{"id":6335,"date":"2026-06-09T14:38:49","date_gmt":"2026-06-09T21:38:49","guid":{"rendered":"https:\/\/www.yakimawa.gov\/services\/utility-services\/?page_id=6335"},"modified":"2026-06-09T14:38:49","modified_gmt":"2026-06-09T21:38:49","slug":"refuse-special-haul-request-form","status":"publish","type":"page","link":"https:\/\/www.yakimawa.gov\/services\/utility-services\/refuse-special-haul-request-form\/","title":{"rendered":"Refuse Special Haul Request Form"},"content":{"rendered":"<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_13' >\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">Customer Refuse Special Haul Request<\/h2>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_13'  action='\/services\/utility-services\/wp-json\/wp\/v2\/pages\/6335' data-formid='13' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_13' class='gform_fields top_label form_sublabel_below description_below validation_below' data-column-layout='fill'><div id=\"field_13_119\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"81d02cff\" data-field-span=\"12\"><h3 class=\"gsection_title\">** Do you have a City of Yakima Utility account already? **<\/h3><div class='gsection_description' id='gfield_description_13_119'>This form is ONLY for customers who do NOT have a City of Yakima Utility account. If you have an account with us already, please contact the office to request service instead of using this form.<\/div><\/div><div id=\"field_13_1\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"fc54dd7a\" data-field-span=\"12\"><h3 class=\"gsection_title\">Customer Refuse Special Haul Request<\/h3><div class='gsection_description' id='gfield_description_13_1'>Before a special haul request can be conducted, you will need to fill out this form so a refuse staff member can contact you. There is a minimum charge of $25.00 for any request. If your special haul is for more than that, then you will be billed for the cost for the haul without the minimum $25.00 charge. For more info, visit: https:\/\/www.yakimawa.gov\/services\/refuse\/ or call 509-575-6005.<\/div><\/div><div id=\"field_13_75\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"a6de158a\" data-field-span=\"12\"><h3 class=\"gsection_title\">HAZARDOUS MATERIALS ARE NOT ALLOWED<\/h3><div class='gsection_description' id='gfield_description_13_75'>HAZARDOUS MATERIALS NOT ALLOWED: Batteries of any kind, Propane tanks, Oxygen tanks, Paint cans, or Liquids that can easily catch fire or emit flammable vapors (gasoline, diesel fuel, ethanol). Please contact Terrace Heights Landfill at 509-574-2450 for questions about that. \n<\/div><\/div><div id=\"field_13_59\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"abaa087b\" data-field-span=\"12\"><h3 class=\"gsection_title\">Refuse Special Haul set rates:<\/h3><div class='gsection_description' id='gfield_description_13_59'>Add specifics here for known charges: <\/div><\/div><div id=\"field_13_9\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"50997feb\" data-field-span=\"12\"><label id='gfield_label_13_9' class='gfield_label gform-field-label' for='input_13_9'><span class='gform-field-label__text'>Today&#039;s Date:<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='mm\/dd\/yyyy'\n\t\t\t\t\tid='input_13_9'\n\t\t\t\t\tclass='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_9'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\taria-required=\"true\"\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_13_9' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_13_9' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_13_9' aria-label='Today's Date:: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_13_66\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"5d05fd85\" data-field-span=\"12\"><label id='gfield_label_13_66' class='gfield_label gform-field-label' for='input_13_66'><span class='gform-field-label__text'>Date Special Haul is Requested for (if not today&#039;s date)<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='mm\/dd\/yyyy'\n\t\t\t\t\tid='input_13_66'\n\t\t\t\t\tclass='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_66'\n\t\t\t\t\tvalue=''\n\t\t\t\t\taria-describedby=\"gfield_description_13_66\" \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_13_66' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_13_66' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_13_66' aria-label='Date Special Haul is Requested for (if not today's date): Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><div class='gfield_description' id='gfield_description_13_66'>Please note we do not do pickups on weekends or major holidays. <\/div><\/div><fieldset id=\"field_13_3\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-seven-twelfths gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"06d27cf9\" data-field-span=\"7\"><legend id='gfield_label_13_3' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Applicant Name:<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_13_3'>\n                            \n                            <span id='input_13_3_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_3.3' id='input_13_3_3' value=''   aria-required='true'     aria-describedby=\"gfield_description_13_3\" aria-labelledby=\"input_13_3_3_label gfield_label_13_3\"\/>\n                                                    <label for='input_13_3_3' id='input_13_3_3_label' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_13_3_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_3.6' id='input_13_3_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_13_3_6' id='input_13_3_6_label' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><div class='gfield_description' id='gfield_description_13_3'>Person who is on site to rent hydrant.<\/div><\/fieldset><div data-field-id=\"3\" class=\"spacer gfield\" style=\"grid-column: span 5;\" data-group-id=\"06d27cf9\"><\/div><fieldset id=\"field_13_5\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-seven-twelfths field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"72cd0ae2\" data-field-span=\"7\"><legend id='gfield_label_13_5' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Applicant Organization\/Company Name (if applicable)<\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name no_last_name no_suffix gf_name_has_1 ginput_container_name gform-grid-row' id='input_13_5'>\n                            \n                            <span id='input_13_5_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_5.3' id='input_13_5_3' value=''   aria-required='false'     aria-describedby=\"gfield_description_13_5\" aria-labelledby=\"input_13_5_3_label gfield_label_13_5\"\/>\n                                                    <label for='input_13_5_3' id='input_13_5_3_label' class='gform-field-label gform-field-label--type-sub '>Business Name<\/label>\n                                                <\/span>\n                            \n                            \n                            \n                        <\/div><div class='gfield_description' id='gfield_description_13_5'>Name of business, if applicable and if it&#8217;s different than the customer name.<\/div><\/fieldset><div id=\"field_13_16\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-international gfield--width-five-twelfths gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"72cd0ae2\" data-field-span=\"5\"><label id='gfield_label_13_16' class='gfield_label gform-field-label' for='input_13_16'><span class='gform-field-label__text'>Applicant Phone Number:<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_16' id='input_13_16' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"    \/><\/div><\/div><div id=\"field_13_65\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-five-twelfths gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"a5c27418\" data-field-span=\"5\"><label id='gfield_label_13_65' class='gfield_label gform-field-label' for='input_13_65'><span class='gform-field-label__text'>Customer Drivers&#039; License Number or tax ID number (Required)<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_65' id='input_13_65' type='text' value='' class='large'  aria-describedby=\"gfield_description_13_65\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_13_65'>Enter your tax ID number, UBI number, or government issued ID number such as a driver&#8217;s license. <\/div><\/div><div data-field-id=\"65\" class=\"spacer gfield\" style=\"grid-column: span 7;\" data-group-id=\"a5c27418\"><\/div><div id=\"field_13_25\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-five-twelfths field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"04ccaaef\" data-field-span=\"5\"><label id='gfield_label_13_25' class='gfield_label gform-field-label' for='input_13_25'><span class='gform-field-label__text'>Email Address:<\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_25' id='input_13_25' type='email' value='' class='medium'     aria-invalid=\"false\" aria-describedby=\"gfield_description_13_25\" \/>\n                        <\/div><div class='gfield_description' id='gfield_description_13_25'>Entering your email will send you a copy of this form and your bill once your account is billed.<\/div><\/div><div data-field-id=\"25\" class=\"spacer gfield\" style=\"grid-column: span 7;\" data-group-id=\"04ccaaef\"><\/div><fieldset id=\"field_13_7\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-five-twelfths gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"56cbfe9b\" data-field-span=\"5\"><legend id='gfield_label_13_7' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Mailing Address:<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_13_7' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_13_7_1_container' >\n                                        <input type='text' name='input_7.1' id='input_13_7_1' value=''    aria-required='true'    aria-labelledby=\"input_13_7_1_label gfield_label_13_7\"\/>\n                                        <label for='input_13_7_1' id='input_13_7_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_13_7_2_container' >\n                                        <input type='text' name='input_7.2' id='input_13_7_2' value=''     aria-required='false'   \/>\n                                        <label for='input_13_7_2' id='input_13_7_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_13_7_3_container' >\n                                    <input type='text' name='input_7.3' id='input_13_7_3' value=''    aria-required='true'    \/>\n                                    <label for='input_13_7_3' id='input_13_7_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_13_7_4_container' >\n                                        <select name='input_7.4' id='input_13_7_4'     aria-required='true'    ><option value='' selected='selected'><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                        <label for='input_13_7_4' id='input_13_7_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_13_7_5_container' >\n                                    <input type='text' name='input_7.5' id='input_13_7_5' value=''    aria-required='true'    \/>\n                                    <label for='input_13_7_5' id='input_13_7_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_7.6' id='input_13_7_6' value='US' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div data-field-id=\"7\" class=\"spacer gfield\" style=\"grid-column: span 7;\" data-group-id=\"56cbfe9b\"><\/div><fieldset id=\"field_13_17\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-five-twelfths field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"40a1ad7a\" data-field-span=\"5\"><legend id='gfield_label_13_17' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Street Address:<\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_13_17' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_13_17_1_container' >\n                                        <input type='text' name='input_17.1' id='input_13_17_1' value=''    aria-required='false'    aria-describedby=\"gfield_description_13_17\" aria-labelledby=\"input_13_17_1_label gfield_label_13_17\"\/>\n                                        <label for='input_13_17_1' id='input_13_17_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_13_17_2_container' >\n                                        <input type='text' name='input_17.2' id='input_13_17_2' value=''     aria-required='false'   \/>\n                                        <label for='input_13_17_2' id='input_13_17_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_13_17_3_container' >\n                                    <input type='text' name='input_17.3' id='input_13_17_3' value=''    aria-required='false'    \/>\n                                    <label for='input_13_17_3' id='input_13_17_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_13_17_4_container' >\n                                        <select name='input_17.4' id='input_13_17_4'     aria-required='false'    ><option value='' selected='selected'><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                        <label for='input_13_17_4' id='input_13_17_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_13_17_5_container' >\n                                    <input type='text' name='input_17.5' id='input_13_17_5' value=''    aria-required='false'    \/>\n                                    <label for='input_13_17_5' id='input_13_17_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_17.6' id='input_13_17_6' value='US' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><div class='gfield_description' id='gfield_description_13_17'>If different from mailing address. <\/div><\/fieldset><div data-field-id=\"17\" class=\"spacer gfield\" style=\"grid-column: span 7;\" data-group-id=\"40a1ad7a\"><\/div><div id=\"field_13_11\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-five-twelfths gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"be5553fd\" data-field-span=\"5\"><label id='gfield_label_13_11' class='gfield_label gform-field-label' for='input_13_11'><span class='gform-field-label__text'>Special Haul Location:<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_11' id='input_13_11' type='text' value='' class='large'  aria-describedby=\"gfield_description_13_11\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_13_11'>List the specific location\/s the request is for. This can include cross streets, property details, etc.. Prices may vary based on placement of items. For example, if a you have special haul items located in the alley, backyard, or another area that is not easily accessible by our grapple truck, the items will need to be placed where the truck can reach them from the road or alley, and may incur additional charges which can range from $25 &#8211; $250 will be applied for the removal, depending on the amount of items you have. <\/div><\/div><div data-field-id=\"11\" class=\"spacer gfield\" style=\"grid-column: span 7;\" data-group-id=\"be5553fd\"><\/div><div id=\"field_13_85\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-full gfield_price gfield_price_13_85 gfield_product_13_85 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"dee3cb89\" data-field-span=\"12\"><label id='gfield_label_13_85' class='gfield_label gform-field-label gfield_label_before_complex' for='input_13_85_1'><span class='gform-field-label__text'><span class=\"gfield_label_product\">Air Conditioner (portable)<\/span> <span class=\"screen-reader-text\">Quantity<\/span><\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_85.1' value='Air Conditioner (portable)' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_13_85' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_13_85'>$38.00<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_85.2' id='ginput_base_price_13_85' class='gform_hidden' value='$38.00'\/>\n\t\t\t\t\t <label for='ginput_quantity_13_85_1' class='ginput_quantity_label gform-field-label' aria-hidden='true'>Quantity<\/label> <input type='number' name='input_85.3' value='' id='input_13_85_1' class='ginput_quantity' size='10' min='0'   aria-label=\"Quantity Air Conditioner (portable)\" aria-describedby=\"ginput_product_price_13_85\" \/>\n\t\t\t\t<\/div><\/div><div id=\"field_13_81\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-full gfield_price gfield_price_13_81 gfield_product_13_81 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"65c7713f\" data-field-span=\"12\"><label id='gfield_label_13_81' class='gfield_label gform-field-label gfield_label_before_complex' for='input_13_81_1'><span class='gform-field-label__text'><span class=\"gfield_label_product\">Accent Chair<\/span> <span class=\"screen-reader-text\">Quantity<\/span><\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_81.1' value='Accent Chair' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_13_81' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_13_81'>$10.00<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_81.2' id='ginput_base_price_13_81' class='gform_hidden' value='$10.00'\/>\n\t\t\t\t\t <label for='ginput_quantity_13_81_1' class='ginput_quantity_label gform-field-label' aria-hidden='true'>Quantity<\/label> <input type='number' name='input_81.3' value='' id='input_13_81_1' class='ginput_quantity' size='10' min='0'   aria-label=\"Quantity Accent Chair\" aria-describedby=\"ginput_product_price_13_81\" \/>\n\t\t\t\t<\/div><\/div><div id=\"field_13_82\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-full gfield_price gfield_price_13_82 gfield_product_13_82 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"be39d149\" data-field-span=\"12\"><label id='gfield_label_13_82' class='gfield_label gform-field-label gfield_label_before_complex' for='input_13_82_1'><span class='gform-field-label__text'><span class=\"gfield_label_product\">BBQ (no tank)<\/span> <span class=\"screen-reader-text\">Quantity<\/span><\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_82.1' value='BBQ (no tank)' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_13_82' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_13_82'>$15.00<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_82.2' id='ginput_base_price_13_82' class='gform_hidden' value='$15.00'\/>\n\t\t\t\t\t <label for='ginput_quantity_13_82_1' class='ginput_quantity_label gform-field-label' aria-hidden='true'>Quantity<\/label> <input type='number' name='input_82.3' value='' id='input_13_82_1' class='ginput_quantity' size='10' min='0'   aria-label=\"Quantity BBQ (no tank)\" aria-describedby=\"ginput_product_price_13_82\" \/>\n\t\t\t\t<\/div><\/div><div id=\"field_13_92\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-full gfield_price gfield_price_13_92 gfield_product_13_92 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"49dd5fd1\" data-field-span=\"12\"><label id='gfield_label_13_92' class='gfield_label gform-field-label gfield_label_before_complex' for='input_13_92_1'><span class='gform-field-label__text'><span class=\"gfield_label_product\">Bicycle<\/span> <span class=\"screen-reader-text\">Quantity<\/span><\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_92.1' value='Bicycle' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_13_92' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_13_92'>$10.00<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_92.2' id='ginput_base_price_13_92' class='gform_hidden' value='$10.00'\/>\n\t\t\t\t\t <label for='ginput_quantity_13_92_1' class='ginput_quantity_label gform-field-label' aria-hidden='true'>Quantity<\/label> <input type='number' name='input_92.3' value='' id='input_13_92_1' class='ginput_quantity' size='10' min='0'   aria-label=\"Quantity Bicycle\" aria-describedby=\"ginput_product_price_13_92\" \/>\n\t\t\t\t<\/div><\/div><div id=\"field_13_91\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-full gfield_price gfield_price_13_91 gfield_product_13_91 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"3ed5cee1\" data-field-span=\"12\"><label id='gfield_label_13_91' class='gfield_label gform-field-label gfield_label_before_complex' for='input_13_91_1'><span class='gform-field-label__text'><span class=\"gfield_label_product\">Book Shelf<\/span> <span class=\"screen-reader-text\">Quantity<\/span><\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_91.1' value='Book Shelf' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_13_91' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_13_91'>$10.00<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_91.2' id='ginput_base_price_13_91' class='gform_hidden' value='$10.00'\/>\n\t\t\t\t\t <label for='ginput_quantity_13_91_1' class='ginput_quantity_label gform-field-label' aria-hidden='true'>Quantity<\/label> <input type='number' name='input_91.3' value='' id='input_13_91_1' class='ginput_quantity' size='10' min='0'   aria-label=\"Quantity Book Shelf\" aria-describedby=\"ginput_product_price_13_91\" \/>\n\t\t\t\t<\/div><\/div><div id=\"field_13_90\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-full gfield_price gfield_price_13_90 gfield_product_13_90 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"4ad9cad9\" data-field-span=\"12\"><label id='gfield_label_13_90' class='gfield_label gform-field-label gfield_label_before_complex' for='input_13_90_1'><span class='gform-field-label__text'><span class=\"gfield_label_product\">Car tire with rim<\/span> <span class=\"screen-reader-text\">Quantity<\/span><\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_90.1' value='Car tire with rim' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_13_90' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_13_90'>$5.00<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_90.2' id='ginput_base_price_13_90' class='gform_hidden' value='$5.00'\/>\n\t\t\t\t\t <label for='ginput_quantity_13_90_1' class='ginput_quantity_label gform-field-label' aria-hidden='true'>Quantity<\/label> <input type='number' name='input_90.3' value='' id='input_13_90_1' class='ginput_quantity' size='10' min='0'   aria-label=\"Quantity Car tire with rim\" aria-describedby=\"ginput_product_price_13_90\" \/>\n\t\t\t\t<\/div><\/div><div id=\"field_13_89\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-full gfield_price gfield_price_13_89 gfield_product_13_89 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"cc92b1b6\" data-field-span=\"12\"><label id='gfield_label_13_89' class='gfield_label gform-field-label gfield_label_before_complex' for='input_13_89_1'><span class='gform-field-label__text'><span class=\"gfield_label_product\">Care tire without rim<\/span> <span class=\"screen-reader-text\">Quantity<\/span><\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_89.1' value='Care tire without rim' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_13_89' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_13_89'>$14.00<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_89.2' id='ginput_base_price_13_89' class='gform_hidden' value='$14.00'\/>\n\t\t\t\t\t <label for='ginput_quantity_13_89_1' class='ginput_quantity_label gform-field-label' aria-hidden='true'>Quantity<\/label> <input type='number' name='input_89.3' value='' id='input_13_89_1' class='ginput_quantity' size='10' min='0'   aria-label=\"Quantity Care tire without rim\" aria-describedby=\"ginput_product_price_13_89\" \/>\n\t\t\t\t<\/div><\/div><div id=\"field_13_88\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-full gfield_price gfield_price_13_88 gfield_product_13_88 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"25492837\" data-field-span=\"12\"><label id='gfield_label_13_88' class='gfield_label gform-field-label gfield_label_before_complex' for='input_13_88_1'><span class='gform-field-label__text'><span class=\"gfield_label_product\">Couch<\/span> <span class=\"screen-reader-text\">Quantity<\/span><\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_88.1' value='Couch' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_13_88' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_13_88'>$20.00<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_88.2' id='ginput_base_price_13_88' class='gform_hidden' value='$20.00'\/>\n\t\t\t\t\t <label for='ginput_quantity_13_88_1' class='ginput_quantity_label gform-field-label' aria-hidden='true'>Quantity<\/label> <input type='number' name='input_88.3' value='' id='input_13_88_1' class='ginput_quantity' size='10' min='0'   aria-label=\"Quantity Couch\" aria-describedby=\"ginput_product_price_13_88\" \/>\n\t\t\t\t<\/div><\/div><div id=\"field_13_87\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-full gfield_price gfield_price_13_87 gfield_product_13_87 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"63fb4922\" data-field-span=\"12\"><label id='gfield_label_13_87' class='gfield_label gform-field-label gfield_label_before_complex' for='input_13_87_1'><span class='gform-field-label__text'><span class=\"gfield_label_product\">Dining Chair<\/span> <span class=\"screen-reader-text\">Quantity<\/span><\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_87.1' value='Dining Chair' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_13_87' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_13_87'>$5.00<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_87.2' id='ginput_base_price_13_87' class='gform_hidden' value='$5.00'\/>\n\t\t\t\t\t <label for='ginput_quantity_13_87_1' class='ginput_quantity_label gform-field-label' aria-hidden='true'>Quantity<\/label> <input type='number' name='input_87.3' value='' id='input_13_87_1' class='ginput_quantity' size='10' min='0'   aria-label=\"Quantity Dining Chair\" aria-describedby=\"ginput_product_price_13_87\" \/>\n\t\t\t\t<\/div><\/div><div id=\"field_13_86\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-full gfield_price gfield_price_13_86 gfield_product_13_86 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"8ddf05d1\" data-field-span=\"12\"><label id='gfield_label_13_86' class='gfield_label gform-field-label gfield_label_before_complex' for='input_13_86_1'><span class='gform-field-label__text'><span class=\"gfield_label_product\">Dishwasher<\/span> <span class=\"screen-reader-text\">Quantity<\/span><\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_86.1' value='Dishwasher' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_13_86' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_13_86'>$15.00<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_86.2' id='ginput_base_price_13_86' class='gform_hidden' value='$15.00'\/>\n\t\t\t\t\t <label for='ginput_quantity_13_86_1' class='ginput_quantity_label gform-field-label' aria-hidden='true'>Quantity<\/label> <input type='number' name='input_86.3' value='' id='input_13_86_1' class='ginput_quantity' size='10' min='0'   aria-label=\"Quantity Dishwasher\" aria-describedby=\"ginput_product_price_13_86\" \/>\n\t\t\t\t<\/div><\/div><div id=\"field_13_93\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-full gfield_price gfield_price_13_93 gfield_product_13_93 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"58a70c6c\" data-field-span=\"12\"><label id='gfield_label_13_93' class='gfield_label gform-field-label gfield_label_before_complex' for='input_13_93_1'><span class='gform-field-label__text'><span class=\"gfield_label_product\">Dresser<\/span> <span class=\"screen-reader-text\">Quantity<\/span><\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_93.1' value='Dresser' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_13_93' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_13_93'>$10.00<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_93.2' id='ginput_base_price_13_93' class='gform_hidden' value='$10.00'\/>\n\t\t\t\t\t <label for='ginput_quantity_13_93_1' class='ginput_quantity_label gform-field-label' aria-hidden='true'>Quantity<\/label> <input type='number' name='input_93.3' value='' id='input_13_93_1' class='ginput_quantity' size='10' min='0'   aria-label=\"Quantity Dresser\" aria-describedby=\"ginput_product_price_13_93\" \/>\n\t\t\t\t<\/div><\/div><div id=\"field_13_104\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-full gfield_price gfield_price_13_104 gfield_product_13_104 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"b4d02c39\" data-field-span=\"12\"><label id='gfield_label_13_104' class='gfield_label gform-field-label gfield_label_before_complex' for='input_13_104_1'><span class='gform-field-label__text'><span class=\"gfield_label_product\">File cabinet<\/span> <span class=\"screen-reader-text\">Quantity<\/span><\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_104.1' value='File cabinet' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_13_104' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_13_104'>$10.00<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_104.2' id='ginput_base_price_13_104' class='gform_hidden' value='$10.00'\/>\n\t\t\t\t\t <label for='ginput_quantity_13_104_1' class='ginput_quantity_label gform-field-label' aria-hidden='true'>Quantity<\/label> <input type='number' name='input_104.3' value='' id='input_13_104_1' class='ginput_quantity' size='10' min='0'   aria-label=\"Quantity File cabinet\" aria-describedby=\"ginput_product_price_13_104\" \/>\n\t\t\t\t<\/div><\/div><div id=\"field_13_103\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-full gfield_price gfield_price_13_103 gfield_product_13_103 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"d6eb0b8f\" data-field-span=\"12\"><label id='gfield_label_13_103' class='gfield_label gform-field-label gfield_label_before_complex' for='input_13_103_1'><span class='gform-field-label__text'><span class=\"gfield_label_product\">Freezer (residential)<\/span> <span class=\"screen-reader-text\">Quantity<\/span><\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_103.1' value='Freezer (residential)' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_13_103' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_13_103'>$38.00<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_103.2' id='ginput_base_price_13_103' class='gform_hidden' value='$38.00'\/>\n\t\t\t\t\t <label for='ginput_quantity_13_103_1' class='ginput_quantity_label gform-field-label' aria-hidden='true'>Quantity<\/label> <input type='number' name='input_103.3' value='' id='input_13_103_1' class='ginput_quantity' size='10' min='0'   aria-label=\"Quantity Freezer (residential)\" aria-describedby=\"ginput_product_price_13_103\" \/>\n\t\t\t\t<\/div><\/div><div id=\"field_13_102\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-full gfield_price gfield_price_13_102 gfield_product_13_102 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"4597fc67\" data-field-span=\"12\"><label id='gfield_label_13_102' class='gfield_label gform-field-label gfield_label_before_complex' for='input_13_102_1'><span class='gform-field-label__text'><span class=\"gfield_label_product\">Hide-a-bed<\/span> <span class=\"screen-reader-text\">Quantity<\/span><\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_102.1' value='Hide-a-bed' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_13_102' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_13_102'>$25.00<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_102.2' id='ginput_base_price_13_102' class='gform_hidden' value='$25.00'\/>\n\t\t\t\t\t <label for='ginput_quantity_13_102_1' class='ginput_quantity_label gform-field-label' aria-hidden='true'>Quantity<\/label> <input type='number' name='input_102.3' value='' id='input_13_102_1' class='ginput_quantity' size='10' min='0'   aria-label=\"Quantity Hide-a-bed\" aria-describedby=\"ginput_product_price_13_102\" \/>\n\t\t\t\t<\/div><\/div><div id=\"field_13_101\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-full gfield_price gfield_price_13_101 gfield_product_13_101 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"94cac772\" data-field-span=\"12\"><label id='gfield_label_13_101' class='gfield_label gform-field-label gfield_label_before_complex' for='input_13_101_1'><span class='gform-field-label__text'><span class=\"gfield_label_product\">Hot tub cover<\/span> <span class=\"screen-reader-text\">Quantity<\/span><\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_101.1' value='Hot tub cover' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_13_101' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_13_101'>$20.00<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_101.2' id='ginput_base_price_13_101' class='gform_hidden' value='$20.00'\/>\n\t\t\t\t\t <label for='ginput_quantity_13_101_1' class='ginput_quantity_label gform-field-label' aria-hidden='true'>Quantity<\/label> <input type='number' name='input_101.3' value='' id='input_13_101_1' class='ginput_quantity' size='10' min='0'   aria-label=\"Quantity Hot tub cover\" aria-describedby=\"ginput_product_price_13_101\" \/>\n\t\t\t\t<\/div><\/div><div id=\"field_13_100\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-full gfield_price gfield_price_13_100 gfield_product_13_100 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"4e2f5415\" data-field-span=\"12\"><label id='gfield_label_13_100' class='gfield_label gform-field-label gfield_label_before_complex' for='input_13_100_1'><span class='gform-field-label__text'><span class=\"gfield_label_product\">Junk pile (quote will be provided by refuse)<\/span> <span class=\"screen-reader-text\">Quantity<\/span><\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_100.1' value='Junk pile (quote will be provided by refuse)' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_13_100' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_13_100'>$25.00<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_100.2' id='ginput_base_price_13_100' class='gform_hidden' value='$25.00'\/>\n\t\t\t\t\t <label for='ginput_quantity_13_100_1' class='ginput_quantity_label gform-field-label' aria-hidden='true'>Quantity<\/label> <input type='number' name='input_100.3' value='' id='input_13_100_1' class='ginput_quantity' size='10' min='0'   aria-label=\"Quantity Junk pile (quote will be provided by refuse)\" aria-describedby=\"ginput_product_price_13_100\" \/>\n\t\t\t\t<\/div><\/div><div id=\"field_13_99\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-full gfield_price gfield_price_13_99 gfield_product_13_99 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"640ac067\" data-field-span=\"12\"><label id='gfield_label_13_99' class='gfield_label gform-field-label gfield_label_before_complex' for='input_13_99_1'><span class='gform-field-label__text'><span class=\"gfield_label_product\">Lawn mower (fluids removed)<\/span> <span class=\"screen-reader-text\">Quantity<\/span><\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_99.1' value='Lawn mower (fluids removed)' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_13_99' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_13_99'>$25.00<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_99.2' id='ginput_base_price_13_99' class='gform_hidden' value='$25.00'\/>\n\t\t\t\t\t <label for='ginput_quantity_13_99_1' class='ginput_quantity_label gform-field-label' aria-hidden='true'>Quantity<\/label> <input type='number' name='input_99.3' value='' id='input_13_99_1' class='ginput_quantity' size='10' min='0'   aria-label=\"Quantity Lawn mower (fluids removed)\" aria-describedby=\"ginput_product_price_13_99\" \/>\n\t\t\t\t<\/div><\/div><div id=\"field_13_98\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-full gfield_price gfield_price_13_98 gfield_product_13_98 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"7a261ad6\" data-field-span=\"12\"><label id='gfield_label_13_98' class='gfield_label gform-field-label gfield_label_before_complex' for='input_13_98_1'><span class='gform-field-label__text'><span class=\"gfield_label_product\">Mattress\/Box spring<\/span> <span class=\"screen-reader-text\">Quantity<\/span><\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_98.1' value='Mattress\/Box spring' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_13_98' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_13_98'>$10.00<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_98.2' id='ginput_base_price_13_98' class='gform_hidden' value='$10.00'\/>\n\t\t\t\t\t <label for='ginput_quantity_13_98_1' class='ginput_quantity_label gform-field-label' aria-hidden='true'>Quantity<\/label> <input type='number' name='input_98.3' value='' id='input_13_98_1' class='ginput_quantity' size='10' min='0'   aria-label=\"Quantity Mattress\/Box spring\" aria-describedby=\"ginput_product_price_13_98\" \/>\n\t\t\t\t<\/div><\/div><div id=\"field_13_97\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-full gfield_price gfield_price_13_97 gfield_product_13_97 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"274174bc\" data-field-span=\"12\"><label id='gfield_label_13_97' class='gfield_label gform-field-label gfield_label_before_complex' for='input_13_97_1'><span class='gform-field-label__text'><span class=\"gfield_label_product\">Microwave<\/span> <span class=\"screen-reader-text\">Quantity<\/span><\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_97.1' value='Microwave' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_13_97' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_13_97'>$5.00<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_97.2' id='ginput_base_price_13_97' class='gform_hidden' value='$5.00'\/>\n\t\t\t\t\t <label for='ginput_quantity_13_97_1' class='ginput_quantity_label gform-field-label' aria-hidden='true'>Quantity<\/label> <input type='number' name='input_97.3' value='' id='input_13_97_1' class='ginput_quantity' size='10' min='0'   aria-label=\"Quantity Microwave\" aria-describedby=\"ginput_product_price_13_97\" \/>\n\t\t\t\t<\/div><\/div><div id=\"field_13_96\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-full gfield_price gfield_price_13_96 gfield_product_13_96 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"80b3c432\" data-field-span=\"12\"><label id='gfield_label_13_96' class='gfield_label gform-field-label gfield_label_before_complex' for='input_13_96_1'><span class='gform-field-label__text'><span class=\"gfield_label_product\">Office Chair<\/span> <span class=\"screen-reader-text\">Quantity<\/span><\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_96.1' value='Office Chair' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_13_96' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_13_96'>$10.00<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_96.2' id='ginput_base_price_13_96' class='gform_hidden' value='$10.00'\/>\n\t\t\t\t\t <label for='ginput_quantity_13_96_1' class='ginput_quantity_label gform-field-label' aria-hidden='true'>Quantity<\/label> <input type='number' name='input_96.3' value='' id='input_13_96_1' class='ginput_quantity' size='10' min='0'   aria-label=\"Quantity Office Chair\" aria-describedby=\"ginput_product_price_13_96\" \/>\n\t\t\t\t<\/div><\/div><div id=\"field_13_95\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-full gfield_price gfield_price_13_95 gfield_product_13_95 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"a054df72\" data-field-span=\"12\"><label id='gfield_label_13_95' class='gfield_label gform-field-label gfield_label_before_complex' for='input_13_95_1'><span class='gform-field-label__text'><span class=\"gfield_label_product\">Pallets (each)<\/span> <span class=\"screen-reader-text\">Quantity<\/span><\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_95.1' value='Pallets (each)' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_13_95' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_13_95'>$5.00<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_95.2' id='ginput_base_price_13_95' class='gform_hidden' value='$5.00'\/>\n\t\t\t\t\t <label for='ginput_quantity_13_95_1' class='ginput_quantity_label gform-field-label' aria-hidden='true'>Quantity<\/label> <input type='number' name='input_95.3' value='' id='input_13_95_1' class='ginput_quantity' size='10' min='0'   aria-label=\"Quantity Pallets (each)\" aria-describedby=\"ginput_product_price_13_95\" \/>\n\t\t\t\t<\/div><\/div><div id=\"field_13_94\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-full gfield_price gfield_price_13_94 gfield_product_13_94 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"851985b4\" data-field-span=\"12\"><label id='gfield_label_13_94' class='gfield_label gform-field-label gfield_label_before_complex' for='input_13_94_1'><span class='gform-field-label__text'><span class=\"gfield_label_product\">Play pen\/crib<\/span> <span class=\"screen-reader-text\">Quantity<\/span><\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_94.1' value='Play pen\/crib' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_13_94' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_13_94'>$5.00<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_94.2' id='ginput_base_price_13_94' class='gform_hidden' value='$5.00'\/>\n\t\t\t\t\t <label for='ginput_quantity_13_94_1' class='ginput_quantity_label gform-field-label' aria-hidden='true'>Quantity<\/label> <input type='number' name='input_94.3' value='' id='input_13_94_1' class='ginput_quantity' size='10' min='0'   aria-label=\"Quantity Play pen\/crib\" aria-describedby=\"ginput_product_price_13_94\" \/>\n\t\t\t\t<\/div><\/div><div id=\"field_13_105\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-full gfield_price gfield_price_13_105 gfield_product_13_105 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"d2e55ac7\" data-field-span=\"12\"><label id='gfield_label_13_105' class='gfield_label gform-field-label gfield_label_before_complex' for='input_13_105_1'><span class='gform-field-label__text'><span class=\"gfield_label_product\">Recliner (or similar size)<\/span> <span class=\"screen-reader-text\">Quantity<\/span><\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_105.1' value='Recliner (or similar size)' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_13_105' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_13_105'>$15.00<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_105.2' id='ginput_base_price_13_105' class='gform_hidden' value='$15.00'\/>\n\t\t\t\t\t <label for='ginput_quantity_13_105_1' class='ginput_quantity_label gform-field-label' aria-hidden='true'>Quantity<\/label> <input type='number' name='input_105.3' value='' id='input_13_105_1' class='ginput_quantity' size='10' min='0'   aria-label=\"Quantity Recliner (or similar size)\" aria-describedby=\"ginput_product_price_13_105\" \/>\n\t\t\t\t<\/div><\/div><div id=\"field_13_109\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-full gfield_price gfield_price_13_109 gfield_product_13_109 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"ee205509\" data-field-span=\"12\"><label id='gfield_label_13_109' class='gfield_label gform-field-label gfield_label_before_complex' for='input_13_109_1'><span class='gform-field-label__text'><span class=\"gfield_label_product\">Refrigerator (residential)<\/span> <span class=\"screen-reader-text\">Quantity<\/span><\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_109.1' value='Refrigerator (residential)' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_13_109' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_13_109'>$38.00<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_109.2' id='ginput_base_price_13_109' class='gform_hidden' value='$38.00'\/>\n\t\t\t\t\t <label for='ginput_quantity_13_109_1' class='ginput_quantity_label gform-field-label' aria-hidden='true'>Quantity<\/label> <input type='number' name='input_109.3' value='' id='input_13_109_1' class='ginput_quantity' size='10' min='0'   aria-label=\"Quantity Refrigerator (residential)\" aria-describedby=\"ginput_product_price_13_109\" \/>\n\t\t\t\t<\/div><\/div><div id=\"field_13_108\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-full gfield_price gfield_price_13_108 gfield_product_13_108 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"47de5e57\" data-field-span=\"12\"><label id='gfield_label_13_108' class='gfield_label gform-field-label gfield_label_before_complex' for='input_13_108_1'><span class='gform-field-label__text'><span class=\"gfield_label_product\">Sectional (per piece)<\/span> <span class=\"screen-reader-text\">Quantity<\/span><\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_108.1' value='Sectional (per piece)' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_13_108' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_13_108'>$20.00<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_108.2' id='ginput_base_price_13_108' class='gform_hidden' value='$20.00'\/>\n\t\t\t\t\t <label for='ginput_quantity_13_108_1' class='ginput_quantity_label gform-field-label' aria-hidden='true'>Quantity<\/label> <input type='number' name='input_108.3' value='' id='input_13_108_1' class='ginput_quantity' size='10' min='0'   aria-label=\"Quantity Sectional (per piece)\" aria-describedby=\"ginput_product_price_13_108\" \/>\n\t\t\t\t<\/div><\/div><div id=\"field_13_107\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-full gfield_price gfield_price_13_107 gfield_product_13_107 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"38c98bfd\" data-field-span=\"12\"><label id='gfield_label_13_107' class='gfield_label gform-field-label gfield_label_before_complex' for='input_13_107_1'><span class='gform-field-label__text'><span class=\"gfield_label_product\">Shower door (set)<\/span> <span class=\"screen-reader-text\">Quantity<\/span><\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_107.1' value='Shower door (set)' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_13_107' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_13_107'>$10.00<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_107.2' id='ginput_base_price_13_107' class='gform_hidden' value='$10.00'\/>\n\t\t\t\t\t <label for='ginput_quantity_13_107_1' class='ginput_quantity_label gform-field-label' aria-hidden='true'>Quantity<\/label> <input type='number' name='input_107.3' value='' id='input_13_107_1' class='ginput_quantity' size='10' min='0'   aria-label=\"Quantity Shower door (set)\" aria-describedby=\"ginput_product_price_13_107\" \/>\n\t\t\t\t<\/div><\/div><div id=\"field_13_106\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-full gfield_price gfield_price_13_106 gfield_product_13_106 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"6dd91ebd\" data-field-span=\"12\"><label id='gfield_label_13_106' class='gfield_label gform-field-label gfield_label_before_complex' for='input_13_106_1'><span class='gform-field-label__text'><span class=\"gfield_label_product\">Stove<\/span> <span class=\"screen-reader-text\">Quantity<\/span><\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_106.1' value='Stove' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_13_106' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_13_106'>$15.00<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_106.2' id='ginput_base_price_13_106' class='gform_hidden' value='$15.00'\/>\n\t\t\t\t\t <label for='ginput_quantity_13_106_1' class='ginput_quantity_label gform-field-label' aria-hidden='true'>Quantity<\/label> <input type='number' name='input_106.3' value='' id='input_13_106_1' class='ginput_quantity' size='10' min='0'   aria-label=\"Quantity Stove\" aria-describedby=\"ginput_product_price_13_106\" \/>\n\t\t\t\t<\/div><\/div><div id=\"field_13_116\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-full gfield_price gfield_price_13_116 gfield_product_13_116 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"9efe21f3\" data-field-span=\"12\"><label id='gfield_label_13_116' class='gfield_label gform-field-label gfield_label_before_complex' for='input_13_116_1'><span class='gform-field-label__text'><span class=\"gfield_label_product\">Table (under 5 ft)<\/span> <span class=\"screen-reader-text\">Quantity<\/span><\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_116.1' value='Table (under 5 ft)' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_13_116' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_13_116'>$10.00<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_116.2' id='ginput_base_price_13_116' class='gform_hidden' value='$10.00'\/>\n\t\t\t\t\t <label for='ginput_quantity_13_116_1' class='ginput_quantity_label gform-field-label' aria-hidden='true'>Quantity<\/label> <input type='number' name='input_116.3' value='' id='input_13_116_1' class='ginput_quantity' size='10' min='0'   aria-label=\"Quantity Table (under 5 ft)\" aria-describedby=\"ginput_product_price_13_116\" \/>\n\t\t\t\t<\/div><\/div><div id=\"field_13_115\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-full gfield_price gfield_price_13_115 gfield_product_13_115 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"fb631a1a\" data-field-span=\"12\"><label id='gfield_label_13_115' class='gfield_label gform-field-label gfield_label_before_complex' for='input_13_115_1'><span class='gform-field-label__text'><span class=\"gfield_label_product\">Table (over 5 ft)<\/span> <span class=\"screen-reader-text\">Quantity<\/span><\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_115.1' value='Table (over 5 ft)' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_13_115' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_13_115'>$15.00<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_115.2' id='ginput_base_price_13_115' class='gform_hidden' value='$15.00'\/>\n\t\t\t\t\t <label for='ginput_quantity_13_115_1' class='ginput_quantity_label gform-field-label' aria-hidden='true'>Quantity<\/label> <input type='number' name='input_115.3' value='' id='input_13_115_1' class='ginput_quantity' size='10' min='0'   aria-label=\"Quantity Table (over 5 ft)\" aria-describedby=\"ginput_product_price_13_115\" \/>\n\t\t\t\t<\/div><\/div><div id=\"field_13_114\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-full gfield_price gfield_price_13_114 gfield_product_13_114 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"c04206cd\" data-field-span=\"12\"><label id='gfield_label_13_114' class='gfield_label gform-field-label gfield_label_before_complex' for='input_13_114_1'><span class='gform-field-label__text'><span class=\"gfield_label_product\">Toilet<\/span> <span class=\"screen-reader-text\">Quantity<\/span><\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_114.1' value='Toilet' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_13_114' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_13_114'>$10.00<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_114.2' id='ginput_base_price_13_114' class='gform_hidden' value='$10.00'\/>\n\t\t\t\t\t <label for='ginput_quantity_13_114_1' class='ginput_quantity_label gform-field-label' aria-hidden='true'>Quantity<\/label> <input type='number' name='input_114.3' value='' id='input_13_114_1' class='ginput_quantity' size='10' min='0'   aria-label=\"Quantity Toilet\" aria-describedby=\"ginput_product_price_13_114\" \/>\n\t\t\t\t<\/div><\/div><div id=\"field_13_113\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-full gfield_price gfield_price_13_113 gfield_product_13_113 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"5381f612\" data-field-span=\"12\"><label id='gfield_label_13_113' class='gfield_label gform-field-label gfield_label_before_complex' for='input_13_113_1'><span class='gform-field-label__text'><span class=\"gfield_label_product\">Truck tire (with rim)<\/span> <span class=\"screen-reader-text\">Quantity<\/span><\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_113.1' value='Truck tire (with rim)' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_13_113' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_13_113'>$11.00<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_113.2' id='ginput_base_price_13_113' class='gform_hidden' value='$11.00'\/>\n\t\t\t\t\t <label for='ginput_quantity_13_113_1' class='ginput_quantity_label gform-field-label' aria-hidden='true'>Quantity<\/label> <input type='number' name='input_113.3' value='' id='input_13_113_1' class='ginput_quantity' size='10' min='0'   aria-label=\"Quantity Truck tire (with rim)\" aria-describedby=\"ginput_product_price_13_113\" \/>\n\t\t\t\t<\/div><\/div><div id=\"field_13_112\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-full gfield_price gfield_price_13_112 gfield_product_13_112 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"bbbea042\" data-field-span=\"12\"><label id='gfield_label_13_112' class='gfield_label gform-field-label gfield_label_before_complex' for='input_13_112_1'><span class='gform-field-label__text'><span class=\"gfield_label_product\">Truck tire (without rim)<\/span> <span class=\"screen-reader-text\">Quantity<\/span><\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_112.1' value='Truck tire (without rim)' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_13_112' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_13_112'>$6.00<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_112.2' id='ginput_base_price_13_112' class='gform_hidden' value='$6.00'\/>\n\t\t\t\t\t <label for='ginput_quantity_13_112_1' class='ginput_quantity_label gform-field-label' aria-hidden='true'>Quantity<\/label> <input type='number' name='input_112.3' value='' id='input_13_112_1' class='ginput_quantity' size='10' min='0'   aria-label=\"Quantity Truck tire (without rim)\" aria-describedby=\"ginput_product_price_13_112\" \/>\n\t\t\t\t<\/div><\/div><div id=\"field_13_111\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-full gfield_price gfield_price_13_111 gfield_product_13_111 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"0f4455f4\" data-field-span=\"12\"><label id='gfield_label_13_111' class='gfield_label gform-field-label gfield_label_before_complex' for='input_13_111_1'><span class='gform-field-label__text'><span class=\"gfield_label_product\">Vacuum<\/span> <span class=\"screen-reader-text\">Quantity<\/span><\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_111.1' value='Vacuum' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_13_111' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_13_111'>$5.00<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_111.2' id='ginput_base_price_13_111' class='gform_hidden' value='$5.00'\/>\n\t\t\t\t\t <label for='ginput_quantity_13_111_1' class='ginput_quantity_label gform-field-label' aria-hidden='true'>Quantity<\/label> <input type='number' name='input_111.3' value='' id='input_13_111_1' class='ginput_quantity' size='10' min='0'   aria-label=\"Quantity Vacuum\" aria-describedby=\"ginput_product_price_13_111\" \/>\n\t\t\t\t<\/div><\/div><div id=\"field_13_110\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-full gfield_price gfield_price_13_110 gfield_product_13_110 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"119759d5\" data-field-span=\"12\"><label id='gfield_label_13_110' class='gfield_label gform-field-label gfield_label_before_complex' for='input_13_110_1'><span class='gform-field-label__text'><span class=\"gfield_label_product\">Washer\/Dryer (per piece)<\/span> <span class=\"screen-reader-text\">Quantity<\/span><\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_110.1' value='Washer\/Dryer (per piece)' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_13_110' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_13_110'>$15.00<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_110.2' id='ginput_base_price_13_110' class='gform_hidden' value='$15.00'\/>\n\t\t\t\t\t <label for='ginput_quantity_13_110_1' class='ginput_quantity_label gform-field-label' aria-hidden='true'>Quantity<\/label> <input type='number' name='input_110.3' value='' id='input_13_110_1' class='ginput_quantity' size='10' min='0'   aria-label=\"Quantity Washer\/Dryer (per piece)\" aria-describedby=\"ginput_product_price_13_110\" \/>\n\t\t\t\t<\/div><\/div><div id=\"field_13_118\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-full gfield_price gfield_price_13_118 gfield_product_13_118 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"fad5eb44\" data-field-span=\"12\"><label id='gfield_label_13_118' class='gfield_label gform-field-label gfield_label_before_complex' for='input_13_118_1'><span class='gform-field-label__text'><span class=\"gfield_label_product\">Water heater (drained)<\/span> <span class=\"screen-reader-text\">Quantity<\/span><\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_118.1' value='Water heater (drained)' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_13_118' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_13_118'>$15.00<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_118.2' id='ginput_base_price_13_118' class='gform_hidden' value='$15.00'\/>\n\t\t\t\t\t <label for='ginput_quantity_13_118_1' class='ginput_quantity_label gform-field-label' aria-hidden='true'>Quantity<\/label> <input type='number' name='input_118.3' value='' id='input_13_118_1' class='ginput_quantity' size='10' min='0'   aria-label=\"Quantity Water heater (drained)\" aria-describedby=\"ginput_product_price_13_118\" \/>\n\t\t\t\t<\/div><\/div><div id=\"field_13_117\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-full gfield_price gfield_price_13_117 gfield_product_13_117 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"6c965446\" data-field-span=\"12\"><label id='gfield_label_13_117' class='gfield_label gform-field-label gfield_label_before_complex' for='input_13_117_1'><span class='gform-field-label__text'><span class=\"gfield_label_product\">Other (quote will be provided by refuse dept)<\/span> <span class=\"screen-reader-text\">Quantity<\/span><\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_117.1' value='Other (quote will be provided by refuse dept)' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_13_117' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_13_117'>$25.00<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_117.2' id='ginput_base_price_13_117' class='gform_hidden' value='$25.00'\/>\n\t\t\t\t\t <label for='ginput_quantity_13_117_1' class='ginput_quantity_label gform-field-label' aria-hidden='true'>Quantity<\/label> <input type='number' name='input_117.3' value='' id='input_13_117_1' class='ginput_quantity' size='10' min='0'   aria-label=\"Quantity Other (quote will be provided by refuse dept)\" aria-describedby=\"ginput_product_price_13_117\" \/>\n\t\t\t\t<\/div><\/div><div id=\"field_13_80\" class=\"gfield gfield--type-total gfield--input-type-total gfield--width-third gfield_price gfield_price_13_ gfield_total gfield_total_13_ field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" aria-atomic=\"true\" aria-live=\"polite\" data-group-id=\"11e81a7d\" data-field-span=\"4\" data-currency-format='1'><label id='gfield_label_13_80' class='gfield_label gform-field-label' for='input_13_80'><span class='gform-field-label__text'>Total<\/span><\/label><div class='ginput_container ginput_container_total'>\n\t\t\t\t\t\t\t<input type='text' readonly name='input_80' id='input_13_80' value='$0.00' class='gform-text-input-reset ginput_total ginput_total_13'  \/>\n\t\t\t\t\t\t<\/div><\/div><div data-field-id=\"80\" class=\"spacer gfield\" style=\"grid-column: span 8;\" data-group-id=\"11e81a7d\"><\/div><fieldset id=\"field_13_69\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-five-twelfths field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_hidden gfield--choice-align-vertical\" data-group-id=\"6fe869fd\" data-field-span=\"5\"><legend id='gfield_label_13_69' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Special Haul Items<\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_13_69'><div class='gchoice gchoice_13_69_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.1' type='checkbox'  value='Air Conditioner (portable) - $38.00'  id='choice_13_69_1'   aria-describedby=\"gfield_description_13_69\" aria-labelledby=\"label_13_69_1 gfield_label_13_69\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_1' id='label_13_69_1' class='gform-field-label gform-field-label--type-inline'>Air Conditioner (portable) &#8211; $38.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.2' type='checkbox'  value='Accent Chair - $10.00'  id='choice_13_69_2'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_2' id='label_13_69_2' class='gform-field-label gform-field-label--type-inline'>Accent Chair &#8211; $10.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.3' type='checkbox'  value='BBQ (no tank) - $15.00'  id='choice_13_69_3'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_3' id='label_13_69_3' class='gform-field-label gform-field-label--type-inline'>BBQ (no tank) &#8211; $15.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.4' type='checkbox'  value='Bicycle - $10.00'  id='choice_13_69_4'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_4' id='label_13_69_4' class='gform-field-label gform-field-label--type-inline'>Bicycle &#8211; $10.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.5' type='checkbox'  value='Book Shelf - $10.00'  id='choice_13_69_5'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_5' id='label_13_69_5' class='gform-field-label gform-field-label--type-inline'>Book Shelf &#8211; $10.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.6' type='checkbox'  value='Car Tire with rim - $5.00'  id='choice_13_69_6'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_6' id='label_13_69_6' class='gform-field-label gform-field-label--type-inline'>Car Tire with rim &#8211; $5.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.7' type='checkbox'  value='Car Tire without rim - $4.00'  id='choice_13_69_7'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_7' id='label_13_69_7' class='gform-field-label gform-field-label--type-inline'>Car Tire without rim &#8211; $4.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.8' type='checkbox'  value='Couch - $20.00'  id='choice_13_69_8'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_8' id='label_13_69_8' class='gform-field-label gform-field-label--type-inline'>Couch &#8211; $20.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.9' type='checkbox'  value='Dining Chair - $5.00'  id='choice_13_69_9'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_9' id='label_13_69_9' class='gform-field-label gform-field-label--type-inline'>Dining Chair &#8211; $5.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.11' type='checkbox'  value='Dishwasher - $15.00'  id='choice_13_69_11'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_11' id='label_13_69_11' class='gform-field-label gform-field-label--type-inline'>Dishwasher &#8211; $15.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.12' type='checkbox'  value='Dresser - $10.00'  id='choice_13_69_12'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_12' id='label_13_69_12' class='gform-field-label gform-field-label--type-inline'>Dresser &#8211; $10.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.13' type='checkbox'  value='File Cabinet - $10.00'  id='choice_13_69_13'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_13' id='label_13_69_13' class='gform-field-label gform-field-label--type-inline'>File Cabinet &#8211; $10.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.14' type='checkbox'  value='Freezer (residential) - $38.00'  id='choice_13_69_14'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_14' id='label_13_69_14' class='gform-field-label gform-field-label--type-inline'>Freezer (residential) &#8211; $38.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.15' type='checkbox'  value='Hide-a-bed - $25.00'  id='choice_13_69_15'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_15' id='label_13_69_15' class='gform-field-label gform-field-label--type-inline'>Hide-a-bed &#8211; $25.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_16'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.16' type='checkbox'  value='Hot Tub Cover - $20.00'  id='choice_13_69_16'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_16' id='label_13_69_16' class='gform-field-label gform-field-label--type-inline'>Hot Tub Cover &#8211; $20.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_17'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.17' type='checkbox'  value='Junk Pile (quote will be provided by refuse dept)'  id='choice_13_69_17'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_17' id='label_13_69_17' class='gform-field-label gform-field-label--type-inline'>Junk Pile (quote will be provided by refuse dept)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_18'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.18' type='checkbox'  value='Lawn Mower (fluids removed) - $25.00'  id='choice_13_69_18'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_18' id='label_13_69_18' class='gform-field-label gform-field-label--type-inline'>Lawn Mower (fluids removed) &#8211; $25.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_19'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.19' type='checkbox'  value='Mattress\/Box Spring - $10.00'  id='choice_13_69_19'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_19' id='label_13_69_19' class='gform-field-label gform-field-label--type-inline'>Mattress\/Box Spring &#8211; $10.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_21'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.21' type='checkbox'  value='Microwave - $5.00'  id='choice_13_69_21'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_21' id='label_13_69_21' class='gform-field-label gform-field-label--type-inline'>Microwave &#8211; $5.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_22'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.22' type='checkbox'  value='Office Chair - $10.00'  id='choice_13_69_22'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_22' id='label_13_69_22' class='gform-field-label gform-field-label--type-inline'>Office Chair &#8211; $10.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_23'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.23' type='checkbox'  value='Pallets (each) - $5.00'  id='choice_13_69_23'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_23' id='label_13_69_23' class='gform-field-label gform-field-label--type-inline'>Pallets (each) &#8211; $5.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_24'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.24' type='checkbox'  value='Play Pen\/Crib - $5.00'  id='choice_13_69_24'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_24' id='label_13_69_24' class='gform-field-label gform-field-label--type-inline'>Play Pen\/Crib &#8211; $5.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_25'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.25' type='checkbox'  value='Recliner (or similar size) - $15.00'  id='choice_13_69_25'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_25' id='label_13_69_25' class='gform-field-label gform-field-label--type-inline'>Recliner (or similar size) &#8211; $15.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_26'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.26' type='checkbox'  value='Refrigerator (residential) - $38.00'  id='choice_13_69_26'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_26' id='label_13_69_26' class='gform-field-label gform-field-label--type-inline'>Refrigerator (residential) &#8211; $38.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_27'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.27' type='checkbox'  value='Sectional (per piece) - $20.00'  id='choice_13_69_27'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_27' id='label_13_69_27' class='gform-field-label gform-field-label--type-inline'>Sectional (per piece) &#8211; $20.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_28'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.28' type='checkbox'  value='Shower Door (set) - $10.00'  id='choice_13_69_28'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_28' id='label_13_69_28' class='gform-field-label gform-field-label--type-inline'>Shower Door (set) &#8211; $10.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_29'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.29' type='checkbox'  value='Stove - $15.00'  id='choice_13_69_29'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_29' id='label_13_69_29' class='gform-field-label gform-field-label--type-inline'>Stove &#8211; $15.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_31'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.31' type='checkbox'  value='Table (under 5ft) - $10.00'  id='choice_13_69_31'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_31' id='label_13_69_31' class='gform-field-label gform-field-label--type-inline'>Table (under 5ft) &#8211; $10.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_32'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.32' type='checkbox'  value='Table (over 5ft) - $15.00'  id='choice_13_69_32'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_32' id='label_13_69_32' class='gform-field-label gform-field-label--type-inline'>Table (over 5ft) &#8211; $15.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_33'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.33' type='checkbox'  value='Toilet - $10.00'  id='choice_13_69_33'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_33' id='label_13_69_33' class='gform-field-label gform-field-label--type-inline'>Toilet &#8211; $10.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_34'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.34' type='checkbox'  value='Truck tire (with rim) - $11.00'  id='choice_13_69_34'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_34' id='label_13_69_34' class='gform-field-label gform-field-label--type-inline'>Truck tire (with rim) &#8211; $11.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_35'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.35' type='checkbox'  value='Truck tire (without rim) - $6.00'  id='choice_13_69_35'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_35' id='label_13_69_35' class='gform-field-label gform-field-label--type-inline'>Truck tire (without rim) &#8211; $6.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_36'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.36' type='checkbox'  value='Vacuum - $5.00'  id='choice_13_69_36'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_36' id='label_13_69_36' class='gform-field-label gform-field-label--type-inline'>Vacuum &#8211; $5.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_37'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.37' type='checkbox'  value='Washer\/Dryer (per piece) - $15.00'  id='choice_13_69_37'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_37' id='label_13_69_37' class='gform-field-label gform-field-label--type-inline'>Washer\/Dryer (per piece) &#8211; $15.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_38'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.38' type='checkbox'  value='Water Heater (drained) - $15.00'  id='choice_13_69_38'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_38' id='label_13_69_38' class='gform-field-label gform-field-label--type-inline'>Water Heater (drained) &#8211; $15.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_39'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.39' type='checkbox'  value='Other (quote will be provided by refuse dept.)'  id='choice_13_69_39'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_39' id='label_13_69_39' class='gform-field-label gform-field-label--type-inline'>Other (quote will be provided by refuse dept.)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_13_69'>Select all that apply. HAZARDOUS MATERIALS NOT ALLOWED: Batteries of any kind, Propane tanks, Oxygen tanks, Paint cans, or Liquids that can easily catch fire or emit flammable vapors (gasoline, diesel fuel, ethanol). For more info, visit: https:\/\/www.yakimawa.gov\/services\/refuse\/ or call 509-575-6005.<\/div><\/fieldset><div data-field-id=\"69\" class=\"spacer gfield\" style=\"grid-column: span 7;\" data-group-id=\"6fe869fd\"><\/div><div id=\"field_13_70\" class=\"gfield gfield--type-post_image gfield--input-type-post_image gfield--width-five-twelfths field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"7e9a1675\" data-field-span=\"5\"><label id='gfield_label_13_70' class='gfield_label gform-field-label' for='input_13_70'><span class='gform-field-label__text'>Photo of Item\/s<\/span><\/label><div class='ginput_complex ginput_container ginput_container_post_image gform-grid-row'><span class='ginput_full gform-grid-col'><input name='input_70' id='input_13_70' type='file' class='large'   aria-invalid=\"false\" aria-describedby=\"gfield_upload_rules_13_70 gfield_description_13_70\" \/><span id='gfield_upload_rules_13_70' class='gfield_description gform_fileupload_rules'>Accepted file types: jpg, jpeg, png, gif.<\/span><\/span><\/div><div class='gfield_description' id='gfield_description_13_70'>Please upload a photo of the item or items you are requesting a special haul quote for. Please be sure to limit the file size so you can submit the form. <\/div><\/div><div data-field-id=\"70\" class=\"spacer gfield\" style=\"grid-column: span 7;\" data-group-id=\"7e9a1675\"><\/div><div id=\"field_13_72\" class=\"gfield gfield--type-post_image gfield--input-type-post_image gfield--width-five-twelfths field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"cb1449aa\" data-field-span=\"5\"><label id='gfield_label_13_72' class='gfield_label gform-field-label' for='input_13_72'><span class='gform-field-label__text'>Photo of Item\/s<\/span><\/label><div class='ginput_complex ginput_container ginput_container_post_image gform-grid-row'><span class='ginput_full gform-grid-col'><input name='input_72' id='input_13_72' type='file' class='large'   aria-invalid=\"false\" aria-describedby=\"gfield_upload_rules_13_72 gfield_description_13_72\" \/><span id='gfield_upload_rules_13_72' class='gfield_description gform_fileupload_rules'>Accepted file types: jpg, jpeg, png, gif.<\/span><\/span><\/div><div class='gfield_description' id='gfield_description_13_72'>Please upload a photo of the item or items you are requesting a special haul quote for. Please be sure to limit the file size so you can submit the form. <\/div><\/div><div data-field-id=\"72\" class=\"spacer gfield\" style=\"grid-column: span 7;\" data-group-id=\"cb1449aa\"><\/div><div id=\"field_13_71\" class=\"gfield gfield--type-post_image gfield--input-type-post_image gfield--width-five-twelfths field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"fa567232\" data-field-span=\"5\"><label id='gfield_label_13_71' class='gfield_label gform-field-label' for='input_13_71'><span class='gform-field-label__text'>Photo of Item\/s<\/span><\/label><div class='ginput_complex ginput_container ginput_container_post_image gform-grid-row'><span class='ginput_full gform-grid-col'><input name='input_71' id='input_13_71' type='file' class='large'   aria-invalid=\"false\" aria-describedby=\"gfield_upload_rules_13_71 gfield_description_13_71\" \/><span id='gfield_upload_rules_13_71' class='gfield_description gform_fileupload_rules'>Accepted file types: jpg, jpeg, png, gif.<\/span><\/span><\/div><div class='gfield_description' id='gfield_description_13_71'>Please upload a photo of the item or items you are requesting a special haul quote for. Please be sure to limit the file size so you can submit the form. <\/div><\/div><div data-field-id=\"71\" class=\"spacer gfield\" style=\"grid-column: span 7;\" data-group-id=\"fa567232\"><\/div><div id=\"field_13_68\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"7e56de66\" data-field-span=\"12\"><label id='gfield_label_13_68' class='gfield_label gform-field-label' for='input_13_68'><span class='gform-field-label__text'>Comments:<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_68' id='input_13_68' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_13_20\" class=\"gfield gfield--type-signature gfield--input-type-signature gfield--width-three-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"00e8b7f1\" data-field-span=\"9\"><legend id='gfield_label_13_20' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Signature<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class=\"ginput_container ginput_container_signature\"><input type='hidden' value='' name='input_20' id='input_13_20_signature_filename' class='gfield_signature_filename'\/><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_13_20_Container' class='gfield_signature_container' style='height:90px; width:300px; ' ><input type='hidden' id='input_13_20_data' name='input_13_20_data' class='gfield_signature_data' \/><canvas id=\"input_13_20\" width=\"300\" height=\"90\" style=\"border-style: Dashed; border-width: 2px; border-color: #757575; background-color:#FFFFFF; cursor: url(https:\/\/www.yakimawa.gov\/services\/utility-services\/wp-content\/plugins\/gravityformssignature\/assets\/img\/pen.cur), pointer;\" tabindex=\"0\" aria-label=\"Signature pad\" ><\/canvas><input type='text' id='input_13_20_textinput' name='input_13_20_textinput' class='gfield_signature_text_input' style='text-indent:10px;display:none;width:300px;height:90px;border-style:Dashed;border-width:2px;border-color:#757575;background-color:#FFFFFF;font-family:&quot;Snell Roundhand&quot;, &quot;Segoe Script&quot;, cursive;font-size:2em;padding:0 12px;box-sizing:border-box;color:#000000;' placeholder='Type your signature' autocomplete='off' aria-label='Type your signature' \/><style type='text\/css'>\n                #input_13_20_textinput::placeholder {\n                    font-size: 1.5rem;\n                    font-family: Arial;\n                    opacity: 0.8;\n                }\n            <\/style><\/div><div id='input_13_20_toolbar' class='gfield_signature_toolbar' dir='ltr' style='margin:5px 0;position:relative;height:35px;width:300px;max-width:100%;display:flex;align-items:center;'><div id='input_13_20_status' class='gfield_signature_status gform-visually-hidden' role='status' aria-live='polite' aria-atomic='true' style='position:absolute;width:1px;height:1px;padding:0;margin:-1px;overflow:hidden;clip:rect(0,0,0,0);white-space:nowrap;border:0;'><\/div><input type='hidden' id='input_13_20_font_select' class='gfield_signature_font_select' value='script' \/><div id='input_13_20_font_dropdown' class='gfield_signature_font_dropdown'><span class='gform-common-icon gform-common-icon--chevron-down gfield_signature_font_dropdown_icon'><\/span><button type='button' id='input_13_20_font_select_button' class='gfield_signature_font_select_button gform-theme__disable' tabindex='0' aria-haspopup='listbox' aria-expanded='false' aria-label='Font Options' style='width:100%;box-sizing:border-box;overflow:hidden;text-overflow:ellipsis;white-space:nowrap;font-family:\"Snell Roundhand\", \"Segoe Script\", cursive;color:#000000'>Your Name<\/button><ul id='input_13_20_font_select_list' class='gfield_signature_font_select_list' role='listbox' tabindex='-1' style='display:none;position:absolute;top:100%;left:0;right:0;margin:0;padding:0;list-style:none;background:#fff;border:1px solid #ccc;z-index:10;max-height:200px;overflow-y:auto;box-sizing:border-box;'><li class='gfield_signature_font_option' role='option' data-value='script' tabindex='0' style='font-family:&quot;Snell Roundhand&quot;, &quot;Segoe Script&quot;, cursive; color:#000000' aria-label='Your Name, Script style'>Your Name<\/li><li class='gfield_signature_font_option' role='option' data-value='handwritten' tabindex='0' style='font-family:&quot;Bradley Hand&quot;, &quot;Comic Sans MS&quot;, cursive; color:#000000' aria-label='Your Name, Handwritten style'>Your Name<\/li><li class='gfield_signature_font_option' role='option' data-value='print' tabindex='0' style='font-family:&quot;Noteworthy&quot;, &quot;Segoe Print&quot;, cursive; color:#000000' aria-label='Your Name, Print style'>Your Name<\/li><\/ul><\/div><div class='gfield_signature_toolbar_icons' style='margin-left:auto;display:flex;align-items:center;'><button type='button' id='input_13_20_textbutton' class='gform-common-icon gform-common-icon--text-field gfield_signature_text_button gform-theme-no-framework' tabindex='0' style='background:none;border:0;padding:0;margin:0;appearance:none;-webkit-appearance:none;cursor:pointer;' alt='Text Signature' aria-label='Text Signature'><\/button><button type='button' id='input_13_20_drawbutton' class='gform-common-icon gform-common-icon--pencil gfield_signature_draw_button gform-theme-no-framework' tabindex='0' style='display:none;background:none;border:0;padding:0;margin:0;appearance:none;-webkit-appearance:none;cursor:pointer;' alt='Draw Signature' aria-label='Draw Signature'><\/button><button type='button' id='input_13_20_resetbutton' class='gform-common-icon gform-common-icon--arrow-path gfield_signature_reset_button gform-theme-no-framework' tabindex='0' style='background:none;border:0;padding:0;margin:0;appearance:none;-webkit-appearance:none;cursor:pointer;' alt='Clear Signature' aria-label='Clear Signature'><\/button><\/div><\/div><\/div><\/div><\/fieldset><div data-field-id=\"20\" class=\"spacer gfield\" style=\"grid-column: span 3;\" data-group-id=\"00e8b7f1\"><\/div><div id=\"field_13_48\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"ea01dc58\" data-field-span=\"12\"><h3 class=\"gsection_title\">FOR OFFICIAL CITY OF YAKIMA USE ONLY<\/h3><div class='gsection_description' id='gfield_description_13_48'>All fields below are for City Of Yakima staff use only. <\/div><\/div><div id=\"field_13_39\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"feb79abb\" data-field-span=\"12\"><h3 class=\"gsection_title\">Driver: ______________________________<\/h3><\/div><div id=\"field_13_49\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"4f821fbb\" data-field-span=\"12\"><h3 class=\"gsection_title\">SPECIAL HAUL PICKUP DATE: ______________________________<\/h3><\/div><div id=\"field_13_40\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"62e641ac\" data-field-span=\"12\"><h3 class=\"gsection_title\">SPECIAL HAUL TOTAL AMOUNT: ______________________________<\/h3><\/div><div id=\"field_13_47\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"23c23c5a\" data-field-span=\"12\"><h3 class=\"gsection_title\">ADDITIONAL CHARGES OR NOTES:<\/h3><div class='gsection_description' id='gfield_description_13_47'>______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________<\/div><\/div><div id=\"field_13_67\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"6033bd81\" data-field-span=\"12\"><h3 class=\"gsection_title\">** If the form doesn&#039;t allow you to submit it due to the file size of the photo\/s, remove the photo\/s and resize before submitting again.**<\/h3><\/div><fieldset id=\"field_13_120\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"5924bb6f\" data-field-span=\"12\"><legend id='gfield_label_13_120' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Untitled<\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_13_120'><div class='gchoice gchoice_13_120_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_120.1' type='checkbox'  value='First Choice'  id='choice_13_120_1'    aria-labelledby=\"label_13_120_1 gfield_label_13_120\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_13_120_1' id='label_13_120_1' class='gform-field-label gform-field-label--type-inline'>First Choice<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_120_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_120.2' type='checkbox'  value='Second Choice'  id='choice_13_120_2'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_120_2' id='label_13_120_2' class='gform-field-label gform-field-label--type-inline'>Second Choice<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_120_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_120.3' type='checkbox'  value='Third Choice'  id='choice_13_120_3'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_120_3' id='label_13_120_3' class='gform-field-label gform-field-label--type-inline'>Third Choice<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <button type='submit' id='gform_submit_button_13' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' >Submit<\/button> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_13' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_13' id='gform_theme_13' value='gravity-theme' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_13' id='gform_style_settings_13' value='{&quot;inputPrimaryColor&quot;:&quot;#204ce5&quot;}' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_13' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='13' \/>\n     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