<?php
require_once(rtrim($_SERVER['DOCUMENT_ROOT'], '/') . '/wp-load.php');
?>



<html>

<head>
    <!-- Global site tag (gtag.js) - Google Analytics -->
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        window.dataLayer = window.dataLayer || [];

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        gtag('js', new Date());

        gtag('config', 'UA-140324885-1');
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    <link rel="preconnect" href="https://fonts.gstatic.com" crossorigin>
    <link href="https://fonts.googleapis.com/css2?family=DM+Sans:opsz@9..40&display=swap" rel="stylesheet">


    <!-- meta charec set -->
    <meta http-equiv="Content-Type" content="text/html; charset=UTF-8">
    <title>Powerplus Mobility Inc.</title>

    <link href="https://cdn.jsdelivr.net/npm/bootstrap@5.1.3/dist/css/bootstrap.min.css" rel="stylesheet">
    <script src="https://cdn.jsdelivr.net/npm/bootstrap@5.1.3/dist/js/bootstrap.bundle.min.js"></script>


    <style>
        .custom-frame {
            display: none;
        }

        p {
            color: rgba(0, 0, 0, 0.80);

            /* Content */
            font-family: DM Sans;
            font-size: 20px;
            font-style: normal;
            font-weight: 400;
            line-height: 30px;
            /* 150% */
        }

        h1 {
            color: #090909;
            font-family: DM Sans;
            font-size: 48px;
            font-style: normal;
            font-weight: 700;
            line-height: 54px;
            /* 112.5% */
            text-transform: capitalize;
        }

        .navtext {
            color: #FFF;
            font-family: DM Sans;
            font-size: 14px;
            font-style: normal;
            font-weight: 700;
            line-height: normal;
        }

        .sec01Img {
            text-align: center;
            font-family: DM Sans;
            font-size: 96px;
            font-style: normal;
            font-weight: 700;
            /* line-height: 100px; */
            /* 104.167% */
            text-transform: uppercase;
            background: url(./images/6218e029a2a9bac499669f7ae42c87a2.png), lightgray 50% / cover no-repeat;
            background-clip: text;
            -webkit-background-clip: text;
            -webkit-text-fill-color: transparent;
        }

        .newsletter {
            /* color: #000; */
            font-family: DM Sans;
            font-size: 24px;
            font-style: normal;
            font-weight: 700;
            line-height: 40px;
            /* 166.667% */
        }

        .btncustom {
            border-radius: 20px 0px;
            margin-left: 10px;
            margin-right: 10px;
            display: flex;
            text-align: center;
            vertical-align: middle;
            width: 75%;
            /* Set a width as a percentage of its container */

            gap: 10px;
        }

        .footertext {
            color: var(--neutral-800, #A5ACBA);

            /* Text L/Regular */
            font-family: Inter;
            font-size: 16px;
            font-style: normal;
            font-weight: 400;
            line-height: 24px;
            /* 150% */
            letter-spacing: -0.1px;
        }

        .ul_font {
            color: #25438B;
            font-family: DM Sans;
            font-size: 24px;
            font-style: normal;
            font-weight: 700;
            line-height: 60px;
            /* 250% */
        }

        paradel {
            background-color: yellow;
        }

        @media screen and (max-width: 629px) {
            .sec01Img {
                text-align: center;
                font-family: DM Sans;
                font-size: 30px;
                font-style: normal;
                font-weight: 350;
                /* line-height: 100px; */
                /* 104.167% */
                text-transform: uppercase;
                background: url(./images/6218e029a2a9bac499669f7ae42c87a2.png), lightgray 50% / cover no-repeat;
                background-clip: text;
                -webkit-background-clip: text;
                -webkit-text-fill-color: transparent;
            }
        }

        @media (min-width: 768px) {
            .carousel-inner {
                display: flex;
            }

            .carousel-item {
                margin-right: 0;
                flex: 0 0 25%;
                display: block;
            }
        }

        @media (max-width: 629px) {
            img#optionalstuff {
                display: none;
            }
        }

        @media screen and (max-width: 629px) {
            .MobileContent {
                display: none;
            }
        }

        @media screen and (min-width: 629px) {
            .clicktocall {
                display: none;
            }
        }

        .carousel-inner {
            padding: 1em;
        }

        .card {
            margin: 0 .5em;
            box-shadow: 2px 6px 8px 0 rgba(22, 22, 26, 0.18);
            border: none;
        }

        .carousel-control-prev,
        .carousel-control-next {
            background-color: #e1e1e1;
            width: 6vh;
            height: 6vh;
            border-radius: 50%;
            top: 50%;
            transform: translateY(-50%);
        }

        .card .img-wrapper {
            max-width: 100%;
            height: 13em;
            display: flex;
            justify-content: center;
            align-items: center;
        }

        img {
            max-height: 100%;
        }
    </style>

    <style>
        @media (max-width:629px) {
            img#optionalstuff {
                display: none;
            }
        }

        @media screen and (max-width: 629px) {

            .MobileContent {

                display: none;

            }

        }

        @media screen and (min-width: 629px) {
            .clicktocall {

                display: none;

            }

        }

        /* Banner */

        .banner {
            background-color: #8a4680;
            color: #e2d1df;
            padding: 8em 0;
            position: relative;
        }

        .banner input,
        .banner select,
        .banner textarea {
            color: #ffffff;
        }

        .banner a {
            color: #ffffff;
        }

        .banner strong,
        .banner b {
            color: #ffffff;
        }

        .banner h1,
        .banner h2,
        .banner h3,
        .banner h4,
        .banner h5,
        .banner h6 {
            color: #ffffff;
        }

        .banner blockquote {
            border-left-color: rgba(255, 255, 255, 0.25);
        }

        .banner code {
            background: rgba(255, 255, 255, 0.075);
            border-color: rgba(255, 255, 255, 0.25);
        }

        .banner hr {
            border-bottom-color: rgba(255, 255, 255, 0.25);
        }

        .banner.full {
            padding: 0;
            min-height: 100vh;
            height: 100vh !important;
        }

        .banner.half {
            padding: 0;
            min-height: 50vh;
            height: 50vh !important;
        }

        .banner:after {
            -moz-pointer-events: none;
            -webkit-pointer-events: none;
            -ms-pointer-events: none;
            pointer-events: none;
            -moz-transition: opacity 1.5s ease-in-out, visibility 1.5s;
            -webkit-transition: opacity 1.5s ease-in-out, visibility 1.5s;
            -ms-transition: opacity 1.5s ease-in-out, visibility 1.5s;
            transition: opacity 1.5s ease-in-out, visibility 1.5s;
            background: #000000;
            content: '';
            display: block;
            height: 100%;
            left: 0;
            opacity: 0;
            position: absolute;
            top: 0;
            visibility: hidden;
            width: 100%;
            z-index: 2;
        }

        .banner .indicators {
            bottom: 1.5em;
            left: 0;
            list-style: none;
            margin: 0;
            padding: 0;
            position: absolute;
            text-align: center;
            width: 100%;
            z-index: 2;
        }

        .banner .indicators li {
            cursor: pointer;
            display: inline-block;
            height: 2em;
            overflow: hidden;
            padding: 0;
            position: relative;
            text-indent: 2em;
            width: 2em;
        }

        .banner .indicators li:before {
            background: rgba(255, 255, 255, 0.35);
            border-radius: 100%;
            content: '';
            display: inline-block;
            height: 0.8em;
            left: 50%;
            margin: -0.4em 0 0 -0.4em;
            position: absolute;
            text-indent: 0;
            top: 50%;
            width: 0.8em;
        }

        .banner .indicators li.visible:before {
            background: #fff;
        }

        .banner>article {
            -moz-transition: opacity 1.5s ease, visibility 1.5s;
            -webkit-transition: opacity 1.5s ease, visibility 1.5s;
            -ms-transition: opacity 1.5s ease, visibility 1.5s;
            transition: opacity 1.5s ease, visibility 1.5s;
            background-attachment: fixed;
            background-position: center;
            background-repeat: no-repeat;
            background-size: cover;
            height: 100%;
            left: 0;
            opacity: 0;
            position: absolute;
            text-align: center;
            top: 0;
            visibility: hidden;
            width: 100%;
            z-index: 0;
        }

        .banner>article:before {
            content: '';
            display: inline-block;
            height: 100%;
            vertical-align: middle;
        }

        .banner>article:after {
            content: '';
            display: block;
            width: 100%;
            height: 100%;
            position: absolute;
            top: 0;
            left: 0;

            opacity: 0.0;
        }

        .banner>article .inner {
            position: relative;
            display: inline-block;
            vertical-align: middle;
            z-index: 1;
        }

        .banner>article .inner> :last-child {
            margin-bottom: 0;
        }

        .banner>article h2 {
            font-size: 3.0vw;
            margin-bottom: 0;
            color: #FFF;
            font-weight: 300;
        }

        .banner>article h2:after {
            display: none;
        }

        .banner>article p {
            color: rgba(255, 255, 255, 0.65);
            text-transform: uppercase;
            font-size: 1rem;
            font-weight: 300;
            margin: 0;
            padding-bottom: 1.75rem;
            letter-spacing: .25rem;
        }

        .banner>article p:after {
            content: '';
            position: absolute;
            margin: auto;
            right: 0;
            bottom: 0;
            left: 0;
            width: 50%;
            height: 1px;
            background-color: rgba(255, 255, 255, 0.65);
        }

        .banner>article a {
            color: #FFF;
            text-decoration: none;
        }

        .banner>article img {
            display: none;
        }

        .banner>article.visible {
            opacity: 1;
            visibility: visible;
        }

        .banner>article.top {
            z-index: 1;
        }

        .banner>article.instant {
            -moz-transition: none !important;
            -webkit-transition: none !important;
            -ms-transition: none !important;
            transition: none !important;
        }

        body.is-loading .banner:after {
            opacity: 1.0;
            visibility: visible;
        }

        @media screen and (max-width: 1280px) {

            .banner.full {
                padding: 0;
                min-height: 75vh;
                height: 75vh !important;
            }

        }

        @media screen and (max-width: 980px) {

            .banner.full {
                padding: 0;
                min-height: 50vh;
                height: 50vh !important;
            }

            .banner>article {
                background-attachment: scroll;
            }

        }

        @media screen and (max-width: 736px) {

            .banner>article .inner {
                width: 90%;
            }

            .banner>article p {
                margin-bottom: 1rem;
            }

            .banner>article h2 {
                font-size: 4vw;
            }

        }

        body.is-mobile .banner>article {
            background-attachment: scroll;
        }

        .wrapper.style3 {
            background-color: #000;
            color: #bfbfbf;
            background-image: url(../../images/power-plus-white.jpg);
            background-size: cover;
            background-attachment: fixed;
            background-position: center;
            position: relative;
        }

        .wrapper.style3 input,
        .wrapper.style3 select,
        .wrapper.style3 textarea {
            color: #ffffff;
        }

        .wrapper.style3 a {
            color: #8a4680;
        }

        .wrapper.style3 strong,
        .wrapper.style3 b {
            color: #ffffff;
        }

        .wrapper.style3 h1,
        .wrapper.style3 h2,
        .wrapper.style3 h3,
        .wrapper.style3 h4,
        .wrapper.style3 h5,
        .wrapper.style3 h6 {
            color: #000000;
        }

        .wrapper.style3 blockquote {
            border-left-color: rgba(255, 255, 255, 0.25);
        }

        .wrapper.style3 code {

            border-color: rgba(255, 255, 255, 0.25);
        }

        .wrapper.style3 hr {
            border-bottom-color: rgba(255, 255, 255, 0.25);
        }

        .wrapper.style3 .box {
            border-color: rgba(255, 255, 255, 0.25);
        }

        .wrapper.style3 input[type="submit"],
        .wrapper.style3 input[type="reset"],
        .wrapper.style3 input[type="button"],
        .wrapper.style3 button,
        .wrapper.style3 .button {
            background-color: #f2f2f2;
            color: #000 !important;
        }

        .wrapper.style3 input[type="submit"]:hover,
        .wrapper.style3 input[type="reset"]:hover,
        .wrapper.style3 input[type="button"]:hover,
        .wrapper.style3 button:hover,
        .wrapper.style3 .button:hover {
            background-color: white;
        }

        .wrapper.style3 input[type="submit"]:active,
        .wrapper.style3 input[type="reset"]:active,
        .wrapper.style3 input[type="button"]:active,
        .wrapper.style3 button:active,
        .wrapper.style3 .button:active {
            background-color: #e5e5e5;
        }

        .wrapper.style3 input[type="submit"].alt,
        .wrapper.style3 input[type="reset"].alt,
        .wrapper.style3 input[type="button"].alt,
        .wrapper.style3 button.alt,
        .wrapper.style3 .button.alt {
            background-color: transparent;
            box-shadow: inset 0 0 0 2px rgba(255, 255, 255, 0.25);
            color: #ffffff !important;
        }

        .wrapper.style3 input[type="submit"].alt:hover,
        .wrapper.style3 input[type="reset"].alt:hover,
        .wrapper.style3 input[type="button"].alt:hover,
        .wrapper.style3 button.alt:hover,
        .wrapper.style3 .button.alt:hover {
            background-color: rgba(255, 255, 255, 0.075);
        }

        .wrapper.style3 input[type="submit"].alt:active,
        .wrapper.style3 input[type="reset"].alt:active,
        .wrapper.style3 input[type="button"].alt:active,
        .wrapper.style3 button.alt:active,
        .wrapper.style3 .button.alt:active {
            background-color: rgba(255, 255, 255, 0.2);
        }

        .wrapper.style3 input[type="submit"].alt.icon:before,
        .wrapper.style3 input[type="reset"].alt.icon:before,
        .wrapper.style3 input[type="button"].alt.icon:before,
        .wrapper.style3 button.alt.icon:before,
        .wrapper.style3 .button.alt.icon:before {
            color: #999999;
        }

        .wrapper.style3 input[type="submit"].special,
        .wrapper.style3 input[type="reset"].special,
        .wrapper.style3 input[type="button"].special,
        .wrapper.style3 button.special,
        .wrapper.style3 .button.special {
            background-color: #8a4680;
            color: #ffffff !important;
        }

        .wrapper.style3 input[type="submit"].special:hover,
        .wrapper.style3 input[type="reset"].special:hover,
        .wrapper.style3 input[type="button"].special:hover,
        .wrapper.style3 button.special:hover,
        .wrapper.style3 .button.special:hover {
            background-color: #9b4f90;
        }

        .wrapper.style3 input[type="submit"].special:active,
        .wrapper.style3 input[type="reset"].special:active,
        .wrapper.style3 input[type="button"].special:active,
        .wrapper.style3 button.special:active,
        .wrapper.style3 .button.special:active {
            background-color: #793d70;
        }

        .wrapper.style3 label {
            color: #ffffff;
        }

        .wrapper.style3 input[type="text"],
        .wrapper.style3 input[type="password"],
        .wrapper.style3 input[type="email"],
        .wrapper.style3 select,
        .wrapper.style3 textarea {
            background: rgba(255, 255, 255, 0.075);
            border-color: rgba(255, 255, 255, 0.25);
        }

        .wrapper.style3 input[type="text"]:focus,
        .wrapper.style3 input[type="password"]:focus,
        .wrapper.style3 input[type="email"]:focus,
        .wrapper.style3 select:focus,
        .wrapper.style3 textarea:focus {
            border-color: #8a4680;
            box-shadow: 0 0 0 1px #8a4680;
        }

        .wrapper.style3 .select-wrapper:before {
            color: rgba(255, 255, 255, 0.25);
        }

        .wrapper.style3 input[type="checkbox"]+label,
        .wrapper.style3 input[type="radio"]+label {
            color: #bfbfbf;
        }

        .wrapper.style3 input[type="checkbox"]+label:before,
        .wrapper.style3 input[type="radio"]+label:before {
            background: rgba(255, 255, 255, 0.075);
            border-color: rgba(255, 255, 255, 0.25);
        }

        .wrapper.style3 input[type="checkbox"]:checked+label:before,
        .wrapper.style3 input[type="radio"]:checked+label:before {
            background-color: #8a4680;
            border-color: #8a4680;
            color: #ffffff;
        }

        .wrapper.style3 input[type="checkbox"]:focus+label:before,
        .wrapper.style3 input[type="radio"]:focus+label:before {
            border-color: #8a4680;
            box-shadow: 0 0 0 1px #8a4680;
        }

        .wrapper.style3 ::-webkit-input-placeholder {
            color: #999999 !important;
        }

        .wrapper.style3 :-moz-placeholder {
            color: #999999 !important;
        }

        .wrapper.style3 ::-moz-placeholder {
            color: #999999 !important;
        }

        .wrapper.style3 :-ms-input-placeholder {
            color: #999999 !important;
        }

        .wrapper.style3 .formerize-placeholder {
            color: #999999 !important;
        }

        .wrapper.style3 ul.alt li {
            border-top-color: rgba(255, 255, 255, 0.25);
        }

        .wrapper.style3 header p {
            color: #000000;
        }

        .wrapper.style3 table tbody tr {
            border-color: rgba(255, 255, 255, 0.25);
        }

        .wrapper.style3 table tbody tr:nth-child(2n + 1) {
            background-color: rgba(255, 255, 255, 0.075);
        }

        .wrapper.style3 table th {
            color: #ffffff;
        }

        .wrapper.style3 table thead {
            border-bottom-color: rgba(255, 255, 255, 0.25);
        }

        .wrapper.style3 table tfoot {
            border-top-color: rgba(255, 255, 255, 0.25);
        }

        .wrapper.style3 table.alt tbody tr td {
            border-color: rgba(255, 255, 255, 0.25);
        }

        .wrapper.style3 .inner {
            position: relative;
            z-index: 2;
        }

        .wrapper.style3 p {
            text-transform: uppercase;
            font-size: .75rem;
            font-weight: 300;
            margin: 0 0 .5rem 0;
            padding: 0 0 1rem 0;
            letter-spacing: .25rem;
        }

        .wrapper.style3 p:after {
            content: '';
            position: absolute;
            margin: auto;
            right: 0;
            bottom: 0;
            left: 0;
            width: 50%;
            height: 1px;
            background-color: rgba(255, 255, 255, 0.5);
        }

        .wrapper.style3:before {
            -moz-transition: opacity 3s ease;
            -webkit-transition: opacity 3s ease;
            -ms-transition: opacity 3s ease;
            transition: opacity 3s ease;
            -moz-transition-delay: 1.25s;
            -webkit-transition-delay: 1.25s;
            -ms-transition-delay: 1.25s;
            transition-delay: 1.25s;
            content: '';
            display: block;

            height: 100%;
            left: 0;
            opacity: 0.75;
            position: absolute;
            top: 0;
            width: 100%;
            z-index: 1;
        }

        @media screen and (max-width: 1280px) {

            .wrapper>.inner {
                width: 75rem;
            }

        }

        @media screen and (max-width: 980px) {

            .wrapper>.inner {
                width: 90%;
            }

            .wrapper.style3 {
                background-attachment: scroll;
            }

        }

        @media screen and (max-width: 736px) {

            .wrapper {
                padding: 3rem 0 1rem 0;
            }


        }

        .wrapper.style5 {
            background-color: #000;
            color: #bfbfbf;
            background-image: url(../../images/power-plus-mobility-proudly-canadian-wheelchair-seating-backs-cushions-owners-manual-background-1.jpg);
            background-size: cover;
            background-attachment: fixed;
            background-position: center;
            position: relative;
        }

        input[type="checkbox"] {
            width: 20px;
            height: 20px;
        }

        .checkbox-labels {
            font-size: 18px;
        }
    </style>

</head>

<body class="url">

    <div>

        <?php

        get_header();

        ?>
    </div>

    <div class="container mt-5 mb-5">
        <div class="row mb-5">
            <h1>Custermize & Buy</h1>
        </div>
    </div>

    <div class="container mt-5 mb-5">
        <div class="row">
            <div class="col-md-6">

            </div>

            <div class="col-md-6">

            </div>
        </div>
    </div>

    <div class="container mt-5 mb-5">
        <div class="row">
            <form action='http://action.powerplusmobility.org/ext.php' method='POST' onsubmit="return validateForm()">
                <div class="row">
                    <div class="col-md-6" style="padding-right: 50px;">

                        <div class="form-group">
                            <label style="font-size: 24px; margin-bottom: 10px;" for="FRAME TYPE">FRAME COLOUR*</label>
                            <select name="frame_colour_c" id="frame_colour_c" class="form-select form-select-lg mb-3" aria-label="Large select example" required tabindex="1" onchange="toggleCustomFrame()">
                                
                                <option value="" >Please select Option</option>
                                <option value="EXTB  Dynamic Frame - Black" data-cal="3899">EXTB  Dynamic Frame - Black</option>
                                <option value="EXTC Dynamic Frame - Custom" data-cal="4299">EXTC Dynamic Frame - Custom</option>

                            </select>
                            <br><br>
                        </div>
                        <div class="form-group custom-frame" id="customFrameBlock">
                            <label style="font-size: 24px; margin-bottom: 10px;" for="FRAME TYPE">Custom frame colour: </label>
                            <input id="input_6" name="q6_customFrame6" class="form-control form-control-lg" type="text" placeholder="Custom frame colour" value="" aria-label=".form-control-lg example">
                            <br>
                        </div>
                        

                        <div class="form-group">
                            <label style="font-size: 24px; margin-bottom: 10px;" for="FRAME TYPE">CLIENT WEIGHT*</label>
                            <select name="client_weight_c" id="client_weight_c" class="form-select form-select-lg mb-3" required aria-label="Large select example">

                                <option value="" >Please select Option</option>
                                <option value="EXTWA Up to 250Lbs" data-cal="0">EXTWA Up to 250Lbs</option>
                                <option value="EXTWAMF Exceeds 250Lbs" data-cal="730">EXTWAMF Exceeds 250Lbs</option>
                                <option value="EXTWAMG Exceeds 350Lbs" data-cal="992">EXTWAMG Exceeds 350Lbs</option>
                                <option value="EXTWAMH Exceeds 400Lbs (Max 600Lbs)" data-cal="1110">EXTWAMH Exceeds 400Lbs (Max 600Lbs)</option>
                            </select>
                            <br><br>
                        </div>
                        <div class="form-group">
                            <label style="font-size: 24px; margin-bottom: 10px;" for="FRAME TYPE">SEAT WIDTH*</label>
                            <select id="seat_width_c" name="seat_width_c" class="form-select form-select-lg mb-3" aria-label="Large select example" required onchange="toggleCustomFrame1()">
                                <option value="" >Please select Option</option>
                                <option value="EXTSW16  Seat Width 16&quot;" data-cal="0">EXTSW16 Seat Width 16&quot;</option>
                                <option value="EXTSW17  Seat Width 17&quot;" data-cal="0">EXTSW17 Seat Width 17&quot;</option>
                                <option value="EXTSW18  Seat Width 18&quot;" data-cal="0">EXTSW18 Seat Width 18&quot;</option>
                                <option value="EXTSW19  Seat Width 19&quot;" data-cal="399">EXTSW19 Seat Width 19&quot;</option>
                                <option value="EXTSW20  Seat Width 20&quot;" data-cal="399">EXTSW20 Seat Width 20&quot;</option>
                                <option value="EXTSWC Custom Seat Width" data-cal="399">EXTSWC Custom Seat Width</option>
                            </select>
                            <br><br>
                        </div>
                        <div class="form-group custom-frame" id="customFrameBlock1">
                            <label style="font-size: 24px; margin-bottom: 10px;" for="FRAME TYPE">If custom seat width:* </label>
                            <input id="input_9" name="q9_ifCustom9" class="form-control form-control-lg" type="text" placeholder="Custom seat width" value="" aria-label=".form-control-lg example">
                            <br><br>
                        </div>
                        <div class="form-group">
                            <label style="font-size: 24px; margin-bottom: 10px;" for="FRAME TYPE">SEAT DEPTH*</label>
                            <select id="seat_depth_c" name="seat_depth_c" class="form-select form-select-lg mb-3" aria-label="Large select example" onchange="toggleCustomFrame2()" required>
                                <option value="" >Please select Option</option>
                                <option value="EXTSD16  Seat Depth 16&quot;" data-cal="0">EXTSD16 Seat Depth 16&quot;</option>
                                <option value="EXTSD17  Seat Depth 17&quot;" data-cal="0">EXTSD17 Seat Depth 17&quot;</option>
                                <option value="EXTSD18  Seat Depth 18&quot;" data-cal="0">EXTSD18 Seat Depth 18&quot;</option>
                                <option value="EXTSD19  Seat Depth 19&quot;" data-cal="265">EXTSD19 Seat Depth 19&quot;</option>
                                <option value="EXTSD20  Seat Depth 20&quot;" data-cal="265">EXTSD20 Seat Depth 20&quot;</option>
                                <option value="EXTSDC Custom Seat Depth" data-cal="265">EXTSDC Custom Seat Depth</option>
                            </select>
                        </div>
<br><br>
                        <div class="form-group custom-frame" id="customFrameBlock2">
                            <label style="font-size: 24px; margin-bottom: 10px;" for="FRAME TYPE">If custom seat depth:* </label>
                            <input id="input_11" name="q11_ifCustom11" class="form-control form-control-lg" type="text" placeholder="Custom seat depth" value="" aria-label=".form-control-lg example">
                        </div>
                        <br><br>

                        <div class="form-group validation">
                            
                            <label style="font-size: 24px; margin-bottom: 10px;text-transform: uppercase" for="FRAME TYPE">Foot rest and foot plates:*</label> &nbsp&nbsp  <div class="error-message" style="color: red; font-size: 13px; display: inline-block; margin-left: 10px;"></div><br>
                            <div class="form-group">
                                <label for="item1" class="checkbox-labels">
                                    <input type="checkbox" id="input_33_0" name="q33_footRest1" value="EXTOFST  Offset Foot Rest " data-cal="0"> EXTOFST Offset Foot Rest
                                </label>
                            </div>
                            <div class="form-group">
                                <label for="item1" class="checkbox-labels">
                                    <input type="checkbox" id="input_33_1" name="q33_footRest2" value="EXTF6A 60 Degree Hanger " data-cal="0"> EXTF6A 60 Degree Hanger
                                </label>
                            </div>
                            <div class="form-group">
                                <label for="item1" class="checkbox-labels">
                                    <input type="checkbox" id="input_33_2" name="q33_footRest3" value="EXTF7A 70 Degree Hanger" data-cal="0"> EXTF7A 70 Degree Hanger
                                </label>
                            </div>
                            <div class="form-group">
                                <label for="item1" class="checkbox-labels">
                                    <input type="checkbox" id="input_33_3" name="q33_footRest4" value="EXTF8A 80 Degree Hanger " data-cal="0"> EXTF8A 80 Degree Hanger
                                </label>
                            </div>
                            <div class="form-group">
                                <label for="item1" class="checkbox-labels">
                                    <input type="checkbox" id="input_33_4" name="q33_footRest5" value="EXTEA Elevating Legrest " data-cal="404"> EXTEA Elevating Legrest
                                </label>
                            </div>
                            <div class="form-group">
                                <label for="item1" class="checkbox-labels">
                                    <input type="checkbox" id="input_33_5" name="q33_footRest6" value="EXTAL Articulating L/R " data-cal="450"> EXTAL Articulating L/R
                                </label>
                            </div>
                            <div class="form-group">
                                <label for="item1" class="checkbox-labels">
                                    <input type="checkbox" id="input_33_6" name="q33_footRest7" value="EXTEB Elevating Legrest System " data-cal="450"> EXTEB Elevating Legrest System
                                </label>
                            </div>
                            <div class="form-group">
                                <label for="item1" class="checkbox-labels">
                                    <input type="checkbox" id="input_33_7" name="q33_footRest8" value="EXTPPL Plastic " data-cal="0"> EXTPPL Plastic
                                </label>
                            </div>
                            <div class="form-group">
                                <label for="item1" class="checkbox-labels">
                                    <input type="checkbox" id="input_33_8" name="q33_footRest9" value="EXTPXL Extra Large" data-cal="150"> EXTPXL Extra Large
                                </label>
                            </div>
                            <div class="form-group">
                                <label for="item1" class="checkbox-labels">
                                    <input type="checkbox" id="input_33_9" name="q33_footRest10" value="EXTPAF Angle Adjustable Footplates " data-cal="240"> EXTPAF Angle Adjustable Footplates
                                </label>
                            </div>
                            <div class="form-group">
                                <label for="item1" class="checkbox-labels">
                                    <input type="checkbox" id="input_33_10" name="q33_footRest11" value="EXT1FB   One Piece Foot Board" data-cal="80"> EXT1FB One Piece Foot Board
                                </label>
                            </div>
                            <div class="form-group">
                                <label for="item1" class="checkbox-labels">
                                    <input type="checkbox" id="input_33_11" name="q33_footRest12" value="EXT1FBP   One Piece Foot Board Padding  " data-cal="44"> EXT1FBP One Piece Foot Board Padding
                                </label>
                            </div>
                            <div class="form-group">
                                <label for="item1" class="checkbox-labels">
                                    <input type="checkbox" id="input_33_12" name="q33_footRest13" value="EXTNLS Nylon Leg Strap Padded  " data-cal="60" onchange="toggleCustomField3()"> EXTNLS Nylon Leg Strap Padded
                                </label>
                            </div>
                            <div class="form-group">
                                <label for="item1" class="checkbox-labels">
                                    <input type="checkbox" id="input_33_13" name="q33_footRest14" value="EXTNLSC Nylon Leg Strap Custom " data-cal="120" onchange="toggleCustomField3()"> EXTNLSC Nylon Leg Strap Custom
                                </label>
                            </div>
                            <div class="form-group">
                                <label for="item1" class="checkbox-labels">
                                    <input type="checkbox" id="input_33_14" name="q33_footRest15" value="EXTCSL Contracture Sling Standard " data-cal="240"> EXTCSL Contracture Sling Standard
                                </label>
                            </div>
                            <div class="form-group">
                                <label for="item1" class="checkbox-labels">
                                    <input type="checkbox" id="input_33_15" name="q33_footRest16" value="EXTCSL Contracture Sling M-Style " data-cal="240"> EXTCSL Contracture Sling M-Style
                                </label>
                            </div>
                            <br><br>
                        </div>
                        <div class="form-group custom-frame" id="customFrameBlock3">
                            <label style="font-size: 24px; margin-bottom: 10px;" for="FRAME TYPE">Size of custom nylon leg strap?* </label>
                            <input id="input_14" name="q14_sizeOf14" class="form-control form-control-lg" type="text" placeholder="Custom seat depth" value="" aria-label=".form-control-lg example">
                            <br><br>
                        </div>
                        <br>
                        <div class="form-group">
                            <label style="font-size: 24px; margin-bottom: 10px;" for="FRAME TYPE">Pivot style or pin style?</label>
                            <select id="q13_pivotStyle13" name="q13_pivotStyle13" class="form-select form-select-lg mb-3" aria-label="Large select example" onchange="toggleCustomFrame2()">
                                
                                <option value="" >Please select Option</option>
                                <option value="Pivot" data-cal="0">Pivot</option>
                                <option value="Pin" data-cal="0">Pin</option>
                            </select>
                        </div>
<br><br>
                        <div class="form-group validation">
                            
                            <label style="font-size: 24px; margin-bottom: 10px;" for="FRAME TYPE">BACK TYPE*</label> &nbsp&nbsp  <div class="error-message" style="color: red; font-size: 13px; display: inline-block; margin-left: 10px;"></div><br>
                            <div class="form-group">
                                <label for="item1" class="checkbox-labels">
                                    <input type="checkbox" id="input_34_0" name="q34_backType341" value="EXTAB1  Angle Adjustable Back" data-cal="0"> EXTAB1 Angle Adjustable Back
                                </label>
                            </div>
                            <div class="form-group">
                                <label for="item1" class="checkbox-labels">
                                    <input type="checkbox" id="input_34_1" name="q34_backType342" value="EXTENDO Endomorph Canes" data-cal="0" onchange="toggleCustomField4()"> EXTENDO Endomorph Canes
                                </label>
                            </div>
                            <div class="form-group">
                                <label for="item1" class="checkbox-labels">
                                    <input type="checkbox" id="input_34_2" name="q34_backType343" value="EXTRBK  Recline Kit " data-cal="560"> EXTRBK Recline Kit
                                </label>
                            </div>
                            <br><br>
                        </div>
                         <div class="form-group custom-frame" id="customFrameBlock4">
                            <label style="font-size: 24px; margin-bottom: 10px;" for="FRAME TYPE">Width of endomorph canes?* </label>
                            <input id="input_16" name="q16_widthOf16" class="form-control form-control-lg" type="text" placeholder="Width of endomorph canes" value="" aria-label=".form-control-lg example">
                            <br><br>
                        </div>
                        
                        <div class="form-group validation">
                        
                            <label style="font-size: 24px; margin-bottom: 10px;" for="FRAME TYPE">HEADREST*</label> &nbsp&nbsp  <div class="error-message" style="color: red; font-size: 13px; display: inline-block; margin-left: 10px;"></div><br>
                            <div class="form-group">
                                <label for="item1" class="checkbox-labels">
                                    <input type="checkbox" id="input_46_0" name="q46_headrestOptions1" value="EXTMAHF Multi-Axis Hardware Complete with Large Pad " data-cal="512"> EXTMAHF Multi-Axis Hardware Complete with Large Pad
                                </label>
                            </div>
                            <div class="form-group">
                                <label for="item1" class="checkbox-labels">
                                    <input type="checkbox" id="input_46_1" name="q46_headrestOptions2" value="EXTMAHFXL  Multi-Axis Hardware Complete with Flex Large" data-cal="512"> EXTMAHFXL Multi-Axis Hardware Complete with Flex Large
                                </label>
                            </div>
                            <div class="form-group">
                                <label for="item1" class="checkbox-labels">
                                    <input type="checkbox" id="input_46_2" name="q46_headrestOptions3" value="EXTMAHKP  Multi-Axis Hardware Complete with Medium Pad  " data-cal="512"> EXTMAHKP Multi-Axis Hardware Complete with Medium Pad
                                </label>
                            </div>
                            <div class="form-group">
                                <label for="item1" class="checkbox-labels">
                                    <input type="checkbox" id="input_46_3" name="q46_headrestOptions4" value="EXTMAHFXS  Multi-Axis Hardware Complete with Flex Medium " data-cal="512"> EXTMAHFXS Multi-Axis Hardware Complete with Flex Medium
                                </label>
                            </div>
                            <div class="form-group">
                                <label for="item1" class="checkbox-labels">
                                    <input type="checkbox" id="input_46_4" name="q46_headrestOptions5" value="EXTMAHFT  Multi-Axis Hardware Complete with Small  " data-cal="512"> EXTMAHFT Multi-Axis Hardware Complete with Small
                                </label>
                            </div>
                            <div class="form-group">
                                <label for="item1" class="checkbox-labels">
                                    <input type="checkbox" id="input_46_5" name="q46_headrestOptions6" value="EXTUPHT219  Contour Headrest Complete with Swivel Hardware " data-cal="433"> EXTUPHT219 Contour Headrest Complete with Swivel Hardware
                                </label>
                            </div>
                            <div class="form-group">
                                <label for="item1" class="checkbox-labels">
                                    <input type="checkbox" id="input_46_6" name="q46_headrestOptions7" value="EXTUPHT218  Contour Headrest with Std. Assembly (1/2&quot;) " data-cal="292"> EXTUPHT218 Contour Headrest with Std. Assembly (1/2&quot;)
                                </label>
                            </div>
                            <div class="form-group">
                                <label for="item1" class="checkbox-labels">
                                    <input type="checkbox" id="input_46_7" name="q46_headrestOptions8" value="EXTUPHT217  Contour Headrest with Std. Assembly (3/4&quot;) " data-cal="292"> EXTUPHT217 Contour Headrest with Std. Assembly (3/4&quot;)
                                </label>
                            </div>
                            <div class="form-group">
                                <label for="item1" class="checkbox-labels">
                                    <input type="checkbox" id="input_46_8" name="q46_headrestOptions9" value="EXTUHA  Universal Hardware Adaptor (Adaptor only) " data-cal="57"> EXTUHA Universal Hardware Adaptor (Adaptor only)
                                </label>
                            </div>
                            <div class="form-group">
                                <label for="item1" class="checkbox-labels">
                                    <input type="checkbox" id="input_46_9" name="q46_headrestOptions10" value="No Headrest" data-cal="0"> No Headrest
                                </label>
                            </div>
                            <br><br>
                        </div>

                        <div class="form-group validation">
                           
                            <label style="font-size: 24px; margin-bottom: 10px;" for="FRAME TYPE">ARM REST*</label> &nbsp&nbsp  <div class="error-message" style="color: red; font-size: 13px; display: inline-block; margin-left: 10px;"></div><br>
                            <div class="form-group">
                                <label for="item1" class="checkbox-labels">
                                    <input type="checkbox" id="input_36_0" name="q36_armRests361" value="EXTTA T-Arm Ht. Adj./ Removable  (Standard 10 - 14 inches)" data-cal="240"> EXTTA T-Arm Ht. Adj./ Removable (Standard 10 - 14 inches)
                                </label>
                            </div>
                             <div class="form-group">
                                <label for="item1" class="checkbox-labels">
                                    <input type="checkbox" id="input_36_2" name="q36_armRests363" value="EXTTAS  T-Arm Ht. Adj./  Removable   (Short 7 - 11 inches)" data-cal="240"> EXTTAS  T-Arm Ht. Adj./  Removable   (Short 7 - 11 inches)
                                </label>
                            </div>
                            <div class="form-group">
                                <label for="item1" class="checkbox-labels">
                                    <input type="checkbox" id="input_36_4" name="q36_armRests365" value="EXTGWAPF  Gel Waterfall Arm Pads " data-cal="180"> EXTGWAPF Gel Waterfall Arm Pads
                                </label>
                            </div>
                            <span style="color:red;">* Note: Gel Waterfall Arm Pads are only compatible with locking laptrays if required</span>
                            <br><br>
                        </div>
                        
                         <div class="form-group">
                            <label style="font-size: 24px; margin-bottom: 10px;" for="FRAME TYPE">Seat to floor specifications (± 0.5")*:</label>
                            <select id="input_39" name="q39_seatTo39" class="form-select form-select-lg mb-3" aria-label="Large select example" required onchange="toggleCustomFrame2()">
                                
                                <option value="" >Please select Option</option>
                                <option value="STF = 13.00	R.Wheel = 20 	Caster = 5 	Fork = XL SHORT " data-cal="0">STF = 13.00	R.Wheel = 20 	Caster = 5 	Fork = XL SHORT </option>
                                <option value="STF = 13.75	R.Wheel = 20 	Caster = 5 	Fork = XL SHORT" data-cal="0">STF = 13.75	R.Wheel = 20 	Caster = 5 	Fork = XL SHORT</option>
                                <option value="STF = 14.50	R.Wheel = 20 	Caster = 6 	Fork = SHORT " data-cal="0">STF = 14.50	R.Wheel = 20 	Caster = 6 	Fork = SHORT </option>
                                <option value="STF = 14.50	R.Wheel = 22 	Caster = 5 	Fork = SHORT " data-cal="0">STF = 14.50	R.Wheel = 22 	Caster = 5 	Fork = SHORT </option>
                                <option value="STF = 14.50	R.Wheel = 22 	Caster = 6 	Fork = SHORT" data-cal="0">STF = 14.50	R.Wheel = 22 	Caster = 6 	Fork = SHORT</option>
                                <option value="STF = 15.25	R.Wheel = 20 	Caster = 5 	Fork = SHT/LONG" data-cal="0">STF = 15.25	R.Wheel = 20 	Caster = 5 	Fork = SHT/LONG</option>
                                <option value="STF = 15.25	R.Wheel = 20 	Caster = 6 	Fork = SHT/LONG " data-cal="0">STF = 15.25	R.Wheel = 20 	Caster = 6 	Fork = SHT/LONG </option>
                                <option value="STF = 15.25	R.Wheel = 22 	Caster = 5	Fork = SHT/LONG " data-cal="0">STF = 15.25	R.Wheel = 22 	Caster = 5	Fork = SHT/LONG </option>
                                <option value="STF = 15.25	R.Wheel = 22 	Caster = 6 	Fork = SHT/LONG " data-cal="0">STF = 15.25	R.Wheel = 22 	Caster = 6 	Fork = SHT/LONG </option>
                                <option value="STF = 16.00	R.Wheel = 22 	Caster = 6 	Fork = LONG" data-cal="0">STF = 16.00	R.Wheel = 22 	Caster = 6 	Fork = LONG</option>
                                <option value="STF = 16.75	R.Wheel = 22 	Caster = 6 	Fork = LONG " data-cal="0">STF = 16.75	R.Wheel = 22 	Caster = 6 	Fork = LONG </option>
                                <option value="STF = 17.50	R.Wheel = 22 	Caster = 6 	Fork = LONG" data-cal="0">STF = 17.50	R.Wheel = 22 	Caster = 6 	Fork = LONG</option>
                                <option value="STF = 17.50	R.Wheel = 22 	Caster = 6 	Fork = LONG" data-cal="0">STF = 17.50	R.Wheel = 22 	Caster = 6 	Fork = LONG</option>
                                <option value="STF = 17.50	R.Wheel = 24 	Caster = 6 	Fork = LONG" data-cal="0">STF = 17.50	R.Wheel = 24 	Caster = 6 	Fork = LONG</option>
                                <option value="STF = 18.25	R.Wheel = 24 	Caster = 8 	Fork = LONG" data-cal="0">STF = 18.25	R.Wheel = 24 	Caster = 8 	Fork = LONG</option>
                            </select>
                            <span style="color:red;">For more Seat To Floor combinations, visit our website</span>
                            <br><br>
                        </div>
                        <div class="form-group">
                            <label style="font-size: 24px; margin-bottom: 10px;" for="FRAME TYPE">REAR WHEEL*</label>
                            <select id="rear_wheel_c" name="rear_wheel_c" class="form-select form-select-lg mb-3" aria-label="Large select example" required>
                                <option value="" >Please select Option</option>
                                <option value="EXTRWT0  20” Solid Treaded Tire" data-cal="0">EXTRWT0 20” Solid Treaded Tire</option>
                                <option value="EXTRWT2  22” Solid Treaded Tire" data-cal="0">EXTRWT2 22” Solid Treaded Tire </option>
                                <option value="EXTRWT4  24” Solid Treaded Tire" data-cal="0">EXTRWT4 24” Solid Treaded Tire</option>
                                <option value="EXTRWT12 12&quot; Solid Tire   (STF 13-19 inches)" data-cal="0">EXTRWT12 12&quot; Solid Tire (STF 13-19 inches)</option>
                                <!--<option value="STPRWT12I	12&quot; Solid Tire Inside Mount   (STF 17-19 inches)" data-cal="120">STPRWT12I 12&quot; Solid Tire Inside Mount (STF 17-19 inches)</option>-->
                                <option value="EXTRWT16  16&quot; Solid  Tire" data-cal="0">EXTRWT16 16&quot; Solid Tire</option>
                                <option value="EXTRWA2  22” Air Tire" data-cal="120">EXTRWA2 22” Air Tire</option>
                                <option value="EXTRWA4  24” Air Tire" data-cal="120">EXTRWA4 24” Air Tire</option>
                                <option value="EXTHRT  Narrow Handrim Config.  (1/2&quot; less)" data-cal="120">EXTHRT Narrow Handrim Config. (1/2&quot; less)</option>
                                <option value="EXTAQR  Axles – Quick Release" data-cal="0">EXTAQR Axles – Quick Release </option>
                            </select>
                            <span style="color:red;">*Note: Quick Release is not available for wheels smaler than 20"</span>
                            <br><br>
                        </div>

                    </div>

                    <div class="col-md-6" style="padding-right: 50px;">

                        <div class="form-group">
                            <label style="font-size: 24px; margin-bottom: 10px;" for="FRAME TYPE">CASTER*</label>
                            <select id="caster_c" name="caster_c" class="form-select form-select-lg mb-3" aria-label="Large select example" required>
                                <option value="" >Please select Option</option>
                                <option value="EXTFC1A  5” X 1.25” Caster" data-cal="0">EXTFC1A 5” X 1.25” Caster</option>
                                <option value="EXTFC1B  6” X 1.25” Castero" data-cal="0">EXTFC1B 6” X 1.25” Castero</option>
                                <option value="EXTFC1C  8” X 1.25” Caster" data-cal="0">EXTFC1C 8” X 1.25” Caster</option>
                                <option value="EXTFC2A	5” X 1.75” Caster (Soft Roll)" data-cal="80"> EXTFC2A 5” X 1.75” Caster (Soft Roll)</option>
                                <option value="EXTFC2B  6” X 1.75” Caster" data-cal="80">EXTFC2B 6” X 1.75” Caster</option>
                                <option value="EXTFC2C  8” X 1.75” Caster" data-cal="80">EXTFC2C 8” X 1.75” Caster</option>
                                <option value="EXTFC4B  6” X 2 Caster (Steel  Fork)" data-cal="80">EXTFC4B 6” X 2 Caster (Steel Fork)</option>
                                <option value="EXTFC4C  8” X 2 Caster (Steel  Fork)" data-cal="80">EXTFC4C 8” X 2 Caster (Steel Fork)</option>
                            </select>
                            <br><br>
                        </div>
                        <div class="form-group validation">
                           
                            <label style="font-size: 24px; margin-bottom: 10px;" for="FRAME TYPE">WHEEL LOCK*</label> &nbsp&nbsp  <div class="error-message" style="color: red; font-size: 13px; display: inline-block; margin-left: 10px;"></div> <br>
                            <div class="form-group">
                                <label for="item1" class="checkbox-labels">
                                    <input type="checkbox" id="input_35_0" name="q35_wheelLock1" value="EXTALPH Aluminium Push To Lock  " data-cal="0"> EXTALPH Aluminium Push To Lock
                                </label>
                            </div>
                            <div class="form-group">
                                <label for="item1" class="checkbox-labels">
                                    <input type="checkbox" id="input_35_1" name="q35_wheelLock2" value="EXTALPL  Aluminium Pull To Lock   " data-cal="0"> EXTALPL Aluminium Pull To Lock
                                </label>
                            </div>
                            <div class="form-group">
                                <label for="item1" class="checkbox-labels">
                                    <input type="checkbox" id="input_35_2" name="q35_wheelLock3" value="EXTEXTH  Steel Push To Lock " data-cal="0"> EXTEXTH Steel Push To Lock
                                </label>
                            </div>
                            <div class="form-group">
                                <label for="item1" class="checkbox-labels">
                                    <input type="checkbox" id="input_35_3" name="q35_wheelLock4" value="EXTEXTL  Steel Pull To Lock  " data-cal="0"> EXTEXTL Steel Pull To Lock
                                </label>
                            </div>
                            <div class="form-group">
                                <label for="item1" class="checkbox-labels">
                                    <input type="checkbox" id="input_35_4" name="q35_wheelLock5" value="EXTBRXC  4” Brake Extension " data-cal="0"> EXTBRXC 4” Brake Extension
                                </label>
                            </div>
                            <div class="form-group">
                                <label for="item1" class="checkbox-labels">
                                    <input type="checkbox" id="input_35_5" name="q35_wheelLock6" value="EXTBRXA  6” Brake Extension" data-cal="0"> EXTBRXA 6” Brake Extension
                                </label>
                            </div>
                            <div class="form-group">
                                <label for="item1" class="checkbox-labels">
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                            <label style="font-size: 24px; margin-bottom: 10px;" for="FRAME TYPE">SEATING-BACKS*</label> &nbsp&nbsp  <div class="error-message" style="color: red; font-size: 13px; display: inline-block; margin-left: 10px;"></div><br>
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                            <label style="font-size: 24px; margin-bottom: 10px;" for="FRAME TYPE">SEATING - CUSHIONS*</label> &nbsp&nbsp  <div class="error-message" style="color: red; font-size: 13px; display: inline-block; margin-left: 10px;"></div><br>
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                            <span style="color:red;">*Note: Please refer to the Seating Booklet for custom sizes</span>
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                        <div class="form-group" id="customFrameBlock5">
                            <label style="font-size: 24px; margin-bottom: 10px;" for="FRAME TYPE">Enter Cushion width and length:* </label>
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                            <label style="font-size: 24px; margin-bottom: 10px;" for="FRAME TYPE">ACCESSORIES</label> &nbsp&nbsp  <div class="error-message" style="color: red; font-size: 13px; display: inline-block; margin-left: 10px;"></div><br>
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                    <p style="font-size: 24px; color: #3E70E8; margin-botom:-20px"> <b>Final Total</b> </p>
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