Wat vond u ervan?

Ik bestel mijn dagschotel steeds bij *
Score *
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<div class="testimonial-index text-center sm:text-left"> <div class="row"> <div class="col medium-10 medium-centered"> <h1 class="page-title"> Wat vond u ervan? </h1> <div class="section"> </div> </div> </div> <div class="row"> <div class="col normal-8 medium-10 medium-centered"> <div class="section"> <div class="testimonial-form-wrap text-left"> <div data-jv-form> <form class="jv_form js-jv-form testimonial--form " data-ga-action="generate_lead" method="post" data-ajax="testimonial:submit" data-id="testimonial" > <section class="jv_form__section " data-id="default_0"> <div class="flex flex--padding"> <div class="flex__item perc-100" data-id="branch_locationID"> <div class="field-wrap field-wrap--radio js-form-field" data-id="branch_locationID"> <div> <div class="field-wrap__label"> Ik bestel mijn dagschotel steeds bij * </div> <div class="field-wrap__error"> </div> </div> <div class="field-wrap-options"> <div class="radio"> <input type="radio" value="1" checked required name="branch_locationID" id="testimonial_branch_locationID_0"> <label title="Dagschotel Merksem" for="testimonial_branch_locationID_0"> Dagschotel Merksem <span class="check"> <i></i> </span> </label> </div> </div> </div> </div> <div class="flex__item perc-50 xs:perc-100 " data-type="text" data-id="fname"> <div class="field-wrap field-wrap--text js-form-field" data-id="fname"> <label for="6073732b6a0a3_testimonial_fname"> Voornaam * </label> <div class="field-wrap__error"> </div> <div class="field-wrap__input "> <input class="" type="text" value="" required name="fname" id="6073732b6a0a3_testimonial_fname" > </div> </div> </div> <div class="flex__item perc-50 xs:perc-100 " data-type="text" data-id="lname"> <div class="field-wrap field-wrap--text js-form-field" data-id="lname"> <label for="6073732b6a0a3_testimonial_lname"> Achternaam * </label> <div class="field-wrap__error"> </div> <div class="field-wrap__input "> <input class="" type="text" value="" required name="lname" id="6073732b6a0a3_testimonial_lname" > </div> </div> </div> <div class="flex__item perc-100 " data-type="text" data-id="email"> <div class="field-wrap field-wrap--text js-form-field" data-id="email"> <label for="6073732b6a0a3_testimonial_email"> E-mail * </label> <div class="field-wrap__error"> </div> <div class="field-wrap__input "> <input class="" type="email" value="" required name="email" id="6073732b6a0a3_testimonial_email" > </div> </div> </div> <div class="flex__item perc-100 " data-type="textarea" data-id="info"> <div class="field-wrap field-wrap--textarea js-form-field" data-id="info"> <label for="6073732b6a0a3_testimonial_info"> Bericht * </label> <div class="field-wrap__error"> </div> <div class="field-wrap__input "> <textarea class="" placeholder="" value="" required name="info" id="6073732b6a0a3_testimonial_info"></textarea> </div> </div> </div> <div class="flex__item perc-100" data-id="rating"> <div class="field-wrap field-wrap--radio js-form-field" data-id="rating"> <div> <div class="field-wrap__label"> Score * </div> <div class="field-wrap__error"> </div> </div> <div class="field-wrap-options"> <div class="radio"> <input type="radio" value="1" required name="rating" id="testimonial_rating_1"> <label title="1" for="testimonial_rating_1"> 1 <span class="check"> <i></i> </span> </label> </div> <div class="radio"> <input type="radio" value="2" required name="rating" id="testimonial_rating_2"> <label title="2" for="testimonial_rating_2"> 2 <span class="check"> <i></i> </span> </label> </div> <div class="radio"> <input type="radio" value="3" required name="rating" id="testimonial_rating_3"> <label title="3" for="testimonial_rating_3"> 3 <span class="check"> <i></i> </span> </label> </div> <div class="radio"> <input type="radio" value="4" required name="rating" id="testimonial_rating_4"> <label title="4" for="testimonial_rating_4"> 4 <span class="check"> <i></i> </span> </label> </div> <div class="radio"> <input type="radio" value="5" required name="rating" id="testimonial_rating_5"> <label title="5" for="testimonial_rating_5"> 5 <span class="check"> <i></i> </span> </label> </div> </div> </div> </div> <div class="flex__item perc-100 " data-type="text" data-id="favo_dish"> <div class="field-wrap field-wrap--text js-form-field" data-id="favo_dish"> <label for="6073732b6a0a3_testimonial_favo_dish"> Favoriet gerecht <i>(optioneel)</i> </label> <div class="field-wrap__error"> </div> <div class="field-wrap__input "> <input class="" type="text" value="" name="favo_dish" id="6073732b6a0a3_testimonial_favo_dish" > </div> </div> </div> <div class="flex__item perc-100" data-id="privacy"> <div class="field-wrap field-wrap--checkbox js-form-field" data-id="privacy"> <div class="field-wrap__error"> </div> <div class="checkbox"> <div class="field-wrap__input"> <input type="checkbox" value="1" required name="privacy" id="6073732b6a0a3_testimonial_privacy"> <label for="6073732b6a0a3_testimonial_privacy"> Ik geef de toestemming om mijn gegevens te bewaren en verwerken zoals aangegeven in onze <a target="_blank" href="https://dagschotel.be/privacy-verklaring">privacy statement</a>. * <span><i class="fas fa-check"></i></span> </label> </div> </div> </div> </div> </div> </section> <div class="field-wrap field-wrap__button" data-id="submit"> <button class="btn" type="submit"> <div class="loader loader--small loader--white"></div> <div class="hide-loading"> Versturen </div> </button> </div> <div class="flex__item " data-type="hidden" data-id="form_key"> <div class="field-wrap field-wrap--hidden js-form-field" data-id="form_key"> <div class="field-wrap__error"> </div> <div class="field-wrap__input "> <input type="hidden" value="testimonial" name="form_key" id="6073732b6a0a3_testimonial_form_key"> </div> </div> </div> <script type="application/json" class="js-form-data"> {"branch_locationID":{"field_conditions":[]},"fname":{"field_conditions":[]},"lname":{"field_conditions":[]},"email":{"field_conditions":[]},"info":{"field_conditions":[]},"rating":{"field_conditions":[]},"favo_dish":{"field_conditions":[]},"privacy":{"field_conditions":[]},"form_key":{"field_conditions":[]}} </script> </form> </div> <div id="testimonialSuccess" class="hidden color-white"> <div class="page-content "> <p>We hebben uw getuigenis goed ontvangen!</p><p>Bedankt voor uw bericht.</p> </div> </div> <div id="messageFailed" class="hidden color-white"> <div class="page-content "> </div> </div> </div> </div> </div> </div> </div>