{"id":456,"date":"2026-02-11T10:28:02","date_gmt":"2026-02-11T10:28:02","guid":{"rendered":"https:\/\/partnershipone.com\/DDC\/?page_id=456"},"modified":"2026-06-19T16:12:03","modified_gmt":"2026-06-19T15:12:03","slug":"hb-paperless","status":"publish","type":"page","link":"https:\/\/partnershipone.com\/DDC\/hb-paperless\/","title":{"rendered":"Sign up for paperless benefit notifications"},"content":{"rendered":"<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of 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#112337;--gf-ctrl-choice-size: var(--gf-ctrl-choice-size-md);--gf-ctrl-checkbox-check-size: var(--gf-ctrl-checkbox-check-size-md);--gf-ctrl-radio-check-size: var(--gf-ctrl-radio-check-size-md);--gf-ctrl-btn-font-size: var(--gf-ctrl-btn-font-size-md);--gf-ctrl-btn-padding-x: var(--gf-ctrl-btn-padding-x-md);--gf-ctrl-btn-size: var(--gf-ctrl-btn-size-md);--gf-ctrl-btn-border-color-secondary: #686e77;--gf-ctrl-btn-bg-color-hover-tertiary: #EBEBEB;--gf-field-img-choice-size: var(--gf-field-img-choice-size-md);--gf-field-img-choice-card-space: var(--gf-field-img-choice-card-space-md);--gf-field-img-choice-check-ind-size: var(--gf-field-img-choice-check-ind-size-md);--gf-field-img-choice-check-ind-icon-size: var(--gf-field-img-choice-check-ind-icon-size-md);--gf-field-pg-steps-number-color: rgba(17, 35, 55, 0.8);}<\/style><div id='gf_76' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data'  id='gform_76'  action='\/DDC\/wp-json\/wp\/v2\/pages\/456#gf_76' data-formid='76' novalidate><div id='gf_page_steps_76' class='gf_page_steps'><div id='gf_step_76_1' class='gf_step gf_step_active gf_step_first'><span class='gf_step_number'>1<\/span><span class='gf_step_label'>Using the form<\/span><\/div><div id='gf_step_76_2' class='gf_step gf_step_next gf_step_pending'><span class='gf_step_number'>2<\/span><span class='gf_step_label'>Declaration<\/span><\/div><div id='gf_step_76_3' class='gf_step gf_step_last gf_step_pending'><span class='gf_step_number'>3<\/span><span class='gf_step_label'>About you<\/span><\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_76_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><div id='gform_fields_76' class='gform_fields top_label form_sublabel_above description_above validation_below'><div id=\"field_76_24\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><p>Use this form to sign up to get your Housing Benefit and Council Tax Support notifications by email.<\/p>\n\n<p>If you are a landlord, you can sign up to receive Housing Benefit notifications and landlord schedules by email.<\/p>\n\n<h2>This form will ask you to provide<\/h2>\n<ul>\n\t<li>your details<\/li>\n\t<li>if you are a claimant &#8211; your National Insurance number<\/li>\n\t<li>if you are a landlord &#8211; your landlord reference number.<\/li>\n<\/ul>\n<p><\/p>\n<p>Please have this information ready as pages time-out after one hour.<\/p>\n\n<p>Do not use your browser back button &#8211; if you need to go to a previous page click on the previous button at the bottom of each page.<\/p>\n\n<h2>Privacy Statement<\/h2>\nDover District Council is a Data Controller under GDPR.  In submitting this form we will collect and process your personal data.  For information about your rights and how the Council uses your data,  please view our Corporate and relevant service privacy notice which can be found on our <a href=\"https:\/\/www.dover.gov.uk\/Website\/Privacy-and-Cookies.aspx\"target=\"_blank\">Privacy page<\/a>.<\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <button type='button' id='gform_next_button_76_26' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Begin form<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_76_2' class='gform_page' data-js='page-field-id-26' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_76_2' class='gform_fields top_label form_sublabel_above description_above validation_below'><div id=\"field_76_56\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">About you<\/h3><\/div><fieldset id=\"field_76_57\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Are you claiming benefit or are you a landlord?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_76_57'>\n\t\t\t<div class='gchoice gchoice_76_57_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_57' type='radio' value='Claiming benefit'  id='choice_76_57_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_76_57_0' id='label_76_57_0' class='gform-field-label gform-field-label--type-inline'>Claiming benefit<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_76_57_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_57' type='radio' value='Landlord'  id='choice_76_57_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_76_57_1' id='label_76_57_1' class='gform-field-label gform-field-label--type-inline'>Landlord<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_76_76\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Declaration &#8211; claimant<\/h3><div class='gsection_description' id='gfield_description_76_76'><p>Please check the box below to confirm that you have read, understand and agree to the following statements before completing this form:<\/p>\n\n<ul>\n\t<li>I confirm the details I will give are correct.<\/li>\n\t<li>I understand that if I give information that is false this could lead to a penalty or legal proceedings being taken against me.<\/li>\n\t<li>I understand my data may be shared with other departments as permitted by law.<\/li>\n\t<li>I understand that you will send all future Housing Benefit and\/or Council Tax Support notifications and Council Tax bills (if chosen) to the email address I give.<\/li>\n\t<li>I understand that if I change my email address I must let you&nbsp;know straight away.<\/li>\n<\/ul><\/div><\/div><div id=\"field_76_77\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Declaration &#8211; landlord<\/h3><div class='gsection_description' id='gfield_description_76_77'><p>Please check the box below to confirm that you have read, understand and agree to the following statements before completing this form:<\/p>\n\n<ul>\n\t<li>I confirm the details I will give are correct.<\/li>\n\t<li>I understand that if I give information that is false this could lead to a penalty or legal proceedings being taken against me.<\/li>\n\t<li>I understand my data may be shared with other departments as permitted by law.<\/li>\n\t<li>I understand that you will send all future Housing Benefit&nbsp;notification letters&nbsp;and landlord schedules for all my tenants to the email address I give.<\/li>\n\t<li>I understand that if I change my email address I must let you&nbsp;know straight away.<\/li>\n<\/ul><\/div><\/div><div id=\"field_76_78\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><h3 class=\"gsection_title\"><\/h3><\/div><fieldset id=\"field_76_60\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Declaration<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_60.1' id='input_76_60_1' type='checkbox' value='1'   aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_76_60_1' ><span class='gform-field-label__text'>I understand and accept the above declaration<\/span><\/label><input type='hidden' name='input_60.2' value='I understand and accept the above declaration' class='gform_hidden' \/><input type='hidden' name='input_60.3' value='48' class='gform_hidden' \/><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_76_8' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='button' id='gform_next_button_76_8' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_76_3' class='gform_page' data-js='page-field-id-8' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_76_3' class='gform_fields top_label form_sublabel_above description_above validation_below'><div id=\"field_76_62\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">About you (claimant)<\/h3><\/div><div id=\"field_76_64\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">About you (landord)<\/h3><div class='gsection_description' id='gfield_description_76_64'>Please note only Housing Benefit notifications and landlord schedules can be sent to landlords.<\/div><\/div><div id=\"field_76_73\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_76_44\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_44'><span class='gform-field-label__text'>Title (for example Mr, Mrs, Ms, Miss)<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_44' id='input_76_44' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_76_45\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_45'><span class='gform-field-label__text'>First name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_45' id='input_76_45' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_76_46\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_46'><span class='gform-field-label__text'>Last name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_46' id='input_76_46' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_76_79\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-international gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_79'><span class='gform-field-label__text'>Phone<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_79' id='input_76_79' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"    \/><\/div><\/div><div id=\"field_76_51\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_51'><span class='gform-field-label__text'>Contact phone number<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_51' id='input_76_51' type='text' value='' class='large'    placeholder='99999 999999' aria-required=\"true\" aria-invalid=\"false\"   data-mask=\"99999 999999\"\/><\/div><\/div><fieldset id=\"field_76_11\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Email address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_76_11_container'>\n                                <span id='input_76_11_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <label for='input_76_11' class='gform-field-label gform-field-label--type-sub '>Enter email address<\/label>\n                                    <input class='' type='email' name='input_11' id='input_76_11' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                <\/span>\n                                <span id='input_76_11_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <label for='input_76_11_2' class='gform-field-label gform-field-label--type-sub '>Confirm email address<\/label>\n                                    <input class='' type='email' name='input_11_2' id='input_76_11_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/fieldset><fieldset id=\"field_76_13\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>If you are the person liable for Council Tax, we can also send your Council Tax bills to you by email. Please tell us if you want us to do so<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_76_13'>\n\t\t\t<div class='gchoice gchoice_76_13_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='Yes, I&#039;m happy to receive my Council Tax bills by email'  id='choice_76_13_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_76_13_0' id='label_76_13_0' class='gform-field-label gform-field-label--type-inline'>Yes, I&#8217;m happy to receive my Council Tax bills by email<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_76_13_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='No, I don&#039;t want to receive my Council Tax bills by email'  id='choice_76_13_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_76_13_1' id='label_76_13_1' class='gform-field-label gform-field-label--type-inline'>No, I don&#8217;t want to receive my Council Tax bills by email<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_76_28\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_28'><span class='gform-field-label__text'>Housing Benefit or Council Tax Support reference number (if known)<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_28' id='input_76_28' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_76_63\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_63'><span class='gform-field-label__text'>National Insurance number<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_63' id='input_76_63' type='text' value='' class='large'    placeholder='aa999999a' aria-required=\"true\" aria-invalid=\"false\"   data-mask=\"aa999999a\"\/><\/div><\/div><div id=\"field_76_71\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_71'><span class='gform-field-label__text'>Company name (if applicable)<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_71' id='input_76_71' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_76_72\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_72'><span class='gform-field-label__text'>Your landlord reference number<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_72' id='input_76_72' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_76_54\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">About your address<\/h3><\/div><fieldset id=\"field_76_75\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full custom-address-field d-block gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_zip ginput_container_address gform-grid-row' id='input_76_75' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_76_75_1_container' >\n                                        <label for='input_76_75_1' id='input_76_75_1_label' class='gform-field-label gform-field-label--type-sub '>Address line 1<\/label>\n                                        <input type='text' name='input_75.1' id='input_76_75_1' value=''    aria-required='true'    \/>\n                                   <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_76_75_2_container' >\n                                        <label for='input_76_75_2' id='input_76_75_2_label' class='gform-field-label gform-field-label--type-sub '>Address line 2<\/label>\n                                        <input type='text' name='input_75.2' id='input_76_75_2' value=''     aria-required='false'   \/>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_76_75_3_container' >\n                                    <label for='input_76_75_3' id='input_76_75_3_label' class='gform-field-label gform-field-label--type-sub '>Town or city<\/label>\n                                    <input type='text' name='input_75.3' id='input_76_75_3' value=''    aria-required='true'    \/>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_75.4' id='input_76_75_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_76_75_5_container' >\n                                    <label for='input_76_75_5' id='input_76_75_5_label' class='gform-field-label gform-field-label--type-sub '>Postcode<\/label>\n                                    <input type='text' name='input_75.5' id='input_76_75_5' value=''    aria-required='true'    \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_75.6' id='input_76_75_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><\/div><\/div>\n        <div class='gform-page-footer gform_page_footer top_label'><button type='submit' id='gform_previous_button_76' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='submit' id='gform_submit_button_76' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' >Submit<\/button> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_76' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_76' id='gform_theme_76' value='orbital' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_76' id='gform_style_settings_76' value='{&quot;inputPrimaryColor&quot;:&quot;#025B99&quot;,&quot;buttonPrimaryBackgroundColor&quot;:&quot;#025B99&quot;}' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_76' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='76' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='GBP' value='PQhakR1LyuXu7Hw+P8KbQVed2jy2MLlAezJSuar9btev4uPcASfUnmsafnAK2HcFN3oCSA96fCfm\/toZsDw+no24Lje3kjJ94v7d+ZwOpVcb4zI=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_76' 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