{"id":68,"date":"2026-01-03T02:44:34","date_gmt":"2026-01-03T02:44:34","guid":{"rendered":"https:\/\/suburbanwaterinc.com\/wp2026\/?page_id=68"},"modified":"2026-01-04T15:45:29","modified_gmt":"2026-01-04T15:45:29","slug":"68-2","status":"publish","type":"page","link":"https:\/\/suburbanwaterinc.com\/home\/developer-service\/68-2\/","title":{"rendered":"Fire Line Application"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"68\" class=\"elementor elementor-68\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-2ecdcb7a e-flex e-con-boxed e-con e-parent\" data-id=\"2ecdcb7a\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-56d05469 elementor-widget elementor-widget-text-editor\" data-id=\"56d05469\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-ec97548 e-flex e-con-boxed e-con e-parent\" data-id=\"ec97548\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-3e03888 e-con-full e-flex e-con e-child\" data-id=\"3e03888\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-3ed6070 elementor-widget elementor-widget-wpforms\" data-id=\"3ed6070\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"wpforms.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"wpforms-container wpforms-container-full wpforms-block wpforms-block-1e131c5c-93f8-4be6-b181-90d256a9e327 wpforms-render-modern\" id=\"wpforms-82\"><form id=\"wpforms-form-82\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"82\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/home\/wp-json\/wp\/v2\/pages\/68\" data-token=\"ee3ac5a53857dba78812df147c8937d5\" data-token-time=\"1775511590\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-82-field_7-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"7\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-100\"><div id=\"wpforms-82-field_1-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"1\"><div id=\"wpforms-82-field_1\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-82-field_1-error\"><p>The undersigned Applicant, owner, hereby requests a connection to SUBURBAN WATER\u2019S distribution system to provide water service at a maximum flow rate of ______ gpm at a minimum residual pressure of 30 psi at the water distribution main to a private fire<\/p>\n<ol>\n<li>Applicant agrees to purchase a single _______-inch diameter fire main connection at the unit price of $10,000.00. Applicant agrees to purchase and install a tapping-saddle\/valve or tee\/valve in the existing distribution main.<\/li>\n<li>Applicant agrees to purchase and install a reduced-pressure detector (RPD) assembly type backflow prevention device with a 5\/8-inch size by-pass water meter with remote-read antenna (supplied by SUBURBAN WATER) within a concrete vault located adjacent to the rights-of-way line on the Applicant\u2019s property. Applicant agrees that the water from this connection is only to be utilized to fight fires through the sprinkler system and\/or private hydrants, and no other use of water through this connection is allowed.<\/li>\n<li>Applicant agrees to have the fire fighting system designed by a professional engineer, registered in the State of Kansas, in accordance with all Federal, State and local plumbing, building, fire codes and standards.<\/li>\n<li>One month prior to the beginning of the installation of the fire fighting system, two complete sets of engineered stamped construction specifications and drawings shall be submitted to SUBURBAN WATER for review and approval. After review, one copy of the submitted specifications and drawings will be returned to the Applicant with comments noted or the acceptance indicated.<\/li>\n<li>Applicant agrees to pay SUBURBAN WATER in advance for the following non-refundable costs:<br \/>\n$10,000.00<\/li>\n<li>Applicant further agrees that the tapping-saddle\/valve or tee\/valves are and shall remain, at all times the property of SUBURBAN WATER and the valves shall only be operated by SUBURBAN WATER personnel. This fire main connection may be removed by SUBURBAN WATER without notice upon discontinuation of service for any reason.<\/li>\n<li>Applicant agrees to comply with the laws of the State of Kansas, the By-Laws ofSUBURBAN WATER, INC., and SUBURBAN WATER\u2019S Rules and Regulations, aspresently exist, and as may be amended from time to time, are made a part of this Agreement,as though fully set out herein. If the Applicant and\/or any of its contractors violate any of theRules and Regulations, the Applicant shall pay a penalty in the amount of $250.00 for thefirst offense and then the amount will double for each subsequent offense.<\/li>\n<li>Pursuant to SUBURBAN WATER\u2019S Rules and Regulations, there is no charge for thequantity of water utilized by the Fire Department to fight fires. Each fire main connectionshall carry the prevailing monthly minimum meter charge for the by-pass water meter.Failure to pay by the due date will result in a 10% penalty. Continued failure will result<br \/>\nin disconnection of this fire main service.<\/li>\n<li>Applicant agrees to claim no damage on account of the temporary stoppage of the flow ofwater or reduced pressure resulting from accidents, or when stoppage and pressure reductionare necessary for SUBURBAN WATER to make alterations, repairs, or improvements.<\/li>\n<li>Applicant shall keep all plumbing fixtures and piping at this facility in good workingcondition and shall promptly eliminate all leaks.<\/li>\n<li>Applicant agrees that the water service supplied by SUBURBAN WATER shall be for thesole use of the Applicant.<\/li>\n<li>Applicant agrees not to extend or permit the extension of pipes for the purpose of<br \/>\ntransferring water from one property and\/or structure to another.<\/li>\n<li>Applicant agrees to not share, re-sell, nor sub-meter the water supplied by SUBURBAN WATER.<\/li>\n<li>Applicant agrees that this fire main connection shall supply water to only one structure<br \/>\nlocated on land within SUBURBAN WATER\u2019S designated service area.<\/li>\n<li>Failure to comply with all of SUBURBAN WATER\u2019S Rules and Regulations shall result in<br \/>\nthe removal of this connection. Re-connection of this service, thereafter, shall result in a<br \/>\n$500.00 service charge\/violation fee.<br \/>\n15.Applicant agrees that if after this water service is made available, the same is discontinued or<br \/>\ndisconnected for any reason, re-connection shall be upon the conditions established by<br \/>\nSUBURBAN WATER.<\/li>\n<li>Applicant agrees not to make any physical connection between a private water system and<br \/>\nthe fire main upstream of the backflow prevention device. Representatives of SUBURBAN<br \/>\nWATER may, at any reasonable time, come on the premises where the water is being used<br \/>\nfor the purpose of conducting an inspection to insure compliance with provisions of thisUser\u2019s Agreement. Violation of this provision shall result in disconnection of this service.<\/li>\n<li>Applicant agrees to have the backflow prevention device tested prior to placing the fire fighting system into operation, and then annually thereafter by a certified backflow prevention specialist. The specialist\u2019s written reports shall be submitted to SUBURBAN WATER within five days of each test. Failure to have the backflow prevention device tested when required may result in termination of the fire main service.<\/li>\n<\/ol>\n<p style=\"text-align:center\"><span style=\"text-decoration:underline\">TOTAL COST\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026.\u2026 $10,000.00<\/span><\/p>\n<p style=\"text-align:left\"><span style=\"text-decoration:underline\">APPLICANT INFORMATION:<\/span><\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-100\"><div id=\"wpforms-82-field_3-container\" class=\"wpforms-field wpforms-field-number-slider\" data-field-type=\"number-slider\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-82-field_3\">Flow Rate (GPM)<\/label>\n<input\n\ttype=\"range\"\n\tid=\"wpforms-82-field_3\" class=\"wpforms-field-medium\" name=\"wpforms[fields][3]\" value=\"50\" aria-errormessage=\"wpforms-82-field_3-error\"\t\tmin=\"10\"\n\tmax=\"500\"\n\tstep=\"10\">\n\n<div class=\"wpforms-field-number-slider-hint\"\n\tdata-hint=\"Selected Value: {value}\">\n\tSelected Value: <b>50<\/b><\/div>\n<\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-82-field_4-container\" class=\"wpforms-field wpforms-field-number-slider\" data-field-type=\"number-slider\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-82-field_4\">Connection Size (Inches)<\/label>\n<input\n\ttype=\"range\"\n\tid=\"wpforms-82-field_4\" class=\"wpforms-field-medium\" name=\"wpforms[fields][4]\" value=\"2\" aria-errormessage=\"wpforms-82-field_4-error\"\t\tmin=\"2\"\n\tmax=\"8\"\n\tstep=\"0.5\">\n\n<div class=\"wpforms-field-number-slider-hint\"\n\tdata-hint=\"Selected Value: {value}\">\n\tSelected Value: <b>2<\/b><\/div>\n<\/div>\t\t<div id=\"wpforms-82-field_2-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"2\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-82-field_2\" >Date Principal Address<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-82-field_2\" class=\"wpforms-field-medium\" name=\"wpforms[fields][2]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-82-field_9-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"9\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-82-field_5-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-82-field_5\">Name of Owner<\/label><input type=\"text\" id=\"wpforms-82-field_5\" class=\"wpforms-field-medium\" name=\"wpforms[fields][5]\" aria-errormessage=\"wpforms-82-field_5-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-82-field_12-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-82-field_12\">Principal Contact<\/label><input type=\"text\" id=\"wpforms-82-field_12\" class=\"wpforms-field-medium\" name=\"wpforms[fields][12]\" aria-errormessage=\"wpforms-82-field_12-error\" ><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-82-field_11-container\" class=\"wpforms-field wpforms-field-address\" data-field-type=\"address\" data-field-id=\"11\"><fieldset><legend class=\"wpforms-field-label\">Address<\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-82-field_11\" class=\"wpforms-field-address-address1\" name=\"wpforms[fields][11][address1]\" aria-errormessage=\"wpforms-82-field_11-error\" ><label for=\"wpforms-82-field_11\" class=\"wpforms-field-sublabel after\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-82-field_11-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][11][address2]\" aria-errormessage=\"wpforms-82-field_11-address2-error\" ><label for=\"wpforms-82-field_11-address2\" class=\"wpforms-field-sublabel after\">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-82-field_11-city\" class=\"wpforms-field-address-city\" name=\"wpforms[fields][11][city]\" aria-errormessage=\"wpforms-82-field_11-city-error\" ><label for=\"wpforms-82-field_11-city\" class=\"wpforms-field-sublabel after\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-82-field_11-state\" class=\"wpforms-field-address-state\" name=\"wpforms[fields][11][state]\" aria-errormessage=\"wpforms-82-field_11-state-error\" ><option class=\"placeholder\" value=\"\" selected disabled>--- Select state ---<\/option><option value=\"AL\" >Alabama<\/option><option value=\"AK\" >Alaska<\/option><option value=\"AZ\" >Arizona<\/option><option value=\"AR\" >Arkansas<\/option><option value=\"CA\" >California<\/option><option value=\"CO\" >Colorado<\/option><option value=\"CT\" >Connecticut<\/option><option value=\"DE\" >Delaware<\/option><option value=\"DC\" >District of Columbia<\/option><option value=\"FL\" >Florida<\/option><option value=\"GA\" >Georgia<\/option><option value=\"HI\" >Hawaii<\/option><option value=\"ID\" >Idaho<\/option><option value=\"IL\" >Illinois<\/option><option value=\"IN\" >Indiana<\/option><option value=\"IA\" >Iowa<\/option><option value=\"KS\" >Kansas<\/option><option value=\"KY\" >Kentucky<\/option><option value=\"LA\" >Louisiana<\/option><option value=\"ME\" >Maine<\/option><option value=\"MD\" >Maryland<\/option><option value=\"MA\" >Massachusetts<\/option><option value=\"MI\" >Michigan<\/option><option value=\"MN\" >Minnesota<\/option><option value=\"MS\" >Mississippi<\/option><option value=\"MO\" >Missouri<\/option><option value=\"MT\" >Montana<\/option><option value=\"NE\" >Nebraska<\/option><option value=\"NV\" >Nevada<\/option><option value=\"NH\" >New Hampshire<\/option><option value=\"NJ\" >New Jersey<\/option><option value=\"NM\" >New Mexico<\/option><option value=\"NY\" >New York<\/option><option value=\"NC\" >North Carolina<\/option><option value=\"ND\" >North Dakota<\/option><option value=\"OH\" >Ohio<\/option><option value=\"OK\" >Oklahoma<\/option><option value=\"OR\" >Oregon<\/option><option value=\"PA\" >Pennsylvania<\/option><option value=\"RI\" >Rhode Island<\/option><option value=\"SC\" >South Carolina<\/option><option value=\"SD\" >South Dakota<\/option><option value=\"TN\" >Tennessee<\/option><option value=\"TX\" >Texas<\/option><option value=\"UT\" >Utah<\/option><option value=\"VT\" >Vermont<\/option><option value=\"VA\" >Virginia<\/option><option value=\"WA\" >Washington<\/option><option value=\"WV\" >West Virginia<\/option><option value=\"WI\" >Wisconsin<\/option><option value=\"WY\" >Wyoming<\/option><\/select><label for=\"wpforms-82-field_11-state\" class=\"wpforms-field-sublabel after\">State<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-82-field_11-postal\" class=\"wpforms-field-address-postal wpforms-masked-input\" data-inputmask-mask=\"(99999)|(99999-9999)\" data-inputmask-keepstatic=\"true\" data-rule-inputmask-incomplete=\"1\" name=\"wpforms[fields][11][postal]\" aria-errormessage=\"wpforms-82-field_11-postal-error\" ><label for=\"wpforms-82-field_11-postal\" class=\"wpforms-field-sublabel after\">Zip Code<\/label><\/div><\/div><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-82-field_10-container\" class=\"wpforms-field wpforms-field-address\" data-field-type=\"address\" data-field-id=\"10\"><fieldset><legend class=\"wpforms-field-label\">Address<\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-82-field_10\" class=\"wpforms-field-address-address1\" name=\"wpforms[fields][10][address1]\" aria-errormessage=\"wpforms-82-field_10-error\" ><label for=\"wpforms-82-field_10\" class=\"wpforms-field-sublabel after\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-82-field_10-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][10][address2]\" aria-errormessage=\"wpforms-82-field_10-address2-error\" ><label for=\"wpforms-82-field_10-address2\" class=\"wpforms-field-sublabel after\">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-82-field_10-city\" class=\"wpforms-field-address-city\" name=\"wpforms[fields][10][city]\" aria-errormessage=\"wpforms-82-field_10-city-error\" ><label for=\"wpforms-82-field_10-city\" class=\"wpforms-field-sublabel after\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-82-field_10-state\" class=\"wpforms-field-address-state\" name=\"wpforms[fields][10][state]\" aria-errormessage=\"wpforms-82-field_10-state-error\" ><option class=\"placeholder\" value=\"\" selected disabled>--- Select state ---<\/option><option value=\"AL\" >Alabama<\/option><option value=\"AK\" >Alaska<\/option><option value=\"AZ\" >Arizona<\/option><option value=\"AR\" >Arkansas<\/option><option value=\"CA\" >California<\/option><option value=\"CO\" >Colorado<\/option><option value=\"CT\" >Connecticut<\/option><option value=\"DE\" >Delaware<\/option><option value=\"DC\" >District of Columbia<\/option><option value=\"FL\" >Florida<\/option><option value=\"GA\" >Georgia<\/option><option value=\"HI\" >Hawaii<\/option><option value=\"ID\" >Idaho<\/option><option value=\"IL\" >Illinois<\/option><option value=\"IN\" >Indiana<\/option><option value=\"IA\" >Iowa<\/option><option value=\"KS\" >Kansas<\/option><option value=\"KY\" >Kentucky<\/option><option value=\"LA\" >Louisiana<\/option><option value=\"ME\" >Maine<\/option><option value=\"MD\" >Maryland<\/option><option value=\"MA\" >Massachusetts<\/option><option value=\"MI\" >Michigan<\/option><option value=\"MN\" >Minnesota<\/option><option value=\"MS\" >Mississippi<\/option><option value=\"MO\" >Missouri<\/option><option value=\"MT\" >Montana<\/option><option value=\"NE\" >Nebraska<\/option><option value=\"NV\" >Nevada<\/option><option value=\"NH\" >New Hampshire<\/option><option value=\"NJ\" >New Jersey<\/option><option value=\"NM\" >New Mexico<\/option><option value=\"NY\" >New York<\/option><option value=\"NC\" >North Carolina<\/option><option value=\"ND\" >North Dakota<\/option><option value=\"OH\" >Ohio<\/option><option value=\"OK\" >Oklahoma<\/option><option value=\"OR\" >Oregon<\/option><option value=\"PA\" >Pennsylvania<\/option><option value=\"RI\" >Rhode Island<\/option><option value=\"SC\" >South Carolina<\/option><option value=\"SD\" >South Dakota<\/option><option value=\"TN\" >Tennessee<\/option><option value=\"TX\" >Texas<\/option><option value=\"UT\" >Utah<\/option><option value=\"VT\" >Vermont<\/option><option value=\"VA\" >Virginia<\/option><option value=\"WA\" >Washington<\/option><option value=\"WV\" >West Virginia<\/option><option value=\"WI\" >Wisconsin<\/option><option value=\"WY\" >Wyoming<\/option><\/select><label for=\"wpforms-82-field_10-state\" class=\"wpforms-field-sublabel after\">State<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-82-field_10-postal\" class=\"wpforms-field-address-postal wpforms-masked-input\" data-inputmask-mask=\"(99999)|(99999-9999)\" data-inputmask-keepstatic=\"true\" data-rule-inputmask-incomplete=\"1\" name=\"wpforms[fields][10][postal]\" aria-errormessage=\"wpforms-82-field_10-postal-error\" ><label for=\"wpforms-82-field_10-postal\" class=\"wpforms-field-sublabel after\">Zip Code<\/label><\/div><\/div><\/fieldset><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-82-field_13-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-type=\"date-time\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-82-field_13\">Date \/ Time<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-82-field_13\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][13][date]\" aria-errormessage=\"wpforms-82-field_13-error\" ><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-82-field_15-container\" class=\"wpforms-field wpforms-field-signature\" data-field-type=\"signature\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-82-field_15\">Signature<\/label><input type=\"text\" id=\"wpforms-82-field_15\" class=\"wpforms-signature-input wpforms-screen-reader-element\" data-is-wrapped-field=\"1\" name=\"wpforms[fields][15]\" autocomplete=\"off\" inputmode=\"none\" aria-errormessage=\"wpforms-82-field_15-error\" ><div class=\"wpforms-signature-wrap wpforms-field-row wpforms-field-large\"><canvas class=\"wpforms-signature-canvas\" id=\"wpforms-82-field_15-signature\" data-color=\"#000000\"><\/canvas><div class=\"wpforms-signature-clear\" title=\"Clear Signature\" tabindex=\"0\">\n\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"1em\" height=\"1em\" preserveAspectRatio=\"xMidYMid meet\" viewBox=\"0 0 1536 1536\">\n\t\t\t\t\t<path fill=\"var( --wpforms-field-text-color, rgba(0, 0, 0, 0.25) )\" d=\"M1149 994q0-26-19-45L949 768l181-181q19-19 19-45q0-27-19-46l-90-90q-19-19-46-19q-26 0-45 19L768 587L587 406q-19-19-45-19q-27 0-46 19l-90 90q-19 19-19 46q0 26 19 45l181 181l-181 181q-19 19-19 45q0 27 19 46l90 90q19 19 46 19q26 0 45-19l181-181l181 181q19 19 45 19q27 0 46-19l90-90q19-19 19-46zm387-226q0 209-103 385.5T1153.5 1433T768 1536t-385.5-103T103 1153.5T0 768t103-385.5T382.5 103T768 0t385.5 103T1433 382.5T1536 768z\"\/>\n\t\t\t\t<\/svg>\n\t\t\t\t<div class=\"wpforms-signature-clear-caption\">Clear Signature<\/div>\n\t\t\t<\/div><\/div><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-82-field_16-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-82-field_16\">Phone<\/label><input type=\"tel\" id=\"wpforms-82-field_16\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][16]\" aria-label=\"Phone\" aria-errormessage=\"wpforms-82-field_16-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-82-field_18-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"18\"><label class=\"wpforms-field-label\" for=\"wpforms-82-field_18\">Printed Name of Signator<\/label><input type=\"text\" id=\"wpforms-82-field_18\" class=\"wpforms-field-medium\" name=\"wpforms[fields][18]\" aria-errormessage=\"wpforms-82-field_18-error\" ><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-82-field_17-container\" class=\"wpforms-field wpforms-field-email\" data-field-type=\"email\" data-field-id=\"17\"><label class=\"wpforms-field-label\" for=\"wpforms-82-field_17\">Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-82-field_17\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][17]\" spellcheck=\"false\" aria-errormessage=\"wpforms-82-field_17-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-82-field_14-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"14\"><label 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