[gravityform id="16" title="false" description="true"]
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<div class='gform_heading'>
<span class='gform_description'>We noticed you didn't complete your purchase today. Could you answer one quick question to help us understand why?</span>
</div>
<div class='gform_body'><ul id='gform_fields_16' class='gform_fields top_label form_sublabel_below description_below'><li id='field_16_2' class='gfield field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' >I chose not to complete the purchase today because: (select all that apply)</label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_16_2'><li class='gchoice_16_2_1'>
<input name='input_2.1' type='checkbox' value='Just needed a quote. Will order later.' id='choice_16_2_1' />
<label for='choice_16_2_1' id='label_16_2_1'>Just needed a quote. Will order later.</label>
</li><li class='gchoice_16_2_2'>
<input name='input_2.2' type='checkbox' value='Needed more information from Assay regarding products or shipping dates.' id='choice_16_2_2' />
<label for='choice_16_2_2' id='label_16_2_2'>Needed more information from Assay regarding products or shipping dates.</label>
</li><li class='gchoice_16_2_3'>
<input name='input_2.3' type='checkbox' value='Product was out of stock.' id='choice_16_2_3' />
<label for='choice_16_2_3' id='label_16_2_3'>Product was out of stock.</label>
</li><li class='gchoice_16_2_4'>
<input name='input_2.4' type='checkbox' value='Cost of shipping' id='choice_16_2_4' />
<label for='choice_16_2_4' id='label_16_2_4'>Cost of shipping</label>
</li><li class='gchoice_16_2_5'>
<input name='input_2.5' type='checkbox' value='Got interrupted' id='choice_16_2_5' />
<label for='choice_16_2_5' id='label_16_2_5'>Got interrupted</label>
</li><li class='gchoice_16_2_6'>
<input name='input_2.6' type='checkbox' value='Other' id='choice_16_2_6' />
<label for='choice_16_2_6' id='label_16_2_6'>Other</label>
</li></ul></div></li><li id='field_16_3' class='gfield field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_16_3' >If Other, can you specify why?</label><div class='ginput_container ginput_container_textarea'><textarea name='input_3' id='input_16_3' class='textarea medium' aria-invalid="false" rows='10' cols='50'></textarea></div></li>
</ul></div>
<div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_16' class='gform_button button' value='Submit' onclick='if(window["gf_submitting_16"]){return false;} window["gf_submitting_16"]=true; ' onkeypress='if( event.keyCode == 13 ){ if(window["gf_submitting_16"]){return false;} window["gf_submitting_16"]=true; jQuery("#gform_16").trigger("submit",[true]); }' />
<input type='hidden' class='gform_hidden' name='is_submit_16' value='1' />
<input type='hidden' class='gform_hidden' name='gform_submit' value='16' />
<input type='hidden' class='gform_hidden' name='gform_unique_id' value='' />
<input type='hidden' class='gform_hidden' name='state_16' value='WyJbXSIsIjc3MDQwYzI0ZTNiZTY1MGI1Mzc0MDZhMzg5NzQxOTc2Il0=' />
<input type='hidden' class='gform_hidden' name='gform_target_page_number_16' id='gform_target_page_number_16' value='0' />
<input type='hidden' class='gform_hidden' name='gform_source_page_number_16' id='gform_source_page_number_16' value='1' />
<input type='hidden' name='gform_field_values' value='' />
</div>
</form>
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