{"id":45427,"date":"2022-05-19T06:42:02","date_gmt":"2022-05-19T06:42:02","guid":{"rendered":"https:\/\/www.rom1961.com\/klachten\/"},"modified":"2022-05-19T06:48:13","modified_gmt":"2022-05-19T06:48:13","slug":"klachten","status":"publish","type":"page","link":"https:\/\/www.rom1961.com\/be_nl\/klachten\/","title":{"rendered":"Serviceformulier"},"content":{"rendered":"\n\n[et_pb_section fb_built=&#8221;1&#8243; theme_builder_area=&#8221;post_content&#8221; _builder_version=&#8221;4.15.1&#8243; _module_preset=&#8221;default&#8221;][et_pb_row _builder_version=&#8221;4.15.1&#8243; _module_preset=&#8221;default&#8221; theme_builder_area=&#8221;post_content&#8221;][et_pb_column _builder_version=&#8221;4.15.1&#8243; _module_preset=&#8221;default&#8221; type=&#8221;4_4&#8243; theme_builder_area=&#8221;post_content&#8221;][et_pb_code _builder_version=&#8221;4.15.1&#8243; _module_preset=&#8221;default&#8221; theme_builder_area=&#8221;post_content&#8221; hover_enabled=&#8221;0&#8243; sticky_enabled=&#8221;0&#8243;]<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\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\/* ]]> *\/\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_1' style='display:none'>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">Meld ons uw klacht<\/h2>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_1'  action='\/be_nl\/wp-json\/wp\/v2\/pages\/45427' data-formid='1' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_1' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_1_43\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_43'>Instagram<\/label><div class='ginput_container'><input name='input_43' id='input_1_43' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_1_43'>This field is for validation purposes and should be left unchanged.<\/div><\/div><div id=\"field_1_1\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p>Gelieve alle velden zorgvuldig en compleet in te vullen. <br>Deze informatie is nodig voor de verdere behandeling van uw dossier.<\/p><\/div><div id=\"field_1_35\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_35'>Onze referentie<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_35'>Gelieve het ROM-factuurnummer (IN00xxxxxx) of het ROM-ordernummer (ON00xxxxxx) te vermelden.<\/div><div class='ginput_container ginput_container_text'><input name='input_35' id='input_1_35' type='text' value='' class='large'  aria-describedby=\"gfield_description_1_35\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_9\" class=\"gfield gfield--type-text gfield--width-full 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_1_9'>Uw referentie<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_9' id='input_1_9' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_12\" class=\"gfield gfield--type-text gfield--width-full 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_1_12'>Welk deel van het meubel is beschadigd?<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_12' id='input_1_12' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_13\" class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_13'>Beschrijving van het probleem<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_13'>Omschrijf het probleem of defect nauwkeurig.<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_13' id='input_1_13' class='textarea large'  aria-describedby=\"gfield_description_1_13\"   aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_1_24\" class=\"gfield gfield--type-select gfield--width-full 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_1_24'>Locatie van de goederen<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_24' id='input_1_24' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Selecteer ...<\/option><option value='Bij de eindklant' >Bij de eindklant<\/option><option value='In de winkel' >In de winkel<\/option><\/select><\/div><\/div><fieldset id=\"field_1_17\" class=\"gfield gfield--type-name 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' >Verantwoordelijke persoon \/ contactpersoon in de winkel<\/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_1_17'>\n                            \n                            <span id='input_1_17_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_17.3' id='input_1_17_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_1_17_3' class='gform-field-label gform-field-label--type-sub '>Eerste<\/label>\n                                                <\/span>\n                            \n                            <span id='input_1_17_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_17.6' id='input_1_17_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_1_17_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_1_27\" class=\"gfield gfield--type-phone 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_1_27'>Telefoon van de contactpersoon<\/label><div class='ginput_container ginput_container_phone'><input name='input_27' id='input_1_27' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_31\" class=\"gfield gfield--type-email 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_1_31'>E-Mail van de contactpersoon<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_31' id='input_1_31' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><fieldset id=\"field_1_29\" class=\"gfield gfield--type-name gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Gegevens van de klant en plaats waar de goederen zich bevinden<\/legend><div class='gfield_description' id='gfield_description_1_29'>\n<\/div><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_1_29'>\n                            \n                            <span id='input_1_29_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_29.3' id='input_1_29_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_1_29_3' class='gform-field-label gform-field-label--type-sub '>Eerste<\/label>\n                                                <\/span>\n                            \n                            <span id='input_1_29_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_29.6' id='input_1_29_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_1_29_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_1_18\" class=\"gfield gfield--type-address gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label screen-reader-text gfield_label_before_complex' ><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_zip has_country ginput_container_address gform-grid-row' id='input_1_18' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_1_18_1_container' >\n                                        <input type='text' name='input_18.1' id='input_1_18_1' value=''    aria-required='false'    \/>\n                                        <label for='input_1_18_1' id='input_1_18_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_1_18_2_container' >\n                                        <input type='text' name='input_18.2' id='input_1_18_2' value=''     aria-required='false'   \/>\n                                        <label for='input_1_18_2' id='input_1_18_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_1_18_3_container' >\n                                    <input type='text' name='input_18.3' id='input_1_18_3' value=''    aria-required='false'    \/>\n                                    <label for='input_1_18_3' id='input_1_18_3_label' class='gform-field-label gform-field-label--type-sub '>Stad<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_18.4' id='input_1_18_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_1_18_5_container' >\n                                    <input type='text' name='input_18.5' id='input_1_18_5' value=''    aria-required='false'    \/>\n                                    <label for='input_1_18_5' id='input_1_18_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_1_18_6_container' >\n                                        <select name='input_18.6' id='input_1_18_6'   aria-required='false'    ><option value='' selected='selected'><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albani\u00eb' >Albani\u00eb<\/option><option value='Algerije' >Algerije<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andora' >Andora<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentini\u00eb' >Argentini\u00eb<\/option><option value='Armeni\u00eb' >Armeni\u00eb<\/option><option value='Aruba' >Aruba<\/option><option value='Australi\u00eb' >Australi\u00eb<\/option><option value='Azerbeidzjan' >Azerbeidzjan<\/option><option value='Bahama&#039;s' >Bahama&#039;s<\/option><option value='Bahrein' >Bahrein<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belgi\u00eb' >Belgi\u00eb<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius en Saba' >Bonaire, Sint Eustatius en Saba<\/option><option value='Bosni\u00eb en Herzegovina' >Bosni\u00eb en Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet' >Bouvet<\/option><option value='Brazili\u00eb' >Brazili\u00eb<\/option><option value='Brits Indische overzeese gebieden' >Brits Indische overzeese gebieden<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgarije' >Bulgarije<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cabo Verde' >Cabo Verde<\/option><option value='Cambodja' >Cambodja<\/option><option value='Canada' >Canada<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Centraal-Afrikaanse Republiek' >Centraal-Afrikaanse Republiek<\/option><option value='Chili' >Chili<\/option><option value='China' >China<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoren' >Comoren<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Congo-Brazzaville' >Congo-Brazzaville<\/option><option value='Cookeilanden' >Cookeilanden<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao ' >Cura\u00e7ao <\/option><option value='Cyprus' >Cyprus<\/option><option value='Czechia' >Czechia<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Denemarken' >Denemarken<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominicaanse Republiek' >Dominicaanse Republiek<\/option><option value='Duitsland' >Duitsland<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypte' >Egypte<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatoriaal Guinea' >Equatoriaal Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estland' >Estland<\/option><option value='Eswatini' >Eswatini<\/option><option value='Ethiopi\u00eb' >Ethiopi\u00eb<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Far\u00f6er Eilanden' >Far\u00f6er Eilanden<\/option><option value='Fiji' >Fiji<\/option><option value='Filipijnen' >Filipijnen<\/option><option value='Finland' >Finland<\/option><option value='Frankrijk' >Frankrijk<\/option><option value='Frans Guinea' >Frans Guinea<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgi\u00eb' >Georgi\u00eb<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Grenada' >Grenada<\/option><option value='Griekenland' >Griekenland<\/option><option value='Groenland' >Groenland<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinee' >Guinee<\/option><option value='Guinee-Bissau' >Guinee-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Ha\u00efti' >Ha\u00efti<\/option><option value='Heard Island and McDonald Islands' >Heard Island and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hongarije' >Hongarije<\/option><option value='IJsland' >IJsland<\/option><option value='Ierland' >Ierland<\/option><option value='India' >India<\/option><option value='Indonesi\u00eb' >Indonesi\u00eb<\/option><option value='Irak' >Irak<\/option><option value='Iran' >Iran<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Isra\u00ebl' >Isra\u00ebl<\/option><option value='Itali\u00eb' >Itali\u00eb<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordani\u00eb' >Jordani\u00eb<\/option><option value='Kameroen' >Kameroen<\/option><option value='Kazachstan' >Kazachstan<\/option><option value='Kenia' >Kenia<\/option><option value='Kersteiland' >Kersteiland<\/option><option value='Kirgizi\u00eb' >Kirgizi\u00eb<\/option><option value='Kiribari' >Kiribari<\/option><option value='Koeweit' >Koeweit<\/option><option value='Korea, Democratic People&#039;s Republic of' >Korea, Democratic People&#039;s Republic of<\/option><option value='Korea, Republic of' >Korea, Republic of<\/option><option value='Kroati\u00eb' >Kroati\u00eb<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Lesotho' >Lesotho<\/option><option value='Letland' >Letland<\/option><option value='Libanon' >Libanon<\/option><option value='Liberi\u00eb' >Liberi\u00eb<\/option><option value='Libi\u00eb' >Libi\u00eb<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Litouwen' >Litouwen<\/option><option value='Luxemburg' >Luxemburg<\/option><option value='Macau' >Macau<\/option><option value='Madagaskar' >Madagaskar<\/option><option value='Malawi' >Malawi<\/option><option value='Malediven' >Malediven<\/option><option value='Maleisi\u00eb' >Maleisi\u00eb<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marokko' >Marokko<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritani\u00eb' >Mauritani\u00eb<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesi\u00eb' >Micronesi\u00eb<\/option><option value='Moldavi\u00eb' >Moldavi\u00eb<\/option><option value='Monaco' >Monaco<\/option><option value='Mongoli\u00eb' >Mongoli\u00eb<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibi\u00eb' >Namibi\u00eb<\/option><option value='Nauru' >Nauru<\/option><option value='Nederland' >Nederland<\/option><option value='Nepal' >Nepal<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Nieuw Zeeland' >Nieuw Zeeland<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Noord-Macedoni\u00eb' >Noord-Macedoni\u00eb<\/option><option value='Noorwegen' >Noorwegen<\/option><option value='Norfolkeiland' >Norfolkeiland<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Oeganda' >Oeganda<\/option><option value='Oekra\u00efne' >Oekra\u00efne<\/option><option value='Oman' >Oman<\/option><option value='Oostenrijk' >Oostenrijk<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papoea-Nieuw-Guinea' >Papoea-Nieuw-Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Polen' >Polen<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Replubliek Vanuatu' >Replubliek Vanuatu<\/option><option value='Roemeni\u00eb' >Roemeni\u00eb<\/option><option value='Russian Federation' >Russian Federation<\/option><option value='Ruwanda' >Ruwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Helena, Ascension and Tristan da Cunha' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saoedi-Arabi\u00eb' >Saoedi-Arabi\u00eb<\/option><option value='Senegal' >Senegal<\/option><option value='Servi\u00eb' >Servi\u00eb<\/option><option value='Seychellen' >Seychellen<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Bartholomeus' >Sint Bartholomeus<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakije' >Slovakije<\/option><option value='Sloveni\u00eb' >Sloveni\u00eb<\/option><option value='Solomoneilanden' >Solomoneilanden<\/option><option value='Somali\u00eb' >Somali\u00eb<\/option><option value='South Georgia and the South Sandwich Islands' >South Georgia and the South Sandwich Islands<\/option><option value='Spanje' >Spanje<\/option><option value='Spitsbergen en Jan Mayen' >Spitsbergen en Jan Mayen<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Syria Arab Republic' >Syria Arab Republic<\/option><option value='Tadzjikistan' >Tadzjikistan<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tanzania, the United Republic of' >Tanzania, the United Republic of<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau-eilanden' >Tokelau-eilanden<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad en Tobago' >Trinidad en Tobago<\/option><option value='Tsjaad' >Tsjaad<\/option><option value='Tunesi\u00eb' >Tunesi\u00eb<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkiye' >T\u00fcrkiye<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Venezuela' >Venezuela<\/option><option value='Verenigd Koninkrijk' >Verenigd Koninkrijk<\/option><option value='Verenigde Arabische Emiraten' >Verenigde Arabische Emiraten<\/option><option value='Verenigde Staten van Amerika' >Verenigde Staten van Amerika<\/option><option value='Viet Nam' >Viet Nam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='West-Sahara' >West-Sahara<\/option><option value='Wit-Rusland' >Wit-Rusland<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='Zuid Soedan' >Zuid Soedan<\/option><option value='Zuid-Afrika' >Zuid-Afrika<\/option><option value='Zweden' >Zweden<\/option><option value='Zwitserland' >Zwitserland<\/option><option value='\u00c5land' >\u00c5land<\/option><\/select>\n                                        <label for='input_1_18_6' id='input_1_18_6_label' class='gform-field-label gform-field-label--type-sub '>Land<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_1_28\" class=\"gfield gfield--type-email 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_1_28'>E-Mail van de klant<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_28' id='input_1_28' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_1_19\" class=\"gfield gfield--type-phone field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_19'>Telefoon van de klant<\/label><div class='ginput_container ginput_container_phone'><input name='input_19' id='input_1_19' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_39\" class=\"gfield gfield--type-fileupload gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_39'>Fotos<\/label><div class='gfield_description' id='gfield_description_1_39'>Om het probleem zo nauwkeurig mogelijk te omschrijven, verzoeken wij u \u00e9\u00e9n of meer foto's te uploaden.<\/div><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='134217728' \/><input name='input_39' id='input_1_39' type='file' class='large' aria-describedby=\"gfield_upload_rules_1_39 gfield_description_1_39\" onchange='javascript:gformValidateFileSize( this, 134217728 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_1_39'>Max. file size: 128 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_1_39'><\/div> <\/div><\/div><div id=\"field_1_40\" class=\"gfield gfield--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 screen-reader-text' for='input_1_40'><\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='134217728' \/><input name='input_40' id='input_1_40' type='file' class='large' aria-describedby=\"gfield_upload_rules_1_40\" onchange='javascript:gformValidateFileSize( this, 134217728 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_1_40'>Max. file size: 128 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_1_40'><\/div> <\/div><\/div><div id=\"field_1_42\" class=\"gfield gfield--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 screen-reader-text' for='input_1_42'><\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='134217728' \/><input name='input_42' id='input_1_42' type='file' class='large' aria-describedby=\"gfield_upload_rules_1_42\" onchange='javascript:gformValidateFileSize( this, 134217728 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_1_42'>Max. file size: 128 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_1_42'><\/div> <\/div><\/div><div id=\"field_1_32\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_32'>Verdere opmerkingen<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_32' id='input_1_32' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_1_37\" class=\"gfield gfield--type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_37'>Uw e-mailadres voor verdere correspondentie met betrekking tot dit dossier<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_37' id='input_1_37' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_1_37\" \/>\n                        <\/div><div class='gfield_description' id='gfield_description_1_37'>Een kopie van dit formulier zal naar dit adres worden verstuurd.<\/div><\/div><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type='submit' id='gform_submit_button_1' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Verzend'  \/> <button type='button'  id='gform_save_1_footer_link' onclick='gform.submission.handleButtonClick(this);' data-submission-type='save-continue' class='gform_save_link gform-theme-button gform-theme-button--secondary button'  ><svg aria-hidden=\"true\" focusable=\"false\" width=\"16\" height=\"16\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M0 8a4 4 0 004 4h3v3a1 1 0 102 0v-3h3a4 4 0 100-8 4 4 0 10-8 0 4 4 0 00-4 4zm9 4H7V7.414L5.707 8.707a1 1 0 01-1.414-1.414l3-3a1 1 0 011.414 0l3 3a1 1 0 01-1.414 1.414L9 7.414V12z\" fill=\"#6B7280\"\/><\/svg> Opslaan en later verder gaan<\/button>\n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_1' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_1' id='gform_theme_1' value='gravity-theme' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_1' id='gform_style_settings_1' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_1' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_save' id='gform_save_1' value='' \/>\n                             <input type='hidden' class='gform_hidden' name='gform_resume_token' id='gform_resume_token_1' value='' \/>\n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='EUR' value='hVIHJARXbgrTDnz8zPaC8W3f72qgnY6RMIkzwxHwUJmmbq1OzlrjSHVeFx4Vyx3nE6pKjVIqZ\/VDwVWPP+vQGPXKk3Sa6fZdFLjCsdaGrb6c3jE=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_1' value='WyJbXSIsIjM1NTEzMjM3YjVjNTZhNTYyMGM0ODRjZmI2ZDYzZjhiIl0=' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_1' id='gform_target_page_number_1' value='0' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_1' id='gform_source_page_number_1' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/form>\n                        <\/div><script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\n gform.initializeOnLoaded( function() {gformInitSpinner( 1, 'https:\/\/www.rom1961.com\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_1').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_1');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_1').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){form_content.find('form').css('opacity', 0);jQuery('#gform_wrapper_1').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_1').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_1').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_1').val();gformInitSpinner( 1, 'https:\/\/www.rom1961.com\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery(document).trigger('gform_page_loaded', [1, current_page]);window['gf_submitting_1'] = 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_1').replaceWith(confirmation_content);jQuery(document).trigger('gform_confirmation_loaded', [1]);window['gf_submitting_1'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_1').text());}else{jQuery('#gform_1').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger(\"gform_pre_post_render\", [{ formId: \"1\", currentPage: \"current_page\", abort: function() { this.preventDefault(); } }]);        if (event && event.defaultPrevented) {                return;        }        const gformWrapperDiv = document.getElementById( \"gform_wrapper_1\" );        if ( gformWrapperDiv ) {            const visibilitySpan = document.createElement( \"span\" );            visibilitySpan.id = \"gform_visibility_test_1\";            gformWrapperDiv.insertAdjacentElement( \"afterend\", visibilitySpan );        }        const visibilityTestDiv = document.getElementById( \"gform_visibility_test_1\" );        let postRenderFired = false;        function triggerPostRender() {            if ( postRenderFired ) {                return;            }            postRenderFired = true;            gform.core.triggerPostRenderEvents( 1, 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();                    }                });            });            observer.observe( document.body, {                attributes: true,                childList: false,                subtree: true,                attributeFilter: [ 'style', 'class' ],            });        } else {            triggerPostRender();        }    } );} ); \n\/* ]]> *\/\n<\/script>\n[\/et_pb_code][\/et_pb_column][\/et_pb_row][\/et_pb_section]\n\n","protected":false},"excerpt":{"rendered":"\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_1' style='display:none'>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">Meld ons uw klacht<\/h2>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_1'  action='\/be_nl\/wp-json\/wp\/v2\/pages\/45427' data-formid='1' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_1' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_1_43\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_43'>LinkedIn<\/label><div class='ginput_container'><input name='input_43' id='input_1_43' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_1_43'>This field is for validation purposes and should be left unchanged.<\/div><\/div><div id=\"field_1_1\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p>Gelieve alle velden zorgvuldig en compleet in te vullen. <br>Deze informatie is nodig voor de verdere behandeling van uw dossier.<\/p><\/div><div id=\"field_1_35\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_35'>Onze referentie<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_35'>Gelieve het ROM-factuurnummer (IN00xxxxxx) of het ROM-ordernummer (ON00xxxxxx) te vermelden.<\/div><div class='ginput_container ginput_container_text'><input name='input_35' id='input_1_35' type='text' value='' class='large'  aria-describedby=\"gfield_description_1_35\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_9\" class=\"gfield gfield--type-text gfield--width-full 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_1_9'>Uw referentie<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_9' id='input_1_9' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_12\" class=\"gfield gfield--type-text gfield--width-full 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_1_12'>Welk deel van het meubel is beschadigd?<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_12' id='input_1_12' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_13\" class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_13'>Beschrijving van het probleem<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_13'>Omschrijf het probleem of defect nauwkeurig.<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_13' id='input_1_13' class='textarea large'  aria-describedby=\"gfield_description_1_13\"   aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_1_24\" class=\"gfield gfield--type-select gfield--width-full 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_1_24'>Locatie van de goederen<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_24' id='input_1_24' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Selecteer ...<\/option><option value='Bij de eindklant' >Bij de eindklant<\/option><option value='In de winkel' >In de winkel<\/option><\/select><\/div><\/div><fieldset id=\"field_1_17\" class=\"gfield gfield--type-name 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' >Verantwoordelijke persoon \/ contactpersoon in de winkel<\/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_1_17'>\n                            \n                            <span id='input_1_17_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_17.3' id='input_1_17_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_1_17_3' class='gform-field-label gform-field-label--type-sub '>Eerste<\/label>\n                                                <\/span>\n                            \n                            <span id='input_1_17_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_17.6' id='input_1_17_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_1_17_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_1_27\" class=\"gfield gfield--type-phone 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_1_27'>Telefoon van de contactpersoon<\/label><div class='ginput_container ginput_container_phone'><input name='input_27' id='input_1_27' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_31\" class=\"gfield gfield--type-email 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_1_31'>E-Mail van de contactpersoon<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_31' id='input_1_31' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><fieldset id=\"field_1_29\" class=\"gfield gfield--type-name gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Gegevens van de klant en plaats waar de goederen zich bevinden<\/legend><div class='gfield_description' id='gfield_description_1_29'>\n<\/div><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_1_29'>\n                            \n                            <span id='input_1_29_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_29.3' id='input_1_29_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_1_29_3' class='gform-field-label gform-field-label--type-sub '>Eerste<\/label>\n                                                <\/span>\n                            \n                            <span id='input_1_29_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_29.6' id='input_1_29_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_1_29_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_1_18\" class=\"gfield gfield--type-address gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label screen-reader-text gfield_label_before_complex' ><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_zip has_country ginput_container_address gform-grid-row' id='input_1_18' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_1_18_1_container' >\n                                        <input type='text' name='input_18.1' id='input_1_18_1' value=''    aria-required='false'    \/>\n                                        <label for='input_1_18_1' id='input_1_18_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_1_18_2_container' >\n                                        <input type='text' name='input_18.2' id='input_1_18_2' value=''     aria-required='false'   \/>\n                                        <label for='input_1_18_2' id='input_1_18_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_1_18_3_container' >\n                                    <input type='text' name='input_18.3' id='input_1_18_3' value=''    aria-required='false'    \/>\n                                    <label for='input_1_18_3' id='input_1_18_3_label' class='gform-field-label gform-field-label--type-sub '>Stad<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_18.4' id='input_1_18_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_1_18_5_container' >\n                                    <input type='text' name='input_18.5' id='input_1_18_5' value=''    aria-required='false'    \/>\n                                    <label for='input_1_18_5' id='input_1_18_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_1_18_6_container' >\n                                        <select name='input_18.6' id='input_1_18_6'   aria-required='false'    ><option value='' selected='selected'><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albani\u00eb' >Albani\u00eb<\/option><option value='Algerije' >Algerije<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andora' >Andora<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentini\u00eb' >Argentini\u00eb<\/option><option value='Armeni\u00eb' >Armeni\u00eb<\/option><option value='Aruba' >Aruba<\/option><option value='Australi\u00eb' >Australi\u00eb<\/option><option value='Azerbeidzjan' >Azerbeidzjan<\/option><option value='Bahama&#039;s' >Bahama&#039;s<\/option><option value='Bahrein' >Bahrein<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belgi\u00eb' >Belgi\u00eb<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius en Saba' >Bonaire, Sint Eustatius en Saba<\/option><option value='Bosni\u00eb en Herzegovina' >Bosni\u00eb en Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet' >Bouvet<\/option><option value='Brazili\u00eb' >Brazili\u00eb<\/option><option value='Brits Indische overzeese gebieden' >Brits Indische overzeese gebieden<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgarije' >Bulgarije<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cabo Verde' >Cabo Verde<\/option><option value='Cambodja' >Cambodja<\/option><option value='Canada' >Canada<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Centraal-Afrikaanse Republiek' >Centraal-Afrikaanse Republiek<\/option><option value='Chili' >Chili<\/option><option value='China' >China<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoren' >Comoren<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Congo-Brazzaville' >Congo-Brazzaville<\/option><option value='Cookeilanden' >Cookeilanden<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao ' >Cura\u00e7ao <\/option><option value='Cyprus' >Cyprus<\/option><option value='Czechia' >Czechia<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Denemarken' >Denemarken<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominicaanse Republiek' >Dominicaanse Republiek<\/option><option value='Duitsland' >Duitsland<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypte' >Egypte<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatoriaal Guinea' >Equatoriaal Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estland' >Estland<\/option><option value='Eswatini' >Eswatini<\/option><option value='Ethiopi\u00eb' >Ethiopi\u00eb<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Far\u00f6er Eilanden' >Far\u00f6er Eilanden<\/option><option value='Fiji' >Fiji<\/option><option value='Filipijnen' >Filipijnen<\/option><option value='Finland' >Finland<\/option><option value='Frankrijk' >Frankrijk<\/option><option value='Frans Guinea' >Frans Guinea<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgi\u00eb' >Georgi\u00eb<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Grenada' >Grenada<\/option><option value='Griekenland' >Griekenland<\/option><option value='Groenland' >Groenland<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinee' >Guinee<\/option><option value='Guinee-Bissau' >Guinee-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Ha\u00efti' >Ha\u00efti<\/option><option value='Heard Island and McDonald Islands' >Heard Island and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hongarije' >Hongarije<\/option><option value='IJsland' >IJsland<\/option><option value='Ierland' >Ierland<\/option><option value='India' >India<\/option><option value='Indonesi\u00eb' >Indonesi\u00eb<\/option><option value='Irak' >Irak<\/option><option value='Iran' >Iran<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Isra\u00ebl' >Isra\u00ebl<\/option><option value='Itali\u00eb' >Itali\u00eb<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordani\u00eb' >Jordani\u00eb<\/option><option value='Kameroen' >Kameroen<\/option><option value='Kazachstan' >Kazachstan<\/option><option value='Kenia' >Kenia<\/option><option value='Kersteiland' >Kersteiland<\/option><option value='Kirgizi\u00eb' >Kirgizi\u00eb<\/option><option value='Kiribari' >Kiribari<\/option><option value='Koeweit' >Koeweit<\/option><option value='Korea, Democratic People&#039;s Republic of' >Korea, Democratic People&#039;s Republic of<\/option><option value='Korea, Republic of' >Korea, Republic of<\/option><option value='Kroati\u00eb' >Kroati\u00eb<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Lesotho' >Lesotho<\/option><option value='Letland' >Letland<\/option><option value='Libanon' >Libanon<\/option><option value='Liberi\u00eb' >Liberi\u00eb<\/option><option value='Libi\u00eb' >Libi\u00eb<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Litouwen' >Litouwen<\/option><option value='Luxemburg' >Luxemburg<\/option><option value='Macau' >Macau<\/option><option value='Madagaskar' >Madagaskar<\/option><option value='Malawi' >Malawi<\/option><option value='Malediven' >Malediven<\/option><option value='Maleisi\u00eb' >Maleisi\u00eb<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marokko' >Marokko<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritani\u00eb' >Mauritani\u00eb<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesi\u00eb' >Micronesi\u00eb<\/option><option value='Moldavi\u00eb' >Moldavi\u00eb<\/option><option value='Monaco' >Monaco<\/option><option value='Mongoli\u00eb' >Mongoli\u00eb<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibi\u00eb' >Namibi\u00eb<\/option><option value='Nauru' >Nauru<\/option><option value='Nederland' >Nederland<\/option><option value='Nepal' >Nepal<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Nieuw Zeeland' >Nieuw Zeeland<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Noord-Macedoni\u00eb' >Noord-Macedoni\u00eb<\/option><option value='Noorwegen' >Noorwegen<\/option><option value='Norfolkeiland' >Norfolkeiland<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Oeganda' >Oeganda<\/option><option value='Oekra\u00efne' >Oekra\u00efne<\/option><option value='Oman' >Oman<\/option><option value='Oostenrijk' >Oostenrijk<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papoea-Nieuw-Guinea' >Papoea-Nieuw-Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Polen' >Polen<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Replubliek Vanuatu' >Replubliek Vanuatu<\/option><option value='Roemeni\u00eb' >Roemeni\u00eb<\/option><option value='Russian Federation' >Russian Federation<\/option><option value='Ruwanda' >Ruwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Helena, Ascension and Tristan da Cunha' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saoedi-Arabi\u00eb' >Saoedi-Arabi\u00eb<\/option><option value='Senegal' >Senegal<\/option><option value='Servi\u00eb' >Servi\u00eb<\/option><option value='Seychellen' >Seychellen<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Bartholomeus' >Sint Bartholomeus<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakije' >Slovakije<\/option><option value='Sloveni\u00eb' >Sloveni\u00eb<\/option><option value='Solomoneilanden' >Solomoneilanden<\/option><option value='Somali\u00eb' >Somali\u00eb<\/option><option value='South Georgia and the South Sandwich Islands' >South Georgia and the South Sandwich Islands<\/option><option value='Spanje' >Spanje<\/option><option value='Spitsbergen en Jan Mayen' >Spitsbergen en Jan Mayen<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Syria Arab Republic' >Syria Arab Republic<\/option><option value='Tadzjikistan' >Tadzjikistan<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tanzania, the United Republic of' >Tanzania, the United Republic of<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau-eilanden' >Tokelau-eilanden<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad en Tobago' >Trinidad en Tobago<\/option><option value='Tsjaad' >Tsjaad<\/option><option value='Tunesi\u00eb' >Tunesi\u00eb<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkiye' >T\u00fcrkiye<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Venezuela' >Venezuela<\/option><option value='Verenigd Koninkrijk' >Verenigd Koninkrijk<\/option><option value='Verenigde Arabische Emiraten' >Verenigde Arabische Emiraten<\/option><option value='Verenigde Staten van Amerika' >Verenigde Staten van Amerika<\/option><option value='Viet Nam' >Viet Nam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='West-Sahara' >West-Sahara<\/option><option value='Wit-Rusland' >Wit-Rusland<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='Zuid Soedan' >Zuid Soedan<\/option><option value='Zuid-Afrika' >Zuid-Afrika<\/option><option value='Zweden' >Zweden<\/option><option value='Zwitserland' >Zwitserland<\/option><option value='\u00c5land' >\u00c5land<\/option><\/select>\n                                        <label for='input_1_18_6' id='input_1_18_6_label' class='gform-field-label gform-field-label--type-sub '>Land<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_1_28\" class=\"gfield gfield--type-email 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_1_28'>E-Mail van de klant<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_28' id='input_1_28' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_1_19\" class=\"gfield gfield--type-phone field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_19'>Telefoon van de klant<\/label><div class='ginput_container ginput_container_phone'><input name='input_19' id='input_1_19' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_39\" class=\"gfield gfield--type-fileupload gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_39'>Fotos<\/label><div class='gfield_description' id='gfield_description_1_39'>Om het probleem zo nauwkeurig mogelijk te omschrijven, verzoeken wij u \u00e9\u00e9n of meer foto's te uploaden.<\/div><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='134217728' \/><input name='input_39' id='input_1_39' type='file' class='large' aria-describedby=\"gfield_upload_rules_1_39 gfield_description_1_39\" onchange='javascript:gformValidateFileSize( this, 134217728 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_1_39'>Max. file size: 128 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_1_39'><\/div> <\/div><\/div><div id=\"field_1_40\" class=\"gfield gfield--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 screen-reader-text' for='input_1_40'><\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='134217728' \/><input name='input_40' id='input_1_40' type='file' class='large' aria-describedby=\"gfield_upload_rules_1_40\" onchange='javascript:gformValidateFileSize( this, 134217728 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_1_40'>Max. file size: 128 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_1_40'><\/div> <\/div><\/div><div id=\"field_1_42\" class=\"gfield gfield--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 screen-reader-text' for='input_1_42'><\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='134217728' \/><input name='input_42' id='input_1_42' type='file' class='large' aria-describedby=\"gfield_upload_rules_1_42\" onchange='javascript:gformValidateFileSize( this, 134217728 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_1_42'>Max. file size: 128 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_1_42'><\/div> <\/div><\/div><div id=\"field_1_32\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_32'>Verdere opmerkingen<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_32' id='input_1_32' class='textarea large'      aria-invalid=\"false\"   rows='10' 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