{"id":55,"date":"2011-07-29T15:46:47","date_gmt":"2011-07-29T20:46:47","guid":{"rendered":"\/?page_id=55"},"modified":"2011-12-12T14:46:29","modified_gmt":"2011-12-12T20:46:29","slug":"contact","status":"publish","type":"page","link":"https:\/\/www.leadershipins.com\/service-center\/contact\/","title":{"rendered":"Contact Us"},"content":{"rendered":"\n                <div class='gf_browser_gecko gform_wrapper auto-quote_wrapper' id='gform_wrapper_2' style='display:none'><a id='gf_2' name='gf_2' class='gform_anchor' ><\/a><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_2' id='gform_2' class='auto-quote' action='\/wp-json\/wp\/v2\/pages\/55#gf_2'>\n                        <div class='gform_body'><div id='gform_page_2_1' class='gform_page' >\n                                    <div class='gform_page_fields'><ul id='gform_fields_2' class='gform_fields top_label form_sublabel_below description_below'><li id='field_2_91' class='gfield field_sublabel_below field_description_below' ><label class='gfield_label' for='input_2_91' >Service Request<\/label><div class='ginput_container'><select name='input_91' id='input_2_91' onchange='gf_apply_rules(2,[101]);' class='medium gfield_select' tabindex='1' ><option value='Contact Us' >Contact Us<\/option><option value='Request a Certificate' >Request a Certificate<\/option><option value='Request Auto ID Cards' >Request Auto ID Cards<\/option><option value='Request a Policy Change' >Request a Policy Change<\/option><option value='Update Your Contact Information' >Update Your Contact Information<\/option><\/select><\/div><\/li><li id='field_2_93' class='gfield field_sublabel_below field_description_below' ><label class='gfield_label'  >Current Customer?<\/label><div class='ginput_container'><ul class='gfield_radio' id='input_2_93'><li class='gchoice_2_93_0'><input name='input_93' type='radio' value='Yes' checked='checked' id='choice_2_93_0' tabindex='2'  onclick='gf_apply_rules(2,[95,96]);'  \/><label for='choice_2_93_0' id='label_2_93_0'>Yes<\/label><\/li><li class='gchoice_2_93_1'><input name='input_93' type='radio' value='No'  id='choice_2_93_1' tabindex='3'  onclick='gf_apply_rules(2,[95,96]);'  \/><label for='choice_2_93_1' id='label_2_93_1'>No<\/label><\/li><\/ul><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer'>\n                         <input type='button' id='gform_next_button_2_92' class='gform_next_button button' value='Next' tabindex='4' onclick='jQuery(\"#gform_target_page_number_2\").val(\"2\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_2' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_2_2' class='gform_fields top_label form_sublabel_below description_below'><li id='field_2_9' class='gfield gfield_contains_required field_sublabel_below field_description_below' ><label class='gfield_label' for='input_2_9' >Name<span class='gfield_required'>*<\/span><\/label><div class='ginput_container'><input name='input_9' id='input_2_9' type='text' value='' class='large' maxlength='100' tabindex='5'   \/><\/div><\/li><li id='field_2_8' class='gfield gfield_contains_required field_sublabel_below field_description_below' ><label class='gfield_label' for='input_2_8' >Email<span class='gfield_required'>*<\/span><\/label><div class='ginput_container'>\n                            <input name='input_8' id='input_2_8' type='text' value='' class='large' tabindex='6'   \/>\n                        <\/div><\/li><li id='field_2_10' class='gfield field_sublabel_below field_description_below' ><label class='gfield_label' for='input_2_10' >Phone<\/label><div class='ginput_container'><input name='input_10' id='input_2_10' type='text' value='' class='large' maxlength='50' tabindex='7'   \/><\/div><\/li><li id='field_2_95' class='gfield field_sublabel_below field_description_below' ><label class='gfield_label' for='input_2_95' >Policy Number (if known)<\/label><div class='ginput_container'><input name='input_95' id='input_2_95' type='text' value='' class='large' maxlength='100' tabindex='8'   \/><\/div><\/li><li id='field_2_96' class='gfield field_sublabel_below field_description_below' ><label class='gfield_label' for='input_2_96' >Name on policy<\/label><div class='ginput_container'><input name='input_96' id='input_2_96' type='text' value='' class='large' maxlength='100' tabindex='9'   \/><\/div><\/li><li id='field_2_101' class='gfield field_sublabel_below field_description_below' ><label class='gfield_label' for='input_2_101' >Message<\/label><div class='ginput_container'>\n\t\t\t\t\t<textarea name='input_101' id='input_2_101' class='textarea small' tabindex='10'    rows='10' cols='50'><\/textarea>\n\t\t\t\t<\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer'>\n                        <input type='button' id='gform_previous_button_2_15' class='gform_previous_button button' value='Previous' tabindex='12' onclick='jQuery(\"#gform_target_page_number_2\").val(\"1\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' \/> <input type='button' id='gform_next_button_2_15' class='gform_next_button button' value='Next' tabindex='11' onclick='jQuery(\"#gform_target_page_number_2\").val(\"3\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_3' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_2_3' class='gform_fields top_label form_sublabel_below description_below'><li id='field_2_97' class='gfield gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below' ><h2>Update Your Contact Information<\/h2><p>Please update the appropriate fields of information. You may leave blank anything that does not need updating.<\/p><\/li><li id='field_2_102' class='gfield field_sublabel_below field_description_below' ><label class='gfield_label'  >Please update (check all that apply)<\/label><div class='ginput_container'><ul class='gfield_checkbox' id='input_2_102'><li class='gchoice_2_102_1'>\n\t\t\t\t\t\t\t\t<input name='input_102.1' type='checkbox' onclick='gf_apply_rules(2,[103,104,105,106,107,108,109,110,111,112,113,114,115]);' value='My Address'  id='choice_2_102_1' tabindex='13'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_102_1' id='label_2_102_1'>My Address<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice_2_102_2'>\n\t\t\t\t\t\t\t\t<input name='input_102.2' type='checkbox' onclick='gf_apply_rules(2,[103,104,105,106,107,108,109,110,111,112,113,114,115]);' value='My Phone Numbers'  id='choice_2_102_2' tabindex='14'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_102_2' id='label_2_102_2'>My Phone Numbers<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice_2_102_3'>\n\t\t\t\t\t\t\t\t<input name='input_102.3' type='checkbox' onclick='gf_apply_rules(2,[103,104,105,106,107,108,109,110,111,112,113,114,115]);' value='My Email Address(es)'  id='choice_2_102_3' tabindex='15'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_102_3' id='label_2_102_3'>My Email Address(es)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice_2_102_4'>\n\t\t\t\t\t\t\t\t<input name='input_102.4' type='checkbox' onclick='gf_apply_rules(2,[103,104,105,106,107,108,109,110,111,112,113,114,115]);' value='My Occupation\/Employer'  id='choice_2_102_4' tabindex='16'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_102_4' id='label_2_102_4'>My Occupation\/Employer<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id='field_2_103' class='gfield field_sublabel_below field_description_below' ><label class='gfield_label' for='input_2_103' >Home Address<\/label><div class='ginput_container'><input name='input_103' id='input_2_103' type='text' value='' class='large' maxlength='200' tabindex='17'   \/><\/div><\/li><li id='field_2_104' class='gfield field_sublabel_below field_description_below' ><label class='gfield_label' for='input_2_104' >Home City<\/label><div class='ginput_container'><input name='input_104' id='input_2_104' type='text' value='' class='medium' maxlength='100' tabindex='18'   \/><\/div><\/li><li id='field_2_105' class='gfield field_sublabel_below field_description_below' ><label class='gfield_label' for='input_2_105' >Home Zip<\/label><div class='ginput_container'><input name='input_105' id='input_2_105' type='text' value='' class='medium' maxlength='20' tabindex='19'   \/><\/div><\/li><li id='field_2_106' class='gfield field_sublabel_below field_description_below' ><label class='gfield_label'  >Update Business Address?<\/label><div class='ginput_container'><ul class='gfield_radio' id='input_2_106'><li class='gchoice_2_106_0'><input name='input_106' type='radio' value='No' checked='checked' id='choice_2_106_0' tabindex='20'  onclick='gf_apply_rules(2,[107,108,109]);'  \/><label for='choice_2_106_0' id='label_2_106_0'>No<\/label><\/li><li class='gchoice_2_106_1'><input name='input_106' type='radio' value='Yes'  id='choice_2_106_1' tabindex='21'  onclick='gf_apply_rules(2,[107,108,109]);'  \/><label for='choice_2_106_1' id='label_2_106_1'>Yes<\/label><\/li><\/ul><\/div><\/li><li id='field_2_107' class='gfield field_sublabel_below field_description_below' ><label class='gfield_label' for='input_2_107' >Business Address<\/label><div class='ginput_container'><input name='input_107' id='input_2_107' type='text' value='' class='large' maxlength='200' tabindex='22'   \/><\/div><\/li><li id='field_2_108' class='gfield field_sublabel_below field_description_below' ><label class='gfield_label' for='input_2_108' >Business City<\/label><div class='ginput_container'><input name='input_108' id='input_2_108' type='text' value='' class='medium' maxlength='100' tabindex='23'   \/><\/div><\/li><li id='field_2_109' class='gfield field_sublabel_below field_description_below' ><label class='gfield_label' for='input_2_109' >Business Zip<\/label><div class='ginput_container'><input name='input_109' id='input_2_109' type='text' value='' class='medium' maxlength='20' tabindex='24'   \/><\/div><\/li><li id='field_2_110' class='gfield field_sublabel_below field_description_below' ><label class='gfield_label' for='input_2_110' >Home Phone<\/label><div class='ginput_container'><input name='input_110' id='input_2_110' type='text' value='' class='medium' maxlength='100' tabindex='25'   \/><\/div><\/li><li id='field_2_111' class='gfield field_sublabel_below field_description_below' ><label class='gfield_label' for='input_2_111' >Work Phone<\/label><div class='ginput_container'><input name='input_111' id='input_2_111' type='text' value='' class='medium' maxlength='100' tabindex='26'   \/><\/div><\/li><li id='field_2_112' class='gfield field_sublabel_below field_description_below' ><label class='gfield_label' for='input_2_112' >Cell Phone<\/label><div class='ginput_container'><input name='input_112' id='input_2_112' type='text' value='' class='medium' maxlength='100' tabindex='27'   \/><\/div><\/li><li id='field_2_113' class='gfield field_sublabel_below field_description_below' ><label class='gfield_label' for='input_2_113' >My Primary Email<\/label><div class='ginput_complex ginput_container' id='input_2_113_container'>\n                                <span id='input_2_113_1_container' class='ginput_left'>\n                                    <input class='' type='text' name='input_113' id='input_2_113' value='' tabindex='28'   \/>\n                                    <label for='input_2_113' >Enter Email<\/label>\n                                <\/span>\n                                <span id='input_2_113_2_container' class='ginput_right'>\n                                    <input class='' type='text' name='input_113_2' id='input_2_113_2' value='' tabindex='29'  \/>\n                                    <label for='input_2_113_2' >Confirm Email<\/label>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/li><li id='field_2_114' class='gfield field_sublabel_below field_description_below' ><label class='gfield_label' for='input_2_114' >My Backup Email<\/label><div class='ginput_complex ginput_container' id='input_2_114_container'>\n                                <span id='input_2_114_1_container' class='ginput_left'>\n                                    <input class='' type='text' name='input_114' id='input_2_114' value='' tabindex='30'   \/>\n                                    <label for='input_2_114' >Enter Email<\/label>\n                                <\/span>\n                                <span id='input_2_114_2_container' class='ginput_right'>\n                                    <input class='' type='text' name='input_114_2' id='input_2_114_2' value='' tabindex='31'  \/>\n                                    <label for='input_2_114_2' >Confirm Email<\/label>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/li><li id='field_2_115' class='gfield field_sublabel_below field_description_below' ><label class='gfield_label' for='input_2_115' >My Employer\/Occupation<\/label><div class='ginput_container'><input name='input_115' id='input_2_115' type='text' value='' class='large' maxlength='200' tabindex='32'   \/><\/div><\/li><li id='field_2_116' class='gfield field_sublabel_below field_description_below' ><label class='gfield_label' for='input_2_116' >Additional Information<\/label><div class='ginput_container'>\n\t\t\t\t\t<textarea name='input_116' id='input_2_116' class='textarea small' tabindex='33'    rows='10' cols='50'><\/textarea>\n\t\t\t\t<\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer'>\n                        <input type='button' id='gform_previous_button_2_117' class='gform_previous_button button' value='Previous' tabindex='35' onclick='jQuery(\"#gform_target_page_number_2\").val(\"2\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' \/> <input type='button' id='gform_next_button_2_117' class='gform_next_button button' value='Next' tabindex='34' onclick='jQuery(\"#gform_target_page_number_2\").val(\"4\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_4' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_2_4' class='gform_fields top_label form_sublabel_below description_below'><li id='field_2_118' class='gfield gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below' ><h2>Request a Policy Change<\/h2><\/li><li id='field_2_119' class='gfield gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below' ><p>DO NOT cancel other coverage until you have heard from your agent. Changes are not effective until your agent notifies you.<\/p><\/li><li id='field_2_120' class='gfield field_sublabel_below field_description_below' ><label class='gfield_label' for='input_2_120' >Name(s) on policy<\/label><div class='ginput_container'><input name='input_120' id='input_2_120' type='text' value='' class='large' maxlength='200' tabindex='36'   \/><\/div><\/li><li id='field_2_122' class='gfield field_sublabel_below field_description_below' ><label class='gfield_label' for='input_2_122' >Policy number (if known)<\/label><div class='ginput_container'><input name='input_122' id='input_2_122' type='text' value='' class='large' maxlength='200' tabindex='37'   \/><\/div><\/li><li id='field_2_121' class='gfield field_sublabel_below field_description_below' ><label class='gfield_label'  >Policy change(s) requested<\/label><div class='ginput_container'><ul class='gfield_checkbox' id='input_2_121'><li class='gchoice_2_121_1'>\n\t\t\t\t\t\t\t\t<input name='input_121.1' type='checkbox' onclick='gf_apply_rules(2,[123,124,125,126,128,127,129,130,131,132,133]);' value='Add a vehicle'  id='choice_2_121_1' tabindex='38'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_121_1' id='label_2_121_1'>Add a vehicle<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice_2_121_2'>\n\t\t\t\t\t\t\t\t<input name='input_121.2' type='checkbox' onclick='gf_apply_rules(2,[123,124,125,126,128,127,129,130,131,132,133]);' value='Remove a vehicle'  id='choice_2_121_2' tabindex='39'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_121_2' id='label_2_121_2'>Remove a vehicle<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice_2_121_3'>\n\t\t\t\t\t\t\t\t<input name='input_121.3' type='checkbox' onclick='gf_apply_rules(2,[123,124,125,126,128,127,129,130,131,132,133]);' value='Homeowners change'  id='choice_2_121_3' tabindex='40'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_121_3' id='label_2_121_3'>Homeowners change<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice_2_121_4'>\n\t\t\t\t\t\t\t\t<input name='input_121.4' type='checkbox' onclick='gf_apply_rules(2,[123,124,125,126,128,127,129,130,131,132,133]);' value='Other coverage change'  id='choice_2_121_4' tabindex='41'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_121_4' id='label_2_121_4'>Other coverage change<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id='field_2_123' class='gfield field_sublabel_below field_description_below' ><label class='gfield_label' for='input_2_123' >Requested Effective Date<\/label><div class='ginput_container'>\n                            <input name='input_123' id='input_2_123' type='text' value='' class='datepicker medium mdy datepicker_with_icon' tabindex='42'  \/>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_2_123' class='gform_hidden' value='https:\/\/www.leadershipins.com\/wp-content\/plugins\/gravityforms\/images\/calendar.png'\/><\/li><li id='field_2_124' class='gfield field_sublabel_below field_description_below' ><label class='gfield_label' for='input_2_124' >Year-Make-Model<\/label><div class='ginput_container'><input name='input_124' id='input_2_124' type='text' value='' class='large' maxlength='200' tabindex='43'   \/><\/div><\/li><li id='field_2_125' class='gfield field_sublabel_below field_description_below' ><label class='gfield_label' for='input_2_125' >VIN (if known)<\/label><div class='ginput_container'><input name='input_125' id='input_2_125' type='text' value='' class='large' maxlength='100' tabindex='44'   \/><\/div><\/li><li id='field_2_126' class='gfield field_sublabel_below field_description_below' ><label class='gfield_label' for='input_2_126' >Existing Damage (if any)<\/label><div class='ginput_container'><input name='input_126' id='input_2_126' type='text' value='' class='large' maxlength='1000' tabindex='45'   \/><\/div><\/li><li id='field_2_128' class='gfield field_sublabel_below field_description_below' ><label class='gfield_label' for='input_2_128' >Coverage Limits<\/label><div class='ginput_container'><select name='input_128' id='input_2_128'  class='large gfield_select' tabindex='46' ><option value='Please Select' >Please Select<\/option><option value='Liability Only' >Liability Only<\/option><option value='Same as current vehicle (see below)' >Same as current vehicle (see below)<\/option><option value='Different coverage (explain below)' >Different coverage (explain below)<\/option><\/select><\/div><\/li><li id='field_2_127' class='gfield field_sublabel_below field_description_below' ><label class='gfield_label' for='input_2_127' >Additional Notes<\/label><div class='ginput_container'>\n\t\t\t\t\t<textarea name='input_127' id='input_2_127' class='textarea small' tabindex='47'    rows='10' cols='50'><\/textarea>\n\t\t\t\t<\/div><\/li><li id='field_2_129' class='gfield field_sublabel_below field_description_below' ><label class='gfield_label' for='input_2_129' >Homeowners Change<\/label><div class='ginput_container'>\n\t\t\t\t\t<textarea name='input_129' id='input_2_129' class='textarea small' tabindex='48'    rows='10' cols='50'><\/textarea>\n\t\t\t\t<\/div><\/li><li id='field_2_130' class='gfield field_sublabel_below field_description_below' ><label class='gfield_label' for='input_2_130' >Other coverage change<\/label><div class='ginput_container'>\n\t\t\t\t\t<textarea name='input_130' id='input_2_130' class='textarea small' tabindex='49'    rows='10' cols='50'><\/textarea>\n\t\t\t\t<\/div><\/li><li id='field_2_131' class='gfield field_sublabel_below field_description_below' ><label class='gfield_label' for='input_2_131' >Vehicle to remove<\/label><div class='ginput_container'><input name='input_131' id='input_2_131' type='text' value='' class='large' maxlength='100' tabindex='50'   \/><\/div><\/li><li id='field_2_132' class='gfield field_sublabel_below field_description_below' ><label class='gfield_label' for='input_2_132' >Effective Date of Dropping Vehicle<\/label><div class='ginput_container'>\n                            <input name='input_132' id='input_2_132' type='text' value='' class='datepicker medium mdy datepicker_with_icon' tabindex='51'  \/>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_2_132' class='gform_hidden' value='https:\/\/www.leadershipins.com\/wp-content\/plugins\/gravityforms\/images\/calendar.png'\/><\/li><li id='field_2_133' class='gfield field_sublabel_below field_description_below' ><label class='gfield_label' for='input_2_133' >Reason for cancellation<\/label><div class='ginput_container'>\n\t\t\t\t\t<textarea name='input_133' id='input_2_133' class='textarea small' tabindex='52'    rows='10' cols='50'><\/textarea>\n\t\t\t\t<\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer'>\n                        <input type='button' id='gform_previous_button_2_134' class='gform_previous_button button' value='Previous' tabindex='54' onclick='jQuery(\"#gform_target_page_number_2\").val(\"3\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' \/> <input type='button' id='gform_next_button_2_134' class='gform_next_button button' value='Next' tabindex='53' onclick='jQuery(\"#gform_target_page_number_2\").val(\"5\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_5' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_2_5' class='gform_fields top_label form_sublabel_below description_below'><li id='field_2_135' class='gfield gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below' ><h2>Request a Certificate<\/h2><\/li><li id='field_2_138' class='gfield gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below' ><h3>Requester (Your) 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