var qsProxy = {};
function FrameBuilder(formId,appendTo,initialHeight,iframeCode,title,embedStyleJSON){this.formId=formId;this.initialHeight=initialHeight;this.iframeCode=iframeCode;this.frame=null;this.timeInterval=200;this.appendTo=appendTo||false;this.formSubmitted=0;this.frameMinWidth='100%';this.defaultHeight='';this.init=function(){this.embedURLHash=this.getMD5(window.location.href);if(embedStyleJSON&&(embedStyleJSON[this.embedURLHash]&&embedStyleJSON[this.embedURLHash]['inlineStyle']['embedWidth'])){this.frameMinWidth=embedStyleJSON[this.embedURLHash]['inlineStyle']['embedWidth']+'px';}
if(embedStyleJSON&&(embedStyleJSON[this.embedURLHash])){if(embedStyleJSON[this.embedURLHash]['inlineStyle']&&embedStyleJSON[this.embedURLHash]['inlineStyle']['embedHeight']){this.defaultHeight='data-frameHeight="'+embedStyleJSON[this.embedURLHash]['inlineStyle']['embedHeight']+'"';}}
this.createFrame();this.addFrameContent(this.iframeCode);};this.createFrame=function(){var tmp_is_ie=!!window.ActiveXObject;this.iframeDomId=document.getElementById(this.formId)?this.formId+'_'+new Date().getTime():this.formId;var htmlCode="<"+"iframe title=\""+title.replace(/[\\"']/g,'\\$&').replace(/&amp;/g,'&')+"\" src=\"\" allowtransparency=\"true\" allow=\"geolocation; microphone; camera\" allowfullscreen=\"true\" name=\""+this.formId+"\" id=\""+this.iframeDomId+"\" style=\"width: 10px; min-width:"+this.frameMinWidth+"; display: block; overflow: hidden; height:"+this.initialHeight+"px; border: none;\" scrolling=\"no\""+this.defaultHeight+"></if"+"rame>";if(this.appendTo===false){document.write(htmlCode);}else{var tmp=document.createElement('div');tmp.innerHTML=htmlCode;var a=this.appendTo;document.getElementById(a).appendChild(tmp.firstChild);}
this.frame=document.getElementById(this.iframeDomId);if(tmp_is_ie===true){try{var iframe=this.frame;var doc=iframe.contentDocument?iframe.contentDocument:(iframe.contentWindow.document||iframe.document);doc.open();doc.write("");}
catch(err){this.frame.src="javascript:void((function(){document.open();document.domain=\'"+this.getBaseDomain()+"\';document.close();})())";}}
this.addEvent(this.frame,'load',this.bindMethod(this.setTimer,this));var self=this;if(window.chrome!==undefined){this.frame.onload=function(){try{var doc=this.contentWindow.document;var _jotform=this.contentWindow.JotForm;if(doc!==undefined){var form=doc.getElementById(""+self.iframeDomId);self.addEvent(form,"submit",function(){if(_jotform.validateAll()){self.formSubmitted=1;}});}}catch(e){}}}};this.addEvent=function(obj,type,fn){if(obj.attachEvent){obj["e"+type+fn]=fn;obj[type+fn]=function(){obj["e"+type+fn](window.event);};obj.attachEvent("on"+type,obj[type+fn]);}
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string=string.replace(new RegExp('src\\=\\"[^"]*captcha.php\"><\/scr'+'ipt>','gim'),'src="http://api.recaptcha.net/js/recaptcha_ajax.js"></scr'+'ipt><'+'div id="recaptcha_div"><'+'/div>'+'<'+'style>#recaptcha_logo{ display:none;} #recaptcha_tagline{display:none;} #recaptcha_table{border:none !important;} .recaptchatable .recaptcha_image_cell, #recaptcha_table{ background-color:transparent !important; } <'+'/style>'+'<'+'script defer="defer"> window.onload = function(){ Recaptcha.create("6Ld9UAgAAAAAAMon8zjt30tEZiGQZ4IIuWXLt1ky", "recaptcha_div", {theme: "clean",tabindex: 0,callback: function (){'+'if (document.getElementById("uword")) { document.getElementById("uword").parentNode.removeChild(document.getElementById("uword")); } if (window["validate"] !== undefined) { if (document.getElementById("recaptcha_response_field")){ document.getElementById("recaptcha_response_field").onblur = function(){ validate(document.getElementById("recaptcha_response_field"), "Required"); } } } if (document.getElementById("recaptcha_response_field")){ document.getElementsByName("recaptcha_challenge_field")[0].setAttribute("name", "anum"); } if (document.getElementById("recaptcha_response_field")){ document.getElementsByName("recaptcha_response_field")[0].setAttribute("name", "qCap"); }}})'+' }<'+'/script>');string=string.replace(/(type="text\/javascript">)\s+(validate\(\"[^"]*"\);)/,'$1 jTime = setInterval(function(){if("validate" in window){$2clearTimeout(jTime);}}, 1000);');if(string.match('#sublabel_litemode')){string=string.replace('class="form-all"','class="form-all" style="margin-top:0;"');}
var iframe=this.frame;var doc=iframe.contentDocument?iframe.contentDocument:(iframe.contentWindow.document||iframe.document);doc.open();doc.write(string);setTimeout(function(){doc.close();try{if('JotFormFrameLoaded'in window){JotFormFrameLoaded();}}catch(e){}},200);};this.setTimer=function(){var self=this;this.interval=setTimeout(this.changeHeight.bind(this),this.timeInterval);};this.getBaseDomain=function(){var thn=window.location.hostname;var cc=0;var buff="";for(var i=0;i<thn.length;i++){var chr=thn.charAt(i);if(chr=="."){cc++;}
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if(cc==2){thn=thn.replace(buff+".","");}
return thn;}
this.changeHeight=function(){var actualHeight=this.getBodyHeight();var currentHeight=this.getViewPortHeight();var skipAutoHeight=(this.frame.contentWindow)?this.frame.contentWindow.document.querySelector('[data-welcome-view="true"]'):null;if(actualHeight===undefined){this.frame.style.height=this.frameHeight;if(!this.frame.style.minHeight){this.frame.style.minHeight="300px";window.parent.scrollTo(0,0);}}else if(Math.abs(actualHeight-currentHeight)>18&&!skipAutoHeight){this.frame.style.height=(actualHeight)+"px";}
this.setTimer();};this.bindMethod=function(method,scope){return function(){method.apply(scope,arguments);};};this.frameHeight=0;this.getBodyHeight=function(){if(this.formSubmitted===1){return;}
var height;var scrollHeight;var offsetHeight;try{if(this.frame.contentWindow.document.height){height=this.frame.contentWindow.document.height;if(this.frame.contentWindow.document.body.scrollHeight){height=scrollHeight=this.frame.contentWindow.document.body.scrollHeight;}
if(this.frame.contentWindow.document.body.offsetHeight){height=offsetHeight=this.frame.contentWindow.document.body.offsetHeight;}}else if(this.frame.contentWindow.document.body){if(this.frame.contentWindow.document.body.offsetHeight){height=offsetHeight=this.frame.contentWindow.document.body.offsetHeight;}
var formWrapper=this.frame.contentWindow.document.querySelector('.form-all');var margin=parseInt(getComputedStyle(formWrapper).marginTop,10);if(!isNaN(margin)){height+=margin;}}}catch(e){}
this.frameHeight=height;return height;};this.getViewPortHeight=function(){if(this.formSubmitted===1){return;}
var height=0;try{if(this.frame.contentWindow.window.innerHeight){height=this.frame.contentWindow.window.innerHeight-18;}else if((this.frame.contentWindow.document.documentElement)&&(this.frame.contentWindow.document.documentElement.clientHeight)){height=this.frame.contentWindow.document.documentElement.clientHeight;}else if((this.frame.contentWindow.document.body)&&(this.frame.contentWindow.document.body.clientHeight)){height=this.frame.contentWindow.document.body.clientHeight;}}catch(e){}
return height;};this.getMD5=function(s){function L(k,d){return(k<<d)|(k>>>(32-d))}function K(G,k){var I,d,F,H,x;F=(G&2147483648);H=(k&2147483648);I=(G&1073741824);d=(k&1073741824);x=(G&1073741823)+(k&1073741823);if(I&d){return(x^2147483648^F^H)}if(I|d){if(x&1073741824){return(x^3221225472^F^H)}else{return(x^1073741824^F^H)}}else{return(x^F^H)}}function r(d,F,k){return(d&F)|((~d)&k)}function q(d,F,k){return(d&k)|(F&(~k))}function p(d,F,k){return(d^F^k)}function n(d,F,k){return(F^(d|(~k)))}function u(G,F,aa,Z,k,H,I){G=K(G,K(K(r(F,aa,Z),k),I));return K(L(G,H),F)}function f(G,F,aa,Z,k,H,I){G=K(G,K(K(q(F,aa,Z),k),I));return K(L(G,H),F)}function D(G,F,aa,Z,k,H,I){G=K(G,K(K(p(F,aa,Z),k),I));return K(L(G,H),F)}function t(G,F,aa,Z,k,H,I){G=K(G,K(K(n(F,aa,Z),k),I));return K(L(G,H),F)}function e(G){var Z;var F=G.length;var x=F+8;var k=(x-(x%64))/64;var I=(k+1)*16;var aa=Array(I-1);var d=0;var H=0;while(H<F){Z=(H-(H%4))/4;d=(H%4)*8;aa[Z]=(aa[Z]|(G.charCodeAt(H)<<d));H++}Z=(H-(H%4))/4;d=(H%4)*8;aa[Z]=aa[Z]|(128<<d);aa[I-2]=F<<3;aa[I-1]=F>>>29;return aa}function B(x){var k="",F="",G,d;for(d=0;d<=3;d++){G=(x>>>(d*8))&255;F="0"+G.toString(16);k=k+F.substr(F.length-2,2)}return k}function J(k){k=k.replace(/rn/g,"n");var d="";for(var F=0;F<k.length;F++){var x=k.charCodeAt(F);if(x<128){d+=String.fromCharCode(x)}else{if((x>127)&&(x<2048)){d+=String.fromCharCode((x>>6)|192);d+=String.fromCharCode((x&63)|128)}else{d+=String.fromCharCode((x>>12)|224);d+=String.fromCharCode(((x>>6)&63)|128);d+=String.fromCharCode((x&63)|128)}}}return d}var C=Array();var P,h,E,v,g,Y,X,W,V;var S=7,Q=12,N=17,M=22;var A=5,z=9,y=14,w=20;var o=4,m=11,l=16,j=23;var U=6,T=10,R=15,O=21;s=J(s);C=e(s);Y=1732584193;X=4023233417;W=2562383102;V=271733878;for(P=0;P<C.length;P+=16){h=Y;E=X;v=W;g=V;Y=u(Y,X,W,V,C[P+0],S,3614090360);V=u(V,Y,X,W,C[P+1],Q,3905402710);W=u(W,V,Y,X,C[P+2],N,606105819);X=u(X,W,V,Y,C[P+3],M,3250441966);Y=u(Y,X,W,V,C[P+4],S,4118548399);V=u(V,Y,X,W,C[P+5],Q,1200080426);W=u(W,V,Y,X,C[P+6],N,2821735955);X=u(X,W,V,Y,C[P+7],M,4249261313);Y=u(Y,X,W,V,C[P+8],S,1770035416);V=u(V,Y,X,W,C[P+9],Q,2336552879);W=u(W,V,Y,X,C[P+10],N,4294925233);X=u(X,W,V,Y,C[P+11],M,2304563134);Y=u(Y,X,W,V,C[P+12],S,1804603682);V=u(V,Y,X,W,C[P+13],Q,4254626195);W=u(W,V,Y,X,C[P+14],N,2792965006);X=u(X,W,V,Y,C[P+15],M,1236535329);Y=f(Y,X,W,V,C[P+1],A,4129170786);V=f(V,Y,X,W,C[P+6],z,3225465664);W=f(W,V,Y,X,C[P+11],y,643717713);X=f(X,W,V,Y,C[P+0],w,3921069994);Y=f(Y,X,W,V,C[P+5],A,3593408605);V=f(V,Y,X,W,C[P+10],z,38016083);W=f(W,V,Y,X,C[P+15],y,3634488961);X=f(X,W,V,Y,C[P+4],w,3889429448);Y=f(Y,X,W,V,C[P+9],A,568446438);V=f(V,Y,X,W,C[P+14],z,3275163606);W=f(W,V,Y,X,C[P+3],y,4107603335);X=f(X,W,V,Y,C[P+8],w,1163531501);Y=f(Y,X,W,V,C[P+13],A,2850285829);V=f(V,Y,X,W,C[P+2],z,4243563512);W=f(W,V,Y,X,C[P+7],y,1735328473);X=f(X,W,V,Y,C[P+12],w,2368359562);Y=D(Y,X,W,V,C[P+5],o,4294588738);V=D(V,Y,X,W,C[P+8],m,2272392833);W=D(W,V,Y,X,C[P+11],l,1839030562);X=D(X,W,V,Y,C[P+14],j,4259657740);Y=D(Y,X,W,V,C[P+1],o,2763975236);V=D(V,Y,X,W,C[P+4],m,1272893353);W=D(W,V,Y,X,C[P+7],l,4139469664);X=D(X,W,V,Y,C[P+10],j,3200236656);Y=D(Y,X,W,V,C[P+13],o,681279174);V=D(V,Y,X,W,C[P+0],m,3936430074);W=D(W,V,Y,X,C[P+3],l,3572445317);X=D(X,W,V,Y,C[P+6],j,76029189);Y=D(Y,X,W,V,C[P+9],o,3654602809);V=D(V,Y,X,W,C[P+12],m,3873151461);W=D(W,V,Y,X,C[P+15],l,530742520);X=D(X,W,V,Y,C[P+2],j,3299628645);Y=t(Y,X,W,V,C[P+0],U,4096336452);V=t(V,Y,X,W,C[P+7],T,1126891415);W=t(W,V,Y,X,C[P+14],R,2878612391);X=t(X,W,V,Y,C[P+5],O,4237533241);Y=t(Y,X,W,V,C[P+12],U,1700485571);V=t(V,Y,X,W,C[P+3],T,2399980690);W=t(W,V,Y,X,C[P+10],R,4293915773);X=t(X,W,V,Y,C[P+1],O,2240044497);Y=t(Y,X,W,V,C[P+8],U,1873313359);V=t(V,Y,X,W,C[P+15],T,4264355552);W=t(W,V,Y,X,C[P+6],R,2734768916);X=t(X,W,V,Y,C[P+13],O,1309151649);Y=t(Y,X,W,V,C[P+4],U,4149444226);V=t(V,Y,X,W,C[P+11],T,3174756917);W=t(W,V,Y,X,C[P+2],R,718787259);X=t(X,W,V,Y,C[P+9],O,3951481745);Y=K(Y,h);X=K(X,E);W=K(W,v);V=K(V,g)}var i=B(Y)+B(X)+B(W)+B(V);return i.toLowerCase()};this.init();}
FrameBuilder.get=qsProxy||[];var i81112898808465=new FrameBuilder("81112898808465",false,"","<!DOCTYPE HTML PUBLIC \"-\/\/W3C\/\/DTD HTML 4.01\/\/EN\" \"http:\/\/www.w3.org\/TR\/html4\/strict.dtd\">\n<html lang=\"he\"  class=\"supernova\"><head>\n<meta http-equiv=\"Content-Type\" content=\"text\/html; charset=utf-8\" \/>\n<link rel=\"alternate\" type=\"application\/json+oembed\" href=\"https:\/\/www.jotform.com\/oembed\/?format=json&amp;url=https%3A%2F%2Fform.jotform.com%2F81112898808465\" title=\"oEmbed Form\">\n<link rel=\"alternate\" type=\"text\/xml+oembed\" href=\"https:\/\/www.jotform.com\/oembed\/?format=xml&amp;url=https%3A%2F%2Fform.jotform.com%2F81112898808465\" title=\"oEmbed Form\">\n<meta property=\"og:title\" content=\"\u05d8\u05d5\u05e4\u05e1 \u05e4\u05ea\u05d9\u05d7\u05ea \u05dc\u05e7\u05d5\u05d7 \u05d7\u05d3\u05e9\" >\n<meta property=\"og:url\" content=\"https:\/\/form.jotform.me\/81112898808465\" >\n<meta property=\"og:description\" content=\"Please click the link to complete this form.\" >\n<meta name=\"slack-app-id\" content=\"AHNMASS8M\">\n<link rel=\"shortcut icon\" href=\"https:\/\/cdn.jotfor.ms\/favicon.ico\">\n<link rel=\"canonical\" href=\"https:\/\/form.jotform.me\/81112898808465\" \/>\n<meta name=\"viewport\" content=\"width=device-width, initial-scale=1.0, maximum-scale=2.0, user-scalable=1\" \/>\n<meta name=\"HandheldFriendly\" content=\"true\" \/>\n<title>\u05d8\u05d5\u05e4\u05e1 \u05e4\u05ea\u05d9\u05d7\u05ea \u05dc\u05e7\u05d5\u05d7 \u05d7\u05d3\u05e9<\/title>\n<link href=\"https:\/\/cdn.jotfor.ms\/static\/formCss.css?3.3.25347\" rel=\"stylesheet\" type=\"text\/css\" \/>\n<link type=\"text\/css\" rel=\"stylesheet\" href=\"https:\/\/cdn.jotfor.ms\/css\/styles\/nova.css?3.3.25347\" \/>\n<link type=\"text\/css\" media=\"print\" rel=\"stylesheet\" href=\"https:\/\/cdn.jotfor.ms\/css\/printForm.css?3.3.25347\" \/>\n<link type=\"text\/css\" rel=\"stylesheet\" href=\"https:\/\/cdn.jotfor.ms\/themes\/CSS\/566a91c2977cdfcd478b4567.css?\"\/>\n<link type=\"text\/css\" rel=\"stylesheet\" href=\"https:\/\/cdn.jotfor.ms\/css\/styles\/payment\/payment_feature.css?3.3.25347\" \/>\n<style type=\"text\/css\">\n\n\n    .form-label-left{\n        width:150px;\n    }\n    .form-line{\n        padding-top:12px;\n        padding-bottom:12px;\n    }\n    .form-label-right{\n        width:150px;\n    }\n    body, html{\n        margin:0;\n        padding:0;\n        background:#fff;\n    }\n\n    .form-all{\n        margin:0px auto;\n        padding-top:0px;\n        width:690px;\n        color:#555 !important;\n        font-family:\"Lucida Grande\", \"Lucida Sans Unicode\", \"Lucida Sans\", Verdana, sans-serif;\n        font-size:14px;\n    }\n<\/style>\n\n<style type=\"text\/css\" id=\"form-designer-style\">\n    \/* Injected CSS Code *\/\n.form-label.form-label-auto {\n        \n        display: inline-block;\n        float: left;\n        text-align: left;\n      \n      } \/*PREFERENCES STYLE*\/\n    .form-all {\n      font-family: Lucida Grande, sans-serif;\n    }\n    .form-all .qq-upload-button,\n    .form-all .form-submit-button,\n    .form-all .form-submit-reset,\n    .form-all .form-submit-print {\n      font-family: Lucida Grande, sans-serif;\n    }\n    .form-all .form-pagebreak-back-container,\n    .form-all .form-pagebreak-next-container {\n      font-family: Lucida Grande, sans-serif;\n    }\n    .form-header-group {\n      font-family: Lucida Grande, sans-serif;\n    }\n    .form-label {\n      font-family: Lucida Grande, sans-serif;\n    }\n  \n    \n  \n    .form-line {\n      margin-top: 12px;\n      margin-bottom: 12px;\n    }\n  \n    .form-all {\n      width: 690px;\n    }\n  \n    .form-label-left,\n    .form-label-right,\n    .form-label-left.form-label-auto,\n    .form-label-right.form-label-auto {\n      width: 150px;\n    }\n  \n    .form-all {\n      font-size: 14px\n    }\n    .form-all 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  margin-top: auto;\n    margin-top: initial;\n  }\n  \n  \/*PREFERENCES STYLE*\/\/*__INSPECT_SEPERATOR__*\/.form-all {\r\n\r\ndirection: rtl !important;\r\n\r\ntext-align: right; !important;\r\n\r\n}\r\n\r\n.form-label-left {\r\n\r\nfloat: right !important;\r\n\r\n}\n    \/* Injected CSS Code *\/\n<\/style>\n\n<link type=\"text\/css\" rel=\"stylesheet\" href=\"https:\/\/cdn.jotfor.ms\/css\/styles\/buttons\/form-submit-button-blue.css?3.3.25347\"\/>\n<script src=\"https:\/\/cdn.jotfor.ms\/js\/vendor\/jquery-1.8.0.min.js?v=3.3.25347\" type=\"text\/javascript\"><\/script>\n<script src=\"https:\/\/cdn.jotfor.ms\/js\/vendor\/maskedinput.min.js?v=3.3.25347\" type=\"text\/javascript\"><\/script>\n<script src=\"https:\/\/cdn.jotfor.ms\/js\/vendor\/jquery.maskedinput.min.js?v=3.3.25347\" type=\"text\/javascript\"><\/script>\n<script src=\"https:\/\/cdnjs.cloudflare.com\/ajax\/libs\/punycode\/1.4.1\/punycode.min.js\"><\/script>\n<script src=\"https:\/\/cdn.jotfor.ms\/static\/prototype.forms.js\" type=\"text\/javascript\"><\/script>\n<script src=\"https:\/\/cdn.jotfor.ms\/static\/jotform.forms.js?3.3.25347\" type=\"text\/javascript\"><\/script>\n<script type=\"text\/javascript\">\n var jsTime = setInterval(function(){try{\n   JotForm.jsForm = true;\n\n   JotForm.setConditions([{\"action\":[{\"id\":\"action_1524548883392\",\"visibility\":\"Show\",\"isError\":false,\"field\":\"21\"}],\"id\":\"1524548909519\",\"index\":\"0\",\"link\":\"Any\",\"priority\":\"0\",\"terms\":[{\"id\":\"term_1524548883392\",\"field\":\"22\",\"operator\":\"isFilled\",\"value\":\"\",\"isError\":false}],\"type\":\"field\"},{\"action\":[{\"id\":\"action_1524470218423\",\"visibility\":\"Show\",\"isError\":false,\"field\":\"15\"}],\"id\":\"1524470251458\",\"index\":\"1\",\"link\":\"Any\",\"priority\":\"1\",\"terms\":[{\"id\":\"term_1524470218423\",\"field\":\"16\",\"operator\":\"equals\",\"value\":\"A2S_customer\",\"isError\":false}],\"type\":\"field\"}]);\n\tJotForm.init(function(){\nif (window.JotForm && JotForm.accessible) $('input_16').setAttribute('tabindex',0);\nif (window.JotForm && JotForm.accessible) $('input_19').setAttribute('tabindex',0);\n      JotForm.setPhoneMaskingValidator( 'input_28_full', '' );\n      JotForm.setPhoneMaskingValidator( 'input_27_full', '' );\n      JotForm.description('input_26', '\u2022\t\u05d1\u05d4\u05ea\u05d0\u05dd \u05dc\u05d4\u05d5\u05e8\u05d0\u05ea \u05e1\u05e2\u05d9\u05e318\u05d1\\' \u05dc\u05d4\u05d5\u05e8\u05d0\u05d5\u05ea \u05de\u05e1 \u05d4\u05db\u05e0\u05e1\u05d4 (\u05e0\u05d9\u05d4\u05d5\u05dc \u05e4\u05e0\u05e7\u05e1\u05d9 \u05d7\u05e9\u05d1\u05d5\u05e0\u05d5\u05ea), \u05ea\u05e9\u05dc&quot;\u05d2 \u2013 1973 (\u05dc\u05d4\u05dc\u05df: &quot;\u05d4\u05d5\u05e8\u05d0\u05d5\u05ea \u05e0\u05d9\u05d4\u05d5\u05dc \u05e4\u05e0\u05e7\u05e1\u05d9\u05dd&quot;), \u05e0\u05d9\u05ea\u05df \u05dc\u05d4\u05e2\u05d1\u05d9\u05e8  \u05d1\u05d0\u05de\u05e6\u05e2\u05d5\u05ea \u05de\u05d7\u05e9\u05d1, \u05de\u05e1\u05de\u05db\u05d9\u05dd \u05de\u05de\u05d5\u05d7\u05e9\u05d1\u05d9\u05dd \u05de\u05e1\u05d5\u05d2 \u05d7\u05e9\u05d1\u05d5\u05e0\u05d9\u05ea \u05de\u05e1, \u05db\u05d0\u05de\u05d5\u05e8 \u05d1\u05ea\u05e7\u05e0\u05d4 9\u05d0 \u05dc\u05ea\u05e7\u05e0\u05d5\u05ea \u05de\u05e1 \u05e2\u05e8\u05da \u05de\u05d5\u05e1\u05e3 (\u05e0\u05d9\u05d4\u05d5\u05dc \u05e4\u05e0\u05e7\u05e1\u05d9 \u05d7\u05e9\u05d1\u05d5\u05e0\u05d5\u05ea) \u05d4\u05ea\u05e9\u05dc&quot;\u05d5 \u2013 1976.<br \/>\u2022\t\u05d1\u05d4\u05ea\u05d0\u05dd \u05dc\u05d4\u05d5\u05e8\u05d0\u05ea \u05e1\u05e2\u05d9\u05e3 18\u05d1\\'(\u05d1) \u05dc\u05d4\u05d5\u05e8\u05d0\u05ea \u05e0\u05d9\u05d4\u05d5\u05dc  \u05e4\u05e0\u05e7\u05e1\u05d9\u05dd, \u05d0\u05e0\u05d5 \u05e0\u05d4\u05d9\u05d4 \u05e8\u05e9\u05d0\u05d9\u05dd \u05dc\u05e9\u05dc\u05d5\u05d7 \u05d0\u05dc\u05d9\u05db\u05dd \u05d0\u05ea \u05d4\u05de\u05e1\u05de\u05db\u05d9\u05dd \u05d4\u05de\u05de\u05d5\u05d7\u05e9\u05d1\u05d9\u05dd \u05d4\u05e0&quot;\u05dc,  \u05d1\u05d0\u05de\u05e6\u05e2\u05d5\u05ea \u05de\u05d7\u05e9\u05d1 \u05e8\u05e7 \u05dc\u05d0\u05d7\u05e8 \u05e9\u05d4\u05d1\u05e2\u05ea\u05dd \u05d4\u05e1\u05db\u05de\u05ea\u05db\u05dd \u05dc\u05db\u05da, \u05d1\u05db\u05ea\u05d1 \u05d0\u05d5 \u05d1\u05d0\u05d5\u05e4\u05df \u05de\u05de\u05d5\u05d7\u05e9\u05d1 \u05d7\u05ea\u05d5\u05dd \u05d1\u05d7\u05ea\u05d9\u05de\u05d4 \u05d0\u05dc\u05e7\u05d8\u05e8\u05d5\u05e0\u05d9\u05ea \u05de\u05d0\u05d5\u05e9\u05e8\u05ea, \u05d5\u05db\u05dc \u05e2\u05d5\u05d3 \u05dc\u05d0 \u05d1\u05d9\u05d8\u05dc\u05ea\u05dd \u05d4\u05e1\u05db\u05de\u05ea\u05db\u05dd \u05dc\u05db\u05da \u05d1\u05d0\u05d5\u05e4\u05df \u05d4\u05d0\u05de\u05d5\u05e8');\n\tJotForm.newDefaultTheme = false;\n\tJotForm.extendsNewTheme = false;\n\tJotForm.newPaymentUIForNewCreatedForms = false;\n      JotForm.alterTexts(undefined);\n\tJotForm.clearFieldOnHide=\"disable\";\n      FormTranslation.init({\"detectUserLanguage\":\"1\",\"firstPageOnly\":\"0\",\"options\":\"Hebrew\",\"originalLanguage\":\"he\",\"primaryLanguage\":\"he\",\"saveUserLanguage\":\"1\",\"showStatus\":\"flag-with-nation\",\"theme\":\"light-theme\",\"version\":\"2\"});\n\tJotForm.submitError=\"jumpToFirstError\";\n    \/*INIT-END*\/\n\t});\n\n   clearInterval(jsTime);\n }catch(e){}}, 1000);\n\n   JotForm.prepareCalculationsOnTheFly([null,{\"name\":\"heading\",\"qid\":\"1\",\"text\":\"\u05d8\u05d5\u05e4\u05e1 \u05e4\u05ea\u05d9\u05d7\u05ea \u05dc\u05e7\u05d5\u05d7 \u05d7\u05d3\u05e9\",\"type\":\"control_head\"},{\"name\":\"submit2\",\"qid\":\"2\",\"text\":\"Submit\",\"type\":\"control_button\"},{\"description\":\"\",\"name\":\"input3\",\"qid\":\"3\",\"text\":\"\u05d4\u05dc\u05e7\u05d5\u05d7 \u05d4\u05d5\u05d0\",\"type\":\"control_checkbox\"},{\"description\":\"\",\"name\":\"name\",\"qid\":\"4\",\"text\":\"\u05e9\u05de\u05d5\u05ea \u05d0\u05e0\u05e9\u05d9 \u05d4\u05e7\u05e9\u05e8:\",\"type\":\"control_fullname\"},{\"description\":\"\",\"name\":\"input5\",\"qid\":\"5\",\"text\":\"\u05e9\u05de\u05d5\u05ea \u05d0\u05e0\u05e9\u05d9 \u05d4\u05e7\u05e9\u05e8 2:\",\"type\":\"control_fullname\"},{\"description\":\"\",\"name\":\"input6\",\"qid\":\"6\",\"subLabel\":\"example@example.com\",\"text\":\"\u05d3\u05d5\u05d0\u05dc\",\"type\":\"control_email\"},{\"description\":\"\",\"name\":\"2\",\"qid\":\"7\",\"subLabel\":\"example@example.com\",\"text\":\"\u05d3\u05d5\u05d0\u05dc 2\",\"type\":\"control_email\"},{\"name\":\"divider\",\"qid\":\"8\",\"type\":\"control_divider\"},{\"name\":\"divider9\",\"qid\":\"9\",\"type\":\"control_divider\"},{\"description\":\"\",\"name\":\"input10\",\"qid\":\"10\",\"text\":\"\u05d0\u05d9\u05e9.\u05ea \u05e7\u05e9\u05e8 \u05d1\u05d4\u05e0\u05d4\\\"\u05d7\",\"type\":\"control_fullname\"},{\"description\":\"\",\"name\":\"input11\",\"qid\":\"11\",\"subLabel\":\"example@example.com\",\"text\":\"\u05d3\u05d5\u05d0\u05dc \u05d4\u05e0\u05d4\\\"\u05d7\",\"type\":\"control_email\"},{\"description\":\"\",\"name\":\"input12\",\"qid\":\"12\",\"text\":\"\",\"type\":\"control_checkbox\"},{\"description\":\"\",\"name\":\"enterThe\",\"qid\":\"13\",\"text\":\"Enter the message as it's shown\",\"type\":\"control_captcha\"},null,{\"name\":\"input15\",\"qid\":\"15\",\"text\":\"\u05dc\u05d7\u05e5 \u05db\u05d0\u05df \u05dc\u05e4\u05ea\u05d9\u05d7\u05ea \u05d4\u05d8\u05d5\u05e4\u05e1\",\"type\":\"control_collapse\"},{\"description\":\"\",\"name\":\"input16\",\"qid\":\"16\",\"subLabel\":\"\",\"text\":\"\u05e7\u05d5\u05d3 \",\"type\":\"control_textbox\"},{\"name\":\"input17\",\"qid\":\"17\",\"text\":\"\u05dc\u05e7\u05d5\u05d7 \u05de\u05e1\u05e4\u05e8\",\"type\":\"control_autoincrement\"},null,{\"description\":\"\",\"name\":\"input19\",\"qid\":\"19\",\"subLabel\":\"\",\"text\":\"\u05de\u05e1\u05e4\u05e8 \u05d7.\u05e4\\u002F\u05e2\u05d5\u05e1\u05e7 \u05de\u05d5\u05e8\u05e9\u05d4\",\"type\":\"control_textbox\"},{\"description\":\"\",\"name\":\"input20\",\"qid\":\"20\",\"text\":\"\u05db\u05ea\u05d5\u05d1\u05ea \u05d4\u05d7\u05d1\u05e8\u05d4\\u002F\u05e2\u05e1\u05e7\",\"type\":\"control_address\"},{\"description\":\"\",\"name\":\"input21\",\"qid\":\"21\",\"text\":\"\u05db\u05ea\u05d5\u05d1\u05ea \u05dc\u05de\u05e9\u05dc\u05d5\u05d7 \u05d8\u05d5\u05d1\u05d9\u05df\",\"type\":\"control_address\"},{\"description\":\"\",\"name\":\"typeA\",\"qid\":\"22\",\"text\":\"\",\"type\":\"control_checkbox\"},{\"description\":\"\",\"name\":\"input23\",\"qid\":\"23\",\"text\":\"\u05e9\u05dd \u05d4\u05d7\u05d1\u05e8\u05d4\\u002F \u05e2\u05e1\u05e7\",\"type\":\"control_fullname\"},{\"description\":\"\",\"name\":\"input24\",\"qid\":\"24\",\"text\":\"\u05db\u05ea\u05d5\u05d1\u05ea \u05dc\u05de\u05e9\u05dc\u05d5\u05d7 \u05d7\u05e9\u05d1\u05d5\u05e0\u05d9\u05d5\u05ea \u05e9\u05d5\u05e0\u05d4 \u05de\u05db\u05ea\u05d5\u05d1\u05ea \u05d4\u05d7\u05d1\u05e8\u05d4\",\"type\":\"control_checkbox\"},{\"description\":\"\",\"name\":\"input25\",\"qid\":\"25\",\"text\":\"\u05db\u05ea\u05d5\u05d1\u05ea \u05dc\u05de\u05e9\u05dc\u05d5\u05d7 \u05d7\u05e9\u05d1\u05d5\u05e0\u05d9\u05d5\u05ea\",\"type\":\"control_address\"},{\"description\":\"\u2022\\t\u05d1\u05d4\u05ea\u05d0\u05dd \u05dc\u05d4\u05d5\u05e8\u05d0\u05ea \u05e1\u05e2\u05d9\u05e318\u05d1' \u05dc\u05d4\u05d5\u05e8\u05d0\u05d5\u05ea \u05de\u05e1 \u05d4\u05db\u05e0\u05e1\u05d4 (\u05e0\u05d9\u05d4\u05d5\u05dc \u05e4\u05e0\u05e7\u05e1\u05d9 \u05d7\u05e9\u05d1\u05d5\u05e0\u05d5\u05ea), \u05ea\u05e9\u05dc&quot;\u05d2 \u2013 1973 (\u05dc\u05d4\u05dc\u05df: &quot;\u05d4\u05d5\u05e8\u05d0\u05d5\u05ea \u05e0\u05d9\u05d4\u05d5\u05dc \u05e4\u05e0\u05e7\u05e1\u05d9\u05dd&quot;), \u05e0\u05d9\u05ea\u05df \u05dc\u05d4\u05e2\u05d1\u05d9\u05e8  \u05d1\u05d0\u05de\u05e6\u05e2\u05d5\u05ea \u05de\u05d7\u05e9\u05d1, \u05de\u05e1\u05de\u05db\u05d9\u05dd \u05de\u05de\u05d5\u05d7\u05e9\u05d1\u05d9\u05dd \u05de\u05e1\u05d5\u05d2 \u05d7\u05e9\u05d1\u05d5\u05e0\u05d9\u05ea \u05de\u05e1, \u05db\u05d0\u05de\u05d5\u05e8 \u05d1\u05ea\u05e7\u05e0\u05d4 9\u05d0 \u05dc\u05ea\u05e7\u05e0\u05d5\u05ea \u05de\u05e1 \u05e2\u05e8\u05da \u05de\u05d5\u05e1\u05e3 (\u05e0\u05d9\u05d4\u05d5\u05dc \u05e4\u05e0\u05e7\u05e1\u05d9 \u05d7\u05e9\u05d1\u05d5\u05e0\u05d5\u05ea) \u05d4\u05ea\u05e9\u05dc&quot;\u05d5 \u2013 1976.\\n\u2022\\t\u05d1\u05d4\u05ea\u05d0\u05dd \u05dc\u05d4\u05d5\u05e8\u05d0\u05ea \u05e1\u05e2\u05d9\u05e3 18\u05d1'(\u05d1) \u05dc\u05d4\u05d5\u05e8\u05d0\u05ea \u05e0\u05d9\u05d4\u05d5\u05dc  \u05e4\u05e0\u05e7\u05e1\u05d9\u05dd, \u05d0\u05e0\u05d5 \u05e0\u05d4\u05d9\u05d4 \u05e8\u05e9\u05d0\u05d9\u05dd \u05dc\u05e9\u05dc\u05d5\u05d7 \u05d0\u05dc\u05d9\u05db\u05dd \u05d0\u05ea \u05d4\u05de\u05e1\u05de\u05db\u05d9\u05dd \u05d4\u05de\u05de\u05d5\u05d7\u05e9\u05d1\u05d9\u05dd \u05d4\u05e0&quot;\u05dc,  \u05d1\u05d0\u05de\u05e6\u05e2\u05d5\u05ea \u05de\u05d7\u05e9\u05d1 \u05e8\u05e7 \u05dc\u05d0\u05d7\u05e8 \u05e9\u05d4\u05d1\u05e2\u05ea\u05dd \u05d4\u05e1\u05db\u05de\u05ea\u05db\u05dd \u05dc\u05db\u05da, \u05d1\u05db\u05ea\u05d1 \u05d0\u05d5 \u05d1\u05d0\u05d5\u05e4\u05df \u05de\u05de\u05d5\u05d7\u05e9\u05d1 \u05d7\u05ea\u05d5\u05dd \u05d1\u05d7\u05ea\u05d9\u05de\u05d4 \u05d0\u05dc\u05e7\u05d8\u05e8\u05d5\u05e0\u05d9\u05ea \u05de\u05d0\u05d5\u05e9\u05e8\u05ea, \u05d5\u05db\u05dc \u05e2\u05d5\u05d3 \u05dc\u05d0 \u05d1\u05d9\u05d8\u05dc\u05ea\u05dd \u05d4\u05e1\u05db\u05de\u05ea\u05db\u05dd \u05dc\u05db\u05da \u05d1\u05d0\u05d5\u05e4\u05df \u05d4\u05d0\u05de\u05d5\u05e8\",\"name\":\"input26\",\"qid\":\"26\",\"text\":\"\u05de\u05d0\u05e9\u05e8 \u05e7\u05d1\u05dc\u05ea \u05d7\u05e9\u05d1\u05d5\u05e0\u05d9\u05d5\u05ea \u05d7\u05ea\u05d5\u05de\u05d5\u05ea \u05d3\u05d9\u05d2\u05d9\u05d8\u05dc\u05d9\u05ea\",\"type\":\"control_radio\"},{\"description\":\"\",\"name\":\"input27\",\"qid\":\"27\",\"text\":\"\u05d8\u05dc\u05e4\u05d5\u05df\",\"type\":\"control_phone\"},{\"description\":\"\",\"name\":\"input28\",\"qid\":\"28\",\"text\":\"\u05d8\u05dc\u05e4\u05d5\u05df\",\"type\":\"control_phone\"},{\"name\":\"divider29\",\"qid\":\"29\",\"type\":\"control_divider\"},{\"name\":\"divider30\",\"qid\":\"30\",\"type\":\"control_divider\"},{\"description\":\"\",\"name\":\"input31\",\"qid\":\"31\",\"text\":\"\",\"type\":\"control_checkbox\"}]);\n   setTimeout(function() {\nJotForm.paymentExtrasOnTheFly([null,{\"name\":\"heading\",\"qid\":\"1\",\"text\":\"\u05d8\u05d5\u05e4\u05e1 \u05e4\u05ea\u05d9\u05d7\u05ea \u05dc\u05e7\u05d5\u05d7 \u05d7\u05d3\u05e9\",\"type\":\"control_head\"},{\"name\":\"submit2\",\"qid\":\"2\",\"text\":\"Submit\",\"type\":\"control_button\"},{\"description\":\"\",\"name\":\"input3\",\"qid\":\"3\",\"text\":\"\u05d4\u05dc\u05e7\u05d5\u05d7 \u05d4\u05d5\u05d0\",\"type\":\"control_checkbox\"},{\"description\":\"\",\"name\":\"name\",\"qid\":\"4\",\"text\":\"\u05e9\u05de\u05d5\u05ea \u05d0\u05e0\u05e9\u05d9 \u05d4\u05e7\u05e9\u05e8:\",\"type\":\"control_fullname\"},{\"description\":\"\",\"name\":\"input5\",\"qid\":\"5\",\"text\":\"\u05e9\u05de\u05d5\u05ea \u05d0\u05e0\u05e9\u05d9 \u05d4\u05e7\u05e9\u05e8 2:\",\"type\":\"control_fullname\"},{\"description\":\"\",\"name\":\"input6\",\"qid\":\"6\",\"subLabel\":\"example@example.com\",\"text\":\"\u05d3\u05d5\u05d0\u05dc\",\"type\":\"control_email\"},{\"description\":\"\",\"name\":\"2\",\"qid\":\"7\",\"subLabel\":\"example@example.com\",\"text\":\"\u05d3\u05d5\u05d0\u05dc 2\",\"type\":\"control_email\"},{\"name\":\"divider\",\"qid\":\"8\",\"type\":\"control_divider\"},{\"name\":\"divider9\",\"qid\":\"9\",\"type\":\"control_divider\"},{\"description\":\"\",\"name\":\"input10\",\"qid\":\"10\",\"text\":\"\u05d0\u05d9\u05e9.\u05ea \u05e7\u05e9\u05e8 \u05d1\u05d4\u05e0\u05d4\\\"\u05d7\",\"type\":\"control_fullname\"},{\"description\":\"\",\"name\":\"input11\",\"qid\":\"11\",\"subLabel\":\"example@example.com\",\"text\":\"\u05d3\u05d5\u05d0\u05dc \u05d4\u05e0\u05d4\\\"\u05d7\",\"type\":\"control_email\"},{\"description\":\"\",\"name\":\"input12\",\"qid\":\"12\",\"text\":\"\",\"type\":\"control_checkbox\"},{\"description\":\"\",\"name\":\"enterThe\",\"qid\":\"13\",\"text\":\"Enter the message as it's shown\",\"type\":\"control_captcha\"},null,{\"name\":\"input15\",\"qid\":\"15\",\"text\":\"\u05dc\u05d7\u05e5 \u05db\u05d0\u05df \u05dc\u05e4\u05ea\u05d9\u05d7\u05ea \u05d4\u05d8\u05d5\u05e4\u05e1\",\"type\":\"control_collapse\"},{\"description\":\"\",\"name\":\"input16\",\"qid\":\"16\",\"subLabel\":\"\",\"text\":\"\u05e7\u05d5\u05d3 \",\"type\":\"control_textbox\"},{\"name\":\"input17\",\"qid\":\"17\",\"text\":\"\u05dc\u05e7\u05d5\u05d7 \u05de\u05e1\u05e4\u05e8\",\"type\":\"control_autoincrement\"},null,{\"description\":\"\",\"name\":\"input19\",\"qid\":\"19\",\"subLabel\":\"\",\"text\":\"\u05de\u05e1\u05e4\u05e8 \u05d7.\u05e4\\u002F\u05e2\u05d5\u05e1\u05e7 \u05de\u05d5\u05e8\u05e9\u05d4\",\"type\":\"control_textbox\"},{\"description\":\"\",\"name\":\"input20\",\"qid\":\"20\",\"text\":\"\u05db\u05ea\u05d5\u05d1\u05ea \u05d4\u05d7\u05d1\u05e8\u05d4\\u002F\u05e2\u05e1\u05e7\",\"type\":\"control_address\"},{\"description\":\"\",\"name\":\"input21\",\"qid\":\"21\",\"text\":\"\u05db\u05ea\u05d5\u05d1\u05ea \u05dc\u05de\u05e9\u05dc\u05d5\u05d7 \u05d8\u05d5\u05d1\u05d9\u05df\",\"type\":\"control_address\"},{\"description\":\"\",\"name\":\"typeA\",\"qid\":\"22\",\"text\":\"\",\"type\":\"control_checkbox\"},{\"description\":\"\",\"name\":\"input23\",\"qid\":\"23\",\"text\":\"\u05e9\u05dd \u05d4\u05d7\u05d1\u05e8\u05d4\\u002F \u05e2\u05e1\u05e7\",\"type\":\"control_fullname\"},{\"description\":\"\",\"name\":\"input24\",\"qid\":\"24\",\"text\":\"\u05db\u05ea\u05d5\u05d1\u05ea \u05dc\u05de\u05e9\u05dc\u05d5\u05d7 \u05d7\u05e9\u05d1\u05d5\u05e0\u05d9\u05d5\u05ea \u05e9\u05d5\u05e0\u05d4 \u05de\u05db\u05ea\u05d5\u05d1\u05ea \u05d4\u05d7\u05d1\u05e8\u05d4\",\"type\":\"control_checkbox\"},{\"description\":\"\",\"name\":\"input25\",\"qid\":\"25\",\"text\":\"\u05db\u05ea\u05d5\u05d1\u05ea \u05dc\u05de\u05e9\u05dc\u05d5\u05d7 \u05d7\u05e9\u05d1\u05d5\u05e0\u05d9\u05d5\u05ea\",\"type\":\"control_address\"},{\"description\":\"\u2022\\t\u05d1\u05d4\u05ea\u05d0\u05dd \u05dc\u05d4\u05d5\u05e8\u05d0\u05ea \u05e1\u05e2\u05d9\u05e318\u05d1' \u05dc\u05d4\u05d5\u05e8\u05d0\u05d5\u05ea \u05de\u05e1 \u05d4\u05db\u05e0\u05e1\u05d4 (\u05e0\u05d9\u05d4\u05d5\u05dc \u05e4\u05e0\u05e7\u05e1\u05d9 \u05d7\u05e9\u05d1\u05d5\u05e0\u05d5\u05ea), \u05ea\u05e9\u05dc&quot;\u05d2 \u2013 1973 (\u05dc\u05d4\u05dc\u05df: &quot;\u05d4\u05d5\u05e8\u05d0\u05d5\u05ea \u05e0\u05d9\u05d4\u05d5\u05dc \u05e4\u05e0\u05e7\u05e1\u05d9\u05dd&quot;), \u05e0\u05d9\u05ea\u05df \u05dc\u05d4\u05e2\u05d1\u05d9\u05e8  \u05d1\u05d0\u05de\u05e6\u05e2\u05d5\u05ea \u05de\u05d7\u05e9\u05d1, \u05de\u05e1\u05de\u05db\u05d9\u05dd \u05de\u05de\u05d5\u05d7\u05e9\u05d1\u05d9\u05dd \u05de\u05e1\u05d5\u05d2 \u05d7\u05e9\u05d1\u05d5\u05e0\u05d9\u05ea \u05de\u05e1, \u05db\u05d0\u05de\u05d5\u05e8 \u05d1\u05ea\u05e7\u05e0\u05d4 9\u05d0 \u05dc\u05ea\u05e7\u05e0\u05d5\u05ea \u05de\u05e1 \u05e2\u05e8\u05da \u05de\u05d5\u05e1\u05e3 (\u05e0\u05d9\u05d4\u05d5\u05dc \u05e4\u05e0\u05e7\u05e1\u05d9 \u05d7\u05e9\u05d1\u05d5\u05e0\u05d5\u05ea) \u05d4\u05ea\u05e9\u05dc&quot;\u05d5 \u2013 1976.\\n\u2022\\t\u05d1\u05d4\u05ea\u05d0\u05dd \u05dc\u05d4\u05d5\u05e8\u05d0\u05ea \u05e1\u05e2\u05d9\u05e3 18\u05d1'(\u05d1) \u05dc\u05d4\u05d5\u05e8\u05d0\u05ea \u05e0\u05d9\u05d4\u05d5\u05dc  \u05e4\u05e0\u05e7\u05e1\u05d9\u05dd, \u05d0\u05e0\u05d5 \u05e0\u05d4\u05d9\u05d4 \u05e8\u05e9\u05d0\u05d9\u05dd \u05dc\u05e9\u05dc\u05d5\u05d7 \u05d0\u05dc\u05d9\u05db\u05dd \u05d0\u05ea \u05d4\u05de\u05e1\u05de\u05db\u05d9\u05dd \u05d4\u05de\u05de\u05d5\u05d7\u05e9\u05d1\u05d9\u05dd \u05d4\u05e0&quot;\u05dc,  \u05d1\u05d0\u05de\u05e6\u05e2\u05d5\u05ea \u05de\u05d7\u05e9\u05d1 \u05e8\u05e7 \u05dc\u05d0\u05d7\u05e8 \u05e9\u05d4\u05d1\u05e2\u05ea\u05dd \u05d4\u05e1\u05db\u05de\u05ea\u05db\u05dd \u05dc\u05db\u05da, \u05d1\u05db\u05ea\u05d1 \u05d0\u05d5 \u05d1\u05d0\u05d5\u05e4\u05df \u05de\u05de\u05d5\u05d7\u05e9\u05d1 \u05d7\u05ea\u05d5\u05dd \u05d1\u05d7\u05ea\u05d9\u05de\u05d4 \u05d0\u05dc\u05e7\u05d8\u05e8\u05d5\u05e0\u05d9\u05ea \u05de\u05d0\u05d5\u05e9\u05e8\u05ea, \u05d5\u05db\u05dc \u05e2\u05d5\u05d3 \u05dc\u05d0 \u05d1\u05d9\u05d8\u05dc\u05ea\u05dd \u05d4\u05e1\u05db\u05de\u05ea\u05db\u05dd \u05dc\u05db\u05da \u05d1\u05d0\u05d5\u05e4\u05df \u05d4\u05d0\u05de\u05d5\u05e8\",\"name\":\"input26\",\"qid\":\"26\",\"text\":\"\u05de\u05d0\u05e9\u05e8 \u05e7\u05d1\u05dc\u05ea \u05d7\u05e9\u05d1\u05d5\u05e0\u05d9\u05d5\u05ea \u05d7\u05ea\u05d5\u05de\u05d5\u05ea \u05d3\u05d9\u05d2\u05d9\u05d8\u05dc\u05d9\u05ea\",\"type\":\"control_radio\"},{\"description\":\"\",\"name\":\"input27\",\"qid\":\"27\",\"text\":\"\u05d8\u05dc\u05e4\u05d5\u05df\",\"type\":\"control_phone\"},{\"description\":\"\",\"name\":\"input28\",\"qid\":\"28\",\"text\":\"\u05d8\u05dc\u05e4\u05d5\u05df\",\"type\":\"control_phone\"},{\"name\":\"divider29\",\"qid\":\"29\",\"type\":\"control_divider\"},{\"name\":\"divider30\",\"qid\":\"30\",\"type\":\"control_divider\"},{\"description\":\"\",\"name\":\"input31\",\"qid\":\"31\",\"text\":\"\",\"type\":\"control_checkbox\"}]);}, 20); \n<\/script>\n<\/head>\n<body>\n<form class=\"jotform-form\" action=\"https:\/\/submit.jotform.me\/submit\/81112898808465\/\" method=\"post\" name=\"form_81112898808465\" id=\"81112898808465\" accept-charset=\"utf-8\" autocomplete=\"on\">\n  <input type=\"hidden\" name=\"formID\" value=\"81112898808465\" \/>\n  <input type=\"hidden\" id=\"JWTContainer\" value=\"\" \/>\n  <input type=\"hidden\" id=\"cardinalOrderNumber\" value=\"\" \/>\n  <div role=\"main\" class=\"form-all\">\n    <link type=\"text\/css\" rel=\"stylesheet\" media=\"all\" href=\"https:\/\/cdn.jotfor.ms\/wizards\/languageWizard\/custom-dropdown\/css\/lang-dd.css?3.3.25347\" \/>\n    <div class=\"cont\">\n      <input type=\"text\" id=\"input_language\" name=\"input_language\" style=\"display:none\" \/>\n      <div class=\"language-dd\" id=\"langDd\" style=\"display:none\">\n        <div class=\"dd-placeholder lang-emp\">\n          Language\n        <\/div>\n        <ul class=\"lang-list dn\" id=\"langList\">\n          <li data-lang=\"he\" class=\"he\">\n            Hebrew\n          <\/li>\n        <\/ul>\n      <\/div>\n    <\/div>\n    <script type=\"text\/javascript\" src=\"https:\/\/cdn.jotfor.ms\/js\/formTranslation.v2.js?3.3.25347\"><\/script>\n    <ul class=\"form-section page-section\">\n      <li id=\"cid_1\" class=\"form-input-wide\" data-type=\"control_head\">\n        <div class=\"form-header-group  header-default\">\n          <div class=\"header-text httac htvam\">\n            <h2 id=\"header_1\" class=\"form-header\" data-component=\"header\">\n              \u05d8\u05d5\u05e4\u05e1 \u05e4\u05ea\u05d9\u05d7\u05ea \u05dc\u05e7\u05d5\u05d7 \u05d7\u05d3\u05e9\n            <\/h2>\n            <div id=\"subHeader_1\" class=\"form-subHeader\">\n              \u05de\u05d9\u05dc\u05d5\u05d9 \u05d4\u05d8\u05d5\u05e4\u05e1 \u05d9\u05d1\u05d5\u05e6\u05e2 \u05e2&quot;\u05d9 \u05d1\u05e2\u05dc\u05d9 \u05d4\u05de\u05e0\u05d9\u05d5\u05ea \u05d1\u05d7\u05d1\u05e8\u05d4 \u05d0\u05d5 \u05de\u05d9\u05e9\u05d4\u05d5 \u05de\u05d5\u05e1\u05de\u05da \u05de\u05d8\u05e2\u05de\u05d5\n            <\/div>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_textbox\" id=\"id_16\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_16\" for=\"input_16\">\n          \u05e7\u05d5\u05d3\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_16\" class=\"form-input jf-required\">\n          <input type=\"text\" id=\"input_16\" name=\"q16_input16\" data-type=\"input-textbox\" class=\"form-textbox validate[required]\" size=\"20\" value=\"\" data-component=\"textbox\" aria-labelledby=\"label_16\" required=\"\" \/>\n        <\/div>\n      <\/li>\n      <ul class=\"form-section-closed\" style=\"height: 60px;clear:both;\" id=\"section_15\" style=\"display:none;\">\n        <li id=\"cid_15\" class=\"form-input-wide\" data-type=\"control_collapse\">\n          <div class=\"form-collapse-table\" id=\"collapse_15\" data-component=\"collapse\">\n            <span class=\"form-collapse-mid\" id=\"collapse-text_15\">\n              \u05dc\u05d7\u05e5 \u05db\u05d0\u05df \u05dc\u05e4\u05ea\u05d9\u05d7\u05ea \u05d4\u05d8\u05d5\u05e4\u05e1\n            <\/span>\n            <span class=\"form-collapse-right form-collapse-right-hide\">\n              \u00a0\n            <\/span>\n          <\/div>\n        <\/li>\n        <li class=\"form-line jf-required\" data-type=\"control_checkbox\" id=\"id_3\">\n          <label class=\"form-label form-label-left form-label-auto\" id=\"label_3\" for=\"input_3\">\n            \u05d4\u05dc\u05e7\u05d5\u05d7 \u05d4\u05d5\u05d0\n            <span class=\"form-required\">\n              *\n            <\/span>\n          <\/label>\n          <div id=\"cid_3\" class=\"form-input jf-required\">\n            <div class=\"form-multiple-column\" data-columncount=\"2\" role=\"group\" aria-labelledby=\"label_3\" data-component=\"checkbox\">\n              <span class=\"form-checkbox-item\">\n                <span class=\"dragger-item\">\n                <\/span>\n                <input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_3_0\" name=\"q3_input3[]\" value=\"\u05d7\u05d1\u05e8\u05d4 \u05d1\u05e2&quot;\u05de\" required=\"\" \/>\n                <label id=\"label_input_3_0\" for=\"input_3_0\"> \u05d7\u05d1\u05e8\u05d4 \u05d1\u05e2\"\u05de <\/label>\n              <\/span>\n              <span class=\"form-checkbox-item\">\n                <span class=\"dragger-item\">\n                <\/span>\n                <input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_3_1\" name=\"q3_input3[]\" value=\"\u05e2\u05d5\u05e1\u05e7 \u05de\u05d5\u05e8\u05e9\u05d4\" required=\"\" \/>\n                <label id=\"label_input_3_1\" for=\"input_3_1\"> \u05e2\u05d5\u05e1\u05e7 \u05de\u05d5\u05e8\u05e9\u05d4 <\/label>\n              <\/span>\n              <span class=\"form-checkbox-item\" style=\"clear:left\">\n                <span class=\"dragger-item\">\n                <\/span>\n                <input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_3_2\" name=\"q3_input3[]\" value=\"\u05de\u05dc\u05db&quot;\u05e8\" required=\"\" \/>\n                <label id=\"label_input_3_2\" for=\"input_3_2\"> \u05de\u05dc\u05db\"\u05e8 <\/label>\n              <\/span>\n              <span class=\"form-checkbox-item\">\n                <span class=\"dragger-item\">\n                <\/span>\n                <input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_3_3\" name=\"q3_input3[]\" value=\"\u05e4\u05e8\u05d8\u05d9\" required=\"\" \/>\n                <label id=\"label_input_3_3\" for=\"input_3_3\"> \u05e4\u05e8\u05d8\u05d9 <\/label>\n              <\/span>\n            <\/div>\n          <\/div>\n        <\/li>\n        <li class=\"form-line jf-required\" data-type=\"control_fullname\" id=\"id_23\">\n          <label class=\"form-label form-label-left form-label-auto\" id=\"label_23\" for=\"first_23\">\n            \u05e9\u05dd \u05d4\u05d7\u05d1\u05e8\u05d4\/ \u05e2\u05e1\u05e7\n            <span class=\"form-required\">\n              *\n            <\/span>\n          <\/label>\n          <div id=\"cid_23\" class=\"form-input jf-required\">\n            <div data-wrapper-react=\"true\">\n              <span class=\"form-sub-label-container\" style=\"vertical-align:top\" data-input-type=\"first\">\n                <input type=\"text\" id=\"first_23\" name=\"q23_input23[first]\" class=\"form-textbox validate[required]\" size=\"10\" value=\"\" data-component=\"first\" aria-labelledby=\"label_23 sublabel_23_first\" required=\"\" \/>\n                <label class=\"form-sub-label\" for=\"first_23\" id=\"sublabel_23_first\" style=\"min-height:13px\" aria-hidden=\"false\"> \u05d1\u05e2\u05d1\u05e8\u05d9\u05ea <\/label>\n              <\/span>\n              <span class=\"form-sub-label-container\" style=\"vertical-align:top\" data-input-type=\"last\">\n                <input type=\"text\" id=\"last_23\" name=\"q23_input23[last]\" class=\"form-textbox validate[required]\" size=\"15\" value=\"\" data-component=\"last\" aria-labelledby=\"label_23 sublabel_23_last\" required=\"\" \/>\n                <label class=\"form-sub-label\" for=\"last_23\" id=\"sublabel_23_last\" style=\"min-height:13px\" aria-hidden=\"false\"> \u05d1\u05d0\u05e0\u05d2\u05dc\u05d9\u05ea <\/label>\n              <\/span>\n            <\/div>\n          <\/div>\n        <\/li>\n        <li class=\"form-line jf-required\" data-type=\"control_textbox\" id=\"id_19\">\n          <label class=\"form-label form-label-left\" id=\"label_19\" for=\"input_19\">\n            \u05de\u05e1\u05e4\u05e8 \u05d7.\u05e4\/\u05e2\u05d5\u05e1\u05e7 \u05de\u05d5\u05e8\u05e9\u05d4\n            <span class=\"form-required\">\n              *\n            <\/span>\n          <\/label>\n          <div id=\"cid_19\" class=\"form-input jf-required\">\n            <input type=\"text\" id=\"input_19\" name=\"q19_input19\" data-type=\"input-textbox\" class=\"form-textbox validate[required, AlphaNumeric]\" size=\"20\" value=\"\" data-component=\"textbox\" aria-labelledby=\"label_19\" required=\"\" \/>\n          <\/div>\n        <\/li>\n        <li class=\"form-line jf-required\" data-type=\"control_phone\" id=\"id_28\">\n          <label class=\"form-label form-label-left\" id=\"label_28\" for=\"input_28_full\">\n            \u05d8\u05dc\u05e4\u05d5\u05df\n            <span class=\"form-required\">\n              *\n            <\/span>\n          <\/label>\n          <div id=\"cid_28\" class=\"form-input jf-required\">\n            <span class=\"form-sub-label-container\" style=\"vertical-align:top\">\n              <input type=\"tel\" id=\"input_28_full\" name=\"q28_input28[full]\" data-type=\"mask-number\" class=\"mask-phone-number form-textbox validate[required]\" autoComplete=\"off\" data-masked=\"true\" value=\"\" data-component=\"phone\" aria-labelledby=\"label_28\" required=\"\" \/>\n              <label class=\"form-sub-label\" for=\"input_28_full\" id=\"sublabel_28_masked\" style=\"min-height:13px\" aria-hidden=\"false\">  <\/label>\n            <\/span>\n          <\/div>\n        <\/li>\n        <li class=\"form-line jf-required\" data-type=\"control_address\" id=\"id_20\" data-compound-hint=\",,,,,\">\n          <label class=\"form-label form-label-left\" id=\"label_20\" for=\"input_20_addr_line1\">\n            \u05db\u05ea\u05d5\u05d1\u05ea \u05d4\u05d7\u05d1\u05e8\u05d4\/\u05e2\u05e1\u05e7\n            <span class=\"form-required\">\n              *\n            <\/span>\n          <\/label>\n          <div id=\"cid_20\" class=\"form-input jf-required\">\n            <div summary=\"\" class=\"form-address-table jsTest-addressField\">\n              <div class=\"form-address-line-wrapper jsTest-address-line-wrapperField\">\n                <span class=\"form-address-line form-address-street-line jsTest-address-lineField\">\n                  <span class=\"form-sub-label-container\" style=\"vertical-align:top\">\n                    <input type=\"text\" id=\"input_20_addr_line1\" name=\"q20_input20[addr_line1]\" class=\"form-textbox validate[required] form-address-line\" value=\"\" data-component=\"address_line_1\" aria-labelledby=\"label_20 sublabel_20_addr_line1\" \/>\n                    <label class=\"form-sub-label\" for=\"input_20_addr_line1\" id=\"sublabel_20_addr_line1\" style=\"min-height:13px\" aria-hidden=\"false\"> \u05e8\u05d7\u05d5\u05d1 <\/label>\n                  <\/span>\n                <\/span>\n              <\/div>\n              <div class=\"form-address-line-wrapper jsTest-address-line-wrapperField\" style=\"display:none\">\n                <span class=\"form-address-line form-address-street-line jsTest-address-lineField\">\n                  <span class=\"form-sub-label-container\" style=\"vertical-align:top\">\n                    <input type=\"text\" id=\"input_20_addr_line2\" name=\"q20_input20[addr_line2]\" class=\"form-textbox form-address-line\" value=\"\" data-component=\"address_line_2\" aria-labelledby=\"label_20 sublabel_20_addr_line2\" \/>\n                    <label class=\"form-sub-label\" for=\"input_20_addr_line2\" id=\"sublabel_20_addr_line2\" style=\"min-height:13px\" aria-hidden=\"false\"> \u05e8\u05d7\u05d5\u05d1 <\/label>\n                  <\/span>\n                <\/span>\n              <\/div>\n              <div class=\"form-address-line-wrapper jsTest-address-line-wrapperField\">\n                <span class=\"form-address-line form-address-city-line jsTest-address-lineField \">\n                  <span class=\"form-sub-label-container\" style=\"vertical-align:top\">\n                    <input type=\"text\" id=\"input_20_city\" name=\"q20_input20[city]\" class=\"form-textbox validate[required] form-address-city\" value=\"\" data-component=\"city\" aria-labelledby=\"label_20 sublabel_20_city\" \/>\n                    <label class=\"form-sub-label\" for=\"input_20_city\" id=\"sublabel_20_city\" style=\"min-height:13px\" aria-hidden=\"false\"> \u05e2\u05d9\u05e8 <\/label>\n                  <\/span>\n                <\/span>\n                <span class=\"form-address-line form-address-state-line jsTest-address-lineField form-address-hiddenLine\" style=\"display:none\">\n                  <span class=\"form-sub-label-container\" style=\"vertical-align:top\">\n                    <input type=\"text\" id=\"input_20_state\" name=\"q20_input20[state]\" class=\"form-textbox validate[required] form-address-state\" value=\"\" data-component=\"state\" aria-labelledby=\"label_20 sublabel_20_state\" \/>\n                    <label class=\"form-sub-label\" for=\"input_20_state\" id=\"sublabel_20_state\" style=\"min-height:13px\" aria-hidden=\"false\"> State \/ Province <\/label>\n                  <\/span>\n                <\/span>\n              <\/div>\n              <div class=\"form-address-line-wrapper jsTest-address-line-wrapperField\">\n                <span class=\"form-address-line form-address-zip-line jsTest-address-lineField \">\n                  <span class=\"form-sub-label-container\" style=\"vertical-align:top\">\n                    <input type=\"text\" id=\"input_20_postal\" name=\"q20_input20[postal]\" class=\"form-textbox form-address-postal\" value=\"\" data-component=\"zip\" aria-labelledby=\"label_20 sublabel_20_postal\" \/>\n                    <label class=\"form-sub-label\" for=\"input_20_postal\" id=\"sublabel_20_postal\" style=\"min-height:13px\" aria-hidden=\"false\"> \u05de\u05d9\u05e7\u05d5\u05d3 <\/label>\n                  <\/span>\n                <\/span>\n              <\/div>\n            <\/div>\n          <\/div>\n        <\/li>\n        <li class=\"form-line\" data-type=\"control_checkbox\" id=\"id_22\">\n          <label class=\"form-label form-label-top\" id=\"label_22\" for=\"input_22\">  <\/label>\n          <div id=\"cid_22\" class=\"form-input-wide\">\n            <div class=\"form-single-column\" role=\"group\" aria-labelledby=\"label_22\" data-component=\"checkbox\">\n              <span class=\"form-checkbox-item\" style=\"clear:left\">\n                <span class=\"dragger-item\">\n                <\/span>\n                <input type=\"checkbox\" class=\"form-checkbox\" id=\"input_22_0\" name=\"q22_typeA[]\" value=\"\u05db\u05ea\u05d5\u05d1\u05ea \u05dc\u05de\u05e9\u05dc\u05d5\u05d7 \u05d8\u05d5\u05d1\u05d9\u05df \u05e9\u05d5\u05e0\u05d4 \u05de\u05db\u05ea\u05d5\u05d1\u05ea \u05d4\u05d7\u05d1\u05e8\u05d4\" \/>\n                <label id=\"label_input_22_0\" for=\"input_22_0\"> \u05db\u05ea\u05d5\u05d1\u05ea \u05dc\u05de\u05e9\u05dc\u05d5\u05d7 \u05d8\u05d5\u05d1\u05d9\u05df \u05e9\u05d5\u05e0\u05d4 \u05de\u05db\u05ea\u05d5\u05d1\u05ea \u05d4\u05d7\u05d1\u05e8\u05d4 <\/label>\n              <\/span>\n            <\/div>\n          <\/div>\n        <\/li>\n        <li class=\"form-line always-hidden form-field-hidden\" style=\"display:none;\" data-type=\"control_address\" id=\"id_21\" data-compound-hint=\",,,,,\">\n          <label class=\"form-label form-label-left\" id=\"label_21\" for=\"input_21_addr_line1\"> \u05db\u05ea\u05d5\u05d1\u05ea \u05dc\u05de\u05e9\u05dc\u05d5\u05d7 \u05d8\u05d5\u05d1\u05d9\u05df <\/label>\n          <div id=\"cid_21\" class=\"form-input always-hidden\">\n            <div summary=\"\" class=\"form-address-table jsTest-addressField\">\n              <div class=\"form-address-line-wrapper jsTest-address-line-wrapperField\">\n                <span class=\"form-address-line form-address-street-line jsTest-address-lineField\">\n                  <span class=\"form-sub-label-container\" style=\"vertical-align:top\">\n                    <input type=\"text\" id=\"input_21_addr_line1\" name=\"q21_input21[addr_line1]\" class=\"form-textbox form-address-line\" value=\"\" data-component=\"address_line_1\" aria-labelledby=\"label_21 sublabel_21_addr_line1\" \/>\n                    <label class=\"form-sub-label\" for=\"input_21_addr_line1\" id=\"sublabel_21_addr_line1\" style=\"min-height:13px\" aria-hidden=\"false\"> \u05e8\u05d7\u05d5\u05d1 <\/label>\n                  <\/span>\n                <\/span>\n              <\/div>\n              <div class=\"form-address-line-wrapper jsTest-address-line-wrapperField\" style=\"display:none\">\n                <span class=\"form-address-line form-address-street-line jsTest-address-lineField\">\n                  <span class=\"form-sub-label-container\" style=\"vertical-align:top\">\n                    <input type=\"text\" id=\"input_21_addr_line2\" name=\"q21_input21[addr_line2]\" class=\"form-textbox form-address-line\" value=\"\" data-component=\"address_line_2\" aria-labelledby=\"label_21 sublabel_21_addr_line2\" \/>\n                    <label class=\"form-sub-label\" for=\"input_21_addr_line2\" id=\"sublabel_21_addr_line2\" style=\"min-height:13px\" aria-hidden=\"false\"> \u05e8\u05d7\u05d5\u05d1 <\/label>\n                  <\/span>\n                <\/span>\n              <\/div>\n              <div class=\"form-address-line-wrapper jsTest-address-line-wrapperField\">\n                <span class=\"form-address-line form-address-city-line jsTest-address-lineField \">\n                  <span class=\"form-sub-label-container\" style=\"vertical-align:top\">\n                    <input type=\"text\" id=\"input_21_city\" name=\"q21_input21[city]\" class=\"form-textbox form-address-city\" value=\"\" data-component=\"city\" aria-labelledby=\"label_21 sublabel_21_city\" \/>\n                    <label class=\"form-sub-label\" for=\"input_21_city\" id=\"sublabel_21_city\" style=\"min-height:13px\" aria-hidden=\"false\"> \u05e2\u05d9\u05e8 <\/label>\n                  <\/span>\n                <\/span>\n                <span class=\"form-address-line form-address-state-line jsTest-address-lineField form-address-hiddenLine\" style=\"display:none\">\n                  <span class=\"form-sub-label-container\" style=\"vertical-align:top\">\n                    <input type=\"text\" id=\"input_21_state\" name=\"q21_input21[state]\" class=\"form-textbox form-address-state\" value=\"\" data-component=\"state\" aria-labelledby=\"label_21 sublabel_21_state\" \/>\n                    <label class=\"form-sub-label\" for=\"input_21_state\" id=\"sublabel_21_state\" style=\"min-height:13px\" aria-hidden=\"false\"> State \/ Province <\/label>\n                  <\/span>\n                <\/span>\n              <\/div>\n              <div class=\"form-address-line-wrapper jsTest-address-line-wrapperField\">\n                <span class=\"form-address-line form-address-zip-line jsTest-address-lineField \">\n                  <span class=\"form-sub-label-container\" style=\"vertical-align:top\">\n                    <input type=\"text\" id=\"input_21_postal\" name=\"q21_input21[postal]\" class=\"form-textbox form-address-postal\" value=\"\" data-component=\"zip\" aria-labelledby=\"label_21 sublabel_21_postal\" \/>\n                    <label class=\"form-sub-label\" for=\"input_21_postal\" id=\"sublabel_21_postal\" style=\"min-height:13px\" aria-hidden=\"false\"> \u05de\u05d9\u05e7\u05d5\u05d3 <\/label>\n                  <\/span>\n                <\/span>\n              <\/div>\n            <\/div>\n          <\/div>\n        <\/li>\n        <li class=\"form-line\" data-type=\"control_divider\" id=\"id_8\">\n          <div id=\"cid_8\" class=\"form-input-wide\">\n            <div data-component=\"divider\" style=\"border-bottom:1px solid #e6e6e6;height:1px;margin-left:0px;margin-right:0px;margin-top:5px;margin-bottom:5px\">\n            <\/div>\n          <\/div>\n        <\/li>\n        <li class=\"form-line jf-required\" data-type=\"control_fullname\" id=\"id_4\">\n          <label class=\"form-label form-label-left form-label-auto\" id=\"label_4\" for=\"first_4\">\n            \u05e9\u05de\u05d5\u05ea \u05d0\u05e0\u05e9\u05d9 \u05d4\u05e7\u05e9\u05e8:\n            <span class=\"form-required\">\n              *\n            <\/span>\n          <\/label>\n          <div id=\"cid_4\" class=\"form-input jf-required\">\n            <div data-wrapper-react=\"true\" class=\"extended\">\n              <span class=\"form-sub-label-container\" style=\"vertical-align:top\" data-input-type=\"first\">\n                <input type=\"text\" id=\"first_4\" name=\"q4_name[first]\" class=\"form-textbox validate[required]\" size=\"10\" value=\"\" data-component=\"first\" aria-labelledby=\"label_4 sublabel_4_first\" required=\"\" \/>\n                <label class=\"form-sub-label\" for=\"first_4\" id=\"sublabel_4_first\" style=\"min-height:13px\" aria-hidden=\"false\"> \u05e9\u05dd \u05e4\u05e8\u05d8\u05d9 <\/label>\n              <\/span>\n              <span class=\"form-sub-label-container\" style=\"vertical-align:top\" data-input-type=\"middle\">\n                <input type=\"text\" id=\"middle_4\" name=\"q4_name[middle]\" class=\"form-textbox\" size=\"10\" value=\"\" data-component=\"middle\" aria-labelledby=\"label_4 sublabel_4_middle\" required=\"\" \/>\n                <label class=\"form-sub-label\" for=\"middle_4\" id=\"sublabel_4_middle\" style=\"min-height:13px\" aria-hidden=\"false\"> \u05e9\u05dd \u05de\u05e9\u05e4\u05d7\u05d4 <\/label>\n              <\/span>\n              <span class=\"form-sub-label-container\" style=\"vertical-align:top\" data-input-type=\"last\">\n                <input type=\"text\" id=\"last_4\" name=\"q4_name[last]\" class=\"form-textbox validate[required]\" size=\"15\" value=\"\" data-component=\"last\" aria-labelledby=\"label_4 sublabel_4_last\" required=\"\" \/>\n                <label class=\"form-sub-label\" for=\"last_4\" id=\"sublabel_4_last\" style=\"min-height:13px\" aria-hidden=\"false\"> \u05ea\u05e4\u05e7\u05d9\u05d3 <\/label>\n              <\/span>\n            <\/div>\n          <\/div>\n        <\/li>\n        <li class=\"form-line jf-required\" data-type=\"control_email\" id=\"id_6\">\n          <label class=\"form-label form-label-left form-label-auto\" id=\"label_6\" for=\"input_6\">\n            \u05d3\u05d5\u05d0\u05dc\n            <span class=\"form-required\">\n              *\n            <\/span>\n          <\/label>\n          <div id=\"cid_6\" class=\"form-input jf-required\">\n            <span class=\"form-sub-label-container\" style=\"vertical-align:top\">\n              <input type=\"email\" id=\"input_6\" name=\"q6_input6\" class=\"form-textbox validate[required, Email]\" size=\"30\" value=\"\" data-component=\"email\" aria-labelledby=\"label_6 sublabel_input_6\" required=\"\" \/>\n              <label class=\"form-sub-label\" for=\"input_6\" id=\"sublabel_input_6\" style=\"min-height:13px\" aria-hidden=\"false\"> example@example.com <\/label>\n            <\/span>\n          <\/div>\n        <\/li>\n        <li class=\"form-line\" data-type=\"control_fullname\" id=\"id_5\">\n          <label class=\"form-label form-label-left form-label-auto\" id=\"label_5\" for=\"first_5\"> \u05e9\u05de\u05d5\u05ea \u05d0\u05e0\u05e9\u05d9 \u05d4\u05e7\u05e9\u05e8 2: <\/label>\n          <div id=\"cid_5\" class=\"form-input\">\n            <div data-wrapper-react=\"true\" class=\"extended\">\n              <span class=\"form-sub-label-container\" style=\"vertical-align:top\" data-input-type=\"first\">\n                <input type=\"text\" id=\"first_5\" name=\"q5_input5[first]\" class=\"form-textbox\" size=\"10\" value=\"\" data-component=\"first\" aria-labelledby=\"label_5 sublabel_5_first\" \/>\n                <label class=\"form-sub-label\" for=\"first_5\" id=\"sublabel_5_first\" style=\"min-height:13px\" aria-hidden=\"false\"> \u05e9\u05dd \u05e4\u05e8\u05d8\u05d9 <\/label>\n              <\/span>\n              <span class=\"form-sub-label-container\" style=\"vertical-align:top\" data-input-type=\"middle\">\n                <input type=\"text\" id=\"middle_5\" name=\"q5_input5[middle]\" class=\"form-textbox\" size=\"10\" value=\"\" data-component=\"middle\" aria-labelledby=\"label_5 sublabel_5_middle\" \/>\n                <label class=\"form-sub-label\" for=\"middle_5\" id=\"sublabel_5_middle\" style=\"min-height:13px\" aria-hidden=\"false\"> \u05e9\u05dd \u05de\u05e9\u05e4\u05d7\u05d4 <\/label>\n              <\/span>\n              <span class=\"form-sub-label-container\" style=\"vertical-align:top\" data-input-type=\"last\">\n                <input type=\"text\" id=\"last_5\" name=\"q5_input5[last]\" class=\"form-textbox\" size=\"15\" value=\"\" data-component=\"last\" aria-labelledby=\"label_5 sublabel_5_last\" \/>\n                <label class=\"form-sub-label\" for=\"last_5\" id=\"sublabel_5_last\" style=\"min-height:13px\" aria-hidden=\"false\"> \u05ea\u05e4\u05e7\u05d9\u05d3 <\/label>\n              <\/span>\n            <\/div>\n          <\/div>\n        <\/li>\n        <li class=\"form-line\" data-type=\"control_email\" id=\"id_7\">\n          <label class=\"form-label form-label-left form-label-auto\" id=\"label_7\" for=\"input_7\"> \u05d3\u05d5\u05d0\u05dc 2 <\/label>\n          <div id=\"cid_7\" class=\"form-input\">\n            <span class=\"form-sub-label-container\" style=\"vertical-align:top\">\n              <input type=\"email\" id=\"input_7\" name=\"q7_2\" class=\"form-textbox validate[Email]\" size=\"30\" value=\"\" data-component=\"email\" aria-labelledby=\"label_7 sublabel_input_7\" \/>\n              <label class=\"form-sub-label\" for=\"input_7\" id=\"sublabel_input_7\" style=\"min-height:13px\" aria-hidden=\"false\"> example@example.com <\/label>\n            <\/span>\n          <\/div>\n        <\/li>\n        <li class=\"form-line\" data-type=\"control_divider\" id=\"id_29\">\n          <div id=\"cid_29\" class=\"form-input-wide\">\n            <div data-component=\"divider\" style=\"border-bottom:1px solid #e6e6e6;height:1px;margin-left:0px;margin-right:0px;margin-top:5px;margin-bottom:5px\">\n            <\/div>\n          <\/div>\n        <\/li>\n        <li class=\"form-line jf-required\" data-type=\"control_fullname\" id=\"id_10\">\n          <label class=\"form-label form-label-left form-label-auto\" id=\"label_10\" for=\"first_10\">\n            \u05d0\u05d9\u05e9.\u05ea \u05e7\u05e9\u05e8 \u05d1\u05d4\u05e0\u05d4&quot;\u05d7\n            <span class=\"form-required\">\n              *\n            <\/span>\n          <\/label>\n          <div id=\"cid_10\" class=\"form-input jf-required\">\n            <div data-wrapper-react=\"true\">\n              <span class=\"form-sub-label-container\" style=\"vertical-align:top\" data-input-type=\"first\">\n                <input type=\"text\" id=\"first_10\" name=\"q10_input10[first]\" class=\"form-textbox validate[required]\" size=\"10\" value=\"\" data-component=\"first\" aria-labelledby=\"label_10 sublabel_10_first\" required=\"\" \/>\n                <label class=\"form-sub-label\" for=\"first_10\" id=\"sublabel_10_first\" style=\"min-height:13px\" aria-hidden=\"false\"> \u05e9\u05dd \u05e4\u05e8\u05d8\u05d9 <\/label>\n              <\/span>\n              <span class=\"form-sub-label-container\" style=\"vertical-align:top\" data-input-type=\"last\">\n                <input type=\"text\" id=\"last_10\" name=\"q10_input10[last]\" class=\"form-textbox validate[required]\" size=\"15\" value=\"\" data-component=\"last\" aria-labelledby=\"label_10 sublabel_10_last\" required=\"\" \/>\n                <label class=\"form-sub-label\" for=\"last_10\" id=\"sublabel_10_last\" style=\"min-height:13px\" aria-hidden=\"false\"> \u05e9\u05dd \u05de\u05e9\u05e4\u05d7\u05d4 <\/label>\n              <\/span>\n            <\/div>\n          <\/div>\n        <\/li>\n        <li class=\"form-line form-line-column form-col-1 jf-required\" data-type=\"control_email\" id=\"id_11\">\n          <label class=\"form-label form-label-top\" id=\"label_11\" for=\"input_11\">\n            \u05d3\u05d5\u05d0\u05dc \u05d4\u05e0\u05d4&quot;\u05d7\n            <span class=\"form-required\">\n              *\n            <\/span>\n          <\/label>\n          <div id=\"cid_11\" class=\"form-input-wide jf-required\">\n            <span class=\"form-sub-label-container\" style=\"vertical-align:top\">\n              <input type=\"email\" id=\"input_11\" name=\"q11_input11\" class=\"form-textbox validate[required, Email]\" size=\"30\" value=\"\" data-component=\"email\" aria-labelledby=\"label_11 sublabel_input_11\" required=\"\" \/>\n              <label class=\"form-sub-label\" for=\"input_11\" id=\"sublabel_input_11\" style=\"min-height:13px\" aria-hidden=\"false\"> example@example.com <\/label>\n            <\/span>\n          <\/div>\n        <\/li>\n        <li class=\"form-line form-line-column form-col-2 jf-required\" data-type=\"control_phone\" id=\"id_27\">\n          <label class=\"form-label form-label-top\" id=\"label_27\" for=\"input_27_full\">\n            \u05d8\u05dc\u05e4\u05d5\u05df\n            <span class=\"form-required\">\n              *\n            <\/span>\n          <\/label>\n          <div id=\"cid_27\" class=\"form-input-wide jf-required\">\n            <span class=\"form-sub-label-container\" style=\"vertical-align:top\">\n              <input type=\"tel\" id=\"input_27_full\" name=\"q27_input27[full]\" data-type=\"mask-number\" class=\"mask-phone-number form-textbox validate[required]\" autoComplete=\"off\" data-masked=\"true\" value=\"\" data-component=\"phone\" aria-labelledby=\"label_27\" required=\"\" \/>\n              <label class=\"form-sub-label\" for=\"input_27_full\" id=\"sublabel_27_masked\" style=\"min-height:13px\" aria-hidden=\"false\">  <\/label>\n            <\/span>\n          <\/div>\n        <\/li>\n        <li class=\"form-line\" data-type=\"control_divider\" id=\"id_30\">\n          <div id=\"cid_30\" class=\"form-input-wide\">\n            <div data-component=\"divider\" style=\"border-bottom:1px solid #e6e6e6;height:1px;margin-left:0px;margin-right:0px;margin-top:5px;margin-bottom:5px\">\n            <\/div>\n          <\/div>\n        <\/li>\n        <li class=\"form-line jf-required\" data-type=\"control_checkbox\" id=\"id_24\">\n          <label class=\"form-label form-label-top\" id=\"label_24\" for=\"input_24\">\n            \u05db\u05ea\u05d5\u05d1\u05ea \u05dc\u05de\u05e9\u05dc\u05d5\u05d7 \u05d7\u05e9\u05d1\u05d5\u05e0\u05d9\u05d5\u05ea \u05e9\u05d5\u05e0\u05d4 \u05de\u05db\u05ea\u05d5\u05d1\u05ea \u05d4\u05d7\u05d1\u05e8\u05d4\n            <span class=\"form-required\">\n              *\n            <\/span>\n          <\/label>\n          <div id=\"cid_24\" class=\"form-input-wide jf-required\">\n            <div class=\"form-multiple-column\" data-columncount=\"2\" role=\"group\" aria-labelledby=\"label_24\" data-component=\"checkbox\">\n              <span class=\"form-checkbox-item\">\n                <span class=\"dragger-item\">\n                <\/span>\n                <input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_24_0\" name=\"q24_input24[]\" value=\"\u05db\u05df\" required=\"\" \/>\n                <label id=\"label_input_24_0\" for=\"input_24_0\"> \u05db\u05df <\/label>\n              <\/span>\n              <span class=\"form-checkbox-item\">\n                <span class=\"dragger-item\">\n                <\/span>\n                <input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_24_1\" name=\"q24_input24[]\" value=\"\u05dc\u05d0\" required=\"\" \/>\n                <label id=\"label_input_24_1\" for=\"input_24_1\"> \u05dc\u05d0 <\/label>\n              <\/span>\n            <\/div>\n          <\/div>\n        <\/li>\n        <li class=\"form-line always-hidden\" data-type=\"control_address\" id=\"id_25\" data-compound-hint=\",,,,,\">\n          <label class=\"form-label form-label-left\" id=\"label_25\" for=\"input_25_addr_line1\"> \u05db\u05ea\u05d5\u05d1\u05ea \u05dc\u05de\u05e9\u05dc\u05d5\u05d7 \u05d7\u05e9\u05d1\u05d5\u05e0\u05d9\u05d5\u05ea <\/label>\n          <div id=\"cid_25\" class=\"form-input always-hidden\">\n            <div summary=\"\" class=\"form-address-table jsTest-addressField\">\n              <div class=\"form-address-line-wrapper jsTest-address-line-wrapperField\">\n                <span class=\"form-address-line form-address-street-line jsTest-address-lineField\">\n                  <span class=\"form-sub-label-container\" style=\"vertical-align:top\">\n                    <input type=\"text\" id=\"input_25_addr_line1\" name=\"q25_input25[addr_line1]\" class=\"form-textbox form-address-line\" value=\"\" data-component=\"address_line_1\" aria-labelledby=\"label_25 sublabel_25_addr_line1\" \/>\n                    <label class=\"form-sub-label\" for=\"input_25_addr_line1\" id=\"sublabel_25_addr_line1\" style=\"min-height:13px\" aria-hidden=\"false\"> \u05e8\u05d7\u05d5\u05d1 <\/label>\n                  <\/span>\n                <\/span>\n              <\/div>\n              <div class=\"form-address-line-wrapper jsTest-address-line-wrapperField\" style=\"display:none\">\n                <span class=\"form-address-line form-address-street-line jsTest-address-lineField\">\n                  <span class=\"form-sub-label-container\" style=\"vertical-align:top\">\n                    <input type=\"text\" id=\"input_25_addr_line2\" name=\"q25_input25[addr_line2]\" class=\"form-textbox form-address-line\" value=\"\" data-component=\"address_line_2\" aria-labelledby=\"label_25 sublabel_25_addr_line2\" \/>\n                    <label class=\"form-sub-label\" for=\"input_25_addr_line2\" id=\"sublabel_25_addr_line2\" style=\"min-height:13px\" aria-hidden=\"false\"> \u05e8\u05d7\u05d5\u05d1 <\/label>\n                  <\/span>\n                <\/span>\n              <\/div>\n              <div class=\"form-address-line-wrapper jsTest-address-line-wrapperField\">\n                <span class=\"form-address-line form-address-city-line jsTest-address-lineField \">\n                  <span class=\"form-sub-label-container\" style=\"vertical-align:top\">\n                    <input type=\"text\" id=\"input_25_city\" name=\"q25_input25[city]\" class=\"form-textbox form-address-city\" value=\"\" data-component=\"city\" aria-labelledby=\"label_25 sublabel_25_city\" \/>\n                    <label class=\"form-sub-label\" for=\"input_25_city\" id=\"sublabel_25_city\" style=\"min-height:13px\" aria-hidden=\"false\"> \u05e2\u05d9\u05e8 <\/label>\n                  <\/span>\n                <\/span>\n                <span class=\"form-address-line form-address-state-line jsTest-address-lineField form-address-hiddenLine\" style=\"display:none\">\n                  <span class=\"form-sub-label-container\" style=\"vertical-align:top\">\n                    <input type=\"text\" id=\"input_25_state\" name=\"q25_input25[state]\" class=\"form-textbox form-address-state\" value=\"\" data-component=\"state\" aria-labelledby=\"label_25 sublabel_25_state\" \/>\n                    <label class=\"form-sub-label\" for=\"input_25_state\" id=\"sublabel_25_state\" style=\"min-height:13px\" aria-hidden=\"false\"> State \/ Province <\/label>\n                  <\/span>\n                <\/span>\n              <\/div>\n              <div class=\"form-address-line-wrapper jsTest-address-line-wrapperField\">\n                <span class=\"form-address-line form-address-zip-line jsTest-address-lineField \">\n                  <span class=\"form-sub-label-container\" style=\"vertical-align:top\">\n                    <input type=\"text\" id=\"input_25_postal\" name=\"q25_input25[postal]\" class=\"form-textbox form-address-postal\" value=\"\" data-component=\"zip\" aria-labelledby=\"label_25 sublabel_25_postal\" \/>\n                    <label class=\"form-sub-label\" for=\"input_25_postal\" id=\"sublabel_25_postal\" style=\"min-height:13px\" aria-hidden=\"false\"> \u05de\u05d9\u05e7\u05d5\u05d3 <\/label>\n                  <\/span>\n                <\/span>\n              <\/div>\n            <\/div>\n          <\/div>\n        <\/li>\n        <li class=\"form-line jf-required\" data-type=\"control_radio\" id=\"id_26\">\n          <label class=\"form-label form-label-left\" id=\"label_26\" for=\"input_26\">\n            \u05de\u05d0\u05e9\u05e8 \u05e7\u05d1\u05dc\u05ea \u05d7\u05e9\u05d1\u05d5\u05e0\u05d9\u05d5\u05ea \u05d7\u05ea\u05d5\u05de\u05d5\u05ea \u05d3\u05d9\u05d2\u05d9\u05d8\u05dc\u05d9\u05ea\n            <span class=\"form-required\">\n              *\n            <\/span>\n          <\/label>\n          <div id=\"cid_26\" class=\"form-input jf-required\">\n            <div class=\"form-multiple-column\" data-columncount=\"2\" role=\"group\" aria-labelledby=\"label_26\" data-component=\"radio\">\n              <span class=\"form-radio-item\">\n                <span class=\"dragger-item\">\n                <\/span>\n                <input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_26_0\" name=\"q26_input26\" value=\"\u05db\u05df\" required=\"\" \/>\n                <label id=\"label_input_26_0\" for=\"input_26_0\"> \u05db\u05df <\/label>\n              <\/span>\n              <span class=\"form-radio-item\">\n                <span class=\"dragger-item\">\n                <\/span>\n                <input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_26_1\" name=\"q26_input26\" value=\"\u05dc\u05d0\" required=\"\" \/>\n                <label id=\"label_input_26_1\" for=\"input_26_1\"> \u05dc\u05d0 <\/label>\n              <\/span>\n            <\/div>\n          <\/div>\n        <\/li>\n        <li class=\"form-line\" data-type=\"control_divider\" id=\"id_9\">\n          <div id=\"cid_9\" class=\"form-input-wide\">\n            <div data-component=\"divider\" style=\"border-bottom:1px solid #e6e6e6;height:1px;margin-left:0px;margin-right:0px;margin-top:5px;margin-bottom:5px\">\n            <\/div>\n          <\/div>\n        <\/li>\n        <li class=\"form-line jf-required\" data-type=\"control_checkbox\" id=\"id_12\">\n          <label class=\"form-label form-label-top\" id=\"label_12\" for=\"input_12\">\n            <span class=\"form-required\">\n              *\n            <\/span>\n          <\/label>\n          <div id=\"cid_12\" class=\"form-input-wide jf-required\">\n            <div class=\"form-single-column\" role=\"group\" aria-labelledby=\"label_12\" data-component=\"checkbox\">\n              <span class=\"form-checkbox-item\" style=\"clear:left\">\n                <span class=\"dragger-item\">\n                <\/span>\n                <input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_12_0\" name=\"q12_input12[]\" value=\"\u05d9\u05d3\u05d5\u05e2 \u05dc\u05d9 \u05db\u05d9 \u05de\u05d5\u05e6\u05e8\u05d9\u05dd \u05de\u05d7\u05d1\u05e8\u05ea A2S \u05d0\u05d9\u05e0\u05dd \u05de\u05e9\u05de\u05e9\u05d9\u05dd \u05d1\u05de\u05d7\u05e7\u05e8 \u05e7\u05dc\u05d9\u05e0\u05d9 \u05d4\u05de\u05e2\u05e8\u05d1 \u05e0\u05d9\u05e1\u05d5\u05d9\u05d9\u05dd \u05d1\u05d1\u05e0\u05d9 \u05d0\u05d3\u05dd, \u05d1\u05d8\u05d9\u05e4\u05d5\u05dc \u05d0\u05d5 \u05d1\u05d0\u05d1\u05d7\u05d5\u05df \u05e8\u05e4\u05d5\u05d0\u05d9 \u05d0\u05dc\u05d0 \u05d0\u05dd \u05de\u05d5\u05e6\u05d4\u05e8 \u05d1\u05de\u05e4\u05d5\u05e8\u05e9 \u05d0\u05d7\u05e8\u05ea.\" required=\"\" \/>\n                <label id=\"label_input_12_0\" for=\"input_12_0\"> \u05d9\u05d3\u05d5\u05e2 \u05dc\u05d9 \u05db\u05d9 \u05de\u05d5\u05e6\u05e8\u05d9\u05dd \u05de\u05d7\u05d1\u05e8\u05ea A2S \u05d0\u05d9\u05e0\u05dd \u05de\u05e9\u05de\u05e9\u05d9\u05dd \u05d1\u05de\u05d7\u05e7\u05e8 \u05e7\u05dc\u05d9\u05e0\u05d9 \u05d4\u05de\u05e2\u05e8\u05d1 \u05e0\u05d9\u05e1\u05d5\u05d9\u05d9\u05dd \u05d1\u05d1\u05e0\u05d9 \u05d0\u05d3\u05dd, \u05d1\u05d8\u05d9\u05e4\u05d5\u05dc \u05d0\u05d5 \u05d1\u05d0\u05d1\u05d7\u05d5\u05df \u05e8\u05e4\u05d5\u05d0\u05d9 \u05d0\u05dc\u05d0 \u05d0\u05dd \u05de\u05d5\u05e6\u05d4\u05e8 \u05d1\u05de\u05e4\u05d5\u05e8\u05e9 \u05d0\u05d7\u05e8\u05ea. <\/label>\n              <\/span>\n            <\/div>\n          <\/div>\n        <\/li>\n        <li class=\"form-line jf-required\" data-type=\"control_checkbox\" id=\"id_31\">\n          <label class=\"form-label form-label-top\" id=\"label_31\" for=\"input_31\">\n            <span class=\"form-required\">\n              *\n            <\/span>\n          <\/label>\n          <div id=\"cid_31\" class=\"form-input-wide jf-required\">\n            <div class=\"form-single-column\" role=\"group\" aria-labelledby=\"label_31\" data-component=\"checkbox\">\n              <span class=\"form-checkbox-item\" style=\"clear:left\">\n                <span class=\"dragger-item\">\n                <\/span>\n                <input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_31_0\" name=\"q31_input31[]\" value=\"\u05d0\u05e0\u05d9 \u05de\u05e0\u05d4\u05dc \u05d5\/\u05d0\u05d5 \u05d1\u05e2\u05dc \u05de\u05e0\u05d9\u05d5\u05ea \u05d1\u05d7\u05d1\u05e8\u05d4 \u05d4\u05e0&quot;\u05dc, \u05de\u05e1\u05db\u05d9\u05dd \u05db\u05d9 \u05d4\u05de\u05d5\u05e6\u05e8\u05d9\u05dd \u05e9\u05d9\u05e1\u05d5\u05e4\u05e7\u05d5 \u05d0\u05dc\u05d9\u05e0\u05d5 \u05d4\u05d9\u05e0\u05dd \u05d1\u05d1\u05e2\u05dc\u05d5\u05ea A2S \u05e2\u05d3 \u05dc\u05d4\u05e9\u05dc\u05de\u05ea \u05d4\u05ea\u05e9\u05dc\u05d5\u05dd \u05d1\u05de\u05dc\u05d5\u05d0\u05d5 .\" required=\"\" \/>\n                <label id=\"label_input_31_0\" for=\"input_31_0\"> \u05d0\u05e0\u05d9 \u05de\u05e0\u05d4\u05dc \u05d5\/\u05d0\u05d5 \u05d1\u05e2\u05dc \u05de\u05e0\u05d9\u05d5\u05ea \u05d1\u05d7\u05d1\u05e8\u05d4 \u05d4\u05e0\"\u05dc, \u05de\u05e1\u05db\u05d9\u05dd \u05db\u05d9 \u05d4\u05de\u05d5\u05e6\u05e8\u05d9\u05dd \u05e9\u05d9\u05e1\u05d5\u05e4\u05e7\u05d5 \u05d0\u05dc\u05d9\u05e0\u05d5 \u05d4\u05d9\u05e0\u05dd \u05d1\u05d1\u05e2\u05dc\u05d5\u05ea A2S \u05e2\u05d3 \u05dc\u05d4\u05e9\u05dc\u05de\u05ea \u05d4\u05ea\u05e9\u05dc\u05d5\u05dd \u05d1\u05de\u05dc\u05d5\u05d0\u05d5 . <\/label>\n              <\/span>\n            <\/div>\n          <\/div>\n        <\/li>\n        <li class=\"form-line jf-required\" data-type=\"control_captcha\" id=\"id_13\">\n          <label class=\"form-label form-label-left form-label-auto\" id=\"label_13\" for=\"input_13\">\n            Enter the message as it's shown\n            <span class=\"form-required\">\n              *\n            <\/span>\n          <\/label>\n          <div id=\"cid_13\" class=\"form-input jf-required\">\n            <section data-wrapper-react=\"true\">\n              <div id=\"recaptcha_input_13\" data-component=\"recaptcha\" data-callback=\"recaptchaCallbackinput_13\" data-expired-callback=\"recaptchaExpiredCallbackinput_13\">\n              <\/div>\n              <input type=\"hidden\" id=\"input_13\" class=\"hidden validate[required]\" name=\"recaptcha_visible\" required=\"\" \/>\n              <script type=\"text\/javascript\" src=\"https:\/\/www.google.com\/recaptcha\/api.js?render=explicit&amp;onload=recaptchaLoadedinput_13\"><\/script>\n              <script type=\"text\/javascript\">\n                      var recaptchaLoadedinput_13 = function()\n          {\n            window.grecaptcha.render($(\"recaptcha_input_13\"), {\n              sitekey: '6LdU3CgUAAAAAB0nnFM3M3T0sy707slYYU51RroJ',\n            });\n            var grecaptchaBadge = document.querySelector('.grecaptcha-badge');\n            if (grecaptchaBadge)\n            {\n              grecaptchaBadge.style.boxShadow = 'gray 0px 0px 2px';\n            }\n          };\n\n        \/**\n         * Called when the reCaptcha verifies the user is human\n         * For invisible reCaptcha;\n         *   Submit event is stopped after validations and recaptcha is executed.\n         *   If a challenge is not displayed, this will be called right after grecaptcha.execute()\n         *   If a challenge is displayed, this will be called when the challenge is solved successfully\n         *   Submit is triggered to actually submit the form since it is stopped before.\n         *\/\n        var recaptchaCallbackinput_13 = function()\n          {\n            var isInvisibleReCaptcha = false;\n            var hiddenInput = $(\"input_13\");\n            hiddenInput.setValue(1);\n            if (!isInvisibleReCaptcha)\n            {\n              if (hiddenInput.validateInput)\n              {\n                hiddenInput.validateInput();\n              }\n            }\n            else\n            {\n              triggerSubmit(hiddenInput.form)\n            }\n\n            function triggerSubmit(formElement)\n            {\n              var button = formElement.ownerDocument.createElement('input');\n              button.style.display = 'none';\n              button.type = 'submit';\n              formElement.appendChild(button).click();\n              formElement.removeChild(button);\n            }\n          }\n\n          \/\/ not really required for invisible recaptcha\n        var recaptchaExpiredCallbackinput_13 = function()\n          {\n            var hiddenInput = $(\"input_13\");\n            hiddenInput.writeAttribute(\"value\", false);\n            if (hiddenInput.validateInput)\n            {\n              hiddenInput.validateInput();\n            }\n          }\n              <\/script>\n            <\/section>\n          <\/div>\n        <\/li>\n        <li class=\"form-line\" data-type=\"control_button\" id=\"id_2\">\n          <div id=\"cid_2\" class=\"form-input-wide\">\n            <div style=\"text-align:center\" data-align=\"center\" class=\"form-buttons-wrapper form-buttons-center   jsTest-button-wrapperField\">\n              <button id=\"input_2\" type=\"submit\" class=\"form-submit-button form-submit-button-blue submit-button jf-form-buttons jsTest-submitField\" data-component=\"button\" data-content=\"\">\n                Submit\n              <\/button>\n            <\/div>\n          <\/div>\n        <\/li>\n        <li style=\"display:none\">\n          Should be Empty:\n          <input type=\"text\" name=\"website\" value=\"\" \/>\n        <\/li>\n      <\/ul>\n  <\/div>\n  <script>\n  JotForm.showJotFormPowered = \"0\";\n  <\/script>\n  <script>\n  JotForm.poweredByText = \"Powered by JotForm\";\n  <\/script>\n  <input type=\"hidden\" class=\"simple_spc\" id=\"simple_spc\" name=\"simple_spc\" value=\"81112898808465\" \/>\n  <script type=\"text\/javascript\">\n  var all_spc = document.querySelectorAll(\"form[id='81112898808465'] .si\" + \"mple\" + \"_spc\");\nfor (var i = 0; i < all_spc.length; i++)\n{\n  all_spc[i].value = \"81112898808465-81112898808465\";\n}\n  <\/script>\n  <input type=\"hidden\" id=\"input_17\" name=\"q17_input17\" class=\"form-textbox form-hidden\" value=\"96\" data-component=\"autoincrement\" \/>\n<\/form><\/body>\n<\/html>\n","טופס פתיחת לקוח חדש",Array);(function(){window.handleIFrameMessage=function(e){if(!e.data||!e.data.split)return;var args=e.data.split(":");if(args[2]!="81112898808465"){return;}
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