{"id":2304,"date":"2019-06-22T14:47:13","date_gmt":"2019-06-22T14:47:13","guid":{"rendered":"http:\/\/www.vandykgroup.com\/?page_id=290"},"modified":"2024-10-30T14:04:29","modified_gmt":"2024-10-30T14:04:29","slug":"home-owners-flood-insurance-quote-form","status":"publish","type":"page","link":"https:\/\/www.vandykgroup.com\/personalinsurance\/home-owners-flood-insurance-quote-form\/","title":{"rendered":"Homeowners \/ Flood Insurance Quote Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"2304\" class=\"elementor elementor-2304\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-530b40ec elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"530b40ec\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-1ef03c0c insertAfterFrm\" data-id=\"1ef03c0c\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-5b9516de elementor-widget elementor-widget-text-editor\" data-id=\"5b9516de\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p style=\"font-weight: normal;\">The Van Dyk Group is licensed in the following states: NJ, NY, PA, MD, DE, FL, VA, RI, CT, ME, &amp; TX<\/p><p>This form is to request a quote from our Experienced Professionals and does not generate automatic quotes.<\/p><p>You will be contacted shortly by one of our representatives so that we may work with you to find the best coverage for your needs.<\/p><p>For an accurate estimate, please fill out All fields. Fields marked with * are required. This is a secure form for your protection.<\/p><p>If you prefer to talk to a representative, please call (800)222-0131.\u00a0<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-e3a1de7 insertAfterCont\" data-id=\"e3a1de7\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-5d43b04 frmholdr elementor-widget elementor-widget-shortcode\" data-id=\"5d43b04\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar 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class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_3'  action='\/personalinsurance\/wp-json\/wp\/v2\/pages\/2304' data-formid='3' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_3_1\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Quote Type Needed<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_1'>\n\t\t\t<div class='gchoice gchoice_3_1_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_1' type='radio' value='Flood Only'  id='choice_3_1_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_1_0' id='label_3_1_0' class='gform-field-label gform-field-label--type-inline'>Flood Only<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_1_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_1' type='radio' value='Home Only'  id='choice_3_1_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_1_1' id='label_3_1_1' class='gform-field-label gform-field-label--type-inline'>Home Only<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_1_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_1' type='radio' value='Home &amp; Flood'  id='choice_3_1_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_1_2' id='label_3_1_2' class='gform-field-label gform-field-label--type-inline'>Home &amp; Flood<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_3_3\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_3'>Primary Usage<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_3' id='input_3_3' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Primary Home' >Primary Home<\/option><option value='Secondary Home' >Secondary Home<\/option><option value='Rental Investment Property' >Rental Investment Property<\/option><\/select><\/div><\/div><fieldset id=\"field_3_4\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<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_3_4'>\n                            \n                            <span id='input_3_4_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_4.3' id='input_3_4_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_3_4_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_3_4_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_4.6' id='input_3_4_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_3_4_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_3_11\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_11'>Phone<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_11' id='input_3_11' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_12\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_12'>Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_12' id='input_3_12' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_3_5\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_5'>Occupation<\/label><div class='ginput_container ginput_container_text'><input name='input_5' id='input_3_5' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_3_6\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Property Address<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_3_6' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_3_6_1_container' >\n                                        <input type='text' name='input_6.1' id='input_3_6_1' value=''    aria-required='true'    \/>\n                                        <label for='input_3_6_1' id='input_3_6_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_3_6_2_container' >\n                                        <input type='text' name='input_6.2' id='input_3_6_2' value=''     aria-required='false'   \/>\n                                        <label for='input_3_6_2' id='input_3_6_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_3_6_3_container' >\n                                    <input type='text' name='input_6.3' id='input_3_6_3' value=''    aria-required='true'    \/>\n                                    <label for='input_3_6_3' id='input_3_6_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_3_6_4_container' >\n                                        <select name='input_6.4' id='input_3_6_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_3_6_4' id='input_3_6_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_3_6_5_container' >\n                                    <input type='text' name='input_6.5' id='input_3_6_5' value=''    aria-required='true'    \/>\n                                    <label for='input_3_6_5' id='input_3_6_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_6.6' id='input_3_6_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_3_7\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_7'>Year Built<\/label><div class='ginput_container ginput_container_text'><input name='input_7' id='input_3_7' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_8\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_8'>Total Square Footage<\/label><div class='ginput_container ginput_container_text'><input name='input_8' id='input_3_8' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_10\" 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\"  ><label class='gfield_label gform-field-label' for='input_3_10'>Notes<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_10' id='input_3_10' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_3_13\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_13'>File<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='1536000' \/><input name='input_13' id='input_3_13' type='file' class='large' aria-describedby=\"gfield_upload_rules_3_13\" onchange='javascript:gformValidateFileSize( this, 1536000 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_3_13'>Max. file size: 1 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_3_13'><\/div> <\/div><\/div><div id=\"field_3_15\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >If you have an Elevation Certificate for Flood or a current Home policy Declaration page, you may upload it here so that we may get a quicker quote back to you.<\/div><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type='submit' id='gform_submit_button_3' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Submit'  \/> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_3' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_3' id='gform_theme_3' value='orbital' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_3' id='gform_style_settings_3' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_3' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='3' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='USD' value='rnyWuXy3LMeUwZRjC6o5Jf89kiUKxvO4zZk+suApQaFGZUSLS+9mYB7g9TwZGsFch0QBDuExhbQhwdK7LZHu5wPnCKgEWu+QLSCtlXJpG8r6Dn4=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_3' value='WyJ7XCIxXCI6W1wiYzJmMjJmYTc3ZDJhNDE3OWRkODg1OWUzOGI2YzNhM2NcIixcIjg5NWU2YjAxNjhkNTg2OGQ5YjZkZWFiODBiZTViZDg4XCIsXCI3N2ZlODk0NTMzMTEwMzZkYmVhMTg3NjFiMzBiZjNiZVwiXSxcIjNcIjpbXCJiODU3YmFkNzc0Y2M0YWM5NGNjMTEzNDkzNDEwOWVhMlwiLFwiZGJiMGE3NjM3NmJiNDUwMDliYzUzYWJhMGE5NmZkMjZcIixcIjVhOGIzZDg0OWZmZGI4OGE3Y2JjZTk2ODY3YjcxN2Q4XCJdfSIsIjc2NTNjZjFmNzI2ZGY2ZmUyYTkwZTAxYzJiYjUyZTlmIl0=' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_3' id='gform_target_page_number_3' value='0' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_3' id='gform_source_page_number_3' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"ak_\"><label>&#916;<textarea name=\"ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_1\" name=\"ak_js\" value=\"133\"\/><script>document.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );<\/script><\/p><\/form>\n                        <\/div><script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\n gform.initializeOnLoaded( function() {gformInitSpinner( 3, 'https:\/\/www.vandykgroup.com\/personalinsurance\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', false );jQuery('#gform_ajax_frame_3').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_3');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_3').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){jQuery('#gform_wrapper_3').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_3').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_3').removeClass('gform_validation_error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/  }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_3').val();gformInitSpinner( 3, 'https:\/\/www.vandykgroup.com\/personalinsurance\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', false );jQuery(document).trigger('gform_page_loaded', [3, current_page]);window['gf_submitting_3'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}jQuery('#gform_wrapper_3').replaceWith(confirmation_content);jQuery(document).trigger('gform_confirmation_loaded', [3]);window['gf_submitting_3'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_3').text());}else{jQuery('#gform_3').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger(\"gform_pre_post_render\", [{ formId: \"3\", currentPage: \"current_page\", abort: function() { this.preventDefault(); } }]);        if (event && event.defaultPrevented) {                return;        }        const gformWrapperDiv = document.getElementById( \"gform_wrapper_3\" );        if ( gformWrapperDiv ) {            const visibilitySpan = document.createElement( \"span\" );            visibilitySpan.id = \"gform_visibility_test_3\";            gformWrapperDiv.insertAdjacentElement( \"afterend\", visibilitySpan );        }        const visibilityTestDiv = document.getElementById( \"gform_visibility_test_3\" );        let postRenderFired = false;        function triggerPostRender() {            if ( postRenderFired ) {                return;            }            postRenderFired = true;            gform.core.triggerPostRenderEvents( 3, current_page );            if ( visibilityTestDiv ) {                visibilityTestDiv.parentNode.removeChild( visibilityTestDiv );            }        }        function debounce( func, wait, immediate ) {            var timeout;            return function() {                var context = this, args = arguments;                var later = function() {                    timeout = null;                    if ( !immediate ) func.apply( context, args );                };                var callNow = immediate && !timeout;                clearTimeout( timeout );                timeout = setTimeout( later, wait );                if ( callNow ) func.apply( context, args );            };        }        const debouncedTriggerPostRender = debounce( function() {            triggerPostRender();        }, 200 );        if ( visibilityTestDiv && visibilityTestDiv.offsetParent === null ) {            const observer = new MutationObserver( ( mutations ) => {                mutations.forEach( ( mutation ) => {                    if ( mutation.type === 'attributes' && visibilityTestDiv.offsetParent !== null ) {                        debouncedTriggerPostRender();                        observer.disconnect();                    }                });            }); 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action=\"\/personalinsurance\/wp-json\/wp\/v2\/pages\/2304\" method=\"post\" id=\"form10\" class=\"fm-form form10  \" enctype=\"multipart\/form-data\"><input type=\"hidden\" id=\"counter10\" value=\"20\" name=\"counter10\" \/><input type=\"hidden\" id=\"Itemid10\" value=\"\" name=\"Itemid10\" \/><input type=\"hidden\" id=\"fm_shake10\" value=\"1\" name=\"fm_shake10\" \/><input type=\"text\" class=\"fm-hide\" id=\"fm_empty_field_validation10\" value=\"\" name=\"fm_empty_field_validation10\" data-value=\"bd736efb144d599cf463541431fbf5c4\" \/><div class=\"fm-header-bg\"><div class=\"fm-header \"><div class=\"fm-header-text\">          <div class=\"fm-header-title\">            Home \/ Flood Insurance Quote Request          <\/div>          <div class=\"fm-header-description\">                      <\/div>        <\/div><\/div><\/div><div class=\"wdform-page-and-images fm-form-builder\" style=\"border-top-color: black; border-top-width: 0px; border-top-style: solid; display: table;\"><div class=\"wdform_page\" id=\"10form_view1\" previous_checkable=\"false\" previous_class=\"wdform-page-button\" previous_type=\"text\" previous_title=\"Previous\" next_checkable=\"false\" next_class=\"wdform-page-button\" next_type=\"text\" next_title=\"Next\" page_title=\"Untitled page\"><div class=\"wdform_section fm-col-2\"><div class=\"wdform_column\"><div class=\"wdform_row\" wdid=\"1\"><div type=\"type_radio\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column\" ><div class=\"wdform-label-section wd-width-100  wd-flex-wrap wd-flex-row\">    <label  class=\"wdform-label\">Quote Type Needed:<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-wrap wd-flex-row wd-width-100\" ><div class=\"wd-flex wd-flex-row\"><input type=\"hidden\" name=\"wdform_1_element10\" value=\"\" \/><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_1_element100\" name=\"wdform_1_element10\" value=\"Flood Only\" onclick=\"set_default(&quot;wdform_1&quot;,&quot;0&quot;,&quot;10&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_1_element100\"><span><\/span>Flood Only<\/label><\/div><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_1_element101\" name=\"wdform_1_element10\" value=\"Home Only\" onclick=\"set_default(&quot;wdform_1&quot;,&quot;1&quot;,&quot;10&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_1_element101\"><span><\/span>Home Only<\/label><\/div><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_1_element102\" name=\"wdform_1_element10\" value=\"Home &amp; Flood\" onclick=\"set_default(&quot;wdform_1&quot;,&quot;2&quot;,&quot;10&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_1_element102\"><span><\/span>Home &amp; Flood<\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div class=\"wdform_row\" wdid=\"2\"><div type=\"type_name\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column\" ><div class=\"wdform-label-section wd-width-100  wd-flex-row\" style=\"max-width: 100px;\">    <label  for=\"wdform_2_element_first10\" class=\"wdform-label\">Name:<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-width-100\" ><div class=\"wd-flex wd-flex-column wd-width-50\"><input type=\"text\" class=\"wd-width-100\" id=\"wdform_2_element_first10\" name=\"wdform_2_element_first10\" value=\"\" title=\"\" placeholder=\"\"  \/><label class=\"mini_label\" for=\"wdform_2_element_first10\">First Name<\/label><\/div><div class=\"wd-flex wd-flex-column wd-name-separator\"><\/div><div class=\"wd-flex wd-flex-column wd-width-50\"><input type=\"text\" class=\"wd-width-100\" id=\"wdform_2_element_last10\" name=\"wdform_2_element_last10\" value=\"\" title=\"\" placeholder=\"\"  \/><label class=\"mini_label\" for=\"wdform_2_element_last10\">Last Name<\/label><\/div><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div class=\"wdform_row\" wdid=\"3\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_address\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column\" ><div class=\"wdform-label-section wd-width-100 wdform_address wd-flex-column\" style=\"max-width: 300px;\">    <label  for=\"wdform_3_street110\" class=\"wdform-label\">Property Address:<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex wdform_address wd-flex-column wd-width-100\" style=\"max-width: 300px;\"><span class=\"wd-width-100 wd-address\" id=\"wdform_3_address_0\">                <input class=\"wd-width-100 wdform_3_address_0\" type=\"text\" id=\"wdform_3_street110\" name=\"wdform_3_street110\" value=\"\"  \/>                <label for=\"wdform_3_street110\" class=\"mini_label\">Street Address<\/label><\/span><span class=\"wd-width-100 wd-flex wd-flex-row wd-flex-wrap wd-justify-content\"><span class=\"wd-width-49 wd-address\" id=\"wdform_3_address_2\">                <input class=\"wd-width-100 wdform_3_address_2\" type=\"text\" id=\"wdform_3_city10\" name=\"wdform_5_city10\" value=\"\"  \/>                <label for=\"wdform_3_city10\" class=\"mini_label\">City<\/label><\/span><span class=\"wd-width-49 wd-address\" id=\"wdform_3_address_3\">                <input class=\"wd-width-100 wdform_3_address_3\" type=\"text\" id=\"wdform_3_state10\" name=\"wdform_6_state10\" value=\"\"  \/>                <label for=\"wdform_3_state10\" class=\"mini_label\">State \/ Province \/ Region<\/label><\/span><span class=\"wd-width-49 wd-address\" id=\"wdform_3_address_4\">              <input class=\"wd-width-100 wdform_3_address_4\" type=\"text\" id=\"wdform_3_postal10\" name=\"wdform_7_postal10\" value=\"\"  \/>              <label for=\"wdform_3_postal10\" class=\"mini_label\">Postal \/ Zip Code<\/label><\/span><\/span><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div class=\"wdform_row\" wdid=\"9\"><div type=\"type_phone\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column\" ><div class=\"wdform-label-section wd-width-100  wd-flex-row\" style=\"max-width: 200px;\">    <label  for=\"wdform_9_element_first10\" class=\"wdform-label\">Phone:<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-width-100\" style=\"max-width: 250px;\"><div class=\"wd-flex wd-flex-column wd-width-20\">                <input type=\"text\" class=\"wd-phone-first\" id=\"wdform_9_element_first10\" name=\"wdform_9_element_first10\" value=\"\" title=\"\" placeholder=\"\" >                <label for=\"wdform_9_element_first10\" class=\"mini_label wd-flex-column\">Area Code<\/label>              <\/div>              <div>                <div class=\"wd-flex wd-flex-column \">&nbsp;-&nbsp;<\/div>              <\/div>              <div class=\"wd-flex wd-flex-column wd-width-80\">                <input type=\"text\" class=\"wd-flex-column wd-width-100\" id=\"wdform_9_element_last10\" name=\"wdform_9_element_last10\" value=\"\" title=\"\" placeholder=\"\"  \/>                <label for=\"wdform_9_element_last10\" class=\"wd-flex-column mini_label\">Phone Number<\/label>              <\/div><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div class=\"wdform_row\" wdid=\"10\"><div type=\"type_submitter_mail\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column\" ><div class=\"wdform-label-section wd-width-100  wd-flex-row\" style=\"max-width: 100px;\">    <label  for=\"wdform_10_element10\" class=\"wdform-label\">E-mail:<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-width-100\" ><input type=\"text\" class=\"wd-width-100\" id=\"wdform_10_element10\" name=\"wdform_10_element10\" value=\"\" title=\"\" placeholder=\"\"   onchange=\"wd_check_email('10', '10', 'This is not a valid email address.')\" \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div class=\"wdform_row\" wdid=\"19\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_editor\" class=\"wdform-field\">If you have an Elevation Certificate for Flood or a current Home policy Declaration page, you may upload it here so that we may get a quicker quote back to you.<style>.fm-form .wd-width-20 {width: 30% !important;}<\/style><\/div><\/div><\/div><\/div><div class=\"wdform_section fm-col-2\"><div class=\"wdform_column\"><div class=\"wdform_row\" wdid=\"11\"><div type=\"type_own_select\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column\" ><div class=\"wdform-label-section wd-width-100 wdform_select wd-flex-row\">    <label  for=\"wdform_11_element10\" class=\"wdform-label\">Primary Usage:<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex wdform_select wd-flex-row wd-width-100\" style=\"max-width: 200px;\"><select class=\"wd-width-100\" id=\"wdform_11_element10\" name=\"wdform_11_element10\" ><option value=\"Select Usage\" selected=\"selected\">Select Usage<\/option><option value=\"Primary Home\" >Primary Home<\/option><option value=\"Secondary Home\" >Secondary Home<\/option><option value=\"Rental\/Investment Property\" >Rental\/Investment Property<\/option><\/select><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div class=\"wdform_row\" wdid=\"12\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column\" ><div class=\"wdform-label-section wd-width-100  wd-flex-row wd-align-items-center\">    <label  for=\"wdform_12_element10\" class=\"wdform-label\">Occupation:<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-align-items-center wd-width-100\" style=\"max-width: 250px;\"><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_12_element10\"                           name=\"wdform_12_element10\"                           value=\"\"                           title=\"\"                           placeholder=\"\"                                                       \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div class=\"wdform_row\" wdid=\"13\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column\" ><div class=\"wdform-label-section wd-width-100  wd-flex-row wd-align-items-center\">    <label  for=\"wdform_13_element10\" class=\"wdform-label\">Year Built:<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-align-items-center wd-width-100\" style=\"max-width: 100px;\"><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_13_element10\"                           name=\"wdform_13_element10\"                           value=\"\"                           title=\"\"                           placeholder=\"\"                                                       \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div class=\"wdform_row\" wdid=\"14\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column\" ><div class=\"wdform-label-section wd-width-100  wd-flex-row wd-align-items-center\">    <label  for=\"wdform_14_element10\" class=\"wdform-label\">Total Square Footage:<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-align-items-center wd-width-100\" style=\"max-width: 150px;\"><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_14_element10\"                           name=\"wdform_14_element10\"                           value=\"\"                           title=\"\"                           placeholder=\"\"                                                       \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div class=\"wdform_row\" wdid=\"17\"><div type=\"type_textarea\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column\" ><div class=\"wdform-label-section wd-width-100 \">    <label  for=\"wdform_17_element10\" class=\"wdform-label\">Notes:<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-width-100\" style=\"max-width: 300px;\"><textarea class=\"wd-width-100\"                      id=\"wdform_17_element10\"                      name=\"wdform_17_element10\"                      placeholder=\"\"                      maxlength=\"\"                      style=\"height: 50px;\"                      ><\/textarea><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div class=\"wdform_row\" wdid=\"18\"><div type=\"type_file_upload\" class=\"wdform-field wd-width-100 wd-flex wd-flex-row\" ><div class=\"wdform-label-section wd-width-30  wd-flex-column\">    <label  for=\"wdform_18_element10\" class=\"wdform-label\">Upload File:<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-column wd-width-70\" ><label class=\"file-upload\"><div class=\"file-picker\"><\/div><input type=\"file\" id=\"wdform_18_element10\" name=\"wdform_18_file10[]\" multiple='multiple'  \/><\/label><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div class=\"wdform_row\" wdid=\"16\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_submit_reset\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column\" ><div class=\"wdform-element-section wd-flex  wd-flex-row wd-justify-content-right wd-width-100\" ><button  type=\"button\" class=\"button-submit\" onclick=\"fm_submit_form('10');\"  data-ajax=\"0\"><span class=\"fm-submit-loading spinner fm-ico-spinner\"><\/span>Submit<\/button><button  type=\"button\" class=\"button-reset \" onclick=\"fm_reset_form(10);\" >Reset<\/button><\/div><\/div><\/div><\/div><\/div><div class=\"wdform_footer\" style=\"width: 100%;\" valign=\"top\"><div style=\"width: 100%;\"><div style=\"width: 100%; padding-top: 10px; display: table;\"><div style=\"display: table-row-group;\"><div id=\"10page_nav1\" style=\"display: table-row;\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"wdform_preload\"><\/div><\/form><\/div><\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>The Van Dyk Group is licensed in the following states: NJ, NY, PA, MD, DE, FL, VA, RI, CT, ME, &amp; TX This form is to request a quote from our Experienced Professionals and does not generate automatic quotes. You will be contacted shortly by one of our representatives so that we may work with [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"open","ping_status":"closed","template":"","meta":{"_acf_changed":false,"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"class_list":["post-2304","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Homeowners \/ Flood Insurance Quote Form - Personal Insurance<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.vandykgroup.com\/personalinsurance\/home-owners-flood-insurance-quote-form\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Homeowners \/ Flood Insurance Quote Form - Personal Insurance\" \/>\n<meta property=\"og:description\" content=\"The Van Dyk Group is licensed in the following states: NJ, NY, PA, MD, DE, FL, VA, RI, CT, ME, &amp; TX This form is to request a quote from our Experienced Professionals and does not generate automatic quotes. 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