{"id":1136,"date":"2025-07-02T10:29:02","date_gmt":"2025-07-02T08:29:02","guid":{"rendered":"https:\/\/helamed-gmbh.de\/request-a-quote\/"},"modified":"2025-07-27T12:46:57","modified_gmt":"2025-07-27T10:46:57","slug":"request-a-quote","status":"publish","type":"page","link":"https:\/\/helamed-gmbh.de\/en\/request-a-quote\/","title":{"rendered":"Request a Quote"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"1136\" class=\"elementor elementor-1136 elementor-70\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-67d54f4 e-flex e-con-boxed e-con e-parent\" data-id=\"67d54f4\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-37566c26 elementor-widget elementor-widget-heading\" data-id=\"37566c26\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Your Path to the Right Ultrasound System<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-338bb3e7 elementor-widget elementor-widget-heading\" data-id=\"338bb3e7\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h5 class=\"elementor-heading-title elementor-size-default\">Get your personalized quote now \u2013 in just a few steps:\nSelect your desired product and let us know your requirements \u2013 we will get back to you as soon as possible with a customized offer.<\/h5>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7f73955 elementor-button-align-center elementor-tablet-button-align-center elementor-widget elementor-widget-form\" data-id=\"7f73955\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;next&quot;,&quot;step_previous_label&quot;:&quot;back&quot;,&quot;button_width&quot;:&quot;100&quot;,&quot;step_type&quot;:&quot;number_text&quot;,&quot;step_icon_shape&quot;:&quot;circle&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t\t\t\t<form class=\"elementor-form\" method=\"post\" name=\"Get Quote Form\" aria-label=\"Get Quote Form\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"1136\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"7f73955\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"Request a Quote - HELAmed GmbH\" \/>\n\n\t\t\t\t\t\t\t<input type=\"hidden\" name=\"queried_id\" value=\"1136\"\/>\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_affedfb elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"\" data-previousButton=\"\" data-nextButton=\"\" data-iconUrl=\"\" data-iconLibrary=\"fas fa-star\" data-icon=\"&lt;svg class=&quot;e-font-icon-svg e-fas-star&quot; viewBox=&quot;0 0 576 512&quot; xmlns=&quot;http:\/\/www.w3.org\/2000\/svg&quot;&gt;&lt;path d=&quot;M259.3 17.8L194 150.2 47.9 171.5c-26.2 3.8-36.7 36.1-17.7 54.6l105.7 103-25 145.5c-4.5 26.3 23.2 46 46.4 33.7L288 439.6l130.7 68.7c23.2 12.2 50.9-7.4 46.4-33.7l-25-145.5 105.7-103c19-18.5 8.5-50.8-17.7-54.6L382 150.2 316.7 17.8c-11.7-23.6-45.6-23.9-57.4 0z&quot;&gt;&lt;\/path&gt;&lt;\/svg&gt;\" ><\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-name elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-name\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tFull Name\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[name]\" id=\"form-field-name\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"First and last name*\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-email elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-email\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tEmail\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[email]\" id=\"form-field-email\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"Email*\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_6c180a9 elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_6c180a9\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tPhone\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[field_6c180a9]\" id=\"form-field-field_6c180a9\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"Telephon*\" required=\"required\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_c44f812 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_c44f812\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tWhat is a good time for us to call you?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-lg\" name=\"form_fields[field_c44f812]\" id=\"form-field-field_c44f812\" rows=\"2\" placeholder=\"Please let us know when we may contact you by phone if needed.\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_8ecabc7 elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"\" data-previousButton=\"\" data-nextButton=\"\" data-iconUrl=\"\" data-iconLibrary=\"fas fa-star\" data-icon=\"&lt;svg class=&quot;e-font-icon-svg e-fas-star&quot; viewBox=&quot;0 0 576 512&quot; xmlns=&quot;http:\/\/www.w3.org\/2000\/svg&quot;&gt;&lt;path d=&quot;M259.3 17.8L194 150.2 47.9 171.5c-26.2 3.8-36.7 36.1-17.7 54.6l105.7 103-25 145.5c-4.5 26.3 23.2 46 46.4 33.7L288 439.6l130.7 68.7c23.2 12.2 50.9-7.4 46.4-33.7l-25-145.5 105.7-103c19-18.5 8.5-50.8-17.7-54.6L382 150.2 316.7 17.8c-11.7-23.6-45.6-23.9-57.4 0z&quot;&gt;&lt;\/path&gt;&lt;\/svg&gt;\" ><\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_955b7c5 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_955b7c5\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tProduct inquiry \u2013 please provide information about:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-lg\" name=\"form_fields[field_955b7c5]\" id=\"form-field-field_955b7c5\" rows=\"4\" placeholder=\"Product inquiry \u2013 please provide information about:\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_4bc524f elementor-col-50\">\n\t\t\t\t\t<span style=\"display: block; margin: 0 0 6px 0; color: #666; font-size: 14px;\">\n Please select the product category:\n<\/span>\n\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_a113bf5 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_a113bf5\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tProduct\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Stationary ultrasound device\" id=\"form-field-field_a113bf5-0\" name=\"form_fields[field_a113bf5][]\"> <label for=\"form-field-field_a113bf5-0\">Stationary ultrasound device<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Mobile ultrasound device\" id=\"form-field-field_a113bf5-1\" name=\"form_fields[field_a113bf5][]\"> <label for=\"form-field-field_a113bf5-1\">Mobile ultrasound device<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Handheld\" id=\"form-field-field_a113bf5-2\" name=\"form_fields[field_a113bf5][]\"> <label for=\"form-field-field_a113bf5-2\">Handheld<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Venablock\" id=\"form-field-field_a113bf5-3\" name=\"form_fields[field_a113bf5][]\"> <label for=\"form-field-field_a113bf5-3\">Venablock<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Consumables\" id=\"form-field-field_a113bf5-4\" name=\"form_fields[field_a113bf5][]\"> <label for=\"form-field-field_a113bf5-4\">Consumables<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_b7f3f38 elementor-col-50\">\n\t\t\t\t\t<span style=\"display: block; margin: 0 0 6px 0; color: #666; font-size: 14px;\">\n Please select the desired probes:\n<\/span>\n\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_c80c7d1 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_c80c7d1\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tProbes\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Linear probe\" id=\"form-field-field_c80c7d1-0\" name=\"form_fields[field_c80c7d1][]\"> <label for=\"form-field-field_c80c7d1-0\">Linear probe<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Microconvex probe\" id=\"form-field-field_c80c7d1-1\" name=\"form_fields[field_c80c7d1][]\"> <label for=\"form-field-field_c80c7d1-1\">Microconvex probe<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Endocavitary probe\" id=\"form-field-field_c80c7d1-2\" name=\"form_fields[field_c80c7d1][]\"> <label for=\"form-field-field_c80c7d1-2\">Endocavitary probe<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Convex probe\" id=\"form-field-field_c80c7d1-3\" name=\"form_fields[field_c80c7d1][]\"> <label for=\"form-field-field_c80c7d1-3\">Convex probe<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Phased array probe\" id=\"form-field-field_c80c7d1-4\" name=\"form_fields[field_c80c7d1][]\"> <label for=\"form-field-field_c80c7d1-4\">Phased array probe<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"CW Doppler pencil probe\" id=\"form-field-field_c80c7d1-5\" name=\"form_fields[field_c80c7d1][]\"> <label for=\"form-field-field_c80c7d1-5\">CW Doppler pencil probe<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"TEE probe\" id=\"form-field-field_c80c7d1-6\" name=\"form_fields[field_c80c7d1][]\"> <label for=\"form-field-field_c80c7d1-6\">TEE probe<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Consultation, please\" id=\"form-field-field_c80c7d1-7\" name=\"form_fields[field_c80c7d1][]\"> <label for=\"form-field-field_c80c7d1-7\">Consultation, please<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_ab3d019 elementor-col-50\">\n\t\t\t\t\t<span style=\"font-size: 14px; color: #666;\">\n Please select the desired procedures:\n<\/span>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_9264b06 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_9264b06\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tWhich ultrasound applications must the device support?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"SWIB mode\" id=\"form-field-field_9264b06-0\" name=\"form_fields[field_9264b06][]\"> <label for=\"form-field-field_9264b06-0\">SWIB mode<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Color Doppler\" id=\"form-field-field_9264b06-1\" name=\"form_fields[field_9264b06][]\"> <label for=\"form-field-field_9264b06-1\">Color Doppler<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"3D\/4D\" id=\"form-field-field_9264b06-2\" name=\"form_fields[field_9264b06][]\"> <label for=\"form-field-field_9264b06-2\">3D\/4D<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Other\" id=\"form-field-field_9264b06-3\" name=\"form_fields[field_9264b06][]\"> <label for=\"form-field-field_9264b06-3\">Other<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_1030b2c elementor-col-50\">\n\t\t\t\t\t<span style=\"font-size: 14px; color: #666;\">\n Do you prefer a specific brand?\n<\/span>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_9a5631f elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_9a5631f\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tWhich brand\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Philips\" id=\"form-field-field_9a5631f-0\" name=\"form_fields[field_9a5631f][]\"> <label for=\"form-field-field_9a5631f-0\">Philips<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Samsung\" id=\"form-field-field_9a5631f-1\" name=\"form_fields[field_9a5631f][]\"> <label for=\"form-field-field_9a5631f-1\">Samsung<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Mindray\" id=\"form-field-field_9a5631f-2\" name=\"form_fields[field_9a5631f][]\"> <label for=\"form-field-field_9a5631f-2\">Mindray<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Venablock\" id=\"form-field-field_9a5631f-3\" name=\"form_fields[field_9a5631f][]\"> <label for=\"form-field-field_9a5631f-3\">Venablock<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_dffc53b elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"\" data-previousButton=\"\" data-nextButton=\"\" data-iconUrl=\"\" data-iconLibrary=\"fas fa-star\" data-icon=\"&lt;svg class=&quot;e-font-icon-svg e-fas-star&quot; viewBox=&quot;0 0 576 512&quot; xmlns=&quot;http:\/\/www.w3.org\/2000\/svg&quot;&gt;&lt;path d=&quot;M259.3 17.8L194 150.2 47.9 171.5c-26.2 3.8-36.7 36.1-17.7 54.6l105.7 103-25 145.5c-4.5 26.3 23.2 46 46.4 33.7L288 439.6l130.7 68.7c23.2 12.2 50.9-7.4 46.4-33.7l-25-145.5 105.7-103c19-18.5 8.5-50.8-17.7-54.6L382 150.2 316.7 17.8c-11.7-23.6-45.6-23.9-57.4 0z&quot;&gt;&lt;\/path&gt;&lt;\/svg&gt;\" ><\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_045f85d elementor-col-50\">\n\t\t\t\t\t<span style=\"font-size: 14px; color: #666;\">\n Where will the ultrasound device be used?\n<\/span>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_17d360f elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_17d360f\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tWhere is the device intended to be used?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Hospital \/ Clinic\" id=\"form-field-field_17d360f-0\" name=\"form_fields[field_17d360f]\"> <label for=\"form-field-field_17d360f-0\">Hospital \/ Clinic<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Medical practice \/ Private practice\" id=\"form-field-field_17d360f-1\" name=\"form_fields[field_17d360f]\"> <label for=\"form-field-field_17d360f-1\">Medical practice \/ Private practice<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Non-fixed location (e.g., mobile use)\" id=\"form-field-field_17d360f-2\" name=\"form_fields[field_17d360f]\"> <label for=\"form-field-field_17d360f-2\">Non-fixed location (e.g., mobile use)<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_ed7e2f2 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ed7e2f2\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tAvailable in:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-eicon-caret-down\" viewBox=\"0 0 571.4 571.4\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M571 393Q571 407 561 418L311 668Q300 679 286 679T261 668L11 418Q0 407 0 393T11 368 36 357H536Q550 357 561 368T571 393Z\"><\/path><\/svg>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_ed7e2f2]\" id=\"form-field-field_ed7e2f2\" class=\"elementor-field-textual elementor-size-lg\">\n\t\t\t\t\t\t\t\t\t<option value=\"\">Available within a maximum of: <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"10 days\">10 days<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"4 weeks\">4 weeks<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"4\u20136 months\">4\u20136 months<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Flexible\">Flexible<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"\"><\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_a2b7f02 elementor-col-50\">\n\t\t\t\t\t<span style=\"font-size: 14px; color: #666;\">\n We offer the right device for every budget. You decide whether it should be a new or used device. \n<\/span>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_a03bb44 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_a03bb44\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tWould you like offers for new or used devices?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"New\" id=\"form-field-field_a03bb44-0\" name=\"form_fields[field_a03bb44][]\"> <label for=\"form-field-field_a03bb44-0\">New<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"New (0\u20133 years)\" id=\"form-field-field_a03bb44-1\" name=\"form_fields[field_a03bb44][]\"> <label for=\"form-field-field_a03bb44-1\">New (0\u20133 years)<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Demo device\" id=\"form-field-field_a03bb44-2\" name=\"form_fields[field_a03bb44][]\"> <label for=\"form-field-field_a03bb44-2\">Demo device<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Used device\" id=\"form-field-field_a03bb44-3\" name=\"form_fields[field_a03bb44][]\"> <label for=\"form-field-field_a03bb44-3\">Used device<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_ffdb093 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ffdb093\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tDo you need additional devices?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_ffdb093]\" id=\"form-field-field_ffdb093\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"Do you need additional devices?\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_645d70f elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_645d70f\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tDo you need consumables?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_645d70f]\" id=\"form-field-field_645d70f\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"Do you need consumables?\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-text elementor-col-100 elementor-field-required\"><div class=\"f12-captcha template-1\">\r\n\t\r\n    <div class=\"c-header\">\r\n        <div class=\"c-input\">\r\n            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