<div class="wpforms-container wpforms-container-full" id="wpforms-14639"><form id="wpforms-form-14639" class="wpforms-validate wpforms-form" data-formid="14639" method="post" enctype="multipart/form-data" action="/categoria-prodotto/ausili-mobilita/scooter/" data-token="c68926ed0b3a4ae2b4873174dd3851d9"><noscript class="wpforms-error-noscript">Abilita JavaScript nel browser per completare questo modulo.</noscript><div class="wpforms-page-indicator progress" data-indicator="progress" data-indicator-color="#041834" data-scroll="1"><span class="wpforms-page-indicator-page-title" ></span><span class="wpforms-page-indicator-page-title-sep" style="display:none;"> - </span><span class="wpforms-page-indicator-steps">Passo <span class="wpforms-page-indicator-steps-current">1</span> di 3</span><div class="wpforms-page-indicator-page-progress-wrap"><div class="wpforms-page-indicator-page-progress" style="width:33.333333333333%;background-color:#041834;"></div></div></div><div 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data-action="next" data-page="1" data-formid="14639" disabled>Successivo</button></div></div></div><div class="wpforms-page wpforms-page-2 " style="display:none;"><div id="wpforms-14639-field_23-container" class="wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show" data-field-id="23" style="display:none;"><label class="wpforms-field-label" for="wpforms-14639-field_23">Sceglie le caratteristiche per te più importanti: <span class="wpforms-required-label">*</span></label><ul id="wpforms-14639-field_23" class="wpforms-field-required"><li class="choice-4 depth-1"><input type="checkbox" id="wpforms-14639-field_23_4" name="wpforms[fields][23][]" value="Deambulatore leggero: meno di 9 kg" required ><label class="wpforms-field-label-inline" for="wpforms-14639-field_23_4">Deambulatore leggero: meno di 9 kg</label></li><li class="choice-1 depth-1"><input type="checkbox" id="wpforms-14639-field_23_1" name="wpforms[fields][23][]" value="Per passaggi stretti: 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class="choice-9 depth-1"><input type="checkbox" id="wpforms-14639-field_25_9" name="wpforms[fields][25][]" value="Almeno 2 ruote: 2 ruote e 2 puntali o 4 ruote" required ><label class="wpforms-field-label-inline" for="wpforms-14639-field_25_9">Almeno 2 ruote: 2 ruote e 2 puntali o 4 ruote</label></li><li class="choice-6 depth-1"><input type="checkbox" id="wpforms-14639-field_25_6" name="wpforms[fields][25][]" value="Con supporto ascellare" required ><label class="wpforms-field-label-inline" for="wpforms-14639-field_25_6">Con supporto ascellare</label></li><li class="choice-7 depth-1"><input type="checkbox" id="wpforms-14639-field_25_7" name="wpforms[fields][25][]" value="Con appoggi antibrachiali" required ><label class="wpforms-field-label-inline" for="wpforms-14639-field_25_7">Con appoggi antibrachiali</label></li><li class="choice-1 depth-1"><input type="checkbox" id="wpforms-14639-field_25_1" name="wpforms[fields][25][]" value="Per passaggi stretti: larghezza meno di 60 cm" 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id="wpforms-14639-field_1-container" class="wpforms-field wpforms-field-name" data-field-id="1"><label class="wpforms-field-label" for="wpforms-14639-field_1">Nome <span class="wpforms-required-label">*</span></label><div class="wpforms-field-row wpforms-field-medium"><div class="wpforms-field-row-block wpforms-first wpforms-one-half"><input type="text" id="wpforms-14639-field_1" class="wpforms-field-name-first wpforms-field-required" name="wpforms[fields][1][first]" required><label for="wpforms-14639-field_1" class="wpforms-field-sublabel after ">Nome</label></div><div class="wpforms-field-row-block wpforms-one-half"><input type="text" id="wpforms-14639-field_1-last" class="wpforms-field-name-last wpforms-field-required" name="wpforms[fields][1][last]" required><label for="wpforms-14639-field_1-last" class="wpforms-field-sublabel after ">Cognome</label></div></div></div><div id="wpforms-14639-field_2-container" class="wpforms-field wpforms-field-email" data-field-id="2"><label 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Non condividiamo o vendiamo le tue informazioni.</div></div><div id="wpforms-14639-field_22-container" class="wpforms-field wpforms-field-pagebreak" data-field-id="22"><div class="wpforms-clear wpforms-pagebreak-left"></div></div></div></div><div class="wpforms-submit-container" style="display:none;"><input type="hidden" name="wpforms[id]" value="14639"><input type="hidden" name="wpforms[author]" value="0"><button type="submit" name="wpforms[submit]" class="wpforms-submit " id="wpforms-submit-14639" value="wpforms-submit" aria-live="assertive" data-alt-text="Invio in corso... " data-submit-text="Mando la mia richiesta per una offerta personalizzato">Mando la mia richiesta per una offerta personalizzato</button></div></form></div> <!-- .wpforms-container -->