{"id":96,"date":"2020-06-08T21:30:50","date_gmt":"2020-06-09T04:30:50","guid":{"rendered":"https:\/\/aquacopiainc.com\/blog\/?page_id=96"},"modified":"2024-01-27T11:19:13","modified_gmt":"2024-01-27T19:19:13","slug":"customer-info-form","status":"publish","type":"page","link":"https:\/\/aquacopiainc.com\/blog\/customer-info-form\/","title":{"rendered":"Customer Registration Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"96\" class=\"elementor elementor-96\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-e45f397 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"e45f397\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-no\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-7da0b66\" data-id=\"7da0b66\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-64a0121 elementor-widget elementor-widget-text-editor\" data-id=\"64a0121\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Welcome Aqua Copia Customer, this form is used to collect your inform for our notification database. We will use email and text messaging to communicate scheduled outages as well as emergencies. This information <u><b>will not<\/b> <\/u>be stored on this site.\u00a0<\/p><p>As the system matures we will enable more features and functionality as they become available.<\/p><p>* = Required fields<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-5092de2 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"5092de2\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-bd7d9da\" data-id=\"bd7d9da\" data-element_type=\"column\" data-e-type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-5f49171\" data-id=\"5f49171\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-cc294af elementor-button-align-center elementor-widget elementor-widget-form\" data-id=\"cc294af\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;button_width&quot;:&quot;50&quot;,&quot;step_next_label&quot;:&quot;Next&quot;,&quot;step_previous_label&quot;:&quot;Previous&quot;,&quot;step_type&quot;:&quot;number_text&quot;,&quot;step_icon_shape&quot;:&quot;circle&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<form class=\"elementor-form\" method=\"post\" name=\"Customer Info  Form\" aria-label=\"Customer Info  Form\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"96\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"cc294af\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"Customer Registration Form\" \/>\n\n\t\t\t\t\t\t\t<input type=\"hidden\" name=\"queried_id\" value=\"96\"\/>\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-above\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-name elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-name\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t* First Name\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[name]\" id=\"form-field-name\" class=\"elementor-field elementor-size-md  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_6789592 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_6789592\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t* Last Name\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_6789592]\" id=\"form-field-field_6789592\" class=\"elementor-field elementor-size-md  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-email elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-email\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t* Email\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[email]\" id=\"form-field-email\" class=\"elementor-field elementor-size-md  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_cbcf540 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_cbcf540\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t* Street Address\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_cbcf540]\" id=\"form-field-field_cbcf540\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"House Number\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-number elementor-field-group elementor-column elementor-field-group-field_74d7150 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_74d7150\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tMeter Number\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t<input type=\"number\" name=\"form_fields[field_74d7150]\" id=\"form-field-field_74d7150\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"found on your bill\" min=\"6\" max=\"14\" >\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-message elementor-col-75\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-message\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCell Number\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[message]\" id=\"form-field-message\" class=\"elementor-field elementor-size-md  elementor-field-textual\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_d56729e elementor-col-75\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_d56729e\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCell Carrier if you want txt messaging\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_d56729e]\" id=\"form-field-field_d56729e\" class=\"elementor-field elementor-size-md  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_ccd787b elementor-col-75\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ccd787b\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHome Number (optional)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[field_ccd787b]\" id=\"form-field-field_ccd787b\" class=\"elementor-field elementor-size-md  elementor-field-textual\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_0571061 elementor-col-75\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_0571061\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAlternate Phone Number\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[field_0571061]\" id=\"form-field-field_0571061\" class=\"elementor-field elementor-size-md  elementor-field-textual\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-field_e77e711 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_e77e711\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAlternate Email\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[field_e77e711]\" id=\"form-field-field_e77e711\" class=\"elementor-field elementor-size-md  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_b594458 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_b594458\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tBilling type\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"E-Billing - sent via email\" id=\"form-field-field_b594458-0\" name=\"form_fields[field_b594458]\" required=\"required\"> <label for=\"form-field-field_b594458-0\">E-Billing - sent via email<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"US Mail\" id=\"form-field-field_b594458-1\" name=\"form_fields[field_b594458]\" required=\"required\"> <label for=\"form-field-field_b594458-1\">US Mail<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_6361724 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_6361724\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAdditional Notes\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-md\" name=\"form_fields[field_6361724]\" id=\"form-field-field_6361724\" rows=\"3\" placeholder=\"Other information you would like us to know\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-recaptcha_v3 elementor-field-group elementor-column elementor-field-group-field_6ed76ad elementor-col-100 recaptcha_v3-bottomright\">\n\t\t\t\t\t<div class=\"elementor-field\" id=\"form-field-field_6ed76ad\"><div class=\"elementor-g-recaptcha\" data-sitekey=\"6LepSh4bAAAAAM-3_ju4BfacBQGKktVsRtzGBekD\" data-type=\"v3\" data-action=\"Form\" data-badge=\"bottomright\" data-size=\"invisible\"><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-group elementor-column elementor-field-type-submit elementor-col-50 e-form__buttons\">\n\t\t\t\t\t<button class=\"elementor-button elementor-size-md\" type=\"submit\" id=\"register_button\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-icon\">\n\t\t\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"far fa-arrow-alt-circle-up\"><\/i>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Register<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/form>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-61d7a3c\" data-id=\"61d7a3c\" data-element_type=\"column\" data-e-type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-334d7d9 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"334d7d9\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-95a91bf\" data-id=\"95a91bf\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-93c5b83 elementor-widget elementor-widget-text-editor\" data-id=\"93c5b83\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>The information entered is accurate to the best of my knowledge, I understand my information will not be used for anything accept Aqua Copia notifications and communications.<\/p><p><span style=\"color: #ff0000;\">Please check your junk folder if you do not receive a confirmation email link within 15 minutes.<\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-4bac072 elementor-section-content-middle elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"4bac072\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-no\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-4d1f3465\" data-id=\"4d1f3465\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-2e51b2c elementor-widget elementor-widget-image\" data-id=\"2e51b2c\" data-element_type=\"widget\" data-e-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=\"1983\" height=\"2560\" src=\"https:\/\/aquacopiainc.com\/blog\/wp-content\/uploads\/2020\/06\/wooden_tank-scaled.jpg\" class=\"attachment-full size-full wp-image-120\" alt=\"\" srcset=\"https:\/\/aquacopiainc.com\/blog\/wp-content\/uploads\/2020\/06\/wooden_tank-scaled.jpg 1983w, https:\/\/aquacopiainc.com\/blog\/wp-content\/uploads\/2020\/06\/wooden_tank-232x300.jpg 232w, https:\/\/aquacopiainc.com\/blog\/wp-content\/uploads\/2020\/06\/wooden_tank-793x1024.jpg 793w, https:\/\/aquacopiainc.com\/blog\/wp-content\/uploads\/2020\/06\/wooden_tank-768x991.jpg 768w, https:\/\/aquacopiainc.com\/blog\/wp-content\/uploads\/2020\/06\/wooden_tank-1190x1536.jpg 1190w, https:\/\/aquacopiainc.com\/blog\/wp-content\/uploads\/2020\/06\/wooden_tank-1587x2048.jpg 1587w, https:\/\/aquacopiainc.com\/blog\/wp-content\/uploads\/2020\/06\/wooden_tank-1200x1549.jpg 1200w, https:\/\/aquacopiainc.com\/blog\/wp-content\/uploads\/2020\/06\/wooden_tank-1980x2556.jpg 1980w\" sizes=\"(max-width: 1983px) 100vw, 1983px\" \/>\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<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-6821a783\" data-id=\"6821a783\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-69cbd8ec elementor-widget elementor-widget-heading\" data-id=\"69cbd8ec\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">About Aqua Copia<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-12eb73c8 elementor-widget elementor-widget-text-editor\" data-id=\"12eb73c8\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>It is a long established fact that Aqua Copia has the best tasting water around the south Snohomish area.\u00a0 Established in 1964, Aqua Copia has been a community managed private water company with the goal of providing clean drinkable water at a reasonable price.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Welcome Aqua Copia Customer, this form is used to collect your inform for our notification database. We will use email and text messaging to communicate scheduled outages as well as [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_uf_show_specific_survey":0,"_uf_disable_surveys":false,"footnotes":""},"class_list":["post-96","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/aquacopiainc.com\/blog\/wp-json\/wp\/v2\/pages\/96","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/aquacopiainc.com\/blog\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/aquacopiainc.com\/blog\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/aquacopiainc.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/aquacopiainc.com\/blog\/wp-json\/wp\/v2\/comments?post=96"}],"version-history":[{"count":89,"href":"https:\/\/aquacopiainc.com\/blog\/wp-json\/wp\/v2\/pages\/96\/revisions"}],"predecessor-version":[{"id":371,"href":"https:\/\/aquacopiainc.com\/blog\/wp-json\/wp\/v2\/pages\/96\/revisions\/371"}],"wp:attachment":[{"href":"https:\/\/aquacopiainc.com\/blog\/wp-json\/wp\/v2\/media?parent=96"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}