{"id":23206,"date":"2025-03-24T18:12:51","date_gmt":"2025-03-24T17:12:51","guid":{"rendered":"https:\/\/bestadeoluwa.ng\/rms\/?page_id=23206"},"modified":"2025-04-23T09:52:20","modified_gmt":"2025-04-23T08:52:20","slug":"kangen-booking","status":"publish","type":"page","link":"https:\/\/bestadeoluwa.ng\/rms\/kangen-booking\/","title":{"rendered":"kangen booking"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"23206\" class=\"elementor elementor-23206\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-8911931 elementor-section-height-min-height elementor-section-stretched elementor-section-boxed elementor-section-height-default elementor-section-items-middle\" data-id=\"8911931\" data-element_type=\"section\" data-settings=\"{&quot;stretch_section&quot;:&quot;section-stretched&quot;,&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-custom\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-16ebb9c\" data-id=\"16ebb9c\" data-element_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-1464239 elementor-widget elementor-widget-thim-ekits-breadcrumb\" data-id=\"1464239\" data-element_type=\"widget\" data-widget_type=\"thim-ekits-breadcrumb.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\n\t\t\t<div class=\"thim-ekit-breadcrumb\">\n\n\t\t\t\tHome\n\t\t\t<\/div>\n\n\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\t<\/div>\n\t\t<\/section>\n\t\t<div class=\"elementor-element elementor-element-170b17d e-flex e-con-boxed e-con e-parent\" data-id=\"170b17d\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-1d67dad elementor-widget__width-initial elementor-widget elementor-widget-image\" data-id=\"1d67dad\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"288\" height=\"300\" src=\"https:\/\/bestadeoluwa.ng\/rms\/wp-content\/uploads\/2025\/03\/BEST_ADEOLUWA_LOGO-png-288x300.png\" class=\"attachment-medium size-medium wp-image-23040\" alt=\"\" srcset=\"https:\/\/bestadeoluwa.ng\/rms\/wp-content\/uploads\/2025\/03\/BEST_ADEOLUWA_LOGO-png-288x300.png 288w, https:\/\/bestadeoluwa.ng\/rms\/wp-content\/uploads\/2025\/03\/BEST_ADEOLUWA_LOGO-png.png 490w\" sizes=\"(max-width: 288px) 100vw, 288px\" \/>\t\t\t\t\t\t\t\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\t\t<\/div>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-731e9ce elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"731e9ce\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-custom\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-f9ef442\" data-id=\"f9ef442\" data-element_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-54f907b elementor-widget__width-initial elementor-widget-tablet__width-inherit elementor-widget elementor-widget-heading\" data-id=\"54f907b\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\"><span>KANGEN PRODUCT(S) ORDER<\/span><\/h1>\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<div class=\"elementor-element elementor-element-d5c6758 e-flex e-con-boxed e-con e-parent\" data-id=\"d5c6758\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-916f697 elementor-widget elementor-widget-everest-forms\" data-id=\"916f697\" data-element_type=\"widget\" data-widget_type=\"everest-forms.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"everest-forms\"><script type='text\/javascript'>\n\/* <![CDATA[ *\/\nvar evf_settings = {\"currency_code\":\"USD\",\"currency_thousands\":\",\",\"currency_decimal\":\".\",\"currency_symbol\":\"$\",\"currency_symbol_pos\":\"left\"}\n\/* ]]> *\/\n<\/script>\n<div class=\"evf-container layout-two\" id=\"evf-23205\"><form id=\"evf-form-23205\" class=\"everest-form\" data-formid=\"23205\" data-ajax_submission=\"0\" data-keyboard_friendly_form=\"0\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/rms\/wp-json\/wp\/v2\/pages\/23206\"><div class=\"evf-field-container\"><input type=\"hidden\" id=\"_wpnonce23205\" name=\"_wpnonce23205\" value=\"86506f7b39\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/rms\/wp-json\/wp\/v2\/pages\/23206\" \/><div class=\"evf-frontend-row\" data-row=\"row_1\" conditional_rules=\"[]\"><div class=\"evf-frontend-grid evf-grid-1\" data-grid=\"grid_1\"><div id=\"evf-23205-field_0rRKcrjjLs-1-container\" class=\"evf-field evf-field-first-name form-row validate-required\" data-required-field-message=\"This field is required.\" data-field-id=\"0rRKcrjjLs-1\"><label class=\"evf-field-label\" for=\"evf-23205-field_0rRKcrjjLs-1\"><span class=\"evf-label\">Full Name (as written in your valid ID Card)<\/span> <abbr class=\"required\" title=\"Required\">*<\/abbr><\/label><input type=\"text\" id=\"evf-23205-field_0rRKcrjjLs-1\" class=\"input-text\" name=\"everest_forms[form_fields][0rRKcrjjLs-1]\" conditional_id=\"0rRKcrjjLs-1\" required><\/div><\/div><\/div><div class=\"evf-frontend-row\" data-row=\"row_2\" conditional_rules=\"[]\"><div class=\"evf-frontend-grid evf-grid-1\" data-grid=\"grid_1\"><div id=\"evf-23205-field_dGKmAhjyol-3-container\" class=\"evf-field evf-field-email form-row validate-required validate-email\" data-required-field-message=\"Please enter a valid email address.\" data-field-id=\"dGKmAhjyol-3\"><label class=\"evf-field-label\" for=\"evf-23205-field_dGKmAhjyol-3\"><span class=\"evf-label\">Email<\/span> <abbr class=\"required\" title=\"Required\">*<\/abbr><\/label><input type=\"email\" id=\"evf-23205-field_dGKmAhjyol-3\" class=\"input-text\" name=\"everest_forms[form_fields][dGKmAhjyol-3]\" conditional_id=\"dGKmAhjyol-3\" required ><\/div><div id=\"evf-23205-field_dPsG9RpYbh-9-container\" class=\"evf-field evf-field-phone form-row validate-required validate-phone\" data-required-field-message=\"Please enter a valid phone number.\" data-field-id=\"dPsG9RpYbh-9\"><label class=\"evf-field-label\" for=\"evf-23205-field_dPsG9RpYbh-9\"><span class=\"evf-label\">Phone Number\/WhatsApp Number<\/span> <abbr class=\"required\" title=\"Required\">*<\/abbr><\/label><input type=\"tel\" id=\"evf-23205-field_dPsG9RpYbh-9\" class=\"input-text evf-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"everest_forms[form_fields][dPsG9RpYbh-9]\" conditional_id=\"dPsG9RpYbh-9\" required><div class=\"evf-field-description\">Separate multiple phone numbers with a space in between<\/div><\/div><\/div><\/div><div class=\"evf-frontend-row\" data-row=\"row_3\" conditional_rules=\"[]\"><div class=\"evf-frontend-grid evf-grid-1\" data-grid=\"grid_1\"><div id=\"evf-23205-field_pt5y57U6nY-23-container\" class=\"evf-field evf-field-radio form-row validate-required everest-forms-trigger-conditional\" data-required-field-message=\"This field is required.\" data-field-id=\"pt5y57U6nY-23\"><label class=\"evf-field-label\" for=\"evf-23205-field_pt5y57U6nY-23\"><span class=\"evf-label\">Select your order item<\/span> <abbr class=\"required\" title=\"Required\">*<\/abbr><\/label><ul id=\"evf-23205-field_pt5y57U6nY-23\" class=\" evf-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"evf-23205-field_pt5y57U6nY-23_1\" class=\"input-text\" name=\"everest_forms[form_fields][pt5y57U6nY-23]\" value=\"Kangen Machine\" conditional_id=\"pt5y57U6nY-23\" required ><label class=\"everest-forms-field-label-inline\" for=\"evf-23205-field_pt5y57U6nY-23_1\">Kangen Machine<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"evf-23205-field_pt5y57U6nY-23_2\" class=\"input-text\" name=\"everest_forms[form_fields][pt5y57U6nY-23]\" value=\"Kangen Water\" conditional_id=\"pt5y57U6nY-23\" required ><label class=\"everest-forms-field-label-inline\" for=\"evf-23205-field_pt5y57U6nY-23_2\">Kangen Water<\/label><\/li><\/ul><\/div><div id=\"evf-23205-field_fnG9xABPBs-10-container\" class=\"evf-field evf-field-divider form-row\" data-field-id=\"fnG9xABPBs-10\"><hr id=\"evf-23205-field_fnG9xABPBs-10\" class=\"input-text evf-divider default\" name=\"everest_forms[form_fields][fnG9xABPBs-10]\" conditional_id=\"fnG9xABPBs-10\"\/><\/div><\/div><\/div><div class=\"evf-frontend-row\" data-row=\"row_6\" data-field-type=repeater-fields data-repeater-field-id=Dmts0Y4nFE-14 data-repeater-row-id=1 conditional_rules=\"[]\"><div class=\"evf-frontend-grid evf-grid-1\" data-grid=\"grid_1\"><div id=\"evf-23205-field_Dmts0Y4nFE-14-container\" class=\"evf-field evf-field-repeater-fields form-row everest-forms-conditional-field\" data-field-id=\"Dmts0Y4nFE-14\"><label class=\"evf-field-label\" for=\"evf-23205-field_Dmts0Y4nFE-14\"><span class=\"evf-label\">Order Details<\/span> <\/label><div type=\"text\" id=\"evf-23205-field_Dmts0Y4nFE-14\" class=\"input-text evf-repeater-fields\" data-rule-evf-repeater-fields=\"math\" name=\"everest_forms[form_fields][Dmts0Y4nFE-14][a]\" data-field-type=\"repeater-fields\" data-repeater-field-id=\"Dmts0Y4nFE-14\" data-repeater-button-add-new-label=\"Request Another Water Type\" data-repeater-button-remove-label=\"Remove\" conditional_id=\"Dmts0Y4nFE-14\" conditional_rules=\"{&quot;conditional_option&quot;:&quot;show&quot;,&quot;conditionals&quot;:{&quot;1&quot;:{&quot;1&quot;:{&quot;field&quot;:&quot;pt5y57U6nY-23&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Kangen Water&quot;}}},&quot;required&quot;:0}\"  class=everest-forms-hidden> <\/div><\/div><div id=\"evf-23205-field_vss4T51Xcm-15-container\" class=\"evf-field evf-field-radio form-row validate-required everest-forms-trigger-conditional everest-forms-conditional-field\" data-required-field-message=\"This field is required.\" data-field-id=\"vss4T51Xcm-15\"><label class=\"evf-field-label\" for=\"evf-23205-field_vss4T51Xcm-15\"><span class=\"evf-label\">Water type needed:<\/span> <abbr class=\"required\" title=\"Required\">*<\/abbr><\/label><ul id=\"evf-23205-field_vss4T51Xcm-15\" class=\" evf-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"evf-23205-field_vss4T51Xcm-15_1\" class=\"input-text\" name=\"everest_forms[form_fields][vss4T51Xcm-15]\" value=\"pH 11.5 (Strong Alkaline Water) &gt;&gt; \u20a61500.00 per litre\" conditional_id=\"vss4T51Xcm-15\" conditional_rules=\"{&quot;conditional_option&quot;:&quot;show&quot;,&quot;conditionals&quot;:{&quot;1&quot;:{&quot;1&quot;:{&quot;field&quot;:&quot;pt5y57U6nY-23&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Kangen Water&quot;}}},&quot;required&quot;:&quot;1&quot;}\" required ><label class=\"everest-forms-field-label-inline\" for=\"evf-23205-field_vss4T51Xcm-15_1\">pH 11.5 (Strong Alkaline Water) &gt;&gt; \u20a61500.00 per litre<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"evf-23205-field_vss4T51Xcm-15_2\" class=\"input-text\" name=\"everest_forms[form_fields][vss4T51Xcm-15]\" value=\"pH 9.5 (Kangen Water) &gt;&gt; \u20a6300.00 per litre\" conditional_id=\"vss4T51Xcm-15\" conditional_rules=\"{&quot;conditional_option&quot;:&quot;show&quot;,&quot;conditionals&quot;:{&quot;1&quot;:{&quot;1&quot;:{&quot;field&quot;:&quot;pt5y57U6nY-23&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Kangen Water&quot;}}},&quot;required&quot;:&quot;1&quot;}\" required ><label class=\"everest-forms-field-label-inline\" for=\"evf-23205-field_vss4T51Xcm-15_2\">pH 9.5 (Kangen Water) &gt;&gt; \u20a6300.00 per litre<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"radio\" id=\"evf-23205-field_vss4T51Xcm-15_6\" class=\"input-text\" name=\"everest_forms[form_fields][vss4T51Xcm-15]\" value=\"pH 8.5\/9.0 (Kangen Water) &gt;&gt; \u20a6300.00 per litre\" conditional_id=\"vss4T51Xcm-15\" conditional_rules=\"{&quot;conditional_option&quot;:&quot;show&quot;,&quot;conditionals&quot;:{&quot;1&quot;:{&quot;1&quot;:{&quot;field&quot;:&quot;pt5y57U6nY-23&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Kangen Water&quot;}}},&quot;required&quot;:&quot;1&quot;}\" required ><label class=\"everest-forms-field-label-inline\" for=\"evf-23205-field_vss4T51Xcm-15_6\">pH 8.5\/9.0 (Kangen Water) &gt;&gt; \u20a6300.00 per litre<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"evf-23205-field_vss4T51Xcm-15_3\" class=\"input-text\" name=\"everest_forms[form_fields][vss4T51Xcm-15]\" value=\"pH 7.0 (Clean Water) &gt;&gt; \u20a6300.00 per litre\" conditional_id=\"vss4T51Xcm-15\" conditional_rules=\"{&quot;conditional_option&quot;:&quot;show&quot;,&quot;conditionals&quot;:{&quot;1&quot;:{&quot;1&quot;:{&quot;field&quot;:&quot;pt5y57U6nY-23&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Kangen Water&quot;}}},&quot;required&quot;:&quot;1&quot;}\" required ><label class=\"everest-forms-field-label-inline\" for=\"evf-23205-field_vss4T51Xcm-15_3\">pH 7.0 (Clean Water) &gt;&gt; \u20a6300.00 per litre<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"evf-23205-field_vss4T51Xcm-15_4\" class=\"input-text\" name=\"everest_forms[form_fields][vss4T51Xcm-15]\" value=\"pH 6.0 (Beauty Water) &gt;&gt; \u20a6300.00 per litre\" conditional_id=\"vss4T51Xcm-15\" conditional_rules=\"{&quot;conditional_option&quot;:&quot;show&quot;,&quot;conditionals&quot;:{&quot;1&quot;:{&quot;1&quot;:{&quot;field&quot;:&quot;pt5y57U6nY-23&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Kangen Water&quot;}}},&quot;required&quot;:&quot;1&quot;}\" required ><label class=\"everest-forms-field-label-inline\" for=\"evf-23205-field_vss4T51Xcm-15_4\">pH 6.0 (Beauty Water) &gt;&gt; \u20a6300.00 per litre<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"evf-23205-field_vss4T51Xcm-15_5\" class=\"input-text\" name=\"everest_forms[form_fields][vss4T51Xcm-15]\" value=\"pH 2.5 (Strong Acidic Water) &gt;&gt; \u20a61500.00 per litre\" conditional_id=\"vss4T51Xcm-15\" conditional_rules=\"{&quot;conditional_option&quot;:&quot;show&quot;,&quot;conditionals&quot;:{&quot;1&quot;:{&quot;1&quot;:{&quot;field&quot;:&quot;pt5y57U6nY-23&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Kangen Water&quot;}}},&quot;required&quot;:&quot;1&quot;}\" required ><label class=\"everest-forms-field-label-inline\" for=\"evf-23205-field_vss4T51Xcm-15_5\">pH 2.5 (Strong Acidic Water) &gt;&gt; \u20a61500.00 per litre<\/label><\/li><\/ul><\/div><div id=\"evf-23205-field_GcQqIMzFBO-16-container\" class=\"evf-field evf-field-number form-row validate-required everest-forms-conditional-field\" data-required-field-message=\"Please enter a valid number.\" data-field-id=\"GcQqIMzFBO-16\"><label class=\"evf-field-label\" for=\"evf-23205-field_GcQqIMzFBO-16\"><span class=\"evf-label\">Quantity of Liters for the chosen option above:<\/span> <abbr class=\"required\" title=\"Required\">*<\/abbr><\/label><input type=\"number\" id=\"evf-23205-field_GcQqIMzFBO-16\" class=\"input-text evf-calculation-field\" name=\"everest_forms[form_fields][GcQqIMzFBO-16]\" conditional_id=\"GcQqIMzFBO-16\" conditional_rules=\"{&quot;conditional_option&quot;:&quot;show&quot;,&quot;conditionals&quot;:{&quot;1&quot;:{&quot;1&quot;:{&quot;field&quot;:&quot;vss4T51Xcm-15&quot;,&quot;operator&quot;:&quot;not_empty&quot;}}},&quot;required&quot;:&quot;1&quot;}\" required\/><div class=\"evf-field-description\">(example: 2, 4 etc)<\/div><\/div><\/div><div class=\"repeater_button_add_remove_label\"><button type=\"button\" class=\"everest-forms-repeater-add-button button\">Request Another Water Type<\/button>&nbsp;<button type=\"button\" class=\"everest-forms-repeater-remove-button button\">Remove<\/button><\/div><\/div><div class=\"evf-frontend-row\" data-row=\"row_5\" conditional_rules=\"[]\"><div class=\"evf-frontend-grid evf-grid-1\" data-grid=\"grid_1\"><div id=\"evf-23205-field_MfUQNhZTCf-17-container\" class=\"evf-field evf-field-radio form-row validate-required everest-forms-trigger-conditional everest-forms-conditional-field\" data-required-field-message=\"This field is required.\" data-field-id=\"MfUQNhZTCf-17\"><label class=\"evf-field-label\" for=\"evf-23205-field_MfUQNhZTCf-17\"><span class=\"evf-label\">Mode of Pickup<\/span> <abbr class=\"required\" title=\"Required\">*<\/abbr><\/label><ul id=\"evf-23205-field_MfUQNhZTCf-17\" class=\" evf-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"evf-23205-field_MfUQNhZTCf-17_1\" class=\"input-text\" name=\"everest_forms[form_fields][MfUQNhZTCf-17]\" value=\"Door Delivery\" conditional_id=\"MfUQNhZTCf-17\" conditional_rules=\"{&quot;conditional_option&quot;:&quot;show&quot;,&quot;conditionals&quot;:{&quot;1&quot;:{&quot;1&quot;:{&quot;field&quot;:&quot;pt5y57U6nY-23&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Kangen Water&quot;}}},&quot;required&quot;:&quot;1&quot;}\" required ><label class=\"everest-forms-field-label-inline\" for=\"evf-23205-field_MfUQNhZTCf-17_1\">Door Delivery<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"evf-23205-field_MfUQNhZTCf-17_4\" class=\"input-text\" name=\"everest_forms[form_fields][MfUQNhZTCf-17]\" value=\"Our Pick-up points\" conditional_id=\"MfUQNhZTCf-17\" conditional_rules=\"{&quot;conditional_option&quot;:&quot;show&quot;,&quot;conditionals&quot;:{&quot;1&quot;:{&quot;1&quot;:{&quot;field&quot;:&quot;pt5y57U6nY-23&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Kangen Water&quot;}}},&quot;required&quot;:&quot;1&quot;}\" required ><label class=\"everest-forms-field-label-inline\" for=\"evf-23205-field_MfUQNhZTCf-17_4\">Our Pick-up points<\/label><\/li><\/ul><\/div><div id=\"evf-23205-field_1QlImm985J-48-container\" class=\"evf-field evf-field-radio form-row validate-required everest-forms-conditional-field\" data-required-field-message=\"This field is required.\" data-field-id=\"1QlImm985J-48\"><label class=\"evf-field-label\" for=\"evf-23205-field_1QlImm985J-48\"><span class=\"evf-label\">Select your pick-up location<\/span> <abbr class=\"required\" title=\"Required\">*<\/abbr><\/label><ul id=\"evf-23205-field_1QlImm985J-48\" class=\" evf-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"evf-23205-field_1QlImm985J-48_1\" class=\"input-text\" name=\"everest_forms[form_fields][1QlImm985J-48]\" value=\"Akobo flow station\" conditional_id=\"1QlImm985J-48\" conditional_rules=\"{&quot;conditional_option&quot;:&quot;show&quot;,&quot;conditionals&quot;:{&quot;1&quot;:{&quot;1&quot;:{&quot;field&quot;:&quot;MfUQNhZTCf-17&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Our Pick-up points&quot;}}},&quot;required&quot;:&quot;1&quot;}\" required ><label class=\"everest-forms-field-label-inline\" for=\"evf-23205-field_1QlImm985J-48_1\">Akobo flow station<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"evf-23205-field_1QlImm985J-48_2\" class=\"input-text\" name=\"everest_forms[form_fields][1QlImm985J-48]\" value=\"Dugbe Head office\" conditional_id=\"1QlImm985J-48\" conditional_rules=\"{&quot;conditional_option&quot;:&quot;show&quot;,&quot;conditionals&quot;:{&quot;1&quot;:{&quot;1&quot;:{&quot;field&quot;:&quot;MfUQNhZTCf-17&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Our Pick-up points&quot;}}},&quot;required&quot;:&quot;1&quot;}\" required ><label class=\"everest-forms-field-label-inline\" for=\"evf-23205-field_1QlImm985J-48_2\">Dugbe Head office<\/label><\/li><\/ul><\/div><div id=\"evf-23205-field_E0D9IkqNIE-18-container\" class=\"evf-field evf-field-text form-row validate-required everest-forms-conditional-field\" data-required-field-message=\"This field is required.\" data-field-id=\"E0D9IkqNIE-18\"><label class=\"evf-field-label\" for=\"evf-23205-field_E0D9IkqNIE-18\"><span class=\"evf-label\">Detailed address for delivery:<\/span> <abbr class=\"required\" title=\"Required\">*<\/abbr><\/label><input type=\"text\" id=\"evf-23205-field_E0D9IkqNIE-18\" class=\"input-text\" name=\"everest_forms[form_fields][E0D9IkqNIE-18]\" conditional_id=\"E0D9IkqNIE-18\" conditional_rules=\"{&quot;conditional_option&quot;:&quot;show&quot;,&quot;conditionals&quot;:{&quot;1&quot;:{&quot;1&quot;:{&quot;field&quot;:&quot;MfUQNhZTCf-17&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Door Delivery&quot;}}},&quot;required&quot;:&quot;1&quot;}\" required><\/div><div id=\"evf-23205-field_oku37wXIhB-19-container\" class=\"evf-field evf-field-date-time form-row validate-required everest-forms-conditional-field\" data-required-field-message=\"This field is required.\" data-field-id=\"oku37wXIhB-19\"><label class=\"evf-field-label\" for=\"evf-23205-field_oku37wXIhB-19\"><span class=\"evf-label\">Select your Pick-up\/Delivery Date<\/span> <abbr class=\"required\" title=\"Required\">*<\/abbr><\/label><input type=\"text\" id=\"evf-23205-field_oku37wXIhB-19\" class=\"flatpickr-field input-text\" name=\"everest_forms[form_fields][oku37wXIhB-19]\" data-time-interval=\"15\" data-date-time=\"date\" data-mode=\"single\" data-locale=\"en\" data-date-format=\"Y-m-d\" conditional_id=\"oku37wXIhB-19\" conditional_rules=\"{&quot;conditional_option&quot;:&quot;show&quot;,&quot;conditionals&quot;:{&quot;1&quot;:{&quot;1&quot;:{&quot;field&quot;:&quot;pt5y57U6nY-23&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Kangen Water&quot;}}},&quot;required&quot;:&quot;1&quot;}\" required ><\/div><div id=\"evf-23205-field_qAAZ4lslOT-20-container\" class=\"evf-field evf-field-radio form-row validate-required everest-forms-trigger-conditional everest-forms-conditional-field\" data-required-field-message=\"This field is required.\" data-field-id=\"qAAZ4lslOT-20\"><label class=\"evf-field-label\" for=\"evf-23205-field_qAAZ4lslOT-20\"><span class=\"evf-label\">Mode of Payment:<\/span> <abbr class=\"required\" title=\"Required\">*<\/abbr><\/label><ul id=\"evf-23205-field_qAAZ4lslOT-20\" class=\" evf-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"evf-23205-field_qAAZ4lslOT-20_1\" class=\"input-text\" name=\"everest_forms[form_fields][qAAZ4lslOT-20]\" value=\"Bank Transfer\" conditional_id=\"qAAZ4lslOT-20\" conditional_rules=\"{&quot;conditional_option&quot;:&quot;show&quot;,&quot;conditionals&quot;:{&quot;1&quot;:{&quot;1&quot;:{&quot;field&quot;:&quot;pt5y57U6nY-23&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Kangen Water&quot;}}},&quot;required&quot;:&quot;1&quot;}\" required ><label class=\"everest-forms-field-label-inline\" for=\"evf-23205-field_qAAZ4lslOT-20_1\">Bank Transfer<\/label><\/li><\/ul><\/div><div id=\"evf-23205-field_N2SLs98kuc-22-container\" class=\"evf-field evf-field-file-upload form-row validate-required everest-forms-conditional-field\" data-required-field-message=\"This field is required.\" data-field-id=\"N2SLs98kuc-22\"><label class=\"evf-field-label\" for=\"evf-23205-field_N2SLs98kuc-22\"><span class=\"evf-label\">Upload your payment receipt<\/span> <abbr class=\"required\" title=\"Required\">*<\/abbr><\/label>\t\t<div class=\"everest-forms-uploader\"\n\t\t\tdata-field-id=\"N2SLs98kuc-22\"\n\t\t\tdata-form-id=\"23205\"\n\t\t\tdata-input-name=\"everest_forms_23205_N2SLs98kuc-22\"\n\t\t\tdata-extensions=\"jpg,jpeg,jpe,gif,png,bmp,tiff,tif,webp,avif,ico,heic,heif,heics,heifs,asf,asx,wmv,wmx,wm,avi,divx,mov,qt,mpeg,mpg,mpe,mp4,m4v,ogv,webm,mkv,3gp,3gpp,3g2,3gp2,txt,asc,c,cc,h,srt,csv,tsv,ics,rtx,css,html,vtt,dfxp,mp3,m4a,m4b,aac,ra,ram,wav,x-wav,ogg,oga,flac,mid,midi,wma,wax,mka,rtf,pdf,class,tar,zip,gz,gzip,rar,7z,psd,xcf,doc,pot,pps,ppt,wri,xla,xls,xlt,xlw,mpp,docx,docm,dotx,dotm,xlsx,xlsm,xlsb,xltx,xltm,xlam,pptx,pptm,ppsx,ppsm,potx,potm,ppam,sldx,sldm,onetoc,onetoc2,onetmp,onepkg,oxps,xps,odt,odp,ods,odg,odc,odb,odf,wp,wpd,key,numbers,pages\"\n\t\t\tdata-max-size=\"1073741824\"\n\t\t\tdata-max-file-number=\"1\"\n\t\t\tdata-post-max-size=\"1073741824\">\n\t\t\t<div class=\"dz-message\">\n\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 32 32\" width=\"32px\" height=\"32px\" fill=\"#868e96\"><path class=\"cls-1\" d=\"M18.12,17.52,17,16.4V25a1,1,0,0,1-2,0V16.4l-1.12,1.12a1,1,0,0,1-1.42,0,1,1,0,0,1,0-1.41l2.83-2.83a1,1,0,0,1,1.42,0l2.83,2.83a1,1,0,0,1-.71,1.7A1,1,0,0,1,18.12,17.52ZM22,22H20a1,1,0,0,1,0-2h2a4,4,0,0,0,.27-8,1,1,0,0,1-.84-.57,6,6,0,0,0-11.36,1.69,1,1,0,0,1-1,.86H9A3,3,0,0,0,9,20h3a1,1,0,0,1,0,2H9a5,5,0,0,1-.75-9.94A8,8,0,0,1,23,10.1,6,6,0,0,1,22,22Z\"\/><\/svg>\n\t\t\t\t<span class=\"everest-forms-upload-title\">\n\t\t\t\t\tDrop your file here or click here to upload\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t<span class=\"everest-forms-upload-hint\">\n\t\t\t\t\t\tYou can upload up to 1 files.\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t<input type=\"text\" class=\"dropzone-input input-text\" id=\"everest-forms-23205-field_N2SLs98kuc-22\" name=\"everest_forms_23205_N2SLs98kuc-22\" required conditional_id=\"N2SLs98kuc-22\" conditional_rules='{\"conditional_option\":\"show\",\"conditionals\":{\"1\":{\"1\":{\"field\":\"qAAZ4lslOT-20\",\"operator\":\"is\",\"value\":\"Bank Transfer\"}}},\"required\":\"1\"}'>\n\t\t<\/div><\/div><\/div><div class=\"evf-frontend-row\" data-row=\"row_7\" conditional_rules=\"[]\"><div class=\"evf-frontend-grid evf-grid-1\" data-grid=\"grid_1\"><div id=\"evf-23205-field_3GWPUXLOI6-24-container\" class=\"evf-field evf-field-title form-row everest-forms-conditional-field\" data-field-id=\"3GWPUXLOI6-24\"><h3 id=\"evf-23205-field_3GWPUXLOI6-24\" class=\"input-text\" name=\"everest_forms[form_fields][3GWPUXLOI6-24]\" conditional_id=\"3GWPUXLOI6-24\" conditional_rules=\"{&quot;conditional_option&quot;:&quot;show&quot;,&quot;conditionals&quot;:{&quot;1&quot;:{&quot;1&quot;:{&quot;field&quot;:&quot;pt5y57U6nY-23&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Kangen Machine&quot;}}},&quot;required&quot;:0}\">Kangen Machine Order Details<\/h3><\/div><div id=\"evf-23205-field_jYraNJfyU7-46-container\" class=\"evf-field evf-field-radio form-row validate-required everest-forms-conditional-field\" data-required-field-message=\"This field is required.\" data-field-id=\"jYraNJfyU7-46\"><label class=\"evf-field-label\" for=\"evf-23205-field_jYraNJfyU7-46\"><span class=\"evf-label\">Select your type of machine being order<\/span> <abbr class=\"required\" title=\"Required\">*<\/abbr><\/label><ul id=\"evf-23205-field_jYraNJfyU7-46\" class=\" evf-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"evf-23205-field_jYraNJfyU7-46_1\" class=\"input-text\" name=\"everest_forms[form_fields][jYraNJfyU7-46]\" value=\"K8\" conditional_id=\"jYraNJfyU7-46\" conditional_rules=\"{&quot;conditional_option&quot;:&quot;show&quot;,&quot;conditionals&quot;:{&quot;1&quot;:{&quot;1&quot;:{&quot;field&quot;:&quot;pt5y57U6nY-23&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Kangen Machine&quot;}}},&quot;required&quot;:&quot;1&quot;}\" required ><label class=\"everest-forms-field-label-inline\" for=\"evf-23205-field_jYraNJfyU7-46_1\">K8<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"evf-23205-field_jYraNJfyU7-46_2\" class=\"input-text\" name=\"everest_forms[form_fields][jYraNJfyU7-46]\" value=\"SD501 Platinum\" conditional_id=\"jYraNJfyU7-46\" conditional_rules=\"{&quot;conditional_option&quot;:&quot;show&quot;,&quot;conditionals&quot;:{&quot;1&quot;:{&quot;1&quot;:{&quot;field&quot;:&quot;pt5y57U6nY-23&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Kangen Machine&quot;}}},&quot;required&quot;:&quot;1&quot;}\" required ><label class=\"everest-forms-field-label-inline\" for=\"evf-23205-field_jYraNJfyU7-46_2\">SD501 Platinum<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"evf-23205-field_jYraNJfyU7-46_3\" class=\"input-text\" name=\"everest_forms[form_fields][jYraNJfyU7-46]\" value=\"SD501\" conditional_id=\"jYraNJfyU7-46\" conditional_rules=\"{&quot;conditional_option&quot;:&quot;show&quot;,&quot;conditionals&quot;:{&quot;1&quot;:{&quot;1&quot;:{&quot;field&quot;:&quot;pt5y57U6nY-23&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Kangen Machine&quot;}}},&quot;required&quot;:&quot;1&quot;}\" required ><label class=\"everest-forms-field-label-inline\" for=\"evf-23205-field_jYraNJfyU7-46_3\">SD501<\/label><\/li><\/ul><\/div><div id=\"evf-23205-field_8PgOyKWmeS-26-container\" class=\"evf-field evf-field-radio form-row validate-required everest-forms-conditional-field\" data-required-field-message=\"This field is required.\" data-field-id=\"8PgOyKWmeS-26\"><label class=\"evf-field-label\" for=\"evf-23205-field_8PgOyKWmeS-26\"><span class=\"evf-label\">Are you currently paying for another machine?<\/span> <abbr class=\"required\" title=\"Required\">*<\/abbr><\/label><ul id=\"evf-23205-field_8PgOyKWmeS-26\" class=\" evf-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"evf-23205-field_8PgOyKWmeS-26_1\" class=\"input-text\" name=\"everest_forms[form_fields][8PgOyKWmeS-26]\" value=\"Yes\" conditional_id=\"8PgOyKWmeS-26\" conditional_rules=\"{&quot;conditional_option&quot;:&quot;show&quot;,&quot;conditionals&quot;:{&quot;1&quot;:{&quot;1&quot;:{&quot;field&quot;:&quot;pt5y57U6nY-23&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Kangen Machine&quot;}}},&quot;required&quot;:&quot;1&quot;}\" required ><label class=\"everest-forms-field-label-inline\" for=\"evf-23205-field_8PgOyKWmeS-26_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"evf-23205-field_8PgOyKWmeS-26_2\" class=\"input-text\" name=\"everest_forms[form_fields][8PgOyKWmeS-26]\" value=\"No\" conditional_id=\"8PgOyKWmeS-26\" conditional_rules=\"{&quot;conditional_option&quot;:&quot;show&quot;,&quot;conditionals&quot;:{&quot;1&quot;:{&quot;1&quot;:{&quot;field&quot;:&quot;pt5y57U6nY-23&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Kangen Machine&quot;}}},&quot;required&quot;:&quot;1&quot;}\" required ><label class=\"everest-forms-field-label-inline\" for=\"evf-23205-field_8PgOyKWmeS-26_2\">No<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"evf-23205-field_8PgOyKWmeS-26_3\" class=\"input-text\" name=\"everest_forms[form_fields][8PgOyKWmeS-26]\" value=\"I don&#039;t understand\" conditional_id=\"8PgOyKWmeS-26\" conditional_rules=\"{&quot;conditional_option&quot;:&quot;show&quot;,&quot;conditionals&quot;:{&quot;1&quot;:{&quot;1&quot;:{&quot;field&quot;:&quot;pt5y57U6nY-23&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Kangen Machine&quot;}}},&quot;required&quot;:&quot;1&quot;}\" required ><label class=\"everest-forms-field-label-inline\" for=\"evf-23205-field_8PgOyKWmeS-26_3\">I don't understand<\/label><\/li><\/ul><\/div><div id=\"evf-23205-field_QRwZQEGhQa-45-container\" class=\"evf-field evf-field-date-time form-row validate-required everest-forms-conditional-field\" data-required-field-message=\"This field is required.\" data-field-id=\"QRwZQEGhQa-45\"><label class=\"evf-field-label\" for=\"evf-23205-field_QRwZQEGhQa-45\"><span class=\"evf-label\">Date of Birth<\/span> <abbr class=\"required\" title=\"Required\">*<\/abbr><\/label><input type=\"text\" id=\"evf-23205-field_QRwZQEGhQa-45\" class=\"flatpickr-field input-text\" name=\"everest_forms[form_fields][QRwZQEGhQa-45]\" data-time-interval=\"15\" data-date-time=\"date\" data-mode=\"single\" data-locale=\"en\" data-date-format=\"Y-m-d\" conditional_id=\"QRwZQEGhQa-45\" conditional_rules=\"{&quot;conditional_option&quot;:&quot;show&quot;,&quot;conditionals&quot;:{&quot;1&quot;:{&quot;1&quot;:{&quot;field&quot;:&quot;pt5y57U6nY-23&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Kangen Machine&quot;}}},&quot;required&quot;:&quot;1&quot;}\" required ><\/div><div id=\"evf-23205-field_OCMnAN54Uj-44-container\" class=\"evf-field evf-field-radio form-row validate-required everest-forms-trigger-conditional everest-forms-conditional-field\" data-required-field-message=\"This field is required.\" data-field-id=\"OCMnAN54Uj-44\"><label class=\"evf-field-label\" for=\"evf-23205-field_OCMnAN54Uj-44\"><span class=\"evf-label\">Are you currently an Enagic distributor?<\/span> <abbr class=\"required\" title=\"Required\">*<\/abbr><\/label><ul id=\"evf-23205-field_OCMnAN54Uj-44\" class=\" evf-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"evf-23205-field_OCMnAN54Uj-44_1\" class=\"input-text\" name=\"everest_forms[form_fields][OCMnAN54Uj-44]\" value=\"Yes\" conditional_id=\"OCMnAN54Uj-44\" conditional_rules=\"{&quot;conditional_option&quot;:&quot;show&quot;,&quot;conditionals&quot;:{&quot;1&quot;:{&quot;1&quot;:{&quot;field&quot;:&quot;pt5y57U6nY-23&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Kangen Machine&quot;}}},&quot;required&quot;:&quot;1&quot;}\" required ><label class=\"everest-forms-field-label-inline\" for=\"evf-23205-field_OCMnAN54Uj-44_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"evf-23205-field_OCMnAN54Uj-44_2\" class=\"input-text\" name=\"everest_forms[form_fields][OCMnAN54Uj-44]\" value=\"No\" conditional_id=\"OCMnAN54Uj-44\" conditional_rules=\"{&quot;conditional_option&quot;:&quot;show&quot;,&quot;conditionals&quot;:{&quot;1&quot;:{&quot;1&quot;:{&quot;field&quot;:&quot;pt5y57U6nY-23&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Kangen Machine&quot;}}},&quot;required&quot;:&quot;1&quot;}\" required ><label class=\"everest-forms-field-label-inline\" for=\"evf-23205-field_OCMnAN54Uj-44_2\">No<\/label><\/li><\/ul><\/div><div id=\"evf-23205-field_exoEwuT2AH-47-container\" class=\"evf-field evf-field-text form-row validate-required everest-forms-conditional-field\" data-required-field-message=\"This field is required.\" data-field-id=\"exoEwuT2AH-47\"><label class=\"evf-field-label\" for=\"evf-23205-field_exoEwuT2AH-47\"><span class=\"evf-label\">Provide your distributor ID<\/span> <abbr class=\"required\" title=\"Required\">*<\/abbr><\/label><input type=\"text\" id=\"evf-23205-field_exoEwuT2AH-47\" class=\"input-text\" name=\"everest_forms[form_fields][exoEwuT2AH-47]\" conditional_id=\"exoEwuT2AH-47\" conditional_rules=\"{&quot;conditional_option&quot;:&quot;show&quot;,&quot;conditionals&quot;:{&quot;1&quot;:{&quot;1&quot;:{&quot;field&quot;:&quot;OCMnAN54Uj-44&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Yes&quot;}}},&quot;required&quot;:&quot;1&quot;}\" required><\/div><div id=\"evf-23205-field_SfYs6hElDT-27-container\" class=\"evf-field evf-field-file-upload form-row everest-forms-conditional-field\" data-field-id=\"SfYs6hElDT-27\"><label class=\"evf-field-label\" for=\"evf-23205-field_SfYs6hElDT-27\"><span class=\"evf-label\">Valid ID Card Upload (International Passport, NIN Slip or Drivers License)<\/span> <\/label>\t\t<div class=\"everest-forms-uploader\"\n\t\t\tdata-field-id=\"SfYs6hElDT-27\"\n\t\t\tdata-form-id=\"23205\"\n\t\t\tdata-input-name=\"everest_forms_23205_SfYs6hElDT-27\"\n\t\t\tdata-extensions=\"jpg,jpeg,jpe,gif,png,bmp,tiff,tif,webp,avif,ico,heic,heif,heics,heifs,asf,asx,wmv,wmx,wm,avi,divx,mov,qt,mpeg,mpg,mpe,mp4,m4v,ogv,webm,mkv,3gp,3gpp,3g2,3gp2,txt,asc,c,cc,h,srt,csv,tsv,ics,rtx,css,html,vtt,dfxp,mp3,m4a,m4b,aac,ra,ram,wav,x-wav,ogg,oga,flac,mid,midi,wma,wax,mka,rtf,pdf,class,tar,zip,gz,gzip,rar,7z,psd,xcf,doc,pot,pps,ppt,wri,xla,xls,xlt,xlw,mpp,docx,docm,dotx,dotm,xlsx,xlsm,xlsb,xltx,xltm,xlam,pptx,pptm,ppsx,ppsm,potx,potm,ppam,sldx,sldm,onetoc,onetoc2,onetmp,onepkg,oxps,xps,odt,odp,ods,odg,odc,odb,odf,wp,wpd,key,numbers,pages\"\n\t\t\tdata-max-size=\"1073741824\"\n\t\t\tdata-max-file-number=\"1\"\n\t\t\tdata-post-max-size=\"1073741824\">\n\t\t\t<div class=\"dz-message\">\n\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 32 32\" width=\"32px\" height=\"32px\" fill=\"#868e96\"><path class=\"cls-1\" d=\"M18.12,17.52,17,16.4V25a1,1,0,0,1-2,0V16.4l-1.12,1.12a1,1,0,0,1-1.42,0,1,1,0,0,1,0-1.41l2.83-2.83a1,1,0,0,1,1.42,0l2.83,2.83a1,1,0,0,1-.71,1.7A1,1,0,0,1,18.12,17.52ZM22,22H20a1,1,0,0,1,0-2h2a4,4,0,0,0,.27-8,1,1,0,0,1-.84-.57,6,6,0,0,0-11.36,1.69,1,1,0,0,1-1,.86H9A3,3,0,0,0,9,20h3a1,1,0,0,1,0,2H9a5,5,0,0,1-.75-9.94A8,8,0,0,1,23,10.1,6,6,0,0,1,22,22Z\"\/><\/svg>\n\t\t\t\t<span class=\"everest-forms-upload-title\">\n\t\t\t\t\tDrop your file here or click here to upload\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t<span class=\"everest-forms-upload-hint\">\n\t\t\t\t\t\tYou can upload up to 1 files.\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t<input type=\"text\" class=\"dropzone-input input-text\" id=\"everest-forms-23205-field_SfYs6hElDT-27\" name=\"everest_forms_23205_SfYs6hElDT-27\"  conditional_id=\"SfYs6hElDT-27\" conditional_rules='{\"conditional_option\":\"show\",\"conditionals\":{\"1\":{\"1\":{\"field\":\"pt5y57U6nY-23\",\"operator\":\"is\",\"value\":\"Kangen Machine\"}}},\"required\":0}'>\n\t\t<\/div><div id=\"evf-23205-field_57uw0kgMrR-28-container\" class=\"evf-field evf-field-address form-row validate-required everest-forms-conditional-field\" data-required-field-message-address1=\"This field is required.\" data-required-field-message-city=\"This field is required.\" data-required-field-message-state=\"This field is required.\" data-required-field-message-postal=\"This field is required.\" data-required-field-message-country=\"This field is required.\" data-field-id=\"57uw0kgMrR-28\"><label class=\"evf-field-label\" for=\"evf-23205-field_57uw0kgMrR-28\"><span class=\"evf-label\">Detailed Address<\/span> <abbr class=\"required\" title=\"Required\">*<\/abbr><\/label><input id=\"57uw0kgMrR-28\" type=\"hidden\" class=\"input-text evf-conditional-logic-holder\" conditional_rules=\"{&quot;conditional_option&quot;:&quot;show&quot;,&quot;conditionals&quot;:{&quot;1&quot;:{&quot;1&quot;:{&quot;field&quot;:&quot;pt5y57U6nY-23&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Kangen Machine&quot;}}},&quot;required&quot;:&quot;1&quot;}\" conditional_id=\"57uw0kgMrR-28\" \/><div class=\"everest-forms-field-row\" ><div ><input type=\"text\" id=\"evf-23205-field_57uw0kgMrR-28\" class=\"evf-field-address-address1 validate-required\" name=\"everest_forms[form_fields][57uw0kgMrR-28][address1]\" required  ><label for=\"evf-23205-field_57uw0kgMrR-28\" class=\"everest-forms-field-sublabel after \">Address Line 1<\/label><\/div><\/div><div class=\"everest-forms-field-row\"><div  ><input type=\"text\" id=\"evf-23205-field_57uw0kgMrR-28-address2\" class=\"evf-field-address-address2\" name=\"everest_forms[form_fields][57uw0kgMrR-28][address2]\"  ><label for=\"evf-23205-field_57uw0kgMrR-28-address2\" class=\"everest-forms-field-sublabel after \">Address Line 2<\/label><\/div><\/div><div class=\"everest-forms-field-row\"><div class=\"evf-field-row-block everest-forms-one-half everest-forms-first\"><input type=\"text\" id=\"evf-23205-field_57uw0kgMrR-28-city\" class=\"evf-field-address-city validate-required\" name=\"everest_forms[form_fields][57uw0kgMrR-28][city]\" required ><label for=\"evf-23205-field_57uw0kgMrR-28-city\" class=\"everest-forms-field-sublabel after \">City<\/label><\/div><div class=\"evf-field-row-block everest-forms-one-half\"><span class=\"evf-23205-field_57uw0kgMrR-28-state\"><input type=\"text\" id=\"evf-23205-field_57uw0kgMrR-28-state\" class=\"evf-field-address-state validate-required\" name=\"everest_forms[form_fields][57uw0kgMrR-28][state]\" required ><\/span><label for=\"evf-23205-field_57uw0kgMrR-28-state\" class=\"everest-forms-field-sublabel after \">State \/ Province \/ Region<\/label><\/div><\/div><div class=\"everest-forms-field-row\"><div class=\"evf-field-row-block everest-forms-one-half everest-forms-first\"><input type=\"text\" id=\"evf-23205-field_57uw0kgMrR-28-postal\" class=\"evf-field-address-postal validate-required\" name=\"everest_forms[form_fields][57uw0kgMrR-28][postal]\" required ><label for=\"evf-23205-field_57uw0kgMrR-28-postal\" class=\"everest-forms-field-sublabel after \">Zip \/ Postal Code<\/label><\/div><div class=\"evf-field-row-block everest-forms-one-half\"><select id=\"evf-23205-field_57uw0kgMrR-28-country\" class=\"evf-field-address-country validate-required\" name=\"everest_forms[form_fields][57uw0kgMrR-28][country]\" required ><option value=\"AF\" >Afghanistan<\/option><option value=\"AX\" >\u00c5land 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=\"PW\" >Belau<\/option><option value=\"BZ\" >Belize<\/option><option value=\"BJ\" >Benin<\/option><option value=\"BM\" >Bermuda<\/option><option value=\"BT\" >Bhutan<\/option><option value=\"BO\" >Bolivia<\/option><option value=\"BQ\" >Bonaire, Saint Eustatius and Saba<\/option><option value=\"BA\" >Bosnia and Herzegovina<\/option><option value=\"BW\" >Botswana<\/option><option value=\"BV\" >Bouvet Island<\/option><option value=\"BR\" >Brazil<\/option><option value=\"IO\" >British Indian Ocean Territory<\/option><option value=\"BN\" >Brunei<\/option><option value=\"BG\" >Bulgaria<\/option><option value=\"BF\" >Burkina Faso<\/option><option value=\"BI\" >Burundi<\/option><option value=\"KH\" >Cambodia<\/option><option value=\"CM\" >Cameroon<\/option><option value=\"CA\" >Canada<\/option><option value=\"CV\" >Cape Verde<\/option><option value=\"KY\" >Cayman Islands<\/option><option value=\"CF\" >Central African Republic<\/option><option value=\"TD\" >Chad<\/option><option value=\"CL\" >Chile<\/option><option value=\"CN\" >China<\/option><option value=\"CX\" >Christmas Island<\/option><option value=\"CC\" >Cocos (Keeling) Islands<\/option><option value=\"CO\" >Colombia<\/option><option value=\"KM\" >Comoros<\/option><option value=\"CG\" >Congo (Brazzaville)<\/option><option value=\"CD\" >Congo (Kinshasa)<\/option><option value=\"CK\" >Cook Islands<\/option><option value=\"CR\" >Costa Rica<\/option><option value=\"HR\" >Croatia<\/option><option value=\"CU\" >Cuba<\/option><option value=\"CW\" >Cura&ccedil;ao<\/option><option value=\"CY\" >Cyprus<\/option><option value=\"CZ\" >Czech Republic<\/option><option value=\"DK\" >Denmark<\/option><option value=\"DJ\" >Djibouti<\/option><option value=\"DM\" >Dominica<\/option><option value=\"DO\" >Dominican Republic<\/option><option value=\"EC\" >Ecuador<\/option><option value=\"EG\" >Egypt<\/option><option value=\"SV\" >El Salvador<\/option><option value=\"GQ\" >Equatorial Guinea<\/option><option value=\"ER\" >Eritrea<\/option><option value=\"EE\" >Estonia<\/option><option value=\"ET\" >Ethiopia<\/option><option value=\"FK\" >Falkland Islands<\/option><option value=\"FO\" >Faroe Islands<\/option><option value=\"FJ\" >Fiji<\/option><option value=\"FI\" >Finland<\/option><option value=\"FR\" >France<\/option><option value=\"GF\" >French Guiana<\/option><option value=\"PF\" >French Polynesia<\/option><option value=\"TF\" >French Southern Territories<\/option><option value=\"GA\" >Gabon<\/option><option value=\"GM\" >Gambia<\/option><option value=\"GE\" >Georgia<\/option><option value=\"DE\" >Germany<\/option><option value=\"GH\" >Ghana<\/option><option value=\"GI\" >Gibraltar<\/option><option value=\"GR\" >Greece<\/option><option value=\"GL\" >Greenland<\/option><option value=\"GD\" >Grenada<\/option><option value=\"GP\" >Guadeloupe<\/option><option value=\"GU\" >Guam<\/option><option value=\"GT\" >Guatemala<\/option><option value=\"GG\" >Guernsey<\/option><option value=\"GN\" >Guinea<\/option><option value=\"GW\" >Guinea-Bissau<\/option><option value=\"GY\" >Guyana<\/option><option value=\"HT\" >Haiti<\/option><option value=\"HM\" >Heard Island and McDonald Islands<\/option><option value=\"HN\" >Honduras<\/option><option value=\"HK\" >Hong Kong<\/option><option value=\"HU\" >Hungary<\/option><option value=\"IS\" >Iceland<\/option><option value=\"IN\" >India<\/option><option value=\"ID\" >Indonesia<\/option><option value=\"IR\" >Iran<\/option><option value=\"IQ\" >Iraq<\/option><option value=\"IE\" >Ireland<\/option><option value=\"IM\" >Isle of Man<\/option><option value=\"IL\" >Israel<\/option><option value=\"IT\" >Italy<\/option><option value=\"CI\" >Ivory Coast<\/option><option value=\"JM\" >Jamaica<\/option><option value=\"JP\" >Japan<\/option><option value=\"JE\" >Jersey<\/option><option value=\"JO\" >Jordan<\/option><option value=\"KZ\" >Kazakhstan<\/option><option value=\"KE\" >Kenya<\/option><option value=\"KI\" >Kiribati<\/option><option value=\"KW\" >Kuwait<\/option><option value=\"XK\" >Kosovo<\/option><option value=\"KG\" >Kyrgyzstan<\/option><option value=\"LA\" >Laos<\/option><option value=\"LV\" >Latvia<\/option><option 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\" >North Macedonia<\/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<\/option><option value=\"MD\" >Moldova<\/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=\"KP\" >North Korea<\/option><option value=\"NO\" >Norway<\/option><option value=\"OM\" >Oman<\/option><option value=\"PK\" >Pakistan<\/option><option value=\"PS\" >Palestinian Territory<\/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\" >Reunion<\/option><option value=\"RO\" >Romania<\/option><option value=\"RU\" >Russia<\/option><option value=\"RW\" >Rwanda<\/option><option value=\"BL\" >Saint Barth&eacute;lemy<\/option><option value=\"SH\" >Saint Helena<\/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=\"SX\" >Saint Martin (Dutch part)<\/option><option value=\"PM\" >Saint Pierre and Miquelon<\/option><option value=\"VC\" >Saint Vincent and the Grenadines<\/option><option value=\"SM\" >San Marino<\/option><option value=\"ST\" >S&atilde;o Tom&eacute; and Pr&iacute;ncipe<\/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=\"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\/Sandwich Islands<\/option><option value=\"KR\" >South Korea<\/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\" >Syria<\/option><option value=\"TW\" >Taiwan<\/option><option value=\"TJ\" >Tajikistan<\/option><option value=\"TZ\" >Tanzania<\/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 (UK)<\/option><option value=\"US\" >United States (US)<\/option><option value=\"UM\" >United States (US) Minor Outlying Islands<\/option><option value=\"UY\" >Uruguay<\/option><option value=\"UZ\" >Uzbekistan<\/option><option value=\"VU\" >Vanuatu<\/option><option value=\"VA\" >Vatican<\/option><option value=\"VE\" >Venezuela<\/option><option value=\"VN\" >Vietnam<\/option><option value=\"VG\" >Virgin Islands (British)<\/option><option value=\"VI\" >Virgin Islands (US)<\/option><option value=\"WF\" >Wallis and Futuna<\/option><option value=\"EH\" >Western Sahara<\/option><option value=\"WS\" >Samoa<\/option><option value=\"YE\" >Yemen<\/option><option value=\"ZM\" >Zambia<\/option><option value=\"ZW\" >Zimbabwe<\/option><\/select><label for=\"evf-23205-field_57uw0kgMrR-28-country\" class=\"everest-forms-field-sublabel after \">Country<\/label><\/div><\/div><\/div><div id=\"evf-23205-field_CjFG1EJ6eO-29-container\" class=\"evf-field evf-field-number form-row everest-forms-conditional-field\" data-field-id=\"CjFG1EJ6eO-29\"><label class=\"evf-field-label\" for=\"evf-23205-field_CjFG1EJ6eO-29\"><span class=\"evf-label\">Years of Resdience in location above<\/span> <\/label><input type=\"number\" id=\"evf-23205-field_CjFG1EJ6eO-29\" class=\"input-text evf-calculation-field\" name=\"everest_forms[form_fields][CjFG1EJ6eO-29]\" conditional_id=\"CjFG1EJ6eO-29\" conditional_rules=\"{&quot;conditional_option&quot;:&quot;show&quot;,&quot;conditionals&quot;:{&quot;1&quot;:{&quot;1&quot;:{&quot;field&quot;:&quot;pt5y57U6nY-23&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Kangen Machine&quot;}}},&quot;required&quot;:0}\" \/><\/div><\/div><\/div><div class=\"evf-frontend-row\" data-row=\"row_8\" conditional_rules=\"[]\"><div class=\"evf-frontend-grid evf-grid-2\" data-grid=\"grid_1\"><div id=\"evf-23205-field_96Tc9nQRNw-31-container\" class=\"evf-field evf-field-radio form-row validate-required everest-forms-trigger-conditional everest-forms-conditional-field\" data-required-field-message=\"This field is required.\" data-field-id=\"96Tc9nQRNw-31\"><label class=\"evf-field-label\" for=\"evf-23205-field_96Tc9nQRNw-31\"><span class=\"evf-label\">Type of Residence<\/span> <abbr class=\"required\" title=\"Required\">*<\/abbr><\/label><ul id=\"evf-23205-field_96Tc9nQRNw-31\" class=\" evf-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"evf-23205-field_96Tc9nQRNw-31_1\" class=\"input-text\" name=\"everest_forms[form_fields][96Tc9nQRNw-31]\" value=\"Rent\" conditional_id=\"96Tc9nQRNw-31\" conditional_rules=\"{&quot;conditional_option&quot;:&quot;show&quot;,&quot;conditionals&quot;:{&quot;1&quot;:{&quot;1&quot;:{&quot;field&quot;:&quot;pt5y57U6nY-23&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Kangen Machine&quot;}}},&quot;required&quot;:&quot;1&quot;}\" required ><label class=\"everest-forms-field-label-inline\" for=\"evf-23205-field_96Tc9nQRNw-31_1\">Rent<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"evf-23205-field_96Tc9nQRNw-31_2\" class=\"input-text\" name=\"everest_forms[form_fields][96Tc9nQRNw-31]\" value=\"Owned\" conditional_id=\"96Tc9nQRNw-31\" conditional_rules=\"{&quot;conditional_option&quot;:&quot;show&quot;,&quot;conditionals&quot;:{&quot;1&quot;:{&quot;1&quot;:{&quot;field&quot;:&quot;pt5y57U6nY-23&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Kangen Machine&quot;}}},&quot;required&quot;:&quot;1&quot;}\" required ><label class=\"everest-forms-field-label-inline\" for=\"evf-23205-field_96Tc9nQRNw-31_2\">Owned<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"evf-23205-field_96Tc9nQRNw-31_3\" class=\"input-text\" name=\"everest_forms[form_fields][96Tc9nQRNw-31]\" value=\"Others\" conditional_id=\"96Tc9nQRNw-31\" conditional_rules=\"{&quot;conditional_option&quot;:&quot;show&quot;,&quot;conditionals&quot;:{&quot;1&quot;:{&quot;1&quot;:{&quot;field&quot;:&quot;pt5y57U6nY-23&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Kangen Machine&quot;}}},&quot;required&quot;:&quot;1&quot;}\" required ><label class=\"everest-forms-field-label-inline\" for=\"evf-23205-field_96Tc9nQRNw-31_3\">Others<\/label><\/li><\/ul><\/div><\/div><div class=\"evf-frontend-grid evf-grid-2\" data-grid=\"grid_2\"><div id=\"evf-23205-field_hiUzkHV6rO-32-container\" class=\"evf-field evf-field-number form-row everest-forms-conditional-field\" data-field-id=\"hiUzkHV6rO-32\"><label class=\"evf-field-label\" for=\"evf-23205-field_hiUzkHV6rO-32\"><span class=\"evf-label\">Annual Rent:<\/span> <\/label><input type=\"number\" id=\"evf-23205-field_hiUzkHV6rO-32\" class=\"input-text evf-calculation-field\" name=\"everest_forms[form_fields][hiUzkHV6rO-32]\" conditional_id=\"hiUzkHV6rO-32\" conditional_rules=\"{&quot;conditional_option&quot;:&quot;show&quot;,&quot;conditionals&quot;:{&quot;1&quot;:{&quot;1&quot;:{&quot;field&quot;:&quot;96Tc9nQRNw-31&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Rent&quot;}}},&quot;required&quot;:0}\" \/><\/div><div id=\"evf-23205-field_PJ7lSEEs6r-33-container\" class=\"evf-field evf-field-text form-row everest-forms-conditional-field\" data-field-id=\"PJ7lSEEs6r-33\"><label class=\"evf-field-label\" for=\"evf-23205-field_PJ7lSEEs6r-33\"><span class=\"evf-label\">If you selected others, provide details here.<\/span> <\/label><input type=\"text\" id=\"evf-23205-field_PJ7lSEEs6r-33\" class=\"input-text\" name=\"everest_forms[form_fields][PJ7lSEEs6r-33]\" conditional_id=\"PJ7lSEEs6r-33\" conditional_rules=\"{&quot;conditional_option&quot;:&quot;show&quot;,&quot;conditionals&quot;:{&quot;1&quot;:{&quot;1&quot;:{&quot;field&quot;:&quot;96Tc9nQRNw-31&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Others&quot;}}},&quot;required&quot;:0}\" ><\/div><\/div><\/div><div class=\"evf-frontend-row\" data-row=\"row_9\" conditional_rules=\"[]\"><div class=\"evf-frontend-grid evf-grid-1\" data-grid=\"grid_1\"><div id=\"evf-23205-field_nyz2eBPIZv-34-container\" class=\"evf-field evf-field-text form-row validate-required everest-forms-conditional-field\" data-required-field-message=\"This field is required.\" data-field-id=\"nyz2eBPIZv-34\"><label class=\"evf-field-label\" for=\"evf-23205-field_nyz2eBPIZv-34\"><span class=\"evf-label\">Current Employer Name<\/span> <abbr class=\"required\" title=\"Required\">*<\/abbr><\/label><input type=\"text\" id=\"evf-23205-field_nyz2eBPIZv-34\" class=\"input-text\" name=\"everest_forms[form_fields][nyz2eBPIZv-34]\" conditional_id=\"nyz2eBPIZv-34\" conditional_rules=\"{&quot;conditional_option&quot;:&quot;show&quot;,&quot;conditionals&quot;:{&quot;1&quot;:{&quot;1&quot;:{&quot;field&quot;:&quot;pt5y57U6nY-23&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Kangen Machine&quot;}}},&quot;required&quot;:&quot;1&quot;}\" required><\/div><div id=\"evf-23205-field_rFySj2tuFF-36-container\" class=\"evf-field evf-field-phone form-row validate-phone everest-forms-conditional-field\" data-field-id=\"rFySj2tuFF-36\"><label class=\"evf-field-label\" for=\"evf-23205-field_rFySj2tuFF-36\"><span class=\"evf-label\">Work Phone Number:<\/span> <\/label><input type=\"tel\" id=\"evf-23205-field_rFySj2tuFF-36\" class=\"input-text evf-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"everest_forms[form_fields][rFySj2tuFF-36]\" conditional_id=\"rFySj2tuFF-36\" conditional_rules=\"{&quot;conditional_option&quot;:&quot;show&quot;,&quot;conditionals&quot;:{&quot;1&quot;:{&quot;1&quot;:{&quot;field&quot;:&quot;pt5y57U6nY-23&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Kangen Machine&quot;}}},&quot;required&quot;:0}\" ><\/div><div id=\"evf-23205-field_Kfc6CCTxzD-37-container\" class=\"evf-field evf-field-number form-row everest-forms-conditional-field\" data-field-id=\"Kfc6CCTxzD-37\"><label class=\"evf-field-label\" for=\"evf-23205-field_Kfc6CCTxzD-37\"><span class=\"evf-label\">Years with Employer<\/span> <\/label><input type=\"number\" id=\"evf-23205-field_Kfc6CCTxzD-37\" class=\"input-text evf-calculation-field\" name=\"everest_forms[form_fields][Kfc6CCTxzD-37]\" conditional_id=\"Kfc6CCTxzD-37\" conditional_rules=\"{&quot;conditional_option&quot;:&quot;show&quot;,&quot;conditionals&quot;:{&quot;1&quot;:{&quot;1&quot;:{&quot;field&quot;:&quot;pt5y57U6nY-23&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Kangen Machine&quot;}}},&quot;required&quot;:0}\" \/><\/div><div id=\"evf-23205-field_xPfvddyRq1-38-container\" class=\"evf-field evf-field-first-name form-row everest-forms-trigger-conditional everest-forms-conditional-field\" data-field-id=\"xPfvddyRq1-38\"><label class=\"evf-field-label\" for=\"evf-23205-field_xPfvddyRq1-38\"><span class=\"evf-label\">Emergency Contact Name<\/span> <\/label><input type=\"text\" id=\"evf-23205-field_xPfvddyRq1-38\" class=\"input-text\" name=\"everest_forms[form_fields][xPfvddyRq1-38]\" conditional_id=\"xPfvddyRq1-38\" conditional_rules=\"{&quot;conditional_option&quot;:&quot;show&quot;,&quot;conditionals&quot;:{&quot;1&quot;:{&quot;1&quot;:{&quot;field&quot;:&quot;pt5y57U6nY-23&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Kangen Machine&quot;}}},&quot;required&quot;:0}\" ><\/div><div id=\"evf-23205-field_p5Xdt3k5I1-39-container\" class=\"evf-field evf-field-phone form-row validate-phone everest-forms-conditional-field\" data-field-id=\"p5Xdt3k5I1-39\"><label class=\"evf-field-label\" for=\"evf-23205-field_p5Xdt3k5I1-39\"><span class=\"evf-label\">Emergency Contact Phone Number<\/span> <\/label><input type=\"tel\" id=\"evf-23205-field_p5Xdt3k5I1-39\" class=\"input-text evf-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"everest_forms[form_fields][p5Xdt3k5I1-39]\" conditional_id=\"p5Xdt3k5I1-39\" conditional_rules=\"{&quot;conditional_option&quot;:&quot;show&quot;,&quot;conditionals&quot;:{&quot;1&quot;:{&quot;1&quot;:{&quot;field&quot;:&quot;xPfvddyRq1-38&quot;,&quot;operator&quot;:&quot;not_empty&quot;}}},&quot;required&quot;:0}\" ><\/div><div id=\"evf-23205-field_QLB0XRMqmP-40-container\" class=\"evf-field evf-field-text form-row everest-forms-conditional-field\" data-field-id=\"QLB0XRMqmP-40\"><label class=\"evf-field-label\" for=\"evf-23205-field_QLB0XRMqmP-40\"><span class=\"evf-label\">Relationship with Emergency Contact<\/span> <\/label><input type=\"text\" id=\"evf-23205-field_QLB0XRMqmP-40\" class=\"input-text\" name=\"everest_forms[form_fields][QLB0XRMqmP-40]\" conditional_id=\"QLB0XRMqmP-40\" conditional_rules=\"{&quot;conditional_option&quot;:&quot;show&quot;,&quot;conditionals&quot;:{&quot;1&quot;:{&quot;1&quot;:{&quot;field&quot;:&quot;xPfvddyRq1-38&quot;,&quot;operator&quot;:&quot;not_empty&quot;}}},&quot;required&quot;:0}\" ><\/div><div id=\"evf-23205-field_D1kX2qnb87-42-container\" class=\"evf-field evf-field-radio form-row validate-required everest-forms-trigger-conditional everest-forms-conditional-field\" data-required-field-message=\"This field is required.\" data-field-id=\"D1kX2qnb87-42\"><label class=\"evf-field-label\" for=\"evf-23205-field_D1kX2qnb87-42\"><span class=\"evf-label\">Payment Mode<\/span> <abbr class=\"required\" title=\"Required\">*<\/abbr><\/label><ul id=\"evf-23205-field_D1kX2qnb87-42\" class=\" evf-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"evf-23205-field_D1kX2qnb87-42_1\" class=\"input-text\" name=\"everest_forms[form_fields][D1kX2qnb87-42]\" value=\"One time payment\" conditional_id=\"D1kX2qnb87-42\" conditional_rules=\"{&quot;conditional_option&quot;:&quot;show&quot;,&quot;conditionals&quot;:{&quot;1&quot;:{&quot;1&quot;:{&quot;field&quot;:&quot;pt5y57U6nY-23&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Kangen Machine&quot;}}},&quot;required&quot;:&quot;1&quot;}\" required ><label class=\"everest-forms-field-label-inline\" for=\"evf-23205-field_D1kX2qnb87-42_1\">One time payment<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"evf-23205-field_D1kX2qnb87-42_2\" class=\"input-text\" name=\"everest_forms[form_fields][D1kX2qnb87-42]\" value=\"Installment Payment\" conditional_id=\"D1kX2qnb87-42\" conditional_rules=\"{&quot;conditional_option&quot;:&quot;show&quot;,&quot;conditionals&quot;:{&quot;1&quot;:{&quot;1&quot;:{&quot;field&quot;:&quot;pt5y57U6nY-23&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Kangen Machine&quot;}}},&quot;required&quot;:&quot;1&quot;}\" required ><label class=\"everest-forms-field-label-inline\" for=\"evf-23205-field_D1kX2qnb87-42_2\">Installment Payment<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"evf-23205-field_D1kX2qnb87-42_4\" class=\"input-text\" name=\"everest_forms[form_fields][D1kX2qnb87-42]\" value=\"Cooperative\/Microfinance\" conditional_id=\"D1kX2qnb87-42\" conditional_rules=\"{&quot;conditional_option&quot;:&quot;show&quot;,&quot;conditionals&quot;:{&quot;1&quot;:{&quot;1&quot;:{&quot;field&quot;:&quot;pt5y57U6nY-23&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Kangen Machine&quot;}}},&quot;required&quot;:&quot;1&quot;}\" required ><label class=\"everest-forms-field-label-inline\" for=\"evf-23205-field_D1kX2qnb87-42_4\">Cooperative\/Microfinance<\/label><\/li><\/ul><\/div><div id=\"evf-23205-field_g9pUcC9cw5-41-container\" class=\"evf-field evf-field-radio form-row everest-forms-conditional-field\" data-field-id=\"g9pUcC9cw5-41\"><label class=\"evf-field-label\" for=\"evf-23205-field_g9pUcC9cw5-41\"><span class=\"evf-label\">Select your payment durations<\/span> <\/label><ul id=\"evf-23205-field_g9pUcC9cw5-41\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"evf-23205-field_g9pUcC9cw5-41_1\" class=\"input-text\" name=\"everest_forms[form_fields][g9pUcC9cw5-41]\" value=\"3 months\" conditional_id=\"g9pUcC9cw5-41\" conditional_rules=\"{&quot;conditional_option&quot;:&quot;show&quot;,&quot;conditionals&quot;:{&quot;1&quot;:{&quot;1&quot;:{&quot;field&quot;:&quot;D1kX2qnb87-42&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Installment Payment&quot;}},&quot;2&quot;:{&quot;1&quot;:{&quot;field&quot;:&quot;D1kX2qnb87-42&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Cooperative\\\/Microfinance&quot;}}},&quot;required&quot;:0}\"  ><label class=\"everest-forms-field-label-inline\" for=\"evf-23205-field_g9pUcC9cw5-41_1\">3 months<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"evf-23205-field_g9pUcC9cw5-41_2\" class=\"input-text\" name=\"everest_forms[form_fields][g9pUcC9cw5-41]\" value=\"6 months\" conditional_id=\"g9pUcC9cw5-41\" conditional_rules=\"{&quot;conditional_option&quot;:&quot;show&quot;,&quot;conditionals&quot;:{&quot;1&quot;:{&quot;1&quot;:{&quot;field&quot;:&quot;D1kX2qnb87-42&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Installment Payment&quot;}},&quot;2&quot;:{&quot;1&quot;:{&quot;field&quot;:&quot;D1kX2qnb87-42&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Cooperative\\\/Microfinance&quot;}}},&quot;required&quot;:0}\"  ><label class=\"everest-forms-field-label-inline\" for=\"evf-23205-field_g9pUcC9cw5-41_2\">6 months<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"evf-23205-field_g9pUcC9cw5-41_3\" class=\"input-text\" name=\"everest_forms[form_fields][g9pUcC9cw5-41]\" value=\"10 months\" conditional_id=\"g9pUcC9cw5-41\" conditional_rules=\"{&quot;conditional_option&quot;:&quot;show&quot;,&quot;conditionals&quot;:{&quot;1&quot;:{&quot;1&quot;:{&quot;field&quot;:&quot;D1kX2qnb87-42&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Installment Payment&quot;}},&quot;2&quot;:{&quot;1&quot;:{&quot;field&quot;:&quot;D1kX2qnb87-42&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Cooperative\\\/Microfinance&quot;}}},&quot;required&quot;:0}\"  ><label class=\"everest-forms-field-label-inline\" for=\"evf-23205-field_g9pUcC9cw5-41_3\">10 months<\/label><\/li><\/ul><\/div><div id=\"evf-23205-field_TMtLxPjjdb-43-container\" class=\"evf-field evf-field-radio form-row everest-forms-conditional-field\" data-field-id=\"TMtLxPjjdb-43\"><label class=\"evf-field-label\" for=\"evf-23205-field_TMtLxPjjdb-43\"><span class=\"evf-label\">Means of payment<\/span> <\/label><ul id=\"evf-23205-field_TMtLxPjjdb-43\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"evf-23205-field_TMtLxPjjdb-43_1\" class=\"input-text\" name=\"everest_forms[form_fields][TMtLxPjjdb-43]\" value=\"Post dated cheque\" conditional_id=\"TMtLxPjjdb-43\" conditional_rules=\"{&quot;conditional_option&quot;:&quot;show&quot;,&quot;conditionals&quot;:{&quot;1&quot;:{&quot;1&quot;:{&quot;field&quot;:&quot;pt5y57U6nY-23&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Kangen Machine&quot;}}},&quot;required&quot;:0}\"  ><label class=\"everest-forms-field-label-inline\" for=\"evf-23205-field_TMtLxPjjdb-43_1\">Post dated cheque<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"evf-23205-field_TMtLxPjjdb-43_2\" class=\"input-text\" name=\"everest_forms[form_fields][TMtLxPjjdb-43]\" value=\"Standing order from domicile bank\" conditional_id=\"TMtLxPjjdb-43\" conditional_rules=\"{&quot;conditional_option&quot;:&quot;show&quot;,&quot;conditionals&quot;:{&quot;1&quot;:{&quot;1&quot;:{&quot;field&quot;:&quot;pt5y57U6nY-23&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Kangen Machine&quot;}}},&quot;required&quot;:0}\"  ><label class=\"everest-forms-field-label-inline\" for=\"evf-23205-field_TMtLxPjjdb-43_2\">Standing order from domicile bank<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"evf-23205-field_TMtLxPjjdb-43_3\" class=\"input-text\" name=\"everest_forms[form_fields][TMtLxPjjdb-43]\" value=\"Direct debit via remita\" conditional_id=\"TMtLxPjjdb-43\" conditional_rules=\"{&quot;conditional_option&quot;:&quot;show&quot;,&quot;conditionals&quot;:{&quot;1&quot;:{&quot;1&quot;:{&quot;field&quot;:&quot;pt5y57U6nY-23&quot;,&quot;operator&quot;:&quot;is&quot;,&quot;value&quot;:&quot;Kangen Machine&quot;}}},&quot;required&quot;:0}\"  ><label class=\"everest-forms-field-label-inline\" for=\"evf-23205-field_TMtLxPjjdb-43_3\">Direct debit via remita<\/label><\/li><\/ul><\/div><div id=\"evf-23205-field_pZx9JH5lHS-49-container\" class=\"evf-field evf-field-file-upload form-row validate-required everest-forms-conditional-field\" data-required-field-message=\"This field is required.\" data-field-id=\"pZx9JH5lHS-49\"><label class=\"evf-field-label\" for=\"evf-23205-field_pZx9JH5lHS-49\"><span class=\"evf-label\">Upload payment receipt of service charge (\u20a610,000)<\/span> <abbr class=\"required\" title=\"Required\">*<\/abbr><\/label>\t\t<div class=\"everest-forms-uploader\"\n\t\t\tdata-field-id=\"pZx9JH5lHS-49\"\n\t\t\tdata-form-id=\"23205\"\n\t\t\tdata-input-name=\"everest_forms_23205_pZx9JH5lHS-49\"\n\t\t\tdata-extensions=\"jpg,jpeg,jpe,gif,png,bmp,tiff,tif,webp,avif,ico,heic,heif,heics,heifs,asf,asx,wmv,wmx,wm,avi,divx,mov,qt,mpeg,mpg,mpe,mp4,m4v,ogv,webm,mkv,3gp,3gpp,3g2,3gp2,txt,asc,c,cc,h,srt,csv,tsv,ics,rtx,css,html,vtt,dfxp,mp3,m4a,m4b,aac,ra,ram,wav,x-wav,ogg,oga,flac,mid,midi,wma,wax,mka,rtf,pdf,class,tar,zip,gz,gzip,rar,7z,psd,xcf,doc,pot,pps,ppt,wri,xla,xls,xlt,xlw,mpp,docx,docm,dotx,dotm,xlsx,xlsm,xlsb,xltx,xltm,xlam,pptx,pptm,ppsx,ppsm,potx,potm,ppam,sldx,sldm,onetoc,onetoc2,onetmp,onepkg,oxps,xps,odt,odp,ods,odg,odc,odb,odf,wp,wpd,key,numbers,pages\"\n\t\t\tdata-max-size=\"1073741824\"\n\t\t\tdata-max-file-number=\"1\"\n\t\t\tdata-post-max-size=\"1073741824\">\n\t\t\t<div class=\"dz-message\">\n\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 32 32\" width=\"32px\" height=\"32px\" fill=\"#868e96\"><path class=\"cls-1\" d=\"M18.12,17.52,17,16.4V25a1,1,0,0,1-2,0V16.4l-1.12,1.12a1,1,0,0,1-1.42,0,1,1,0,0,1,0-1.41l2.83-2.83a1,1,0,0,1,1.42,0l2.83,2.83a1,1,0,0,1-.71,1.7A1,1,0,0,1,18.12,17.52ZM22,22H20a1,1,0,0,1,0-2h2a4,4,0,0,0,.27-8,1,1,0,0,1-.84-.57,6,6,0,0,0-11.36,1.69,1,1,0,0,1-1,.86H9A3,3,0,0,0,9,20h3a1,1,0,0,1,0,2H9a5,5,0,0,1-.75-9.94A8,8,0,0,1,23,10.1,6,6,0,0,1,22,22Z\"\/><\/svg>\n\t\t\t\t<span class=\"everest-forms-upload-title\">\n\t\t\t\t\tDrop your file here or click here to upload\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t<span class=\"everest-forms-upload-hint\">\n\t\t\t\t\t\tYou can upload up to 1 files.\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t<input type=\"text\" class=\"dropzone-input input-text\" id=\"everest-forms-23205-field_pZx9JH5lHS-49\" name=\"everest_forms_23205_pZx9JH5lHS-49\" required conditional_id=\"pZx9JH5lHS-49\" conditional_rules='{\"conditional_option\":\"show\",\"conditionals\":{\"1\":{\"1\":{\"field\":\"pt5y57U6nY-23\",\"operator\":\"is\",\"value\":\"Kangen Machine\"}}},\"required\":\"1\"}'>\n\t\t<\/div><\/div><\/div><\/div><div class=\"evf-honeypot-container evf-field-hp\"><label for=\"evf-23205-field-hp\" class=\"evf-field-label\">Phone<\/label><input type=\"text\" name=\"everest_forms[hp]\" id=\"evf-23205-field-hp\" class=\"input-text\"><\/div><div class=\"evf-submit-container \" ><input type=\"hidden\" name=\"everest_forms[id]\" value=\"23205\"><input type=\"hidden\" name=\"everest_forms[author]\" value=\"1\"><button type='submit' name='everest_forms[submit]' class='everest-forms-submit-button button evf-submit ' id='evf-submit-23205' value='evf-submit' data-process-text=\"Processing\u2026\" conditional_rules='&quot;&quot;' conditional_id='evf-submit-23205'  id=\"evf-submit-23205\" aria-live=\"assertive\">Place Order<\/button><\/div><\/form><\/div><!-- .evf-container --><\/div>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-31254ee e-flex e-con-boxed e-con e-parent\" data-id=\"31254ee\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-ae1a959 elementor-widget elementor-widget-text-editor\" data-id=\"ae1a959\" data-element_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>Account Name: <strong>Vute \/ -eiye<\/strong><br \/>Account Number: <strong>1100255209<\/strong><br \/>Bank: <strong>Sulspap MFB<\/strong><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-45857e2 elementor-widget elementor-widget-text-editor\" data-id=\"45857e2\" data-element_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>Having any issues in completing your order, reach us on 08025276754 or 09130959446<\/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\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Home KANGEN PRODUCT(S) ORDER First Name *Last Name *Email *Date of Birth *Phone Number\/WhatsApp Number *Separate multiple phone numbers with a space in betweenSelect your order item * Kangen Machine Kangen Water Order Details Water type needed: * pH 11.5 &hellip; 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