{"id":116,"date":"2021-03-12T03:05:48","date_gmt":"2021-03-11T19:05:48","guid":{"rendered":"https:\/\/northsidecaravansrepairsandspares.com\/?page_id=116"},"modified":"2023-06-08T12:10:17","modified_gmt":"2023-06-08T04:10:17","slug":"insurance-lodgement-form","status":"publish","type":"page","link":"https:\/\/northsidecaravansrepairsandspares.com\/insurance-lodgement-form\/","title":{"rendered":"Insurance Lodgement Form"},"content":{"rendered":"<div class=\"wpforms-container wpforms-container-full\" id=\"wpforms-115\"><form id=\"wpforms-form-115\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"115\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/wp-json\/wp\/v2\/pages\/116?wpforms_form_id=115\" data-token=\"02c9ff8e54718f748df3c27cebee530c\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-page-indicator progress\" data-indicator=\"progress\" data-indicator-color=\"#72b239\" data-scroll=\"1\"><span class=\"wpforms-page-indicator-page-title\" ><\/span><span class=\"wpforms-page-indicator-page-title-sep\" style=\"display:none;\"> - <\/span><span class=\"wpforms-page-indicator-steps\">Step <span class=\"wpforms-page-indicator-steps-current\">1<\/span> of 2<\/span><div class=\"wpforms-page-indicator-page-progress-wrap\"><div class=\"wpforms-page-indicator-page-progress\" style=\"width:50%;background-color:#72b239\"><\/div><\/div><\/div><div class=\"wpforms-field-container\"><div class=\"wpforms-page wpforms-page-1 \" data-page=\"1\"><div id=\"wpforms-115-field_31-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"31\"><\/div><div id=\"wpforms-115-field_33-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"33\"><div id=\"wpforms-115-field_33\" class=\"wpforms-field-medium wpforms-field-row\" name=\"wpforms[fields][33]\"><p>Thank you for your enquiry.<\/p>\n<p>Insurance claims will be attended to within the normal timeframe (5-7 business days).<\/p>\n<p>Press \u2018Agree and Continue\u2019 for us to proceed with your enquiry.<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-115-field_30-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"30\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"1\" data-formid=\"115\" disabled>Agree and Continue<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-2 last \" data-page=\"2\" style=\"display:none;\"><div id=\"wpforms-115-field_35-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"35\"><label class=\"wpforms-field-label\" for=\"wpforms-115-field_35\">Single Line Text<\/label><input type=\"text\" id=\"wpforms-115-field_35\" class=\"wpforms-field-medium\" name=\"wpforms[fields][35]\" ><div class=\"wpforms-field-description\">Insurance Enquiry Form<\/div><\/div><div id=\"wpforms-115-field_7-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"7\"><h3 id=\"wpforms-115-field_7\" name=\"wpforms[fields][7]\">1. Your Details<\/h3><\/div><div id=\"wpforms-115-field_29-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"29\"><label class=\"wpforms-field-label\" for=\"wpforms-115-field_29\">Name <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-115-field_29\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][29][first]\" required><label for=\"wpforms-115-field_29\" class=\"wpforms-field-sublabel after \">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-115-field_29-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][29][last]\" required><label for=\"wpforms-115-field_29-last\" class=\"wpforms-field-sublabel after \">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-115-field_2-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-115-field_2\">Street <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-115-field_2\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][2]\" required><\/div><div id=\"wpforms-115-field_3-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-115-field_3\">Suburb <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-115-field_3\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][3]\" required><\/div><div id=\"wpforms-115-field_4-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-115-field_4\">State <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-115-field_4\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][4]\" required=\"required\"><option value=\"WA\" >WA<\/option><option value=\"SA\" >SA<\/option><option value=\"Vic\" >Vic<\/option><option value=\"NSW\" >NSW<\/option><option value=\"QLD\" >QLD<\/option><option value=\"ACT\" >ACT<\/option><option value=\"NT\" >NT<\/option><option value=\"Tas\" >Tas<\/option><\/select><\/div><div id=\"wpforms-115-field_5-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-115-field_5\">Phone Number <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-115-field_5\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][5]\" required><\/div><div id=\"wpforms-115-field_24-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"24\"><label class=\"wpforms-field-label\" for=\"wpforms-115-field_24\">Email <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-115-field_24\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][24]\" spellcheck=\"false\" required><\/div><div id=\"wpforms-115-field_25-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"25\"><label class=\"wpforms-field-label\" for=\"wpforms-115-field_25\">Prefered Contact Method<\/label><ul id=\"wpforms-115-field_25\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-115-field_25_1\" name=\"wpforms[fields][25][]\" value=\"Phone\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-115-field_25_1\">Phone<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-115-field_25_2\" name=\"wpforms[fields][25][]\" value=\"Email\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-115-field_25_2\">Email<\/label><\/li><\/ul><\/div><div id=\"wpforms-115-field_6-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"6\"><h3 id=\"wpforms-115-field_6\" name=\"wpforms[fields][6]\">2. Your Caravan Details<\/h3><\/div><div id=\"wpforms-115-field_8-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-115-field_8\">Make <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-115-field_8\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][8]\" required><\/div><div id=\"wpforms-115-field_9-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-115-field_9\">Model <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-115-field_9\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][9]\" required><\/div><div id=\"wpforms-115-field_10-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-115-field_10\">Registration Plate<\/label><input type=\"text\" id=\"wpforms-115-field_10\" class=\"wpforms-field-medium\" name=\"wpforms[fields][10]\" ><\/div><div id=\"wpforms-115-field_11-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-115-field_11\">VIN <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-115-field_11\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][11]\" required><div class=\"wpforms-field-description\">Chassis number<\/div><\/div><div id=\"wpforms-115-field_12-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-115-field_12\">Claim Type <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-115-field_12\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-115-field_12_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][12][]\" value=\"Caravan\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-115-field_12_1\">Caravan<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-115-field_12_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][12][]\" value=\"Appliance\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-115-field_12_2\">Appliance<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-115-field_12_3\" data-rule-check-limit=\"true\" name=\"wpforms[fields][12][]\" value=\"Other\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-115-field_12_3\">Other<\/label><\/li><\/ul><\/div><div id=\"wpforms-115-field_14-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"14\"><label class=\"wpforms-field-label\" for=\"wpforms-115-field_14\">- If Other<\/label><textarea id=\"wpforms-115-field_14\" class=\"wpforms-field-medium\" name=\"wpforms[fields][14]\" placeholder=\"If Other claim type, please provide more information\" ><\/textarea><\/div><div id=\"wpforms-115-field_15-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-115-field_15\">Product \/ Brand<\/label><input type=\"text\" id=\"wpforms-115-field_15\" class=\"wpforms-field-medium\" name=\"wpforms[fields][15]\" ><\/div><div id=\"wpforms-115-field_16-container\" class=\"wpforms-field wpforms-field-file-upload\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-115-field_16\">Please Upload your Proof of Purchase (and other files) <span class=\"wpforms-required-label\">*<\/span><\/label><div\n\t\tclass=\"wpforms-uploader\"\n\t\tdata-field-id=\"16\"\n\t\tdata-form-id=\"115\"\n\t\tdata-input-name=\"wpforms_115_16\"\n\t\tdata-extensions=\"jpg,jpeg,jpe,gif,png,bmp,tiff,tif,webp,avif,ico,heic,asf,asx,wmv,wmx,wm,avi,divx,mov,qt,mpeg,mpg,mpe,mp4,m4v,ogv,webm,mkv,3gp,3gpp,3g2,3gp2,txt,asc,c,cc,h,srt,csv,tsv,ics,rtx,css,vtt,mp3,m4a,m4b,aac,ra,ram,wav,ogg,oga,flac,mid,midi,wma,wax,mka,rtf,pdf,class,tar,zip,gz,gzip,rar,7z,psd,xcf,doc,pot,pps,ppt,wri,xla,xls,xlt,xlw,mpp,docx,docm,dotx,dotm,xlsx,xlsm,xlsb,xltx,xltm,xlam,pptx,pptm,ppsx,ppsm,potx,potm,ppam,sldx,sldm,onetoc,onetoc2,onepkg,oxps,xps,odt,odp,ods,odg,odc,odb,odf,wp,wpd,key,numbers,pages\"\n\t\tdata-max-size=\"104857600\"\n\t\tdata-max-file-number=\"8\"\n\t\tdata-post-max-size=\"104857600\"\n\t\tdata-max-parallel-uploads=\"4\"\n\t\tdata-parallel-uploads=\"true\"\n\t\tdata-file-chunk-size=\"2097152\">\n\t<div class=\"dz-message\">\n\t\t<svg viewBox=\"0 0 1024 1024\" focusable=\"false\" data-icon=\"inbox\" width=\"50px\" height=\"50px\" fill=\"currentColor\" aria-hidden=\"true\">\n\t\t\t<path d=\"M885.2 446.3l-.2-.8-112.2-285.1c-5-16.1-19.9-27.2-36.8-27.2H281.2c-17 0-32.1 11.3-36.9 27.6L139.4 443l-.3.7-.2.8c-1.3 4.9-1.7 9.9-1 14.8-.1 1.6-.2 3.2-.2 4.8V830a60.9 60.9 0 0 0 60.8 60.8h627.2c33.5 0 60.8-27.3 60.9-60.8V464.1c0-1.3 0-2.6-.1-3.7.4-4.9 0-9.6-1.3-14.1zm-295.8-43l-.3 15.7c-.8 44.9-31.8 75.1-77.1 75.1-22.1 0-41.1-7.1-54.8-20.6S436 441.2 435.6 419l-.3-15.7H229.5L309 210h399.2l81.7 193.3H589.4zm-375 76.8h157.3c24.3 57.1 76 90.8 140.4 90.8 33.7 0 65-9.4 90.3-27.2 22.2-15.6 39.5-37.4 50.7-63.6h156.5V814H214.4V480.1z\"><\/path>\n\t\t<\/svg>\n\t\t<span class=\"modern-title\">Click or drag files to this area to upload.<\/span>\n\n\t\t\t\t\t<span class=\"modern-hint\">You can upload up to 8 files.<\/span>\n\t\t\t<\/div>\n<\/div>\n<input\n\t\ttype=\"text\"\n\t\tautocomplete=\"off\"\n\t\tclass=\"dropzone-input\"\n\t\tstyle=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\"\n\t\tid=\"wpforms-115-field_16\"\n\t\tname=\"wpforms_115_16\" required\t\tvalue=\"\">\n<\/div><div id=\"wpforms-115-field_17-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"17\"><label class=\"wpforms-field-label\" for=\"wpforms-115-field_17\">Fault Details<\/label><textarea id=\"wpforms-115-field_17\" class=\"wpforms-field-medium\" name=\"wpforms[fields][17]\" placeholder=\"Please provide details of the fault\" ><\/textarea><\/div><div id=\"wpforms-115-field_21-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"21\"><h3 id=\"wpforms-115-field_21\" name=\"wpforms[fields][21]\">3. Your Insurance Details<\/h3><\/div><div id=\"wpforms-115-field_22-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"22\"><label class=\"wpforms-field-label\" for=\"wpforms-115-field_22\">Insurance Company<\/label><input type=\"text\" id=\"wpforms-115-field_22\" class=\"wpforms-field-medium\" name=\"wpforms[fields][22]\" ><div class=\"wpforms-field-description\">The Insurer that the claim is with<\/div><\/div><div id=\"wpforms-115-field_23-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"23\"><label class=\"wpforms-field-label\" for=\"wpforms-115-field_23\">Claim Number<\/label><input type=\"text\" id=\"wpforms-115-field_23\" class=\"wpforms-field-medium\" name=\"wpforms[fields][23]\" ><\/div><div id=\"wpforms-115-field_32-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"32\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><\/div><\/div><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-recaptcha-container wpforms-is-recaptcha wpforms-is-recaptcha-type-v2\" style=\"display:none;\"><div class=\"g-recaptcha\" data-sitekey=\"6Le5ZqQhAAAAAHvSfeaydZgNy-iYoR3W00qEf5yh\"><\/div><input type=\"text\" name=\"g-recaptcha-hidden\" class=\"wpforms-recaptcha-hidden\" style=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\" data-rule-recaptcha=\"1\"><\/div><div class=\"wpforms-submit-container\" style=\"display:none;\"><input type=\"hidden\" name=\"wpforms[id]\" value=\"115\"><input type=\"hidden\" name=\"wpforms[author]\" value=\"1\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-115\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/northsidecaravansrepairsandspares.com\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"site-sidebar-layout":"default","site-content-layout":"default","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"default","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center 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