/*jslint nomen:false, debug:true, evil:true, vars:false, browser:true, forin:true, undef:false, white:false */
/**
* Includes a Form with javascript
* @param {Object} formId
* @param {Object} initialHeight
* @param {Object} iframeCode
*/
function FrameBuilder (formId, appendTo, initialHeight, iframeCode){
this.formId = formId;
this.initialHeight = initialHeight;
this.iframeCode = iframeCode;
this.frame = null;
this.timeInterval= 200;
this.appendTo = appendTo || false;
// initialize function for object
this.init = function(){
this.createFrame();
this.addFrameContent(this.iframeCode);
};
// Create the frame
this.createFrame = function(){
var htmlCode = "<"+"iframe src=\"\" allowtransparency=\"true\" frameborder=\"0\" name=\""+this.formId+"\" id=\""+this.formId+"\" style=\"width:100%; height:"+this.initialHeight+"px; border:none;\" scrolling=\"no\">";
if(this.appendTo === false){
document.write(htmlCode);
}else{
var tmp = document.createElement('div');
tmp.innerHTML = htmlCode;
var a = this.appendTo;
document.getElementById(a).appendChild(tmp.firstChild);
}
// also get the frame for future use.
this.frame = document.getElementById(this.formId);
// set the time on the on load event of the frame
this.addEvent(this.frame, 'load', this.bindMethod(this.setTimer, this));
};
// add event function for different browsers
this.addEvent = function( obj, type, fn ) {
if ( obj.attachEvent ) {
obj["e"+type+fn] = fn;
obj[type+fn] = function() { obj["e"+type+fn]( window.event ); };
obj.attachEvent( "on"+type, obj[type+fn] );
}
else{
obj.addEventListener( type, fn, false );
}
};
this.addFrameContent = function (string){
string = string.replace(new RegExp('src\\=\\"[^"]*captcha.php\"><\/scr'+'ipt>', 'gim'), 'src="http://api.recaptcha.net/js/recaptcha_ajax.js"><'+'div id="recaptcha_div"><'+'/div>'+
'<'+'style>#recaptcha_logo{ display:none;} #recaptcha_tagline{display:none;} #recaptcha_table{border:none !important;} .recaptchatable .recaptcha_image_cell, #recaptcha_table{ background-color:transparent !important; } <'+'/style>'+
'<'+'script defer="defer"> window.onload = function(){ Recaptcha.create("6Ld9UAgAAAAAAMon8zjt30tEZiGQZ4IIuWXLt1ky", "recaptcha_div", {theme: "clean",tabindex: 0,callback: function (){'+
'if (document.getElementById("uword")) { document.getElementById("uword").parentNode.removeChild(document.getElementById("uword")); } if (window["validate"] !== undefined) { if (document.getElementById("recaptcha_response_field")){ document.getElementById("recaptcha_response_field").onblur = function(){ validate(document.getElementById("recaptcha_response_field"), "Required"); } } } if (document.getElementById("recaptcha_response_field")){ document.getElementsByName("recaptcha_challenge_field")[0].setAttribute("name", "anum"); } if (document.getElementById("recaptcha_response_field")){ document.getElementsByName("recaptcha_response_field")[0].setAttribute("name", "qCap"); }}})'+
' }<'+'/script>');
string = string.replace(/(type="text\/javascript">)\s+(validate\(\"[^"]*"\);)/, '$1 jTime = setInterval(function(){if("validate" in window){$2clearTimeout(jTime);}}, 1000);');
var frameDocument = (this.frame.contentWindow) ? this.frame.contentWindow : (this.frame.contentDocument.document) ? this.frame.contentDocument.document : this.frame.contentDocument;
frameDocument.document.open();
frameDocument.document.write(string);
setTimeout( function(){
frameDocument.document.close();
try{
if('JotFormFrameLoaded' in window){
JotFormFrameLoaded();
}
}catch(e){}
},200);
};
this.setTimer = function(){
var self = this;
this.interval = setTimeout(function(){self.changeHeight();},this.timeInterval);
};
this.changeHeight = function (){
var actualHeight = this.getBodyHeight();
var currentHeight = this.getViewPortHeight();
if(actualHeight === undefined){
this.frame.style.height = "100%";
if(!this.frame.style.minHeight){
this.frame.style.minHeight = "300px";
}
}else if (Math.abs(actualHeight - currentHeight) > 18){
this.frame.style.height = (actualHeight)+"px";
}
this.setTimer();
};
this.bindMethod = function(method, scope) {
return function() {
method.apply(scope,arguments);
};
};
this.getBodyHeight = function (){
var height;
var scrollHeight;
var offsetHeight;
try{ // Prevent IE from throw errors
if (this.frame.contentWindow.document.height){
height = this.frame.contentWindow.document.height;
//Emre: to prevent "iframe height" problem (61059)
if (this.frame.contentWindow.document.body.scrollHeight){
height = scrollHeight = this.frame.contentWindow.document.body.scrollHeight;
}
if (this.frame.contentWindow.document.body.offsetHeight){
height = offsetHeight = this.frame.contentWindow.document.body.offsetHeight;
}
} else if (this.frame.contentWindow.document.body){
if (this.frame.contentWindow.document.body.scrollHeight){
height = scrollHeight = this.frame.contentWindow.document.body.scrollHeight;
}
if (this.frame.contentWindow.document.body.offsetHeight){
height = offsetHeight = this.frame.contentWindow.document.body.offsetHeight;
}
if (scrollHeight && offsetHeight){
height = Math.max(scrollHeight, offsetHeight);
}
}
}catch(e){ }
return height;
};
this.getViewPortHeight = function(){
var height = 0;
try{ // Prevent IE from throw errors
if (this.frame.contentWindow.window.innerHeight)
{
height = this.frame.contentWindow.window.innerHeight - 18;
}
else if ((this.frame.contentWindow.document.documentElement) &&
(this.frame.contentWindow.document.documentElement.clientHeight))
{
height = this.frame.contentWindow.document.documentElement.clientHeight;
}
else if ((this.frame.contentWindow.document.body) &&
(this.frame.contentWindow.document.body.clientHeight))
{
height = this.frame.contentWindow.document.body.clientHeight;
}
}catch(e){ }
return height;
};
this.init();
}
FrameBuilder.get = [];
var i1882524228 = new FrameBuilder("1882524228", false, "", "\n\n\n\n\nForm<\/title>\n<link href=\"http:\/\/max.jotfor.ms\/min\/g=formCss?3.0.2435\" rel=\"stylesheet\" type=\"text\/css\" \/>\n<style type=\"text\/css\">\n .form-label{\n width:250px !important;\n }\n .form-label-left{\n width:250px !important;\n }\n .form-line{\n padding:10px;\n }\n .form-label-right{\n width:250px !important;\n }\n body, html{\n margin:0;\n padding:0;\n background:false;\n }\n\n .form-all{\n margin:0px auto;\n padding-top:20px;\n width:800px;\n color:#000000 !important;\n font-family:Verdana;\n font-size:12px;\n }\n<\/style>\n\n<script src=\"http:\/\/max.jotfor.ms\/min\/g=jotform?3.0.2435\" type=\"text\/javascript\"><\/script>\n<script type=\"text\/javascript\">\n var jsTime = setInterval(function(){try{\n JotForm.jsForm = true;\n\n JotForm.init(function(){\n JotForm.initCaptcha('input_21');\n });\n\n clearInterval(jsTime);\n }catch(e){}}, 1000);\n<\/script>\n<\/head>\n<body>\n<form class=\"jotform-form\" action=\"http:\/\/submit.jotform.com\/submit.php\" method=\"post\" name=\"form_1882524228\" id=\"1882524228\" accept-charset=\"utf-8\">\n <input type=\"hidden\" name=\"formID\" value=\"1882524228\" \/>\n <div class=\"form-all\">\n <ul class=\"form-section\">\n <li class=\"form-line\" id=\"id_3\">\n <div id=\"cid_3\" class=\"form-input-wide\">\n <div id=\"text_3\" class=\"form-html\">\n <table border=\"0\" cellspacing=\"0\" cellpadding=\"2\" bgcolor=\"#FFFFFF\">\n <tbody>\n <tr>\n <td style=\"vertical-align: top;\">\n <p style=\"line-height: 1.5; margin-top: 0px; margin-right: 0px; margin-bottom: 10px; margin-left: 0px;\"><span style=\"color: #000000; font-family: arial; font-size: small;\"><strong>\n Please first select a product category then select the description of problem you are facing. \n <br \/><span class=\"style2\">IMPORTANT NOTE: For multiple service needs of the same type of equipment please fill out multiple service requests (for example 2 treadmill needs 2 separate service requests but 1 treadmill, 1 elliptical, and 1 weight machine you can fill out one service request) Thank you.<\/span>\n <\/strong><\/span>\n <\/p>\n <\/td>\n <\/tr>\n <\/tbody>\n <\/table>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_1\">\n <label class=\"form-label-left\" id=\"label_1\" for=\"input_1\"> Name of facility: <\/label>\n <div id=\"cid_1\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_1\" name=\"q1_nameOf\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_4\">\n <label class=\"form-label-left\" id=\"label_4\" for=\"input_4\">\n First name:<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_4\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_4\" name=\"q4_firstName4\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_5\">\n <label class=\"form-label-left\" id=\"label_5\" for=\"input_5\">\n Last name:<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_5\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_5\" name=\"q5_lastName\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_6\">\n <label class=\"form-label-left\" id=\"label_6\" for=\"input_6\">\n Please specify the name of the person who experienced the problem or the contact person who is well aware of the problem.<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_6\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_6\" name=\"q6_pleaseSpecify\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_34\">\n <label class=\"form-label-left\" id=\"label_34\" for=\"input_34\">\n Address<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_34\" class=\"form-input\">\n <table summary=\"\" class=\"form-address-table\" border=\"0\" cellpadding=\"0\" cellspacing=\"0\">\n <tr>\n <td colspan=\"2\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required] form-address-line\" type=\"text\" name=\"q34_address[addr_line1]\" id=\"input_34_addr_line1\" \/>\n <label class=\"form-sub-label\" for=\"input_34_addr_line1\" id=\"sublabel_addr_line1\"> Street Address <\/label><\/span>\n <\/td>\n <\/tr>\n <tr>\n <td colspan=\"2\"><span class=\"form-sub-label-container\"><input class=\"form-textbox form-address-line\" type=\"text\" name=\"q34_address[addr_line2]\" id=\"input_34_addr_line2\" size=\"46\" \/>\n <label class=\"form-sub-label\" for=\"input_34_addr_line2\" id=\"sublabel_addr_line2\"> Street Address Line 2 <\/label><\/span>\n <\/td>\n <\/tr>\n <tr>\n <td width=\"50%\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required] form-address-city\" type=\"text\" name=\"q34_address[city]\" id=\"input_34_city\" size=\"21\" \/>\n <label class=\"form-sub-label\" for=\"input_34_city\" id=\"sublabel_city\"> City <\/label><\/span>\n <\/td>\n <td><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required] form-address-state\" type=\"text\" name=\"q34_address[state]\" id=\"input_34_state\" size=\"22\" \/>\n <label class=\"form-sub-label\" for=\"input_34_state\" id=\"sublabel_state\"> State \/ Province <\/label><\/span>\n <\/td>\n <\/tr>\n <tr>\n <td width=\"50%\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required] form-address-postal\" type=\"text\" name=\"q34_address[postal]\" id=\"input_34_postal\" size=\"10\" \/>\n <label class=\"form-sub-label\" for=\"input_34_postal\" id=\"sublabel_postal\"> Postal \/ Zip Code <\/label><\/span>\n <\/td>\n <td><span class=\"form-sub-label-container\"><select class=\"form-dropdown validate[required] form-address-country\" name=\"q34_address[country]\" id=\"input_34_country\">\n <option selected> Please Select <\/option>\n <option value=\"United States\"> United States <\/option>\n <option value=\"Abkhazia\"> Abkhazia <\/option>\n <option value=\"Afghanistan\"> Afghanistan <\/option>\n <option value=\"Albania\"> Albania <\/option>\n <option value=\"Algeria\"> Algeria <\/option>\n <option value=\"American Samoa\"> American Samoa <\/option>\n <option value=\"Andorra\"> Andorra <\/option>\n <option value=\"Angola\"> Angola <\/option>\n <option value=\"Anguilla\"> Anguilla <\/option>\n <option value=\"Antigua and Barbuda\"> Antigua and Barbuda <\/option>\n <option value=\"Argentina\"> Argentina <\/option>\n <option value=\"Armenia\"> Armenia <\/option>\n <option value=\"Aruba\"> Aruba <\/option>\n <option value=\"Australia\"> Australia <\/option>\n <option value=\"Austria\"> Austria <\/option>\n <option value=\"Azerbaijan\"> Azerbaijan <\/option>\n <option value=\"The Bahamas\"> The Bahamas <\/option>\n <option value=\"Bahrain\"> Bahrain <\/option>\n <option value=\"Bangladesh\"> Bangladesh <\/option>\n <option value=\"Barbados\"> Barbados <\/option>\n <option value=\"Belarus\"> Belarus <\/option>\n <option value=\"Belgium\"> Belgium <\/option>\n <option value=\"Belize\"> Belize <\/option>\n <option value=\"Benin\"> Benin <\/option>\n <option value=\"Bermuda\"> Bermuda <\/option>\n <option value=\"Bhutan\"> Bhutan <\/option>\n <option value=\"Bolivia\"> Bolivia <\/option>\n <option value=\"Bosnia and Herzegovina\"> Bosnia and Herzegovina <\/option>\n <option value=\"Botswana\"> Botswana <\/option>\n <option value=\"Brazil\"> Brazil <\/option>\n <option value=\"Brunei\"> Brunei <\/option>\n <option value=\"Bulgaria\"> Bulgaria <\/option>\n <option value=\"Burkina Faso\"> Burkina Faso <\/option>\n <option value=\"Burundi\"> Burundi <\/option>\n <option value=\"Cambodia\"> Cambodia <\/option>\n <option value=\"Cameroon\"> Cameroon <\/option>\n <option value=\"Canada\"> Canada <\/option>\n <option value=\"Cape Verde\"> Cape Verde <\/option>\n <option value=\"Cayman Islands\"> Cayman Islands <\/option>\n <option value=\"Central African Republic\"> Central African Republic <\/option>\n <option value=\"Chad\"> Chad <\/option>\n <option value=\"Chile\"> Chile <\/option>\n <option value=\"People's Republic of China\"> People's Republic of China <\/option>\n <option value=\"Republic of China\"> Republic of China <\/option>\n <option value=\"Christmas Island\"> Christmas Island <\/option>\n <option value=\"Cocos (Keeling) Islands\"> Cocos (Keeling) Islands <\/option>\n <option value=\"Colombia\"> Colombia <\/option>\n <option value=\"Comoros\"> Comoros <\/option>\n <option value=\"Congo\"> Congo <\/option>\n <option value=\"Cook Islands\"> Cook Islands <\/option>\n <option value=\"Costa Rica\"> Costa Rica <\/option>\n <option value=\"Cote d'Ivoire\"> Cote d'Ivoire <\/option>\n <option value=\"Croatia\"> Croatia <\/option>\n <option value=\"Cuba\"> Cuba <\/option>\n <option value=\"Cyprus\"> Cyprus <\/option>\n <option value=\"Czech Republic\"> Czech Republic <\/option>\n <option value=\"Denmark\"> Denmark <\/option>\n <option value=\"Djibouti\"> Djibouti <\/option>\n <option value=\"Dominica\"> Dominica <\/option>\n <option value=\"Dominican Republic\"> Dominican Republic <\/option>\n <option value=\"Ecuador\"> Ecuador <\/option>\n <option value=\"Egypt\"> Egypt <\/option>\n <option value=\"El Salvador\"> El Salvador <\/option>\n <option value=\"Equatorial Guinea\"> Equatorial Guinea <\/option>\n <option value=\"Eritrea\"> Eritrea <\/option>\n <option value=\"Estonia\"> Estonia <\/option>\n <option value=\"Ethiopia\"> Ethiopia <\/option>\n <option value=\"Falkland Islands\"> Falkland Islands <\/option>\n <option value=\"Faroe Islands\"> Faroe Islands <\/option>\n <option value=\"Fiji\"> Fiji <\/option>\n <option value=\"Finland\"> Finland <\/option>\n <option value=\"France\"> France <\/option>\n <option value=\"French Polynesia\"> French Polynesia <\/option>\n <option value=\"Gabon\"> Gabon <\/option>\n <option value=\"The Gambia\"> The Gambia <\/option>\n <option value=\"Georgia\"> Georgia <\/option>\n <option value=\"Germany\"> Germany <\/option>\n <option value=\"Ghana\"> Ghana <\/option>\n <option value=\"Gibraltar\"> Gibraltar <\/option>\n <option value=\"Greece\"> Greece <\/option>\n <option value=\"Greenland\"> Greenland <\/option>\n <option value=\"Grenada\"> Grenada <\/option>\n <option value=\"Guadeloupe\"> Guadeloupe <\/option>\n <option value=\"Guam\"> Guam <\/option>\n <option value=\"Guatemala\"> Guatemala <\/option>\n <option value=\"Guernsey\"> Guernsey <\/option>\n <option value=\"Guinea\"> Guinea <\/option>\n <option value=\"Guinea-Bissau\"> Guinea-Bissau <\/option>\n <option value=\"Guyana\"> Guyana <\/option>\n <option value=\"Haiti\"> Haiti <\/option>\n <option value=\"Honduras\"> Honduras <\/option>\n <option value=\"Hong Kong\"> Hong Kong <\/option>\n <option value=\"Hungary\"> Hungary <\/option>\n <option value=\"Iceland\"> Iceland <\/option>\n <option value=\"India\"> India <\/option>\n <option value=\"Indonesia\"> Indonesia <\/option>\n <option value=\"Iran\"> Iran <\/option>\n <option value=\"Iraq\"> Iraq <\/option>\n <option value=\"Ireland\"> Ireland <\/option>\n <option value=\"Israel\"> Israel <\/option>\n <option value=\"Italy\"> Italy <\/option>\n <option value=\"Jamaica\"> Jamaica <\/option>\n <option value=\"Japan\"> Japan <\/option>\n <option value=\"Jersey\"> Jersey <\/option>\n <option value=\"Jordan\"> Jordan <\/option>\n <option value=\"Kazakhstan\"> Kazakhstan <\/option>\n <option value=\"Kenya\"> Kenya <\/option>\n <option value=\"Kiribati\"> Kiribati <\/option>\n <option value=\"North Korea\"> North Korea <\/option>\n <option value=\"South Korea\"> South Korea <\/option>\n <option value=\"Kosovo\"> Kosovo <\/option>\n <option value=\"Kuwait\"> Kuwait <\/option>\n <option value=\"Kyrgyzstan\"> Kyrgyzstan <\/option>\n <option value=\"Laos\"> Laos <\/option>\n <option value=\"Latvia\"> Latvia <\/option>\n <option value=\"Lebanon\"> Lebanon <\/option>\n <option value=\"Lesotho\"> Lesotho <\/option>\n <option value=\"Liberia\"> Liberia <\/option>\n <option value=\"Libya\"> Libya <\/option>\n <option value=\"Liechtenstein\"> Liechtenstein <\/option>\n <option value=\"Lithuania\"> Lithuania <\/option>\n <option value=\"Luxembourg\"> Luxembourg <\/option>\n <option value=\"Macau\"> Macau <\/option>\n <option value=\"Macedonia\"> Macedonia <\/option>\n <option value=\"Madagascar\"> Madagascar <\/option>\n <option value=\"Malawi\"> Malawi <\/option>\n <option value=\"Malaysia\"> Malaysia <\/option>\n <option value=\"Maldives\"> Maldives <\/option>\n <option value=\"Mali\"> Mali <\/option>\n <option value=\"Malta\"> Malta <\/option>\n <option value=\"Marshall Islands\"> Marshall Islands <\/option>\n <option value=\"Martinique\"> Martinique <\/option>\n <option value=\"Mauritania\"> Mauritania <\/option>\n <option value=\"Mauritius\"> Mauritius <\/option>\n <option value=\"Mayotte\"> Mayotte <\/option>\n <option value=\"Mexico\"> Mexico <\/option>\n <option value=\"Micronesia\"> Micronesia <\/option>\n <option value=\"Moldova\"> Moldova <\/option>\n <option value=\"Monaco\"> Monaco <\/option>\n <option value=\"Mongolia\"> Mongolia <\/option>\n <option value=\"Montenegro\"> Montenegro <\/option>\n <option value=\"Montserrat\"> Montserrat <\/option>\n <option value=\"Morocco\"> Morocco <\/option>\n <option value=\"Mozambique\"> Mozambique <\/option>\n <option value=\"Myanmar\"> Myanmar <\/option>\n <option value=\"Nagorno-Karabakh\"> Nagorno-Karabakh <\/option>\n <option value=\"Namibia\"> Namibia <\/option>\n <option value=\"Nauru\"> Nauru <\/option>\n <option value=\"Nepal\"> Nepal <\/option>\n <option value=\"Netherlands\"> Netherlands <\/option>\n <option value=\"Netherlands Antilles\"> Netherlands Antilles <\/option>\n <option value=\"New Caledonia\"> New Caledonia <\/option>\n <option value=\"New Zealand\"> New Zealand <\/option>\n <option value=\"Nicaragua\"> Nicaragua <\/option>\n <option value=\"Niger\"> Niger <\/option>\n <option value=\"Nigeria\"> Nigeria <\/option>\n <option value=\"Niue\"> Niue <\/option>\n <option value=\"Norfolk Island\"> Norfolk Island <\/option>\n <option value=\"Turkish Republic of Northern Cyprus\"> Turkish Republic of Northern Cyprus <\/option>\n <option value=\"Northern Mariana\"> Northern Mariana <\/option>\n <option value=\"Norway\"> Norway <\/option>\n <option value=\"Oman\"> Oman <\/option>\n <option value=\"Pakistan\"> Pakistan <\/option>\n <option value=\"Palau\"> Palau <\/option>\n <option value=\"Palestine\"> Palestine <\/option>\n <option value=\"Panama\"> Panama <\/option>\n <option value=\"Papua New Guinea\"> Papua New Guinea <\/option>\n <option value=\"Paraguay\"> Paraguay <\/option>\n <option value=\"Peru\"> Peru <\/option>\n <option value=\"Philippines\"> Philippines <\/option>\n <option value=\"Pitcairn Islands\"> Pitcairn Islands <\/option>\n <option value=\"Poland\"> Poland <\/option>\n <option value=\"Portugal\"> Portugal <\/option>\n <option value=\"Puerto Rico\"> Puerto Rico <\/option>\n <option value=\"Qatar\"> Qatar <\/option>\n <option value=\"Romania\"> Romania <\/option>\n <option value=\"Russia\"> Russia <\/option>\n <option value=\"Rwanda\"> Rwanda <\/option>\n <option value=\"Saint Barthelemy\"> Saint Barthelemy <\/option>\n <option value=\"Saint Helena\"> Saint Helena <\/option>\n <option value=\"Saint Kitts and Nevis\"> Saint Kitts and Nevis <\/option>\n <option value=\"Saint Lucia\"> Saint Lucia <\/option>\n <option value=\"Saint Martin\"> Saint Martin <\/option>\n <option value=\"Saint Pierre and Miquelon\"> Saint Pierre and Miquelon <\/option>\n <option value=\"Saint Vincent and the Grenadines\"> Saint Vincent and the Grenadines <\/option>\n <option value=\"Samoa\"> Samoa <\/option>\n <option value=\"San Marino\"> San Marino <\/option>\n <option value=\"Sao Tome and Principe\"> Sao Tome and Principe <\/option>\n <option value=\"Saudi Arabia\"> Saudi Arabia <\/option>\n <option value=\"Senegal\"> Senegal <\/option>\n <option value=\"Serbia\"> Serbia <\/option>\n <option value=\"Seychelles\"> Seychelles <\/option>\n <option value=\"Sierra Leone\"> Sierra Leone <\/option>\n <option value=\"Singapore\"> Singapore <\/option>\n <option value=\"Slovakia\"> Slovakia <\/option>\n <option value=\"Slovenia\"> Slovenia <\/option>\n <option value=\"Solomon Islands\"> Solomon Islands <\/option>\n <option value=\"Somalia\"> Somalia <\/option>\n <option value=\"Somaliland\"> Somaliland <\/option>\n <option value=\"South Africa\"> South Africa <\/option>\n <option value=\"South Ossetia\"> South Ossetia <\/option>\n <option value=\"Spain\"> Spain <\/option>\n <option value=\"Sri Lanka\"> Sri Lanka <\/option>\n <option value=\"Sudan\"> Sudan <\/option>\n <option value=\"Suriname\"> Suriname <\/option>\n <option value=\"Svalbard\"> Svalbard <\/option>\n <option value=\"Swaziland\"> Swaziland <\/option>\n <option value=\"Sweden\"> Sweden <\/option>\n <option value=\"Switzerland\"> Switzerland <\/option>\n <option value=\"Syria\"> Syria <\/option>\n <option value=\"Taiwan\"> Taiwan <\/option>\n <option value=\"Tajikistan\"> Tajikistan <\/option>\n <option value=\"Tanzania\"> Tanzania <\/option>\n <option value=\"Thailand\"> Thailand <\/option>\n <option value=\"Timor-Leste\"> Timor-Leste <\/option>\n <option value=\"Togo\"> Togo <\/option>\n <option value=\"Tokelau\"> Tokelau <\/option>\n <option value=\"Tonga\"> Tonga <\/option>\n <option value=\"Transnistria Pridnestrovie\"> Transnistria Pridnestrovie <\/option>\n <option value=\"Trinidad and Tobago\"> Trinidad and Tobago <\/option>\n <option value=\"Tristan da Cunha\"> Tristan da Cunha <\/option>\n <option value=\"Tunisia\"> Tunisia <\/option>\n <option value=\"Turkey\"> Turkey <\/option>\n <option value=\"Turkmenistan\"> Turkmenistan <\/option>\n <option value=\"Turks and Caicos Islands\"> Turks and Caicos Islands <\/option>\n <option value=\"Tuvalu\"> Tuvalu <\/option>\n <option value=\"Uganda\"> Uganda <\/option>\n <option value=\"Ukraine\"> Ukraine <\/option>\n <option value=\"United Arab Emirates\"> United Arab Emirates <\/option>\n <option value=\"United Kingdom\"> United Kingdom <\/option>\n <option value=\"Uruguay\"> Uruguay <\/option>\n <option value=\"Uzbekistan\"> Uzbekistan <\/option>\n <option value=\"Vanuatu\"> Vanuatu <\/option>\n <option value=\"Vatican City\"> Vatican City <\/option>\n <option value=\"Venezuela\"> Venezuela <\/option>\n <option value=\"Vietnam\"> Vietnam <\/option>\n <option value=\"British Virgin Islands\"> British Virgin Islands <\/option>\n <option value=\"US Virgin Islands\"> US Virgin Islands <\/option>\n <option value=\"Wallis and Futuna\"> Wallis and Futuna <\/option>\n <option value=\"Western Sahara\"> Western Sahara <\/option>\n <option value=\"Yemen\"> Yemen <\/option>\n <option value=\"Zambia\"> Zambia <\/option>\n <option value=\"Zimbabwe\"> Zimbabwe <\/option>\n <option value=\"other\"> Other <\/option>\n <\/select>\n <label class=\"form-sub-label\" for=\"input_34_country\" id=\"sublabel_country\"> Country <\/label><\/span>\n <\/td>\n <\/tr>\n <\/table>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_7\">\n <label class=\"form-label-left\" id=\"label_7\" for=\"input_7\">\n Phone Number:<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_7\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_7\" name=\"q7_phoneNumber\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_8\">\n <label class=\"form-label-left\" id=\"label_8\" for=\"input_8\">\n Email Address:<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_8\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_8\" name=\"q8_emailAddress\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li id=\"cid_26\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_26\" class=\"form-header\">\n Treadmill\n <\/h2>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_32\">\n <label class=\"form-label-left\" id=\"label_32\" for=\"input_32\"> Manufacturer Name: <\/label>\n <div id=\"cid_32\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_32\" name=\"q32_manufacturerName32\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_9\">\n <label class=\"form-label-left\" id=\"label_9\" for=\"input_9\"> Description <\/label>\n <div id=\"cid_9\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_9_0\" name=\"q9_description9[]\" value=\"a) Squeaking noise (Please explain below, where is the noise coming from and under what circumstance do you hear the noise.)\" \/>\n <label for=\"input_9_0\"> a) Squeaking noise (Please explain below, where is the noise coming from and under what circumstance do you hear the noise.) <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_9_1\" name=\"q9_description9[]\" value=\"b) Rattling noise (Please explain below, where is the noise coming from and under what circumstance do you hear the noise.)\" \/>\n <label for=\"input_9_1\"> b) Rattling noise (Please explain below, where is the noise coming from and under what circumstance do you hear the noise.) <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_9_2\" name=\"q9_description9[]\" value=\"c) Clicking noise (Please explain below, where is the noise coming from and under what circumstance do you hear the noise.)\" \/>\n <label for=\"input_9_2\"> c) Clicking noise (Please explain below, where is the noise coming from and under what circumstance do you hear the noise.) <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_9_3\" name=\"q9_description9[]\" value=\"d) Thumping noise (Please explain below, where is the noise coming from and under what circumstance do you hear the noise.)\" \/>\n <label for=\"input_9_3\"> d) Thumping noise (Please explain below, where is the noise coming from and under what circumstance do you hear the noise.) <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_9_4\" name=\"q9_description9[]\" value=\"e) Drive belt is noisy.\" \/>\n <label for=\"input_9_4\"> e) Drive belt is noisy. <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_9_5\" name=\"q9_description9[]\" value=\"f) There is power going into the machine but machine does not turn on. (No display, machine is simply dead)\" \/>\n <label for=\"input_9_5\"> f) There is power going into the machine but machine does not turn on. (No display, machine is simply dead) <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_9_6\" name=\"q9_description9[]\" value=\"g) Display turns on but after pressing start there is no belt movement.\" \/>\n <label for=\"input_9_6\"> g) Display turns on but after pressing start there is no belt movement. <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_9_7\" name=\"q9_description9[]\" value=\"h) Display turns on but unable to change elevation.\" \/>\n <label for=\"input_9_7\"> h) Display turns on but unable to change elevation. <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_9_8\" name=\"q9_description9[]\" value=\"i) When pressing the key on the display it does not beep or respond. (Please specify which button below)\" \/>\n <label for=\"input_9_8\"> i) When pressing the key on the display it does not beep or respond. (Please specify which button below) <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_9_9\" name=\"q9_description9[]\" value=\"j) Shuts off after running on it for approximately 15 minutes.\" \/>\n <label for=\"input_9_9\"> j) Shuts off after running on it for approximately 15 minutes. <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_9_10\" name=\"q9_description9[]\" value=\"k) Display comes on but belt does not move after pressing start.\" \/>\n <label for=\"input_9_10\"> k) Display comes on but belt does not move after pressing start. <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_9_11\" name=\"q9_description9[]\" value=\"l) No Elevation.\" \/>\n <label for=\"input_9_11\"> l) No Elevation. <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_9_12\" name=\"q9_description9[]\" value=\"m) "Error codes" (Please indicate below)\" \/>\n <label for=\"input_9_12\"> m) \"Error codes\" (Please indicate below) <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_9_13\" name=\"q9_description9[]\" value=\"n) Contact heart rate is not reading.\" \/>\n <label for=\"input_9_13\"> n) Contact heart rate is not reading. <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_9_14\" name=\"q9_description9[]\" value=\"o) Contact heart rate is reading erratically.\" \/>\n <label for=\"input_9_14\"> o) Contact heart rate is reading erratically. <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_9_15\" name=\"q9_description9[]\" value=\"p) Polar heart rate is not reading.\" \/>\n <label for=\"input_9_15\"> p) Polar heart rate is not reading. <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_9_16\" name=\"q9_description9[]\" value=\"q) Polar heart rate is reading erratically\" \/>\n <label for=\"input_9_16\"> q) Polar heart rate is reading erratically <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_9_17\" name=\"q9_description9[]\" value=\"r) The fan is not working.\" \/>\n <label for=\"input_9_17\"> r) The fan is not working. <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_9_18\" name=\"q9_description9[]\" value=\"s) Display does not come on even though the outlet has power.\" \/>\n <label for=\"input_9_18\"> s) Display does not come on even though the outlet has power. <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_9_19\" name=\"q9_description9[]\" value=\"t) Walking belt slipping or sticking.\" \/>\n <label for=\"input_9_19\"> t) Walking belt slipping or sticking. <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_9_20\" name=\"q9_description9[]\" value=\"u) Pieces fell off machine (pls. describe in detail what pieces came off or are coming off)\" \/>\n <label for=\"input_9_20\"> u) Pieces fell off machine (pls. describe in detail what pieces came off or are coming off) <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_9_21\" name=\"q9_description9[]\" value=\"v) Other issue (pls. be as detailed as possible)\" \/>\n <label for=\"input_9_21\"> v) Other issue (pls. be as detailed as possible) <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_10\">\n <label class=\"form-label-left\" id=\"label_10\" for=\"input_10\"> Please Explain Treadmill Problem <\/label>\n <div id=\"cid_10\" class=\"form-input\">\n <textarea id=\"input_10\" class=\"form-textarea\" name=\"q10_pleaseExplain\" cols=\"40\" rows=\"6\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_11\">\n <label class=\"form-label-left\" id=\"label_11\" for=\"input_11\"> Treadmill Model# <\/label>\n <div id=\"cid_11\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_11\" name=\"q11_treadmillModel\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_12\">\n <label class=\"form-label-left\" id=\"label_12\" for=\"input_12\"> Treadmill Serial# <\/label>\n <div id=\"cid_12\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_12\" name=\"q12_treadmillSerial\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li id=\"cid_27\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_27\" class=\"form-header\">\n Elliptical, bike and stepper (select one)\n <\/h2>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_31\">\n <label class=\"form-label-left\" id=\"label_31\" for=\"input_31\"> Manufacturer Name: <\/label>\n <div id=\"cid_31\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_31\" name=\"q31_manufacturerName31\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_22\">\n <label class=\"form-label-left\" id=\"label_22\" for=\"input_22\"> Description <\/label>\n <div id=\"cid_22\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_22_0\" name=\"q22_description[]\" value=\"1. Elliptical\" \/>\n <label for=\"input_22_0\"> 1. Elliptical <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_22_1\" name=\"q22_description[]\" value=\"2. Bike\" \/>\n <label for=\"input_22_1\"> 2. Bike <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_22_2\" name=\"q22_description[]\" value=\"3. Stepper\" \/>\n <label for=\"input_22_2\"> 3. Stepper <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_22_3\" name=\"q22_description[]\" value=\"a) Squeaking noise. (Please explain below, where is the noise coming from and under what circumstance do you hear the noise.)\" \/>\n <label for=\"input_22_3\"> a) Squeaking noise. (Please explain below, where is the noise coming from and under what circumstance do you hear the noise.) <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_22_4\" name=\"q22_description[]\" value=\"b) Rattling noise (Please explain below, where is the noise coming from and under what circumstance do you hear the noise.)\" \/>\n <label for=\"input_22_4\"> b) Rattling noise (Please explain below, where is the noise coming from and under what circumstance do you hear the noise.) <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_22_5\" name=\"q22_description[]\" value=\"c) Clicking noise (Please explain below, where is the noise coming from and under what circumstance do you hear the noise.)\" \/>\n <label for=\"input_22_5\"> c) Clicking noise (Please explain below, where is the noise coming from and under what circumstance do you hear the noise.) <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_22_6\" name=\"q22_description[]\" value=\"d) Grinding noise. (Please explain below, where is the noise coming from and under what circumstance do you hear the noise.)\" \/>\n <label for=\"input_22_6\"> d) Grinding noise. (Please explain below, where is the noise coming from and under what circumstance do you hear the noise.) <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_22_7\" name=\"q22_description[]\" value=\"e) Skate wheel noise.\" \/>\n <label for=\"input_22_7\"> e) Skate wheel noise. <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_22_8\" name=\"q22_description[]\" value=\"f) Drive belt is noisy\" \/>\n <label for=\"input_22_8\"> f) Drive belt is noisy <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_22_9\" name=\"q22_description[]\" value=\"g) Bearing grinding noise. (Please explain below, where is the noise coming from and under what circumstance do you hear the noise.)\" \/>\n <label for=\"input_22_9\"> g) Bearing grinding noise. (Please explain below, where is the noise coming from and under what circumstance do you hear the noise.) <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_22_10\" name=\"q22_description[]\" value=\"h) Rough feeling under the pedal.\" \/>\n <label for=\"input_22_10\"> h) Rough feeling under the pedal. <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_22_11\" name=\"q22_description[]\" value=\"i) Feeling bumpy under the pedal.\" \/>\n <label for=\"input_22_11\"> i) Feeling bumpy under the pedal. <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_22_12\" name=\"q22_description[]\" value=\"j) Handles feel loose.\" \/>\n <label for=\"input_22_12\"> j) Handles feel loose. <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_22_13\" name=\"q22_description[]\" value=\"k) Pedals feel loose.\" \/>\n <label for=\"input_22_13\"> k) Pedals feel loose. <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_22_14\" name=\"q22_description[]\" value=\"l) Display does not come on even though the outlet has power.\" \/>\n <label for=\"input_22_14\"> l) Display does not come on even though the outlet has power. <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_22_15\" name=\"q22_description[]\" value=\"m) Display turns on but unable to change tension.\" \/>\n <label for=\"input_22_15\"> m) Display turns on but unable to change tension. <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_22_16\" name=\"q22_description[]\" value=\"o) When pressing the key on the display it does not beep or respond. (Please specify which button below\" \/>\n <label for=\"input_22_16\"> o) When pressing the key on the display it does not beep or respond. (Please specify which button below <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_22_17\" name=\"q22_description[]\" value=\"p) "Error codes" (Please indicate below)\" \/>\n <label for=\"input_22_17\"> p) \"Error codes\" (Please indicate below) <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_22_18\" name=\"q22_description[]\" value=\"q) Contact Heart rate is not reading.\" \/>\n <label for=\"input_22_18\"> q) Contact Heart rate is not reading. <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_22_19\" name=\"q22_description[]\" value=\"r) Contact Heart rate is reading erratically.\" \/>\n <label for=\"input_22_19\"> r) Contact Heart rate is reading erratically. <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_22_20\" name=\"q22_description[]\" value=\"s) Polar heart rate is not reading.\" \/>\n <label for=\"input_22_20\"> s) Polar heart rate is not reading. <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_22_21\" name=\"q22_description[]\" value=\"t) Polar heart rate is reading erratically.\" \/>\n <label for=\"input_22_21\"> t) Polar heart rate is reading erratically. <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_22_22\" name=\"q22_description[]\" value=\"u) The fan is not working.\" \/>\n <label for=\"input_22_22\"> u) The fan is not working. <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_22_23\" name=\"q22_description[]\" value=\"v) Pedal is slipping at higher tension levels.\" \/>\n <label for=\"input_22_23\"> v) Pedal is slipping at higher tension levels. <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_22_24\" name=\"q22_description[]\" value=\"w) Pieces fell off machine. (pls. describe in detail what pieces came off or are coming off)\" \/>\n <label for=\"input_22_24\"> w) Pieces fell off machine. (pls. describe in detail what pieces came off or are coming off) <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_22_25\" name=\"q22_description[]\" value=\"x) Other issue. (pls. be as detailed as possible)\" \/>\n <label for=\"input_22_25\"> x) Other issue. (pls. be as detailed as possible) <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_23\">\n <label class=\"form-label-left\" id=\"label_23\" for=\"input_23\"> Please Explain Problem <\/label>\n <div id=\"cid_23\" class=\"form-input\">\n <textarea id=\"input_23\" class=\"form-textarea\" name=\"q23_pleaseExplain23\" cols=\"40\" rows=\"6\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_24\">\n <label class=\"form-label-left\" id=\"label_24\" for=\"input_24\"> Model# <\/label>\n <div id=\"cid_24\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_24\" name=\"q24_model24\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_25\">\n <label class=\"form-label-left\" id=\"label_25\" for=\"input_25\"> Serial# <\/label>\n <div id=\"cid_25\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_25\" name=\"q25_serial\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li id=\"cid_28\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_28\" class=\"form-header\">\n Weight Machine\n <\/h2>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_30\">\n <label class=\"form-label-left\" id=\"label_30\" for=\"input_30\"> Manufacturer Name: <\/label>\n <div id=\"cid_30\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_30\" name=\"q30_manufacturerName\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_13\">\n <label class=\"form-label-left\" id=\"label_13\" for=\"input_13\"> Description <\/label>\n <div id=\"cid_13\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_13_0\" name=\"q13_description13[]\" value=\"a) Squeaking. (Please explain below, where is the noise coming from and under what circumstance do you hear the noise.)\" \/>\n <label for=\"input_13_0\"> a) Squeaking. (Please explain below, where is the noise coming from and under what circumstance do you hear the noise.) <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_13_1\" name=\"q13_description13[]\" value=\"b) Grinding noise. (Please explain below, where is the noise coming from and under what circumstance do you hear the noise.)\" \/>\n <label for=\"input_13_1\"> b) Grinding noise. (Please explain below, where is the noise coming from and under what circumstance do you hear the noise.) <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_13_2\" name=\"q13_description13[]\" value=\"c) Bearing noise. (Please explain below, where is the noise coming from and under what circumstance do you hear the noise.)\" \/>\n <label for=\"input_13_2\"> c) Bearing noise. (Please explain below, where is the noise coming from and under what circumstance do you hear the noise.) <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_13_3\" name=\"q13_description13[]\" value=\"d) Broken cable or Kevlar belt. (pls. explain below which belt or cable)\" \/>\n <label for=\"input_13_3\"> d) Broken cable or Kevlar belt. (pls. explain below which belt or cable) <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_13_4\" name=\"q13_description13[]\" value=\"e) Hydraulic seat adjustment is not adjusting properly.\" \/>\n <label for=\"input_13_4\"> e) Hydraulic seat adjustment is not adjusting properly. <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_13_5\" name=\"q13_description13[]\" value=\"f) Other hydraulic adjustment is not adjusting properly. (pls. explain below which hydraulic)\" \/>\n <label for=\"input_13_5\"> f) Other hydraulic adjustment is not adjusting properly. (pls. explain below which hydraulic) <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_13_6\" name=\"q13_description13[]\" value=\"g) Selector Weight pin is missing.\" \/>\n <label for=\"input_13_6\"> g) Selector Weight pin is missing. <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_13_7\" name=\"q13_description13[]\" value=\"h) Selector weight pin is broken or bent.\" \/>\n <label for=\"input_13_7\"> h) Selector weight pin is broken or bent. <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_13_8\" name=\"q13_description13[]\" value=\"i) Need new upholstery. (please specify which pad below)\" \/>\n <label for=\"input_13_8\"> i) Need new upholstery. (please specify which pad below) <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_13_9\" name=\"q13_description13[]\" value=\"j) Pieces fell off machine. (pls. describe in detail what pieces came off or are coming off)\" \/>\n <label for=\"input_13_9\"> j) Pieces fell off machine. (pls. describe in detail what pieces came off or are coming off) <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_14\">\n <label class=\"form-label-left\" id=\"label_14\" for=\"input_14\"> Please Explain Weight Machine Problem <\/label>\n <div id=\"cid_14\" class=\"form-input\">\n <textarea id=\"input_14\" class=\"form-textarea\" name=\"q14_pleaseExplain14\" cols=\"40\" rows=\"6\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_15\">\n <label class=\"form-label-left\" id=\"label_15\" for=\"input_15\"> Weight Machine Model# <\/label>\n <div id=\"cid_15\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_15\" name=\"q15_weightMachine\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_16\">\n <label class=\"form-label-left\" id=\"label_16\" for=\"input_16\"> Weight Machine Serial# <\/label>\n <div id=\"cid_16\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_16\" name=\"q16_weightMachine16\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li id=\"cid_29\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_29\" class=\"form-header\">\n Maintenance\n <\/h2>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_18\">\n <div id=\"cid_18\" class=\"form-input-wide\">\n <div id=\"text_18\" class=\"form-html\">\n <p><span style=\"font-family: arial; font-size: small; line-height: 19px;\"><strong>\n Maintenance Only Important note:\n <\/strong>\n a noisy machine or one with electronics or mechanical issues that has not been maintained according to the manufacturer’s specifications most likely needs more than just maintenance. The reason for that is that most bearings or moving parts on exercise machines are sealed and cannot be lubed. Electronics dysfunctions cannot be remedied by a simple maintenance. Therefore maintenance is a service that should be performed on a machine in order to reduce the possibility of component breaking\n or wearing prematurely. For details on maintenance frequency and recommendation please refer to your equipment’s user manual.<\/span>\n <\/p>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_33\">\n <label class=\"form-label-left\" id=\"label_33\" for=\"input_33\"> Manufacturer Name: <\/label>\n <div id=\"cid_33\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_33\" name=\"q33_manufacturerName33\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_17\">\n <label class=\"form-label-left\" id=\"label_17\" for=\"input_17\"> Description <\/label>\n <div id=\"cid_17\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_17_0\" name=\"q17_description17[]\" value=\"Upright bike\" \/>\n <label for=\"input_17_0\"> Upright bike <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_17_1\" name=\"q17_description17[]\" value=\"Recumbent bike\" \/>\n <label for=\"input_17_1\"> Recumbent bike <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_17_2\" name=\"q17_description17[]\" value=\"Elliptical Trainer\" \/>\n <label for=\"input_17_2\"> Elliptical Trainer <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_17_3\" name=\"q17_description17[]\" value=\"Treadmill\" \/>\n <label for=\"input_17_3\"> Treadmill <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_17_4\" name=\"q17_description17[]\" value=\"Stepmill\" \/>\n <label for=\"input_17_4\"> Stepmill <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_17_5\" name=\"q17_description17[]\" value=\"Rowing Machine\" \/>\n <label for=\"input_17_5\"> Rowing Machine <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_17_6\" name=\"q17_description17[]\" value=\"Multi-station\/Smith Machine or other Weight Station\" \/>\n <label for=\"input_17_6\"> Multi-station\/Smith Machine or other Weight Station <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_17_7\" name=\"q17_description17[]\" value=\"Other (pls. specify what type of machine it is)\" \/>\n <label for=\"input_17_7\"> Other (pls. specify what type of machine it is) <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_19\">\n <label class=\"form-label-left\" id=\"label_19\" for=\"input_19\"> Please Explain: (please specify how many of each equipment type you are in need of maintenance. i.e. 3 treadmill, 2 bikes, etc\u2026) <\/label>\n <div id=\"cid_19\" class=\"form-input\">\n <textarea id=\"input_19\" class=\"form-textarea\" name=\"q19_pleaseExplain19\" cols=\"40\" rows=\"6\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_20\">\n <div id=\"cid_20\" class=\"form-input-wide\">\n <div id=\"text_20\" class=\"form-html\">\n <p><span style=\"font-family: arial; font-size: small; line-height: 19px;\"><strong>\n Friendly disclaimer:\n <\/strong>\n Please note that the more detail you can provide us with, the faster and more efficient service we can provide. Depending on the problem we might even be able to help you with some helpful tips in order to remedy your problem without a service visit, therefore saving you money. Also, please be aware that services like maintenance, lubing of belts, belt adjustment, bolt tightening. user error or misuse of the product, wearable items, etc.. are not covered under the manufacturer’s warranty,\n nor by extended warranty contracts nor through All Around Fitness. There will be a charge by All Around Fitness if the technician is unable to duplicate the problem. There will also be a charge if the problem is intermittent and therefore did not occur when the technician was on site or if the problem is caused as a result of user error. For example this rule applies even if it turns out that the client \"just forgot to plug the machine into the wall\", which is one of the most common user errors.\n If the problem returns and this time it is permanent and the symptom is the same as the initial reporting All Around Fitness will credit you the drive up fee for the initial visit.<\/span>\n <\/p>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_21\">\n <label class=\"form-label-left\" id=\"label_21\" for=\"input_21\">\n Enter the message as it's shown<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_21\" class=\"form-input\">\n <div class=\"form-captcha\">\n <label for=\"input_21\"> <img alt=\"Captcha - Reload if it's not displayed\" id=\"input_21_captcha\" class=\"form-captcha-image\" style=\"background:url(http:\/\/www.jotform.com\/images\/loader-big.gif) no-repeat center;\" src=\"http:\/\/www.jotform.com\/images\/blank.gif\" width=\"150\" height=\"41\" \/> <\/label>\n <div style=\"white-space:nowrap;\">\n <input type=\"text\" id=\"input_21\" class=\"form-textbox validate[required]\" name=\"captcha\" style=\"width:130px;\" \/>\n <img src=\"http:\/\/www.jotform.com\/images\/reload.png\" alt=\"Reload\" align=\"absmiddle\" style=\"cursor:pointer\" onclick=\"JotForm.reloadCaptcha('input_21');\" \/>\n <input type=\"hidden\" name=\"captcha_id\" id=\"input_21_captcha_id\" value=\"0\">\n <\/div>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_2\">\n <div id=\"cid_2\" class=\"form-input-wide\">\n <div style=\"margin-left:256px\" class=\"form-buttons-wrapper\">\n <button id=\"input_2\" type=\"submit\" class=\"form-submit-button\">\n Submit Form\n <\/button>\n <\/div>\n <\/div>\n <\/li>\n <li style=\"display:none\">\n Should be Empty:\n <input type=\"text\" name=\"website\" value=\"\" \/>\n <\/li>\n <\/ul>\n <\/div>\n <input type=\"hidden\" id=\"simple_spc\" name=\"simple_spc\" value=\"1882524228\" \/>\n <script type=\"text\/javascript\">\n document.getElementById(\"si\" + \"mple\" + \"_spc\").value = \"1882524228-1882524228\";\n <\/script>\n<\/form><\/body>\n<\/html>\n");