<div class="et_pb_section et_pb_section_0 et_section_regular">
				
				
				
				
					<div class="et_pb_row et_pb_row_0">
							<div class="et_pb_column et_pb_column_4_4 et_pb_column_0  et_pb_css_mix_blend_mode_passthrough et-last-child">
				
				
				<div class="et_pb_module et_pb_text et_pb_text_0 et_pb_bg_layout_light  et_pb_text_align_left">
				
				
				<div class="et_pb_text_inner"><style type="text/css" id="cspFormShell_11_694094_style">#cspFormShell_11_694094 {
	}
#cspFormShell_11_694094 label {
	width: 100%;
}
/*Fields shell basic*/
#cspFormShell_11_694094 .cfsFieldShell input:not([type="checkbox"]):not([type="radio"]),
#cspFormShell_11_694094 .cfsFieldShell textarea,
#cspFormShell_11_694094 .cfsFieldShell .cfsListSelect, 
#cspFormShell_11_694094 .cfsFieldShell .cfsCheck,
#cspFormShell_11_694094 .cfsFieldShell button{
    padding: 10px;
    width: 100%;
    font-size: 18px;
    line-height: normal;
  	  	border: 1px solid rgba(51,51,51,0.1);
    color: rgba(51,51,51,0.7);
  	background-color: #f7f7f7;
  	    hyphens: none;
    border-radius: 0;
    margin: 0;
    max-width: 100%;
    vertical-align: baseline;
  	display: block;
  	height: auto;
}
#cspFormShell_11_694094 .cfsFieldShell input[type="submit"]:not([type="checkbox"]):not([type="radio"]), 
#cspFormShell_11_694094 .cfsFieldShell input[type="reset"]:not([type="checkbox"]):not([type="radio"]), 
#cspFormShell_11_694094 .cfsFieldShell input[type="button"],
#cspFormShell_11_694094 .cfsFieldShell button {
	cursor: pointer;
  	font-weight: 700;
    border: 0 none;
    color: #fff;
    text-transform: uppercase;
  	-webkit-appearance: none;
}
#cspFormShell_11_694094 .cfsFieldShell input[type="submit"]:not([type="checkbox"]):not([type="radio"]), 
#cspFormShell_11_694094 .cfsFieldShell input[type="button"],
#cspFormShell_11_694094 .cfsFieldShell button {
	  	background-color: #333333;
  	background-image: none;
  	}
#cspFormShell_11_694094 .cfsFieldShell input[type="submit"]:not([type="checkbox"]):not([type="radio"]):hover, 
#cspFormShell_11_694094 .cfsFieldShell input[type="button"]:hover,
#cspFormShell_11_694094 .cfsFieldShell button:hover {
  	  	background-color: rgba(51,51,51,0.7);
  	}
#cspFormShell_11_694094 .cfsFieldShell input[type="reset"]:not([type="checkbox"]):not([type="radio"]) {
	  	background-color: #333333;
  	background-image: none;
  	}
#cspFormShell_11_694094 .cfsFieldShell input[type="reset"]:not([type="checkbox"]):not([type="radio"]):hover {
	  	background-color: rgba(51,51,51,0.7);
  	}
/* Placeholder text color -- selectors need to be separate to work. */
#cspFormShell_11_694094 ::-webkit-input-placeholder {
	color: rgba(51, 51, 51, 0.7);
}
#cspFormShell_11_694094 :-moz-placeholder {
	color: rgba(51, 51, 51, 0.7);
}
#cspFormShell_11_694094 ::-moz-placeholder {
	color: rgba(51, 51, 51, 0.7);
	opacity: 1; /* Since FF19 lowers the opacity of the placeholder by default */
}
#cspFormShell_11_694094 :-ms-input-placeholder {
	color: rgba(51, 51, 51, 0.7);
}#cspFormShell_11_694094 { width: 100%}#cspFormShell_11_694094 .cfsSuccessMsg { color: #4ae8ea !important}</style><div id="cspFormShell_11_694094" class="cfsFormShell"><form class="csfForm" method="post" action="https://www.ingrambenefits.com/">
<div class="row cfsFieldsRow"><div class="col-sm-12 cfsFieldCol" data-name="communication-method" data-type="radiobuttons"><div class="cfsFieldShell cfsField_radiobuttons" ><label><span class="cfsListSelectLabel">How do you prefer to get benefits communication? </span><span class="cfsListSelect"><table class="cfsCheckTbl"><tr><td><input type="radio" name="fields[communication-method]" value="mail" data-name="communication-method" id="cfsCheckRandId_91181" /></td><td><label for="cfsCheckRandId_91181">In the mail</label></td></tr><tr><td><input type="radio" name="fields[communication-method]" value="email" data-name="communication-method" id="cfsCheckRandId_42237" /></td><td><label for="cfsCheckRandId_42237">E-mail</label></td></tr><tr><td><input type="radio" name="fields[communication-method]" value="online" data-name="communication-method" id="cfsCheckRandId_71429" /></td><td><label for="cfsCheckRandId_71429">Online</label></td></tr><tr><td><input type="radio" name="fields[communication-method]" value="text" data-name="communication-method" id="cfsCheckRandId_90934" /></td><td><label for="cfsCheckRandId_90934">Via text message</label></td></tr><tr><td><input type="radio" name="fields[communication-method]" value="other" data-name="communication-method" id="cfsCheckRandId_12797" /></td><td><label for="cfsCheckRandId_12797">Other - please specify</label></td></tr></table></span></label></div></div></div><div class="row cfsFieldsRow"><div class="col-sm-12 cfsFieldCol" data-name="other-method" data-type="text"><div class="cfsFieldShell cfsField_text" ><label><span class="cfsInputLabel">Specify other method&nbsp;</span><input type="text" name="fields[other-method]" value="" data-name="other-method" /></label></div></div></div><div class="row cfsFieldsRow"><div class="col-sm-12 cfsFieldCol" data-name="send" data-type="submit"><div class="cfsFieldShell cfsField_submit" ><input type="submit" name="fields[send]" value="Send" data-name="send" /></div></div></div>
<input type="hidden" name="mod" value="forms"  /><input type="hidden" name="action" value="contact"  /><input type="hidden" name="id" value="11"  /><input type="hidden" name="_wpnonce" value="162f36cd1c"  /><div class="cfsContactMsg"></div></form></div><span style="display: none !important;" class="cfsFormDesc">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</span></div>
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