{"id":517,"date":"2018-12-09T19:15:49","date_gmt":"2018-12-09T19:15:49","guid":{"rendered":"https:\/\/simeoncanada.com\/?page_id=517"},"modified":"2023-08-28T18:53:28","modified_gmt":"2023-08-28T18:53:28","slug":"form-service-request","status":"publish","type":"page","link":"https:\/\/simeonaudio.com\/?page_id=517","title":{"rendered":"form &#8211; service request"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; custom_padding_last_edited=&#8221;on|desktop&#8221; _builder_version=&#8221;4.16&#8243; custom_margin_tablet=&#8221;&#8221; custom_margin_phone=&#8221;&#8221; custom_margin_last_edited=&#8221;on|phone&#8221; custom_padding_tablet=&#8221;&#8221; custom_padding_phone=&#8221;&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row custom_padding_last_edited=&#8221;on|desktop&#8221; _builder_version=&#8221;4.16&#8243; custom_margin_tablet=&#8221;&#8221; custom_margin_phone=&#8221;&#8221; custom_margin_last_edited=&#8221;on|phone&#8221; custom_padding=&#8221;||||false|false&#8221; custom_padding_tablet=&#8221;&#8221; custom_padding_phone=&#8221;&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;|||&#8221; global_colors_info=&#8221;{}&#8221; custom_padding__hover=&#8221;|||&#8221;][et_pb_text _builder_version=&#8221;4.16&#8243; text_font=&#8221;|700|||||||&#8221; text_text_color=&#8221;#00a1df&#8221; text_font_size=&#8221;45px&#8221; text_line_height=&#8221;1em&#8221; header_font=&#8221;||||||||&#8221; text_orientation=&#8221;center&#8221; custom_margin_tablet=&#8221;&#8221; custom_margin_phone=&#8221;&#8221; custom_margin_last_edited=&#8221;on|phone&#8221; custom_padding_tablet=&#8221;&#8221; custom_padding_phone=&#8221;&#8221; custom_padding_last_edited=&#8221;on|desktop&#8221; text_font_size_tablet=&#8221;&#8221; text_font_size_phone=&#8221;&#8221; text_font_size_last_edited=&#8221;on|desktop&#8221; text_line_height_tablet=&#8221;&#8221; text_line_height_phone=&#8221;&#8221; text_line_height_last_edited=&#8221;on|phone&#8221; header_font_size_tablet=&#8221;&#8221; header_font_size_phone=&#8221;&#8221; header_font_size_last_edited=&#8221;on|desktop&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p style=\"text-align: center;\"><strong>Service Request Form<\/strong><\/p>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=&#8221;4.21.0&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.21.0&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.22.1&#8243; _module_preset=&#8221;default&#8221; hover_enabled=&#8221;0&#8243; global_colors_info=&#8221;{}&#8221; sticky_enabled=&#8221;0&#8243;]<\/p>\n<p>Download summer service pdf form here<\/p>\n<p><a href=\"https:\/\/simeoncanada.com\/wp-content\/uploads\/2023\/08\/Summer-Service-Form.pdf\" rel=\"attachment wp-att-4389\">Summer Service Form<\/a><\/p>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row custom_padding_last_edited=&#8221;on|desktop&#8221; _builder_version=&#8221;4.16&#8243; custom_margin_tablet=&#8221;&#8221; custom_margin_phone=&#8221;&#8221; custom_margin_last_edited=&#8221;on|phone&#8221; custom_padding_tablet=&#8221;&#8221; custom_padding_phone=&#8221;&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;|||&#8221; global_colors_info=&#8221;{}&#8221; custom_padding__hover=&#8221;|||&#8221;][et_pb_text _builder_version=&#8221;4.16&#8243; custom_margin=&#8221;||&#8221; custom_margin_tablet=&#8221;&#8221; custom_margin_phone=&#8221;&#8221; custom_margin_last_edited=&#8221;on|phone&#8221; custom_padding_tablet=&#8221;&#8221; custom_padding_phone=&#8221;&#8221; custom_padding_last_edited=&#8221;on|desktop&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<div class=\"frm_forms  with_frm_style frm_style_formidable-style\" id=\"frm_form_8_container\" data-token=\"9d611d83dc4b42cc39ce4713cdb472b8\">\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_pro_form \" id=\"form_eyabf\" data-token=\"9d611d83dc4b42cc39ce4713cdb472b8\">\n<div class=\"frm_form_fields \">\n<fieldset>\n<legend class=\"frm_screen_reader\">service request form<\/legend>\r\n\r\n<div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"8\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_8\" id=\"frm_hide_fields_8\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"eyabf\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_8\" name=\"frm_submit_entry_8\" value=\"ce9123ff10\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F517\" \/><div id=\"frm_field_109_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Customer Information<\/h3>\r\n\r\n\r\n<\/div>\n<div id=\"frm_field_98_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_8qxyq\" class=\"frm_primary_label\">Requester Name\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_8qxyq\" name=\"item_meta[98]\" value=\"\"  data-reqmsg=\"this field cannot be blank\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_99_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_hag80\" class=\"frm_primary_label\">Email Address\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_hag80\" name=\"item_meta[99]\" value=\"\"  data-reqmsg=\"this field cannot be blank\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_100_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_6chh8\" class=\"frm_primary_label\">Phone Number\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_6chh8\" name=\"item_meta[100]\" value=\"\"  data-reqmsg=\"this field cannot be blank\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_103_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_31cws\" class=\"frm_primary_label\">Student Name and School name\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_31cws\" name=\"item_meta[103]\" value=\"\"  data-reqmsg=\"this field cannot be blank\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_101_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_dxi5p\" class=\"frm_primary_label\">School Board\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_dxi5p\" name=\"item_meta[101]\" value=\"\"  data-reqmsg=\"School Board cannot be blank\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_104_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_1wp7s\" class=\"frm_primary_label\">Ship Back Address\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_1wp7s\" name=\"item_meta[104]\" value=\"\"  data-reqmsg=\"this field cannot be blank\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_105_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_kigb2\" class=\"frm_primary_label\">City\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_kigb2\" name=\"item_meta[105]\" value=\"\"  data-reqmsg=\"this field cannot be blank\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_106_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_h44er\" class=\"frm_primary_label\">State\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_h44er\" name=\"item_meta[106]\" value=\"\"  data-reqmsg=\"this field cannot be blank\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_107_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_dh1ug\" class=\"frm_primary_label\">Zip Code\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_dh1ug\" name=\"item_meta[107]\" value=\"\"  data-reqmsg=\"this field cannot be blank\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_108_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_lk2d8\" class=\"frm_primary_label\">Attention To\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_lk2d8\" name=\"item_meta[108]\" value=\"\"  data-reqmsg=\"this field cannot be blank\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_111_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Repair Information<\/h3>\r\n\r\n\r\n<\/div>\n<div id=\"frm_field_113_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_ky8ex\" class=\"frm_primary_label\">Original Invoice \/ Packing Slip Number\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_ky8ex\" name=\"item_meta[113]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_148_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_frxxx\" class=\"frm_primary_label\">System Serial Numbers\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_frxxx\" name=\"item_meta[148]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_115_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_pkxuh\" class=\"frm_primary_label\">Covered Under Warranty or Service Plus?\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    \t\t<select name=\"item_meta[115]\" id=\"field_pkxuh\"  data-reqmsg=\"this field cannot be blank\" aria-required=\"true\" data-invmsg=\"Covered Under Warranty or Service Plus? is invalid\" aria-invalid=\"false\"  >\n\t\t<option  value=\"\" selected='selected'> <\/option><option  value=\"yes\">yes<\/option><option  value=\"no\">no<\/option>\t<\/select>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_116_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_jyoe6\" class=\"frm_primary_label\">If not covered, what service level is preferred?\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    \t\t<select name=\"item_meta[116]\" id=\"field_jyoe6\"  data-reqmsg=\"this field cannot be blank\" aria-required=\"true\" data-invmsg=\"If not covered, what service level is preferred? is invalid\" aria-invalid=\"false\" aria-describedby=\"frm_desc_field_jyoe6\"  >\n\t\t<option  value=\"\" selected='selected'> <\/option><option  value=\"level 0 (repair quote requested; customer to decide on desired repairs at that time) - minimum shipping base charge of $25 \/ system will be applied\">level 0 (repair quote requested; customer to decide on desired repairs at that time) - minimum shipping base charge of $25 \/ system will be applied<\/option><option  value=\"level 1 (necessary repairs only; no battery replacements) - $50 \/ system for labour and shipping + parts up to $50\">level 1 (necessary repairs only; no battery replacements) - $50 \/ system for labour and shipping + parts up to $50<\/option><option  value=\"level 2 (necessary repairs and transmitter battery replacements) - $95 \/ system for labour, shipping, and batteries + any extra parts up to $50\">level 2 (necessary repairs and transmitter battery replacements) - $95 \/ system for labour, shipping, and batteries + any extra parts up to $50<\/option><option  value=\"level 3 (necessary repairs and transmitter \/ receiver battery replacements) - $195 \/ system for labour, shipping, and batteries + any extra parts up to $50\">level 3 (necessary repairs and transmitter \/ receiver battery replacements) - $195 \/ system for labour, shipping, and batteries + any extra parts up to $50<\/option><option  value=\"level 4 (necessary repairs and transmitter \/ receiver battery and boom mic replacements) - $248 \/ system for labour, shipping, batteries, and mic + any extra parts up to $50\">level 4 (necessary repairs and transmitter \/ receiver battery and boom mic replacements) - $248 \/ system for labour, shipping, batteries, and mic + any extra parts up to $50<\/option>\t<\/select>\n\t\r\n    <div class=\"frm_description\" id=\"frm_desc_field_jyoe6\">Above service levels apply to standard soundfield configurations only. Customer will be contacted with a repair quote for personal fm systems (base charge of $25 still applies). Customer will be contacted with a repair quote if required repairs exceed service level designation or replacements are required.<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_117_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <label for=\"field_c6ryu\" class=\"frm_primary_label\">What units have been sent in?\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_117-0\">\t\t\t<label  for=\"field_c6ryu-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[117][]\" id=\"field_c6ryu-0\" value=\"Soundfield Receiver \/ Speaker\"  data-reqmsg=\"this field cannot be blank\" data-invmsg=\"What units have been sent in? is invalid\"   aria-required=\"true\"  \/> Soundfield Receiver \/ Speaker<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_117-1\">\t\t\t<label  for=\"field_c6ryu-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[117][]\" id=\"field_c6ryu-1\" value=\"Teacher Transmitter \/ Microphone\"  data-reqmsg=\"this field cannot be blank\" data-invmsg=\"What units have been sent in? is invalid\"   \/> Teacher Transmitter \/ Microphone<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_117-2\">\t\t\t<label  for=\"field_c6ryu-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[117][]\" id=\"field_c6ryu-2\" value=\"Handheld Transmitter \/ Microphone\"  data-reqmsg=\"this field cannot be blank\" data-invmsg=\"What units have been sent in? is invalid\"   \/> Handheld Transmitter \/ Microphone<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_117-4\">\t\t\t<label  for=\"field_c6ryu-4\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[117][]\" id=\"field_c6ryu-4\" value=\"Charging Cradle\"  data-reqmsg=\"this field cannot be blank\" data-invmsg=\"What units have been sent in? is invalid\"   \/> Charging Cradle<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_117-7\">\t\t\t<label  for=\"field_c6ryu-7\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[117][]\" id=\"field_c6ryu-7\" value=\"Personal FM Transmitter\"  data-reqmsg=\"this field cannot be blank\" data-invmsg=\"What units have been sent in? is invalid\"   \/> Personal FM Transmitter<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_117-24\">\t\t\t<label  for=\"field_c6ryu-24\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[117][]\" id=\"field_c6ryu-24\" value=\"Personal FM Receiver\"  data-reqmsg=\"this field cannot be blank\" data-invmsg=\"What units have been sent in? is invalid\"   \/> Personal FM Receiver<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_117-26\">\t\t\t<label  for=\"field_c6ryu-26\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[117][]\" id=\"field_c6ryu-26\" value=\"Power Adapters\"  data-reqmsg=\"this field cannot be blank\" data-invmsg=\"What units have been sent in? is invalid\"   \/> Power Adapters<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_117-29\">\t\t\t<label  for=\"field_c6ryu-29\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[117][]\" id=\"field_c6ryu-29\" value=\"Boom Microphones\"  data-reqmsg=\"this field cannot be blank\" data-invmsg=\"What units have been sent in? is invalid\"   \/> Boom Microphones<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_117-33\">\t\t\t<label  for=\"field_c6ryu-33\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[117][]\" id=\"field_c6ryu-33\" value=\"Listening Accessories\"  data-reqmsg=\"this field cannot be blank\" data-invmsg=\"What units have been sent in? is invalid\"   \/> Listening Accessories<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_117-38\">\t\t\t<label  for=\"field_c6ryu-38\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[117][]\" id=\"field_c6ryu-38\" value=\"Other\"  data-reqmsg=\"this field cannot be blank\" data-invmsg=\"What units have been sent in? is invalid\"   \/> Other<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_118_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_opdmr\" class=\"frm_primary_label\">Please describe the issue with the unit and any troubleshooting performed (be specific)\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_opdmr\" name=\"item_meta[118]\" value=\"\"  data-reqmsg=\"this field cannot be blank\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_119_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_axosz\" class=\"frm_primary_label\">Additional Comments \/ Special Instructions\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_axosz\" name=\"item_meta[119]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_120_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <label for=\"field_z7iuf\" class=\"frm_primary_label\">Charge for declined repairs\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_120-0\">\t\t\t<label  for=\"field_z7iuf-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[120]\" id=\"field_z7iuf-0\" value=\"I understand that if this is not covered under warranty and repair is declined there will be a base charge of $25 for shipping.\"\n\t\t data-reqmsg=\"this field cannot be blank\" data-invmsg=\"Charge for declined repairs is invalid\"   \/> I understand that if this is not covered under warranty and repair is declined there will be a base charge of $25 for shipping.<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_146_container\" class=\"frm_form_field form-field  frm_none_container\">\r\n    <label  class=\"frm_primary_label\">Captcha\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <div  id=\"field_g3o8q\" class=\"g-recaptcha\" data-sitekey=\"6Lc7_GEpAAAAALw3nO-E8NLvz_91GJ183IPAx2cf\" data-size=\"invisible\" data-theme=\"light\" data-callback=\"frmAfterRecaptcha\"><\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_188_container\" class=\"frm_form_field form-field \">\r\n\t<div class=\"frm_submit\">\r\n\r\n<button class=\"frm_button_submit frm_final_submit\" type=\"submit\"  >submit<\/button>\r\n\r\n<\/div>\r\n<\/div>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t\t\t<div id=\"frm_field_190_container\">\n\t\t\t<label for=\"field_a9jzg\" >\n\t\t\t\tIf you are human, leave this field blank.\t\t\t<\/label>\n\t\t\t<input  id=\"field_a9jzg\" type=\"text\" class=\"frm_form_field form-field frm_verify\" name=\"item_meta[190]\" value=\"\"  \/>\n\t\t<\/div>\n\t\t<input name=\"frm_state\" type=\"hidden\" value=\"h+aZTjkqqIR\/hEayJu4HPBNN0Qhcyz4mRoRMnFDYUxm9peNy9FK96tsZps\/Mz1LG\" \/><\/div>\n<\/fieldset>\n<\/div>\n\n<\/form>\n<\/div>\n\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Service Request FormDownload summer service pdf form here Summer Service Form<div class=\"frm_forms  with_frm_style frm_style_formidable-style\" id=\"frm_form_8_container\" data-token=\"9d611d83dc4b42cc39ce4713cdb472b8\">\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_pro_form \" id=\"form_eyabf\" data-token=\"9d611d83dc4b42cc39ce4713cdb472b8\">\n<div class=\"frm_form_fields \">\n<fieldset>\n<legend class=\"frm_screen_reader\">service request form<\/legend>\r\n\r\n<div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"8\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_8\" id=\"frm_hide_fields_8\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"eyabf\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_8\" name=\"frm_submit_entry_8\" value=\"ce9123ff10\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F517\" \/><div id=\"frm_field_109_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Customer Information<\/h3>\r\n\r\n\r\n<\/div>\n<div id=\"frm_field_98_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_8qxyq\" class=\"frm_primary_label\">Requester Name\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_8qxyq\" name=\"item_meta[98]\" value=\"\"  data-reqmsg=\"this field cannot be blank\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_99_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_hag80\" class=\"frm_primary_label\">Email Address\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_hag80\" name=\"item_meta[99]\" value=\"\"  data-reqmsg=\"this field cannot be blank\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_100_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_6chh8\" class=\"frm_primary_label\">Phone Number\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_6chh8\" name=\"item_meta[100]\" value=\"\"  data-reqmsg=\"this field cannot be blank\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_103_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_31cws\" class=\"frm_primary_label\">Student Name and School name\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_31cws\" name=\"item_meta[103]\" value=\"\"  data-reqmsg=\"this field cannot be blank\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_101_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_dxi5p\" class=\"frm_primary_label\">School Board\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_dxi5p\" name=\"item_meta[101]\" value=\"\"  data-reqmsg=\"School Board cannot be blank\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_104_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_1wp7s\" class=\"frm_primary_label\">Ship Back Address\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_1wp7s\" name=\"item_meta[104]\" value=\"\"  data-reqmsg=\"this field cannot be blank\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_105_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_kigb2\" class=\"frm_primary_label\">City\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_kigb2\" name=\"item_meta[105]\" value=\"\"  data-reqmsg=\"this field cannot be blank\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_106_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_h44er\" class=\"frm_primary_label\">State\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_h44er\" name=\"item_meta[106]\" value=\"\"  data-reqmsg=\"this field cannot be blank\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_107_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_dh1ug\" class=\"frm_primary_label\">Zip Code\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_dh1ug\" name=\"item_meta[107]\" value=\"\"  data-reqmsg=\"this field cannot be blank\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_108_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_lk2d8\" class=\"frm_primary_label\">Attention To\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_lk2d8\" name=\"item_meta[108]\" value=\"\"  data-reqmsg=\"this field cannot be blank\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_111_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Repair Information<\/h3>\r\n\r\n\r\n<\/div>\n<div id=\"frm_field_113_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_ky8ex\" class=\"frm_primary_label\">Original Invoice \/ Packing Slip Number\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_ky8ex\" name=\"item_meta[113]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_148_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_frxxx\" class=\"frm_primary_label\">System Serial Numbers\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_frxxx\" name=\"item_meta[148]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_115_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_pkxuh\" class=\"frm_primary_label\">Covered Under Warranty or Service Plus?\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    \t\t<select name=\"item_meta[115]\" id=\"field_pkxuh\"  data-reqmsg=\"this field cannot be blank\" aria-required=\"true\" data-invmsg=\"Covered Under Warranty or Service Plus? is invalid\" aria-invalid=\"false\"  >\n\t\t<option  value=\"\" selected='selected'> <\/option><option  value=\"yes\">yes<\/option><option  value=\"no\">no<\/option>\t<\/select>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_116_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_jyoe6\" class=\"frm_primary_label\">If not covered, what service level is preferred?\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    \t\t<select name=\"item_meta[116]\" id=\"field_jyoe6\"  data-reqmsg=\"this field cannot be blank\" aria-required=\"true\" data-invmsg=\"If not covered, what service level is preferred? is invalid\" aria-invalid=\"false\" aria-describedby=\"frm_desc_field_jyoe6\"  >\n\t\t<option  value=\"\" selected='selected'> <\/option><option  value=\"level 0 (repair quote requested; customer to decide on desired repairs at that time) - minimum shipping base charge of $25 \/ system will be applied\">level 0 (repair quote requested; customer to decide on desired repairs at that time) - minimum shipping base charge of $25 \/ system will be applied<\/option><option  value=\"level 1 (necessary repairs only; no battery replacements) - $50 \/ system for labour and shipping + parts up to $50\">level 1 (necessary repairs only; no battery replacements) - $50 \/ system for labour and shipping + parts up to $50<\/option><option  value=\"level 2 (necessary repairs and transmitter battery replacements) - $95 \/ system for labour, shipping, and batteries + any extra parts up to $50\">level 2 (necessary repairs and transmitter battery replacements) - $95 \/ system for labour, shipping, and batteries + any extra parts up to $50<\/option><option  value=\"level 3 (necessary repairs and transmitter \/ receiver battery replacements) - $195 \/ system for labour, shipping, and batteries + any extra parts up to $50\">level 3 (necessary repairs and transmitter \/ receiver battery replacements) - $195 \/ system for labour, shipping, and batteries + any extra parts up to $50<\/option><option  value=\"level 4 (necessary repairs and transmitter \/ receiver battery and boom mic replacements) - $248 \/ system for labour, shipping, batteries, and mic + any extra parts up to $50\">level 4 (necessary repairs and transmitter \/ receiver battery and boom mic replacements) - $248 \/ system for labour, shipping, batteries, and mic + any extra parts up to $50<\/option>\t<\/select>\n\t\r\n    <div class=\"frm_description\" id=\"frm_desc_field_jyoe6\">Above service levels apply to standard soundfield configurations only. Customer will be contacted with a repair quote for personal fm systems (base charge of $25 still applies). Customer will be contacted with a repair quote if required repairs exceed service level designation or replacements are required.<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_117_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <label for=\"field_c6ryu\" class=\"frm_primary_label\">What units have been sent in?\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_117-0\">\t\t\t<label  for=\"field_c6ryu-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[117][]\" id=\"field_c6ryu-0\" value=\"Soundfield Receiver \/ Speaker\"  data-reqmsg=\"this field cannot be blank\" data-invmsg=\"What units have been sent in? is invalid\"   aria-required=\"true\"  \/> Soundfield Receiver \/ Speaker<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_117-1\">\t\t\t<label  for=\"field_c6ryu-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[117][]\" id=\"field_c6ryu-1\" value=\"Teacher Transmitter \/ Microphone\"  data-reqmsg=\"this field cannot be blank\" data-invmsg=\"What units have been sent in? is invalid\"   \/> Teacher Transmitter \/ Microphone<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_117-2\">\t\t\t<label  for=\"field_c6ryu-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[117][]\" id=\"field_c6ryu-2\" value=\"Handheld Transmitter \/ Microphone\"  data-reqmsg=\"this field cannot be blank\" data-invmsg=\"What units have been sent in? is invalid\"   \/> Handheld Transmitter \/ Microphone<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_117-4\">\t\t\t<label  for=\"field_c6ryu-4\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[117][]\" id=\"field_c6ryu-4\" value=\"Charging Cradle\"  data-reqmsg=\"this field cannot be blank\" data-invmsg=\"What units have been sent in? is invalid\"   \/> Charging Cradle<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_117-7\">\t\t\t<label  for=\"field_c6ryu-7\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[117][]\" id=\"field_c6ryu-7\" value=\"Personal FM Transmitter\"  data-reqmsg=\"this field cannot be blank\" data-invmsg=\"What units have been sent in? is invalid\"   \/> Personal FM Transmitter<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_117-24\">\t\t\t<label  for=\"field_c6ryu-24\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[117][]\" id=\"field_c6ryu-24\" value=\"Personal FM Receiver\"  data-reqmsg=\"this field cannot be blank\" data-invmsg=\"What units have been sent in? is invalid\"   \/> Personal FM Receiver<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_117-26\">\t\t\t<label  for=\"field_c6ryu-26\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[117][]\" id=\"field_c6ryu-26\" value=\"Power Adapters\"  data-reqmsg=\"this field cannot be blank\" data-invmsg=\"What units have been sent in? is invalid\"   \/> Power Adapters<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_117-29\">\t\t\t<label  for=\"field_c6ryu-29\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[117][]\" id=\"field_c6ryu-29\" value=\"Boom Microphones\"  data-reqmsg=\"this field cannot be blank\" data-invmsg=\"What units have been sent in? is invalid\"   \/> Boom Microphones<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_117-33\">\t\t\t<label  for=\"field_c6ryu-33\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[117][]\" id=\"field_c6ryu-33\" value=\"Listening Accessories\"  data-reqmsg=\"this field cannot be blank\" data-invmsg=\"What units have been sent in? is invalid\"   \/> Listening Accessories<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_117-38\">\t\t\t<label  for=\"field_c6ryu-38\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[117][]\" id=\"field_c6ryu-38\" value=\"Other\"  data-reqmsg=\"this field cannot be blank\" data-invmsg=\"What units have been sent in? is invalid\"   \/> Other<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_118_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_opdmr\" class=\"frm_primary_label\">Please describe the issue with the unit and any troubleshooting performed (be specific)\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_opdmr\" name=\"item_meta[118]\" value=\"\"  data-reqmsg=\"this field cannot be blank\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_119_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_axosz\" class=\"frm_primary_label\">Additional Comments \/ Special Instructions\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_axosz\" name=\"item_meta[119]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_120_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <label for=\"field_z7iuf\" class=\"frm_primary_label\">Charge for declined repairs\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_120-0\">\t\t\t<label  for=\"field_z7iuf-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[120]\" id=\"field_z7iuf-0\" value=\"I understand that if this is not covered under warranty and repair is declined there will be a base charge of $25 for shipping.\"\n\t\t data-reqmsg=\"this field cannot be blank\" data-invmsg=\"Charge for declined repairs is invalid\"   \/> I understand that if this is not covered under warranty and repair is declined there will be a base charge of $25 for shipping.<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_146_container\" class=\"frm_form_field form-field  frm_none_container\">\r\n    <label  class=\"frm_primary_label\">Captcha\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <div  id=\"field_g3o8q\" class=\"g-recaptcha\" data-sitekey=\"6Lc7_GEpAAAAALw3nO-E8NLvz_91GJ183IPAx2cf\" data-size=\"invisible\" data-theme=\"light\" data-callback=\"frmAfterRecaptcha\"><\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_188_container\" class=\"frm_form_field form-field \">\r\n\t<div class=\"frm_submit\">\r\n\r\n<button class=\"frm_button_submit frm_final_submit\" type=\"submit\"  >submit<\/button>\r\n\r\n<\/div>\r\n<\/div>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t\t\t<div id=\"frm_field_191_container\">\n\t\t\t<label for=\"field_c8u0v\" >\n\t\t\t\tIf you are human, leave this field blank.\t\t\t<\/label>\n\t\t\t<input  id=\"field_c8u0v\" type=\"text\" 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property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"form - service request - Simeon Audio\" \/>\n<meta property=\"og:description\" content=\"Service Request FormDownload summer service pdf form here Summer Service Form\" \/>\n<meta property=\"og:url\" content=\"https:\/\/simeonaudio.com\/?page_id=517\" \/>\n<meta property=\"og:site_name\" content=\"Simeon Audio\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/simeonsupportivehearingsystems\/\" \/>\n<meta property=\"article:modified_time\" content=\"2023-08-28T18:53:28+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:site\" content=\"@simeonshs\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" 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