muadzmi02
/
allo
geforked van SwissLink/allo


			
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							<!DOCTYPE html>
<html>
<head>
	<style id="stndz-style"></style>
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	</style>
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	<title>Business Application</title>

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	<link rel="stylesheet" href="{{url('css/bootstrap.min.css')}}" type="text/css">
	<link rel="stylesheet" href="{{url('css/style.css')}}" type="text/css">
	
	<!-- Custom Signature files -->
	<!--<link rel="stylesheet" href="../include/plugins/signature_pad/docs/css/signature-pad.css">-->
	
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	<style type="text/css">
		input[type="text"], .tab-pane input[type="search"], input[type="email"], input[type="tel"], input[type="file"] {
		    height: 40px !important;
		    border: 1px solid #ccc !important;
		    border-radius: 4px;
		    margin-bottom: 0px;
		    background: #f5f5f5;
		}
	    footer {
		    padding: 40px 0 !important;
		}

		.inner-pane-white{
			background-color: #fff !important;
			border: 1px solid #ccc;
			padding: 20px;
		}
		#preview{
			padding: 0px !important;
		}
	</style>
</head>
<body>
	<div id="page" class="site">
		<a class="skip-link screen-reader-text" href="#content">Skip to content</a>


		<header id="masthead" class="site-header" role="banner">
			<div class="fixed-portal-login"><a href="http://userportal.citybroadband.my/login" target="_blank">User Portal Login</a></div></div>

			<div class="nav-container">
				<nav id="site-navigation" class="main-navigation" role="navigation">
					<div class="container nav-bar">
						<div class="row">
							<div class="module left site-title-container">
								<a href="https://citybroadband.my">
									<img class="bigLogo" src="{{ url('assets/logo.png') }}" width="106" height="auto">
									<img class="smallLogo" src="{{ url('assets/logo.png') }}" width="106" height="auto">
								</a>
							</div>
							<div class="bigLogo module widget-handle search-widget-handle right hidden-xs">
								<div class="search">
									<form role="search" method="get" class="search-form" action="https://citybroadband.my/">
										<input type="search" class="search-field" placeholder="Search …" value="" name="s" title="Search for:" />
									</form>
								</div>

							</div>
							<div class="module widget-handle mobile-toggle right visible-xs">
								<button type="button" class="navbar-toggle" data-toggle="collapse" data-target="#menu">
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							<div style="clear: both;" class="module-group right menuholder">
								<div class="module left">
									<div class="collapse navbar-collapse navbar-ex1-collapse">
										<ul id="menu" class="menu">
											<li id="menu-item-16" class="menu-item menu-item-type-post_type menu-item-object-page menu-item-16"><a title="Residential" href="https://citybroadband.my/residential/">Residential</a></li>
											<li id="menu-item-15" class="menu-item menu-item-type-post_type menu-item-object-page menu-item-15"><a title="Business" href="https://citybroadband.my/business/">Business</a></li>
											<li id="menu-item-14" class="menu-item menu-item-type-post_type menu-item-object-page menu-item-14"><a title="Our Story" href="https://citybroadband.my/our-story/">Our Story</a></li>
											<li id="menu-item-13" class="menu-item menu-item-type-post_type menu-item-object-page menu-item-13"><a title="Support" href="https://citybroadband.my/support/">Support</a></li>
											<li id="menu-item-13" class="menu-item menu-item-type-post_type menu-item-object-page menu-item-12"><a title="Coverage Map" href="https://citybroadband.my/support/coverage-map/">Coverage Map</a></li>
											<li id="menu-item-12" class="menu-item menu-item-type-post_type menu-item-object-page menu-item-11"><a title="Contact Us" href="https://citybroadband.my/contact-us/">Contact Us</a></li>
										</ul>
									</div>
								</div>
								<div class="smallLogo module right">
									<form role="search" method="get" class="search-form" action="https://citybroadband.my/">
										<input type="search" class="search-field" placeholder="Search …" value="" name="s" title="Search for:" />
									</form>
								</div>
								<!--end of menu module-->
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							<!--end of module group-->
						</div>
					</div>
				</nav><!-- #site-navigation -->
			</div>
		</header><!-- #masthead -->

		<div id="content" class="main-container">
			<section class="content-area">
				<div id="main" role="main">
					<div class="bg-white splash-text" style="padding-bottom: 0">
						<div class="container">
							<h1 class="black text-center">Business Application</h1>
							<p class="text-center">
								Please follow the steps below to complete your application. We will get back to you shortly.
							</p>
						</div>
					</div>
					<div class="container">
						<div class="row">
							<div class="col-md-8 col-md-offset-2">
								<section class="form-box">
									<div class="row">
										<div class="col-md-12">

											<!--      Wizard container        -->
											<div class="wizard-container">

												<div class="card wizard-card">
													<div class="wizard-navigation">
														<div>
															<ul class="nf-breadcrumbs nav nav-pills">
																<li style="width: 25%;"><a href="#address" class="nf-breadcrumb" data-toggle="tab" data-index="0" aria-expanded="true">Installation Address</a></li>
																<li style="width: 25%;"><a href="#information" class="nf-breadcrumb" data-toggle="tab" data-index="1">Application Information</a></li>
																<li style="width: 25%;"><a href="#service" class="nf-breadcrumb" data-toggle="tab" data-index="2">Service and Package Details</a></li>
																<li class="active" style="width: 25%;"><a href="#signaturess" class="nf-breadcrumb" data-toggle="tab" data-index="3">Preview</a></li>
															</ul>
														</div>
													</div>

													@foreach($data as $a)
													<form method="post" action="{{ url('/business/application-form/store') }}" enctype="multipart/form-data" name="registerForm" novalidate="novalidate">

														<input type="hidden" name="_token" value="<?php echo csrf_token(); ?>">
														<input type="hidden" name="coverage" value="{{$a['coverage']}}">
														<input type="hidden" name="unit" value="{{$a['unit']}}">
														<input type="hidden" name="street" value="{{$a['street']}}">
														<input type="hidden" name="package" value="{{ $a['package'] }}">
														<input type="hidden" name="application" value="{{$a['application']}}">
														<input type="hidden" name="company_name" value="{{$a['company_name']}}">
														<input type="hidden" name="company_register" value="{{$a['company_register']}}">
														<input type="hidden" name="company_number" value="{{$a['company_number']}}">
														<input type="hidden" name="company_fax" value="{{$a['company_fax']}}">
														<input type="hidden" name="full_name" value="{{$a['full_name']}}">
														<input type="hidden" name="nric_passport" value="{{$a['nric_passport']}}">
														<input type="hidden" name="designation" value="{{$a['designation']}}">
														<input type="hidden" name="contact_primary" value="{{$a['contact_primary']}}">
														<input type="hidden" name="contact_secondary" value="{{$a['contact_secondary']}}">
														<input type="hidden" name="email" value="{{$a['email']}}">
														<input type="hidden" name="subscription" value="{{$a['subscription']}}">
														<input type="hidden" name="voice" value="{{$a['voice']}}">
														<input type="hidden" name="ip" value="{{$a['ip']}}">
														<input type="hidden" name="ip_tax" value="{{ $a['ip_tax'] }}">
														<input type="hidden" name="rfs" value="{{$a['thedate']}}">
														<input type="hidden" name="postcode" value="{{ $coverage->postcode }}">
														<input type="hidden" name="city" value="{{ $coverage->city }}">
														<input type="hidden" name="state" value="{{ $coverage->state }}">
														<input type="hidden" name="deposit" value="{{ $deposit }}">
														<input type="hidden" name="otc" value="{{ $otc_st }}">
														<input type="hidden" name="gst" value="{{ $gst }}">
														<input type="hidden" name="promo_st" value="{{ $promo_st }}">
														<input type="hidden" name="total_monthly" value="{{ $total_monthly }}">
														
														<div class="tracking-process"></div>
													
														<div>
															<div class="inner-pane-white">
																<!-- Preview -->
																<div class="row">
																	<div class="col-md-12">
																		<div id="preview">
																			<label><b>Subscription Details</b></label>
																			<table class="table table-sm table-bordered">
																				<tbody>
																					<tr><th width="50%">Application Type</th>
																						<td>{{$a['application']}}</td>
																					</tr>
																					<tr><th width="50%">Package</th>
																						<td>City Broadband Business {{$a['package']}}</td>
																					</tr>
																					@if ($a['subscription']==24 && ($a['package'] != '1Gbps'))
																					<tr><th width="50%">Promotion</th>
																						<td>Year End Promotion (RM10 off for 24 months)</td>
																					</tr>
																					@endif
																					<tr><th width="50%">Contract Term</th>
																						<td>{{$a['subscription']}} Months</td>
																					</tr>
																					<tr><th width="50%">Preferred Installation Date</th>
																						<td>{{$a['thedate']}}</td>
																					</tr>
																				</tbody>
																			</table>
																			<hr><label><b>Add-On(s)</b></label>
																			<table class="table table-sm table-bordered">
																				<tbody>
																					<tr><th width="50%">Business Voice Plan and Dect Phone</th>
																					@if($a['package'] != '50Mbps') 
																						<td>Free</td>
																					@else
																						<td>{{$a['voice']}}</td>
																					@endif
																					</tr>
																					<tr><th width="50%">Fixed IP</th>
																					@if($a['ip'] == '') 
																						<td>No</td>
																					@else
																						<td>{{$a['ip']}}</td>
																					@endif
																					</tr>
																				</tbody>
																			</table>
																			<hr><label><b>Personal Details</b></label>
																			<table class="table table-sm table-bordered">
																				<tbody>
																					<tr><th width="50%">Full Name</th>
																						<td>{{$a['full_name']}}</td>
																					</tr>
																					<tr><th width="50%">MyKad/Passport</th>
																						<td>{{$a['nric_passport']}}</td>
																					</tr>
																					<tr><th width="50%">Designation</th>
																						<td>{{$a['designation']}}</td>
																					</tr>
																					<tr><th width="50%">Primary Phone Number</th>
																						<td>{{$a['contact_primary']}}</td>
																					</tr>
																					<tr><th width="50%">Secondary Phone Number</th>
																						<td>{{$a['contact_secondary']}}</td>
																					</tr>
																					<tr><th width="50%">Email Address</th>
																						<td>{{$a['email']}}</td>
																					</tr>
																				</tbody>
																			</table>
																			<hr><label><b>Service Installation Address</b></label>
																			<table class="table table-sm table-bordered">
																				<tbody>
																					<tr><th width="50%">Unit Number</th>
																						<td>{{$a['unit']}}</td>
																					</tr>
																					<tr><th width="50%">Building</th>
																						<td>{{$coverage->building_name}}</td>
																					</tr>
																					<tr><th width="50%">Street</th>
																						<td>{{ucwords($a['street'])}}</td>
																					</tr>
																					<tr><th width="50%">Postcode</th>
																						<td>{{$coverage->postcode}}</td>
																					</tr>
																					<tr><th width="50%">City</th>
																						<td>{{$coverage->city}}</td>
																					</tr>
																					<tr><th width="50%">State</th>
																						<td>{{$coverage->state}}</td>
																					</tr>
																				</tbody>
																			</table>
																			<hr><label><b>Monthly Recurring Charges</b></label>
																			<table class="table table-sm table-bordered">
																				<tbody>
																					<tr>
																						<th>Description</th>
																						<th>Price exclude ST</th>
																						<th>Total*</th>
																					</tr>
																					<tr><th>City Broadband Business - {{$a['package']}}</th>
																					@if($a['package']!='1Gbps' && $a['subscription']=='24')
																						<td><span style="text-decoration: line-through;">RM{{ $product->retail_price }}</span>  RM{{ $promo_price}}</td>
																						<td>RM{{ $promo_st }}</td>
																					@else
																						<td>RM{{ $product->retail_price }}</td>
																						<td>RM{{ $gst }}</td>
																					@endif
																					</tr>
																					@if($a['voice']=='Yes')
																					<tr><th>Business Voice Plan</th>
																						<td>
																							RM20
																						</td>
																						<td>
																							RM21.20
																						</td>
																					</tr>
																					@endif
																					@if($a['ip'] == '1 Fixed IP RM200/1P/Month')  
																					<tr>
																						<th>Fixed IP</th>
																						<td>RM {{$a['ip_fee']}}</td>
																						<td>RM {{$a['ip_tax']}}</td>
																					</tr>
																					@endif
																					<tr><th colspan="2">Total Charges</th>
																						<td><b>RM{{ $total_monthly }}</b></td>
																					</tr>
																				</tbody>
																			</table>
																			<small>*Price subject to 6% Service Tax (if applicable).</small><br>
																			@if ($upfront_total != '0')
																			<hr><label><b>Upfront Charges</b></label>
																			<table class="table table-sm table-bordered">
																				<tbody>
																					<tr>
																						<th>Description</th>
																						<th>Price exclude ST</th>
																						<th>Total*</th>
																					</tr>
																					@if ($otc_st != '0')
																					<tr><th>One Time Charges</th>
																						<td>RM {{ $otc }}</td>
																						<td>RM {{ $otc_st }}</td>
																					</tr>
																					@endif
																					@if ($deposit != '0')
																					<tr><th colspan="2">Deposit</th></th>
																						<td>RM {{ $deposit}}</td>
																					</tr>
																					@endif
																					<tr><th colspan="2">Total Charges</th>
																						<td><b>RM{{ $upfront_total }}</b></td>
																					</tr>
																				</tbody>
																			</table>
																			<small>*Price subject to 6% Service Tax (if applicable).</small><br>
																			<small>All upfront charges will need to be paid prior installation. You will receive an email once your application has been processed.</small>
																			@endif
																		</div>
																	</div>
																</div>
															</div>
															
															<!-- Document -->
																
															<div class="inner-pane">
																<h3>Declaration and Signature</h3>
																<div class="row">
																	<div class="col-md-12" id="document">
																		<label><b>Document &amp; Declaration </b><small style="color: red">*</small></label>
																		<div class="form-group">
																			<div class="checkbox">
																				<label>
																					<input type="checkbox" name="photocopy" id="photocopy" value="24" required /> <p>Photocopy of MyKad (front and back) or passport for Non-Malaysian (minimum 12 months validity)</p>
																				</label>
																			</div>
																			<div class="checkbox">
																				<label>
																					<input type="checkbox" name="formss" id="formss" value="24" required /> <p>Local Registered Company<br>Photocopy of Form 9/Form 13/Notice of Registration (Section 15)/Certificate of Incorporation (Section 17)/Section 28/Certificateof Practice issued by the relevant authority (NGO/Association /Cooperative)
																					<br>Foreign Registered Company<br>Form 79/Form 80/Form 80a/Form 83/Form 83a/Section 562(1)</p>
																				</label>
																			</div>
																			<div class="checkbox">
																				<label>
																					<input type="checkbox" name="consent" id="consent" value="24" required /> <p>I hereby consent to the collection, use,
																						disclosure of my personal information in accordance with the <b><a href="https://www.citybroadband.my/privacy-policy-2/" > Privacy Policy</a></b> available on www.citybroadband.my.</p>
																				</label>
																			</div>
																			<div class="checkbox">
																				<label>
																					<input type="checkbox" name="declare" id="declare" value="24" required /> <p>I hereby declare that the above information, documents, and
																						any appendices attached are true and valid. I have read and understood the contents of this form and agreed to be bound by <b> <a href="https://www.citybroadband.my/terms-conditions/">Terms & Condition</a> </b>
																						as stated on the next page of this form which accompany the subscription of product(s) and/ or service(s). Allo Technology Sdn Bhd reserve the rights
																						to refuse any application  at any given time should any of the information is incorrect.
																					</p>
																				</label>
																			</div>
																		</div>
																	</div>
																</div>

																<h3>Upload Documents</h3>
																<small><b>Acceptable formats: jpg , jpeg , png, pdf</b></small>
																<div class="row">

																	<div class="col-md-6">
																		<div class="form-group">
																			<label>MyKad / Passport (Front) <small style="color: red">*</small></label>
																			<input type="file" id="front_ic" name="front_ic" multiple onchange="validateImage1()" class="form-control" required />
																		</div>
																	</div>
																	<div class="col-md-6">
																		<div class="form-group">
																			<label>MyKad/ Passport (Back)<small style="color: red">*</small></label>
																			<input type="file" id="back_ic" name="back_ic" multiple onchange="validateImage2()" class="form-control" required />
																		</div>
																	</div>

																	<div class="col-md-12">
																		<div class="form-group">
																			<label>Local Registered Company<br>Form 9/Form 13/Notice of Registration (Section 15)/Certificate of Incorporation (Section 17)/Section 28/Certificateof Practice issued by the relevant authority (NGO/Association /Cooperative)<small style="color: red"> *</small><br>
																			Foreign Registered Company<br>Form 79/Form 80/Form 80a/Form 83/Form 83a/Section 562(1)<small style="color: red"> *</small></label>
																			<input type="file" id="form9" name="form9" multiple onchange="validateImage3()" class="form-control" required />
																		</div>
																	</div>
																</div>
															</div>
														</div>

														<!-- Wizard Footer -->
														<div class="wizard-footer height-wizard">
															<div class="wizard-footer-inner">
																<div class="pull-right">
																	<!-- <a href="{{url('Residential/form2')}}"> -->
																	<!-- <button type="submit" class="btn btn-next" name="next" value="Next" style="background-color: orangered; display: inline-block;">Next</button> -->
																	<!-- <input type="button" id="save-data" class="btn btn-finish" data-loading-text="Please Wait..." name="finish" value="Submit" style="display: none;"> -->
																	<div id="showB">
																		<input type="submit" class="btn btn-finish" data-loading-text="Please Wait..." name="finish" value="Submit" style="display: none;">
																		<!-- </a> -->
																	</div>
																</div>
																	
																	<!-- <div class="pull-left">
																		<a href="{{url('/application-form/residential/address/step1')}}">
																			<input type="button" class="btn btn-previous" name="previous" value="Previous" style="background-color: grey;">
																		</a>
																	</div> -->
																<div class="clearfix"></div>
															</div>
														</div>
													</form>
													@endforeach
												</div>
											</div>
										</div>
									</div>	
								</section>
							</div>
						</div>
					</div>
					<div class="nonstick-footer padding bg-blue" align="center">
						<span class="medium-title text-centeryellow" style="color: yellow;">Got A Question?</span>
						<div align="center">
							<a class="nomargin btn btn-default" href="https://www.citybroadband.my/support/faqs/business/year-end-promo/" style="width: 230px;">
								Read FAQ
							</a>
							<a style="width:230px" href="#" class="nomargin btn btn-default">
								Write to us
							</a>
						</div>
					</div>
				</div>
			</section>
		</div>
	<div class="footer-callout"></div>
		<footer id="colophon" class="site-footer footer" role="contentinfo">
		<div class="container footer-inner">
			<div class="row">
				<div class="footer-widget-area">
					<div class="col-md-6 col-md-3 footer-widget" role="complementary">
						<div class="widget widget_nav_menu" id="nav_menu-3">
							<h2 class="widget-title">Overview</h2>
							<div class="menu-main-container">
								<ul id="menu-main" class="menu">
									<li class="menu-item menu-item-type-post_type menu-item-object-page menu-item-16">
										<a href="https://citybroadband.my/residential/">Residential</a>
									</li>
									<li class="menu-item menu-item-type-post_type menu-item-object-page menu-item-15">
										<a href="https://citybroadband.my/business/">Business</a>
									</li>
									<li class="menu-item menu-item-type-post_type menu-item-object-page menu-item-14">
										<a href="https://citybroadband.my/our-story/">Our Story</a>
									</li>
									<li class="menu-item menu-item-type-post_type menu-item-object-page menu-item-13">
										<a href="https://citybroadband.my/support/">Support</a>
									</li>
									<li class="menu-item menu-item-type-post_type menu-item-object-page menu-item-13">
										<a href="https://citybroadband.my/support/coverage-map/">Coverage Map</a>
									</li>
									<li class="menu-item menu-item-type-post_type menu-item-object-page menu-item-12">
										<a href="https://citybroadband.my/contact-us/">Contact Us</a>
									</li>
								</ul>
							</div>
						</div>
					</div>
					<div class="col-md-3 col-sm-6 footer-widget" role="complementary">
						<div id="nav_menu-2" class="widget widget_nav_menu">
							<h2 class="widget-title">Legal</h2>
							<div class="menu-footer-2-container">
								<ul id="menu-footer-2" class="menu">
									<li id="menu-item-22" class="menu-item menu-item-type-post_type menu-item-object-page menu-item-22">
										<a href="https://citybroadband.my/terms-conditions/">Terms &amp; Conditions</a>
									</li>
									<li id="menu-item-373" class="menu-item menu-item-type-post_type menu-item-object-page menu-item-373">
										<a href="https://citybroadband.my/privacy-policy/">Privacy Policy</a>
									</li>
									<li id="menu-item-373" class="menu-item menu-item-type-post_type menu-item-object-page menu-item-373">
										<a href="https://citybroadband.my/refund-policy/">Refund Policy</a>
									</li>
								</ul>
							</div>
						</div>
					</div>
					<div class="col-md-3 col-sm-6 footer-widget" role="complementary">
						<div id="text-2" class="widget widget_text">
							<h2 class="widget-title">Hotline</h2>			
							<div class="textwidget"><span class="number-big yellow">1300-38-8000</span></div>
						</div>	
					</div>
					<div class="col-md-3 col-sm-6 footer-widget" role="complementary">
						<div id="text-4" class="widget widget_text">
							<h2 class="widget-title">We Accept</h2>	
							<div class="textwidget"><img src="https://citybroadband.my/wp-content/themes/cb1g/assets/images/weaccept.png"></div>
						</div>
					</div>
				</div>
			</div>
		</div>
		<div class="container">
			<div class="lowerfooter">
				<img width="50px" src="{{url('assets/logo/footerlogo.png')}}" align="left">
				<span class="lower-disclaimer">Copyright © 2019 Allo Technology Sdn Bhd. All rights reserved.</span>
			</div>
			<a class="btn btn-sm fade-half back-to-top inner-link" href="#top"><i class="fa fa-angle-up"></i></a>
		</div>
	</footer>
	<script type="text/javascript" src="{{url('js/navigation.js')}}"></script>
	<script type="text/javascript" src="{{url('js/skip-link-focus.js')}}"></script>
	
	<!-- Boostrap Wizard -->
	<script src="{{url('js/jquery.bootstrap.wizard.js')}}" type="text/javascript"></script>
	<!--  Plugin for the Wizard -->
	<script src="{{url('js/gsdk.bootstrap.wizard.js')}}" type="text/javascript"></script>
	<script src="{{url('js/jquery.validate.min.js')}}" type="text/javascript"></script>
	<!-- DatePicker -->
	<script src="https://cdnjs.cloudflare.com/ajax/libs/bootstrap-datepicker/1.8.0/js/bootstrap-datepicker.min.js" type="text/javascript"></script>
	<!-- Signature -->
	<script src="{{url('js/signature_pad.ums.js')}}" type="text/javascript"></script>
	<script type="text/javascript">

		function validateImage1() {
			var formData = new FormData();
			 
			var file = document.getElementById("front_ic").files[0];
			 
			formData.append("Filedata", file);
			var t = file.type.split('/').pop().toLowerCase();
			if (t != "jpeg" && t != "jpg" && t != "pdf" && t != "png") {
				alert('Accept jpeg, jpg, pdf and png only.');
				document.getElementById("front_ic").value = '';
				return false;
			}
			return true;
		}
		
		function validateImage2() {
			var formData = new FormData();
			var file = document.getElementById("back_ic").files[0];
			 
			formData.append("Filedata", file);
			var t = file.type.split('/').pop().toLowerCase();
			if (t != "jpeg" && t != "jpg" && t != "pdf" && t != "png") {
				alert('Accept jpeg, jpg, pdf and png only.');
				document.getElementById("back_ic").value = '';
				return false;
			}
			return true;
		}
		
		function validateImage3() {
			var formData = new FormData();
			 
			var file = document.getElementById("form9").files[0];
			 
			formData.append("Filedata", file);
			var t = file.type.split('/').pop().toLowerCase();
			if (t != "jpeg" && t != "jpg" && t != "pdf" && t != "png") {
				alert('Accept jpeg, jpg, pdf and png only.');
				document.getElementById("form9").value = '';
				return false;
			}
			return true;
		}

	</script>

</body>
</html>
<script type="text/javascript">
	$(window).scroll(function() {    
		var scroll = $(window).scrollTop();
		if (scroll >= 150) {
			$(".site-header").addClass("smallHeader");
		}
		else {
			$(".site-header").removeClass("smallHeader");
		}

	});
	$(".header-blue100,.header-blue500,.header-pink, .header-blue-10, .header-blue-30, .header-blue-50, .header-blue-100, .header-blue-500").hover(function () {
		$(this).toggleClass("expanded-column");
	 
	});
	$(window).on("scroll touchmove",function() {
	    if($('body').height() <= ($(window).height() + $(window).scrollTop())) {
		   $('footer').addClass('reached-bottom');
	    } else {
			$('footer').removeClass('reached-bottom');   
		}
	});
</script>
<style>
	select {
		height: 40px !important;
	}
	#nf-field-21-wrap .nf-field-label {
		padding-left: 5px;
	}
	.nf-field-element p {margin:0;}
	div#nf-field-22-container {
		margin: 0;
	} 
</style>