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class="d-block mt-2">(650) 336-0064</span> </a> </div> <div class="col-6 p-0"> <a title=" Chat now about this Medical LCD Monitor" style="cursor : pointer" class="chat-btn-demo chat_now d-block text-center h-100"><img src="./assets/images/chat-512.png" class="img-fluid d-block mx-auto"><span class="d-block mt-2">Chat Now</span> </a> </div> </div> </div> <div class="col-5 p-0"> </div> </div> <p class="mt-4"><span class="text-danger">*</span> All Fields Required</p> <div class="msg-area"></div> <div class="form-group"><input value="" type="text" placeholder="First Name" name="form[firstname]" class="form-control" required></div> <div class="form-group"><input value="" type="text" placeholder="Last Name" name="form[lastname]" class="form-control" required></div> <div class="form-group"><input value="" type="email" placeholder="Email" name="form[email]" class="form-control" required></div> <div class="form-group"><input value="" type="text" placeholder="Organization" name="form[organization]" class="form-control" required></div> <div class="form-group"><input value="" type="text" placeholder="State" name="form[state]" class="form-control" required></div> <div class="form-group"><input value="" type="text" placeholder="Phone Number" name="form[phone]" class="form-control" required></div> <div class="form-group input-group"> <div class="form-radio me-5"> <input type="radio" id="Evaluate" name="form[type]" value="Evaluate" class="form-radio-input" checked=""> <label for="Evaluate" class="form-radio-label" style="">Evaluate</label> </div> <div class="form-radio"> <input type="radio" id="requestQuote" name="form[type]" value="Quote" class="form-radio-input"> <label for="requestQuote" class="form-radio-label" style="">Request for Quote</label> </div> </div> <input type="hidden" name="form[request_type]" value="evaluation_unit"> <input type="hidden" name="tag_id" id="tag_id" value="" class="tag_id"> <input type="hidden" id="ip_addres_user" name="form[ip_address]"> <input type="hidden" class="form-control" id="referral" name="form[referral]"> <div class="form-group"> <select class="form-control form-select" required name="form[quantity]"> <option value="">Number of Quantity </option> <option value="0-50">0-50 </option> <option value="50-250">50-250 </option> <option value="250+">250+ </option> </select> </div> <div class="form-group"> <div id="recaptcha"></div> </div> <hr> <input value="ajax" type="hidden" name="form[method]"> <input value="ads.txt" type="hidden" name="page"> <button type="submit" class="btn btn-primary" name="submit" data-tooltip="Please note evaluation equipment comes in a standard configuration." value="Submit Request">Submit Request</button> </form> </div> </div> </div></div><div class="quote-pop-ups d-none"> <div class="get-quote-pop-up-1 quick-eval d-none"> <div class="block-feat"> <div class="close close-bt">X</div> <div class="pop-up-form"> <form method="post" action="./eval-info-form-submit/" id="myform"> <fieldset id="info1" class=""> <div class="row"> <div class="col-sm-6"> <h2>Send My Eval</h2> <h3></h3> </div> <div class="col-sm-6 img-eval"> <img src="./assets/images/medix-c22-IP65-front-panel-medical-pc.png" alt="Medix C22" title="Medix C22" class="pop-up-img" /> </div> </div> <div class="clear"></div> <input value="" type="hidden" name="to_mail"> <input value="Eval Info: " type="hidden" name="subject2"> <input value="" type="hidden" name="product"> <div class="form-group"><input type="text" id="fullname" placeholder="Full Name" name="fullname"></div> <div class="form-group"><input type="email" placeholder="Email" name="email"></div> <div class="form-group"><input type="text" placeholder="Phone Number" name="phone"></div> <p> <div class="need-card"> No Credit Card Needed </div> <a class="btn btn-primary next">Submit</a> </p> </fieldset> <fieldset id="info2" class=""> <h3 class="text-right"></h3> <h2>Shipping Address</h2> <div class="form-group"> <select id="country" name="country" placeholder="Country"> <option value="AF">Afghanistan</option> <option value="AX">Åland Islands</option> <option value="AL">Albania</option> <option value="DZ">Algeria</option> <option value="AS">American Samoa</option> <option value="AD">Andorra</option> <option value="AO">Angola</option> <option value="AI">Anguilla</option> <option value="AQ">Antarctica</option> <option value="AG">Antigua and Barbuda</option> <option value="AR">Argentina</option> <option value="AM">Armenia</option> <option value="AW">Aruba</option> <option value="AU">Australia</option> <option value="AT">Austria</option> <option value="AZ">Azerbaijan</option> <option value="BS">Bahamas</option> <option value="BH">Bahrain</option> <option value="BD">Bangladesh</option> <option value="BB">Barbados</option> <option value="BY">Belarus</option> <option value="BE">Belgium</option> <option value="BZ">Belize</option> <option value="BJ">Benin</option> <option value="BM">Bermuda</option> <option 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value="LB">Lebanon</option> <option value="LS">Lesotho</option> <option value="LR">Liberia</option> <option value="LY">Libya</option> <option value="LI">Liechtenstein</option> <option value="LT">Lithuania</option> <option value="LU">Luxembourg</option> <option value="MO">Macao</option> <option value="MK">Macedonia, the former Yugoslav Republic of</option> <option value="MG">Madagascar</option> <option value="MW">Malawi</option> <option value="MY">Malaysia</option> <option value="MV">Maldives</option> <option value="ML">Mali</option> <option value="MT">Malta</option> <option value="MH">Marshall Islands</option> <option value="MQ">Martinique</option> <option value="MR">Mauritania</option> <option value="MU">Mauritius</option> <option value="YT">Mayotte</option> <option value="MX">Mexico</option> <option value="FM">Micronesia, Federated States of</option> <option value="MD">Moldova, Republic of</option> <option value="MC">Monaco</option> <option value="MN">Mongolia</option> <option value="ME">Montenegro</option> <option value="MS">Montserrat</option> <option value="MA">Morocco</option> <option value="MZ">Mozambique</option> <option value="MM">Myanmar</option> <option value="NA">Namibia</option> <option value="NR">Nauru</option> <option value="NP">Nepal</option> <option value="NL">Netherlands</option> <option value="NC">New Caledonia</option> <option value="NZ">New Zealand</option> <option value="NI">Nicaragua</option> <option value="NE">Niger</option> <option value="NG">Nigeria</option> <option value="NU">Niue</option> <option value="NF">Norfolk Island</option> <option value="MP">Northern Mariana Islands</option> <option value="NO">Norway</option> <option value="OM">Oman</option> <option value="PK">Pakistan</option> <option value="PW">Palau</option> <option value="PS">Palestinian Territory, Occupied</option> <option value="PA">Panama</option> <option value="PG">Papua New Guinea</option> <option value="PY">Paraguay</option> <option value="PE">Peru</option> <option value="PH">Philippines</option> <option value="PN">Pitcairn</option> <option value="PL">Poland</option> <option value="PT">Portugal</option> <option value="PR">Puerto Rico</option> <option value="QA">Qatar</option> <option value="RE">Réunion</option> <option value="RO">Romania</option> <option value="RU">Russian Federation</option> <option value="RW">Rwanda</option> <option value="BL">Saint Barthélemy</option> <option value="SH">Saint Helena, Ascension and Tristan da Cunha</option> <option value="KN">Saint Kitts and Nevis</option> <option value="LC">Saint Lucia</option> <option value="MF">Saint Martin (French part)</option> <option value="PM">Saint Pierre and Miquelon</option> <option value="VC">Saint Vincent and the Grenadines</option> <option value="WS">Samoa</option> <option value="SM">San Marino</option> <option value="ST">Sao Tome and Principe</option> <option value="SA">Saudi Arabia</option> <option value="SN">Senegal</option> <option value="RS">Serbia</option> <option value="SC">Seychelles</option> <option value="SL">Sierra Leone</option> <option value="SG">Singapore</option> <option value="SX">Sint Maarten (Dutch part)</option> <option value="SK">Slovakia</option> <option value="SI">Slovenia</option> <option value="SB">Solomon Islands</option> <option value="SO">Somalia</option> <option value="ZA">South Africa</option> <option value="GS">South Georgia and the South Sandwich Islands</option> <option value="SS">South Sudan</option> <option value="ES">Spain</option> <option value="LK">Sri Lanka</option> <option value="SD">Sudan</option> <option value="SR">Suriname</option> <option value="SJ">Svalbard and Jan Mayen</option> <option value="SZ">Swaziland</option> <option value="SE">Sweden</option> <option value="CH">Switzerland</option> <option value="SY">Syrian Arab Republic</option> <option value="TW">Taiwan, Province of China</option> <option value="TJ">Tajikistan</option> <option value="TZ">Tanzania, United Republic of</option> <option value="TH">Thailand</option> <option value="TL">Timor-Leste</option> <option value="TG">Togo</option> <option value="TK">Tokelau</option> <option value="TO">Tonga</option> <option value="TT">Trinidad and Tobago</option> <option value="TN">Tunisia</option> <option value="TR">Turkey</option> <option value="TM">Turkmenistan</option> <option value="TC">Turks and Caicos Islands</option> <option value="TV">Tuvalu</option> <option value="UG">Uganda</option> <option value="UA">Ukraine</option> <option value="AE">United Arab Emirates</option> <option value="GB">United Kingdom</option> <option value="US">United States</option> <option value="UM">United States Minor Outlying Islands</option> <option value="UY">Uruguay</option> <option value="UZ">Uzbekistan</option> <option value="VU">Vanuatu</option> <option value="VE">Venezuela, Bolivarian Republic of</option> <option value="VN">Viet Nam</option> <option value="VG">Virgin Islands, British</option> <option value="VI">Virgin Islands, U.S.</option> 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