{"id":4280,"date":"2012-09-10T21:19:41","date_gmt":"2012-09-10T21:19:41","guid":{"rendered":"http:\/\/@WEBSITE_1@\/?page_id=4280"},"modified":"2018-06-02T08:03:52","modified_gmt":"2018-06-02T08:03:52","slug":"offerte_personenwagen","status":"publish","type":"page","link":"https:\/\/www.zakenkantoorgoethals.be\/en\/offerte_personenwagen\/","title":{"rendered":"Quotation Car"},"content":{"rendered":"<p>\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_6' style='display:none'><div id='gf_6' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data'  id='gform_6'  action=\"\/en\/wp-json\/wp\/v2\/pages\/4280#gf_6\" data-formid='6' novalidate>\n        <div id='gf_progressbar_wrapper_6' class='gf_progressbar_wrapper' data-start-at-zero=''>\n        \t<h3 class=\"gf_progressbar_title\">Step <span class='gf_step_current_page'>1<\/span> of <span class='gf_step_page_count'>10<\/span><span class='gf_step_page_name'><\/span>\n        \t<\/h3>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_10' style='width:10%;'><span>10%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_6_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><ul id='gform_fields_6' class='gform_fields left_label form_sublabel_above description_below validation_below' data-column-layout='fill'><li id=\"field_6_55\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_6_55' class='gfield_label gform-field-label' for='input_6_55'><span class='gform-field-label__text'>Email<\/span><\/label><div class='ginput_container'><input name='input_55' id='input_6_55' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_6_55'>This field is for validation purposes and should be left unchanged.<\/div><\/li><li id=\"field_6_5\" class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><h2 class=\"gsection_title\">Policyholder<\/h2><\/li><li id=\"field_6_1\" class=\"gfield gfield--type-name gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_6_1' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_6_1'>\n                            \n                            <span id='input_6_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_6_1_3' id='input_6_1_3_label' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                    <input type='text' name='input_1.3' id='input_6_1_3' value=''   aria-required='true'     aria-labelledby=\"input_6_1_3_label gfield_label_6_1\"\/>\n                                                <\/span>\n                            \n                            <span id='input_6_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_6_1_6' id='input_6_1_6_label' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                            <input type='text' name='input_1.6' id='input_6_1_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/li><li id=\"field_6_2\" class=\"gfield gfield--type-address gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_6_2' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip ginput_container_address gform-grid-row' id='input_6_2' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_6_2_1_container' >\n                                        <label for='input_6_2_1' id='input_6_2_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                        <input type='text' name='input_2.1' id='input_6_2_1' value=''    aria-required='true'    aria-labelledby=\"input_6_2_1_label gfield_label_6_2\"\/>\n                                   <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_6_2_3_container' >\n                                    <label for='input_6_2_3' id='input_6_2_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                    <input type='text' name='input_2.3' id='input_6_2_3' value=''    aria-required='true'    \/>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_2.4' id='input_6_2_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_6_2_5_container' >\n                                    <label for='input_6_2_5' id='input_6_2_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                    <input type='text' name='input_2.5' id='input_6_2_5' value=''    aria-required='true'    \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_2.6' id='input_6_2_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_6_3\" class=\"gfield gfield--type-email gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_6_3' class='gfield_label gform-field-label' for='input_6_3'><span class='gform-field-label__text'>Email<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_3' id='input_6_3' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_6_4\" class=\"gfield gfield--type-phone gfield--phone-format-international gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_6_4' class='gfield_label gform-field-label' for='input_6_4'><span class='gform-field-label__text'>Telephone<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_4' id='input_6_4' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"    \/><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer left_label'>\n                         <button type='button' id='gform_next_button_6_12' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Volgende<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_6_2' class='gform_page' data-js='page-field-id-12' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_6_2' class='gform_fields left_label form_sublabel_above description_below validation_below' data-column-layout='fill'><li id=\"field_6_7\" class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><h2 class=\"gsection_title\">Your contract type<\/h2><\/li><li id=\"field_6_9\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"><label id='gfield_label_6_9' class='gfield_label gform-field-label screen-reader-text' ><span class='gform-field-label__text'><\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_6_9'>\n\t\t\t<li class='gchoice gchoice_6_9_0'>\n\t\t\t\t<input name='input_9' type='radio' value='First contract (in own name)'  id='choice_6_9_0'    \/>\n\t\t\t\t<label for='choice_6_9_0' id='label_6_9_0' class='gform-field-label gform-field-label--type-inline'>First contract (in own name)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_6_9_1'>\n\t\t\t\t<input name='input_9' type='radio' value='Replacement vehicle (in existing contract of KBC)'  id='choice_6_9_1'    \/>\n\t\t\t\t<label for='choice_6_9_1' id='label_6_9_1' class='gform-field-label gform-field-label--type-inline'>Replacement vehicle (in existing contract of KBC)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_6_9_2'>\n\t\t\t\t<input name='input_9' type='radio' value='Acquisition contract (other company)'  id='choice_6_9_2'    \/>\n\t\t\t\t<label for='choice_6_9_2' id='label_6_9_2' class='gform-field-label gform-field-label--type-inline'>Acquisition contract (other company)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_6_9_3'>\n\t\t\t\t<input name='input_9' type='radio' value='Additional vehicle'  id='choice_6_9_3'    \/>\n\t\t\t\t<label for='choice_6_9_3' id='label_6_9_3' class='gform-field-label gform-field-label--type-inline'>Additional vehicle<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer left_label'>\n                        <button type='button' id='gform_previous_button_6_13' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Vorige<\/button> <button type='button' id='gform_next_button_6_13' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Volgende<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_6_3' class='gform_page' data-js='page-field-id-13' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_6_3' class='gform_fields left_label form_sublabel_above description_below validation_below' data-column-layout='fill'><li id=\"field_6_10\" class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><h2 class=\"gsection_title\">Which policies have you already with KBC?<\/h2><\/li><li id=\"field_6_11\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"><label id='gfield_label_6_11' class='gfield_label gform-field-label screen-reader-text gfield_label_before_complex' ><span class='gform-field-label__text'><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_6_11'><li class='gchoice gchoice_6_11_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.1' type='checkbox'  value='Fire (&gt; 180 \u20ac \/ year)'  id='choice_6_11_1'    aria-labelledby=\"label_6_11_1 gfield_label_6_11\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_6_11_1' id='label_6_11_1' class='gform-field-label gform-field-label--type-inline'>Fire (> 180 \u20ac \/ year)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_6_11_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.2' type='checkbox'  value='Family insurance'  id='choice_6_11_2'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_11_2' id='label_6_11_2' class='gform-field-label gform-field-label--type-inline'>Family insurance<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_6_11_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.3' type='checkbox'  value='Accident insurance'  id='choice_6_11_3'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_11_3' id='label_6_11_3' class='gform-field-label gform-field-label--type-inline'>Accident insurance<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer left_label'>\n                        <button type='button' id='gform_previous_button_6_14' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Vorige<\/button> <button type='button' id='gform_next_button_6_14' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Volgende<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_6_4' class='gform_page' data-js='page-field-id-14' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_6_4' class='gform_fields left_label form_sublabel_above description_below validation_below' data-column-layout='fill'><li id=\"field_6_16\" class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><h2 class=\"gsection_title\">Vehicle specifications<\/h2><\/li><li id=\"field_6_17\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_6_17' class='gfield_label gform-field-label' for='input_6_17'><span class='gform-field-label__text'>Type of vehicle<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_17' id='input_6_17' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Passenger car' >Passenger car<\/option><option value='Light truck' >Light truck<\/option><\/select><\/div><\/li><li id=\"field_6_18\" class=\"gfield gfield--type-text field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_6_18' class='gfield_label gform-field-label' for='input_6_18'><span class='gform-field-label__text'>Brand<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_18' id='input_6_18' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_6_19\" class=\"gfield gfield--type-text field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_6_19' class='gfield_label gform-field-label' for='input_6_19'><span class='gform-field-label__text'>Type<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_19' id='input_6_19' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_6_20\" class=\"gfield gfield--type-text field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_6_20' class='gfield_label gform-field-label' for='input_6_20'><span class='gform-field-label__text'>Capacity of engine (CC)<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_20' id='input_6_20' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_6_21\" class=\"gfield gfield--type-text field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_6_21' class='gfield_label gform-field-label' for='input_6_21'><span class='gform-field-label__text'>Power (KW)<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_21' id='input_6_21' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_6_22\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_6_22' class='gfield_label gform-field-label' for='input_6_22'><span class='gform-field-label__text'>Fuel<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_22' id='input_6_22' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Gasoline' >Gasoline<\/option><option value='Diesel' >Diesel<\/option><option value='LPG' >LPG<\/option><option value='CNG' >CNG<\/option><option value='Electrical' >Electrical<\/option><option value='Hydrogen' >Hydrogen<\/option><\/select><\/div><\/li><li id=\"field_6_23\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-default-icon field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_6_23' class='gfield_label gform-field-label' for='input_6_23'><span class='gform-field-label__text'>Date 1st commissioning<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='dd\/mm\/yyyy'\n\t\t\t\t\tid='input_6_23'\n\t\t\t\t\tclass='datepicker gform-datepicker dmy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_23'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_6_23' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_6_23' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_6_23' aria-label='Date 1st commissioning: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/li><li id=\"field_6_24\" class=\"gfield gfield--type-text field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_6_24' class='gfield_label gform-field-label' for='input_6_24'><span class='gform-field-label__text'>License plate<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_24' id='input_6_24' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_6_25\" class=\"gfield gfield--type-text field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_6_25' class='gfield_label gform-field-label' for='input_6_25'><span class='gform-field-label__text'>Chassis number<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_25' id='input_6_25' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer left_label'>\n                        <button type='button' id='gform_previous_button_6_15' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Vorige<\/button> <button type='button' id='gform_next_button_6_15' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Volgende<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_6_5' class='gform_page' data-js='page-field-id-15' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_6_5' class='gform_fields left_label form_sublabel_above description_below validation_below' data-column-layout='fill'><li id=\"field_6_26\" class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><h2 class=\"gsection_title\">Use of vehicle<\/h2><\/li><li id=\"field_6_27\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"><label id='gfield_label_6_27' class='gfield_label gform-field-label screen-reader-text gfield_label_before_complex' ><span class='gform-field-label__text'><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_6_27'><li class='gchoice gchoice_6_27_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_27.1' type='checkbox'  value='&lt; 10.000 km\/year'  id='choice_6_27_1'    aria-labelledby=\"label_6_27_1 gfield_label_6_27\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_6_27_1' id='label_6_27_1' class='gform-field-label gform-field-label--type-inline'>< 10.000 km\/year<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_6_27_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_27.2' type='checkbox'  value='Pulls trailer (&gt; 750 kg)'  id='choice_6_27_2'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_27_2' id='label_6_27_2' class='gform-field-label gform-field-label--type-inline'>Pulls trailer (> 750 kg)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_6_27_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_27.3' type='checkbox'  value='Daily traffic'  id='choice_6_27_3'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_27_3' id='label_6_27_3' class='gform-field-label gform-field-label--type-inline'>Daily traffic<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_6_27_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_27.4' type='checkbox'  value='Professional use'  id='choice_6_27_4'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_27_4' id='label_6_27_4' class='gform-field-label gform-field-label--type-inline'>Professional use<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_6_27_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_27.5' type='checkbox'  value='Leasing\/Renting-contract'  id='choice_6_27_5'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_27_5' id='label_6_27_5' class='gform-field-label gform-field-label--type-inline'>Leasing\/Renting-contract<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer left_label'>\n                        <button type='button' id='gform_previous_button_6_28' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Vorige<\/button> <button type='button' id='gform_next_button_6_28' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Volgende<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_6_6' class='gform_page' data-js='page-field-id-28' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_6_6' class='gform_fields left_label form_sublabel_above description_below validation_below' data-column-layout='fill'><li id=\"field_6_29\" class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><h2 class=\"gsection_title\">Drivers<\/h2><\/li><li id=\"field_6_30\" class=\"gfield gfield--type-textarea field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_6_30' class='gfield_label gform-field-label' for='input_6_30'><span class='gform-field-label__text'>Frequent drivers<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_30' id='input_6_30' class='textarea large'  aria-describedby=\"gfield_description_6_30\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><div class='gfield_description' id='gfield_description_6_30'><strong>(each name + date of birth + date of license)<\/strong><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer left_label'>\n                        <button type='button' id='gform_previous_button_6_31' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Vorige<\/button> <button type='button' id='gform_next_button_6_31' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Volgende<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_6_7' class='gform_page' data-js='page-field-id-31' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_6_7' class='gform_fields left_label form_sublabel_above description_below validation_below' data-column-layout='fill'><li id=\"field_6_32\" class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><h2 class=\"gsection_title\">Ensuring safeguards<\/h2><\/li><li id=\"field_6_54\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"><label id='gfield_label_6_54' class='gfield_label gform-field-label screen-reader-text gfield_label_before_complex' ><span class='gform-field-label__text'><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_6_54'><li class='gchoice gchoice_6_54_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_54.1' type='checkbox'  value='Civil liability'  id='choice_6_54_1'    aria-labelledby=\"label_6_54_1 gfield_label_6_54\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_6_54_1' id='label_6_54_1' class='gform-field-label gform-field-label--type-inline'>Civil liability<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_6_54_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_54.2' type='checkbox'  value='Judicial assistance'  id='choice_6_54_2'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_54_2' id='label_6_54_2' class='gform-field-label gform-field-label--type-inline'>Judicial assistance<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_6_54_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_54.3' type='checkbox'  value='Full omnium'  id='choice_6_54_3'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_54_3' id='label_6_54_3' class='gform-field-label gform-field-label--type-inline'>Full omnium<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_6_54_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_54.4' type='checkbox'  value='Partial omnium'  id='choice_6_54_4'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_54_4' id='label_6_54_4' class='gform-field-label gform-field-label--type-inline'>Partial omnium<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_6_54_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_54.5' type='checkbox'  value='Assistance (VAB, replacement vehicle,...)'  id='choice_6_54_5'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_54_5' id='label_6_54_5' class='gform-field-label gform-field-label--type-inline'>Assistance (VAB, replacement vehicle,...)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_6_54_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_54.6' type='checkbox'  value='Accident insurance (driver)'  id='choice_6_54_6'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_54_6' id='label_6_54_6' class='gform-field-label gform-field-label--type-inline'>Accident insurance (driver)<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer left_label'>\n                        <button type='button' id='gform_previous_button_6_35' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Vorige<\/button> <button type='button' id='gform_next_button_6_35' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Volgende<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_6_8' class='gform_page' data-js='page-field-id-35' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_6_8' class='gform_fields left_label form_sublabel_above description_below validation_below' data-column-layout='fill'><li id=\"field_6_34\" class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><h2 class=\"gsection_title\">In case to ensure Full Omnium<\/h2><\/li><li id=\"field_6_36\" class=\"gfield gfield--type-text field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_6_36' class='gfield_label gform-field-label' for='input_6_36'><span class='gform-field-label__text'>Invoice price<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_36' id='input_6_36' type='text' value='' class='medium'  aria-describedby=\"gfield_description_6_36\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_6_36'><strong>(incl. VAT) without reducing of a possible takeover price!<\/strong><\/div><\/li><li id=\"field_6_37\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-default-icon field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_6_37' class='gfield_label gform-field-label' for='input_6_37'><span class='gform-field-label__text'>Invoice date<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='dd\/mm\/yyyy'\n\t\t\t\t\tid='input_6_37'\n\t\t\t\t\tclass='datepicker gform-datepicker dmy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_37'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_6_37' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_6_37' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_6_37' aria-label='Invoice date: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/li><li id=\"field_6_38\" class=\"gfield gfield--type-select field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_6_38' class='gfield_label gform-field-label' for='input_6_38'><span class='gform-field-label__text'>Exemption<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_38' id='input_6_38' class='medium gfield_select'     aria-invalid=\"false\" ><option value='\u20ac250' >\u20ac250<\/option><option value='\u20ac500' >\u20ac500<\/option><option value='\u20ac750' >\u20ac750<\/option><option value='\u20ac1000' >\u20ac1000<\/option><option value='\u20ac1250' >\u20ac1250<\/option><\/select><\/div><\/li><li id=\"field_6_39\" class=\"gfield gfield--type-select field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_6_39' class='gfield_label gform-field-label' for='input_6_39'><span class='gform-field-label__text'>Exemption theft<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_39' id='input_6_39' class='medium gfield_select'     aria-invalid=\"false\" ><option value='\u20ac0' >\u20ac0<\/option><option value='\u20ac250' >\u20ac250<\/option><option value='\u20ac500' >\u20ac500<\/option><option value='\u20ac750' >\u20ac750<\/option><option value='\u20ac1000' >\u20ac1000<\/option><option value='\u20ac1250' >\u20ac1250<\/option><\/select><\/div><\/li><li id=\"field_6_40\" class=\"gfield gfield--type-select field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_6_40' class='gfield_label gform-field-label' for='input_6_40'><span class='gform-field-label__text'>VAT recovery<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_40' id='input_6_40' class='medium gfield_select'  aria-describedby=\"gfield_description_6_40\"   aria-invalid=\"false\" ><option value='0%' >0%<\/option><option value='50%' >50%<\/option><option value='100%' >100%<\/option><\/select><\/div><div class='gfield_description' id='gfield_description_6_40'><strong>(for self-employed)<\/strong><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer left_label'>\n                        <button type='button' id='gform_previous_button_6_41' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Vorige<\/button> <button type='button' id='gform_next_button_6_41' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Volgende<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_6_9' class='gform_page' data-js='page-field-id-41' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_6_9' class='gform_fields left_label form_sublabel_above description_below validation_below' data-column-layout='fill'><li id=\"field_6_42\" class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><h2 class=\"gsection_title\">In case you currently have no car insurance at our office<\/h2><\/li><li id=\"field_6_43\" class=\"gfield gfield--type-select field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_6_43' class='gfield_label gform-field-label' for='input_6_43'><span class='gform-field-label__text'>Frequent driver?<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_43' id='input_6_43' class='medium gfield_select'     aria-invalid=\"false\" ><option value='Yes' >Yes<\/option><option value='No' >No<\/option><\/select><\/div><\/li><li id=\"field_6_44\" class=\"gfield gfield--type-text field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_6_44' class='gfield_label gform-field-label' for='input_6_44'><span class='gform-field-label__text'>With which company?<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_44' id='input_6_44' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_6_46\" class=\"gfield gfield--type-number field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_6_46' class='gfield_label gform-field-label' for='input_6_46'><span class='gform-field-label__text'>How many years have you been insured as a frequent driver?<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_46' id='input_6_46' type='text' step='any'   value='' class='medium'      aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_6_47\" class=\"gfield gfield--type-number field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_6_47' class='gfield_label gform-field-label' for='input_6_47'><span class='gform-field-label__text'>Number of accidents in error?<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_47' id='input_6_47' type='text' step='any'   value='' class='medium'      aria-invalid=\"false\" aria-describedby=\"gfield_description_6_47\" \/><\/div><div class='gfield_description' id='gfield_description_6_47'>(last five years)<\/div><\/li><li id=\"field_6_48\" class=\"gfield gfield--type-number field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_6_48' class='gfield_label gform-field-label' for='input_6_48'><span class='gform-field-label__text'>Number of accidents in right?<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_48' id='input_6_48' type='text' step='any'   value='' class='medium'      aria-invalid=\"false\" aria-describedby=\"gfield_description_6_48\" \/><\/div><div class='gfield_description' id='gfield_description_6_48'>(last five years)<\/div><\/li><li id=\"field_6_49\" class=\"gfield gfield--type-number field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_6_49' class='gfield_label gform-field-label' for='input_6_49'><span class='gform-field-label__text'>Current Bonus Malus?<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_49' id='input_6_49' type='text' step='any'   value='' class='medium'      aria-invalid=\"false\"  \/><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer left_label'>\n                        <button type='button' id='gform_previous_button_6_50' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Vorige<\/button> <button type='button' id='gform_next_button_6_50' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Volgende<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_6_10' class='gform_page' data-js='page-field-id-50' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_6_10' class='gform_fields left_label form_sublabel_above description_below validation_below' data-column-layout='fill'><li id=\"field_6_51\" class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><h2 class=\"gsection_title\">Extra<\/h2><\/li><li id=\"field_6_52\" class=\"gfield gfield--type-textarea field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_6_52' class='gfield_label gform-field-label' for='input_6_52'><span class='gform-field-label__text'>Other remarks<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_52' id='input_6_52' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><\/ul><\/div>\n        <div class='gform-page-footer gform_page_footer left_label'><button type='submit' id='gform_previous_button_6' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Vorige<\/button> <button type='submit' id='gform_submit_button_6' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' >Send<\/button> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_6' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_6' id='gform_theme_6' value='legacy' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_6' id='gform_style_settings_6' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_6' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='6' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='EUR' value='bE0XF5A7wB+qcR1kZpeSB7EgV6g4whQiDXb8lllEhUkCynPtGtZ2UfTfIutTdd+QQBi\/tIMYQS\/s6ctgaBO2E5Iod\/3jKoR1YrEnSquEcDUQpFA=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_6' 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  <\/div><\/div>\n                        <\/form>\n                        <\/div><\/p>","protected":false},"excerpt":{"rendered":"Step 1 of 10 10% CommentsThis field is for validation purposes and should be left unchanged.PolicyholderName* First Last Address* Street Address City ZIP \/ Postal Code Email* Telephone* Volgende Your contract type* First contract (in own name) Replacement vehicle (in existing contract of KBC) Acquisition contract (other company) Additional vehicle Vorige Volgende Which policies have you already with KBC? 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