RR_CONTACT_ADDRESSES

 

[
    {
        "type": "Text",
        "id": "textLabel",
        "label": "Contact BeRailSafe for more information or to schedule free classes and trainings."
    },
    {
        "type": "Textbox",
        "id": "textName",
        "label": "Name",
        "datatype": "text",
        "required": true,
        "validation": "none",
        "requiredMessage": "Name",
        "placeholder": "Please enter your name"
    },
    {
        "type": "Textbox",
        "id": "textPhone",
        "label": "Phone",
        "datatype": "text",
        "required": true,
        "validation": "none",
        "requiredMessage": "Phone",
        "datatype": "tel",
        "placeholder": "(555)515-1234"
    },
    {
        "type": "Textbox",
        "id": "textEmail",
        "label": "Email",
        "datatype": "text",
        "required": true,
        "validation": "none",
        "requiredMessage": "Email",
        "validationMessage": "Email",
        "placeholder": "Please enter your email"
    }
]

["textLabel","textName","textPhone","textEmail"]

[
  {
    "type": "Text",
    "id": "textContactLabel",
    "label": "If you need to report a pothole, traffic light issue, or other road hazard, please use our problem reporting forms.<br><br><a href='/contact' class='btn btn--w-icon btn--w-icon-right'>Report a Problem</a>"
  },
  {
    "type": "Textarea",
    "id": "textComment",
    "label": "Question/Comment",
    "required": true,
    "validation": "none",
    "requiredMessage": "Please enter a question/comment",
    "maxlength": 1500,
    "placeholder": "Enter your question/comment here in 1500 characters or less"
  },

  {
    "type": "Dropdown",
    "id": "ddCounty",
    "label": "County",
    "required": true,
    "validation": "none",
    "requiredMessage": "Select county related to your question",
    "options": [
      {"value": "", "text": "Select county related to your question"},
      {"value": "Alamance", "text": "Alamance"},
      {"value": "Alexander", "text": "Alexander"},
      {"value": "Alleghany", "text": "Alleghany"},
      {"value": "Anson", "text": "Anson"},
      {"value": "Ashe", "text": "Ashe"},
      {"value": "Avery", "text": "Avery"},
      {"value": "Beaufort", "text": "Beaufort"},
      {"value": "Bertie", "text": "Bertie"},
      {"value": "Bladen", "text": "Bladen"},
      {"value": "Brunswick", "text": "Brunswick"},
      {"value": "Buncombe", "text": "Buncombe"},
      {"value": "Burke", "text": "Burke"},
      {"value": "Cabarrus", "text": "Cabarrus"},
      {"value": "Caldwell", "text": "Caldwell"},
      {"value": "Camden", "text": "Camden"},
      {"value": "Carteret", "text": "Carteret"},
      {"value": "Caswell", "text": "Caswell"},
      {"value": "Catawba", "text": "Catawba"},
      {"value": "Chatham", "text": "Chatham"},
      {"value": "Cherokee", "text": "Cherokee"},
      {"value": "Chowan", "text": "Chowan"},
      {"value": "Clay", "text": "Clay"},
      {"value": "Cleveland", "text": "Cleveland"},
      {"value": "Columbus", "text": "Columbus"},
      {"value": "Craven", "text": "Craven"},
      {"value": "Cumberland", "text": "Cumberland"},
      {"value": "Currituck", "text": "Currituck"},
      {"value": "Dare", "text": "Dare"},
      {"value": "Davidson", "text": "Davidson"},
      {"value": "Davie", "text": "Davie"},
      {"value": "Duplin", "text": "Duplin"},
      {"value": "Durham", "text": "Durham"},
      {"value": "Edgecombe", "text": "Edgecombe"},
      {"value": "Forsyth", "text": "Forsyth"},
      {"value": "Franklin", "text": "Franklin"},
      {"value": "Gaston", "text": "Gaston"},
      {"value": "Gates", "text": "Gates"},
      {"value": "Graham", "text": "Graham"},
      {"value": "Granville", "text": "Granville"},
      {"value": "Greene", "text": "Greene"},
      {"value": "Guilford", "text": "Guilford"},
      {"value": "Halifax", "text": "Halifax"},
      {"value": "Harnett", "text": "Harnett"},
      {"value": "Haywood", "text": "Haywood"},
      {"value": "Henderson", "text": "Henderson"},
      {"value": "Hertford", "text": "Hertford"},
      {"value": "Hoke", "text": "Hoke"},
      {"value": "Hyde", "text": "Hyde"},
      {"value": "Iredell", "text": "Iredell"},
      {"value": "Jackson", "text": "Jackson"},
      {"value": "Johnston", "text": "Johnston"},
      {"value": "Jones", "text": "Jones"},
      {"value": "Lee", "text": "Lee"},
      {"value": "Lenoir", "text": "Lenoir"},
      {"value": "Lincoln", "text": "Lincoln"},
      {"value": "Macon", "text": "Macon"},
      {"value": "Madison", "text": "Madison"},
      {"value": "Martin", "text": "Martin"},
      {"value": "McDowell", "text": "McDowell"},
      {"value": "Mecklenburg", "text": "Mecklenburg"},
      {"value": "Mitchell", "text": "Mitchell"},
      {"value": "Montgomery", "text": "Montgomery"},
      {"value": "Moore", "text": "Moore"},
      {"value": "Nash", "text": "Nash"},
      {"value": "New Hanover", "text": "New Hanover"},
      {"value": "Northampton", "text": "Northampton"},
      {"value": "Onslow", "text": "Onslow"},
      {"value": "Orange", "text": "Orange"},
      {"value": "Pamlico", "text": "Pamlico"},
      {"value": "Pasquotank", "text": "Pasquotank"},
      {"value": "Pender", "text": "Pender"},
      {"value": "Perquimans", "text": "Perquimans"},
      {"value": "Person", "text": "Person"},
      {"value": "Pitt", "text": "Pitt"},
      {"value": "Polk", "text": "Polk"},
      {"value": "Randolph", "text": "Randolph"},
      {"value": "Richmond", "text": "Richmond"},
      {"value": "Robeson", "text": "Robeson"},
      {"value": "Rockingham", "text": "Rockingham"},
      {"value": "Rowan", "text": "Rowan"},
      {"value": "Rutherford", "text": "Rutherford"},
      {"value": "Sampson", "text": "Sampson"},
      {"value": "Scotland", "text": "Scotland"},
      {"value": "Stanly", "text": "Stanly"},
      {"value": "Stokes", "text": "Stokes"},
      {"value": "Surry", "text": "Surry"},
      {"value": "Swain", "text": "Swain"},
      {"value": "Transylvania", "text": "Transylvania"},
      {"value": "Tyrrell", "text": "Tyrrell"},
      {"value": "Union", "text": "Union"},
      {"value": "Vance", "text": "Vance"},
      {"value": "Wake", "text": "Wake"},
      {"value": "Warren", "text": "Warren"},
      {"value": "Washington", "text": "Washington"},
      {"value": "Watauga", "text": "Watauga"},
      {"value": "Wayne", "text": "Wayne"},
      {"value": "Wilkes", "text": "Wilkes"},
      {"value": "Wilson", "text": "Wilson"},
      {"value": "Yadkin", "text": "Yadkin"},
      {"value": "Yancey", "text": "Yancey"}
    ]
  },

  {
    "type": "Textbox",
    "id": "textName",
    "label": "Name",
    "datatype": "text",
    "required": true,
    "validation": "none",
    "requiredMessage": "Please enter your name",
    "placeholder": "Enter your first and last name"
  },
  {
    "type": "Textbox",
    "id": "textEmail",
    "label": "Email",
    "datatype": "email",
    "required": true,
    "validation": "email",
    "requiredMessage": "Please enter an email address",
    "validationMessage": "Please enter a valid email address",
    "placeholder": "Enter your email address"
  },
  {
    "type": "Text",
    "id": "textLabel",
    "label": "We'll email your tracking number to this address. Please see our <a href='../../about-us/how-we-operate/policy-process/Pages/privacy-policy.aspx'>privacy policy</a> for information about email usage."
  },
  {
    "type": "Textbox",
    "id": "textPhone",
    "label": "Phone",
    "required": true,
    "validation": "none",
    "requiredMessage": "Please enter your phone number",
    "datatype": "tel",
    "placeholder": "555-515-1234"
  }
]

["ddCounty"]

[   
    {
        "type": "Textbox",
        "id": "textVehicleIdentificationNumber",
        "label": "Vehicle Identification Number",
        "datatype": "text",
        "required": false,
        "validation": "none",
        "requiredMessage": "Vehicle Identification Number",
        "placeholder": "Enter Vehicle Identification Number"
    }, 
    {
        "type": "Textbox",
        "id": "textLicensePlateNumber",
        "label": "License Plate Number",
        "datatype": "text",
        "required": false,
        "validation": "none",
        "requiredMessage": "License Plate Number",
        "placeholder": "Enter License Plate Number"
    },
    {
        "type": "Textarea",
        "id": "textComment",
        "label": "Question/Comment",
        "required": true,
        "validation": "none",
        "requiredMessage": "Please enter a question/comment",
        "maxlength": 400,
        "placeholder": "Enter your question/comment here in 400 characters or less"
    },
    {
        "type": "Textbox",
        "id": "textName",
        "label": "Name",
        "datatype": "text",
        "required": true,
        "validation": "none",
        "requiredMessage": "Please enter your name",
        "placeholder": "Enter your first and last name"
    },
    {
        "type": "Textbox",
        "id": "textEmail",
        "label": "Email",
        "datatype": "email",
        "required": true,
        "validation": "email",
        "requiredMessage": "Please enter an email address",
        "validationMessage": "Please enter a valid email address",
        "placeholder": "Enter your email address"
    },
    {
        "type": "Text",
        "id": "textLabel",
        "label": "We'll email your tracking number to this address. Please see our <a href='../../about-us/how-we-operate/policy-process/Pages/privacy-policy.aspx'>privacy policy</a> for information about email usage."
    },
    {
        "type": "Textbox",
        "id": "textPhone",
        "label": "Phone",
        "required": true,
        "validation": "none",
        "requiredMessage": "Please enter your phone number",
        "datatype": "tel",
        "placeholder": "555-515-1234"
    }
]

["textLicensePlateNumber","textVehicleIdentificationNumber"]

<strong>To include an attachment, please use this form instead:<br><a href="https://apps.ncdot.gov/contactus/Home/PostComment?Unit=DMV_Insure">https://apps.ncdot.gov/contactus/Home/PostComment?Unit=DMV_Insure</a></strong>