{"id":7553,"date":"2026-02-07T15:13:38","date_gmt":"2026-02-07T20:13:38","guid":{"rendered":"https:\/\/www.gosselinassurances.ca\/?page_id=7553"},"modified":"2026-08-12T11:46:26","modified_gmt":"2026-08-12T15:46:26","slug":"submission-request","status":"publish","type":"page","link":"https:\/\/www.gosselinassurances.ca\/en\/submission-request\/","title":{"rendered":"Demande de soumission"},"content":{"rendered":"<div data-elementor-type=\"wp-page\" data-elementor-id=\"7553\" class=\"elementor elementor-7553\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"ob-is-breaking-bad elementor-section elementor-top-section elementor-element elementor-element-7e2586d elementor-section-full_width elementor-section-height-default elementor-section-height-default\" data-id=\"7e2586d\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;_ob_bbad_use_it&quot;:&quot;yes&quot;,&quot;_ob_bbad_sssic_use&quot;:&quot;no&quot;,&quot;_ob_glider_is_slider&quot;:&quot;no&quot;}\">\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-9cca572\" data-id=\"9cca572\" data-element_type=\"column\" data-e-type=\"column\" data-settings=\"{&quot;_ob_bbad_is_stalker&quot;:&quot;no&quot;,&quot;_ob_teleporter_use&quot;:false,&quot;_ob_column_hoveranimator&quot;:&quot;no&quot;,&quot;_ob_column_has_pseudo&quot;:&quot;no&quot;}\">\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-fdac4b5 ob-harakiri-inherit ob-has-background-overlay elementor-widget elementor-widget-heading\" data-id=\"fdac4b5\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;_ob_use_harakiri&quot;:&quot;yes&quot;,&quot;_ob_harakiri_writing_mode&quot;:&quot;inherit&quot;,&quot;_ob_harakiri_text_clip&quot;:&quot;none&quot;,&quot;_ob_perspektive_use&quot;:&quot;no&quot;,&quot;_ob_poopart_use&quot;:&quot;yes&quot;,&quot;_ob_shadough_use&quot;:&quot;no&quot;,&quot;_ob_allow_hoveranimator&quot;:&quot;no&quot;,&quot;_ob_widget_stalker_use&quot;:&quot;no&quot;}\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Contact a broker now!<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-cdfb440 ob-harakiri-inherit ob-has-background-overlay elementor-widget elementor-widget-heading\" data-id=\"cdfb440\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;_ob_use_harakiri&quot;:&quot;yes&quot;,&quot;_ob_harakiri_writing_mode&quot;:&quot;inherit&quot;,&quot;_ob_harakiri_text_clip&quot;:&quot;none&quot;,&quot;_ob_perspektive_use&quot;:&quot;no&quot;,&quot;_ob_poopart_use&quot;:&quot;yes&quot;,&quot;_ob_shadough_use&quot;:&quot;no&quot;,&quot;_ob_allow_hoveranimator&quot;:&quot;no&quot;,&quot;_ob_widget_stalker_use&quot;:&quot;no&quot;}\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\"><a href=\"tel:1-866-961-3553\">1 866 961-3553<\/a><\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2740e0d ob-harakiri-inherit ob-has-background-overlay elementor-widget elementor-widget-text-editor\" data-id=\"2740e0d\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;_ob_use_harakiri&quot;:&quot;yes&quot;,&quot;_ob_harakiri_writing_mode&quot;:&quot;inherit&quot;,&quot;_ob_postman_use&quot;:&quot;no&quot;,&quot;_ob_perspektive_use&quot;:&quot;no&quot;,&quot;_ob_poopart_use&quot;:&quot;yes&quot;,&quot;_ob_shadough_use&quot;:&quot;no&quot;,&quot;_ob_allow_hoveranimator&quot;:&quot;no&quot;,&quot;_ob_widget_stalker_use&quot;:&quot;no&quot;}\" 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>Our business hours are:<\/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-4680f16 elementor-align-center elementor-icon-list--layout-traditional elementor-list-item-link-full_width ob-has-background-overlay elementor-widget elementor-widget-icon-list\" data-id=\"4680f16\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;_ob_perspektive_use&quot;:&quot;no&quot;,&quot;_ob_poopart_use&quot;:&quot;yes&quot;,&quot;_ob_shadough_use&quot;:&quot;no&quot;,&quot;_ob_allow_hoveranimator&quot;:&quot;no&quot;,&quot;_ob_widget_stalker_use&quot;:&quot;no&quot;}\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Monday to Thursday: 9 am to 4:30 pm<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Friday: 9 am to 4 pm<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\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\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"ob-is-breaking-bad elementor-section elementor-top-section elementor-element elementor-element-fcaf23d elementor-section-full_width elementor-section-height-default elementor-section-height-default\" data-id=\"fcaf23d\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;_ob_bbad_use_it&quot;:&quot;yes&quot;,&quot;_ob_bbad_sssic_use&quot;:&quot;no&quot;,&quot;_ob_glider_is_slider&quot;:&quot;no&quot;}\">\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-b47a9a5\" data-id=\"b47a9a5\" data-element_type=\"column\" data-e-type=\"column\" data-settings=\"{&quot;_ob_bbad_is_stalker&quot;:&quot;no&quot;,&quot;_ob_teleporter_use&quot;:false,&quot;_ob_column_hoveranimator&quot;:&quot;no&quot;,&quot;_ob_column_has_pseudo&quot;:&quot;no&quot;}\">\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-ef066f7 ob-harakiri-inherit ob-has-background-overlay elementor-widget elementor-widget-heading\" data-id=\"ef066f7\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;_ob_use_harakiri&quot;:&quot;yes&quot;,&quot;_ob_harakiri_writing_mode&quot;:&quot;inherit&quot;,&quot;_ob_harakiri_text_clip&quot;:&quot;none&quot;,&quot;_ob_perspektive_use&quot;:&quot;no&quot;,&quot;_ob_poopart_use&quot;:&quot;yes&quot;,&quot;_ob_shadough_use&quot;:&quot;no&quot;,&quot;_ob_allow_hoveranimator&quot;:&quot;no&quot;,&quot;_ob_widget_stalker_use&quot;:&quot;no&quot;}\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Quote Request Form<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-4d96b26 uael-gf-button-right uael-gf-ajax-true uael-gf-style-box uael-gf-input-size-sm 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class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_1'  action='\/en\/wp-json\/wp\/v2\/pages\/7553' data-formid='1' novalidate data-trp-original-action=\"\/en\/wp-json\/wp\/v2\/pages\/7553\">\n                        <div class='gform-body gform_body'><div id='gform_fields_1' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_1_1\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-seven-twelfths gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Select your needs:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_1_1'><div class='gchoice gchoice_1_1_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_1.1' type='checkbox'  value='Auto'  id='choice_1_1_1' tabindex='1'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_1_1' id='label_1_1_1' class='gform-field-label gform-field-label--type-inline'>Auto<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_1_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_1.2' type='checkbox'  value='Habitation'  id='choice_1_1_2' tabindex='2'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_1_2' id='label_1_1_2' class='gform-field-label gform-field-label--type-inline'>Home<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_1_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_1.3' type='checkbox'  value='Entreprise'  id='choice_1_1_3' tabindex='3'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_1_3' id='label_1_1_3' class='gform-field-label gform-field-label--type-inline'>Business<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_1_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_1.4' type='checkbox'  value='Agricole'  id='choice_1_1_4' tabindex='4'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_1_4' id='label_1_1_4' class='gform-field-label gform-field-label--type-inline'>Agricultural<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_1_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_1.5' type='checkbox'  value='Autre'  id='choice_1_1_5' tabindex='5'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_1_5' id='label_1_1_5' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_3\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-five-twelfths 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_1_3'>Autre besoin<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_1_3' type='text' value='' class='large'   tabindex='6'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_4\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_4'>Detail your request:<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_4' id='input_1_4' class='textarea medium' tabindex='7'   placeholder='Provide additional details regarding your request: vehicle make and year, place of residence, business name, or any other information you consider relevant.'  aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_1_5\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half 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_1_5'>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_5' id='input_1_5' type='text' value='' class='large'   tabindex='8'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_6\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half 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_1_6'>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_6' id='input_1_6' type='text' value='' class='large'   tabindex='9'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_7\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half 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_1_7'>Phone number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_7' id='input_1_7' type='tel' value='' class='large' tabindex='10'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_8\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_8'>Email address<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_8' id='input_1_8' type='email' value='' class='large' tabindex='11'    aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_1_11\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Best time to contact you:<\/h3><\/div><fieldset id=\"field_1_10\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-third gf_list_inline field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Monday<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_1_10'><div class='gchoice gchoice_1_10_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.1' type='checkbox'  value='AM'  id='choice_1_10_1' tabindex='12'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_10_1' id='label_1_10_1' class='gform-field-label gform-field-label--type-inline'>AM<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_10_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.2' type='checkbox'  value='PM'  id='choice_1_10_2' tabindex='13'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_10_2' id='label_1_10_2' class='gform-field-label gform-field-label--type-inline'>PM<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_12\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-third gf_list_inline field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Tuesday<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_1_12'><div class='gchoice gchoice_1_12_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_12.1' type='checkbox'  value='AM'  id='choice_1_12_1' tabindex='14'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_12_1' id='label_1_12_1' class='gform-field-label gform-field-label--type-inline'>AM<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_12_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_12.2' type='checkbox'  value='PM'  id='choice_1_12_2' tabindex='15'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_12_2' id='label_1_12_2' class='gform-field-label gform-field-label--type-inline'>PM<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_13\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-third gf_list_inline field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Wednesday<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_1_13'><div class='gchoice gchoice_1_13_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.1' type='checkbox'  value='AM'  id='choice_1_13_1' tabindex='16'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_13_1' id='label_1_13_1' class='gform-field-label gform-field-label--type-inline'>AM<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_13_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.2' type='checkbox'  value='PM'  id='choice_1_13_2' tabindex='17'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_13_2' id='label_1_13_2' class='gform-field-label gform-field-label--type-inline'>PM<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_14\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-third gf_list_inline field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Thursday<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_1_14'><div class='gchoice gchoice_1_14_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.1' type='checkbox'  value='AM'  id='choice_1_14_1' tabindex='18'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_14_1' id='label_1_14_1' class='gform-field-label gform-field-label--type-inline'>AM<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_14_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.2' type='checkbox'  value='PM'  id='choice_1_14_2' tabindex='19'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_14_2' id='label_1_14_2' class='gform-field-label gform-field-label--type-inline'>PM<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_15\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-third gf_list_inline field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Friday<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_1_15'><div class='gchoice gchoice_1_15_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.1' type='checkbox'  value='AM'  id='choice_1_15_1' tabindex='20'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_15_1' id='label_1_15_1' class='gform-field-label gform-field-label--type-inline'>AM<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_15_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.2' type='checkbox'  value='PM'  id='choice_1_15_2' tabindex='21'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_15_2' id='label_1_15_2' class='gform-field-label gform-field-label--type-inline'>PM<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_16\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-third gf_list_inline field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Any time<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_1_16'><div class='gchoice gchoice_1_16_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_16.1' type='checkbox'  value='AM'  id='choice_1_16_1' tabindex='22'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_16_1' id='label_1_16_1' class='gform-field-label gform-field-label--type-inline'>AM<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_16_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_16.2' type='checkbox'  value='PM'  id='choice_1_16_2' tabindex='23'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_16_2' id='label_1_16_2' class='gform-field-label gform-field-label--type-inline'>PM<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_23\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Preferred communication method<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_1_23'><div class='gchoice gchoice_1_23_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_23.1' type='checkbox'  value='Courriel'  id='choice_1_23_1' tabindex='24'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_23_1' id='label_1_23_1' class='gform-field-label gform-field-label--type-inline'>Email<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_23_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_23.2' type='checkbox'  value='T\u00e9l\u00e9phone'  id='choice_1_23_2' tabindex='25'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_23_2' id='label_1_23_2' class='gform-field-label gform-field-label--type-inline'>Phone<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_24\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Language preference<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_1_24'><div class='gchoice gchoice_1_24_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.1' type='checkbox'  value='Fran\u00e7ais'  id='choice_1_24_1' tabindex='26'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_24_1' id='label_1_24_1' class='gform-field-label gform-field-label--type-inline'>French<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_24_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.2' type='checkbox'  value='Anglais'  id='choice_1_24_2' tabindex='27'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_24_2' id='label_1_24_2' class='gform-field-label gform-field-label--type-inline'>English<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_31\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Before submitting your application<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_1_31'><div class='gchoice gchoice_1_31_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_31.1' type='checkbox'  value='Notre \u00e9quipe traite les demandes dans un d\u00e9lai pouvant aller jusqu&#039;\u00e0 10 jours ouvrables.  Pour assurer un traitement efficace, veuillez inscrire la date de renouvellement applicable dans le formulaire.  Veuillez prendre note que les demandes dont la date de renouvellement est \u00e0 moins de 10 jours ouvrables ne pourront malheureusement pas \u00eatre prises en charge dans les d\u00e9lais n\u00e9cessaires.  Merci de votre compr\u00e9hension.'  id='choice_1_31_1' tabindex='28'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_31_1' id='label_1_31_1' class='gform-field-label gform-field-label--type-inline'>Our team processes requests within up to 10 business days. To ensure efficient processing, please enter the applicable renewal date in the form. Please note that requests with a renewal date less than 10 business days away cannot unfortunately be processed within the required timeframe. Thank you for your understanding.<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_18\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datefield gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Renewal date<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div id='input_1_18' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_1_18_1_container'>\n                                            <input type='number' maxlength='2' name='input_18[]' id='input_1_18_1' value='' tabindex='29'  aria-required='true'   placeholder='MM' min='1' max='12' step='1'\/>\n                                            <label for='input_1_18_1' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Month<\/label>\n                                        <\/div><div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_1_18_2_container'>\n                                            <input type='number' maxlength='2' name='input_18[]' id='input_1_18_2' value='' tabindex='30'  aria-required='true'   placeholder='DD' min='1' max='31' step='1'\/>\n                                            <label for='input_1_18_2' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Day<\/label>\n                                        <\/div><div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_1_18_3_container'>\n                                            <input type='number' maxlength='4' name='input_18[]' id='input_1_18_3' value='' tabindex='31'  aria-required='true'   placeholder='YYYY' min='1920' max='2027' step='1'\/>\n                                            <label for='input_1_18_3' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Year<\/label>\n                                       <\/div>\n                                   <\/div><\/fieldset><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type='submit' id='gform_submit_button_1' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Submit my request' tabindex='32' \/> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_1' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_1' id='gform_theme_1' value='orbital' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_1' id='gform_style_settings_1' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_1' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='1' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='CAD' value='9VlMi8TBLELE5feWW4cILO9L8mYqccFTtOv6+et9EFMIThEPHr74JZj5hKJVnVAgw58L+JmYtX7DAoO1CI3Xg7TjQjr6C62QBCgWaSU\/JOqy4sc=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_1' 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