{"id":9691,"date":"2019-10-27T15:25:36","date_gmt":"2019-10-27T19:25:36","guid":{"rendered":"http:\/\/bodimetrics.com\/staging\/?page_id=9691"},"modified":"2019-11-03T19:48:31","modified_gmt":"2019-11-04T00:48:31","slug":"agent-order-form","status":"publish","type":"page","link":"https:\/\/bodimetrics.com\/staging\/agent-order-form\/","title":{"rendered":"Agent Order Form"},"content":{"rendered":"<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof 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gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_13' style='display:none'>\n                        <div class='gform_heading'>\n                            <h3 class=\"gform_title\">Sales Agent Order - Pricing Fields<\/h3>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_13'  action='\/staging\/wp-json\/wp\/v2\/pages\/9691' data-formid='13' novalidate>\n                        <div class='gform-body gform_body'><ul id='gform_fields_13' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_13_1\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_13_1'>Business Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_1' id='input_13_1' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_13_2\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_13_2'>First Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_2' id='input_13_2' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_13_3\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_13_3'>Last Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_3' id='input_13_3' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_13_22\" class=\"gfield gfield--type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Billing Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_13_22' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_13_22_1_container' >\n                                        <input type='text' name='input_22.1' id='input_13_22_1' value=''    aria-required='true'    \/>\n                                        <label for='input_13_22_1' id='input_13_22_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_13_22_2_container' >\n                                        <input type='text' name='input_22.2' id='input_13_22_2' value=''     aria-required='false'   \/>\n                                        <label for='input_13_22_2' id='input_13_22_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_13_22_3_container' >\n                                    <input type='text' name='input_22.3' id='input_13_22_3' value=''    aria-required='true'    \/>\n                                    <label for='input_13_22_3' id='input_13_22_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_13_22_4_container' >\n                                        <select name='input_22.4' id='input_13_22_4'     aria-required='true'    ><option value='' selected='selected'><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                        <label for='input_13_22_4' id='input_13_22_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_13_22_5_container' >\n                                    <input type='text' name='input_22.5' id='input_13_22_5' value=''    aria-required='true'    \/>\n                                    <label for='input_13_22_5' id='input_13_22_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_22.6' id='input_13_22_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_13_24\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Shipping Address Same as Billing Address?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_13_24'>\n\t\t\t<li class='gchoice gchoice_13_24_0'>\n\t\t\t\t<input name='input_24' type='radio' value='Yes'  id='choice_13_24_0'    \/>\n\t\t\t\t<label for='choice_13_24_0' id='label_13_24_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_13_24_1'>\n\t\t\t\t<input name='input_24' type='radio' value='No'  id='choice_13_24_1'    \/>\n\t\t\t\t<label for='choice_13_24_1' id='label_13_24_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_13_23\" class=\"gfield gfield--type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Shipping Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_13_23' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_13_23_1_container' >\n                                        <input type='text' name='input_23.1' id='input_13_23_1' value=''    aria-required='true'    \/>\n                                        <label for='input_13_23_1' id='input_13_23_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_13_23_2_container' >\n                                        <input type='text' name='input_23.2' id='input_13_23_2' value=''     aria-required='false'   \/>\n                                        <label for='input_13_23_2' id='input_13_23_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_13_23_3_container' >\n                                    <input type='text' name='input_23.3' id='input_13_23_3' value=''    aria-required='true'    \/>\n                                    <label for='input_13_23_3' id='input_13_23_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_13_23_4_container' >\n                                        <select name='input_23.4' id='input_13_23_4'     aria-required='true'    ><option value='' selected='selected'><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                        <label for='input_13_23_4' id='input_13_23_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_13_23_5_container' >\n                                    <input type='text' name='input_23.5' id='input_13_23_5' value=''    aria-required='true'    \/>\n                                    <label for='input_13_23_5' id='input_13_23_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_23.6' id='input_13_23_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_13_7\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_13_7'>Shipping Method<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_7' id='input_13_7' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Ground' >Ground<\/option><option value='Expedited' >Expedited<\/option><\/select><\/div><\/li><li id=\"field_13_9\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_13_9'>PO Number<\/label><div class='ginput_container ginput_container_text'><input name='input_9' id='input_13_9' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_13_8\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_13_8'>Date Required<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_8' id='input_13_8' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_13_8_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_13_8_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_13_8' class='gform_hidden' value='https:\/\/bodimetrics.com\/staging\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_13_10\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_13_10'>Sales Representative<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_10' id='input_13_10' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_13_27\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Products<\/h2><\/li><li id=\"field_13_12\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield_price gfield_price_13_12 gfield_product_13_12 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_13_12_1'><span class=\"gform-field-label gfield_label_product\">Performance Monitor<\/span> <span class=\"screen-reader-text\">Quantity<\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_12.1' value='Performance Monitor' class='gform_hidden' \/>\n\t\t\t\t\t\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_13_12'>$299.00<\/span>\n\t\t\t\t\t\n\t\t\t\t\t<input type='hidden' name='input_12.2' id='ginput_base_price_13_12' class='gform_hidden' value='$299.00'\/>\n\t\t\t\t\t <label for='ginput_quantity_13_12_1' class='ginput_quantity_label gform-field-label' aria-hidden='true'>Quantity<\/label> <input type='number' name='input_12.3' value='' id='input_13_12_1' class='ginput_quantity' size='10' min='0'   aria-label=\"Quantity Performance Monitor\"  \/>\n\t\t\t\t<\/div><\/li><li id=\"field_13_25\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield_price gfield_price_13_25 gfield_product_13_25 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_13_25_1'><span class=\"gform-field-label gfield_label_product\">O2 Vibe<\/span> <span class=\"screen-reader-text\">Quantity<\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_25.1' value='O2 Vibe' class='gform_hidden' \/>\n\t\t\t\t\t\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_13_25'>$199.00<\/span>\n\t\t\t\t\t\n\t\t\t\t\t<input type='hidden' name='input_25.2' id='ginput_base_price_13_25' class='gform_hidden' value='$199.00'\/>\n\t\t\t\t\t <label for='ginput_quantity_13_25_1' class='ginput_quantity_label gform-field-label' aria-hidden='true'>Quantity<\/label> <input type='number' name='input_25.3' value='' id='input_13_25_1' class='ginput_quantity' size='10' min='0'   aria-label=\"Quantity O2 Vibe\"  \/>\n\t\t\t\t<\/div><\/li><li id=\"field_13_26\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield_price gfield_price_13_26 gfield_product_13_26 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_13_26_1'><span class=\"gform-field-label gfield_label_product\">Wrist Blood Pressure Monitor<\/span> <span class=\"screen-reader-text\">Quantity<\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_26.1' value='Wrist Blood Pressure Monitor' class='gform_hidden' \/>\n\t\t\t\t\t\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_13_26'>$69.00<\/span>\n\t\t\t\t\t\n\t\t\t\t\t<input type='hidden' name='input_26.2' id='ginput_base_price_13_26' class='gform_hidden' value='$69.00'\/>\n\t\t\t\t\t <label for='ginput_quantity_13_26_1' class='ginput_quantity_label gform-field-label' aria-hidden='true'>Quantity<\/label> <input type='number' name='input_26.3' value='' id='input_13_26_1' class='ginput_quantity' size='10' min='0'   aria-label=\"Quantity Wrist Blood Pressure Monitor\"  \/>\n\t\t\t\t<\/div><\/li><li id=\"field_13_28\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\"><\/h2><\/li><li id=\"field_13_21\" class=\"gfield gfield--type-number gfield_calculation field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_13_21'>Retail Price (Calculated)<\/label><div class='ginput_container ginput_container_number'><input name='input_21' id='input_13_21' type='text' step='any'   value='' class='medium gform-text-input-reset'  readonly=\"readonly\"    aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_13_31\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\"><\/h2><\/li><li id=\"field_13_16\" class=\"gfield gfield--type-number field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_13_16'>Agent Discount (%)<\/label><div class='ginput_container ginput_container_number'><input name='input_16' id='input_13_16' type='number' step='any' min='1' max='100' value='' class='medium'      aria-invalid=\"false\" aria-describedby=\"gfield_instruction_13_16\" \/><div class='gfield_description instruction ' id='gfield_instruction_13_16'>Please enter a number from <strong>1<\/strong> to <strong>100<\/strong>.<\/div><\/div><\/li><li id=\"field_13_20\" class=\"gfield gfield--type-product gfield--input-type-calculation gfield_price gfield_price_13_20 gfield_product_13_20 gfield_calculation field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_13_20_1'>Agent Discount (Calculated) $<\/label><div class='ginput_container ginput_container_product_calculation'>\n\t\t\t\t\t<input type='hidden' name='input_20.1' value='Agent Discount (Calculated) $' class='gform_hidden' \/>\n\t\t\t\t\t\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_13_20'>$0.00<\/span>\n\t\t\t\t\t\n\t\t\t\t\t<input type='hidden' name='input_20.2' id='ginput_base_price_13_20' class='gform_hidden ginput_calculated_price' value='$0.00'\/>\n\t\t\t\t\t<input type='hidden' name='input_20.3' value='1' class='ginput_quantity_13_20 gform_hidden' \/>\n\t\t\t\t<\/div><\/li><li id=\"field_13_33\" class=\"gfield gfield--type-total gfield_price gfield_price_13_ gfield_total gfield_total_13_ field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  aria-atomic=\"true\" aria-live=\"polite\" ><label class='gfield_label gform-field-label' for='input_13_33'>Discounted Price $<\/label><div class='ginput_container ginput_container_total'>\n\t\t\t\t\t\t\t<span class='ginput_total ginput_total_13'>$0.00<\/span>\n\t\t\t\t\t\t\t<input type='hidden' name='input_33' id='input_13_33' class='gform_hidden'\/>\n\t\t\t\t\t\t<\/div><\/li><li id=\"field_13_11\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_13_11'>Special Instructions<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_11' id='input_13_11' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><\/ul><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type=\"hidden\" name=\"affwp_action\" value=\"affiliate_register\" \/><input type='submit' id='gform_submit_button_13' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Submit'  \/> \n            <input 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Name*Billing Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Shipping Address Same as Billing ... <div><a href=\"https:\/\/bodimetrics.com\/staging\/agent-order-form\/\" class=\"more-link\">Read 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