500pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"1rep-12-1-Sign-179070569\" name=\"1rep.12.1.Sign\"  type=\"sign\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemHidden\"  value=\"\" readonly=\"readonly\" style=\"left:319.73pt;top: 6586.21pt;;height:27.220pt;line-height: 27.220pt;width:259.500pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"1spou-12-1-Sign-179070570\" name=\"1spou.12.1.Sign\"  type=\"sign\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemHidden\"  value=\"\" readonly=\"readonly\" style=\"left:255.57pt;top: 6740.14pt;;height:27.220pt;;width:194.310pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"1spou-12-1-Sign-179070570\" name=\"1spou.12.1.Sign\"  type=\"sign\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemHidden\"  value=\"\" readonly=\"readonly\" style=\"left:257.07pt;top: 6742.54pt;;height:27.220pt;line-height: 27.220pt;width:194.310pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"2spou-12-1-Sign-179070571\" name=\"2spou.12.1.Sign\"  type=\"sign\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemHidden\"  value=\"\" readonly=\"readonly\" style=\"left:255.57pt;top: 6775.59pt;;height:27.220pt;;width:194.310pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"2spou-12-1-Sign-179070571\" name=\"2spou.12.1.Sign\"  type=\"sign\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemHidden\"  value=\"\" readonly=\"readonly\" style=\"left:257.07pt;top: 6777.99pt;;height:27.220pt;line-height: 27.220pt;width:194.310pt\" /><!-- <![endif]--></div> </li> <li id=\"FID12p10\"> <!--[if lte IE 8]><a id=\"FID12p10\"></a><![endif]--><div style=\"float:none; clear:both; background-color:#ffffff; height:792pt; width:612pt;\"><div id=\"ID12p10\" style=\"background-color: Gray; margin:0pt; padding:0pt; height:792pt; width:612pt; \"> <img src='https://dq6apn6hy8vc6.cloudfront.net/prod/forms/publish/current/12_10_38.png?Expires=1655394765&Signature=Q3gdT9fQpvCa-~xaAWO08yAzLO3VkSJJHnz85N7GVjPOexD~wU2rNs9euzSFqBen9aG~i8OKzq2LXG7csnO0nwjvrfL3f~ZBPl3SM8SQ7-WlCgg7Q8mIzPnWqYtm5pnqrWMXc-1sm7Z0z2xZRi17JNnmz6mrSexSbHDWaKdjY5k_&Key-Pair-Id=APKAIO63VAHYK7C5DQRQ' alt=\"FormID12p10\" /></div> <!--[if lte IE 9]><input id=\"AMFDS0012-chk1-23-179070572\" name=\"QuikRadio12.AMFDS0012.chk1.23\"  type=\"checkbox\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"1\"  style=\"left:34.01pt;top: 7676.05pt;\" /><label for=\"AMFDS0012-chk1-23-179070572\" class=\"\" \" style=\"position:absolute;left: 34.01pt;top: 7676.05pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"AMFDS0012-chk1-23-179070572\" name=\"QuikRadio12.AMFDS0012.chk1.23\"  type=\"checkbox\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  value=\"1\"  style=\"left:36.81pt;top: 7678.05pt;\" /><label for=\"AMFDS0012-chk1-23-179070572\" class=\"\" \" style=\"position:absolute;left: 36.81pt;top: 7678.05pt;width:15.190pt;cursor: pointer;\"><span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></label><!-- <![endif]--><!--[if lte IE 9]><input id=\"1own-12-2-SignDate-179070573\" name=\"1own.12.2.SignDate\"  type=\"text\"  class=\" itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:460pt;top: 7743.14pt;;background:rgba(255,255,255,1);height:14.560pt;;width:117.090pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"1own-12-2-SignDate-179070573\" name=\"1own.12.2.SignDate\"  type=\"text\"  class=\" itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:461.5pt;top: 7745.54pt;;background:rgba(255,255,255,1);height:14.560pt;line-height: 14.560pt;width:117.090pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"2own-12-1-SignDate-179070574\" name=\"2own.12.1.SignDate\"  type=\"text\"  class=\" itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:460pt;top: 7781.11pt;;background:rgba(255,255,255,1);height:14.560pt;;width:117.090pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"2own-12-1-SignDate-179070574\" name=\"2own.12.1.SignDate\"  type=\"text\"  class=\" itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemVisible\"  onblur=\"setProgressiveFillData(this)\" value=\"\"  style=\"left:461.5pt;top: 7783.51pt;;background:rgba(255,255,255,1);height:14.560pt;line-height: 14.560pt;width:117.090pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"1own-12-2-Sign-179070575\" name=\"1own.12.2.Sign\"  type=\"sign\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemHidden\"  value=\"\" readonly=\"readonly\" style=\"left:44.17pt;top: 7731.11pt;;height:27.220pt;;width:405.700pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"1own-12-2-Sign-179070575\" name=\"1own.12.2.Sign\"  type=\"sign\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemHidden\"  value=\"\" readonly=\"readonly\" style=\"left:45.67pt;top: 7733.51pt;;height:27.220pt;line-height: 27.220pt;width:405.700pt\" /><!-- <![endif]--><!--[if lte IE 9]><input id=\"2own-12-1-Sign-179070576\" name=\"2own.12.1.Sign\"  type=\"sign\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemHidden\"  value=\"\" readonly=\"readonly\" style=\"left:44.17pt;top: 7769.09pt;;height:27.220pt;;width:405.700pt\" /><![endif]--><!--[if gt IE 9 | !IE]> --><input id=\"2own-12-1-Sign-179070576\" name=\"2own.12.1.Sign\"  type=\"sign\"  class=\" itemBackgroundTransparent itemPositionAbsolute itemBlue itemBorderSolid itemBorderWidth1 itemBorderTransparent itemHidden\"  value=\"\" readonly=\"readonly\" style=\"left:45.67pt;top: 7771.49pt;;height:27.220pt;line-height: 27.220pt;width:405.700pt\" /><!-- <![endif]--></div> </li> <li id=\"FID12p11\"> <!--[if lte IE 8]><a id=\"FID12p11\"></a><![endif]--><div style=\"float:none; clear:both; background-color:#ffffff; height:792pt; width:612pt;\"><div id=\"ID12p11\" style=\"background-color: Gray; margin:0pt; padding:0pt; height:792pt; width:612pt; \"> <img src='https://dq6apn6hy8vc6.cloudfront.net/prod/forms/publish/current/12_11_38.png?Expires=1655394765&Signature=AbCPXfC7iCHDkEfDuPEK7Tf4NSoI~HwGG-8eC8zRws056dD9BOJteHmQTEW~VEHWQ0H7PbyosHl9BWbRi~gn1XZPs1DHXQfWd1-KcvWHZ-0Oz4hbmgLmCaNQpk6XvkdjOlP7vrE~6fO72Oc~-Vdf0ocm06awBtdk7T~3RXjAu5A_&Key-Pair-Id=APKAIO63VAHYK7C5DQRQ' alt=\"FormID12p11\" /></div> </div> </li> </ul> </div> </div> </div> <input type=\"hidden\" id=\"RoutingRulesOn-9001\" name=\"RoutingRulesOn\" value='FALSE'> <input type=\"hidden\" id=\"Quik-CustomFieldMetaData-9002\" name=\"Quik.CustomFieldMetaData\" value=''> <input type=\"hidden\" id=\"GeoLocationOn-9003\" name=\"GeoLocationOn\" value='true'> <input type=\"hidden\" id=\"ProductLicenseID-9004\" name=\"ProductLicenseID\" value='0'> <input type=\"hidden\" id=\"nativeESign\" name=\"nativeESign\" value='false'/></form> </td> <td class=\"tableheader\"></td> </tr> <tr> <td></td> <td style=\"width:100pt; vertical-align:top;\"> <div id=\"navWrapper\"> <span style=\"font-family:sans-serif; font-size:small; font-weight:bold; line-height:18pt;\">Pages:</span> <div id=\"navPage\"> <ul> <li> <!--[if lte IE 9]><a href=\"#FID12p1\"><![endif]--> <!--[if lte IE 9]><div title=\"Form 12 Page 1\" style=\"cursor: pointer;text-align:center; height:75pt; background-image:url('https://dq6apn6hy8vc6.cloudfront.net/prod/forms/publish/current/t12_1_38.png?Expires=1655394765&Signature=X6GTXscq5Nl4ajjnDbDFkqjsA6aekGIdcXot705XbhoplUjRIkc5Opvk3JH~fT6YCQjJ7mUiXF1TzYFXGf11~uP1Zf~hJBJwsrNFAiwfhIBv6md7CSZciYhP-rbPLIC~OGPEZGz1ul9n0iLuMVFwMg0AMdeYv5UYI4L-XFmx9-4_&Key-Pair-Id=APKAIO63VAHYK7C5DQRQ'); background-repeat:no-repeat;border-color:#ccc; border-width:2pt; border-style:solid;\"><![endif]--> <!--[if gt IE 9 | !IE]> --><div title=\"Form 12 Page 1\" onclick=\"myScrollToEvent(document.getElementById('FID12p1'))\" style=\"cursor: pointer;text-align:center; height:75pt; background-image:url('https://dq6apn6hy8vc6.cloudfront.net/prod/forms/publish/current/t12_1_38.png?Expires=1655394765&Signature=X6GTXscq5Nl4ajjnDbDFkqjsA6aekGIdcXot705XbhoplUjRIkc5Opvk3JH~fT6YCQjJ7mUiXF1TzYFXGf11~uP1Zf~hJBJwsrNFAiwfhIBv6md7CSZciYhP-rbPLIC~OGPEZGz1ul9n0iLuMVFwMg0AMdeYv5UYI4L-XFmx9-4_&Key-Pair-Id=APKAIO63VAHYK7C5DQRQ'); background-repeat:no-repeat;border-color:#ccc; border-width:2pt; border-style:solid;\"> <!-- <![endif]--> <span style=\"font-family:sans-serif; font-size:x-large; font-weight:bold; color:#cf0000; height:75pt; text-align:left;\"><br />1</span> </div> <!--[if lte IE 9]></a><![endif]--> </li> <li> <!--[if lte IE 9]><a href=\"#FID12p2\"><![endif]--> <!--[if lte IE 9]><div title=\"Form 12 Page 2\" style=\"cursor: pointer;text-align:center; height:75pt; background-image:url('https://dq6apn6hy8vc6.cloudfront.net/prod/forms/publish/current/t12_2_38.png?Expires=1655394765&Signature=HzzUfOOgQ~Ci8bTm745~KZbG7d~9nPD0myMqoUyF8KC6aF~wryDaaYutEEn9V6q4m7AhAKqw0YSJOQbIy2RycwWGMrTQoGVRttiUelA2fZDIO3zK5kG6Outx3Bd8UqdV2jdL4jJinjBj8vLsD3rLQOKAOyeAWZhE5iDMqZqg4cY_&Key-Pair-Id=APKAIO63VAHYK7C5DQRQ'); background-repeat:no-repeat;border-color:#ccc; border-width:2pt; border-style:solid;\"><![endif]--> <!--[if gt IE 9 | !IE]> --><div title=\"Form 12 Page 2\" onclick=\"myScrollToEvent(document.getElementById('FID12p2'))\" style=\"cursor: pointer;text-align:center; height:75pt; background-image:url('https://dq6apn6hy8vc6.cloudfront.net/prod/forms/publish/current/t12_2_38.png?Expires=1655394765&Signature=HzzUfOOgQ~Ci8bTm745~KZbG7d~9nPD0myMqoUyF8KC6aF~wryDaaYutEEn9V6q4m7AhAKqw0YSJOQbIy2RycwWGMrTQoGVRttiUelA2fZDIO3zK5kG6Outx3Bd8UqdV2jdL4jJinjBj8vLsD3rLQOKAOyeAWZhE5iDMqZqg4cY_&Key-Pair-Id=APKAIO63VAHYK7C5DQRQ'); background-repeat:no-repeat;border-color:#ccc; border-width:2pt; border-style:solid;\"> <!-- <![endif]--> <span style=\"font-family:sans-serif; font-size:x-large; font-weight:bold; color:#cf0000; height:75pt; text-align:left;\"><br />2</span> </div> <!--[if lte IE 9]></a><![endif]--> </li> <li> <!--[if lte IE 9]><a href=\"#FID12p3\"><![endif]--> <!--[if lte IE 9]><div title=\"Form 12 Page 3\" style=\"cursor: pointer;text-align:center; height:75pt; background-image:url('https://dq6apn6hy8vc6.cloudfront.net/prod/forms/publish/current/t12_3_38.png?Expires=1655394765&Signature=WCitXzVnkObakIc~tqRTgOWJPWnPNb~3MKY~1PBBvrT7Uxlh8W~w5~Nm7QGLV0d4xEYXODfXWS-iE1OoLBNGN-xXDOgirdZr11bvmD1n1YRq6N84ZYwJdpuPX1fVJZSmu8AarfJogVl9Gb3ukZ8tFNW-haV5IuLD222Kv6tB77U_&Key-Pair-Id=APKAIO63VAHYK7C5DQRQ'); background-repeat:no-repeat;border-color:#ccc; border-width:2pt; border-style:solid;\"><![endif]--> <!--[if gt IE 9 | !IE]> --><div title=\"Form 12 Page 3\" onclick=\"myScrollToEvent(document.getElementById('FID12p3'))\" style=\"cursor: pointer;text-align:center; height:75pt; background-image:url('https://dq6apn6hy8vc6.cloudfront.net/prod/forms/publish/current/t12_3_38.png?Expires=1655394765&Signature=WCitXzVnkObakIc~tqRTgOWJPWnPNb~3MKY~1PBBvrT7Uxlh8W~w5~Nm7QGLV0d4xEYXODfXWS-iE1OoLBNGN-xXDOgirdZr11bvmD1n1YRq6N84ZYwJdpuPX1fVJZSmu8AarfJogVl9Gb3ukZ8tFNW-haV5IuLD222Kv6tB77U_&Key-Pair-Id=APKAIO63VAHYK7C5DQRQ'); background-repeat:no-repeat;border-color:#ccc; border-width:2pt; border-style:solid;\"> <!-- <![endif]--> <span style=\"font-family:sans-serif; font-size:x-large; font-weight:bold; color:#cf0000; height:75pt; text-align:left;\"><br />3</span> </div> <!--[if lte IE 9]></a><![endif]--> </li> <li> <!--[if lte IE 9]><a href=\"#FID12p4\"><![endif]--> <!--[if lte IE 9]><div title=\"Form 12 Page 4\" style=\"cursor: pointer;text-align:center; height:75pt; background-image:url('https://dq6apn6hy8vc6.cloudfront.net/prod/forms/publish/current/t12_4_38.png?Expires=1655394765&Signature=Ghh1CjYPWXDHdWi5OfrYfSlC2P1ZCEhWCoAqVIa4ZsEHxokVqM5FGVWJIHGg13cP7PwVQfT-firqbSOk~Nim5aGKAL1EM6C7igf5g4Z2YYGo7Ji7vciZio3G9-R6fO73kTXSz-av0iuxQ8qtcFyB6wVJv-n7hmHwgqE1fPm2R~E_&Key-Pair-Id=APKAIO63VAHYK7C5DQRQ'); background-repeat:no-repeat;border-color:#ccc; border-width:2pt; border-style:solid;\"><![endif]--> <!--[if gt IE 9 | !IE]> --><div title=\"Form 12 Page 4\" onclick=\"myScrollToEvent(document.getElementById('FID12p4'))\" style=\"cursor: pointer;text-align:center; height:75pt; background-image:url('https://dq6apn6hy8vc6.cloudfront.net/prod/forms/publish/current/t12_4_38.png?Expires=1655394765&Signature=Ghh1CjYPWXDHdWi5OfrYfSlC2P1ZCEhWCoAqVIa4ZsEHxokVqM5FGVWJIHGg13cP7PwVQfT-firqbSOk~Nim5aGKAL1EM6C7igf5g4Z2YYGo7Ji7vciZio3G9-R6fO73kTXSz-av0iuxQ8qtcFyB6wVJv-n7hmHwgqE1fPm2R~E_&Key-Pair-Id=APKAIO63VAHYK7C5DQRQ'); background-repeat:no-repeat;border-color:#ccc; border-width:2pt; border-style:solid;\"> <!-- <![endif]--> <span style=\"font-family:sans-serif; font-size:x-large; font-weight:bold; color:#cf0000; height:75pt; text-align:left;\"><br />4</span> </div> <!--[if lte IE 9]></a><![endif]--> </li> <li> <!--[if lte IE 9]><a href=\"#FID12p5\"><![endif]--> <!--[if lte IE 9]><div title=\"Form 12 Page 5\" style=\"cursor: pointer;text-align:center; height:75pt; background-image:url('https://dq6apn6hy8vc6.cloudfront.net/prod/forms/publish/current/t12_5_38.png?Expires=1655394765&Signature=dNw~FRFUi~Fqz6jaqOoW12CmXxsofL4YItwI3pD0s-kFZ~5xQur~gs9S0fiBWd1n1XSssJ0dCDYxcTM9AAsupZFvdnchYM2JVd48Nmj1RwXgn43CaSOqlJoCYcm~QBhPVBa~EAdYNj0yGof0XrTWX8ukJFb6HDKcKnI0qxZbDeU_&Key-Pair-Id=APKAIO63VAHYK7C5DQRQ'); background-repeat:no-repeat;border-color:#ccc; border-width:2pt; border-style:solid;\"><![endif]--> <!--[if gt IE 9 | !IE]> --><div title=\"Form 12 Page 5\" onclick=\"myScrollToEvent(document.getElementById('FID12p5'))\" style=\"cursor: pointer;text-align:center; height:75pt; background-image:url('https://dq6apn6hy8vc6.cloudfront.net/prod/forms/publish/current/t12_5_38.png?Expires=1655394765&Signature=dNw~FRFUi~Fqz6jaqOoW12CmXxsofL4YItwI3pD0s-kFZ~5xQur~gs9S0fiBWd1n1XSssJ0dCDYxcTM9AAsupZFvdnchYM2JVd48Nmj1RwXgn43CaSOqlJoCYcm~QBhPVBa~EAdYNj0yGof0XrTWX8ukJFb6HDKcKnI0qxZbDeU_&Key-Pair-Id=APKAIO63VAHYK7C5DQRQ'); background-repeat:no-repeat;border-color:#ccc; border-width:2pt; border-style:solid;\"> <!-- <![endif]--> <span style=\"font-family:sans-serif; font-size:x-large; font-weight:bold; color:#cf0000; height:75pt; text-align:left;\"><br />5</span> </div> <!--[if lte IE 9]></a><![endif]--> </li> <li> <!--[if lte IE 9]><a href=\"#FID12p6\"><![endif]--> <!--[if lte IE 9]><div title=\"Form 12 Page 6\" style=\"cursor: pointer;text-align:center; height:75pt; background-image:url('https://dq6apn6hy8vc6.cloudfront.net/prod/forms/publish/current/t12_6_38.png?Expires=1655394765&Signature=aG5ivKjxhVJvb77Evf8nnwdkrTnTgxyEOJpXr0kFYllbbA~g~aADuB0JENsI5zR4yxasziS2lFMaVr~ZPo6BDZbxdvr5515k60ZlOV7CoW8QKsk6eeWK0gOxJ56Zf7Av0dgjYL~7rpAe4TJjIjMkV9zPrn6Q8sPFPLrHtyrMDyY_&Key-Pair-Id=APKAIO63VAHYK7C5DQRQ'); background-repeat:no-repeat;border-color:#ccc; border-width:2pt; border-style:solid;\"><![endif]--> <!--[if gt IE 9 | !IE]> --><div title=\"Form 12 Page 6\" onclick=\"myScrollToEvent(document.getElementById('FID12p6'))\" style=\"cursor: pointer;text-align:center; height:75pt; background-image:url('https://dq6apn6hy8vc6.cloudfront.net/prod/forms/publish/current/t12_6_38.png?Expires=1655394765&Signature=aG5ivKjxhVJvb77Evf8nnwdkrTnTgxyEOJpXr0kFYllbbA~g~aADuB0JENsI5zR4yxasziS2lFMaVr~ZPo6BDZbxdvr5515k60ZlOV7CoW8QKsk6eeWK0gOxJ56Zf7Av0dgjYL~7rpAe4TJjIjMkV9zPrn6Q8sPFPLrHtyrMDyY_&Key-Pair-Id=APKAIO63VAHYK7C5DQRQ'); background-repeat:no-repeat;border-color:#ccc; border-width:2pt; border-style:solid;\"> <!-- <![endif]--> <span style=\"font-family:sans-serif; font-size:x-large; font-weight:bold; color:#cf0000; height:75pt; text-align:left;\"><br />6</span> </div> <!--[if lte IE 9]></a><![endif]--> </li> <li> <!--[if lte IE 9]><a href=\"#FID12p7\"><![endif]--> <!--[if lte IE 9]><div title=\"Form 12 Page 7\" style=\"cursor: pointer;text-align:center; height:75pt; background-image:url('https://dq6apn6hy8vc6.cloudfront.net/prod/forms/publish/current/t12_7_38.png?Expires=1655394765&Signature=O6cK4p4gEtaiNEKrydOriiaTRr0~kNgtQrM8XpOAB6gIVIdjejWCoV137O03JS~KiIG34dA2FTc1uPm7l12CdelP0tgsiBloSWS5jOQLhK9Qwv3zyempjfyuDkgDR1PDcqynxXwerC~m5GgHkOh5fg2MRCKByXbskgvalLyS640_&Key-Pair-Id=APKAIO63VAHYK7C5DQRQ'); background-repeat:no-repeat;border-color:#ccc; border-width:2pt; border-style:solid;\"><![endif]--> <!--[if gt IE 9 | !IE]> --><div title=\"Form 12 Page 7\" onclick=\"myScrollToEvent(document.getElementById('FID12p7'))\" style=\"cursor: pointer;text-align:center; height:75pt; background-image:url('https://dq6apn6hy8vc6.cloudfront.net/prod/forms/publish/current/t12_7_38.png?Expires=1655394765&Signature=O6cK4p4gEtaiNEKrydOriiaTRr0~kNgtQrM8XpOAB6gIVIdjejWCoV137O03JS~KiIG34dA2FTc1uPm7l12CdelP0tgsiBloSWS5jOQLhK9Qwv3zyempjfyuDkgDR1PDcqynxXwerC~m5GgHkOh5fg2MRCKByXbskgvalLyS640_&Key-Pair-Id=APKAIO63VAHYK7C5DQRQ'); background-repeat:no-repeat;border-color:#ccc; border-width:2pt; border-style:solid;\"> <!-- <![endif]--> <span style=\"font-family:sans-serif; font-size:x-large; font-weight:bold; color:#cf0000; height:75pt; text-align:left;\"><br />7</span> </div> <!--[if lte IE 9]></a><![endif]--> </li> <li> <!--[if lte IE 9]><a href=\"#FID12p8\"><![endif]--> <!--[if lte IE 9]><div title=\"Form 12 Page 8\" style=\"cursor: pointer;text-align:center; height:75pt; background-image:url('https://dq6apn6hy8vc6.cloudfront.net/prod/forms/publish/current/t12_8_38.png?Expires=1655394765&Signature=MTtl14W-OADSGbduUfQ53U0i~G5QKmokBcx6BT~F2Y18jCp29nvVLzOXzDb5Qdele6fYsv0bWvCEwVqID7aJiOjA8kH7H1ed70nzmnXCpSZxrFkdoOCxssmxwhC3UIZQCxwJCQqLiM2ZMf8wimWCJcUi1cOSGdmdLNkh~bFVywQ_&Key-Pair-Id=APKAIO63VAHYK7C5DQRQ'); background-repeat:no-repeat;border-color:#ccc; border-width:2pt; border-style:solid;\"><![endif]--> <!--[if gt IE 9 | !IE]> --><div title=\"Form 12 Page 8\" onclick=\"myScrollToEvent(document.getElementById('FID12p8'))\" style=\"cursor: pointer;text-align:center; height:75pt; background-image:url('https://dq6apn6hy8vc6.cloudfront.net/prod/forms/publish/current/t12_8_38.png?Expires=1655394765&Signature=MTtl14W-OADSGbduUfQ53U0i~G5QKmokBcx6BT~F2Y18jCp29nvVLzOXzDb5Qdele6fYsv0bWvCEwVqID7aJiOjA8kH7H1ed70nzmnXCpSZxrFkdoOCxssmxwhC3UIZQCxwJCQqLiM2ZMf8wimWCJcUi1cOSGdmdLNkh~bFVywQ_&Key-Pair-Id=APKAIO63VAHYK7C5DQRQ'); background-repeat:no-repeat;border-color:#ccc; border-width:2pt; border-style:solid;\"> <!-- <![endif]--> <span style=\"font-family:sans-serif; font-size:x-large; font-weight:bold; color:#cf0000; height:75pt; text-align:left;\"><br />8</span> </div> <!--[if lte IE 9]></a><![endif]--> </li> <li> <!--[if lte IE 9]><a href=\"#FID12p9\"><![endif]--> <!--[if lte IE 9]><div title=\"Form 12 Page 9\" style=\"cursor: pointer;text-align:center; height:75pt; background-image:url('https://dq6apn6hy8vc6.cloudfront.net/prod/forms/publish/current/t12_9_38.png?Expires=1655394765&Signature=T7AtLbSs1QkO2A5jusHHLei2W6KMqQb9yOeT12iI8jdHfMvfgSnB-Vtjgp26Jsfxn~RyTpOABAhflSXw1D6LP47gNnQxLHQyxhe7hLVEw5qqEUrTDt5Sc0bam9cdClsB33lX3uWEsCipZS4tiEXmoIwd~poqi2YkTfn4ixdA6M8_&Key-Pair-Id=APKAIO63VAHYK7C5DQRQ'); background-repeat:no-repeat;border-color:#ccc; border-width:2pt; border-style:solid;\"><![endif]--> <!--[if gt IE 9 | !IE]> --><div title=\"Form 12 Page 9\" onclick=\"myScrollToEvent(document.getElementById('FID12p9'))\" style=\"cursor: pointer;text-align:center; height:75pt; background-image:url('https://dq6apn6hy8vc6.cloudfront.net/prod/forms/publish/current/t12_9_38.png?Expires=1655394765&Signature=T7AtLbSs1QkO2A5jusHHLei2W6KMqQb9yOeT12iI8jdHfMvfgSnB-Vtjgp26Jsfxn~RyTpOABAhflSXw1D6LP47gNnQxLHQyxhe7hLVEw5qqEUrTDt5Sc0bam9cdClsB33lX3uWEsCipZS4tiEXmoIwd~poqi2YkTfn4ixdA6M8_&Key-Pair-Id=APKAIO63VAHYK7C5DQRQ'); background-repeat:no-repeat;border-color:#ccc; border-width:2pt; border-style:solid;\"> <!-- <![endif]--> <span style=\"font-family:sans-serif; font-size:x-large; font-weight:bold; color:#cf0000; height:75pt; text-align:left;\"><br />9</span> </div> <!--[if lte IE 9]></a><![endif]--> </li> <li> <!--[if lte IE 9]><a href=\"#FID12p10\"><![endif]--> <!--[if lte IE 9]><div title=\"Form 12 Page 10\" style=\"cursor: pointer;text-align:center; height:75pt; background-image:url('https://dq6apn6hy8vc6.cloudfront.net/prod/forms/publish/current/t12_10_38.png?Expires=1655394765&Signature=Cg6zb2nFMKk7kveEYrenE~Gw5XOs15S~sPeqISBybKCn0sHoNXUrzk0Z~Ttpr8EqKSDzFlNqcKvt42iKULYurH01vNVDXrL8JjfjyRGUqlc2P2wfjOh~O8lGEcR3URjoEheqQ0Oas~hhLCdED3BhPmFz0P2NUfasqbPsp5QIIRk_&Key-Pair-Id=APKAIO63VAHYK7C5DQRQ'); background-repeat:no-repeat;border-color:#ccc; border-width:2pt; border-style:solid;\"><![endif]--> <!--[if gt IE 9 | !IE]> --><div title=\"Form 12 Page 10\" onclick=\"myScrollToEvent(document.getElementById('FID12p10'))\" style=\"cursor: pointer;text-align:center; height:75pt; background-image:url('https://dq6apn6hy8vc6.cloudfront.net/prod/forms/publish/current/t12_10_38.png?Expires=1655394765&Signature=Cg6zb2nFMKk7kveEYrenE~Gw5XOs15S~sPeqISBybKCn0sHoNXUrzk0Z~Ttpr8EqKSDzFlNqcKvt42iKULYurH01vNVDXrL8JjfjyRGUqlc2P2wfjOh~O8lGEcR3URjoEheqQ0Oas~hhLCdED3BhPmFz0P2NUfasqbPsp5QIIRk_&Key-Pair-Id=APKAIO63VAHYK7C5DQRQ'); background-repeat:no-repeat;border-color:#ccc; border-width:2pt; border-style:solid;\"> <!-- <![endif]--> <span style=\"font-family:sans-serif; font-size:x-large; font-weight:bold; color:#cf0000; height:75pt; text-align:left;\"><br />10</span> </div> <!--[if lte IE 9]></a><![endif]--> </li> <li> <!--[if lte IE 9]><a href=\"#FID12p11\"><![endif]--> <!--[if lte IE 9]><div title=\"Form 12 Page 11\" style=\"cursor: pointer;text-align:center; height:75pt; background-image:url('https://dq6apn6hy8vc6.cloudfront.net/prod/forms/publish/current/t12_11_38.png?Expires=1655394765&Signature=cgId54484wHBorXxF8Ecg8gY3I9Db2eu762tbLS8Er70KS32Ma7G8Hocy7~w5~Fx15av78qGIlwFIl2lJ18AYzwe~3cu5EtWxwTnTrhl65-uWkJjy3ZJxqYPkiJs~UlF43ulI0xdMmGyQ0XS2JErDH-CMKc5A1rol6zrOlrGyJg_&Key-Pair-Id=APKAIO63VAHYK7C5DQRQ'); background-repeat:no-repeat;border-color:#ccc; border-width:2pt; border-style:solid;\"><![endif]--> <!--[if gt IE 9 | !IE]> --><div title=\"Form 12 Page 11\" onclick=\"myScrollToEvent(document.getElementById('FID12p11'))\" style=\"cursor: pointer;text-align:center; height:75pt; background-image:url('https://dq6apn6hy8vc6.cloudfront.net/prod/forms/publish/current/t12_11_38.png?Expires=1655394765&Signature=cgId54484wHBorXxF8Ecg8gY3I9Db2eu762tbLS8Er70KS32Ma7G8Hocy7~w5~Fx15av78qGIlwFIl2lJ18AYzwe~3cu5EtWxwTnTrhl65-uWkJjy3ZJxqYPkiJs~UlF43ulI0xdMmGyQ0XS2JErDH-CMKc5A1rol6zrOlrGyJg_&Key-Pair-Id=APKAIO63VAHYK7C5DQRQ'); background-repeat:no-repeat;border-color:#ccc; border-width:2pt; border-style:solid;\"> <!-- <![endif]--> <span style=\"font-family:sans-serif; font-size:x-large; font-weight:bold; color:#cf0000; height:75pt; text-align:left;\"><br />11</span> </div> <!--[if lte IE 9]></a><![endif]--> </li> </ul> </div> <!--[if lte IE 9]><a href=\"#FID12p1\"><span style=\"cursor: pointer;\">First</span></a><![endif]--><!--[if gt IE 9 | !IE]> --><span onclick=\"myScrollToEvent(document.getElementById('FID12p1'))\" style=\"cursor: pointer;\">First</span><!-- <![endif]-->&nbsp;<!--[if lte IE 9]><a href=\"#FID12p11\"><span style=\"cursor: pointer;\">Last</span></a><![endif]--><!--[if gt IE 9 | !IE]> --><span onclick=\"myScrollToEvent(document.getElementById('FID12p11'))\" style=\"cursor: pointer;\">Last</span><!-- <![endif]--><!-- <![endif]--> <div id=\"navFormHeader\" style = \"height: 230;\"><span style=\"font-family:sans-serif; font-size:small; font-weight:bold; line-height:18pt;\"><br />Forms:</span></div> <div id=\"navForm\"> <ul> <li> <!--[if lte IE 9]><span title=\"Individual or Joint Accounts Application (Digital)\" style=\"cursor: pointer;\"><strong><a href=\"#FID12p1\"> American Funds (12)</a></strong><br /><em>Individual or Joint Accounts Application (Digital)</em></span><br /><br /><![endif]--> <!--[if gt IE 9 | !IE]> --><span title=\"Individual or Joint Accounts Application (Digital)\" onclick=\"myScrollToEvent(document.getElementById('FID12p1'))\" style=\"cursor: pointer;\"><strong><a>American Funds (12)</a></strong><br /><em>Individual or Joint Accounts Application (Digital)</em></span><br /><br /> <!-- <![endif]--> </li> </ul> </div> <div id=\"navAttachmentsHeader\"><img src=\"https://quikforms.com/shared/images/quikformviewer/paperclip.png\" style=\"width: 15px; height: 15px;display:inline-block; cursor:pointer;\" onclick=\"showAttachFileModal({id:'attach-field-0', title:'', url:'https://websvcs.quikforms.com/rest/QuikFormsEngine/'})\"/><span style=\"display:inline-block; font-family:sans-serif; font-size:small; font-weight:bold; line-height:18pt;\"><br />Attachments:</span> <div id=\"navAttachments\"><ul style=\"list-style-type: none;\"></ul></div></div></div> <div id=\"footer\"> <table><tr> <td style=\"width:400px; text-align:left;\"><span style=\"font-family:sans-serif; font-size:8pt; font-style:italic; color:#aa0000; text-align:right; line-height:30px;\">Quik! Forms powered by Efficient Technology Inc - <a href=\"https://www.QuikForms.com\" target=\"_blank\">www.QuikForms.com</a></span></td> <td style=\"width:100px; text-align:center;\"><span style=\"font-family:sans-serif; font-size:8pt; font-style:italic; color:#aa0000; text-align:right; line-height:30px;\"></span></td> <td style=\"width:300px; text-align:right;\"><span style=\"font-family:sans-serif; font-size:8pt; font-style:italic; color:#aa0000; text-align:right; line-height:30px;\">Expires:6/16/2022 3:52:44 PM (GMT)</span><span id=\"QFVLastSaved\" style=\"font-family:sans-serif; font-size:8pt; font-style:italic; font-weight:bold; color:#aa0000; text-align:right; line-height:30px;\"></span></td> </tr></table> </div> </td> </tr> </table> </div> <div class=\"maxWH\"></div></body> <script type=\"text/javascript\" src=\"https://www.quikforms.com/shared/scripts/QFE/jquery-1.9.1.min.js\"> /**  * Copyright (c) 2002-2022 Efficient Technology Incorporated, All rights reserved.  *  * This document and the technology contained herein, including code, scripts, visual layout and data, except for third-party components,  * is confidential and proprietary to Efficient Technology Inc, and is considered a trade secret as defined under civil and criminal statutes.  * Efficient Technology Incorporated shall pursue its civil and criminal remedies in the event of unauthorized use or misappropriation  * of its trade secrets. Use of this document, technology and/or information by anyone other than authorized employees of Efficient  * Technology Incorporated is granted only under a written non-disclosure agreement, expressly prescribing the scope and manner of such use.  **/  </script> <script type=\"text/javascript\" src=\"https://www.quikforms.com/shared/scripts/QFE/jquery.blockUI.js\"></script> <script type = \"text/javascript\" src=\"https://www.quikforms.com/shared/scripts/QFE/jquery-ui.min.js\"></script> <!--<![endif]--> <script type=\"text/javascript\" src=\"https://www.quikforms.com/shared/scripts/qfe/inputmask.js\"></script> <script type=\"text/javascript\"> if (!String.prototype.endsWith) {     String.prototype.endsWith = function (char) {         if(!(this instanceof String)) return false;         var str = this || \"\";         char = char || \"\";         return str.lastIndexOf(char) == str.length - char.length;     }; }  if (!String.prototype.startsWith) {     String.prototype.startsWith = function (char) {         if (!(this instanceof String)) return false;         var str = this || \"\";         char = char || \"\";         return str.indexOf(char) == 0;     }; }  Date.prototype.getFullDate = function () {     var yyyy = this.getFullYear().toString();     var mm = (this.getMonth() + 1).toString();     var dd = this.getDate().toString();     var hours = this.getHours();     var minutes = this.getMinutes();     var seconds = this.getSeconds();     var ampm = hours >= 12 ? \"PM\" : \"AM\";     if (parseInt(hours) < 10) {         hours = \"0\" + hours;     }     if (parseInt(minutes) < 10) {         minutes = \"0\" + minutes;     }     if (parseInt(seconds) < 10) {         seconds = \"0\" + seconds;     }      return mm + \"/\" + dd + \"/\" + yyyy + \" \" + hours + \":\" + minutes + \":\" + seconds + \" \" + ampm; };  Date.prototype.getShortDate = function () {     var yyyy = this.getFullYear().toString();     var mm = (this.getMonth() + 1).toString();     var dd = this.getDate().toString();     if (parseInt(mm) < 10) {         mm = \"0\" + mm;     }     if (parseInt(dd) < 10) {         dd = \"0\" + dd;     }     return mm + \"/\" + dd + \"/\" + yyyy; };  Object.defineProperty(String.prototype, 'applyFormat', {     value: function () {         var args = arguments;         return this.replace(/{(\\d+)}/g, function (match, number) {             return typeof args[number] != 'undefined'               ? args[number]               : match             ;         });     },     enumerable: false });   function serializeArrayToJSON(array) {     var json = {};     $.each(array, function (index) { json[index.toString() + '-' + this.name] = this.value });     return json; }  function GetFieldParts(fieldName) {     var role = fieldName.split('.')[0] || '';     var level23 = fieldName.substring(fieldName.indexOf('.') + 1).split('-')[0] || '';     var instance = $.inArray('-', fieldName) > -1 ? '-' + fieldName.split('-')[1] : '';     return {         'role': role,         'level23': level23,         'instance': instance     }; }  function getTextWidth(txt, font) {     var id = 'text-width-tester',         $tag = $('#' + id);     if (!$tag.length) {         $tag = $('<span id=\"' + id + '\" style=\"display:none;font:' + font + ';\">' + txt + '</span>');         $('body').append($tag);     } else {         $tag.css({ font: font }).html(txt);     }     var width = $tag.width();     $tag.remove();     return width; }  function getSpaceWidth(charA, charB, font) {     var charAWidth = getTextWidth(charA, font);     var charBWidth = getTextWidth(charB, font);     var totalWidth = getTextWidth(charA + ' ' + charB, font);     return totalWidth - charAWidth - charBWidth; }  function Ajax(options) {     var type = options.type || \"POST\";     var url = options.url || \"\";     var data = options.data || \"\";     var headers = options.headers || \"\";     var contentType = options.contentType || \"application/json; charset=utf-8\";     var dataType = options.dataType || \"json\";     var beforeSend = options.beforeSend || function () { };     var success = options.success || function () { };     var done = options.done || function () { };     var fail = options.fail || function () { };     var always = options.always || function () { };      $.ajax({         type: type,         url: url,         headers:headers,         data: data,         contentType: contentType,         dataType: dataType,         beforeSend: beforeSend,         success: success     })     .done(done)     .fail(fail)     .always(always); }  function Fields() { } Fields.prototype.PrefilledFields = [{\"DataSetType\": \"Client\", \"FieldValue\": \"Joe\", \"FieldName\": \"1own.FName\"},{\"DataSetType\": \"Client\", \"FieldValue\": \"Smith\", \"FieldName\": \"1own.LName\"},{\"DataSetType\": \"Client\", \"FieldValue\": \"Joe Smith\", \"FieldName\": \"1own.FullName\"},{\"DataSetType\": \"Client\", \"FieldValue\": \"Smith, Joe\", \"FieldName\": \"1own.FullNameRev\"}]; Fields.prototype.CalculatedFields = [{\"FieldValue\": \"Joe Smith\", \"FieldName\": \"1own.FullName\"},{\"FieldValue\": \"Smith, Joe\", \"FieldName\": \"1own.FullNameRev\"},{\"FieldValue\": \"Joe\", \"FieldName\": \"1own.FName\"},{\"FieldValue\": \"Smith\", \"FieldName\": \"1own.LName\"}]; Fields.prototype.ResetCalculatedFields = [{\"FieldValue\": \"Joe Smith\", \"FieldName\": \"1own.FullName\"},{\"FieldValue\": \"Smith, Joe\", \"FieldName\": \"1own.FullNameRev\"},{\"FieldValue\": \"Joe\", \"FieldName\": \"1own.FName\"},{\"FieldValue\": \"Smith\", \"FieldName\": \"1own.LName\"}]; Fields.prototype.CalculatedFieldsOn = true;   function RefreshToken(successCallback, errorCallback) {      var refresh_token = $('#RestRefreshToken');     var access_token = $('#RestAccessToken');      $.ajax({         url: $('#refreshTokenUrl').val(),         method: 'POST',         data: 'grant_type=refresh_token&refresh_token=' + encodeURIComponent(refresh_token.val()),         contentType: 'application/x-www-form-urlencoded; charset=UTF-8',         success: function (data) {             /* reset the tokens */             access_token.val(data.access_token);             refresh_token.val(data.refresh_token);             successCallback(data);         },         error: errorCallback     }); };  function RefreshTokenFailCallback() {     alert(\"There was an error while refreshing Quik! tokens. Please contact an administrator.\"); };  function ProcessAuthorizedApiError(jqXHR, textStatus, errorThrown, successCallback, errorCallback) {     if (jqXHR.status === 401) {         RefreshToken(successCallback, RefreshTokenFailCallback);     }     else {         errorCallback(jqXHR, textStatus, errorThrown);     } }  function GetUNID() {     return $('#QFVUNID').val(); }  function UNIDHasValue() {     return GetUNID().length > 0; }  function getSeparator(dateValue) {     if (!dateValue) {         return null;     }     var separators = dateValue.replace(/[a-zA-Z\\d]/g, \"\");     return (separators && separators.length > 0) ? separators[0] : null; }  if (!jQuery.support.cors && jQuery.ajaxTransport && window.XDomainRequest) { var httpRegEx = /^https?:\/\//i; var getOrPostRegEx = /^get|post$/i; var sameSchemeRegEx = new RegExp('^' + location.protocol, 'i'); var htmlRegEx = /text\/html/i; var jsonRegEx = /\/json/i; var xmlRegEx = /\/xml/i; jQuery.ajaxTransport('text html xml json', function (options, userOptions, jqXHR) { if (options.crossDomain && options.async && getOrPostRegEx.test(options.type) && httpRegEx.test(options.url) && sameSchemeRegEx.test(options.url)) { var xdr = null; var userType = (userOptions.dataType || '').toLowerCase(); return { send: function (headers, complete) { xdr = new XDomainRequest(); if (/^\\d+$/.test(userOptions.timeout)) { xdr.timeout = userOptions.timeout } xdr.ontimeout = function () { complete(500, 'timeout') }; xdr.onload = function () { var allResponseHeaders = 'Content-Length: ' + xdr.responseText.length + '\\r\\nContent-Type: ' + xdr.contentType; var status = { code: 200, message: 'success' }; var responses = { text: xdr.responseText }; try { if (userType === 'html' || htmlRegEx.test(xdr.contentType)) { responses.html = xdr.responseText } else if (userType === 'json' || (userType !== 'text' && jsonRegEx.test(xdr.contentType))) { try { responses.json = jQuery.parseJSON(xdr.responseText) } catch (e) { status.code = 500; status.message = 'parseerror' } } else if (userType === 'xml' || (userType !== 'text' && xmlRegEx.test(xdr.contentType))) { var doc = new ActiveXObject('Microsoft.XMLDOM'); doc.async = false; try { doc.loadXML(xdr.responseText) } catch (e) { doc = undefined } if (!doc || !doc.documentElement || doc.getElementsByTagName('parsererror').length) { status.code = 500; status.message = 'parseerror'; throw 'Invalid XML: ' + xdr.responseText; } responses.xml = doc } } catch (parseMessage) { throw parseMessage; } finally { complete(status.code, status.message, responses, allResponseHeaders) } }; xdr.onprogress = function () { }; xdr.onerror = function () { complete(500, 'error', { text: xdr.responseText }) }; var postData = ''; if (userOptions.data) { postData = (jQuery.type(userOptions.data) === 'string') ? userOptions.data : jQuery.param(userOptions.data) } xdr.open(options.type, options.url); xdr.send(postData) }, abort: function () { if (xdr) { xdr.abort() } } } } }) } var show = true; var ieVersion = -1;  function addLoadEvent(func) {     var oldonload = window.onload;     if (typeof window.onload != 'function') {         window.onload = func;     } else {         window.onload = function () {             if (oldonload) {                 oldonload();             }             func();         };     } }  function SetFieldValues() {     var jsonFieldVals = {         \"Fields\": Fields.prototype.PrefilledFields     };     SetValues(jsonFieldVals);     setInputMasks(); }  function SetValues(jsonFieldVals) {     var i = 0;     var j = 0;     var frmElement;     var oForm = document.forms['QFVFormPage'];     var getElement = function (fieldName) {         return fieldName.indexOf('QuikRadio') > -1 ? getQuikRadio(fieldName) : oForm.elements[fieldName];     };      var setFieldValue = function (fieldType, value, frmElement) {         switch (fieldType) {             case \"text\":             case \"password\":             case \"textarea\":             case \"date\":             case \"datetime\":             case \"datetime-local\":             case \"range\":             case \"month\":             case \"time\":             case \"week\":             case \"email\":             case \"select-one\":             case \"select-multi\":                 frmElement.value = value;                 break;             case \"hidden\":                 break;             case \"radio\":             case \"checkbox\":                 frmElement.checked = frmElement.value == value;                 break;             default:                 break;         };     };      for (i = 0; i < jsonFieldVals.Fields.length; i++) {         var fieldName = jsonFieldVals.Fields[i].FieldName;         frmElement = getElement(fieldName);         if (frmElement != undefined) {             if (frmElement.length > 0 && frmElement.type == undefined) {                 for (j = 0; j < frmElement.length; j++) {                     setFieldValue(frmElement[j].type.toLowerCase(), jsonFieldVals.Fields[i].FieldValue, frmElement[j]);                 }             } else {                 setFieldValue(frmElement.type.toLowerCase(), jsonFieldVals.Fields[i].FieldValue, frmElement);             }         }     } }  function ClearFormValues() {     $('input[type=\"text\"]').inputmask('remove');     var elements = jQuery.merge($(document.forms['QFVFormPage']).find(':input[readonly!=\"readonly\"]'), $(document.forms['QFVFormPage']).find(':input[disabled!=\"disabled\"]'));     for (i = 0; i < elements.length; i++) {         field_type = elements[i].type.toLowerCase();         switch (field_type) {             case \"text\":             case \"password\":             case \"textarea\":             case \"date\":             case \"datetime\":             case \"datetime-local\":             case \"range\":             case \"month\":             case \"time\":             case \"week\":             case \"email\":                 if ($(elements[i]).attr('readonly') != 'readonly') {                     elements[i].value = \"\";                 }                 break;             case \"hidden\":                 break;             case \"radio\":             case \"checkbox\":                 if (elements[i].checked && $(elements[i]).attr('disabled') != 'disabled') {                     elements[i].checked = false;                 }                 break;             case \"select-one\":             case \"select-multi\":                 elements[i].selectedIndex = -1;                 break;             default:                 break;         }     }     setInputMasks(); }  function PostData(url) {     var disabledElements = $(document.forms['QFVFormPage']).find(':input:disabled');     disabledElements.each(function () { $(this).removeAttr('disabled'); });     var formData = $('#QFVFormPage').serialize();     disabledElements.each(function () { $(this).attr('disabled', 'disabled'); });     $.support.cors = true;     $.ajax({         type: 'POST',         url: url,         dataType: 'html',         crossDomain: true,         data: formData,         success: function (data) {             alert(data);         },         error: function (data) {             alert('error');         }     }); }  function SaveForm() {     if (!supportsLocalStorage()) {         return false;     }     var frmElement = document.getElementById('QFVFormPage').elements;     for (var i = 0; i < frmElement.length; i++) {         if (!isCheckbox(frmElement[i])) {             var value = frmElement[i].value === \"\" ? \" \" : frmElement[i].value;             localStorage[frmElement[i].id] = value;         } else {             localStorage[frmElement[i].id] = booleanToString(frmElement[i].checked);         }     }     var date = new Date();     var hours = date.getHours();     var mins = date.getMinutes();     var secs = date.getSeconds();     hours = (hours < 10) ? '0' + hours : hours;     mins = (mins < 10) ? '0' + mins : mins;     secs = (secs < 10) ? '0' + secs : secs;     var msg = ' (Saved: ' + hours + ':' + mins + ':' + secs + ')';     var timecont = document.getElementById('QFVLastSaved');     if (timecont !== null) {         timecont.innerHTML = msg;     } }  function supportsLocalStorage() {     try {         if ('localStorage' in window && window['localStorage']) {             return true;         }     } catch (e) {         $(\"#btnSave\").css(\"visibility\", \"hidden\");         $(\"#btnLoad\").css(\"visibility\", \"hidden\");         return false;     } }  function stringToBoolean(string) {     if (string) {         switch (string.toLowerCase()) {             case \"true\":             case \"yes\":             case \"1\":                 return true;             case \"false\":             case \"no\":             case \"0\":             case null:                 return false;             default:                 return Boolean(string);         }     } else {         return false;     } }  function booleanToString(blnSwitch) {     switch (blnSwitch) {         case true:             return \"true\";         case false:             return \"false\";         default:             return string(blnSwitch);     } }  function formDataAlreadySubmitted(formData) {     if (supportsLocalStorage()) {         var localStorageFormData = localStorage['FormData'];         if (localStorageFormData) {             return localStorageFormData == formData;         }     }     return false; }  function getRepName() {     var repName = \"\";     if ($('[name=\"1rep.FullName\"]').length > 0) {         repName = $('[name=\"1rep.FullName\"]').val();     } else if ($('[name=\"1rep.FName\"]').length > 0) {         if ($('[name=\"1rep.LName\"]').length > 0) {             repName = $('[name=\"1rep.FName\"]').val() + ' ' + $('[name=\"1rep.LName\"]').val();         }     }     return repName; }  function setProgressiveFillData(input) {     $('input[name=\"' + input.name + '\"]').val(input.value).keyup(); }  function hideSignFields() {     $('input[type=\"sign\"]').css('visibility', 'hidden'); }  function ValidateBrowser(show, FormExpiryDate) {     var isValidBrowser = BrowserDetection();     var expires = itsExpired(FormExpiryDate);     if (!isValidBrowser) {         show = false;         $(\"#wrapper\").html(\"\");         $(\"#navPage\").html(\"\");         $(\"#navForm\").html(\"\");         alert('In Order to Use this Form you will have to update your browser');     } else if (expires) {         $(\"#wrapper\").html(\"\");         $(\"#navPage\").html(\"\");         $(\"#navForm\").html(\"\");         $(\".blockOverlay\").css(\"background-color\", \"black\");         $(\".blockMsg\").css(\"color\", \"black\");         $('.ie8').css(\"height\", \"100%\");         $('.ie8').block({             message: '<p style=\"font-size:22px; color:white; background-color:black\">This document expired on ' + FormExpiryDate + ' (GMT).<br /><br /> Please generate this form again.</p>',             css: {                 padding: '30px'             },             overlayCSS: {                 backgroundColor: '#000',                 opacity: '0.55'             }         });         $('.nonIE8').css(\"height\", \"100%\");         $('.nonIE8').block({             message: '<p style=\"font-size:22px; color:white; background-color:black\">This document expired on ' + FormExpiryDate + ' (GMT).<br /><br /> Please generate this form again.</p>',             css: {                 padding: '30px'             },             overlayCSS: {                 backgroundColor: '#000',                 opacity: '0.55'             }         });         $(\".blockMsg\").css(\"border\", \"3px solid black\");         $(\".blockMsg\").css(\"background-color\", \"black\");     }     return show; }  function validateEMail(email) {     var emailReg = /^([\\w-\\.\\+]+@([\\w-]+\\.)+[\\w-]+)?$/;     return emailReg.test(email); }  function RunQFEScripts(options) {     var UNID = options.UNID;     var FormExpiryDate = options.FormExpiryDate;     var EnableNativeESign = options.EnableNativeESign;     var iScrollOff = options.iScrollOff;     var HTMLShowButtonPrint = options.HTMLShowButtonPrint;     var SaveURL = options.SaveURL;     var PrintURL = options.PrintURL;     var PrintEditablePDF = options.PrintEditablePDF;     var SubmitJavascript = options.SubmitJavascript;     var HTMLMinorInstruction = options.HTMLMinorInstruction;     var HTMLShowButtonSubmit = options.HTMLShowButtonSubmit;     var HTMLShowButtonClear = options.HTMLShowButtonClear;     var HTMLShowButtonSave = options.HTMLShowButtonSave;     var HTMLShowButtonReset = options.HTMLShowButtonReset;     var HTMLShowAltDataButtons = options.HTMLShowAltDataButtons;     var ShowButtonEmail = options.ShowButtonEmail;     var HTMLFormViewURL = options.HTMLFormViewURL;     var RoutingRulesOn = options.RoutingRulesOn;     var AutoCenterFieldsOff = options.AutoCenterFieldsOff;     var EmailSendButtonURL = options.EmailSendButtonURL;     var FormPackageAlreadyNamed = options.FormPackageAlreadyNamed;     var EnableCustomFieldEditor = options.EnableCustomFieldEditor;     var SaveJavascript = options.SaveJavascript || \"\";     var SubmitContentType = options.SubmitContentType || \"Legacy\";     var SaveURL_RestQFE = options.SaveURL_RestQFE;     var AttachmentsBaseUrl = options.AttachmentsBaseUrl;     var PreviewMode = options.PreviewMode || false;     var DraftMode = options.DraftMode || false;     var FormIds = options.FormIds || [];     var formUNID = GetUNID();     var FormPackageName = options.FormPackageName;      show = ValidateBrowser(show, FormExpiryDate);     if (show) {          if (HTMLShowAltDataButtons) {             RemoveRegularButtons();         }          if (HTMLShowButtonClear) {             $('#btnClear').click(function () {                 ClearFormValues();                 if (EnableNativeESign) {                     ClearSignatures();                 }             });         }         if (HTMLShowButtonReset) {             $('#btnReset').click(function () {                 ClearFormValues();                 if (EnableNativeESign) {                     ClearSignatures();                 }                 SetFieldValues();                 Fields.prototype.CalculatedFields = JSON.parse(JSON.stringify(Fields.prototype.ResetCalculatedFields));             });         }          if (ShowButtonEmail) {             $('#btnEmail').on('click', function () {                 showEmailDialog({                     url: EmailSendButtonURL,                     routingRulesUrl: HTMLFormViewURL                 });             });         }          if (document.getElementById(\"loading\") != null) {             var ld = document.all;             var ns4 = document.layers;             var ns6 = document.getElementById && !document.all;             var ie4 = document.all;             if (ns4)                 ld = document.loading;             else if (ns6)                 ld = document.getElementById(\"loading\").style;             else if (ie4)                 ld = document.all.loading.style;         }          if (ieVersion > 8 || ieVersion < 0) {              if (!iScrollOff) {                 $('#wrapper').css('overflow', 'hidden');                 $('#navPage').css('overflow', 'hidden');                 $('#navForm').css('overflow', 'hidden');                 myScroll = new IScroll('#wrapper', {                     zoom: true,                     useTransform: true,                     momentum: true,                     mouseWheel: true,                     scrollbars: true,                     preventDefaultException: {                         tagName: /.*/                     },                     onBeforeScrollStart: function (e) {                         var target = e.target;                         while (target.nodeType != 1) target = target.parentNode;                         if (target.tagName != 'SELECT' && target.tagName != 'INPUT' && target.tagName != 'TEXTAREA') e.preventDefault();                     }                 });                 myScroll2 = new IScroll('#navPage', {                     momentum: true,                     mouseWheel: true,                     click: true,                     scrollbars: true,                     hScrollbar: false,                     vScrollbar: false                 });                 myScroll3 = new IScroll('#navForm', {                     momentum: true,                     mouseWheel: true,                     click: true,                     scrollbars: true,                     hScrollbar: false,                     vScrollbar: false                 });                 window.addEventListener(\"orientationchange\", RefreshIScroll(myScroll), false);                 window.addEventListener(\"resize\", RefreshIScroll(myScroll), false);                  setTimeout(function () {                     myScroll.refresh();                 }, 100);              }               if (!AutoCenterFieldsOff) {                 $('#wrapper input[type=\"text\"]').each(function () {                     $(this).focus(function () {                         iScrollOff ?                             centerScreenTo(this, 700, $('#wrapper')) :                             myScroll.scrollToElement('#' + $(this).attr('id'), 700, 0, -250);                     });                 });             }         }          addLoadEvent(supportsLocalStorage);         addLoadEvent(function () {             FormViewTransaction(UNID, FormIds[0] || '', HTMLFormViewURL, PreviewMode, HTMLShowButtonPrint, PrintEditablePDF, DraftMode);         });          if (!PreviewMode) {             addLoadEvent(function () { GetAttachments(formUNID.replace('UNID=',''), AttachmentsBaseUrl) });         }          if (!EnableNativeESign) {             addLoadEvent(hideSignFields);         }           if (EnableCustomFieldEditor) BindCustomFieldsButtons();          var ua = navigator.userAgent,             event = (ua.match(/iPad/i)) ? \"touchstart\" : \"click\";          if (HTMLShowButtonPrint) {             $(document.forms['QFVFormPage']).submit(function (e) {                 e.preventDefault();             });              BindPrintButton(PrintEditablePDF, SaveURL, UNIDHasValue(), PrintURL);         }          if (HTMLShowButtonSubmit) {             $('#btnSubmit').bind(event, function (e) {                 var currentInstText = $('#MinorInstructions').text();                 var save = $('#btnSubmit').hasClass(\"saveBefore\");                 SubmitClick({                     routingRulesOn: RoutingRulesOn,                     routingRulesUrl: HTMLFormViewURL,                     instructions: currentInstText,                     submitJavaScript: SubmitJavascript,                     saveURL: SaveURL,                     minorInstruction: HTMLMinorInstruction,                     saveBefore: save,                     submitContentType: SubmitContentType,                     printEditablePdf: PrintEditablePDF                 });                 e.preventDefault();             });         }          if (HTMLShowButtonSave) {             if (RoutingRulesOn) {                 var $buttonSave = $('#btnSave');                 $buttonSave.data('clickCount', 0);                 window.onbeforeunload = function (event) {                     var clickCount = $buttonSave.data('clickCount');                     /*If btnPrint was clicked (submit event), don't show the alert*/                     var activeElementID = document.activeElement.id || '';                     if (activeElementID === 'btnPrint') {                         /*Blur the button so that it's not the activeElement -> for beforeunload*/                         $(document.activeElement).blur();                     }                     if (!clickCount && activeElementID !== 'btnPrint') return \"The Form has not been saved. Please, save your changes.\";                 };                 $buttonSave.click(function () {                     if (!FormPackageAlreadyNamed) {                         showDocumentNamePopUp(SaveURL_RestQFE);                     } else {                         SaveFormRoutingRules(SaveURL_RestQFE, FormPackageName);                     }                 });             } else {                 $('#btnSave').bind(event, function (e) {                     if (SaveJavascript) {                         eval(SaveJavascript);                     } else {                         if (SaveURL == \"\") {                             SaveForm();                         } else {                             CustomerSaveForm(SaveURL);                         }                     }                 });                 $('#btnLoad').bind(event, function (e) {                     if (!supportsLocalStorage()) {                         return false;                     }                     var frmElement = document.getElementById('QFVFormPage').elements;                     for (var i = 0; i < frmElement.length; i++) {                         if (frmElement[i].id != 'QFVUNID') {                             if (!isCheckbox(frmElement[i])) {                                 var resultText = localStorage[frmElement[i].id];                                 if (resultText) {                                     frmElement[i].value = resultText;                                 }                             } else {                                 frmElement[i].checked = stringToBoolean(localStorage[frmElement[i].id]);                             }                         }                     }                 });             }          }     } }   function BindPrintButton(editablePdf, saveUrl, unidHasValue, printUrl) {     var event = (navigator.userAgent.match(/iPad/i)) ? \"touchstart\" : \"click\";     $('#btnPrint').off(event);     $('#btnPrint').bind(event, function (e) {         var DownloadPDF = function (url) {             var $form = $('<form method=\"POST\">');             var $inputData = $('<input>');             $inputData.attr({                 type: 'hidden',                 id: 'data',                 name: 'data'             }).val(JSON.stringify(GetPrintData(editablePdf, true, false)));             $form.append($inputData);             $form.attr('action', url);             $(document.body).append($form);             $form.submit();             $form.remove();         };          if (saveUrl == \"\") SaveForm();          if (unidHasValue) {             DownloadPDF(printUrl);         }     }); }  function showError() {     var $ErrorSpans = $('span.ItemError');     if ($ErrorSpans.length > 0) {         $ErrorSpans.each(function () {             var distance = 500;             var width = 5;             var start = width + distance;             $(this).show().css({                 display: 'block',                 opacity: 0,                 right: -start + 'px'             }).animate({                 right: -width + 'px',                 opacity: 1             }, 'slow');          });     } }  function codeSpecialCharescape() {     var $inputs = $('#wrapper').find('input[type=\"hidden\"],input[type=\"text\"], textarea, select').filter(function () {         return $.trim($(this).val());     });     $.each($inputs, function () {         $(this).val(window.escape($(this).val()));     }); }  function codeSpecialCharunescape() {     var $inputs = $('#wrapper').find('input[type=\"hidden\"],input[type=\"text\"], textarea, select').filter(function () {         return $.trim($(this).val());     });     $.each($inputs, function () {         $(this).val(window.unescape($(this).val()));     }); }  function SubmitClick(options) {     if (options.saveBefore) {         showDocumentNamePopUp(options.routingRulesUrl, options);         return true;     } else {         return submitNoSave(options);     } }  function submitNoSave(options) {     options = options || {};     var routingRulesOn = options.routingRulesOn || false;     var routingRulesUrl = options.routingRulesUrl || \"\";     var instructions = options.instructions || \"\";     var SubmitJavascript = options.submitJavaScript || \"\";     var SaveURL = options.saveURL || \"\";     var HTMLMinorInstruction = options.minorInstruction || \"\";     var submitForm = true;     if (SubmitJavascript != \"\") {         eval(SubmitJavascript);     } else {         if (SaveURL == \"\") {             SaveForm();         } else {             CustomerSaveForm(SaveURL);         }         var $formId = $('#QFVFormPage');         $('input', $formId).removeClass('ItemError');         $('span.ItemError').remove();         var minorInstr = $('#MinorInstructions');         var origVal = HTMLMinorInstruction;         minorInstr.removeClass('InstrError');         minorInstr.addClass('MinorInstr');         minorInstr.text(origVal);         var formData = $('#QFVFormPage').serialize();         var setErrorMessage = function () {             $('#MinorInstructions').text('Error: Please complete all the required fields before submitting.');             $('#MinorInstructions').removeClass('MinorInstr');             $('#MinorInstructions').addClass('InstrError');         };          $('.itemRequired', $formId).each(function () {             var $parentTag = $(this).parent();             var posLeft = $(this)[0].style.left.replace('pt', '');             var posWidth = $(this)[0].style.width.replace('pt', '');             var posTop = $(this)[0].style.top.replace('pt', '');             var $error = $('<span class=\"ItemError\" style=\"position:absolute; left:' + (parseFloat(posLeft) - 5) + 'pt; top:' + (parseFloat(posTop) - 10) + 'pt; width:5px; height:5px;\"></span>');             var isEmpty = function (e) {                 var empty = false;                 switch (e.type) {                     case \"text\":                     case \"password\":                     case \"textarea\":                     case \"date\":                     case \"datetime\":                     case \"datetime-local\":                     case \"range\":                     case \"month\":                     case \"time\":                     case \"week\":                     case \"email\":                         empty = $.trim($(e).val()) == \"\";                         break;                     case \"radio\":                     case \"checkbox\":                         empty = allCheckboxesUnchecked($(e).attr('name'));                         break;                     case \"select-one\":                     case \"select-multi\":                         empty = this.selectedIndex == -1;                         break;                     default:                         empty = true;                         break;                 }                 return empty;             };              if (isEmpty(this)) {                 if ($(this).hasClass('semirequiredsubmit')) {                     if (!formDataAlreadySubmitted(formData)) {                         addToLocalStorage('FormData', formData);                         $parentTag.addClass('ItemError').append($error.clone());                         $(this).addClass('ItemError');                         setErrorMessage();                         submitForm = false;                     }                 } else {                     if ($(this).hasClass('semirequired')) {                         $(this).removeClass('semirequired');                         $(this).addClass('semirequiredsubmit');                         addToLocalStorage('FormData', formData);                     }                      $parentTag.addClass('ItemError').append($error.clone());                     $(this).addClass('ItemError');                     setErrorMessage();                     submitForm = false;                 }             }             showError();         });          $.each($('input').filter(function () {             return $(this).attr('pattern') != undefined;         }), function () {             var regEx = new RegExp('^' + $(this).attr('pattern') + '$');             var inputValue = $(this).val();             if (!regEx.test(inputValue)) {                 submitForm = false;                 var $parentTag = $(this).parent();                 var posLeft = $(this)[0].style.left.replace('pt', '');                 var posWidth = $(this)[0].style.width.replace('pt', '');                 var posTop = $(this)[0].style.top.replace('pt', '');                 var $error = $('<span class=\"ItemError\" style=\"position:absolute; left:' + (parseFloat(posLeft) - 5) + 'pt; top:' + (parseFloat(posTop) - 10) + 'pt; width:5px; height:5px;\"></span>');                 $parentTag.addClass('ItemError').append($error.clone());                 $(this).addClass('ItemError');                 $(this).css({                     \"border-color\": \"#FF0000\",                     \"border-width\": \"1pt 1pt 1pt 1pt\"                 });                 showError();             } else {                 $(this).css({                     \"border-color\": \"\",                     \"border-width\": \"\"                 });                 $(this).removeClass('ItemError');             }         });          if (submitForm) {             if (routingRulesOn) {                 var formDataArray = $('#QFVFormPage').serializeArray();                 formData = JSON.stringify(serializeArrayToJSON(formDataArray));                 routingRulesUrl += \"/Submit.aspx\";                 SubmitForm(routingRulesUrl, 'POST', formData, SubmitBeforeSend, SubmitSuccess, SubmitError, function () {                     SubmitComplete();                     $('#MinorInstructions').text(instructions);                 });             } else {                 var url = $(document.forms['QFVFormPage']).attr('action');                 var contentType = '';                 var submitData = formData;                 switch (options.submitContentType) {                     case \"Json\":                         contentType = 'application/json charset=UTF-8';                         var printEditablePdf = options.printEditablePdf || false;                         submitData = JSON.stringify(GetPrintData(printEditablePdf, true, false));                         break;                     case \"UrlEncoded\":                     case \"Legacy\":                         contentType = \"application/x-www-form-urlencoded; charset=UTF-8\";                         break;                 }                 if (url != undefined && url !== \"\") {                     $.ajax({                         type: 'POST',                         url: url,                         dataType: 'html',                         crossDomain: true,                         data: submitData,                         contentType: contentType                     });                 }             }         }          $('.itemRequired').focus(function () {             var $parent = $(this).parent();             $parent.removeClass('ItemError');             $('span.ItemError', $parent).fadeOut();         });     }     return submitForm; }    function RunSignJS(options) {     var currentESignType = options.ESignType || \"\";     var EnableNativeESign = options.EnableNativeESign || false;     var defaultSignMessage = options.defaultSignMessage || \"\";     var signMessageIsDefault = options.signMessageIsDefault|| false;     var SignHideEmptySigners = options.SignHideEmptySigners || false;     var SignSubmitCombined = options.SignSubmitCombined || false;     var SignURL = options.SignURL || \"\";     var SignCallBackURL = options.SignCallBackURL || \"\";     var SetContentTypeCallBackURL = options.SetContentTypeCallBackURL || \"\";     var SignErrorMessage = options.SignErrorMessage || \"\";     var SignJavascript = options.SignJavascript || \"\";     var SignSendJavascript = options.SignSendJavascript || \"\";     var SubmitJavascript = options.SubmitJavascript || \"\";     var SaveURL = options.SaveURL || \"\";     var PrintUrl = options.PrintUrl || \"\";     var HTMLMinorInstruction = options.HTMLMinorInstruction || \"\";     var iScrollOff = options.iScrollOff || false;     var proccessGif = $('#showMessage');     var sendButton = $('#btnSend');     var disabledElements = $(document.forms['QFVFormPage']).find(':input:disabled');      function ESignCallBack(data) {         var done = function (data) {             if (parseInt($.trim(data.StatusCode)) === 0) {                 currentESignType.vendorsuccess(data, true);             } else {                 alert(data.StatusMessage || 'There was no message response from the CallBack URL. Plase contact an administrator.');             }         };         var fail = function (xhr, textStatus, errorThrown) {             alert(errorThrown);         };          var always = function () {             RunEsignSuccessBehavior(currentESignType.esignSuccessBehavior, SaveURL, UNIDHasValue(), PrintUrl);         };          switch (SetContentTypeCallBackURL) {             case \"Json\":                 Ajax({                     url: SignCallBackURL,                     contentType: 'application/json charset=UTF-8',                     data: JSON.stringify(data),                     done: done,                     fail: fail,                     always: always                 });                 break;             case \"UrlEncoded\":                 Ajax({                     url: SignCallBackURL,                     contentType: \"application/x-www-form-urlencoded; charset=UTF-8\",                     data: $.param(data),                     done: done,                     fail: fail,                     always: always                 });                 break;             case \"Legacy\":                 Ajax({                     url: SignCallBackURL,                     contentType: \"application/x-www-form-urlencoded; charset=UTF-8\",                     data: JSON.stringify(data),                     done: done,                     fail: fail,                     always: always                 });                 break;             default:                 Ajax({                     url: SignCallBackURL,                     contentType: 'application/json charset=UTF-8',                     data: JSON.stringify(data),                     done: done,                     fail: fail,                     always: always                 });         }     }      function ESignVendorCall(disabledElements, formData) {          var tokenSettings = {             eSignVendorCall: ESignVendorCall,             formData: formData,             disabledElements: disabledElements,             proccessGif: proccessGif,             sendButton: sendButton         };          currentESignType.GetTokenSettings(tokenSettings);          var error = function (xhr, textStatus, errorThrown) { };          var done = function (data) {             proccessGif.hide();             if (currentESignType.SignRequestSuccess(data)) {                 if (supportsLocalStorage()) localStorage['FormData'] = formData;                 currentESignType.SaveTransactionID(data);                 if (SignCallBackURL != null && SignCallBackURL !== \"\") {                     ESignCallBack(data);                 } else {                     currentESignType.vendorsuccess(data, false);                     RunEsignSuccessBehavior(currentESignType.esignSuccessBehavior, SaveURL, UNIDHasValue(), PrintUrl );                 }             } else {                 currentESignType.SignRequestFail(data, SignErrorMessage);             }             sendButton.removeAttr('disabled');         };          var always = function () {             disabledElements.attr('disabled', 'disabled');             if(currentESignType.always) currentESignType.always();         };          Ajax({             url: SignURL,             data: formData,             headers: currentESignType.GetHeaders(),             contentType: currentESignType.GetContentType(),             beforeSend: currentESignType.beforeSend,             error: error,             done: done,             fail: function (jqXHR, textStatus, errorThrown) {                 currentESignType.ESignVendorCallFail(jqXHR, textStatus, SignErrorMessage) || function () { };             },             always: always         });     };      function beginESignTransaction(self, currentESignType, disabledElements) {         self.attr('disabled', 'disabled');         $.support.cors = true;         if ('XDomainRequest' in window && window.XDomainRequest !== null && detectIE() === 8) {             jQuery.ajaxSettings.xhr = function () {                 return new XDomainRequest();             };         }         disabledElements.removeAttr('disabled');         var formData = currentESignType.getDataToPost();         var alreadySigned = formDataAlreadySubmitted(formData);         var signWithESignVendor = true;          if (alreadySigned) {             signWithESignVendor = confirm('The form bundle has already been signed. Are you sure you want to sign it again?');         }         if (signWithESignVendor) ESignVendorCall(disabledElements, formData);     }      if (!currentESignType && !EnableNativeESign) return;      $('#btnSign').click(function (e) {         var self = $(this);         var save = $('#btnSign').hasClass('saveBefore');         var addRecipientButton = $('.prepareToSignWindow #btnAddRecipient');         sendButton.unbind();         addRecipientButton.unbind();         if (EnableNativeESign) {             ScrollToSignFields(iScrollOff, true);         } else {             if (!SignJavascript) {                 var showPopup = true;                 if (SignSubmitCombined) {                     showPopup = SubmitClick({                         submitJavaScript: SubmitJavascript,                         saveURL: SaveURL,                         minorInstruction: HTMLMinorInstruction,                         saveBefore: save                     });                 }                 if (showPopup) {                     currentESignType.showEmailPopup(defaultSignMessage, signMessageIsDefault, e, SignHideEmptySigners);                     if (!SignSendJavascript) {                         addRecipientButton.click(function () {                             currentESignType.addRecipientRow();                         });                          sendButton.click(function () {                             $('.checkEmail').each(function () {                                 $(this).val($.trim($(this).val()));                             });                             if (currentESignType.validate()) {                                  $('#fieldsErrors').hide();                                 proccessGif.show();                                 beginESignTransaction($(this), currentESignType, disabledElements);                             }                         });                     } else {                         sendButton.click(SignSendJavascript);                     }                     if (currentESignType.skipESignPopup) {                         $('.checkEmail').each(function () {                             $(this).val($.trim($(this).val()));                         });                         if (currentESignType.validate()) {                             beginESignTransaction(self, currentESignType, disabledElements);                         } else {                             displayPopUp(true);                         }                     } else {                         displayPopUp(false);                     }                 }             } else {                 eval(SignJavascript);             }         }     }); }  function displayPopUp(makeFieldsReadonly) {     $(\"#prepareToSignDialog\").show();     var maskWidth = $(window).width();     var inputMask = $('#mask');     inputMask.css({         'width': maskWidth,         'visibility': 'visible'     }).fadeIn(1000)       .fadeTo(\"slow\", 0.8);      inputMask.click(function () {         $(this).css(\"visibility\", \"hidden\");         $('.prepareToSignWindow').hide();     });      if (makeFieldsReadonly) $('#signTable').find('input,select').not('[type=\"hidden\"]').not('.invalid').prop('disabled', true); }  function itsExpired(FormExpiryDate) {     var currentDate = new Date();     var expiryDate = new Date(FormExpiryDate);     return expiryDate <= currentDate; }  function BrowserDetection() {     /*legacy method was buggy - return true*/     return true; }  function init() {     if (document.getElementById(\"loading\") != null) {         var ld = (document.all);         var ns4 = document.layers;         var ns6 = document.getElementById && !document.all;         var ie4 = document.all;         if (ns4)             ld = document.loading;         else if (ns6)             ld = document.getElementById(\"loading\").style;         else if (ie4)             ld = document.all.loading.style;         if (ns4) {             ld.visibility = \"hidden\";         } else if (ns6 || ie4) ld.display = \"none\";     } }  function detectIE() {     var ua = window.navigator.userAgent;      var msie = ua.indexOf('MSIE ');     if (msie > 0) {         return parseInt(ua.substring(msie + 5, ua.indexOf('.', msie)), 10);     }      var trident = ua.indexOf('Trident/');     if (trident > 0) {         var rv = ua.indexOf('rv:');         return parseInt(ua.substring(rv + 3, ua.indexOf('.', rv)), 10);     }      var edge = ua.indexOf('Edge/');     if (edge > 0) {         return parseInt(ua.substring(edge + 5, ua.indexOf('.', edge)), 10);     }     return false; }  function decodeHTML() {     var value = \"\";     $(\"input:text\").each(function () {         value = $(this).val();         if (value != \"\") {             $(this).val(HtmlDecode(value));         }     }); }  function showInvalidFormsAlert(showMessage, invalidForms) {     if (showMessage) {         var message = 'The following forms are invalid and were not generated:\\n\\n';         alert(message + invalidForms);     } }  function getFieldValue($selector) {     if (isCheckbox($selector)) {         return $selector.filter(':checked').val() || \"\";     } else {         return $selector.val();     } }  function updateRequiredFieldByReferenceUI($requiredInput, referenceFieldValue, referenceValuesToInclude) {     if ((!!referenceFieldValue) && ((!referenceValuesToInclude) || $.inArray(referenceFieldValue, referenceValuesToInclude.split(',')) > -1)) {         $requiredInput.removeClass('itemBorderTransparent');         $requiredInput.addClass('itemRequired');         if (isCheckbox($requiredInput)) {             $requiredInput.map(function () {                 return $('label[for=\"' + $(this).prop('id') + '\"]')[0];             }).addClass('isrequired');         }         removeRedBorderWhenNotEmpty($requiredInput[0]);     } else {         if (isCheckbox($requiredInput)) {             $requiredInput.map(function () {                 return $('label[for=\"' + $(this).prop('id') + '\"]')[0];             }).removeClass('isrequired cbrequired');         }         $requiredInput.addClass('itemBorderTransparent');         $requiredInput.removeClass('itemRequired');     } }  function processRequiredInputsByReference($referenceInput, $requiredInput, referenceValues) {     var referenceFieldValue;     if (isCheckbox($referenceInput)) {         var groupCheckedValue = $('input[name=\"' + $referenceInput.attr('name') + '\"]').filter(':checked').val();         referenceFieldValue = groupCheckedValue;     } else {         referenceFieldValue = $referenceInput.val();     }     updateRequiredFieldByReferenceUI($requiredInput, referenceFieldValue, referenceValues); }  function setRequiredInputByReference(requiredInput, referenceName, referenceValues) {     var $referenceInput = $('[name$=\"' + referenceName + '\"]');     var $requiredInput = $('[name$=\"' + requiredInput + '\"]');     if ($referenceInput.length > 0) {         $referenceInput.on('keyup', function () {             processRequiredInputsByReference($(this), $requiredInput, referenceValues);         });          var referenceValue = '';         if (isCheckbox($referenceInput)) {             referenceValue = $('input[name=\"' + $referenceInput.attr('name') + '\"]').filter(':checked').val();         } else {             referenceValue = $referenceInput.val();         }         updateRequiredFieldByReferenceUI($requiredInput, referenceValue, referenceValues);          $requiredInput.addClass('requiredByRef');         $requiredInput.on('keyup', function () {             UpdateRequiredFieldByReference($(this), $referenceInput);         });     } }  function addToLocalStorage(key, value) {     if (supportsLocalStorage()) {         localStorage[key] = value;     } }  function SubmitForm(url, type, data, beforeSend, success, error, complete) {          submit = function () {          $.ajax({             url: url,             type: type,             data: data,             beforeSend: beforeSend,             success: success,             error: function (jqXHR, textStatus, errorThrown) { ProcessAuthorizedApiError(jqXHR, textStatus, errorThrown, submit, error) },             complete: complete         });     };      submit(); }  function SubmitBeforeSend() {     $('#MinorInstructions').text('Submitting the form, please wait...');     $('#btnSubmit').css(\"opacity\", \"0.6\");     $('#btnSubmit').attr('disabled', 'disabled');     SetTrianglesColor(); }  function SubmitSuccess(data) {     alert(data.ErrorMessage); }  function SubmitError(jqXHR, textStatus, errorThrown) {     alert('Unexpected error occurred. Plase, try again or contact an administrator'); }  function SubmitComplete() {     $('#btnSubmit').css(\"opacity\", \"1\");     $('#btnSubmit').removeAttr('disabled');     window.onbeforeunload = null; }  function SetTrianglesColor() {     var tri = $('#navPage').find('div').filter(function () {         return $(this).prop('id').startsWith(\"tri-\") && $(this).css('border-right-color').replace(/\\s+/g, '') == 'rgb(255,255,0)';     });     $.each(tri, function () {         $(this).css('border-right-color', 'red');     }); }  function closePopUp() {     $(\".ui-widget-overlay\").remove();     $(\"#alt-popup\").parent().remove(); }  function closeEmailSavePopUp() {     $(\".ui-widget-overlay\").remove();     $(\"#alt-popup-Email\").parent().remove(); }  function removeRedBorderWhenNotEmpty(elem) {     if (isCheckbox(elem)) {         cbRequired(elem);         return;     }     if ($(elem).val().length) {         $(elem).removeClass('itemRequired');         $(elem).addClass('itemBorderTransparent');     } else {         $(elem).addClass('itemRequired');         $(elem).removeClass('itemBorderTransparent');     } }  function UpdateRequiredFieldByReference($elem, $reference) {     var fieldValue = getFieldValue($reference);     if (!!fieldValue) {         removeRedBorderWhenNotEmpty($elem[0]);     } }  function GetPrintData(editablePDF, includeCoverPage, forSign, fieldsToExclude) {     fieldsToExclude = fieldsToExclude || [];     var IncludeField = function ($field, fieldsToExclude) {         if ($.inArray($field.attr('name'), fieldsToExclude) > -1) {             return false;         }         if (isCheckbox($field)) {              return $field.prop('checked');         } else {             return $.trim($field.val());         }     };      /* PrintData - NativeESignatures */     var signatures = JSON.parse($('#signatures').val() || '[]');     var nativeESignatures = signatures.map(function (s) {         var o = {};         o.FieldName = Object.keys(s)[0];         return o;     });      $.each(nativeESignatures, function (i) {         this.SignURL = signatures[i][this.FieldName].signURL;         this.Width = signatures[i][this.FieldName].width;         this.Height = signatures[i][this.FieldName].height;         this.GeoLocation = signatures[i][this.FieldName].geoLocation;         this.SignDate = signatures[i][this.FieldName].signDate;         this.NewSignature = signatures[i][this.FieldName].newSignature;     });      /* PrintData - Fields */     var pages = $('#QFVPageList').find('li');     var order = 1;     var groups = [];     $.each(pages, function () {         var li = this;         var formData = $(li).attr('id').replace('FID', '').split('p')[0];         var hasInstance = formData.indexOf('-') >= 0;         var formID = hasInstance ? formData.split('-')[0] : formData;         var instance = hasInstance ? formData.split('-')[1] : 0;         var group = $(groups).filter(function () {             return this.FormID == formID && this.FormInstance == instance;         })[0];         var fields = $(li).find('*')             .filter(function () {                 return $(this).attr('name') && IncludeField($(this), fieldsToExclude);             }).map(function () {                 var field = $(this);                 var val = encodeURIComponent(field.val());                 var o = {};                 o.Name = field.attr('name');                 o.Value = val;                 return o;             });         if (group) {             Array.prototype.push.apply(group.HTMLFields, fields);         } else {             group = {};             group.FormID = parseInt(formID);             group.FormInstance = parseInt(instance);             group.Order = order++;             group.HTMLFields = fields.toArray();             groups.push(group);         }     });      /* PrintData - CustomFields */     var metaDataValue = $.trim($('[name*=\"CustomFieldMetaData\"]').val()) || '[]';     var metaData = JSON.parse(metaDataValue).map(function (e) {         var CustomFieldMetaData = {};         CustomFieldMetaData.Name = e.Name;         CustomFieldMetaData.Left = e.Left;         CustomFieldMetaData.Top = e.Top;         CustomFieldMetaData.Width = e.Width;         CustomFieldMetaData.Height = e.Height;         CustomFieldMetaData.Page = e.Page;         CustomFieldMetaData.FormID = parseInt(e.FormID);         CustomFieldMetaData.RelPage = e.RelPage;         CustomFieldMetaData.Value = \"\";         return CustomFieldMetaData;     });      var customField = $('[name*=\"QuikCustomField\"]').map(function () {         var HTMLField = {};         var self = $(this);         HTMLField.Value = self.val();         HTMLField.Name = self.attr('name');         return HTMLField;     }).get();      var customFields = {         MetaData: metaData,         Fields: customField     };      return {         EditablePDF: editablePDF,         IncludeCoverPage: includeCoverPage,         UNID: GetUNID().replace(\"UNID=\", \"\"),         CustomerID: $('input[name=QFECustomerID]').val() || 0,         Fields: groups,         NativeESign: $('input[name=\"nativeESign\"]').val(),         NativeESignatures: nativeESignatures,         SignAllDocsCombined: $('input[name=\"signAllDocsCombined\"]').val(),         SignMultipleDocs: $('input[name=\"signMultipleDocs\"]').val(),         CustomFields: customFields,         ForSign: forSign     };  }  function centerScreenTo(target, speed, container) {     var el = $(target);     var offset = el.position().top - $(container).height() / 2;     $(container).animate({ scrollTop: offset }, speed); }   function FormViewTransaction(strUNID, formId, apiBaseUrl, previewMode, showPrintButton, editablePdf, draftMode) {     var formUNID = GetUNID();     if (formUNID.length > 0) {         var strUNID = localStorage['UNID=\"' + strUNID + '\"'];         if (strUNID != formUNID) {             localStorage['UNID=\"' + strUNID + '\"'] = formUNID;             var url =                 apiBaseUrl + '/HTMLFormViewTransaction.asmx/' +                 (previewMode ? 'FormViewTransactionForPreviewMode' : (draftMode ? 'FormViewTransactionForDraftMode' : 'FormViewTransaction')) +                 '?Edit=' + editablePdf.toString() +                 '&formID=' + formId +                 '&UNID=' + JSON.stringify(formUNID.replace('UNID=', ''));              $.ajax({                 url: url,                 cache: true,                 type: 'GET',                 contentType: 'application/json',                 dataType: 'jsonp',                 success: function (data) {                     if (typeof data != 'undefined') {                         if (data.errorCode != \"0\") {                             alert('This form is invalid and should not be used. Please try regenerating the form or refreshing your browser screen. You may also report the following error information:\\n\\n(Error Code = ' + data.errorCode + ' - Error Message = ' + data.message + ').');                             $(\"#btnPrint\").css(\"visibility\", \"hidden\");                         }                         else {                             $(\"#btnPrint\").css(\"visibility\", showPrintButton ? \"visible\" : \"hidden\");                             $('#btnPrint').removeAttr('disabled');                         }                     }                     else                     {                         alert('This form view request cannot be validated for an unknown reason and should not be used. Please try regenerating the form or refreshing your browser screen.')                     }                 },                 error: function (xhr, ajaxOptions, thrownError) {                         alert(xhr.status);                         alert(thrownError);                 }             });         }         else {             $(\"#btnPrint\").css(\"visibility\", showPrintButton ? \"visible\" : \"hidden\");             if (showPrintButton) {                 $(\"#btnPrint\").removeProp('disabled');             }            };     }     else {         alert('This form view request cannot be validated for an unknown reason and should not be used. Please try regenerating the form or refreshing your browser screen.');     } }  function CustomerSaveForm(url) {   PostData(url); }   function showAttachFileModal(options) {     var title = options.title.substring(0, 50);     var url = options.url;     var attachDialog = $('<div id=\"alt-popup\" style=\"padding-bottom:0px;\">');     attachDialog.append('<form id=\"attachForm\" enctype=\"multipart/form-data\" style=\"margin-bottom:0px;\"><div style=\"margin-bottom:5px;text-align:left;font-family:Arial;\"><div style=\"margin-bottom:5px;\"><b><span style=\"color:#aa0000; font-size:20px; margin-right:10px;\">Attach a File</span><span style=\"font-size:13px;\">' + title + ' </span></b></div><div style=\"margin-bottom:5px;\"><i><span style=\"font-size:12px\">Click the Browse button, locate one or more files to attach and click Add.</span></i></div><div style=\"margin-bottom:5px; height:100px;\"><input type=\"button\" id=\"btnAttachFileBrowse\" value=\"Browse\" style=\"width:60px;margin-right: 5px;\" onclick=\"openBrowser();\" /><input type=\"button\" id=\"btnAttachFileAdd\" value=\"Add\" style=\"position: absolute;top: 127px;left: 13px;width: 60px;\"/><textarea id=\"txtFiles\" rows=\"6\" cols=\"63\" readonly=\"readonly\" style=\"resize:none; position:absolute;\"></textarea><input type=\"file\" id=\"fileAttachFileBrowse\" name=\"attachments\" style=\"visibility:hidden;\" multiple>\t</div><div style=\"margin-top:15px;\">  <div id=\"updiv\" style=\"display: block;\"><span>Uploading files </span><img src=\"https://quikforms.com/shared/images/loading.gif\"></div><b><span style=\"font-size:14px;\"> Acceptable File Types: </span></b></div><div style=\"float:right;\"><input id=\"attachCancel\" type=\"button\" value=\"Cancel\" style=\"float:right; position:relative; top:12px;\"/></div><ul style=\"list-style-type: none; margin-left: 10px; margin-top: 5px;\"><li>- Documents - PDF</li><li>- Images - JPG, PNG, GIF, BMP, TIF</li></ul></div></form>');     attachDialog.dialog({ appendTo: 'body', closeOnEscape: false, width: 615, modal: true, title: '', position: { my: \"center top\", at: \"center\", of: wrapper}});     $('#updiv').hide();     $(\".ui-dialog-titlebar\").hide();     $('.ui-button').removeClass('ui-button');     $('.ui-dialog-content').css('text-align', 'center');     var popUpHeight = $(\".ui-dialog\").height();     var currentTop = $(\".ui-dialog\").position().top;     $(\".ui-dialog\").css('top', currentTop - popUpHeight * 0.5);     $(\".ui-button\").css(\"width\", \"25\");     $(\".ui-button\").removeClass(\"ui-button\");     $('#fileAttachFileBrowse').change(addFilesToModal);     $('#btnAttachFileAdd').click(addAttachments);     $('#attachCancel').click(closePopUp);     $('#attachForm').submit(function (e) {         e.preventDefault();         var formData = new FormData();         var maximumSize = 20;         var maximumFileCount = 100;         var totalFiles = $('#fileAttachFileBrowse')[0].files.length;         var addedFilesCount = $('#navAttachments').find('li').length;         if (totalFiles + addedFilesCount > 100) {             alert('Maximum amount of files reached. The total amount of attachments to upload must not be greater than ' + maximumFileCount.toString() + '.');             closePopUp();             return;         }         var validFiles = true;         $.each($('#fileAttachFileBrowse')[0].files, function () {             if (isValidFileType(this.type)) {                 formData.append(\"attachment\", this);             } else {                 alert('File ' + this.name + ' is not a valid PDF or Image');                 validFiles = false;                 return;             }              if (this.size > maximumSize * 1024 * 1024) {                 alert('One of the files exceeds the maximun allowed size, which is ' + maximumSize.toString() + 'MB.');                 closePopUp();                 return;             }         });         if (!validFiles) {             $('#updiv').hide();             $('#btnAttachFileAdd').removeAttr('disabled');             return;         }          var unid = $('#QFVUNID').val().replace(\"UNID=\", \"\");         formData.append(\"unid\", unid);                  var errorCallback = function (jqXHR, textStatus, errorThrown) {             var errors;             try {                 errors = JSON.parse(jqXHR.responseText).Errors;             } catch (e) {                 errors = [{ Message: 'Unknown error occurred when trying to upload the attachments.' }];             }             var message = errors.map(function (e) { return e.Message }).join('. ');             alert(message);             HideLoading();             EnableAddButton();         };          var HideLoading = function () {             $('#updiv').hide();                      };          var EnableAddButton = function () {             $('#btnAttachFileAdd').removeAttr('disabled');         };          var callEndpoint = function () {             $.ajax({                 url: url + \"attachments/upload/viewer\",                 type: \"POST\",                 data: formData,                 contentType: false,                 processData: false,                 beforeSend: function (xhr) {                     AttachFileBeforeSend(xhr);                     $('#btnAttachFileAdd').attr('disabled', 'disabled');                     $('#updiv').show();                 },                 error: function (jqXHR, textStatus, errorThrown) {                     ProcessAuthorizedApiError(jqXHR, textStatus, errorThrown, callEndpoint, errorCallback)                 },                 success: function (data) {                     AttachmentSuccessCallback(data, url);                 }             });         };         callEndpoint();     });  }  function AttachmentSuccessCallback(data, url) {     addFilesToPanel(data, url) }  function GetAttachments(unid, url) {     var errorCallback = function (jqXHR, textStatus, errorThrown) {         alert(errorThrown);     };     $.ajax({         url: url + 'attachments?unid=' + encodeURIComponent(unid),         type: 'GET',         contentType: 'application/json',         beforeSend: AttachFileBeforeSend,         success: function (data) {             AttachmentSuccessCallback(data, url);         },         error: function (jqXHR, textStatus, errorThrown) {             ProcessAuthorizedApiError(jqXHR, textStatus, errorThrown, function () { GetAttachments(unid, url) }, errorCallback)         }     }); }  function AttachFileBeforeSend(xhr) {     xhr.setRequestHeader(\"Authorization\", \"BEARER \" + $('#RestAccessToken').val()); }  function openBrowser() {    $('#fileAttachFileBrowse').click();  }  function addFilesToModal() {     var textArea = $('#txtFiles');     textArea.html('');     $.each($('#fileAttachFileBrowse')[0].files, function () {         var filetype = this.type;         var lineBreak = \"\";         if (isValidFileType(filetype)) {             if (textArea.html().length > 0) lineBreak = \"\\n\";             textArea.html(textArea.html() + lineBreak + this.name);         }     }); }  function addFilesToPanel(data, url) {     if (data.ErrorCode == 0) {         var files = data.ResultData;         $.each(files, function () {             $('#navAttachments').find('ul').append(buildAttachmentListItem(this,url));         });     }     else {         var errors = (data.Errors || [{Message:'Unknown error occurred while trying to upload the selected attachments. Please, try again or contact an administrator'}]);         alert(errors[0].Message);     }     closePopUp(); }  function buildAttachmentListItem(file, url) {     var finalName = getNameToShow(file.Name);     var li = $('<li>');     var img = $('<img>');     img.attr('src', 'https://quikforms.com/shared/images/quikformviewer/remove.png');     img.css('width', '10px');     img.css('height', '10px');     img.on('click', { elem: img, id: file.Id, url: url }, removeAttachment);     var span = $('<span>');     span.append(finalName);     li.append(img);     li.append(span);     return li; }  function getNameToShow(name) {     var maxLength = 17;     var pattern = \"...\";     var extension = name.substring(name.lastIndexOf('.') - 1);     if (name.length > maxLength) {         name = name.substring(0, maxLength - pattern.length - extension.length) + pattern + extension;      }     return name; }  function addAttachments() {     $('#attachForm').submit(); }  function isValidFileType(fileType) {     return fileType == \"application/pdf\" || fileType.startsWith(\"image/\");   }  function removeAttachment(data){     var img = data.data.elem;     var url = data.data.url;     var id = data.data.id;     var unid = $('#QFVUNID').val().replace(\"UNID=\", \"\");     $.ajax({         url: url + 'attachments/' + id + '/remove',         type: \"DELETE\",         data: JSON.stringify(unid),         contentType: 'application/json',         beforeSend: AttachFileBeforeSend,         complete: function (data) { removeFileFromPanel(data, img) }     }); }  function removeFileFromPanel(data,img) {     var response;     try {         response = JSON.parse(data.responseText);     } catch (e) {         response = \"\";     }     if (response.ErrorCode == 0) {         $(img.closest('li')).remove();     }     else {         alert(response.ErrorMessage);     }  }  function showCalculatedPopUp(options) {     var fieldParts = options.fieldParts || {};     var calculatedFieldID = options.calculatedFieldID;     var level1 = calculatedFieldID.split('-')[0];     if (!$.isEmptyObject(fieldParts)) {         var calculatedDialog = $('<div id=\"alt-popup\" style=\"padding-bottom:0px;\">');            calculatedDialog.append('<div style=\"margin-bottom:5px;text-align:left;font-family:Arial;\"><div style=\"margin-bottom:5px;\"><b><span style=\"color:#aa0000; font-size:20px; margin-right:10px;\">Enter Data</span></b><span style=\"font-size:13px;\">Enter each of the individual fields below to automatically fill in the form.</span></div>');         var divFieldParts = $('<div id=\"fieldParts\"style=\"margin-bottom:5px; text-align:left;\">');         var getCalculatedValue = function (name) {                          var calculatedFields = Fields.prototype.CalculatedFields || [];             var value = '';             return $(calculatedFields).filter(function () {                 return this.FieldName === name;             }).map(function () {                 return this.FieldValue;             })[0] || '';         };         $.each(Object.getOwnPropertyNames(fieldParts), function (i) {             var text = fieldParts[this];             var fieldName = this;             var $div = $('<div style=\"margin-bottom:5px;\">');             var $span = $('<span>');             $span.css('margin-right', '5px');             $span.css('font-weight', 'bold');             $span.text(text);             var $txtCalcField = $('<input>');             $txtCalcField.attr('type', 'text');             $txtCalcField.attr('id', 'txtCalc' + fieldName);             $txtCalcField.attr('data-index', i.toString());             $txtCalcField.attr('data-fieldName', fieldName);             $txtCalcField.css('width', '500px');             $txtCalcField.css('display', 'block');             var fullName = level1 + '.' + fieldName + getFieldInstance(calculatedFieldID);             var calculatedValue = getCalculatedValue(fullName);             $txtCalcField.val($('input[name=\"' + fullName + '\"]').val() || calculatedValue);             $txtCalcField.on('keydown', function (e) {                 var objLength = function (obj) {                     var count = 0;                     for (var i in obj) {                         if (obj.hasOwnProperty(i)) {                             count++;                         }                     }                     return count;                 };                 var key = e.which || e.keyCode || e.charCode;                 var fieldPartsLength = objLength(fieldParts);                 if ($(this).data('index') + 1 == fieldPartsLength && key == 9) {                     e.preventDefault();                     saveCalculatedField({ data: { calculatedFieldID: calculatedFieldID } });                     $('#' + calculatedFieldID).next().focus();                 }             });             $div.append($span);             $div.append($txtCalcField);             divFieldParts.append($div);         });         calculatedDialog.append(divFieldParts);         calculatedDialog.append('<div style=\"float:right; height:35px;\"><input id=\"calculatedSave\" type=\"button\" value=\"Save\" style=\"float:right; position:relative; top:12px;\"/><input id=\"calculatedCancel\" type=\"button\" value=\"Cancel\" style=\"float:right; position:relative; top:12px; margin-right:15px;\"/></div></div>');         calculatedDialog.dialog({ appendTo: 'body', closeOnEscape: false, width: 650, modal: true, title: '', position: { my: \"center top\", at: \"center\", of: wrapper} });         $(\".ui-dialog-titlebar\").hide();         $('.ui-button').removeClass('ui-button');         $('.ui-dialog-content').css('text-align', 'center');         var popUpHeight = $(\".ui-dialog\").height();         var currentTop = $(\".ui-dialog\").position().top;         $(\".ui-dialog\").css('top', currentTop - popUpHeight * 0.5);         $(\".ui-button\").css(\"width\", \"25\");         $(\".ui-button\").removeClass(\"ui-button\");         $(\".ui-widget-overlay\").click(closePopUp);         $('#calculatedCancel').click(closePopUp);         $('#calculatedSave').on('click', { calculatedFieldID: calculatedFieldID }, saveCalculatedField);     }  }  function setCalculatedField(fieldID, fieldParts) {     var $field = $('#' + fieldID);     if($field.attr('readonly') !== 'readonly'){         $field.on('focus', function () { showCalculatedPopUp({ fieldParts: fieldParts, calculatedFieldID: fieldID }) });     } }  function getFieldInstance(id) {     var fieldName = $('#' + id).attr('name');     return fieldName.indexOf('-') > -1 ? '-' + fieldName.split('-')[1] : ''; }  function saveCalculatedField(options) {     var calculatedFieldID = options.data.calculatedFieldID || \"\";     var calculatedFieldValue = \"\";     var level1 = calculatedFieldID.split('-')[0];     var calculatedFields = Fields.prototype.CalculatedFields || [];      $.each($(fieldParts).find('div'), function () {         var fieldPartName = $(this).find('input').data('fieldname');         var fieldPartValue = $(this).find('input').val();         calculatedFieldValue += !!fieldPartValue ? fieldPartValue + \" \" : \"\";         var fullName = level1 + '.' + fieldPartName + getFieldInstance(calculatedFieldID);         $('input[name=\"' + fullName + '\"]').val(fieldPartValue);         var calculatedField = $(calculatedFields).filter(function () {             return this.FieldName === fullName;         })[0];         if (calculatedField) {             calculatedField.FieldValue = fieldPartValue;         } else {             Fields.prototype.CalculatedFields.push({ \"FieldValue\": fieldPartValue, \"FieldName\": fullName });         }     });     $('#' + calculatedFieldID).val($.trim(calculatedFieldValue)).change().keyup();     setProgressiveFillData($('#' + calculatedFieldID)[0]);     closePopUp(); }  function shrinkText(input) {     var removedCharacters = function ($input) {         var textl = $input.val().length;         var old = $input.data('oldl') || 0;         $input.data('oldl',textl);         return old - textl;     };     var getShrinkedFontSize = function ($input, currentSize, maxWidth, textWidth) {         $input.data('shrinkfactor', maxWidth / textWidth);         return currentSize * maxWidth / textWidth * .95;     };     var getEnlargedFontSize = function ($input, currentSize, maxWidth, textWidth, removedChars) {         var ratio = $input.data('shrinkfactor') || 1;         var size = currentSize;         var i = 0;         var originalSize =  $input.data('originalSize').slice(0, -2) || 13;         var fontFamily = $input.css('font-family');         var prev = size;         while (i++ < removedChars) {             var font = size + 'px ' + fontFamily;             var textWidth = getTextWidth($input.val(), font);             if (textWidth > maxWidth) return Math.min(prev, originalSize);;             prev = size;             size = size / ratio / .95;         }         return Math.min(size,originalSize);     };      var $input = $(input),     txt = $input.val(),     maxWidth = $input.width() + 5,     fontFamily = $input.css('fontFamily'),     fontSize = $input.css('fontSize'),     font = fontSize + \" \" + fontFamily;     if(!$input.data('originalSize')) $input.data('originalSize',fontSize);     var textWidth = getTextWidth(txt, font);     var removedChars = removedCharacters($input);     if (removedChars > 0) {         fontSize = getEnlargedFontSize($input, fontSize.slice(0, -2), maxWidth, textWidth, removedChars);         font = fontSize + \"px \" + fontFamily;         var newWidth = getTextWidth(txt, font);         if (newWidth <=  maxWidth) $input.css({ \"font-size\": fontSize + \"px\" });     }else if(textWidth > maxWidth) {         $input.data('oldl', $input.val().length);         fontSize = getShrinkedFontSize($input,fontSize.slice(0, -2), maxWidth, textWidth);         font = fontSize + \"px \" + fontFamily;         $input.css({ font: font });           }  }  $(document).ready(function () {     $('#QFVContainer input:not([type=\"button\"],[type=\"radio\"],[type=\"checkbox\"],[type=\"hidden\"],[type=\"sign\"])').each(function () {         shrinkText(this);         $(this).on('keyup change', function () {shrinkText(this)});     }); });  function showDialog(options) {      /*****  This block remove fields in groups without values to fill.  *****/     $.each(alternateDataBlocks, function (key, value) {         var emptyRow;         $.each(value.Data, function (index, value) {             var emptyDataCounter = 0;             $.each(value, function (i, v) {                 if ($.trim(v).length == 0) emptyDataCounter++;             });             emptyRow = (emptyDataCounter == value.length);         });         if (emptyRow) delete alternateDataBlocks[key];     });     /***********************************************************************/       var id = options.id;      var currentBlockFunction = options.CurrentBlockFunction;      var alternateBlocksFunction = options.AlternativeBlocksFunction;      if((myScroll)&&(ieVersion > 8||ieVersion<0)) myScroll.scrollToElement(id,0,0,-250); \t closePopUp(); \t var finalList = new Array(); \t var headers = \"\"; \t var n=$('<div id=\"alt-popup\">'); \t $(n).append('<h1>Choose Alternate Data <span class=\"subtitle\">Click on any record to match your selection and close this window</span></h1>'); \t $(n).append(\"<h2>Current Block:</h2>\"); \t $(n).append(currentBlockFunction(finalList,options)); \t $(n).append(\"<h2>Alternate Blocks:</h2>\"); \t $(n).append(alternateBlocksFunction(finalList,options)); \t $(n).css({width:\"350px\",margin:\"0\",\"font-size\":\"0.7em\"}); \t $(n).find(\"h1\").css({\"font-size\":\"1.3em\",margin:\".6em 0\",color:\"#BD061E\"}); \t $(n).find(\"h2\").css({\"font-size\":\"1.1em\",margin:\".6em 0;\"}); \t $(n).find(\".subtitle\").css({\"font-size\":\"0.8em\",\"font-weight\":\"normal\",color:\"#000\"}); \t $(n).find(\"table\").css({margin:\"1em 0\",\"border-collapse\":\"collapse\",width:\"100%\"}); \t $(n).find(\"table td, table th\").css({border:\"1px solid #eee\",padding:\".6em 10px\",\"text-align\":\"left\"}); \t $(n).dialog({appendTo:\"body\",draggable:false,height:300,resizable:false,title:\"Select an option\",closeOnEscape:true,modal:true,position:{my:\"center top\",at:\"center\",of:wrapper}}); \t /*$(\".ui-dialog\").css(\"left\",\"50\");  \t var posY = $(id).offset().top; \t var windowSize = $(document).height();  \t var popUpHeight = $(\".ui-dialog\").height();  \t var finalSize = posY + popUpHeight; \t if(finalSize < windowSize - 60 ){ \t\t$(\".ui-dialog\").css(\"top\",posY+60); \t }else{ \t\t$(\".ui-dialog\").css(\"top\",posY - popUpHeight - 40); \t }*/ \t var popUpHeight = $(\".ui-dialog\").height(); \t var currentTop = $(\".ui-dialog\").position().top; \t $(\".ui-dialog\").css('top', currentTop - popUpHeight * 0.5); \t $(\".ui-dialog\").css(\"width\",\"auto\");  \t $(\".ui-widget-overlay\").bind(\"click\",function(){closePopUp();}); \t $(\".ui-button-text\").text(\"X\"); \t $(\".ui-button-text\").css(\"font-weight\", \"bold\"); \t $(\".ui-button-icon-primary\").css(\"width\",\"100%\"); \t $(\".ui-button-icon-primary\").css(\"left\",\"8\"); \t $(\".ui-button-icon-primary\").css(\"top\",\"8\"); \t $(\".ui-button-icon-primary\").css(\"height\",\"19\"); \t $('.ui-dialog-titlebar').find('button').click(closePopUp); \t $(\".ui-button\").css(\"width\",\"25\"); \t $(\".ui-button\").removeClass(\"ui-button\");  }   function AltDataButtonsDefaultCurrentBlock(finalList, options) {     var e = options.e;     var t = options.t; \tvar r=$('<table id=\"users\"class=\"ui-widget ui-widget-content\" >'); \tvar i=[\"Selected\",\"Role\"]; \tvar s=$(\"<tr>\"); \t$(s).append('<td><input type=\"radio\" class = \"radio\" name=\"block\" checked=\"true\" style=\"display:inline\" /></td>'); \tvar instArray = new Array(); \tvar groupId=getKey(blockList[e]); \tvar groupList=getGroupList(groupId); \tfor(var el in groupList){ \t\tvar partialName = groupList[el]; \t\tvar query='input[name*=\\''+partialName+'\\']'; \t\tif($(query).length>0){ \t\ti.push(groupList[el]); \t\t} \t} \tvar myArray=new Array(); \tvar resultArray=new Array(); \tfor(var j in alternateDataBlocks){ \t    myArray.push(j); \t} \tmyArray.sort(); \tfor(var l=0;l<myArray.length;l++){ \t    resultArray.push(alternateDataBlocks[myArray[l]]); \t}     var value = \"\"; \tfor(var o in i){ \t\tif(i[o]!='Selected'){ \t\t    var alternativeDataList=new Array(); \t\t    for(var t in resultArray){ \t\t        var found = false; \t\t        if (i[o] == 'Role' && alternateDataBlocks[myArray[t]].Headers.filter(function (item) { return $.inArray(item, i) > -1 }).length) { \t\t            var role = alternateDataBlocks[myArray[t]].SystemName || myArray[t].split('-')[0] || '';                     alternativeDataList.push(role); \t\t        } else { \t\t            for (var p in resultArray[t][\"Headers\"]) { \t\t                value = resultArray[t][\"Data\"][0][p]; \t\t                if (areEquals(resultArray[t][\"Headers\"][p], i[o]) && value != null) { \t\t                    alternativeDataList.push(value); \t\t                    found = true; \t\t                } \t\t            } \t\t            if (!found) { \t\t                alternativeDataList.push(\"\"); \t\t            } \t\t        } \t\t    } \t\t    if (i[o] != 'Role') { \t\t        var a=\"\"; \t\t        for(var p in blockList[e][groupId]){ \t\t\t        var role=p.split(\"-\")[0]; \t\t\t        var nameSplit=$('#'+p)[0].name.split(\"-\"); \t\t\t        var instance=\"\"; \t\t\t        if(nameSplit.length>1){ \t\t\t\t        instance=nameSplit[1]; \t\t\t        } \t\t        } \t\t        var roleFilter='input[name^=\\''+role+'\\']'; \t\t        if(instance!=\"\"){ \t\t\t        instance='-'+instance; \t\t        } \t\t        var nameFilter='[name$=\\''+i[o]+instance+'\\']'; \t\t        var elem=$(roleFilter).filter(nameFilter); \t\t        a=$(elem).val()||\"\"; \t\t        $(s).append(\"<td>\"+a+\"</td>\"); \t\t    } \t\t    finalList.push(alternativeDataList); \t\t} \t} \t$(r).append(createTableHead(i,false)); \tvar f=$(\"<tbody>\"); \tif($.inArray(\"FullName\",i)!=-1){ \t    fillFullName(s); \t} \t$(f).append(s); \t$(r).append(f); \theaders=i; \treturn r; }  function AltDataButtonsDefaultAlternateBlocks(finalList, options) {     var e = options.e;     var arr = new Array(); \tvar n = $('<table id=\"users\"class=\"ui-widget ui-widget-content\">'); \t$(n).append(createTableHead(headers,true)); \tvar r = $(\"<tbody>\"); \tfor (var k = 0; k < finalList[0].length; k++) { \t    var s = $(\"<tr>\"); \t    var button = $('<input type=\"radio\" class=\"radio\" name=\"block\" style=\"display:inline\"/>'); \t    button.on('click' ,{list:blockList[e][getKey(blockList[e])],headers:headers,input:button},AltDataButtonsRadioClick); \t    var td = $('<td>'); \t    td.append(button); \t\t$(s).append(td); \t\tvar value = \"\"; \t\tfor (var x = 0; x < finalList.length; x++) { \t\t    value = finalList[x] === undefined ? \"\" : finalList[x][k] === undefined ? \"\" : finalList[x][k]; \t\t    $(s).append(\"<td>\" + value + \"</td>\"); \t\t} \t\tif (showRow(s) && notRepeated(s, arr)) { \t\t    $(r).append(s); \t\t} \t} \t$(n).append(r); \treturn n; }   function fillFullName(a){ \tvar arr=a.find(\"td\"); \tvar fullName=arr[1].innerHTML; \tif(fullName===\"\"){ \t\tfor(var i=2;i<arr.length;i++){ \t\t\tfullName+=arr[i].innerHTML+' '; \t\t} \t} \tarr[1].innerHTML=fullName; }  function showRow(a){ \tvar ret=false; \t$(a).find('td').each(function(index){ \t\t\t\t\t\t\tif(this.innerHTML!=\"\" && index>0){ \t\t\t\t\t\t\t\tret=true; \t\t\t\t\t\t\t} \t\t\t\t\t}); \treturn ret; }  function notRepeated(s,arr){ \tvar id=\"\"; \t$(s).find('td').each(function(){id+=this.innerHTML+\"-\";}); \tif($.inArray(id,arr)!=-1){ \t\treturn false; \t}else{ \t\tarr.push(id);  \t\treturn true; \t} }  function createTableHead(t, showRoleColumn) {     showRoleColumn = showRoleColumn || false; \tvar n=$('<tr  class=\"ui-widget-header\">'); \tvar r=$(\"<thead>\"); \tfor(var i=0;i<t.length;i++){ \t    var s = t[i]; \t    if (s == 'Role' && !showRoleColumn) { \t        continue; \t    }        $(n).append(\"<th>\" + s + \"</th>\"); \t} \t$(r).append(n); \treturn r; }  function areEquals(a,b){ \treturn a.split(\"-\")[0]===b.split(\"-\")[0]; }  function getKey(o){ \tvar a=new Array();  \tfor(var i in o){ \t    a.push(i); \t} \treturn a[0]; }  function AltDataButtonsFieldTypeCurrentBlock(finalList, options) {     var r = $('<table id=\"users\"class=\"ui-widget ui-widget-content\" >');     var i = [\"Selected\",\"Role\"];     var fieldName = options.fieldName;     var role = fieldName.substring(0, fieldName.indexOf('.'));     var values = options.values;     var s = $(\"<tr>\");     $(s).append('<td><input type=\"radio\" class = \"radio\" name=\"block\" checked=\"true\" style=\"display:inline\" /></td>');     $.each(values, function () {          i.push(this);          var nameFilter = '[name=\"' + role + \".\" + this + '\"]';         var elem = $(nameFilter);         a = $(elem).val() || \"\";         $(s).append(\"<td>\" + a + \"</td>\");     });      $(r).append(createTableHead(i,false));     var f = $(\"<tbody>\");     $(f).append(s);     $(r).append(f);     headers = i;     return r; }  function AltDataButtonsFieldTypeAlternateBlocks(finalList, options) {     var arr = new Array();     var n = $('<table id=\"users\"class=\"ui-widget ui-widget-content\">');     $(n).append(createTableHead(headers, true));     var r = $(\"<tbody>\");     var role = \"\";     var instance = \"\";     var roleKey = \"\";     var rolesAdded = [];     var fullKey = \"\";     var getLevel2IFLevel3 = function (key) {         var from = key.indexOf('.') + 1;         var level2 = \"\";         if (from > 0) {             var til = key.indexOf('-');             level2 = key.substr(from, til - from) + \".\";         }         return level2;     };     var filterAltDataBlocks = function (objADB, arrValues) {         var obj = {};         var found = false;         for (var key in objADB) {             var level2 = getLevel2IFLevel3(key);;             var arrFields = objADB[key].Headers || [];             $.each(arrFields, function () {                 found = $.inArray(level2 + this.toString(), arrValues) > -1;                 if (found) {                     obj[key] = objADB[key];                     return;                 }             });         }         return obj;     };      for (var key in filterAltDataBlocks(alternateDataBlocks,options.values)) {         var roleObj = {};         role = key.split('-')[0].split('.')[0];         instance = key.split('-').length == 3 ? key.charAt(key.length - 1) : \"0\";         roleKey = role + \"-\" + instance;         if (roleKey.length > 0 && $.inArray(roleKey, rolesAdded) == -1) {             roleObj[\"roleKey\"] = roleKey;             roleObj[\"fullKey\"] = key;             rolesAdded.push(roleObj);         }     }      $.each(rolesAdded, function () {         fullKey = this.fullKey;         roleKey = this.roleKey;         role = roleKey.split('-')[0];         instance = roleKey.split('-')[1];         var s = $(\"<tr>\");         var button = $('<input type=\"radio\" class=\"radio\" name=\"block\" style=\"display:inline\"/>');         button.on('click', { fieldName: options.fieldName}, AltDataButtonsFieldTypeRadioClick);         var td = $('<td>');         td.append(button);         $(s).append(td);         var systemName = alternateDataBlocks[fullKey].SystemName || role || \"\";         if (instance != \"0\") systemName += ' - ' + instance;         $(s).append(\"<td>\" + systemName + \"</td>\");         $.each(options.values, function () {             var hasValue = false;             var key = this;             for(var elem in alternateDataBlocks){                 var currentLevel1_2 = elem.split('-')[0];                 var currentRole = elem.split('-')[0].split('.')[0];                 var currentInstance = elem.split('-').length == 3 ? elem.charAt(elem.length - 1) : \"0\";                 for (var x = 0; x < alternateDataBlocks[elem].Headers.length; x++) {                     var whatWeWantToFind = role + '.' + key;                     var whatWeFound = currentLevel1_2 + '.' + alternateDataBlocks[elem].Headers[x];                     if (whatWeWantToFind == whatWeFound && instance == currentInstance && role == currentRole) {                         $(s).append(\"<td>\" + alternateDataBlocks[elem].Data[0][x] + \"</td>\");                         hasValue = true;                         break;                     }                 }             }             if (!hasValue) {                 $(s).append(\"<td></td>\");             }         });         if (showRow(s) && notRepeated(s, arr)) {             $(r).append(s);         }     });      $(n).append(r);     return n; }  function AltDataButtonsRadioClick(data) {     var list = data.data.list;     var headers = data.data.headers;     var input = data.data.input;     for(var p in list){ \t\tvar id='#'+p; \t\tfor(var h in headers){ \t\t\tif(p.indexOf(headers[h])>0){ \t\t\t    $(id).val(HtmlDecode($(input).parent().parent().find(\"td\")[$(input).closest('table').find('th:contains(' + headers[h] + ')').index()].innerHTML)).keyup();                  setProgressiveFillData($(id)[0]); \t\t\t} \t\t} \t} \tclosePopUp();  }  function AltDataButtonsFieldTypeRadioClick(data){     var fieldName = data.data.fieldName;     var role = fieldName.split('.')[0];     var $radio = $(this);     $.each($radio.closest('tr').find('td :not(:first)'), function () {         var value = $(this).text();         var index = $(this).index();         var fieldName = role + \".\" + $($radio.closest('table').find('thead').find('th')[index]).text();         var filter = '[name=\"' + fieldName + '\"]';         $(filter).val(HtmlDecode(value));     });     closePopUp(); }  function RemoveRegularButtons() {     var customFilter = \"-custom\";     var customButtons = $('.popupButton').filter(function () { return this.id.endsWith(customFilter) });     var regularID = \"\";     $.each(customButtons, function () {         regularID = this.id.substring(0, this.id.indexOf(customFilter));         $('#' + regularID).remove();     }); }  function BindCustomFieldsButtons() {     var title = $('#majortitle');     var subtitle = $('#MinorInstructions');     var minorInstructions = subtitle.text();     var majorTitle = title.text();      $('#btnSaveField').click(function () {         customFieldsSaveClick(minorInstructions, majorTitle);     });      $('#btnEditCustomField').click(function () {         customFieldsEditClick(minorInstructions,majorTitle);     });      $('#btnCancelField').click(function () {         customFieldsCancelClick(minorInstructions, majorTitle);     });      $('#btnCreate').click(function () {         customFieldsCreateClick();     });  }  function SaveCustomFields() {      var getRelativePage = function (text) {         return text.substring(text.lastIndexOf(\"p\") + 1).split('-')[0]; /*No instance needed*/     };      var $hdnMetaDataField = $('[name=\"Quik.CustomFieldMetaData\"]'),         $hdnMetaDataValue = $hdnMetaDataField.val() || '[]',         $customFields = JSON.parse($hdnMetaDataValue),         $fieldsToUpdate = $('input[type=text][name*=\"QuikCustomField\"]');      var getPageProperties = function (fieldTop) {         var $pages = $('#QFVPageList').find('li');         var pageNumberAlreadySet = false;         var pageProperties = {             pageNumber: 0,             relPageNumber: 0,             formID: 0,             sumHeight: 0.0         };          var oldTextID = \"\";         var text = \"\";         for (var i = 0; i < $pages.length; i++) {             text = $($pages[i]).attr('id');             var removeBefore = text.substring(text.indexOf('D') + 1);             var matchChar = removeBefore.indexOf('p');             pageProperties.formID = removeBefore.substring(0, matchChar != -1 ? matchChar : removeBefore.length);              var pageTop = $($pages[i]).position().top;             if (pageTop >= fieldTop && !pageNumberAlreadySet) {                 pageProperties.pageNumber = i;                 pageProperties.relPageNumber = getRelativePage(oldTextID);                  pageNumberAlreadySet = true;                 break;             }             if (i > 0) pageProperties.sumHeight += $($pages[i - 1]).outerHeight();             oldTextID = text;         }         if (!pageNumberAlreadySet) {             pageProperties.pageNumber = $pages.length;             pageProperties.relPageNumber = getRelativePage(text);         }         return pageProperties;     };          var lastFrmId = 0;     var counter = 0;     var lastFormID = 0;     $.each($fieldsToUpdate, function () {         var $field = $(this);         var totalTop = $field.position().top;         var objPage = getPageProperties(totalTop);         var Height = $field.outerHeight();         var Top = totalTop - objPage.sumHeight - Height;         var Page = objPage.pageNumber;         var RelPage = objPage.relPageNumber;         var Name = $field.attr('name');         if (lastFormID === objPage.formID) {             fieldInstance = counter + 1;                    }else{             counter = 0;             fieldInstance = counter + 1;          }         var Left = $field.position().left;         var Width = $field.width();          var FormID = objPage.formID;         lastFormID = FormID;         var Found = false;          $.each($customFields, function () {             if (this.Name === Name) {                 /*Field exists -> update values*/                 this.Name = Name;                 this.Left = Left;                 this.Top = Top;                 this.Width = Width;                 this.Height = Height;                 this.Page = Page;                 this.RelPage = RelPage;                 this.FormID;                 Found = true;                 return false;             }         });          if (!Found) {             /*Field does not exist -> create object and add to list*/             var metaDataObj = {};             metaDataObj.Name = Name;             metaDataObj.Left = Left;             metaDataObj.Top = Top;             metaDataObj.Width = Width;             metaDataObj.Height = Height;             metaDataObj.Page = Page;             metaDataObj.RelPage = RelPage;             metaDataObj.FormID = FormID;             $customFields.push(metaDataObj);         }     });         /*Update the hidden field value*/     $hdnMetaDataField.val(JSON.stringify($customFields)); }  function removeFieldFromHiddenValues(field) {     var $hdnMetaDataField = $('[name=\"Quik.CustomFieldMetaData\"]'),      $hdnMetaDataValue = $hdnMetaDataField.val() || '[]',      $customFields = JSON.parse($hdnMetaDataValue);      $customFields = $customFields.filter(function (e) { return e.Name !== $(field).attr('name') });     $hdnMetaDataField.val(JSON.stringify($customFields)); };  function displayCustomFieldsButtons(visible, selector) {     var $buttons = $(selector);     if (visible) {         $buttons.show();     } else {         $buttons.hide();     } };  function showCustomFieldsDiscardModal(minorInstructions, majorTitle) {     var cfDialog = $('<div id=\"alt-popup\">');     cfDialog.append('<div style=\"padding-bottom:10px;\"><span id=\"cfX\" style=\"float:right; font-weight:bold; cursor:pointer;\">X</span></div><div style=\"margin-bottom:15px; text-align:left;\"> <p>Clicking the <span style=\"color: red;\">Discard Changes</span> button will discard all changes made since your last save. Are you sure you want to discard all changes?</p></div><div><input id=\"cfBack\" type=\"button\" value=\"Back\" style=\"color:blue; float:left;\"></input><input id=\"cfDiscard\" type=\"button\" value=\"Discard Changes\" style=\"float:right; color:red;\"></input></div>');     cfDialog.dialog({ appendTo: 'body', closeOnEscape: false, width: 365, modal: true, title: '', position: { my: \"center top\", at: \"bottom\", of: btnCancelField } });     $(\".ui-dialog-titlebar\").hide();     $('.ui-button').removeClass('ui-button');     $('.ui-dialog-content').css('text-align', 'center');     $(\".ui-button\").removeClass(\"ui-button\");     $(\".ui-widget-overlay\").click(closePopUp);     $('#cfBack').click(closePopUp);     $('#cfX').click(closePopUp);     $('#cfDiscard').on('click', function () { discardCustomFields(minorInstructions, majorTitle) }); };  function discardCustomFields(minorInstructions, majorTitle) {     removeUnsavedFields();     undoUnsavedChanges();     changeMode(false, minorInstructions, majorTitle);     closePopUp(); };  function changeMode(isEdit, minorInstructions, majorTitle) {     var title = $('#majortitle');     var subtitle = $('#MinorInstructions');      if (isEdit) {         subtitle.text(\"Add new fields by clicking 'Add Field' button. Clicking 'Cancel' will discard your work and 'Save' will save your changes.\");         title.text(\"Edit Mode\");          displayCustomFieldsButtons(true, '.customFieldsButtons:not(:first)');         displayCustomFieldsButtons(false, 'input[type=button]:not(.customFieldsButtons)');         displayCustomFieldsButtons(true, $('.cfxbutton'));         displayCustomFieldsButtons(false, $('#btnEditCustomField'));         $('body:not(#wrapper)').css('backgroundColor', '#bcbcbc');         $('#footer').css('backgroundColor', '#bcbcbc');         $('#wrapper').css('outline', '2px #aa0000 dotted');         $('#headerlogo').closest('td').hide();     } else {         subtitle.text(minorInstructions);         title.text(majorTitle);          displayCustomFieldsButtons(false, '.customFieldsButtons:not(:first)');         displayCustomFieldsButtons(true, 'input[type=button]:not(.customFieldsButtons)');         displayCustomFieldsButtons(true, '.customFieldsButtons:first');         $('body:not(#wrapper)').css('backgroundColor', 'white');         $('#footer').css('backgroundColor', 'white');         $('#wrapper').css('outline', 'none');         $('#headerlogo').closest('td').show();     } };  function removeUnsavedFields() {     var hiddenFields = $('[name=\"Quik.CustomFieldMetaData\"]');     if (hiddenFields.val().length !== 0) {         var hiddenNames = [];          var controls = $($.parseJSON(hiddenFields.val()));         $.each(controls, function (key, value) {             hiddenNames.push(value.Name);         });          $('*[name*=\"QuikCustomField\"]').each(function () {             self = $(this);             if ($.inArray(self.attr('name'), hiddenNames) === -1) self.remove();         });     } };  function undoUnsavedChanges() {     $('input[type=\"text\"][name*=\"QuikCustomField\"]').show();     $('div[name*=\"QuikCustomField\"]').remove(); };  function removeOldCustomInputs() {     var $inputs = $('input[type=\"text\"][name*=\"QuikCustomField\"]');     var $divs = $('div[name*=\"QuikCustomField\"]').map(function () { return $(this).attr('name') });      $inputs.each(function () {         var self = $(this);         if ($.inArray(self.attr('name'), $divs) === -1) {             removeFieldFromHiddenValues(self);             self.remove();         };     }); };  function customFieldsCancelClick(minorInstructions, majorTitle) {     showCustomFieldsDiscardModal(minorInstructions, majorTitle); }; function customFieldsCreateClick() {     var $div = $('<div>');     var $button = createXButton();     var dragDivs = $('div[name*=\"QuikCustomField\"]');     var ids = [];     dragDivs.each(function () {         id = $(this).data('id');         if (!isNaN(id)) ids.push(id + 1);     });     var id = dragDivs.length == 0 ? 1 : Math.max.apply(Math, ids);     var divName = 'QuikCustomField.' + id;     $div.attr({         'id': divName,         'name': divName     })     .css({         'border': '2px #aa0000 dotted',         'position': 'absolute',         'top': $('#QFVPageList').offset().top * -1 + 400,         'left': 300,         'width': '150px',         'height': '14.56pt',         'cursor': 'move',         'z-index': 999999999,         'box-sizing': 'border-box'     })     .data('id', id)     .addClass('ui-widget-content')     .draggable({         drag: function (event, ui) {             $button.hide();         },         stop: function (event, ui) {             $button.show();         },         start: function (event, ui) {             $button.show();         }     })     .resizable({         handles: \"all\",         resize: function (event, ui) {             $button.hide();         },         stop: function (event, ui) {             $button.show();         },         start: function (event, ui) {             $button.show();         }     });     $div.append($button);     $('#QFVPageList').append($div); }; function customFieldsSaveClick(minorInstructions, majorTitle) {     removeOldCustomInputs();     var customDivs = $('div[name*=\"QuikCustomField\"]');     customDivs.each(function () {         divToInput(this);     });     SaveCustomFields();     changeMode(false, minorInstructions, majorTitle); }; function customFieldsEditClick(minorInstructions, majorTitle) {     var hiddenFields = $('[name=\"Quik.CustomFieldMetaData\"]');     if (hiddenFields.val().length !== 0) {         var hiddenNames = [];         var controls = $($.parseJSON(hiddenFields.val()));         $.each(controls, function (key, value) {             hiddenNames.push(value.Name);         });          $('input[type=\"text\"][name*=\"QuikCustomField\"]').each(function () {             var self = $(this);             var $button = createXButton();             if ($.inArray(self.attr('name'), hiddenNames) > -1) {                 var $div = $('<div>');                 $div.attr({                     'id': self.attr('name'),                     'name': self.attr('name')                 })                 .css({                     'border': '2px #aa0000 dotted',                     'position': 'absolute',                     'top': self.css('top'),                     'left': self.css('left'),                     'width': self.css('width'),                     'height': self.css('height'),                     'cursor': 'move',                     'z-index': 999999999,                     'box-sizing': 'border-box'                 })                 .data('id', self.data(\"id\"))                 .addClass('ui-widget-content')                 .draggable({                     drag: function (event, ui) {                         $button.hide();                     },                     stop: function (event, ui) {                         $button.show();                     },                     start: function (event, ui) {                         $button.show();                     }                 })                 .resizable({                     handles: \"all\",                     resize: function (event, ui) {                         $button.hide();                     },                     stop: function (event, ui) {                         $button.show();                     },                     start: function (event, ui) {                         $button.show();                     }                 });                 $div.append($button);                     $('#QFVPageList').append($div);                 self.hide();             }         });     }     changeMode(true, majorTitle, minorInstructions); };  function divToInput(sourceDiv) {     var replacementTag = \"input type='text'\";     var $source = $(sourceDiv);     $source.find('*').remove();     var dataID = $source.data('id');     var outer = $source.clone().wrap('<div>').parent().html();     var name = $source.attr('name');     var $hiddenInput = $('input[type=text][name=\"' + name + '\"]');     var lastInputText = $hiddenInput.length === 0 ? '' : $hiddenInput.val();     $hiddenInput.remove();     var tagName = $source.prop('tagName');     var regex = new RegExp('<' + tagName, 'i');     var newTag = outer.replace(regex, '<' + replacementTag);     regex = new RegExp('</' + tagName, 'i');     newTag = newTag.replace(regex, '</' + replacementTag);     $source.replaceWith(newTag);     var $input = $('input[name=\"' + name + '\"]');     $input.css({         'cursor': 'default',         'border': 'solid 1px black'     })     .val(lastInputText)     .removeClass()     .data('id', dataID); }  function createXButton() {      var $button = $('<input type=\"button\">');      $button.attr({         'value': 'x'     })     .css({         'position': 'absolute',         'right': -18,         'padding': '0',         'cursor': 'pointer',         'z-index': 999999999,         'box-sizing': 'border-box',         'font-weight': 'bold',         'background-color': 'transparent',         'text-align': 'center',         'border-style': 'none',         'color': '#aa0000',         'top': '50%',         'margin-top': '-10px',         'font': '15px Arial'     })     .addClass('cfxbutton')     .click(function () {         var self = $(this);         var parent = self.parent();         parent.remove();     });     return $button; }  function showCustomDialog(options) {     var buttonData = options.data;     var getDDLOption = function (val, txt) {         return $('<option>').val(val).html(txt);     };      if ((myScroll) && (ieVersion > 8 || ieVersion < 0)) myScroll.scrollToElement(id, 0, 0, -250);     closePopUp();     var n = $('<div id=\"alt-popup\">');     var title = buttonData.Title ? buttonData.Title : \"Select Your Information\";     $(n).append('<h1>' + title + '</h1>');     var ddlOptions = $('<select id=\"ddlOptions\"></select>');      ddlOptions.append(getDDLOption('grp-clr', ''));     if (buttonData.Groups) {         for (var i = 0; i < buttonData.Groups.length; i++) {             ddlOptions.append(getDDLOption(buttonData.Groups[i].GroupLabel, buttonData.Groups[i].GroupLabel));         }     }      ddlOptions.val($(options.btn).data('grp'));      $(n).append(ddlOptions);     $(n).addClass('custom-button-popup');     $(n).dialog({ appendTo: \"body\", draggable: false, resizable: false, title: \"Select an option\", closeOnEscape: true, modal: true, position: { my: \"center top\", at: \"center\", of: window.wrapper }, buttons: { \"Cancel\": function () { $(this).dialog(\"close\"); }, \"Select\": function () { AddFieldsData(options); } } });      var popUpHeight = $(\".ui-dialog\").height();     var currentTop = $(\".ui-dialog\").position().top;     $(\".ui-dialog\").css('top', currentTop - popUpHeight * 0.5);     $(\".ui-dialog-titlebar\").hide();     $(\".ui-dialog\").css(\"width\", \"auto\");     $(\".ui-dialog\").css(\"min-width\", \"350px\");     $(\".ui-widget-overlay\").bind(\"click\", function () { closePopUp(); });     $(\".ui-dialog-buttonpane\").css(\"border-width\", \"0\"); }  function AddFieldsData(options) {     var buttonData = options.data;     if (!buttonData.Groups) {         closePopUp();         return;     }      var valSelected = $(\"#ddlOptions\").val();     var groupFields = valSelected == \"grp-clr\" ? buttonData.Groups[0].Fields : SearchGroup(buttonData, valSelected);     for (var i = 0; i < groupFields.length; i++) {         var val = valSelected == \"grp-clr\" ? \"\" : groupFields[i].Value;         var groupFieldsFound = $(\"input[name='\" + groupFields[i].Name + \"']\");         if (isCheckbox(groupFieldsFound)) {             for (var j = 0; j < groupFieldsFound.length; j++)                 groupFieldsFound[j].checked = groupFieldsFound[j].value === val;         } else             groupFieldsFound.val(val);     }     closePopUp();     $(options.btn).data('grp', valSelected); }  function SearchGroup(buttonData, valSelected) {     var output = \"\";     for (var i = 0; i < buttonData.Groups.length; i++) {         if (buttonData.Groups[i].GroupLabel === valSelected)             output = buttonData.Groups[i].Fields;     }     return output; }  function HtmlDecode(s) { var out = \"\"; if (s == null) return; var l = s.length; for (var i = 0; i < l; i++) { var ch = s.charAt(i); if (ch == '&') { var semicolonIndex = s.indexOf(';', i + 1); if (semicolonIndex > 0) { var entity = s.substring(i + 1, semicolonIndex); if (entity.length > 1 && entity.charAt(0) == '#') { if (entity.charAt(1) == 'x' || entity.charAt(1) == 'X') ch = String.fromCharCode(eval('0' + entity.substring(1))); else ch = String.fromCharCode(eval(entity.substring(1))) } else { switch (entity) { case 'quot': ch = String.fromCharCode(0x0022); break; case 'amp': ch = String.fromCharCode(0x0026); break; case 'lt': ch = String.fromCharCode(0x003c); break; case 'gt': ch = String.fromCharCode(0x003e); break; case 'nbsp': ch = String.fromCharCode(0x00a0); break; case 'iexcl': ch = String.fromCharCode(0x00a1); break; case 'cent': ch = String.fromCharCode(0x00a2); break; case 'pound': ch = String.fromCharCode(0x00a3); break; case 'curren': ch = String.fromCharCode(0x00a4); break; case 'yen': ch = String.fromCharCode(0x00a5); break; case 'brvbar': ch = String.fromCharCode(0x00a6); break; case 'sect': ch = String.fromCharCode(0x00a7); break; case 'uml': ch = String.fromCharCode(0x00a8); break; case 'copy': ch = String.fromCharCode(0x00a9); break; case 'ordf': ch = String.fromCharCode(0x00aa); break; case 'laquo': ch = String.fromCharCode(0x00ab); break; case 'not': ch = String.fromCharCode(0x00ac); break; case 'shy': ch = String.fromCharCode(0x00ad); break; case 'reg': ch = String.fromCharCode(0x00ae); break; case 'macr': ch = String.fromCharCode(0x00af); break; case 'deg': ch = String.fromCharCode(0x00b0); break; case 'plusmn': ch = String.fromCharCode(0x00b1); break; case 'sup2': ch = String.fromCharCode(0x00b2); break; case 'sup3': ch = String.fromCharCode(0x00b3); break; case 'acute': ch = String.fromCharCode(0x00b4); break; case 'micro': ch = String.fromCharCode(0x00b5); break; case 'para': ch = String.fromCharCode(0x00b6); break; case 'middot': ch = String.fromCharCode(0x00b7); break; case 'cedil': ch = String.fromCharCode(0x00b8); break; case 'sup1': ch = String.fromCharCode(0x00b9); break; case 'ordm': ch = String.fromCharCode(0x00ba); break; case 'raquo': ch = String.fromCharCode(0x00bb); break; case 'frac14': ch = String.fromCharCode(0x00bc); break; case 'frac12': ch = String.fromCharCode(0x00bd); break; case 'frac34': ch = String.fromCharCode(0x00be); break; case 'iquest': ch = String.fromCharCode(0x00bf); break; case 'Agrave': ch = String.fromCharCode(0x00c0); break; case 'Aacute': ch = String.fromCharCode(0x00c1); break; case 'Acirc': ch = String.fromCharCode(0x00c2); break; case 'Atilde': ch = String.fromCharCode(0x00c3); break; case 'Auml': ch = String.fromCharCode(0x00c4); break; case 'Aring': ch = String.fromCharCode(0x00c5); break; case 'AElig': ch = String.fromCharCode(0x00c6); break; case 'Ccedil': ch = String.fromCharCode(0x00c7); break; case 'Egrave': ch = String.fromCharCode(0x00c8); break; case 'Eacute': ch = String.fromCharCode(0x00c9); break; case 'Ecirc': ch = String.fromCharCode(0x00ca); break; case 'Euml': ch = String.fromCharCode(0x00cb); break; case 'Igrave': ch = String.fromCharCode(0x00cc); break; case 'Iacute': ch = String.fromCharCode(0x00cd); break; case 'Icirc': ch = String.fromCharCode(0x00ce); break; case 'Iuml': ch = String.fromCharCode(0x00cf); break; case 'ETH': ch = String.fromCharCode(0x00d0); break; case 'Ntilde': ch = String.fromCharCode(0x00d1); break; case 'Ograve': ch = String.fromCharCode(0x00d2); break; case 'Oacute': ch = String.fromCharCode(0x00d3); break; case 'Ocirc': ch = String.fromCharCode(0x00d4); break; case 'Otilde': ch = String.fromCharCode(0x00d5); break; case 'Ouml': ch = String.fromCharCode(0x00d6); break; case 'times': ch = String.fromCharCode(0x00d7); break; case 'Oslash': ch = String.fromCharCode(0x00d8); break; case 'Ugrave': ch = String.fromCharCode(0x00d9); break; case 'Uacute': ch = String.fromCharCode(0x00da); break; case 'Ucirc': ch = String.fromCharCode(0x00db); break; case 'Uuml': ch = String.fromCharCode(0x00dc); break; case 'Yacute': ch = String.fromCharCode(0x00dd); break; case 'THORN': ch = String.fromCharCode(0x00de); break; case 'szlig': ch = String.fromCharCode(0x00df); break; case 'agrave': ch = String.fromCharCode(0x00e0); break; case 'aacute': ch = String.fromCharCode(0x00e1); break; case 'acirc': ch = String.fromCharCode(0x00e2); break; case 'atilde': ch = String.fromCharCode(0x00e3); break; case 'auml': ch = String.fromCharCode(0x00e4); break; case 'aring': ch = String.fromCharCode(0x00e5); break; case 'aelig': ch = String.fromCharCode(0x00e6); break; case 'ccedil': ch = String.fromCharCode(0x00e7); break; case 'egrave': ch = String.fromCharCode(0x00e8); break; case 'eacute': ch = String.fromCharCode(0x00e9); break; case 'ecirc': ch = String.fromCharCode(0x00ea); break; case 'euml': ch = String.fromCharCode(0x00eb); break; case 'igrave': ch = String.fromCharCode(0x00ec); break; case 'iacute': ch = String.fromCharCode(0x00ed); break; case 'icirc': ch = String.fromCharCode(0x00ee); break; case 'iuml': ch = String.fromCharCode(0x00ef); break; case 'eth': ch = String.fromCharCode(0x00f0); break; case 'ntilde': ch = String.fromCharCode(0x00f1); break; case 'ograve': ch = String.fromCharCode(0x00f2); break; case 'oacute': ch = String.fromCharCode(0x00f3); break; case 'ocirc': ch = String.fromCharCode(0x00f4); break; case 'otilde': ch = String.fromCharCode(0x00f5); break; case 'ouml': ch = String.fromCharCode(0x00f6); break; case 'divide': ch = String.fromCharCode(0x00f7); break; case 'oslash': ch = String.fromCharCode(0x00f8); break; case 'ugrave': ch = String.fromCharCode(0x00f9); break; case 'uacute': ch = String.fromCharCode(0x00fa); break; case 'ucirc': ch = String.fromCharCode(0x00fb); break; case 'uuml': ch = String.fromCharCode(0x00fc); break; case 'yacute': ch = String.fromCharCode(0x00fd); break; case 'thorn': ch = String.fromCharCode(0x00fe); break; case 'yuml': ch = String.fromCharCode(0x00ff); break; case 'OElig': ch = String.fromCharCode(0x0152); break; case 'oelig': ch = String.fromCharCode(0x0153); break; case 'Scaron': ch = String.fromCharCode(0x0160); break; case 'scaron': ch = String.fromCharCode(0x0161); break; case 'Yuml': ch = String.fromCharCode(0x0178); break; case 'fnof': ch = String.fromCharCode(0x0192); break; case 'circ': ch = String.fromCharCode(0x02c6); break; case 'tilde': ch = String.fromCharCode(0x02dc); break; case 'Alpha': ch = String.fromCharCode(0x0391); break; case 'Beta': ch = String.fromCharCode(0x0392); break; case 'Gamma': ch = String.fromCharCode(0x0393); break; case 'Delta': ch = String.fromCharCode(0x0394); break; case 'Epsilon': ch = String.fromCharCode(0x0395); break; case 'Zeta': ch = String.fromCharCode(0x0396); break; case 'Eta': ch = String.fromCharCode(0x0397); break; case 'Theta': ch = String.fromCharCode(0x0398); break; case 'Iota': ch = String.fromCharCode(0x0399); break; case 'Kappa': ch = String.fromCharCode(0x039a); break; case 'Lambda': ch = String.fromCharCode(0x039b); break; case 'Mu': ch = String.fromCharCode(0x039c); break; case 'Nu': ch = String.fromCharCode(0x039d); break; case 'Xi': ch = String.fromCharCode(0x039e); break; case 'Omicron': ch = String.fromCharCode(0x039f); break; case 'Pi': ch = String.fromCharCode(0x03a0); break; case ' Rho ': ch = String.fromCharCode(0x03a1); break; case 'Sigma': ch = String.fromCharCode(0x03a3); break; case 'Tau': ch = String.fromCharCode(0x03a4); break; case 'Upsilon': ch = String.fromCharCode(0x03a5); break; case 'Phi': ch = String.fromCharCode(0x03a6); break; case 'Chi': ch = String.fromCharCode(0x03a7); break; case 'Psi': ch = String.fromCharCode(0x03a8); break; case 'Omega': ch = String.fromCharCode(0x03a9); break; case 'alpha': ch = String.fromCharCode(0x03b1); break; case 'beta': ch = String.fromCharCode(0x03b2); break; case 'gamma': ch = String.fromCharCode(0x03b3); break; case 'delta': ch = String.fromCharCode(0x03b4); break; case 'epsilon': ch = String.fromCharCode(0x03b5); break; case 'zeta': ch = String.fromCharCode(0x03b6); break; case 'eta': ch = String.fromCharCode(0x03b7); break; case 'theta': ch = String.fromCharCode(0x03b8); break; case 'iota': ch = String.fromCharCode(0x03b9); break; case 'kappa': ch = String.fromCharCode(0x03ba); break; case 'lambda': ch = String.fromCharCode(0x03bb); break; case 'mu': ch = String.fromCharCode(0x03bc); break; case 'nu': ch = String.fromCharCode(0x03bd); break; case 'xi': ch = String.fromCharCode(0x03be); break; case 'omicron': ch = String.fromCharCode(0x03bf); break; case 'pi': ch = String.fromCharCode(0x03c0); break; case 'rho': ch = String.fromCharCode(0x03c1); break; case 'sigmaf': ch = String.fromCharCode(0x03c2); break; case 'sigma': ch = String.fromCharCode(0x03c3); break; case 'tau': ch = String.fromCharCode(0x03c4); break; case 'upsilon': ch = String.fromCharCode(0x03c5); break; case 'phi': ch = String.fromCharCode(0x03c6); break; case 'chi': ch = String.fromCharCode(0x03c7); break; case 'psi': ch = String.fromCharCode(0x03c8); break; case 'omega': ch = String.fromCharCode(0x03c9); break; case 'thetasym': ch = String.fromCharCode(0x03d1); break; case 'upsih': ch = String.fromCharCode(0x03d2); break; case 'piv': ch = String.fromCharCode(0x03d6); break; case 'ensp': ch = String.fromCharCode(0x2002); break; case 'emsp': ch = String.fromCharCode(0x2003); break; case 'thinsp': ch = String.fromCharCode(0x2009); break; case 'zwnj': ch = String.fromCharCode(0x200c); break; case 'zwj': ch = String.fromCharCode(0x200d); break; case 'lrm': ch = String.fromCharCode(0x200e); break; case 'rlm': ch = String.fromCharCode(0x200f); break; case 'ndash': ch = String.fromCharCode(0x2013); break; case 'mdash': ch = String.fromCharCode(0x2014); break; case 'lsquo': ch = String.fromCharCode(0x2018); break; case 'rsquo': ch = String.fromCharCode(0x2019); break; case 'sbquo': ch = String.fromCharCode(0x201a); break; case 'ldquo': ch = String.fromCharCode(0x201c); break; case 'rdquo': ch = String.fromCharCode(0x201d); break; case 'bdquo': ch = String.fromCharCode(0x201e); break; case 'dagger': ch = String.fromCharCode(0x2020); break; case 'Dagger': ch = String.fromCharCode(0x2021); break; case 'bull': ch = String.fromCharCode(0x2022); break; case 'hellip': ch = String.fromCharCode(0x2026); break; case 'permil': ch = String.fromCharCode(0x2030); break; case 'prime': ch = String.fromCharCode(0x2032); break; case 'Prime': ch = String.fromCharCode(0x2033); break; case 'lsaquo': ch = String.fromCharCode(0x2039); break; case 'rsaquo': ch = String.fromCharCode(0x203a); break; case 'oline': ch = String.fromCharCode(0x203e); break; case 'frasl': ch = String.fromCharCode(0x2044); break; case 'euro': ch = String.fromCharCode(0x20ac); break; case 'image': ch = String.fromCharCode(0x2111); break; case 'weierp': ch = String.fromCharCode(0x2118); break; case 'real': ch = String.fromCharCode(0x211c); break; case 'trade': ch = String.fromCharCode(0x2122); break; case 'alefsym': ch = String.fromCharCode(0x2135); break; case 'larr': ch = String.fromCharCode(0x2190); break; case 'uarr': ch = String.fromCharCode(0x2191); break; case 'rarr': ch = String.fromCharCode(0x2192); break; case 'darr': ch = String.fromCharCode(0x2193); break; case 'harr': ch = String.fromCharCode(0x2194); break; case 'crarr': ch = String.fromCharCode(0x21b5); break; case 'lArr': ch = String.fromCharCode(0x21d0); break; case 'uArr': ch = String.fromCharCode(0x21d1); break; case 'rArr': ch = String.fromCharCode(0x21d2); break; case 'dArr': ch = String.fromCharCode(0x21d3); break; case 'hArr': ch = String.fromCharCode(0x21d4); break; case 'forall': ch = String.fromCharCode(0x2200); break; case 'part': ch = String.fromCharCode(0x2202); break; case 'exist': ch = String.fromCharCode(0x2203); break; case 'empty': ch = String.fromCharCode(0x2205); break; case 'nabla': ch = String.fromCharCode(0x2207); break; case 'isin': ch = String.fromCharCode(0x2208); break; case 'notin': ch = String.fromCharCode(0x2209); break; case 'ni': ch = String.fromCharCode(0x220b); break; case 'prod': ch = String.fromCharCode(0x220f); break; case 'sum': ch = String.fromCharCode(0x2211); break; case 'minus': ch = String.fromCharCode(0x2212); break; case 'lowast': ch = String.fromCharCode(0x2217); break; case 'radic': ch = String.fromCharCode(0x221a); break; case 'prop': ch = String.fromCharCode(0x221d); break; case 'infin': ch = String.fromCharCode(0x221e); break; case 'ang': ch = String.fromCharCode(0x2220); break; case 'and': ch = String.fromCharCode(0x2227); break; case 'or': ch = String.fromCharCode(0x2228); break; case 'cap': ch = String.fromCharCode(0x2229); break; case 'cup': ch = String.fromCharCode(0x222a); break; case 'int': ch = String.fromCharCode(0x222b); break; case 'there4': ch = String.fromCharCode(0x2234); break; case 'sim': ch = String.fromCharCode(0x223c); break; case 'cong': ch = String.fromCharCode(0x2245); break; case 'asymp': ch = String.fromCharCode(0x2248); break; case 'ne': ch = String.fromCharCode(0x2260); break; case 'equiv': ch = String.fromCharCode(0x2261); break; case 'le': ch = String.fromCharCode(0x2264); break; case 'ge': ch = String.fromCharCode(0x2265); break; case 'sub': ch = String.fromCharCode(0x2282); break; case 'sup': ch = String.fromCharCode(0x2283); break; case 'nsub': ch = String.fromCharCode(0x2284); break; case 'sube': ch = String.fromCharCode(0x2286); break; case 'supe': ch = String.fromCharCode(0x2287); break; case 'oplus': ch = String.fromCharCode(0x2295); break; case 'otimes': ch = String.fromCharCode(0x2297); break; case 'perp': ch = String.fromCharCode(0x22a5); break; case 'sdot': ch = String.fromCharCode(0x22c5); break; case 'lceil': ch = String.fromCharCode(0x2308); break; case 'rceil': ch = String.fromCharCode(0x2309); break; case 'lfloor': ch = String.fromCharCode(0x230a); break; case 'rfloor': ch = String.fromCharCode(0x230b); break; case 'lang': ch = String.fromCharCode(0x2329); break; case 'rang': ch = String.fromCharCode(0x232a); break; case 'loz': ch = String.fromCharCode(0x25ca); break; case 'spades': ch = String.fromCharCode(0x2660); break; case 'clubs': ch = String.fromCharCode(0x2663); break; case 'hearts': ch = String.fromCharCode(0x2665); break; case 'diams': ch = String.fromCharCode(0x2666); break; default: ch = ''; break } } i = semicolonIndex } } out += ch } return out }  var $container = $('#QFVContainer');  var onLabelClick = function () {      var $labels = $container.find('label').filter(function () {         var radioID = '#' + $(this).attr('for');         return $(radioID).is(':radio') && $(radioID).is(':enabled');     });     $labels.on('click', function (e) {         e.preventDefault();         var radio = $('#' + $(this).attr('for'))[0];         radio.focus();         return updateRadiosAndCheckboxes(radio, !radio.checked);     }); };  var onRadioKeyup = function () {     $container.find('input:radio').keyup(function (e) {         /*Select code are the keycodes of the space and arrows keys wich can check/uncheck radio buttons */         var targetCodes = [32, 37, 38, 39, 40];         var isTargetCode = $.inArray(e.which || e.keyCode, targetCodes) !== -1;         if (!isTargetCode) return true;          updateRadiosAndCheckboxes(this, !this.checked);         cbRequired(this);         return false;     }); };  var onCheckboxChange = function () {     $container.find('input:checkbox').change(function () {         return setProgressiveFillDataForCheckBoxesAndRadios(this);     }); };  var toggleDottedFrameInCheckableInputs = function () {     $(':checkbox, :radio')         .css({             'display': 'inline',             'z-index': '-1'         })         .focus(function () {             applyDottedFrame(getLabel(this.id), true);         })         .blur(function () {             applyDottedFrame(getLabel(this.id), false);         }); };  var applyDottedFrame = function (elem, show) {     return elem.css({ 'border': show ? 'dotted 1px' : 'none' }); };  var getLabel = function (id) {     return $(\"label[for='\" + id + \"']\"); };  var getInputByName = function (name) {     return $('input[name=\"' + name + '\"]'); };  var getRadio = function (elem) {     return $('#' + $(elem).attr('for')); };  function cbRequired(elem) {     var $input = getInputByName(elem.name);     if (!getLabel(elem.id).hasClass('isrequired')) return;          var allLabels = $input.map(function() { return getLabel(this.id)[0]; });     var existsChecked = $input.filter(function() { return $(this).prop('checked'); }).length;     existsChecked ? allLabels.removeClass('cbrequired') :allLabels.addClass('cbrequired'); }  function setRequiredCheckboxes() {     var $radios = $('#wrapper input:radio');     $radios.each(function() {         cbRequired(this);     });     $radios.click(function (e) {         e.preventDefault();     }); }  function isCheckbox(selector) {     var $result = $(selector)[0];     return $result && ($result.type === 'checkbox' || $result.type === 'radio'); }  function setProgressiveFillDataForCheckBoxesAndRadios(input) {     return updateRadiosAndCheckboxes(input, input.checked); }  function updateRadiosAndCheckboxes(input, checked) {     var name = input.name.substring(input.name.indexOf('.') + 1);     var allRadios = $('input[name$=\"' + name + '\"]');     allRadios.prop('checked', false);     var inputs = allRadios.filter(function () {         return this.value === input.value;     });     inputs.each(function() {         $(this).prop('checked', checked).keyup();     });     return false; }  function getQuikRadio(fieldName) {     var arrayByDots = fieldName.split('.');     arrayByDots[0] = '';     var name = arrayByDots.join('.');     return getInputByName(name).length > 0 ? getInputByName(name) : undefined; }  var allCheckboxesUnchecked = function (name) {     return !getInputByName(name).toArray().some(function (cb) {         return cb.checked;     }); };  var removeQuikRadioPrefix = function (name) {     return name.replace(/QuikRadio[0-9]+./g, '') };  RunQFEScripts({'UNID': 'UNID=Iv0B%2bkfgnWQlobJH%2bSlZsdrTi2H3gkhYSxu3gwMQZEXhJ%2bJFadr0iO%2bzEozc1Xpm','FormIds': [\"12\"],'FormExpiryDate': '06/16/2022','EnableNativeESign': false,'iScrollOff': true,'HTMLShowButtonPrint': true,'SaveURL': '','SaveURL_RestQFE': 'https://websvcs.quikforms.com/rest/QuikFormsEngine/save','AttachmentsBaseUrl': 'https://websvcs.quikforms.com/rest/QuikFormsEngine/','PrintURL': 'https://websvcs.quikforms.com/rest/QuikFormsEngine/print/submit','PrintEditablePDF': false,'SubmitJavascript': '','HTMLMinorInstruction': 'Review and complete your forms below. When done, print, submit and/or save for your records.','HTMLShowButtonSubmit': false,'HTMLShowButtonClear': true,'HTMLShowButtonSave': true,'HTMLShowButtonReset': true,'HTMLShowAltDataButtons': true,'ShowButtonEmail': false,'HTMLFormViewURL': 'https://websvcs.quikforms.com/HTMLFormViewTrans/v5400','RoutingRulesOn': false,'PreviewMode': false,'DraftMode': false,'AutoCenterFieldsOff': true,'EmailSendButtonURL': 'https://websvcs.quikforms.com/HTMLFormViewTrans/v5400/Submit.aspx','FormPackageAlreadyNamed': false,'EnableCustomFieldEditor': true,'SaveJavascript': '','FormPackageName': '','SubmitContentType': 'Legacy'}); var alternateDataBlocks = { '1own-0':{ 'Headers':[ 'FName', 'LName', 'FullName' ], 'Data':[ [ 'Joe', 'Smith', 'Joe Smith' ] ], 'SystemName':'Owner 1' }, '1own-7-0':{ 'Headers':[ 'FullNameRev' ], 'Data':[ [ 'Smith, Joe' ] ], 'SystemName':'Owner 1' } };function getGroupList(a){var ret=\"\";var json={'ContactNameGroup':['FullName','Prefix','FName','MName','LName','Suffix'],'SocialSecurityNumberGroup':['SSN','TaxID','EmpTaxID'],'AddressGroup':['FullAddr','Addr123','CityStateZip','Addr1','Addr2','Addr3','Addr4','City','State','Zip','Country','County','ForeignRoute'],'PhoneGroup':['Phone','Fax','Mobile','Pager','Other'],'EmailGroup':['Email'],'IdentificationGroup':['ID','IDCountry','IDState','IDExpire','IDIssueDate','IDCopied','IDType','IDTypeOther','IDVerified','IDVerifiedNotes','IDVerifiedMethod'],'RepresentativeNumbersGroup':['RepNumber','RepNumber2','RepNumber3','RepNumber4','RepNumber5','RepNumber6','RepNumber7','RepNumber8','RepNumber9','RepNumber10','RepNumber11','RepNumber12','RepNumber13','RepNumber14','RepNumber15','RepLicNum','RepLicNum1','RepLicNum2','RepLicNum3','RepLicNum4','RepLicNum5','RepLicNum6','RepLicNum7','RepLicNum8','RepLicNum9','RepLicNum10','RepLicNum11','RepLicNum12','RepLicNum13','RepLicNum14']}; for(var e in json){ if(e===a){ ret=json[e];}}  return ret;}$(\"#wrapper\").width(\"620pt\"); $(\"#navWrapper\").css('left','642pt'); var blockList=[ { 'ContactNameGroup':{ '1own-FName-179070330':[ 'FName', 'Joe' ], '1own-LName-179070332':[ 'LName', 'Smith' ] } }, { 'ContactNameGroup':{ '2own-FName-179070343':[ 'FName', null ], '2own-LName-179070345':[ 'LName', null ] } }, { 'ContactNameGroup':{ '1ben-FName-179070426':[ 'FName', null ], '1ben-LName-179070428':[ 'LName', null ] } }, { 'ContactNameGroup':{ '2ben-FName-179070444':[ 'FName', null ], '2ben-LName-179070446':[ 'LName', null ] } }, { 'ContactNameGroup':{ '3ben-FName-179070460':[ 'FName', null ], '3ben-LName-179070462':[ 'LName', null ] } }, { 'ContactNameGroup':{ '1cben-FName-179070476':[ 'FName', null ], '1cben-LName-179070478':[ 'LName', null ] } }, { 'ContactNameGroup':{ '2cben-FName-179070494':[ 'FName', null ], '2cben-LName-179070496':[ 'LName', null ] } }, { 'ContactNameGroup':{ '3cben-FName-179070510':[ 'FName', null ], '3cben-LName-179070512':[ 'LName', null ] } }, { 'ContactNameGroup':{ '4cben-FName-179070526':[ 'FName', null ], '4cben-LName-179070528':[ 'LName', null ] } }, { 'ContactNameGroup':{ '1wit-FullName-179070549':[ 'FullName', null ] } }, { 'ContactNameGroup':{ '2wit-FullName-179070550':[ 'FullName', null ] } }, { 'ContactNameGroup':{ '1rep-FullName-179070555':[ 'FullName', null ] } }, { 'ContactNameGroup':{ '1spou-FullName-179070565':[ 'FullName', null ] } }, { 'ContactNameGroup':{ '2spou-FullName-179070567':[ 'FullName', null ] } } ]; var show = true, ieVersion = -1, myScroll, myScroll2, myScroll3;  function setInputMasks(){$('#1own-SSN-179070327').inputmask('###-##-####'); $('#1own-SSN-179070327').inputmask('###-##-####'); $('#1own-DOB-179070328').datemask(''); $('#1own-DOB-179070328').datemask(''); $('#1own-O-Phone-179070342').inputmask('(###) ###-####'); $('#1own-O-Phone-179070342').inputmask('(###) ###-####'); $('#2own-O-Phone-179070351').inputmask('(###) ###-####'); $('#2own-O-Phone-179070351').inputmask('(###) ###-####'); $('#2own-SSN-179070352').inputmask('###-##-####'); $('#2own-SSN-179070352').inputmask('###-##-####'); $('#2own-DOB-179070353').datemask(''); $('#2own-DOB-179070353').datemask(''); $('#1ben-DOB-179070441').datemask(''); $('#1ben-DOB-179070441').datemask(''); $('#1ben-SSN-179070442').inputmask('###-##-####'); $('#1ben-SSN-179070442').inputmask('###-##-####'); $('#2ben-DOB-179070457').datemask(''); $('#2ben-DOB-179070457').datemask(''); $('#2ben-SSN-179070458').inputmask('###-##-####'); $('#2ben-SSN-179070458').inputmask('###-##-####'); $('#3ben-DOB-179070473').datemask(''); $('#3ben-DOB-179070473').datemask(''); $('#3ben-SSN-179070474').inputmask('###-##-####'); $('#3ben-SSN-179070474').inputmask('###-##-####'); $('#1cben-DOB-179070491').datemask(''); $('#1cben-DOB-179070491').datemask(''); $('#1cben-SSN-179070492').inputmask('###-##-####'); $('#1cben-SSN-179070492').inputmask('###-##-####'); $('#2cben-DOB-179070507').datemask(''); $('#2cben-DOB-179070507').datemask(''); $('#2cben-SSN-179070508').inputmask('###-##-####'); $('#2cben-SSN-179070508').inputmask('###-##-####'); $('#3cben-DOB-179070523').datemask(''); $('#3cben-DOB-179070523').datemask(''); $('#3cben-SSN-179070524').inputmask('###-##-####'); $('#3cben-SSN-179070524').inputmask('###-##-####'); $('#4cben-DOB-179070539').datemask(''); $('#4cben-DOB-179070539').datemask(''); $('#4cben-SSN-179070540').inputmask('###-##-####'); $('#4cben-SSN-179070540').inputmask('###-##-####'); $('#1ntry-LicenseExpiry-179070548').datemask(''); $('#1ntry-LicenseExpiry-179070548').datemask(''); $('#1rep-P-Phone-179070558').inputmask('(###) ###-####'); $('#1rep-P-Phone-179070558').inputmask('(###) ###-####'); } function myScrollToEvent(liChild) { var id = '#' + liChild.id; $('#wrapper').scrollTop($(id).position().top); } $(document).ready(function(){ setCalculatedField('1own-H-Addr123-179070333', {\"H.Addr1\":\"Home or Legal Address Line 1\",\"H.Addr2\":\"Home or Legal Address Line 2\",\"H.Addr3\":\"Home or Legal Address Line 3\",\"H.Addr4\":\"Home or Legal Address Line 4\"});  setCalculatedField('1own-M-Addr123-179070337', {\"M.Addr1\":\"Mailing Address Line 1\",\"M.Addr2\":\"Mailing Address Line 2\",\"M.Addr3\":\"Mailing Address Line 3\",\"M.Addr4\":\"Mailing Address Line 4\"});  setCalculatedField('2own-H-Addr123-179070346', {\"H.Addr1\":\"Home or Legal Address Line 1\",\"H.Addr2\":\"Home or Legal Address Line 2\",\"H.Addr3\":\"Home or Legal Address Line 3\",\"H.Addr4\":\"Home or Legal Address Line 4\"});  setCalculatedField('1ben-H-Addr123-179070431', {\"H.Addr1\":\"Home or Legal Address Line 1\",\"H.Addr2\":\"Home or Legal Address Line 2\",\"H.Addr3\":\"Home or Legal Address Line 3\",\"H.Addr4\":\"Home or Legal Address Line 4\"});  setCalculatedField('2ben-H-Addr123-179070448', {\"H.Addr1\":\"Home or Legal Address Line 1\",\"H.Addr2\":\"Home or Legal Address Line 2\",\"H.Addr3\":\"Home or Legal Address Line 3\",\"H.Addr4\":\"Home or Legal Address Line 4\"});  setCalculatedField('3ben-H-Addr123-179070464', {\"H.Addr1\":\"Home or Legal Address Line 1\",\"H.Addr2\":\"Home or Legal Address Line 2\",\"H.Addr3\":\"Home or Legal Address Line 3\",\"H.Addr4\":\"Home or Legal Address Line 4\"});  setCalculatedField('1cben-H-Addr123-179070481', {\"H.Addr1\":\"Home or Legal Address Line 1\",\"H.Addr2\":\"Home or Legal Address Line 2\",\"H.Addr3\":\"Home or Legal Address Line 3\",\"H.Addr4\":\"Home or Legal Address Line 4\"});  setCalculatedField('2cben-H-Addr123-179070498', {\"H.Addr1\":\"Home or Legal Address Line 1\",\"H.Addr2\":\"Home or Legal Address Line 2\",\"H.Addr3\":\"Home or Legal Address Line 3\",\"H.Addr4\":\"Home or Legal Address Line 4\"});  setCalculatedField('3cben-H-Addr123-179070514', {\"H.Addr1\":\"Home or Legal Address Line 1\",\"H.Addr2\":\"Home or Legal Address Line 2\",\"H.Addr3\":\"Home or Legal Address Line 3\",\"H.Addr4\":\"Home or Legal Address Line 4\"});  setCalculatedField('4cben-H-Addr123-179070530', {\"H.Addr1\":\"Home or Legal Address Line 1\",\"H.Addr2\":\"Home or Legal Address Line 2\",\"H.Addr3\":\"Home or Legal Address Line 3\",\"H.Addr4\":\"Home or Legal Address Line 4\"});  setCalculatedField('1wit-FullName-179070549', {\"FName\":\"First Name\",\"MName\":\"Middle Name\",\"LName\":\"Last Name\",\"Suffix\":\"Suffix\"});  setCalculatedField('2wit-FullName-179070550', {\"FName\":\"First Name\",\"MName\":\"Middle Name\",\"LName\":\"Last Name\",\"Suffix\":\"Suffix\"});  setCalculatedField('1rep-FullName-179070555', {\"FName\":\"First Name\",\"MName\":\"Middle Name\",\"LName\":\"Last Name\",\"Suffix\":\"Suffix\"});  setCalculatedField('1rep-BR-Addr123-179070560', {\"BR.Addr1\":\"Branch Address Line 1\",\"BR.Addr2\":\"Branch Address Line 2\",\"BR.Addr3\":\"Branch Address Line 3\",\"BR.Addr4\":\"Branch Address Line 4\"});  setCalculatedField('1spou-FullName-179070565', {\"FName\":\"First Name\",\"MName\":\"Middle Name\",\"LName\":\"Last Name\",\"Suffix\":\"Suffix\"});  setCalculatedField('2spou-FullName-179070567', {\"FName\":\"First Name\",\"MName\":\"Middle Name\",\"LName\":\"Last Name\",\"Suffix\":\"Suffix\"}); $.extend($.inputmask.defaults.definitions, { '#': { \"validator\": \"[0-9]\", \"cardinality\": 1, 'prevalidator': null } }); $.extend($.inputmask.defaults.definitions, {'x': { \"validator\": \"[a-zA-Z]\",\"cardinality\": 1, 'prevalidator': null}}); $.extend($.inputmask.defaults.definitions, { 'd': { \"validator\": function (day) { return new RegExp(\"(0[1-9]|1[0-9]|2[0-9]|3[0-1])\").test(day); }, \"cardinality\": 2, 'prevalidator': null } }); $.extend($.inputmask.defaults.definitions, { 'M': { \"validator\": function (month) { return new RegExp(\"(0[1-9]|1[012])\").test(month); }, \"cardinality\": 2, 'prevalidator': null } }); $.extend($.inputmask.defaults.definitions, { 'y': { \"validator\": function (year) { return parseInt(year) >= 1800 && parseInt(year) <= 2500; }, \"cardinality\": 4, 'prevalidator': null } });  $.fn.extend({     datemask: function (format) {         var separator = getSeparator(format);         var formatArgs = format ? format.split(separator) : [];         if (formatArgs && formatArgs.length>0) {             var newArgs = formatArgs.map(function (ars) { return ars[0]; });             var newFormat = newArgs.join(separator);             $(this).inputmask(newFormat);         }     } });  $('#signTable td input:text').css('border','silver 1px inset');  toggleDottedFrameInCheckableInputs();  $.each($('.itemRequired').not('.requiredByRef'), function() {     removeRedBorderWhenNotEmpty(this);     $(this).on('keyup', function() {         removeRedBorderWhenNotEmpty(this);     }); });  setInputMasks(); setRequiredCheckboxes(); showInvalidFormsAlert(false, '');  onCheckboxChange(); onRadioKeyup(); onLabelClick();   });</script></html>",
        "FormIDs": "12"
    },
    "ErrorCode": 0,
    "Message": "Forms generated successfully.",
    "Errors": null
}

Example Response when HostFormOnQuik is set to true, we supply the URL for you to view the form (for testing purposes only):

{
    "ResultData": {
        "UNID": "xgIPud28cnT%2fx4iobhPkJpHoT3tGTcoZrZNK5FJD2hDIgEnrX3CmpAU4ZQoby37u",
        "HTML": "https://quikforms.com/viewform/zqRR-pOcljpqx1R",
        "FormIDs": "12"
    },
    "ErrorCode": 0,
    "Message": "Forms generated successfully.",
    "Errors": null
}

Quik! Form Engine Properties

For a full list of properties that can be used in an Execute HTML request, please see: Quik! Forms Engine Property List