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<div class='gform_heading'>
<span class='gform_description'>We noticed you didn't request a quote today. Can you help us understand why? (Select all that apply)</span>
</div>
<div class='gform_body'><ul id='gform_fields_20' class='gform_fields top_label form_sublabel_below description_below'><li id='field_20_1' class='gfield field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' ></label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_20_1'><li class='gchoice_20_1_1'>
<input name='input_1.1' type='checkbox' value='Could not find filter that fits my needs' id='choice_20_1_1' />
<label for='choice_20_1_1' id='label_20_1_1'>Could not find filter that fits my needs</label>
</li><li class='gchoice_20_1_2'>
<input name='input_1.2' type='checkbox' value='Not enough product information' id='choice_20_1_2' />
<label for='choice_20_1_2' id='label_20_1_2'>Not enough product information</label>
</li><li class='gchoice_20_1_3'>
<input name='input_1.3' type='checkbox' value='Other (please specify below)' id='choice_20_1_3' />
<label for='choice_20_1_3' id='label_20_1_3'>Other (please specify below)</label>
</li></ul></div></li><li id='field_20_2' class='gfield field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_20_2' >We welcome your feedback.</label><div class='ginput_container ginput_container_textarea'><textarea name='input_2' id='input_20_2' class='textarea medium' aria-invalid="false" rows='10' cols='50'></textarea></div></li><li id='field_20_3' class='gfield field_sublabel_below field_description_above gfield_visibility_visible' ><label class='gfield_label' ></label><div class='gfield_description' id='gfield_description_20_3'>We will contact you <b>only</b> to respond to your message.</div><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_20_3'><li class='gchoice_20_3_1'>
<input name='input_3.1' type='checkbox' value='Please contact me regarding my feedback' id='choice_20_3_1' />
<label for='choice_20_3_1' id='label_20_3_1'>Please contact me regarding my feedback</label>
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<input name='input_4' id='input_20_4' type='text' value='' class='medium' aria-required="true" aria-invalid="false" />
</div></li><li id='field_20_5' class='gfield field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' ></label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_20_5'><li class='gchoice_20_5_1'>
<input name='input_5.1' type='checkbox' value='Subscribe me to your newsletter' id='choice_20_5_1' />
<label for='choice_20_5_1' id='label_20_5_1'>Subscribe me to your newsletter</label>
</li></ul></div></li>
</ul></div>
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</form>
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