{"id":1852,"date":"2019-06-17T13:34:15","date_gmt":"2019-06-17T18:34:15","guid":{"rendered":"https:\/\/cityofedgerton.org\/pubpress\/?page_id=1852"},"modified":"2021-05-09T13:43:06","modified_gmt":"2021-05-09T18:43:06","slug":"contact","status":"publish","type":"page","link":"https:\/\/cityofedgerton.org\/pubpress\/?page_id=1852","title":{"rendered":"Contact"},"content":{"rendered":"<div class='fluentform ff-default fluentform_wrapper_1 ffs_default_wrap'><form data-form_id=\"1\" id=\"fluentform_1\" class=\"frm-fluent-form fluent_form_1 ff-el-form-top ff_form_instance_1_1 ff-form-loading ffs_default\" data-form_instance=\"ff_form_instance_1_1\" method=\"POST\" ><fieldset  style=\"border: none!important;margin: 0!important;padding: 0!important;background-color: transparent!important;box-shadow: none!important;outline: none!important; min-inline-size: 100%;\">\n                    <legend class=\"ff_screen_reader_title\" style=\"display: block; margin: 0!important;padding: 0!important;height: 0!important;text-indent: -999999px;width: 0!important;overflow:hidden;\">Contact Form<\/legend>        <span style=\"display: none !important;\"><input type=\"checkbox\"\n                name=\"item__1__fluent_checkme_\"\n                value=\"1\" style=\"display:none !important;\" tabindex=\"-1\" aria-hidden=\"true\"><\/span>\n        <input type='hidden' name='__fluent_form_embded_post_id' value='1852' \/><input type=\"hidden\" id=\"_fluentform_1_fluentformnonce\" name=\"_fluentform_1_fluentformnonce\" value=\"efb69d0504\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/pubpress\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F1852\" \/><div class='ff-el-group  ff-custom_html' data-name=\"custom_html-1_1\" ><h4 style=\"text-align: center\">Please fill out the following form with your Concern. We will review your request and follow up with you as soon as possible.<\/h4><\/div><div data-type=\"name-element\" data-name=\"names\" class=\" ff-field_container ff-name-field-wrapper\" ><div class='ff-t-container'><div class='ff-t-cell '><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_1_names_first_name_' aria-label=\"First Name\">First Name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names[first_name]\" id=\"ff_1_names_first_name_\" class=\"ff-el-form-control\" aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell '><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_1_names_last_name_' aria-label=\"Last Name\">Last Name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names[last_name]\" id=\"ff_1_names_last_name_\" class=\"ff-el-form-control\" aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_1_email' aria-label=\"Email\">Email<\/label><\/div><div class='ff-el-input--content'><input type=\"email\" name=\"email\" id=\"ff_1_email\" class=\"ff-el-form-control\" data-name=\"email\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class=\"ff-name-address-wrapper fluent-address\" data-type=\"address-element\" data-name=\"address1\" ><div class='ff-el-input--label'><label aria-label=Address>Address<\/label><\/div><div class='ff-el-input--content'><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_1_address1_address_line_1_' aria-label=\"Address Line 1\">Address Line 1<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address1[address_line_1]\" id=\"ff_1_address1_address_line_1_\" class=\"ff-el-form-control\" data-key_name=\"address_line_1\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_1_address1_address_line_2_' aria-label=\"Address Line 2\">Address Line 2<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address1[address_line_2]\" id=\"ff_1_address1_address_line_2_\" class=\"ff-el-form-control\" data-key_name=\"address_line_2\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_1_address1_city_' aria-label=\"City\">City<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address1[city]\" id=\"ff_1_address1_city_\" class=\"ff-el-form-control\" data-key_name=\"city\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_1_address1_state_' aria-label=\"State\">State<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address1[state]\" id=\"ff_1_address1_state_\" class=\"ff-el-form-control\" data-key_name=\"state\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_1_address1_zip_' aria-label=\"Zip Code\">Zip Code<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address1[zip]\" id=\"ff_1_address1_zip_\" class=\"ff-el-form-control\" data-key_name=\"zip\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_1_datetime' aria-label=\"Date of incident\">Date of incident<\/label><\/div><div class='ff-el-input--content'><input data-type-datepicker data-format='d\/m\/Y' type=\"text\" name=\"datetime\" id=\"ff_1_datetime\" class=\"ff-el-form-control ff-el-datepicker\" data-name=\"datetime\"  aria-invalid='false' aria-required=false><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_1_dropdown' aria-label=\"Whom would you like to contact\">Whom would you like to contact<\/label><\/div><div class='ff-el-input--content'><select name=\"dropdown\" id=\"ff_1_dropdown\" class=\"ff-el-form-control  ff_has_multi_select\" data-name=\"dropdown\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=true><option value=\"\">- Select -<\/option><option value=\"Mayor\"  >Mayor<\/option><option value=\"City Clerk\"  selected>City Clerk<\/option><option value=\"Police Department\"  >Police Department<\/option><option value=\"Water Department\"  >Water Department<\/option><option value=\"Street Department\"  >Street Department<\/option><option value=\"Accounts Receivable\"  >Accounts Receivable<\/option><option value=\"East Ward Alderman\"  >East Ward Alderman<\/option><option value=\"West Ward Alderman\"  >West Ward Alderman<\/option><option value=\"Zoning Officer\"  >Zoning Officer<\/option><\/select><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_1_dropdown_1' aria-label=\"Response Requested?\">Response Requested?<\/label><\/div><div class='ff-el-input--content'><select name=\"dropdown_1\" id=\"ff_1_dropdown_1\" class=\"ff-el-form-control\" data-name=\"dropdown_1\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=true><option value=\"\">- Select -<\/option><option value=\"None Needed\"  selected>None Needed<\/option><option value=\"By Phone\"  >By Phone<\/option><option value=\"By Email\"  >By Email<\/option><\/select><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_1_dropdown_2' aria-label=\"Area of Concern\">Area of Concern<\/label><\/div><div class='ff-el-input--content'><select name=\"dropdown_2\" id=\"ff_1_dropdown_2\" class=\"ff-el-form-control\" data-name=\"dropdown_2\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=true><option value=\"\">- Select -<\/option><option value=\"Pothole\"  selected>Pothole<\/option><option value=\"Weeds \/ Tall Grass\"  >Weeds \/ Tall Grass<\/option><option value=\"Animal Control\"  >Animal Control<\/option><option value=\"Abandoned Vehilce\"  >Abandoned Vehilce<\/option><option value=\"Water Bill\"  >Water Bill<\/option><option value=\"Water Leak\"  >Water Leak<\/option><option value=\"Litter\"  >Litter<\/option><option value=\"Street Lights\"  >Street Lights<\/option><option value=\"Traffic \/ Road Signs\"  >Traffic \/ Road Signs<\/option><option value=\"Playgrounds \/ Parks\"  >Playgrounds \/ Parks<\/option><option value=\"Overhanging Trees \/ Shrubs\"  >Overhanging Trees \/ Shrubs<\/option><option value=\"Other\"  >Other<\/option><\/select><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_1_description_2' aria-label=\"Location of Problem?\">Location of Problem?<\/label><\/div><div class='ff-el-input--content'><textarea aria-invalid=\"false\" aria-required=false name=\"description_2\" id=\"ff_1_description_2\" class=\"ff-el-form-control\" rows=\"3\" cols=\"2\" data-name=\"description_2\" ><\/textarea><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_1_description' aria-label=\"Please describe the incident you would like to report.\">Please describe the incident you would like to report.<\/label><\/div><div class='ff-el-input--content'><textarea aria-invalid=\"false\" aria-required=false name=\"description\" id=\"ff_1_description\" class=\"ff-el-form-control\" rows=\"4\" cols=\"2\" data-name=\"description\" ><\/textarea><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_1_description_1' aria-label=\"How would you like to see this incident resolved?\">How would you like to see this incident resolved?<\/label><\/div><div class='ff-el-input--content'><textarea aria-invalid=\"false\" aria-required=false name=\"description_1\" id=\"ff_1_description_1\" class=\"ff-el-form-control\" rows=\"4\" cols=\"2\" data-name=\"description_1\" ><\/textarea><\/div><\/div><div class='ff-el-group    ff-el-input--content'><div class='ff-el-form-check ff-el-tc'><label aria-label='terms & conditions' class='ff-el-form-check-label ff_tc_label' for=terms-n-condition_86c3f44f5293911e8817a624878e203c><span class='ff_tc_checkbox'><input type=\"checkbox\" name=\"terms-n-condition\" class=\"ff-el-form-check-input\" data-name=\"terms-n-condition\" id=\"terms-n-condition_86c3f44f5293911e8817a624878e203c\"  value='on' aria-invalid='false' aria-required=true><\/span> <div class='ff_t_c'><p>All the data I submitted is truthfull, and I am responsible for that.<\/p><\/div><\/label><\/div><\/div><div class='ff-el-group ff-text-left ff_submit_btn_wrapper'><button type=\"submit\" class=\"ff-btn ff-btn-submit ff-btn-md ff_btn_style\" >Submit Form<\/button><\/div><\/fieldset><\/form><div id='fluentform_1_errors' class='ff-errors-in-stack ff_form_instance_1_1 ff-form-loading_errors ff_form_instance_1_1_errors'><\/div><\/div>        <script type=\"text\/javascript\">\n            window.fluent_form_ff_form_instance_1_1 = {\"id\":\"1\",\"settings\":{\"layout\":{\"labelPlacement\":\"top\",\"helpMessagePlacement\":\"with_label\",\"errorMessagePlacement\":\"inline\"},\"restrictions\":{\"denyEmptySubmission\":{\"enabled\":false}}},\"form_instance\":\"ff_form_instance_1_1\",\"form_id_selector\":\"fluentform_1\",\"rules\":{\"names[first_name]\":{\"required\":{\"value\":false,\"message\":\"This field is 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