{"id":356,"date":"2016-07-12T17:00:23","date_gmt":"2016-07-12T21:00:23","guid":{"rendered":"https:\/\/innovatex-inc.com\/?page_id=356"},"modified":"2022-12-29T18:43:21","modified_gmt":"2022-12-29T23:43:21","slug":"reseller-quote","status":"publish","type":"page","link":"https:\/\/innovatex-inc.com\/?page_id=356","title":{"rendered":"Reseller Quote"},"content":{"rendered":"<h2>Request a free product sample and\/or to become a reseller.<\/h2>\n<p>If you are a licensed eye care professional and would like to receive a free&nbsp;<em>Tear Duct Occluder<sup>TM<\/sup><\/em> and\/or become a reseller, &nbsp;please fill out the following form. (* indicates required field) Upon verification of your information, we will mail you a free sample along with a reseller discount price.<br \/>\n<div role=\"form\" class=\"wpcf7\" id=\"wpcf7-f363-o1\" lang=\"en-US\" dir=\"ltr\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F356#wpcf7-f363-o1\" method=\"post\" class=\"wpcf7-form init\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"363\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"5.4\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f363-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/div>\n<p>First Name*<br \/>\n    <span class=\"wpcf7-form-control-wrap first-name\"><input type=\"text\" name=\"first-name\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span><br \/>\nLast Name*<br \/>\n    <span class=\"wpcf7-form-control-wrap last-name\"><input type=\"text\" name=\"last-name\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span><br \/>\nPhone Number<br \/>\n    <span class=\"wpcf7-form-control-wrap phone-number\"><input type=\"text\" name=\"phone-number\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" \/><\/span><br \/>\nEmail*<br \/>\n    <span class=\"wpcf7-form-control-wrap your-email\"><input type=\"email\" name=\"your-email\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-email wpcf7-validates-as-required wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span><br \/>\nInstitution\/Practice Name<br \/>\n    <span class=\"wpcf7-form-control-wrap institution-name\"><input type=\"text\" name=\"institution-name\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" \/><\/span><br \/>\nNPI Number*<br \/>\n    <span class=\"wpcf7-form-control-wrap license-number\"><input type=\"text\" name=\"license-number\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span><br \/>\nPractice Website*<br \/>\n    <span class=\"wpcf7-form-control-wrap website\"><input type=\"text\" name=\"website\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span><br \/>\nStreet Address*<br \/>\n    <span class=\"wpcf7-form-control-wrap street-address\"><input type=\"text\" name=\"street-address\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span><br \/>\nCity*<br \/>\n    <span class=\"wpcf7-form-control-wrap city\"><input type=\"text\" name=\"city\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span><br \/>\nState\/Region*<br \/>\n    <span class=\"wpcf7-form-control-wrap state-region\"><input type=\"text\" name=\"state-region\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span><br \/>\nZip\/Postal Code*<br \/>\n    <span class=\"wpcf7-form-control-wrap zip-code\"><input type=\"text\" name=\"zip-code\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span><br \/>\nCountry*<br \/>\n    <span class=\"wpcf7-form-control-wrap country\"><input type=\"text\" name=\"country\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span><br \/>\nJob Title<br \/>\n    <span class=\"wpcf7-form-control-wrap job-title\"><input type=\"text\" name=\"job-title\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" \/><\/span><br \/>\n<input type=\"submit\" value=\"Submit\" class=\"wpcf7-form-control wpcf7-submit\" \/><\/p>\n<div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div><\/form><\/div><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Request a free product sample and\/or to become a reseller. If you are a licensed eye care professional and would like to receive a free&nbsp;Tear Duct OccluderTM and\/or become a reseller, &nbsp;please fill out the following form. (* indicates required<a class=\"more-link\" href=\"https:\/\/innovatex-inc.com\/?page_id=356\" title=\"Reseller Quote\"><span>Read more<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"_links":{"self":[{"href":"https:\/\/innovatex-inc.com\/index.php?rest_route=\/wp\/v2\/pages\/356"}],"collection":[{"href":"https:\/\/innovatex-inc.com\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/innovatex-inc.com\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/innovatex-inc.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/innovatex-inc.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=356"}],"version-history":[{"count":17,"href":"https:\/\/innovatex-inc.com\/index.php?rest_route=\/wp\/v2\/pages\/356\/revisions"}],"predecessor-version":[{"id":1466,"href":"https:\/\/innovatex-inc.com\/index.php?rest_route=\/wp\/v2\/pages\/356\/revisions\/1466"}],"wp:attachment":[{"href":"https:\/\/innovatex-inc.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=356"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}