bhl-forms 0.1.33 → 0.2.1
This diff represents the content of publicly available package versions that have been released to one of the supported registries. The information contained in this diff is provided for informational purposes only and reflects changes between package versions as they appear in their respective public registries.
- package/dist/bhl-forms.es.js +322 -142
- package/dist/bhl-forms.iife.js +7 -7
- package/dist/bhl-forms.modern.es.js +382 -278
- package/dist/bhl-forms.modern.iife.js +10 -10
- package/dist/bhl-forms.modern.umd.js +10 -10
- package/dist/bhl-forms.umd.js +7 -7
- package/dist/forms/accidentsAndInjuries.es.js +63 -77
- package/dist/forms/accidentsAndInjuries.iife.js +1 -1
- package/dist/forms/accidentsAndInjuries.json +1 -1
- package/dist/forms/appraisals.es.js +27 -17
- package/dist/forms/appraisals.iife.js +1 -1
- package/dist/forms/appraisals.json +1 -1
- package/dist/forms/childAndFamily.es.js +38 -78
- package/dist/forms/childAndFamily.iife.js +1 -1
- package/dist/forms/childAndFamily.json +1 -1
- package/dist/forms/civilLawsuit.es.js +63 -77
- package/dist/forms/civilLawsuit.iife.js +1 -1
- package/dist/forms/civilLawsuit.json +1 -1
- package/dist/forms/coins.es.js +27 -17
- package/dist/forms/coins.iife.js +1 -1
- package/dist/forms/coins.json +1 -1
- package/dist/forms/contracts.es.js +96 -88
- package/dist/forms/contracts.iife.js +1 -1
- package/dist/forms/contracts.json +1 -1
- package/dist/forms/criminal.es.js +63 -77
- package/dist/forms/criminal.iife.js +1 -1
- package/dist/forms/criminal.json +1 -1
- package/dist/forms/employmentAndWorkplace.es.js +63 -77
- package/dist/forms/employmentAndWorkplace.iife.js +1 -1
- package/dist/forms/employmentAndWorkplace.json +1 -1
- package/dist/forms/generalLegal.es.js +63 -77
- package/dist/forms/generalLegal.iife.js +1 -1
- package/dist/forms/generalLegal.json +1 -1
- package/dist/forms/generalLegalPopUnder.es.js +63 -77
- package/dist/forms/generalLegalPopUnder.iife.js +1 -1
- package/dist/forms/generalLegalPopUnder.json +1 -1
- package/dist/forms/generalLegalPopUnderTF.es.js +38 -78
- package/dist/forms/generalLegalPopUnderTF.iife.js +1 -1
- package/dist/forms/generalLegalPopUnderTF.json +1 -1
- package/dist/forms/generalLegalThankYou.es.js +63 -77
- package/dist/forms/generalLegalThankYou.iife.js +1 -1
- package/dist/forms/generalLegalThankYou.json +1 -1
- package/dist/forms/harassmentAndDiscrimination.es.js +63 -77
- package/dist/forms/harassmentAndDiscrimination.iife.js +1 -1
- package/dist/forms/harassmentAndDiscrimination.json +1 -1
- package/dist/forms/malpractice.es.js +96 -88
- package/dist/forms/malpractice.iife.js +1 -1
- package/dist/forms/malpractice.json +1 -1
- package/dist/forms/mechanics.es.js +27 -17
- package/dist/forms/mechanics.iife.js +1 -1
- package/dist/forms/mechanics.json +1 -1
- package/dist/forms/realEstate.es.js +63 -77
- package/dist/forms/realEstate.iife.js +1 -1
- package/dist/forms/realEstate.json +1 -1
- package/dist/forms/repossession.es.js +96 -88
- package/dist/forms/repossession.iife.js +1 -1
- package/dist/forms/repossession.json +1 -1
- package/dist/forms/ssdi.es.js +214 -138
- package/dist/forms/ssdi.iife.js +1 -1
- package/dist/forms/ssdi.json +1 -1
- package/dist/forms/testForm.es.js +92 -85
- package/dist/forms/testForm.iife.js +1 -1
- package/dist/forms/testForm.json +1 -1
- package/dist/forms/testRedirects.es.js +19 -10
- package/dist/forms/testRedirects.iife.js +1 -1
- package/dist/forms/testRedirects.json +1 -1
- package/dist/forms/vets.es.js +27 -17
- package/dist/forms/vets.iife.js +1 -1
- package/dist/forms/vets.json +1 -1
- package/dist/forms/willsAndTrusts.es.js +63 -77
- package/dist/forms/willsAndTrusts.iife.js +1 -1
- package/dist/forms/willsAndTrusts.json +1 -1
- package/dist/main.css +1 -1
- package/package.json +4 -4
package/dist/forms/ssdi.es.js
CHANGED
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@@ -65,7 +65,8 @@ function defaultMetaProps() {
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finalHeadlines: TOLPFinalHeadlines,
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defaultFinalSubHeadline: DEFAULT_FINAL_SUBHEADLINE,
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finalSubHeadlines: TOLPFinalSubHeadlines,
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-
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// Added everywhere for now
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// trustedFormTOLPs: trustedFormTOLPs
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})
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}
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@@ -93,30 +94,90 @@ function formAnchor(updates) {
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)
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}
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const
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$el: '
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const progressBarDefaults = {
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$el: 'div',
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attrs: {
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class: 't-
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class: 't-mt-7 t-mb-5 t-w-full t-flex t-flex-col t-justify-center t-items-center',
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style: {
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if: '$fns.eq($activeStep, $firstStep()) || $fns.eq($activeStep, $lastStep())',
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then: 'display: none'
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},
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},
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children: [
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{
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$el: 'div',
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attrs: {
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class: 't-flex t-justify-center'
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},
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children: [
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{
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$el: 'span',
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attrs: {
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id: 'progress-bar-text',
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class: 't-text-sm t-mb-1'
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},
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children: [
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"0% Complete"
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]
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},
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]
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},
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{
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$el: 'div',
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attrs: {
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class: 't-bg-gray-100 t-w-9/12 t-rounded'
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},
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children: [
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{
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$el: 'div',
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attrs: {
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id: 'progress-bar',
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class: 't-flex t-flex-col t-justify-center t-text-center t-whitespace-nowrap t-w-[10%] t-h-1.5 t-rounded t-text-white t-bg-[#007bff]',
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style: {
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transition: 'width 0.5s ease'
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},
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},
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}
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]
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}
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]
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};
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function
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function progressBar(updates) {
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return merge(
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progressBarDefaults,
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updates
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)
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}
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function headlineDefaults(updates = {}) {
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return {
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$el: 'h1',
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attrs: {
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class: 't-flex t-justify-center t-text-center !t-text-[2rem] t-font-semibold t-pt-5 t-px-7 md:t-px-3' + ' ' + (updates.headlineClass || '')
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}
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}
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}
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}
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function
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function headline(updates = {}) {
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return merge(
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headlineDefaults(updates),
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updates
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)
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}
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function subHeadlineDefaults(updates = {}) {
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return {
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$el: 'h3',
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attrs: {
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class: 't-flex t-justify-center t-text-center !t-text-[1.2rem] t-font-medium t-text-blue-500 t-px-10' + ' ' + (updates.subHeadlineClass || '')
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}
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}
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}
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function subHeadline(updates = {}) {
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return merge(
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subHeadlineDefaults(updates),
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updates
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)
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}
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@@ -366,61 +427,6 @@ const TOLPFinalSubHeadlines = {
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// 'Non-Workplace Discrimination': '',
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};
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const trustedFormTOLPs = {
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'Adoption': true,
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// 'Asbestos and Mesothelioma': '',
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// 'Auto and Car Accidents': '',
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// 'Bankruptcy': '',
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// 'Birth Certificate and Name Change': '',
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// 'Business Lawyers': '',
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'Child Custody and Support': true,
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'Child Custody': true,
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'Child Support': true,
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// 'Civil Rights and Discrimination': '',
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// 'Civil Lawsuit': '',
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// 'Consumer Lawyers': '',
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// 'Copyrights and Trademarks': '',
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// 'Criminal and Felony': '',
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// 'Debt and Collections': '',
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'Divorce and Separation': true,
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// 'DUI and DWI': '',
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// 'Elder Law': '',
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// 'Employment and Workplace': '',
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// 'Expungement': '',
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'Family Issues': true,
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// 'Foreclosure': '',
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'Guardianship': true,
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// 'Harassment and Discrimination': '',
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// 'Identity Theft': '',
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// 'Immigration and Visas': '',
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// 'Insurance': '',
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// 'Landlord and Tenant': '',
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// 'Lemon Law': '',
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// 'Long Term Disability': '',
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// 'Medical Malpractice': '',
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// 'Nursing Home Abuse': '',
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// 'Patents and Intellectual Property': '',
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// 'Personal Injury': '',
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// 'Power of Attorney': '',
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// 'Probate and Estates': '',
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// 'Product Liability': '',
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// 'Social Security Disability and Insurance': '',
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// 'Tax and IRS': '',
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// 'Traffic and Tickets': '',
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// 'Unemployment': '',
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// 'Vaccination Injury': '',
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// 'Victim of a Crime': '',
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// 'Wills and Trusts': '',
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// 'Workers Compensation': '',
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// 'Wrongful Death': '',
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'Not Sure or Other': true,
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};
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// ------ Common Base Settings
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const checkbox = (updates) => {
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}, updates)
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};
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const
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updates.legendClass = 'legend-left
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updates.fieldsetClass = '$reset
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const vertical2ItemRadio = (updates) => {
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updates.optionClass = 'radiobtn t-mx-5';
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updates.wrapperClass = '$reset formkit-wrapper t-mb-0';
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updates.labelClass = 't-font-semibold t-text-[#1e448f]';
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const verticalYesNoRadio = (updates) => {
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return vertical2ItemRadio(updates)
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const select = (updates) => {
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const verticalSelect = (updates) => {
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updates.labelClass = 'required';
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updates.wrapperClass = '
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updates.helpClass = 't-mt-2.5 md:t-text-right md:t-mt-[-5px]';
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updates.wrapperClass = 't-flex t-justify-center';
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updates.messagesClass = 't-flex t-justify-center';
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const text = (updates) => {
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$formkit: 'text',
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const applicantAge = () => sbsSelect({
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label: 'Age of Applicant?',
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const applicantAgeVertical = () => verticalSelect({
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name: 'Applicant_Age',
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value: "50",
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const
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const disabilityConditionStopWorkVertical = () => verticalYesNoRadio({
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name: 'Disability_Condition_Stop_Work',
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label: 'Do You Expect To Be Out Of Work For At Least a Year Due To Your Health?'
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// label: 'Do You Expect To Be Out Of Work For At Least a Year Due To Your Health?'
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const
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const disabilityWorkHistoryVertical = () => verticalYesNoRadio({
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name: 'Disability_Work_History',
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label: 'Have You Had a Full-Time Job Within the Past 5 Years?'
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// label: 'Have You Had a Full-Time Job Within the Past 5 Years?'
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const
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const doctorTreatmentVertical = () => verticalYesNoRadio({
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name: 'Doctor_Treatment',
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label: 'Have You Recently Been Treated by a Doctor, Hospital or Clinic?'
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// label: 'Have You Recently Been Treated by a Doctor, Hospital or Clinic?'
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const email = () => sbsText({
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const
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const haveAttorneyVertical = () => verticalYesNoRadio({
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name: 'Have_Attorney',
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label: 'Already Working with An Attorney?'
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// label: 'Already Working with An Attorney?'
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const lastName = () => sbsText({
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helpClass: "t-mt-2.5 md:t-text-right md:t-mt-[-2px]"
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const
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const socialSecurityDisabilityReceivingBenefitsVertical = () => verticalYesNoRadio({
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|
name: 'Social_Security_Disability_Receiving_Benefits',
|
|
669
|
-
label: 'Are You Currently Receiving Social Security Disability Benefits?'
|
|
677
|
+
// label: 'Are You Currently Receiving Social Security Disability Benefits?'
|
|
670
678
|
});
|
|
671
679
|
|
|
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680
|
const TCPAConsent = () => ({
|
|
@@ -684,9 +692,8 @@ const TCPAConsent = () => ({
|
|
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684
692
|
}
|
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685
693
|
});
|
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686
694
|
|
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687
|
-
const
|
|
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|
-
|
|
689
|
-
placeholder: '#####',
|
|
695
|
+
const zipcodeCenter = () => text({
|
|
696
|
+
placeholder: 'Please Enter Your Zip Code',
|
|
690
697
|
name: 'Zip',
|
|
691
698
|
maxlength: 5,
|
|
692
699
|
inputmode: "numeric",
|
|
@@ -695,10 +702,13 @@ const zipcode = () => sbsText({
|
|
|
695
702
|
validationMessages: {
|
|
696
703
|
required: 'Zip Code is required',
|
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697
704
|
matches: 'Invalid Zip Code'
|
|
698
|
-
}
|
|
705
|
+
},
|
|
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|
+
wrapperClass: 't-flex t-justify-center',
|
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|
+
messagesClass: 't-flex t-justify-center'
|
|
699
708
|
});
|
|
700
709
|
|
|
701
710
|
const NEXT_ON_ENTER = '$onEnter($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))';
|
|
711
|
+
const NEXT_ON_INPUT = '$onInput($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))';
|
|
702
712
|
|
|
703
713
|
const isInput = (n) => { return (n.type !== 'group' && n.type !== 'section' && n.type !== 'form' && n.$formkit !== 'hidden' && !n.children) };
|
|
704
714
|
|
|
@@ -733,22 +743,23 @@ const stepDefaults = (step) => ({
|
|
|
733
743
|
}
|
|
734
744
|
});
|
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735
745
|
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|
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|
-
function
|
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|
+
function verticalStepHeadline(updates) {
|
|
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|
return {
|
|
738
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|
$el: 'h3',
|
|
739
749
|
children: updates.headline || 'Tell Us About Your Case',
|
|
740
750
|
attrs: {
|
|
741
|
-
class: 't-flex t-justify-center t-text-center t-text-2xl t-font-bold t-text-
|
|
751
|
+
class: 't-flex t-justify-center t-text-center t-text-2xl t-font-bold t-text-dark t-pb-5 t-pt-0 t-px-3'
|
|
742
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|
}
|
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|
}
|
|
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|
}
|
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755
|
|
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|
+
|
|
746
757
|
function commentsStepHeadline(updates) {
|
|
747
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|
return {
|
|
748
759
|
$el: 'h3',
|
|
749
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|
children: updates.headline || 'Additional Case Details',
|
|
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|
attrs: {
|
|
751
|
-
class: 't-flex t-justify-center t-text-center t-text-2xl t-font-bold t-text-blue-500 t-pb-5 t-pt-0 t-px-3'
|
|
762
|
+
class: 't-flex t-justify-center t-text-center t-text-2xl t-font-bold t-text-blue-500 t-pb-5 t-pt-0 t-px-3' + ' ' + (updates.headlineClass || '')
|
|
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763
|
}
|
|
753
764
|
}
|
|
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765
|
}
|
|
@@ -758,7 +769,7 @@ function firstAndLastStepHeadline(updates) {
|
|
|
758
769
|
$el: 'h3',
|
|
759
770
|
children: updates.headline || 'Please Provide a Contact Name',
|
|
760
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|
attrs: {
|
|
761
|
-
class: 't-flex t-justify-center t-text-center t-text-2xl t-font-bold t-text-blue-500 t-pb-5 t-pt-0 t-px-3'
|
|
772
|
+
class: 't-flex t-justify-center t-text-center t-text-2xl t-font-bold t-text-blue-500 t-pb-5 t-pt-0 t-px-3' + ' ' + (updates.headlineClass || '')
|
|
762
773
|
}
|
|
763
774
|
}
|
|
764
775
|
}
|
|
@@ -783,13 +794,44 @@ function contactStepSubHeadline(updates) {
|
|
|
783
794
|
}
|
|
784
795
|
}
|
|
785
796
|
|
|
786
|
-
|
|
797
|
+
const TRUSTED_FORM_JS = `(function() {
|
|
798
|
+
if (window.xxTrustedFormLoaded) {
|
|
799
|
+
return
|
|
800
|
+
}
|
|
801
|
+
var vid = '';
|
|
802
|
+
if (typeof window.zar !== 'undefined') {
|
|
803
|
+
vid = window.zar.getVID();
|
|
804
|
+
}
|
|
805
|
+
window.xxTrustedFormLoaded = true;
|
|
806
|
+
var sandbox = document.location.hostname.indexOf('localhost') > -1 ? 'true' : 'false'
|
|
807
|
+
var tf = document.createElement('script');
|
|
808
|
+
tf.type = 'text/javascript'; tf.async = true;
|
|
809
|
+
tf.src = ("https:" == document.location.protocol ? 'https' : 'http') + "://api.trustedform.com/trustedform.js?field=xxTrustedFormCertUrl&identifier=" + vid + "&ping_field=xxTrustedFormPingUrl&provideReferrer=false&invert_field_sensitivity=true&sandbox=" + sandbox + "&l=" + new Date().getTime() + Math.random();
|
|
810
|
+
var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(tf, s);
|
|
811
|
+
})();`;
|
|
812
|
+
|
|
813
|
+
function trustedFormScript() {
|
|
814
|
+
return {
|
|
815
|
+
$el: 'script',
|
|
816
|
+
// if: '$activeStep === $lastStep() && $getKey($meta, "trustedFormTOLPs." + $get(Type_Of_Legal_Problem).value, false) == true',
|
|
817
|
+
// Added everywhere:
|
|
818
|
+
if: '$activeStep === $lastStep()',
|
|
819
|
+
children: TRUSTED_FORM_JS
|
|
820
|
+
}
|
|
821
|
+
}
|
|
822
|
+
|
|
823
|
+
function step(name, inputs, nextOnEnter = true, nextOnInput = false) {
|
|
787
824
|
if (typeof nextOnEnter === 'undefined') {
|
|
788
825
|
nextOnEnter = true;
|
|
789
826
|
}
|
|
790
|
-
if (inputs && inputs.length && nextOnEnter) {
|
|
827
|
+
if (inputs && inputs.length && (nextOnEnter || nextOnInput)) {
|
|
791
828
|
const lastInput = findLastInput(inputs[inputs.length - 1]);
|
|
792
|
-
|
|
829
|
+
if (nextOnEnter === true) {
|
|
830
|
+
lastInput.onKeypress = NEXT_ON_ENTER;
|
|
831
|
+
}
|
|
832
|
+
if (nextOnInput === true) {
|
|
833
|
+
lastInput.onInput = NEXT_ON_INPUT;
|
|
834
|
+
}
|
|
793
835
|
}
|
|
794
836
|
|
|
795
837
|
return merge(
|
|
@@ -813,7 +855,7 @@ function commentsWithBankruptcyV2(updates = {}) {
|
|
|
813
855
|
[
|
|
814
856
|
commentsStepHeadline(updates),
|
|
815
857
|
comments({
|
|
816
|
-
label: updates.label
|
|
858
|
+
label: updates.label === undefined ? DEFAULT_COMMENTS_LABEL : updates.label,
|
|
817
859
|
placeholder: updates.placeholder || DEFAULT_COMMENTS_PLACEHOLDER_DYNAMIC
|
|
818
860
|
}),
|
|
819
861
|
bankruptcyCrossSell()
|
|
@@ -828,6 +870,8 @@ function contactInfoV2(updates = {}) {
|
|
|
828
870
|
[
|
|
829
871
|
contactStepHeadline(updates),
|
|
830
872
|
contactStepSubHeadline(updates),
|
|
873
|
+
// Added TF everywhere
|
|
874
|
+
trustedFormScript(),
|
|
831
875
|
email(),
|
|
832
876
|
phone(),
|
|
833
877
|
TCPAConsent(),
|
|
@@ -859,9 +903,10 @@ function ssdiTOLPAndZip(updates = {}) {
|
|
|
859
903
|
id: "Type_Of_Legal_Problem",
|
|
860
904
|
value: "Social Security Disability and Insurance"
|
|
861
905
|
},
|
|
862
|
-
|
|
906
|
+
zipcodeCenter()
|
|
863
907
|
],
|
|
864
|
-
updates.nextOnEnter
|
|
908
|
+
updates.nextOnEnter,
|
|
909
|
+
updates.nextOnInput
|
|
865
910
|
)
|
|
866
911
|
}
|
|
867
912
|
|
|
@@ -869,10 +914,11 @@ function ssdiApplicantAge(updates = {}) {
|
|
|
869
914
|
return step(
|
|
870
915
|
'ssdiApplicantAge',
|
|
871
916
|
[
|
|
872
|
-
|
|
873
|
-
|
|
917
|
+
verticalStepHeadline(updates),
|
|
918
|
+
applicantAgeVertical(),
|
|
874
919
|
],
|
|
875
|
-
updates.nextOnEnter
|
|
920
|
+
updates.nextOnEnter,
|
|
921
|
+
updates.nextOnInput
|
|
876
922
|
)
|
|
877
923
|
}
|
|
878
924
|
|
|
@@ -880,10 +926,11 @@ function ssdiDisabilityConditionStopWork(updates = {}) {
|
|
|
880
926
|
return step(
|
|
881
927
|
'ssdiDisabilityConditionStopWork',
|
|
882
928
|
[
|
|
883
|
-
|
|
884
|
-
|
|
929
|
+
verticalStepHeadline(updates),
|
|
930
|
+
disabilityConditionStopWorkVertical(),
|
|
885
931
|
],
|
|
886
|
-
updates.nextOnEnter
|
|
932
|
+
updates.nextOnEnter,
|
|
933
|
+
updates.nextOnInput
|
|
887
934
|
)
|
|
888
935
|
}
|
|
889
936
|
|
|
@@ -891,10 +938,11 @@ function ssdiDisabilityWorkHistory(updates = {}) {
|
|
|
891
938
|
return step(
|
|
892
939
|
'ssdiDisabilityWorkHistory',
|
|
893
940
|
[
|
|
894
|
-
|
|
895
|
-
|
|
941
|
+
verticalStepHeadline(updates),
|
|
942
|
+
disabilityWorkHistoryVertical(),
|
|
896
943
|
],
|
|
897
|
-
updates.nextOnEnter
|
|
944
|
+
updates.nextOnEnter,
|
|
945
|
+
updates.nextOnInput
|
|
898
946
|
)
|
|
899
947
|
}
|
|
900
948
|
|
|
@@ -902,10 +950,11 @@ function ssdiSocialSecurityDisabilityReceivingBenefits(updates = {}) {
|
|
|
902
950
|
return step(
|
|
903
951
|
'ssdiSocialSecurityDisabilityReceivingBenefits',
|
|
904
952
|
[
|
|
905
|
-
|
|
906
|
-
|
|
953
|
+
verticalStepHeadline(updates),
|
|
954
|
+
socialSecurityDisabilityReceivingBenefitsVertical(),
|
|
907
955
|
],
|
|
908
|
-
updates.nextOnEnter
|
|
956
|
+
updates.nextOnEnter,
|
|
957
|
+
updates.nextOnInput
|
|
909
958
|
)
|
|
910
959
|
}
|
|
911
960
|
|
|
@@ -913,10 +962,11 @@ function ssdiDoctorTreatment(updates = {}) {
|
|
|
913
962
|
return step(
|
|
914
963
|
'ssdiDoctorTreatment',
|
|
915
964
|
[
|
|
916
|
-
|
|
917
|
-
|
|
965
|
+
verticalStepHeadline(updates),
|
|
966
|
+
doctorTreatmentVertical(),
|
|
918
967
|
],
|
|
919
|
-
updates.nextOnEnter
|
|
968
|
+
updates.nextOnEnter,
|
|
969
|
+
updates.nextOnInput
|
|
920
970
|
)
|
|
921
971
|
}
|
|
922
972
|
|
|
@@ -925,10 +975,11 @@ function ssdiHaveAttorney(updates = {}) {
|
|
|
925
975
|
return step(
|
|
926
976
|
'ssdiHaveAttorney',
|
|
927
977
|
[
|
|
928
|
-
|
|
929
|
-
|
|
978
|
+
verticalStepHeadline(updates),
|
|
979
|
+
haveAttorneyVertical(),
|
|
930
980
|
],
|
|
931
|
-
updates.nextOnEnter
|
|
981
|
+
updates.nextOnEnter,
|
|
982
|
+
updates.nextOnInput
|
|
932
983
|
)
|
|
933
984
|
}
|
|
934
985
|
|
|
@@ -941,7 +992,7 @@ const formNavigationV2 = () => ({
|
|
|
941
992
|
{
|
|
942
993
|
$formkit: 'button',
|
|
943
994
|
name: 'back_button',
|
|
944
|
-
onClick: '$setPreviousStep($
|
|
995
|
+
onClick: '$setPreviousStep($prevStepFunc($get(form)))',
|
|
945
996
|
children: 'Back',
|
|
946
997
|
style: {
|
|
947
998
|
if: '$activeStep === $firstStep()',
|
|
@@ -1031,13 +1082,15 @@ const schema = [
|
|
|
1031
1082
|
},
|
|
1032
1083
|
}),
|
|
1033
1084
|
children: [
|
|
1085
|
+
progressBar(),
|
|
1034
1086
|
headline({
|
|
1035
1087
|
children: '$urlParam("hl", "Start Your FREE Case Application Now")',
|
|
1036
|
-
if: '$activeStep === $firstStep()'
|
|
1088
|
+
if: '$activeStep === $firstStep()',
|
|
1089
|
+
headlineClass: '!t-text-dark'
|
|
1037
1090
|
}),
|
|
1038
1091
|
subHeadline({
|
|
1039
|
-
children: '$urlParam("shl", "
|
|
1040
|
-
if: '$activeStep === $firstStep()'
|
|
1092
|
+
children: '$urlParam("shl", "Find Out If We Can Assist You in Obtaining $3,148 Per Month in Disability Benefits")',
|
|
1093
|
+
if: '$activeStep === $firstStep()',
|
|
1041
1094
|
}),
|
|
1042
1095
|
...hiddenInputsLegal,
|
|
1043
1096
|
{
|
|
@@ -1047,16 +1100,39 @@ const schema = [
|
|
|
1047
1100
|
},
|
|
1048
1101
|
children: [
|
|
1049
1102
|
ssdiTOLPAndZip(),
|
|
1050
|
-
ssdiApplicantAge(
|
|
1051
|
-
|
|
1052
|
-
|
|
1053
|
-
|
|
1054
|
-
|
|
1055
|
-
|
|
1103
|
+
ssdiApplicantAge({
|
|
1104
|
+
nextOnInput: true,
|
|
1105
|
+
headline: 'What is the Age of the Applicant?'
|
|
1106
|
+
}),
|
|
1107
|
+
ssdiDisabilityConditionStopWork({
|
|
1108
|
+
nextOnInput: true,
|
|
1109
|
+
headline: "Do You Expect To Be Out Of Work For At Least a Year Due To Your Health?"
|
|
1110
|
+
}),
|
|
1111
|
+
ssdiDisabilityWorkHistory({
|
|
1112
|
+
nextOnInput: true,
|
|
1113
|
+
headline: "Have You Had a Full-Time Job Within the Past 5 Years?"
|
|
1114
|
+
}),
|
|
1115
|
+
ssdiSocialSecurityDisabilityReceivingBenefits({
|
|
1116
|
+
nextOnInput: true,
|
|
1117
|
+
headline: "Are You Currently Receiving Social Security Disability Benefits?"
|
|
1118
|
+
}),
|
|
1119
|
+
ssdiDoctorTreatment({
|
|
1120
|
+
nextOnInput: true,
|
|
1121
|
+
headline: "Have You Recently Been Treated by a Doctor, Hospital or Clinic?"
|
|
1122
|
+
}),
|
|
1123
|
+
ssdiHaveAttorney({
|
|
1124
|
+
nextOnInput: true,
|
|
1125
|
+
headline: "Already Working with An Attorney?"
|
|
1126
|
+
}),
|
|
1056
1127
|
commentsWithBankruptcyV2({
|
|
1057
|
-
nextOnEnter: false
|
|
1128
|
+
nextOnEnter: false,
|
|
1129
|
+
label: null,
|
|
1130
|
+
headline: 'Please briefly describe your situation:',
|
|
1131
|
+
headlineClass: '!t-text-dark'
|
|
1132
|
+
}),
|
|
1133
|
+
firstAndLastV2({
|
|
1134
|
+
headlineClass: '!t-text-dark'
|
|
1058
1135
|
}),
|
|
1059
|
-
firstAndLastV2(),
|
|
1060
1136
|
contactInfoV2({
|
|
1061
1137
|
headline: 'Submit Your Free Application',
|
|
1062
1138
|
subheadline: 'Based on your input you may qualify for SSDI benefits. Please verify your contact information.',
|