bhl-forms 0.11.12 → 0.11.14

package/dist/forms/ssdi.iife.js

@@ -1 +1 @@
-var ssdi=function(){"use strict";function e(){return Object.assign({},...arguments)}const t='$getKey($meta, "commentsPlaceholders." + $get(Type_Of_Legal_Problem).value, $meta.defaultCommentsPlaceholder)',a=e=>(e.name&&!e.id&&(e.id=e.name),e),i=t=>(t.legendClass="legend-left required",t.fieldsetClass="$reset side-by-side",t.optionsClass="t-pl-1",t.innerClass="t-flex t-items-center",t.wrapperClass="t-mb-3",(t=>(a(t),e({$formkit:"checkbox",validation:"required",validationMessages:{required:"Field is required"}},t)))(t)),n=t=>(a(t),e({$formkit:"radio",validation:"required",validationMessages:{required:"Field is required"},optionsClass:"t-pt-3 t-pl-1",legendClass:"required"},t)),l=e=>(e.options=["Yes","No"],(e=>(e.legendClass="legend-left t-pb-1 required",e.fieldsetClass="$reset side-by-side t-items-center",e.optionsClass="t-mt-1 t-grid t-grid-cols-1 md:t-grid-cols-2-125 t-items-center",e.innerClass="t-flex t-items-center",e.optionClass="t-pr-1",n(e)))(e)),s=e=>(e.options=["Yes","No"],e.optionsClass="t-flex t-justify-center t-my-3",(e=>(e.legendClass="legend-left",e.fieldsetClass="$reset t-flex t-justify-center t-flex-col-reverse t-items-center",void 0===e.optionsClass&&(e.optionsClass="t-flex t-flex-col sm:t-flex-row t-justify-center t-my-3"),e.optionClass="radiobtn t-my-2 sm:t-my-0 t-mx-2 md:t-mx-5",e.wrapperClass="$reset formkit-wrapper t-mb-0 t-flex t-items-center t-h-[100%]",e.labelClass="t-font-semibold t-text-[#1e448f] t-w-[100%]",e.decoratorIcon=!1,e.messagesClass="t-flex t-justify-center",e.helpClass="t-mt-2.5 !t-text-sm t-text-center",n(e)))(e)),r=t=>(a(t),e({$formkit:"text",validation:"required",validationMessages:{required:"Field is required"},labelClass:"required"},t)),o=e=>(e.wrapperClass="side-by-side t-items-center",r(e)),d=e=>(e.wrapperClass="t-flex t-justify-center",e.messagesClass="t-flex t-justify-center",e.inputClass="t-text-center",e.helpClass="t-mt-2.5 !t-text-sm t-text-center",r(e)),c=(e,t,a={})=>(t?d:o)({$formkit:"email",name:e?e+":Email":"Email",label:t?a.label:"Email Address:",placeholder:"email@domain.com",autocomplete:"email","data-tf-sensitive":"false",validation:"required|email",validationMessages:{required:"Email is required",email:"Invalid Email"},...a}),p=(e,t,a={})=>(t?d:o)({label:t?a.label:"First Name:",placeholder:"First Name",name:e?e+":First_Name":"First_Name",autocomplete:"given-name",validationMessages:{required:"First Name is required"},...a}),u=(e,t,a={})=>(t?d:o)({label:t?a.label:"Last Name:",placeholder:"Last Name",name:e?e+":Last_Name":"Last_Name",autocomplete:"family-name",validationMessages:{required:"Last Name is required"},...a}),m=(e,t,a={})=>(t?d:o)({$formkit:"tel",name:e?e+":Primary_Phone":"Primary_Phone",label:t?a.label:"Phone Number:",placeholder:a.placeholder||"###-###-####",maxlength:12,help:a.help||"10-digit phone number, hyphens optional",autocomplete:"tel-national","data-tf-sensitive":"false",validation:"required|matches:/^[0-9]{3}-?[0-9]{3}-?[0-9]{4}$/|valid_phone",validationMessages:{required:"Phone Number is required",matches:"Invalid Phone Format, use ###-###-####",valid_phone:"Invalid Phone Number"},helpClass:"t-mt-2.5 md:t-text-right md:t-mt-[-2px]",...a}),f=(e,t,a={})=>(t?d:o)({label:t?a.label:"Zip Code:",help:t?a.help??"We try to match you with local help":null,placeholder:"#####",name:e?e+":Zip":"Zip",maxlength:5,inputmode:"numeric",autocomplete:"postal-code",validation:"required|matches:/^[0-9]{5}$/",validationMessages:{required:"Zip Code is required",matches:"Invalid Zip Code"},...a}),y=(t,a,i={})=>(a?d:o)(e({label:a?i.label:"Age of Applicant?",placeholder:"Age between 18 and 65",name:t?t+":Applicant_Age":"Applicant_Age",value:a?i.value??"50":null,maxlength:2,inputmode:"numeric",validation:"required|min:18,max:65",validationMessages:{required:"Applicant Age is required",min:"Invalid Age - must be between 18 and 65",max:"Invalid Age - must be between 18 and 65"},...i})),h=(t,i,n)=>(t=>(a(t),e({$formkit:"textarea",rows:5,maxlength:500,validation:"required",validationMessages:{required:"Field is required"},innerClass:"t-max-w-xl",labelClass:"required"},t)))(e({name:t?t+":Comments":"Comments",label:"Please briefly describe your situation in a few words:",placeholder:'For Example: "I would like help with child support payments" or "I need help with visitation rights"'},n)),g=(t,a,i={})=>(a?s:l)(e({name:t?t+":Disability_Condition_Stop_Work":"Disability_Condition_Stop_Work",label:a?i.label:"Do You Expect To Be Out Of Work For At Least a Year Due To Your Health?"},i)),b=(t,a,i={})=>(a?s:l)(e({name:t?t+":Disability_Work_History":"Disability_Work_History",label:a?i.label:"Have You Had a Full-Time Job Within the Past 5 Years?"},i)),C=(t,a,i={})=>(a?s:l)(e({name:t?t+":Doctor_Treatment":"Doctor_Treatment",label:a?i.label:"Have You Recently Been Treated by a Doctor, Hospital or Clinic?"},i)),x=(t,a,i={})=>(a?s:l)(e({label:a?i.label:"Already Working with An Attorney?",name:t?t+":Have_Attorney":"Have_Attorney"},i)),v=(t,a,i={})=>(a?s:l)(e({name:t?t+":Social_Security_Disability_Receiving_Benefits":"Social_Security_Disability_Receiving_Benefits",label:a?i.label:"Are You Currently Receiving Social Security Disability Benefits?"},i)),w=(e,t={})=>({$formkit:"checkbox",label:"$meta.tcpaLanguage",__raw__sectionsSchema:{label:{attrs:{innerHTML:"$label"}}},name:e?e+":TCPA_Opt_In":"TCPA_Opt_In","data-tf-sensitive":"false",validation:"required|accepted",validationMessages:{required:"Consent is required",accepted:"Consent is required"},classes:{outer:t.outerClass?t.outerClass:"",wrapper:t.wrapperClass?t.wrapperClass:"",messages:t.messagesClass?t.messagesClass:"",label:"!t-text-[0.7rem] t-text-slate-500 t-font-normal !t-leading-[0.9rem]"+(t.labelClass?" "+t.labelClass:"")}}),I=e=>"group"!==e.type&&"section"!==e.type&&"form"!==e.type&&"hidden"!==e.$formkit&&!e.children,S=e=>{if(I(e))return e;for(var t=e.children.length-1;t>=0;t--){if("string"==typeof e.children)continue;const a=e.children[t];if(I(a))return a;const i=S(a);if(i)return i}return null},$={$el:"div",if:"$activeStep === $lastStep()",attrs:{class:"t-flex t-justify-center t-items-center t-text-sm t-text-gray-500"},children:[{$el:"img",attrs:{loading:"lazy",alt:"",style:{border:0},width:"25",height:"25",src:"https://d27hmee62k45vz.cloudfront.net/lock_icon_1.jpeg"}},{$el:"span",children:"Secure & Encrypted",attrs:{class:"t-pl-2 t-pt-1 t-font-medium"}}]};function k(t={}){return e($,t)}function P(e){return{$el:"h3",children:e.headline||"Tell Us About Your Situation",attrs:{class:"t-flex t-justify-center t-text-center t-text-lg sm:t-text-xl t-font-bold t-text-dark t-pb-5 t-pt-0 t-px-1 "+(e.headlineClass||"")}}}function D(e){return function(e){return{$el:"h3",children:e.headline||"Additional Details",attrs:{class:"t-flex t-justify-center t-text-center t-text-lg sm:t-text-xl t-font-bold t-text-blue-500 t-pb-5 t-pt-0 t-px-1 "+(e.headlineClass||"")}}}({headline:e.headline||"Additional Case Details",headlineClass:e.headlineClass})}function E(e){return{$el:"h3",children:e.headline||"Please Provide a Contact Name",attrs:{class:"t-flex t-justify-center t-text-center t-text-xl t-font-bold t-text-blue-500 t-pb-5 t-pt-0 t-px-1 "+(e.headlineClass||"")}}}function T(e){return{$el:"h3",children:e.headline||'$getKey($meta, "finalHeadlines." + $get(Type_Of_Legal_Problem).value, $meta.defaultFinalHeadline)',attrs:{class:"t-flex t-justify-center t-text-center t-text-2xl t-font-bold t-text-blue-500 t-pb-3 t-pt-4 t-px-1 "+(e.headlineClass||"")+" f-contact-info-headline"}}}function _(e){return{$el:"h5",children:e.subheadline||'$getKey($meta, "finalSubHeadlines." + $get(Type_Of_Legal_Problem).value, $meta.defaultFinalSubHeadline)',attrs:{class:"t-flex t-justify-center t-text-center !t-text-lg t-font-semibold t-pb-6 t-pt-0 t-px-3 "+(e.subheadlineClass||"")+" f-contact-info-subheadline"}}}function A(t,a,i={}){const{nextOnEnter:n=!0,nextOnInput:l=!1,stepKey:s,nextStepMap:r,triggerRedirectMap:o,autoFocus:d}=i;if(a&&a.length&&(n||l)){const e=S(a[a.length-1]);e&&!0===n&&(e.onKeypress="$onEnter($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))"),e&&!0===l&&(e.onInput="$onInput($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))")}return e(((e,t)=>({$el:"section",if:'$stepEnabled("'+e+'")',attrs:{hidden:'$activeStep !== "'+e+'"',key:t||e}}))(t,s),{children:[{$formkit:"group",id:t,name:t,nextStepMap:r,triggerRedirectMap:o,autoFocus:d,children:a}]})}const L={type:"form",id:"form",config:{validationVisibility:"submit"},onSubmit:'$submit($submitUrl, $prepData, $handleRedirect, "text/plain; charset=UTF-8")',plugins:"$plugins",actions:!1,anchorElement:"form-anchor",useLocalStorage:!0,prepop:{fromURL:!0},errorCodes:{403:{message:"An Error Occurred",abort:!1},409:{abort:!1},429:"An Error Occurred",504:{message:"An Error Occurred",abort:!1}},formClass:"!t-max-w-[40rem]"};function W(e,t){return Object.fromEntries(Object.entries(e).filter((([e])=>t.includes(e))))}const O={};const F={$el:"div",children:[{$el:"div",attrs:{id:"form-anchor",class:"t-absolute",style:{top:"-30px",left:0}}}],attrs:{class:"t-relative"}};const B={$el:"div",attrs:{class:"t-mt-7 t-mb-5 t-w-full t-flex t-flex-col t-justify-center t-items-center",style:{if:"$fns.eq($activeStep, $firstStep()) || $fns.eq($activeStep, $lastStep())",then:"display: none"}},children:[{$el:"div",attrs:{class:"t-flex t-justify-center"},children:[{$el:"span",attrs:{id:"progress-bar-text",class:"t-text-sm t-mb-1"},children:["0% Complete"]}]},{$el:"div",attrs:{class:"t-bg-gray-100 t-w-9/12 t-rounded"},children:[{$el:"div",attrs:{id:"progress-bar",class:"t-flex t-flex-col t-justify-center t-text-center t-whitespace-nowrap t-w-[10%] t-h-1.5 t-rounded t-text-white t-bg-[#007bff]",style:{transition:"width 0.5s ease"}}}]}]};const j=[{$formkit:"hidden",name:"vertical",value:"Legal"},{$formkit:"hidden",name:"TCPA_Language",value:"$meta.tcpaLanguage"},{$formkit:"hidden",name:"gclid",value:null},{$formkit:"hidden",name:"campaignid",value:null},{$formkit:"hidden",name:"s",value:null}],M={Adoption:'Example: "I need help with adoption forms"',"Asbestos and Mesothelioma":'Example: "I was exposed to asbestos at work and would like to file a claim"',"Auto and Car Accidents":'Example: "A truck crashed into my car on the highway" or "I\'ve been involved in a hit and run accident"',Bankruptcy:'Example: "I need help filing for bankruptcy"',"Birth Certificate and Name Change":'Example: "Just married and would like to change my last name"',"Business Lawyers":'Example: "I need help incorporating a business" or "I would like a legal contract reviewed"',"Child Custody and Support":'Example: "Need help getting custody" or "Issues with child support payments"',"Child Custody":'Example: "Need help getting custody"',"Child Support":'Example: "Issues with child support payments"',"Civil Rights and Discrimination":'Example: "Police brutality" or "Coworker keeps harassing me"',"Civil Lawsuit":'Example: "A contractor took my money and never completed the job" or "I am being sued by a neighbor"',"File a Lawsuit":'Example: "A contractor took my money and never completed the job"',"Defend a Lawsuit":'Example: "I am being sued by a neighbor"',"Consumer Lawyers":'Example: "Someone committed fraud against me" or "A contractor took my money and never completed the job"',"Copyrights and Trademarks":'Example: "I would like to register a trademark or copyright a name"',"Criminal and Felony":'Example: "I was arrested for DUI and need legal defense" or "I am being charged with assault"',"Debt and Collections":'Example: "I would like to consolidate my debt" or "A collection agency is harassing me"',"Divorce and Separation":'Example: "I would like to file for an uncontested divorce"',"DUI and DWI":'Example: "I was arrested for DUI and need legal defense"',"Elder Law":'Example: "I would like help with Estate Planning" or "I need help with a guardianship"',"Employment and Workplace":'Example: "I was injured while on the job" or "My company is discriminating against me"',Expungement:'Example: "I would like to file for an expungement and clear my record"',"Family Issues":'Example: "I need help with guardianship" or "I need a simple will created"',Foreclosure:'Example: "I need help to avoid foreclosure on my house"',Guardianship:'Example: "I need help with guardianship documents"',"Harassment and Discrimination":'Example: "I am being discriminated at work" or "My neighbor is harassing me"',"Sexual Harassment":'Example: "I am being sexually harassed by a coworker"',"Workplace Harassment":'Example: "My coworker is being aggressive towards me"',"Non-Workplace Harassment":'Example: "My neighbor is harassing me"',"Workplace Discrimination":'Example: "I am being discriminated at work based on my age"',"Non-Workplace Discrimination":'Example: "I am being discriminated against by a local official"',"Identity Theft":'Example: "Someone stole my identity and I need help fixing the issue"',"Immigration and Visas":'Example: "I need help filing for a visa" or "Help with a green card"',Insurance:'Example: "I need help filing an insurance claim for damage to my house"',"Landlord and Tenant":'Example: "I need help to fight an eviction" or "I would like a lawyer to review a rental contract"',"Lemon Law":'Example: "I purchased a new vehicle that broke down already and seller will not assist"',"Long Term Disability":'Example: "I was injured on the job and would like to file for benefits" or "I need help filing for disability benefits"',"Medical Malpractice":'Example: "A doctor performed surgery on the wrong limb and I would like to file a lawsuit"',"Patents and Intellectual Property":'Example: "I would like to file for a patent" or "I need to copyright a name"',"Personal Injury":'Example: "I was bit by the neighbor\'s dog" or "I fell in the icy grocery store parking lot"',"Power of Attorney":'Example: "I need help with a limited or general power of attorney"',"Probate and Estates":'Example: "I need help with planning for my estate" or "A family member passed without a will in place"',"Product Liability":'Example: "My car battery caught on fire" or "I purchased a faulty product"',"Property Damage":'Example: "The neighbor\'s tree fell on my fence" or "My car was hit in the parking lot"',"Real Estate":'Example: "I need help with a quitclaim deed" or "I need a lawyer to review a purchase and sales agreement"',"Social Security Disability and Insurance":'Example: "I would like help filing for disability benefits" or "I\'ve been denied for SSDI and would like to appeal"',"Tax and IRS":'Example: "I need help fighting an IRS tax claim" or "I need audit defense"',"Traffic and Tickets":'Example: "I need help reinstating a supsended license" or "I would like to fight a traffic ticket"',Unemployment:'Example: "I need help filing for unemployment benefits"',"Victim of a Crime":'Example: "I was assaulted in the store" or "I am being discriminated against at work"',"Wills and Trusts":'Example: "I need a simple will created" or "I would like guidance on creating a trust fund"',"Workers Compensation":'Example: "I broke my arm at work and need help getting compensation"',"Wrongful Death":'Example: "A family member was killed on the job and we need legal representation"',"Wrongful Termination":'Example: "I was fired by my employer without cause"',"Not Sure or Other":'Example: "I was involved in a car accident" or "I need help setting up power of attorney"'},H={Adoption:"Connect With Adoption Professionals Today","Auto and Car Accidents":"Connect With Accident Professionals Today",Bankruptcy:"Take Control of Your Financial Future","Birth Certificate and Name Change":"Start Your Change Today","Business Lawyers":"Connect With Business Professionals Today","Child Custody":"Connect With Custody Professionals Today","Child Support":"Connect With Child Support Professionals","Civil Rights and Discrimination":"Stand Up For Your Rights","Civil Lawsuit":"Connect With Lawsuit Professionals Today","Copyrights and Trademarks":"Protect Your Intellectual Property","Debt and Collections":"Connect With Debt Professionals Today","Divorce and Separation":"Connect With Divorce Professionals Today","DUI and DWI":"Defend Against DUI Charges","Elder Law":"Connect With Elder Law Professionals",Expungement:"Clear Your Record","Family Issues":"Connect With Family Legal Help",Foreclosure:"Fight to Keep Your Home",Guardianship:"Connect With Guardianship Professionals","Immigration and Visas":"Get Immigration Legal Help",Insurance:"Get Insurance Legal Help","Lemon Law":"Connect With Lemon Law Professionals","Long Term Disability":"Connect With Disability Professionals","Medical Malpractice":"Hold Negligent Providers Accountable","Patents and Intellectual Property":"Connect With IP Professionals Today","Personal Injury":"Maximize Your Injury Compensation","Probate and Estates":"Manage Probate with Expert Guidance","Product Liability":"Get Justice for Faulty Products","Real Estate":"Connect With Real Estate Professionals","Sexual Harassment":"Stand Up Against Sexual Harassment","Social Security Disability and Insurance":"Get the Benefits You Deserve","Tax and IRS":"Connect With Tax Legal Help","Traffic and Tickets":"Protect Your Record Today",Unemployment:"Connect With Unemployment Professionals","Victim of a Crime":"Seek Justice as a Crime Victim","Wills and Trusts":"Plan Your Estate with Confidence","Workers Compensation":"Maximize Your Workers' Comp Benefits","Wrongful Death":"Seek Justice for a Loved One","Wrongful Termination":"Fight Back Against Unfair Firing Today"},q={},R=["haveAttorney","degreeOfInterest","commentsWithBankruptcy","zipcode","legalCrossSells","firstAndLast","contactInfo"],N=["haveAttorney","degreeOfInterest","lawyerPaymentMethod","commentsWithBankruptcy","zipcode","legalCrossSells","firstAndLast","contactInfo"],Y=["haveAttorney","commentsWithBankruptcy","zipcode","legalCrossSells","firstAndLast","contactInfo"],U={values:{Type_Of_Legal_Problem:{Adoption:["maritalStatus","haveChildren",...N],"Asbestos and Mesothelioma":["incidentDate","doctorTreatment",...R],"Auto and Car Accidents":["incidentDate","atFault","primaryInjury","doctorTreatment","policeReportFiled",...Y],Bankruptcy:["totalMonthlyIncome","totalDebt","ownRealEstate","valueOfAssets",...R],"Business Lawyers":["businessServices","businessType","numEmployeesOfBusiness",...R],"Child Custody":["childRelationship","childHome","childPrimaryCaregiver",...N],"Child Support":["childRelationship","childHome","childPrimaryCaregiver",...N],"Civil Rights and Discrimination":["civilRightsType",...R],"Civil Lawsuit":["civilDefense","lawsuitOtherParty",...R],"File a Lawsuit":["civilLawsuitTOLPDisplay","lawsuitOtherParty",...R],"Defend a Lawsuit":["lawsuitOtherParty",...R],"Consumer Lawyers":["consumerLawyerType","incidentDate","lawsuitOtherParty",...R],"Criminal and Felony":["criminalTOLPDisplay","crimeCommittedDate","roleInMatterCriminal","pendingCharges",...N],"Debt and Collections":["totalMonthlyIncome","totalDebt","ownRealEstate","valueOfAssets",...R],"Divorce and Separation":["maritalStatus","haveChildren",...N],"DUI and DWI":["incidentDate","priorAlcoholOffenses","typeOfAlcoholTest","bloodContentAlcoholTest","pendingCharges",...R],"Employment and Workplace":["employmentAndWorkplaceTOLPDisplay","numEmployeesOfBusiness","employerType","employeeAtCompany",...R],Expungement:["incidentDate","criminalChargeType",...N],"Family Issues":["maritalStatus","haveChildren",...N],Foreclosure:["ownRealEstate","typeOfProperty","amountPaymentsPastDue","loanAmount","defaultNotice",...R],Guardianship:["maritalStatus","haveChildren",...N],"Immigration and Visas":["countryOfCitizenship","immigrationLocation","immigrationEntry","immigrationType","immigrationStatus","immigrationDetails",...R],"Landlord and Tenant":["landlordTenantIssue","landlordTenantParty",...R],"Lemon Law":["incidentDate","lawsuitOtherParty",...R],"Long Term Disability":["applicantOccupation","applicantAge","applicantLTDisabilityPolicy","applicantDisabilityHowObtain","applicantPreviouslyAppliedLtdBenefits","applicantReceivedDisabilityBenefits","applicantMonthlySalary",...Y],"Medical Malpractice":["incidentDate","claimStatus","doctorTreatment","medicalMalpracticeInjuries",...R],"Patents and Intellectual Property":["patentAssistanceType","patentFor",...R],"Personal Injury":["incidentDate","claimStatus","atFault","primaryInjury","doctorTreatment",...Y],"Probate and Estates":["valueOfAssets","typeOfAssets","roleInMatterProbate","estateLegalServicesNeeded",...R],"Property Damage":["wouldLikeLawyerTo",...R],"Real Estate":["realEstateTOLPDisplay","realEstateArea","wouldLikeLawyerTo",...R],"Social Security Disability and Insurance":["applicantAge","disabilityConditionStopWork","disabilityWorkHistory","socialSecurityDisabilityReceivingBenefits","doctorTreatment",...Y],"Tax and IRS":["totalDebt","taxProblemDetails","taxLevel","taxIssueType",...R],"Traffic and Tickets":["driversLicenseType","trafficViolations","haveCourtDate",...R],Unemployment:["numEmployeesOfBusiness","employerType","degreeOfInterest","commentsWithBankruptcy","zipcode","legalCrossSells","firstAndLast","contactInfo"],"Victim of a Crime":["crimeCommittedDate","roleInMatterCriminal","pendingCharges",...N],"Wills and Trusts":["valueOfAssets","typeOfAssets","roleInMatterProbate","estateLegalServicesNeeded",...R],"Workers Compensation":["incidentDate","claimStatus","primaryInjury","causeOfInjury","doctorTreatment",...Y],"Workplace Harassment":["numEmployeesOfBusiness","employerType","employeeAtCompany",...R],"Workplace Discrimination":["numEmployeesOfBusiness","employerType","employeeAtCompany",...R],"Wrongful Death":["incidentDate","relationshipToVictim","criminalChargesFiled","causeOfDeath",...Y],"Wrongful Termination":["numEmployeesOfBusiness","employerType",...R]},"*":R}};function V(e,t=[],a={}){const i={...e};return i.values=function e(i){const n={};for(const l in i)Array.isArray(i[l])?n[l]=i[l].filter((e=>!t.includes(e))).map((e=>a[e]||e)):"object"==typeof i[l]?n[l]=e(i[l]):n[l]=i[l];return n}(e.values),i}V(U,["legalCrossSells"],{commentsWithBankruptcy:"comments"});const z=U.values.Type_Of_Legal_Problem;z["Auto and Car Accidents"].filter((e=>"legalCrossSells"!==e)),z["Workers Compensation"].filter((e=>"legalCrossSells"!==e)),z["Personal Injury"].filter((e=>"legalCrossSells"!==e)),z["Personal Injury"].filter((e=>"legalCrossSells"!==e)),z["Auto and Car Accidents"].filter((e=>"legalCrossSells"!==e)),z["Auto and Car Accidents"].filter((e=>"legalCrossSells"!==e)),z["Personal Injury"].filter((e=>"legalCrossSells"!==e)),z["Personal Injury"].filter((e=>"legalCrossSells"!==e)),z["Child Custody"],z["Child Support"],U.values["*"],z["Family Issues"],z["Child Support"],z["Child Custody"],U.values["*"],z["Divorce and Separation"],z["Defend a Lawsuit"],z["File a Lawsuit"];V({values:{Type_Of_Legal_Problem:{"Defend a Lawsuit":z["Defend a Lawsuit"],"File a Lawsuit":z["File a Lawsuit"]},"*":["lawsuitOtherParty",...R]}},["legalCrossSells"],{commentsWithBankruptcy:"comments"});V({values:{Type_Of_Legal_Problem_Display:{"Automobile Accident":z["Auto and Car Accidents"],"Contract Disputes":z["Business Lawyers"],"Dog Bite":z["Personal Injury"],"Employment and Workplace":z["Employment and Workplace"],Fraud:z["Consumer Lawyers"],"Medical Malpractice":z["Medical Malpractice"],"Personal Injury":z["Personal Injury"],"Property Damage":z["Property Damage"],"Real Estate":z["Real Estate"],"Not Sure or Other":U.values["*"]},"*":["lawsuitOtherParty",...R]}},["legalCrossSells"],{commentsWithBankruptcy:"comments"});V({values:{Type_Of_Legal_Problem_Display:{"Victim of a Crime":z["Victim of a Crime"],"DUI and DWI":z["DUI and DWI"],Expungement:z.Expungement,"Not Sure or Other":U.values["*"]},"*":["crimeCommittedDate","roleInMatterCriminal","pendingCharges",...N]}},["legalCrossSells"],{commentsWithBankruptcy:"comments"});V({values:{Type_Of_Legal_Problem_Display:{"Wrongful Termination":z["Wrongful Termination"],"Workers Compensation":z["Workers Compensation"],"Personal Injury":z["Personal Injury"],Unemployment:z.Unemployment},"*":["numEmployeesOfBusiness","employerType","employeeAtCompany",...R]}},["legalCrossSells"],{commentsWithBankruptcy:"comments"}),z["Workplace Harassment"],z["Workplace Discrimination"],z["Probate and Estates"],z["Wills and Trusts"],z["Wrongful Death"],z["Patents and Intellectual Property"],z["Business Lawyers"],z["Business Lawyers"],U.values["*"];V({values:{Type_Of_Legal_Problem_Display:{Foreclosure:z.Foreclosure,"Landlord and Tenant":z["Landlord and Tenant"],"Wills, Trusts, and Estates":z["Wills and Trusts"],"Property Damage":z["Property Damage"]},"*":["realEstateArea","wouldLikeLawyerTo",...R]}},["legalCrossSells"],{commentsWithBankruptcy:"comments"});const G=[function(a=null){let i=M,n=H,l=q;return a&&(i=W(M,a),n=W(H,a),l=W(q,a)),{type:"meta",data:e(O,{tcpaLanguage:"By checking this box, I a) agree to the Terms of Use, and b) consent to be contacted by lawyers, lawyer networks, and partners of this website using live, autodialed, pre-recorded, or artificial voice calls, as well as text messages. Your consent is not required as a condition of purchasing any goods or services. To submit this request without this consent, call 878-213-4937.",defaultCommentsPlaceholder:t,commentsPlaceholders:i,defaultFinalHeadline:"Connect With The Legal Help You Deserve",finalHeadlines:n,defaultFinalSubHeadline:"Get a no-obligation consultation with a legal expert.",finalSubHeadlines:l})}}(),e(F,K),{$cmp:"FormKit",props:function(t){const a=e(L,t);return a.formId&&!a.name&&(a.name=a.formId),a}({formId:"ssdi",redirectMap:{"*":"https://listings.ziplawyer.com/api/v1/redirect?zone_id=4&vertical=Legal&category=${properties.Type_Of_Legal_Problem}&Degree_Of_Interest=${properties.Degree_Of_Interest}&zip_code=${properties.Zip}&sub_id=${properties.vid}"}}),children:[function(t){return e(B,t)}(),function(t={}){return e(function(e={}){return{$el:"h1",attrs:{class:"t-flex t-justify-center t-text-center t-text-[1.7rem] sm:t-text-[2rem] t-font-semibold t-pt-5 t-px-7 md:t-px-3 "+(e.headlineClass||"")+" f-first-headline"}}}(t),t)}({children:'$urlParam("hl", "Start Your FREE Case Evaluation")',if:"$activeStep === $firstStep()",headlineClass:"!t-text-dark"}),function(t={}){return e(function(e={}){return{$el:"h3",attrs:{class:"t-flex t-justify-center t-text-center t-text-[1.1rem] md:t-text-[1.2rem] t-font-medium t-text-blue-500 t-px-10 t-pb-3 "+(e.subheadlineClass||"")+" f-first-subheadline"}}}(t),t)}({children:'$urlParam("shl", "You Could Receive up to $3,148 Per Month!")',if:"$activeStep === $firstStep()",subheadlineClass:"!t-text-[#00428A]"}),...j,{$el:"div",attrs:{class:"form-body"},children:[function(e={}){return A("ssdiTOLPAndZip",[{$formkit:"hidden",name:"Type_Of_Legal_Problem",id:"Type_Of_Legal_Problem",value:"Social Security Disability and Insurance"},f(e.scope,!0,e.input)],e)}(),function(e={}){return A("ssdiApplicantAge",[P(e),y(e.scope,!0,e.input)],e)}({nextOnInput:!0,headline:"What is the Age of the Applicant?"}),function(e={}){return A("ssdiDisabilityConditionStopWork",[P(e),g(e.scope,!0,e.input)],e)}({nextOnInput:!0,headline:"Do You Expect To Be Out Of Work For At Least a Year Due To Your Health?"}),function(e={}){return A("ssdiDisabilityWorkHistory",[P(e),b(e.scope,!0,e.input)],e)}({nextOnInput:!0,headline:"Have You Had a Full-Time Job Within the Past 5 Years?"}),function(e={}){return A("ssdiSocialSecurityDisabilityReceivingBenefits",[P(e),v(e.scope,!0,e.input)],e)}({nextOnInput:!0,headline:"Are You Currently Receiving Social Security Disability Benefits?"}),function(e={}){return A("ssdiDoctorTreatment",[P(e),C(e.scope,!0,e.input)],e)}({nextOnInput:!0,headline:"Have You Recently Been Treated by a Doctor, Hospital or Clinic?"}),function(e={}){return A("ssdiHaveAttorney",[P(e),x(e.scope,!0,e.input)],e)}({nextOnInput:!0,headline:"Already Working with An Attorney?"}),function(e={}){return A("commentsWithBankruptcy",[D(e),h(e.scope,0,{label:void 0===e.label?"Please briefly describe your legal issue in a few words:":e.label,placeholder:e.placeholder||t,inputClass:void 0===e.inputClass?"!t-h-32":e.inputClass}),i({label:"I'd also like a consult for bankruptcy or debt elimination (optional)",help:"Note: you will be contacted separately by a bankruptcy/debt expert",name:a?a+":CrossSell_Bankruptcy":"CrossSell_Bankruptcy",id:a?a+":CrossSell_Bankruptcy":"CrossSell_Bankruptcy",if:'$getVal($get(form), "Type_Of_Legal_Problem") != "Bankruptcy" && ($getVal($get(form), "Degree_Of_Interest") == "Absolutely Can\'t Afford" || $getVal($get(form), "Degree_Of_Interest") == "Maybe" || $getVal($get(form), "Degree_Of_Interest") == "Probably")',validation:null,helpClass:"!t-text-sm"}),{$el:"div",if:"$get(CrossSell_Bankruptcy).value == true",children:[h("CrossSell:Bankruptcy",0,{label:"Bankruptcy or debt details:",placeholder:"Please describe your bankrtupcy or debt situation in a few words...",inputClass:"!t-h-16"})]}],{nextOnEnter:!1});var a}({label:null,headline:"Please briefly describe your situation:",headlineClass:"!t-text-dark"}),function(e={}){return A("firstAndLast",[E(e),p(e.scope),u(e.scope)],e)}({headlineClass:"!t-text-dark"}),function(e={}){return A("contactInfo",[T(e),_(e),{$el:"script",if:"$activeStep === $lastStep()",children:"(function() {\n  if (window.xxTrustedFormLoaded) {\n    return\n  }\n  var vid = '';\n  if (typeof window.zar !== 'undefined') {\n    vid = window.zar.getVID();\n  }\n  window.xxTrustedFormLoaded = true;\n  var sandbox = document.location.hostname.indexOf('localhost') > -1 ? 'true' : 'false'\n  var tf = document.createElement('script');\n  tf.type = 'text/javascript'; tf.async = true;\n  tf.src = (\"https:\" == document.location.protocol ? 'https' : 'http') + \"://api.trustedform.com/trustedform.js?field=xxTrustedFormCertUrl&identifier=\" + vid + \"&ping_field=xxTrustedFormPingUrl&provideReferrer=false&invert_field_sensitivity=true&sandbox=\" + sandbox + \"&l=\" + new Date().getTime() + Math.random();\n  var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(tf, s);\n})();"},c(e.scope),m(e.scope),w(e.scope),k()],{nextOnEnter:!1})}({headline:"Submit Your Free Application",headlineClass:"!t-text-[#00428A]",subheadline:"Based on your input you may qualify for SSDI benefits. Please verify your contact information."}),((e={})=>({$el:"div",attrs:{class:{if:"$activeStep === $firstStep()",then:"step-nav "+(e.firstStepButtonClass||"!t-justify-center sm:!t-justify-between"),else:"step-nav !t-justify-between"}},children:[{$formkit:"button",name:"back_button",onClick:"$setPreviousStep($prevStepFunc($get(form)))",children:"Back",outerClass:{if:"$activeStep === $firstStep()",then:"t-hidden sm:t-block",else:""},style:{if:"$activeStep === $firstStep()",then:"display: none;"},classes:{input:(e.inputClass||"")+" f-navigation-input"}},{$formkit:"button",name:"next_button",onClick:"$setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form)))",children:{if:"$activeStep === $firstStep()",then:e.startText||"Start",else:"Next"},outerClass:{if:"$activeStep === $lastStep()",then:"t-hidden",else:""},style:{if:"$activeStep === $lastStep()",then:"display: none;"},classes:{input:(e.inputClass||"")+" f-navigation-input"}},{$formkit:"submit",name:"submit_button",label:e.submitLabel||"Submit",if:"$activeStep === $lastStep()",style:{if:"$activeStep !== $lastStep()",then:"display: none;"},classes:{input:(e.inputClass||"")+" !t-ml-2 sm:!t-ml-auto f-navigation-input"}}]}))(),{$el:"pre",if:'$urlParam("fdbg", "") == 1',children:[{$el:"pre",children:"$stringify( $get(form).value )",attrs:{class:"t-text-xs",style:"overflow: scroll"}},{$el:"pre",children:["activeStep: ","$activeStep"],attrs:{class:"t-text-xs",style:"overflow: scroll"}},{$el:"pre",children:["stepHistory: ","$stepHistory"],attrs:{class:"t-text-xs",style:"overflow: scroll"}},{$el:"pre",children:["stepQueue: ","$stepQueue"],attrs:{class:"t-text-xs",style:"overflow: scroll"}},{$el:"pre",children:["steps: ","$stepKeys()"],attrs:{class:"t-text-xs",style:"overflow: scroll"}}]}]}]}];var K;return G}();
+var ssdi=function(){"use strict";function e(){return Object.assign({},...arguments)}const t='$getKey($meta, "commentsPlaceholders." + $get(Type_Of_Legal_Problem).value, $meta.defaultCommentsPlaceholder)',a=e=>(e.name&&!e.id&&(e.id=e.name),e),i=t=>(t.legendClass="legend-left required",t.fieldsetClass="$reset side-by-side",t.optionsClass="t-pl-1",t.innerClass="t-flex t-items-center",t.wrapperClass="t-mb-3",(t=>(a(t),e({$formkit:"checkbox",validation:"required",validationMessages:{required:"Field is required"}},t)))(t)),n=t=>(a(t),e({$formkit:"radio",validation:"required",validationMessages:{required:"Field is required"},optionsClass:"t-pt-3 t-pl-1",legendClass:"required"},t)),l=e=>(e.options=["Yes","No"],(e=>(e.legendClass="legend-left t-pb-1 required",e.fieldsetClass="$reset side-by-side t-items-center",e.optionsClass="t-mt-1 t-grid t-grid-cols-1 md:t-grid-cols-2-125 t-items-center",e.innerClass="t-flex t-items-center",e.optionClass="t-pr-1",n(e)))(e)),r=e=>(e.options=["Yes","No"],e.optionsClass="t-flex t-justify-center t-my-3",(e=>(e.legendClass="legend-left",e.fieldsetClass="$reset t-flex t-justify-center t-flex-col-reverse t-items-center",void 0===e.optionsClass&&(e.optionsClass="t-flex t-flex-col sm:t-flex-row t-justify-center t-my-3"),e.optionClass="radiobtn t-my-2 sm:t-my-0 t-mx-2 md:t-mx-5",e.wrapperClass="$reset formkit-wrapper t-mb-0 t-flex t-items-center t-h-[100%]",e.labelClass="t-font-semibold t-text-[#1e448f] t-w-[100%]",e.decoratorIcon=!1,e.messagesClass="t-flex t-justify-center",e.helpClass="t-mt-2.5 !t-text-sm t-text-center",n(e)))(e)),s=t=>(a(t),e({$formkit:"text",validation:"required",validationMessages:{required:"Field is required"},labelClass:"required"},t)),o=e=>(e.wrapperClass="side-by-side t-items-center",s(e)),d=e=>(e.wrapperClass="t-flex t-justify-center",e.messagesClass="t-flex t-justify-center",e.inputClass="t-text-center",e.helpClass="t-mt-2.5 !t-text-sm t-text-center",s(e)),c=(e,t,a={})=>(t?d:o)({$formkit:"email",name:e?e+":Email":"Email",label:t?a.label:"Email Address:",placeholder:"email@domain.com",autocomplete:"email","data-tf-sensitive":"false",validation:"required|email",validationMessages:{required:"Email is required",email:"Invalid Email"},...a}),p=(e,t,a={})=>(t?d:o)({label:t?a.label:"First Name:",placeholder:"First Name",name:e?e+":First_Name":"First_Name",autocomplete:"given-name",validationMessages:{required:"First Name is required"},...a}),u=(e,t,a={})=>(t?d:o)({label:t?a.label:"Last Name:",placeholder:"Last Name",name:e?e+":Last_Name":"Last_Name",autocomplete:"family-name",validationMessages:{required:"Last Name is required"},...a}),m=(e,t,a={})=>(t?d:o)({$formkit:"tel",name:e?e+":Primary_Phone":"Primary_Phone",label:t?a.label:"Phone Number:",placeholder:a.placeholder||"###-###-####",maxlength:12,help:a.help||"10-digit phone number, hyphens optional",autocomplete:"tel-national","data-tf-sensitive":"false",validation:"required|matches:/^[0-9]{3}-?[0-9]{3}-?[0-9]{4}$/|valid_phone",validationMessages:{required:"Phone Number is required",matches:"Invalid Phone Format, use ###-###-####",valid_phone:"Invalid Phone Number"},helpClass:"t-mt-2.5 md:t-text-right md:t-mt-[-2px]",...a}),f=(e,t,a={})=>(t?d:o)({label:t?a.label:"Zip Code:",help:t?a.help??"We try to match you with local help":null,placeholder:"#####",name:e?e+":Zip":"Zip",maxlength:5,inputmode:"numeric",autocomplete:"postal-code",validation:"required|matches:/^[0-9]{5}$/",validationMessages:{required:"Zip Code is required",matches:"Invalid Zip Code"},...a}),y=(t,a,i={})=>(a?d:o)(e({label:a?i.label:"Age of Applicant?",placeholder:"Age between 18 and 65",name:t?t+":Applicant_Age":"Applicant_Age",value:a?i.value??"50":null,maxlength:2,inputmode:"numeric",validation:"required|min:18,max:65",validationMessages:{required:"Applicant Age is required",min:"Invalid Age - must be between 18 and 65",max:"Invalid Age - must be between 18 and 65"},...i})),h=(t,i,n)=>(t=>(a(t),e({$formkit:"textarea",rows:5,maxlength:500,validation:"required",validationMessages:{required:"Field is required"},innerClass:"t-max-w-xl",labelClass:"required"},t)))(e({name:t?t+":Comments":"Comments",label:"Please briefly describe your situation in a few words:",placeholder:'For Example: "I would like help with child support payments" or "I need help with visitation rights"'},n)),g=(t,a,i={})=>(a?r:l)(e({name:t?t+":Disability_Condition_Stop_Work":"Disability_Condition_Stop_Work",label:a?i.label:"Do You Expect To Be Out Of Work For At Least a Year Due To Your Health?"},i)),b=(t,a,i={})=>(a?r:l)(e({name:t?t+":Disability_Work_History":"Disability_Work_History",label:a?i.label:"Have You Had a Full-Time Job Within the Past 5 Years?"},i)),C=(t,a,i={})=>(a?r:l)(e({name:t?t+":Doctor_Treatment":"Doctor_Treatment",label:a?i.label:"Have You Recently Been Treated by a Doctor, Hospital or Clinic?"},i)),x=(t,a,i={})=>(a?r:l)(e({label:a?i.label:"Already Working with An Attorney?",name:t?t+":Have_Attorney":"Have_Attorney"},i)),v=(t,a,i={})=>(a?r:l)(e({name:t?t+":Social_Security_Disability_Receiving_Benefits":"Social_Security_Disability_Receiving_Benefits",label:a?i.label:"Are You Currently Receiving Social Security Disability Benefits?"},i)),w=(e,t={})=>({$formkit:"checkbox",label:"$meta.tcpaLanguage",__raw__sectionsSchema:{label:{attrs:{innerHTML:"$label"}}},name:e?e+":TCPA_Opt_In":"TCPA_Opt_In","data-tf-sensitive":"false",validation:"required|accepted",validationMessages:{required:"Consent is required",accepted:"Consent is required"},classes:{outer:t.outerClass?t.outerClass:"",wrapper:t.wrapperClass?t.wrapperClass:"",messages:t.messagesClass?t.messagesClass:"",label:"!t-text-[0.7rem] t-text-slate-500 t-font-normal !t-leading-[0.9rem]"+(t.labelClass?" "+t.labelClass:"")}}),I=e=>"group"!==e.type&&"section"!==e.type&&"form"!==e.type&&"hidden"!==e.$formkit&&!e.children,$=e=>{if(I(e))return e;for(var t=e.children.length-1;t>=0;t--){if("string"==typeof e.children)continue;const a=e.children[t];if(I(a))return a;const i=$(a);if(i)return i}return null},S={$el:"div",if:"$activeStep === $lastStep()",attrs:{class:"t-flex t-justify-center t-items-center t-text-sm t-text-gray-500"},children:[{$el:"img",attrs:{loading:"lazy",alt:"",style:{border:0},width:"25",height:"25",src:"https://d27hmee62k45vz.cloudfront.net/lock_icon_1.jpeg"}},{$el:"span",children:"Secure & Encrypted",attrs:{class:"t-pl-2 t-pt-1 t-font-medium"}}]};function k(t={}){return e(S,t)}function P(e){return{$el:"h3",children:e.headline||"Tell Us About Your Situation",attrs:{class:"t-flex t-justify-center t-text-center t-text-lg sm:t-text-xl t-font-bold t-text-dark t-pb-5 t-pt-0 t-px-1 "+(e.headlineClass||"")}}}function D(e){return function(e){return{$el:"h3",children:e.headline||"Additional Details",attrs:{class:"t-flex t-justify-center t-text-center t-text-lg sm:t-text-xl t-font-bold t-text-blue-500 t-pb-5 t-pt-0 t-px-1 "+(e.headlineClass||"")}}}({headline:e.headline||"Additional Case Details",headlineClass:e.headlineClass})}function E(e){return{$el:"h3",children:e.headline||"Please Provide a Contact Name",attrs:{class:"t-flex t-justify-center t-text-center t-text-xl t-font-bold t-text-blue-500 t-pb-5 t-pt-0 t-px-1 "+(e.headlineClass||"")}}}function T(e){return{$el:"h3",children:e.headline||'$getKey($meta, "finalHeadlines." + ($get(Type_Of_Legal_Problem).value || $get(Category).value), $meta.defaultFinalHeadline)',attrs:{class:"t-flex t-justify-center t-text-center t-text-2xl t-font-bold t-text-blue-500 t-pb-3 t-pt-4 t-px-1 "+(e.headlineClass||"")+" f-contact-info-headline"}}}function _(e){return{$el:"h5",children:e.subheadline||'$getKey($meta, "finalSubHeadlines." + ($get(Type_Of_Legal_Problem).value || $get(Category).value), $meta.defaultFinalSubHeadline)',attrs:{class:"t-flex t-justify-center t-text-center !t-text-lg t-font-semibold t-pb-6 t-pt-0 t-px-3 "+(e.subheadlineClass||"")+" f-contact-info-subheadline"}}}function A(t,a,i={}){const{nextOnEnter:n=!0,nextOnInput:l=!1,stepKey:r,nextStepMap:s,triggerRedirectMap:o,autoFocus:d}=i;if(a&&a.length&&(n||l)){const e=$(a[a.length-1]);e&&!0===n&&(e.onKeypress="$onEnter($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))"),e&&!0===l&&(e.onInput="$onInput($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))")}return e(((e,t)=>({$el:"section",if:'$stepEnabled("'+e+'")',attrs:{hidden:'$activeStep !== "'+e+'"',key:t||e}}))(t,r),{children:[{$formkit:"group",id:t,name:t,nextStepMap:s,triggerRedirectMap:o,autoFocus:d,children:a}]})}const L={type:"form",id:"form",config:{validationVisibility:"submit"},onSubmit:'$submit($submitUrl, $prepData, $handleRedirect, "text/plain; charset=UTF-8")',plugins:"$plugins",actions:!1,anchorElement:"form-anchor",useLocalStorage:!0,prepop:{fromURL:!0},errorCodes:{403:{message:"An Error Occurred",abort:!1},409:{abort:!1},429:"An Error Occurred",504:{message:"An Error Occurred",abort:!1}},formClass:"!t-max-w-[40rem]"};function W(e,t){return Object.fromEntries(Object.entries(e).filter((([e])=>t.includes(e))))}const O={};const F={$el:"div",children:[{$el:"div",attrs:{id:"form-anchor",class:"t-absolute",style:{top:"-30px",left:0}}}],attrs:{class:"t-relative"}};const B={$el:"div",attrs:{class:"t-mt-7 t-mb-5 t-w-full t-flex t-flex-col t-justify-center t-items-center",style:{if:"$fns.eq($activeStep, $firstStep()) || $fns.eq($activeStep, $lastStep())",then:"display: none"}},children:[{$el:"div",attrs:{class:"t-flex t-justify-center"},children:[{$el:"span",attrs:{id:"progress-bar-text",class:"t-text-sm t-mb-1"},children:["0% Complete"]}]},{$el:"div",attrs:{class:"t-bg-gray-100 t-w-9/12 t-rounded"},children:[{$el:"div",attrs:{id:"progress-bar",class:"t-flex t-flex-col t-justify-center t-text-center t-whitespace-nowrap t-w-[10%] t-h-1.5 t-rounded t-text-white t-bg-[#007bff]",style:{transition:"width 0.5s ease"}}}]}]};const j=[{$formkit:"hidden",name:"vertical",value:"Legal"},{$formkit:"hidden",name:"TCPA_Language",value:"$meta.tcpaLanguage"},{$formkit:"hidden",name:"gclid",value:null},{$formkit:"hidden",name:"campaignid",value:null},{$formkit:"hidden",name:"s",value:null}],M={Adoption:'Example: "I need help with adoption forms"',"Asbestos and Mesothelioma":'Example: "I was exposed to asbestos at work and would like to file a claim"',"Auto and Car Accidents":'Example: "A truck crashed into my car on the highway" or "I\'ve been involved in a hit and run accident"',Bankruptcy:'Example: "I need help filing for bankruptcy"',"Birth Certificate and Name Change":'Example: "Just married and would like to change my last name"',"Business Lawyers":'Example: "I need help incorporating a business" or "I would like a legal contract reviewed"',"Child Custody and Support":'Example: "Need help getting custody" or "Issues with child support payments"',"Child Custody":'Example: "Need help getting custody"',"Child Support":'Example: "Issues with child support payments"',"Civil Rights and Discrimination":'Example: "Police brutality" or "Coworker keeps harassing me"',"Civil Lawsuit":'Example: "A contractor took my money and never completed the job" or "I am being sued by a neighbor"',"File a Lawsuit":'Example: "A contractor took my money and never completed the job"',"Defend a Lawsuit":'Example: "I am being sued by a neighbor"',"Consumer Lawyers":'Example: "Someone committed fraud against me" or "A contractor took my money and never completed the job"',"Copyrights and Trademarks":'Example: "I would like to register a trademark or copyright a name"',"Criminal and Felony":'Example: "I was arrested for DUI and need legal defense" or "I am being charged with assault"',"Debt and Collections":'Example: "I would like to consolidate my debt" or "A collection agency is harassing me"',"Divorce and Separation":'Example: "I would like to file for an uncontested divorce"',"DUI and DWI":'Example: "I was arrested for DUI and need legal defense"',"Elder Law":'Example: "I would like help with Estate Planning" or "I need help with a guardianship"',"Employment and Workplace":'Example: "I was injured while on the job" or "My company is discriminating against me"',Expungement:'Example: "I would like to file for an expungement and clear my record"',"Family Issues":'Example: "I need help with guardianship" or "I need a simple will created"',Foreclosure:'Example: "I need help to avoid foreclosure on my house"',Guardianship:'Example: "I need help with guardianship documents"',"Harassment and Discrimination":'Example: "I am being discriminated at work" or "My neighbor is harassing me"',"Sexual Harassment":'Example: "I am being sexually harassed by a coworker"',"Workplace Harassment":'Example: "My coworker is being aggressive towards me"',"Non-Workplace Harassment":'Example: "My neighbor is harassing me"',"Workplace Discrimination":'Example: "I am being discriminated at work based on my age"',"Non-Workplace Discrimination":'Example: "I am being discriminated against by a local official"',"Identity Theft":'Example: "Someone stole my identity and I need help fixing the issue"',"Immigration and Visas":'Example: "I need help filing for a visa" or "Help with a green card"',Insurance:'Example: "I need help filing an insurance claim for damage to my house"',"Landlord and Tenant":'Example: "I need help to fight an eviction" or "I would like a lawyer to review a rental contract"',"Lemon Law":'Example: "I purchased a new vehicle that broke down already and seller will not assist"',"Long Term Disability":'Example: "I was injured on the job and would like to file for benefits" or "I need help filing for disability benefits"',"Medical Malpractice":'Example: "A doctor performed surgery on the wrong limb and I would like to file a lawsuit"',"Patents and Intellectual Property":'Example: "I would like to file for a patent" or "I need to copyright a name"',"Personal Injury":'Example: "I was bit by the neighbor\'s dog" or "I fell in the icy grocery store parking lot"',"Power of Attorney":'Example: "I need help with a limited or general power of attorney"',"Probate and Estates":'Example: "I need help with planning for my estate" or "A family member passed without a will in place"',"Product Liability":'Example: "My car battery caught on fire" or "I purchased a faulty product"',"Property Damage":'Example: "The neighbor\'s tree fell on my fence" or "My car was hit in the parking lot"',"Real Estate":'Example: "I need help with a quitclaim deed" or "I need a lawyer to review a purchase and sales agreement"',"Social Security Disability and Insurance":'Example: "I would like help filing for disability benefits" or "I\'ve been denied for SSDI and would like to appeal"',"Tax and IRS":'Example: "I need help fighting an IRS tax claim" or "I need audit defense"',"Traffic and Tickets":'Example: "I need help reinstating a supsended license" or "I would like to fight a traffic ticket"',Unemployment:'Example: "I need help filing for unemployment benefits"',"Victim of a Crime":'Example: "I was assaulted in the store" or "I am being discriminated against at work"',"Wills and Trusts":'Example: "I need a simple will created" or "I would like guidance on creating a trust fund"',"Workers Compensation":'Example: "I broke my arm at work and need help getting compensation"',"Wrongful Death":'Example: "A family member was killed on the job and we need legal representation"',"Wrongful Termination":'Example: "I was fired by my employer without cause"',"Not Sure or Other":'Example: "I was involved in a car accident" or "I need help setting up power of attorney"'},H={Adoption:"Connect With Adoption Professionals Today","Auto and Car Accidents":"Connect With Accident Professionals Today",Bankruptcy:"Take Control of Your Financial Future","Birth Certificate and Name Change":"Start Your Change Today","Business Lawyers":"Connect With Business Professionals Today","Child Custody":"Connect With Custody Professionals Today","Child Support":"Connect With Child Support Professionals","Civil Rights and Discrimination":"Stand Up For Your Rights","Civil Lawsuit":"Connect With Lawsuit Professionals Today","Copyrights and Trademarks":"Protect Your Intellectual Property","Debt and Collections":"Connect With Debt Professionals Today","Divorce and Separation":"Connect With Divorce Professionals Today","DUI and DWI":"Defend Against DUI Charges","Elder Law":"Connect With Elder Law Professionals",Expungement:"Clear Your Record","Family Issues":"Connect With Family Legal Help",Foreclosure:"Fight to Keep Your Home",Guardianship:"Connect With Guardianship Professionals","Immigration and Visas":"Get Immigration Legal Help",Insurance:"Get Insurance Legal Help","Lemon Law":"Connect With Lemon Law Professionals","Long Term Disability":"Connect With Disability Professionals","Medical Malpractice":"Hold Negligent Providers Accountable","Patents and Intellectual Property":"Connect With IP Professionals Today","Personal Injury":"Maximize Your Injury Compensation","Probate and Estates":"Manage Probate with Expert Guidance","Product Liability":"Get Justice for Faulty Products","Real Estate":"Connect With Real Estate Professionals","Sexual Harassment":"Stand Up Against Sexual Harassment","Social Security Disability and Insurance":"Get the Benefits You Deserve","Tax and IRS":"Connect With Tax Legal Help","Traffic and Tickets":"Protect Your Record Today",Unemployment:"Connect With Unemployment Professionals","Victim of a Crime":"Seek Justice as a Crime Victim","Wills and Trusts":"Plan Your Estate with Confidence","Workers Compensation":"Maximize Your Workers' Comp Benefits","Wrongful Death":"Seek Justice for a Loved One","Wrongful Termination":"Fight Back Against Unfair Firing Today"},q={},R=["haveAttorney","degreeOfInterest","commentsWithBankruptcy","zipcode","legalCrossSells","firstAndLast","contactInfo"],N=["haveAttorney","degreeOfInterest","lawyerPaymentMethod","commentsWithBankruptcy","zipcode","legalCrossSells","firstAndLast","contactInfo"],Y=["haveAttorney","commentsWithBankruptcy","zipcode","legalCrossSells","firstAndLast","contactInfo"],U={values:{Type_Of_Legal_Problem:{Adoption:["maritalStatus","haveChildren",...N],"Asbestos and Mesothelioma":["incidentDate","doctorTreatment",...R],"Auto and Car Accidents":["incidentDate","atFault","primaryInjury","doctorTreatment","policeReportFiled",...Y],Bankruptcy:["totalMonthlyIncome","totalDebt","ownRealEstate","valueOfAssets",...R],"Business Lawyers":["businessServices","businessType","numEmployeesOfBusiness",...R],"Child Custody":["childRelationship","childHome","childPrimaryCaregiver",...N],"Child Support":["childRelationship","childHome","childPrimaryCaregiver",...N],"Civil Rights and Discrimination":["civilRightsType",...R],"Civil Lawsuit":["civilDefense","lawsuitOtherParty",...R],"File a Lawsuit":["civilLawsuitTOLPDisplay","lawsuitOtherParty",...R],"Defend a Lawsuit":["lawsuitOtherParty",...R],"Consumer Lawyers":["consumerLawyerType","incidentDate","lawsuitOtherParty",...R],"Criminal and Felony":["criminalTOLPDisplay","crimeCommittedDate","roleInMatterCriminal","pendingCharges",...N],"Debt and Collections":["totalMonthlyIncome","totalDebt","ownRealEstate","valueOfAssets",...R],"Divorce and Separation":["maritalStatus","haveChildren",...N],"DUI and DWI":["incidentDate","priorAlcoholOffenses","typeOfAlcoholTest","bloodContentAlcoholTest","pendingCharges",...R],"Employment and Workplace":["employmentAndWorkplaceTOLPDisplay","numEmployeesOfBusiness","employerType","employeeAtCompany",...R],Expungement:["incidentDate","criminalChargeType",...N],"Family Issues":["maritalStatus","haveChildren",...N],Foreclosure:["ownRealEstate","typeOfProperty","amountPaymentsPastDue","loanAmount","defaultNotice",...R],Guardianship:["maritalStatus","haveChildren",...N],"Immigration and Visas":["countryOfCitizenship","immigrationLocation","immigrationEntry","immigrationType","immigrationStatus","immigrationDetails",...R],"Landlord and Tenant":["landlordTenantIssue","landlordTenantParty",...R],"Lemon Law":["incidentDate","lawsuitOtherParty",...R],"Long Term Disability":["applicantOccupation","applicantAge","applicantLTDisabilityPolicy","applicantDisabilityHowObtain","applicantPreviouslyAppliedLtdBenefits","applicantReceivedDisabilityBenefits","applicantMonthlySalary",...Y],"Medical Malpractice":["incidentDate","claimStatus","doctorTreatment","medicalMalpracticeInjuries",...R],"Patents and Intellectual Property":["patentAssistanceType","patentFor",...R],"Personal Injury":["incidentDate","claimStatus","atFault","primaryInjury","doctorTreatment",...Y],"Probate and Estates":["valueOfAssets","typeOfAssets","roleInMatterProbate","estateLegalServicesNeeded",...R],"Property Damage":["wouldLikeLawyerTo",...R],"Real Estate":["realEstateTOLPDisplay","realEstateArea","wouldLikeLawyerTo",...R],"Social Security Disability and Insurance":["applicantAge","disabilityConditionStopWork","disabilityWorkHistory","socialSecurityDisabilityReceivingBenefits","doctorTreatment",...Y],"Tax and IRS":["totalDebt","taxProblemDetails","taxLevel","taxIssueType",...R],"Traffic and Tickets":["driversLicenseType","trafficViolations","haveCourtDate",...R],Unemployment:["numEmployeesOfBusiness","employerType","degreeOfInterest","commentsWithBankruptcy","zipcode","legalCrossSells","firstAndLast","contactInfo"],"Victim of a Crime":["crimeCommittedDate","roleInMatterCriminal","pendingCharges",...N],"Wills and Trusts":["valueOfAssets","typeOfAssets","roleInMatterProbate","estateLegalServicesNeeded",...R],"Workers Compensation":["incidentDate","claimStatus","primaryInjury","causeOfInjury","doctorTreatment",...Y],"Workplace Harassment":["numEmployeesOfBusiness","employerType","employeeAtCompany",...R],"Workplace Discrimination":["numEmployeesOfBusiness","employerType","employeeAtCompany",...R],"Wrongful Death":["incidentDate","relationshipToVictim","criminalChargesFiled","causeOfDeath",...Y],"Wrongful Termination":["numEmployeesOfBusiness","employerType",...R]},"*":R}};function V(e,t=[],a={}){const i={...e};return i.values=function e(i){const n={};for(const l in i)Array.isArray(i[l])?n[l]=i[l].filter((e=>!t.includes(e))).map((e=>a[e]||e)):"object"==typeof i[l]?n[l]=e(i[l]):n[l]=i[l];return n}(e.values),i}V(U,["legalCrossSells"],{commentsWithBankruptcy:"comments"});const z=U.values.Type_Of_Legal_Problem;z["Auto and Car Accidents"].filter((e=>"legalCrossSells"!==e)),z["Workers Compensation"].filter((e=>"legalCrossSells"!==e)),z["Personal Injury"].filter((e=>"legalCrossSells"!==e)),z["Personal Injury"].filter((e=>"legalCrossSells"!==e)),z["Auto and Car Accidents"].filter((e=>"legalCrossSells"!==e)),z["Auto and Car Accidents"].filter((e=>"legalCrossSells"!==e)),z["Personal Injury"].filter((e=>"legalCrossSells"!==e)),z["Personal Injury"].filter((e=>"legalCrossSells"!==e)),z["Child Custody"],z["Child Support"],U.values["*"],z["Family Issues"],z["Child Support"],z["Child Custody"],U.values["*"],z["Divorce and Separation"],z["Defend a Lawsuit"],z["File a Lawsuit"];V({values:{Type_Of_Legal_Problem:{"Defend a Lawsuit":z["Defend a Lawsuit"],"File a Lawsuit":z["File a Lawsuit"]},"*":["lawsuitOtherParty",...R]}},["legalCrossSells"],{commentsWithBankruptcy:"comments"});V({values:{Type_Of_Legal_Problem_Display:{"Automobile Accident":z["Auto and Car Accidents"],"Contract Disputes":z["Business Lawyers"],"Dog Bite":z["Personal Injury"],"Employment and Workplace":z["Employment and Workplace"],Fraud:z["Consumer Lawyers"],"Medical Malpractice":z["Medical Malpractice"],"Personal Injury":z["Personal Injury"],"Property Damage":z["Property Damage"],"Real Estate":z["Real Estate"],"Not Sure or Other":U.values["*"]},"*":["lawsuitOtherParty",...R]}},["legalCrossSells"],{commentsWithBankruptcy:"comments"});V({values:{Type_Of_Legal_Problem_Display:{"Victim of a Crime":z["Victim of a Crime"],"DUI and DWI":z["DUI and DWI"],Expungement:z.Expungement,"Not Sure or Other":U.values["*"]},"*":["crimeCommittedDate","roleInMatterCriminal","pendingCharges",...N]}},["legalCrossSells"],{commentsWithBankruptcy:"comments"});V({values:{Type_Of_Legal_Problem_Display:{"Wrongful Termination":z["Wrongful Termination"],"Workers Compensation":z["Workers Compensation"],"Personal Injury":z["Personal Injury"],Unemployment:z.Unemployment},"*":["numEmployeesOfBusiness","employerType","employeeAtCompany",...R]}},["legalCrossSells"],{commentsWithBankruptcy:"comments"}),z["Workplace Harassment"],z["Workplace Discrimination"],z["Probate and Estates"],z["Wills and Trusts"],z["Wrongful Death"],z["Patents and Intellectual Property"],z["Business Lawyers"],z["Business Lawyers"],U.values["*"];V({values:{Type_Of_Legal_Problem_Display:{Foreclosure:z.Foreclosure,"Landlord and Tenant":z["Landlord and Tenant"],"Wills, Trusts, and Estates":z["Wills and Trusts"],"Property Damage":z["Property Damage"]},"*":["realEstateArea","wouldLikeLawyerTo",...R]}},["legalCrossSells"],{commentsWithBankruptcy:"comments"});const G=[function(a=null){let i=M,n=H,l=q;return a&&(i=W(M,a),n=W(H,a),l=W(q,a)),{type:"meta",data:e(O,{tcpaLanguage:'By checking this box, I agree to the Terms of Use and consent to be contacted by <a href="/providers" target="_blank">lawyers, lawyer networks, and partners</a> of this website using live, autodialed, pre-recorded, or artificial voice calls and text messages, at any time including before 8 AM or after 9 PM local time. Your consent is not required as a condition of purchasing any goods or services. To submit this request without this consent, call 878-213-4937.',defaultCommentsPlaceholder:t,commentsPlaceholders:i,defaultFinalHeadline:"Connect With The Legal Help You Deserve",finalHeadlines:n,defaultFinalSubHeadline:"Get a no-obligation consultation with a legal expert.",finalSubHeadlines:l})}}(),e(F,K),{$cmp:"FormKit",props:function(t){const a=e(L,t);return a.formId&&!a.name&&(a.name=a.formId),a}({formId:"ssdi",redirectMap:{"*":"https://listings.ziplawyer.com/api/v1/redirect?zone_id=4&vertical=Legal&category=${properties.Type_Of_Legal_Problem}&Degree_Of_Interest=${properties.Degree_Of_Interest}&zip_code=${properties.Zip}&sub_id=${properties.vid}"}}),children:[function(t){return e(B,t)}(),function(t={}){return e(function(e={}){return{$el:"h1",attrs:{class:"t-flex t-justify-center t-text-center t-text-[1.7rem] sm:t-text-[2rem] t-font-semibold t-pt-5 t-px-7 md:t-px-3 "+(e.headlineClass||"")+" f-first-headline"}}}(t),t)}({children:'$urlParam("hl", "Start Your FREE Case Evaluation")',if:"$activeStep === $firstStep()",headlineClass:"!t-text-dark"}),function(t={}){return e(function(e={}){return{$el:"h3",attrs:{class:"t-flex t-justify-center t-text-center t-text-[1.1rem] md:t-text-[1.2rem] t-font-medium t-text-blue-500 t-px-10 t-pb-3 "+(e.subheadlineClass||"")+" f-first-subheadline"}}}(t),t)}({children:'$urlParam("shl", "You Could Receive up to $3,148 Per Month!")',if:"$activeStep === $firstStep()",subheadlineClass:"!t-text-[#00428A]"}),...j,{$el:"div",attrs:{class:"form-body"},children:[function(e={}){return A("ssdiTOLPAndZip",[{$formkit:"hidden",name:"Type_Of_Legal_Problem",id:"Type_Of_Legal_Problem",value:"Social Security Disability and Insurance"},f(e.scope,!0,e.input)],e)}(),function(e={}){return A("ssdiApplicantAge",[P(e),y(e.scope,!0,e.input)],e)}({nextOnInput:!0,headline:"What is the Age of the Applicant?"}),function(e={}){return A("ssdiDisabilityConditionStopWork",[P(e),g(e.scope,!0,e.input)],e)}({nextOnInput:!0,headline:"Do You Expect To Be Out Of Work For At Least a Year Due To Your Health?"}),function(e={}){return A("ssdiDisabilityWorkHistory",[P(e),b(e.scope,!0,e.input)],e)}({nextOnInput:!0,headline:"Have You Had a Full-Time Job Within the Past 5 Years?"}),function(e={}){return A("ssdiSocialSecurityDisabilityReceivingBenefits",[P(e),v(e.scope,!0,e.input)],e)}({nextOnInput:!0,headline:"Are You Currently Receiving Social Security Disability Benefits?"}),function(e={}){return A("ssdiDoctorTreatment",[P(e),C(e.scope,!0,e.input)],e)}({nextOnInput:!0,headline:"Have You Recently Been Treated by a Doctor, Hospital or Clinic?"}),function(e={}){return A("ssdiHaveAttorney",[P(e),x(e.scope,!0,e.input)],e)}({nextOnInput:!0,headline:"Already Working with An Attorney?"}),function(e={}){return A("commentsWithBankruptcy",[D(e),h(e.scope,0,{label:void 0===e.label?"Please briefly describe your legal issue in a few words:":e.label,placeholder:e.placeholder||t,inputClass:void 0===e.inputClass?"!t-h-32":e.inputClass}),i({label:"I'd also like a consult for bankruptcy or debt elimination (optional)",help:"Note: you will be contacted separately by a bankruptcy/debt expert",name:a?a+":CrossSell_Bankruptcy":"CrossSell_Bankruptcy",id:a?a+":CrossSell_Bankruptcy":"CrossSell_Bankruptcy",if:'$getVal($get(form), "Type_Of_Legal_Problem") != "Bankruptcy" && ($getVal($get(form), "Degree_Of_Interest") == "Absolutely Can\'t Afford" || $getVal($get(form), "Degree_Of_Interest") == "Maybe" || $getVal($get(form), "Degree_Of_Interest") == "Probably")',validation:null,helpClass:"!t-text-sm"}),{$el:"div",if:"$get(CrossSell_Bankruptcy).value == true",children:[h("CrossSell:Bankruptcy",0,{label:"Bankruptcy or debt details:",placeholder:"Please describe your bankrtupcy or debt situation in a few words...",inputClass:"!t-h-16"})]}],{nextOnEnter:!1});var a}({label:null,headline:"Please briefly describe your situation:",headlineClass:"!t-text-dark"}),function(e={}){return A("firstAndLast",[E(e),p(e.scope),u(e.scope)],e)}({headlineClass:"!t-text-dark"}),function(e={}){return A("contactInfo",[T(e),_(e),{$el:"script",if:"$activeStep === $lastStep()",children:"(function() {\n  if (window.xxTrustedFormLoaded) {\n    return\n  }\n  var vid = '';\n  if (typeof window.zar !== 'undefined') {\n    vid = window.zar.getVID();\n  }\n  window.xxTrustedFormLoaded = true;\n  var sandbox = document.location.hostname.indexOf('localhost') > -1 ? 'true' : 'false'\n  var tf = document.createElement('script');\n  tf.type = 'text/javascript'; tf.async = true;\n  tf.src = (\"https:\" == document.location.protocol ? 'https' : 'http') + \"://api.trustedform.com/trustedform.js?field=xxTrustedFormCertUrl&identifier=\" + vid + \"&ping_field=xxTrustedFormPingUrl&provideReferrer=false&invert_field_sensitivity=true&sandbox=\" + sandbox + \"&l=\" + new Date().getTime() + Math.random();\n  var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(tf, s);\n})();"},c(e.scope),m(e.scope),w(e.scope),k()],{nextOnEnter:!1})}({headline:"Submit Your Free Application",headlineClass:"!t-text-[#00428A]",subheadline:"Based on your input you may qualify for SSDI benefits. Please verify your contact information."}),((e={})=>({$el:"div",attrs:{class:{if:"$activeStep === $firstStep()",then:"step-nav "+(e.firstStepButtonClass||"!t-justify-center sm:!t-justify-between"),else:"step-nav !t-justify-between"}},children:[{$formkit:"button",name:"back_button",onClick:"$setPreviousStep($prevStepFunc($get(form)))",children:"Back",outerClass:{if:"$activeStep === $firstStep()",then:"t-hidden sm:t-block",else:""},style:{if:"$activeStep === $firstStep()",then:"display: none;"},classes:{input:(e.inputClass||"")+" f-navigation-input"}},{$formkit:"button",name:"next_button",onClick:"$setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form)))",children:{if:"$activeStep === $firstStep()",then:e.startText||"Start",else:"Next"},outerClass:{if:"$activeStep === $lastStep()",then:"t-hidden",else:""},style:{if:"$activeStep === $lastStep()",then:"display: none;"},classes:{input:(e.inputClass||"")+" f-navigation-input"}},{$formkit:"submit",name:"submit_button",label:e.submitLabel||"Submit",if:"$activeStep === $lastStep()",style:{if:"$activeStep !== $lastStep()",then:"display: none;"},classes:{input:(e.inputClass||"")+" !t-ml-2 sm:!t-ml-auto f-navigation-input"}}]}))(),{$el:"pre",if:'$urlParam("fdbg", "") == 1',children:[{$el:"pre",children:"$stringify( $get(form).value )",attrs:{class:"t-text-xs",style:"overflow: scroll"}},{$el:"pre",children:["activeStep: ","$activeStep"],attrs:{class:"t-text-xs",style:"overflow: scroll"}},{$el:"pre",children:["stepHistory: ","$stepHistory"],attrs:{class:"t-text-xs",style:"overflow: scroll"}},{$el:"pre",children:["stepQueue: ","$stepQueue"],attrs:{class:"t-text-xs",style:"overflow: scroll"}},{$el:"pre",children:["steps: ","$stepKeys()"],attrs:{class:"t-text-xs",style:"overflow: scroll"}}]}]}]}];var K;return G}();

package/dist/forms/ssdi.json

@@ -1 +1 @@
-[{"type":"meta","data":{"tcpaLanguage":"By checking this box, I a) agree to the Terms of Use, and b) consent to be contacted by lawyers, lawyer networks, and partners of this website using live, autodialed, pre-recorded, or artificial voice calls, as well as text messages. Your consent is not required as a condition of purchasing any goods or services. To submit this request without this consent, call 878-213-4937.","defaultCommentsPlaceholder":"$getKey($meta, \"commentsPlaceholders.\" + $get(Type_Of_Legal_Problem).value, $meta.defaultCommentsPlaceholder)","commentsPlaceholders":{"Adoption":"Example: \"I need help with adoption forms\"","Asbestos and Mesothelioma":"Example: \"I was exposed to asbestos at work and would like to file a claim\"","Auto and Car Accidents":"Example: \"A truck crashed into my car on the highway\" or \"I've been involved in a hit and run accident\"","Bankruptcy":"Example: \"I need help filing for bankruptcy\"","Birth Certificate and Name Change":"Example: \"Just married and would like to change my last name\"","Business Lawyers":"Example: \"I need help incorporating a business\" or \"I would like a legal contract reviewed\"","Child Custody and Support":"Example: \"Need help getting custody\" or \"Issues with child support payments\"","Child Custody":"Example: \"Need help getting custody\"","Child Support":"Example: \"Issues with child support payments\"","Civil Rights and Discrimination":"Example: \"Police brutality\" or \"Coworker keeps harassing me\"","Civil Lawsuit":"Example: \"A contractor took my money and never completed the job\" or \"I am being sued by a neighbor\"","File a Lawsuit":"Example: \"A contractor took my money and never completed the job\"","Defend a Lawsuit":"Example: \"I am being sued by a neighbor\"","Consumer Lawyers":"Example: \"Someone committed fraud against me\" or \"A contractor took my money and never completed the job\"","Copyrights and Trademarks":"Example: \"I would like to register a trademark or copyright a name\"","Criminal and Felony":"Example: \"I was arrested for DUI and need legal defense\" or \"I am being charged with assault\"","Debt and Collections":"Example: \"I would like to consolidate my debt\" or \"A collection agency is harassing me\"","Divorce and Separation":"Example: \"I would like to file for an uncontested divorce\"","DUI and DWI":"Example: \"I was arrested for DUI and need legal defense\"","Elder Law":"Example: \"I would like help with Estate Planning\" or \"I need help with a guardianship\"","Employment and Workplace":"Example: \"I was injured while on the job\" or \"My company is discriminating against me\"","Expungement":"Example: \"I would like to file for an expungement and clear my record\"","Family Issues":"Example: \"I need help with guardianship\" or \"I need a simple will created\"","Foreclosure":"Example: \"I need help to avoid foreclosure on my house\"","Guardianship":"Example: \"I need help with guardianship documents\"","Harassment and Discrimination":"Example: \"I am being discriminated at work\" or \"My neighbor is harassing me\"","Sexual Harassment":"Example: \"I am being sexually harassed by a coworker\"","Workplace Harassment":"Example: \"My coworker is being aggressive towards me\"","Non-Workplace Harassment":"Example: \"My neighbor is harassing me\"","Workplace Discrimination":"Example: \"I am being discriminated at work based on my age\"","Non-Workplace Discrimination":"Example: \"I am being discriminated against by a local official\"","Identity Theft":"Example: \"Someone stole my identity and I need help fixing the issue\"","Immigration and Visas":"Example: \"I need help filing for a visa\" or \"Help with a green card\"","Insurance":"Example: \"I need help filing an insurance claim for damage to my house\"","Landlord and Tenant":"Example: \"I need help to fight an eviction\" or \"I would like a lawyer to review a rental contract\"","Lemon Law":"Example: \"I purchased a new vehicle that broke down already and seller will not assist\"","Long Term Disability":"Example: \"I was injured on the job and would like to file for benefits\" or \"I need help filing for disability benefits\"","Medical Malpractice":"Example: \"A doctor performed surgery on the wrong limb and I would like to file a lawsuit\"","Patents and Intellectual Property":"Example: \"I would like to file for a patent\" or \"I need to copyright a name\"","Personal Injury":"Example: \"I was bit by the neighbor's dog\" or \"I fell in the icy grocery store parking lot\"","Power of Attorney":"Example: \"I need help with a limited or general power of attorney\"","Probate and Estates":"Example: \"I need help with planning for my estate\" or \"A family member passed without a will in place\"","Product Liability":"Example: \"My car battery caught on fire\" or \"I purchased a faulty product\"","Property Damage":"Example: \"The neighbor's tree fell on my fence\" or \"My car was hit in the parking lot\"","Real Estate":"Example: \"I need help with a quitclaim deed\" or \"I need a lawyer to review a purchase and sales agreement\"","Social Security Disability and Insurance":"Example: \"I would like help filing for disability benefits\" or \"I've been denied for SSDI and would like to appeal\"","Tax and IRS":"Example: \"I need help fighting an IRS tax claim\" or \"I need audit defense\"","Traffic and Tickets":"Example: \"I need help reinstating a supsended license\" or \"I would like to fight a traffic ticket\"","Unemployment":"Example: \"I need help filing for unemployment benefits\"","Victim of a Crime":"Example: \"I was assaulted in the store\" or \"I am being discriminated against at work\"","Wills and Trusts":"Example: \"I need a simple will created\" or \"I would like guidance on creating a trust fund\"","Workers Compensation":"Example: \"I broke my arm at work and need help getting compensation\"","Wrongful Death":"Example: \"A family member was killed on the job and we need legal representation\"","Wrongful Termination":"Example: \"I was fired by my employer without cause\"","Not Sure or Other":"Example: \"I was involved in a car accident\" or \"I need help setting up power of attorney\""},"defaultFinalHeadline":"Connect With The Legal Help You Deserve","finalHeadlines":{"Adoption":"Connect With Adoption Professionals Today","Auto and Car Accidents":"Connect With Accident Professionals Today","Bankruptcy":"Take Control of Your Financial Future","Birth Certificate and Name Change":"Start Your Change Today","Business Lawyers":"Connect With Business Professionals Today","Child Custody":"Connect With Custody Professionals Today","Child Support":"Connect With Child Support Professionals","Civil Rights and Discrimination":"Stand Up For Your Rights","Civil Lawsuit":"Connect With Lawsuit Professionals Today","Copyrights and Trademarks":"Protect Your Intellectual Property","Debt and Collections":"Connect With Debt Professionals Today","Divorce and Separation":"Connect With Divorce Professionals Today","DUI and DWI":"Defend Against DUI Charges","Elder Law":"Connect With Elder Law Professionals","Expungement":"Clear Your Record","Family Issues":"Connect With Family Legal Help","Foreclosure":"Fight to Keep Your Home","Guardianship":"Connect With Guardianship Professionals","Immigration and Visas":"Get Immigration Legal Help","Insurance":"Get Insurance Legal Help","Lemon Law":"Connect With Lemon Law Professionals","Long Term Disability":"Connect With Disability Professionals","Medical Malpractice":"Hold Negligent Providers Accountable","Patents and Intellectual Property":"Connect With IP Professionals Today","Personal Injury":"Maximize Your Injury Compensation","Probate and Estates":"Manage Probate with Expert Guidance","Product Liability":"Get Justice for Faulty Products","Real Estate":"Connect With Real Estate Professionals","Sexual Harassment":"Stand Up Against Sexual Harassment","Social Security Disability and Insurance":"Get the Benefits You Deserve","Tax and IRS":"Connect With Tax Legal Help","Traffic and Tickets":"Protect Your Record Today","Unemployment":"Connect With Unemployment Professionals","Victim of a Crime":"Seek Justice as a Crime Victim","Wills and Trusts":"Plan Your Estate with Confidence","Workers Compensation":"Maximize Your Workers' Comp Benefits","Wrongful Death":"Seek Justice for a Loved One","Wrongful Termination":"Fight Back Against Unfair Firing Today"},"defaultFinalSubHeadline":"Get a no-obligation consultation with a legal expert.","finalSubHeadlines":{}}},{"$el":"div","children":[{"$el":"div","attrs":{"id":"form-anchor","class":"t-absolute","style":{"top":"-30px","left":0}}}],"attrs":{"class":"t-relative"}},{"$cmp":"FormKit","props":{"type":"form","id":"form","config":{"validationVisibility":"submit"},"onSubmit":"$submit($submitUrl, $prepData, $handleRedirect, \"text/plain; charset=UTF-8\")","plugins":"$plugins","actions":false,"anchorElement":"form-anchor","useLocalStorage":true,"prepop":{"fromURL":true},"errorCodes":{"403":{"message":"An Error Occurred","abort":false},"409":{"abort":false},"429":"An Error Occurred","504":{"message":"An Error Occurred","abort":false}},"formClass":"!t-max-w-[40rem]","formId":"ssdi","redirectMap":{"*":"https://listings.ziplawyer.com/api/v1/redirect?zone_id=4&vertical=Legal&category=${properties.Type_Of_Legal_Problem}&Degree_Of_Interest=${properties.Degree_Of_Interest}&zip_code=${properties.Zip}&sub_id=${properties.vid}"},"name":"ssdi"},"children":[{"$el":"div","attrs":{"class":"t-mt-7 t-mb-5 t-w-full t-flex t-flex-col t-justify-center t-items-center","style":{"if":"$fns.eq($activeStep, $firstStep()) || $fns.eq($activeStep, $lastStep())","then":"display: none"}},"children":[{"$el":"div","attrs":{"class":"t-flex t-justify-center"},"children":[{"$el":"span","attrs":{"id":"progress-bar-text","class":"t-text-sm t-mb-1"},"children":["0% Complete"]}]},{"$el":"div","attrs":{"class":"t-bg-gray-100 t-w-9/12 t-rounded"},"children":[{"$el":"div","attrs":{"id":"progress-bar","class":"t-flex t-flex-col t-justify-center t-text-center t-whitespace-nowrap t-w-[10%] t-h-1.5 t-rounded t-text-white t-bg-[#007bff]","style":{"transition":"width 0.5s ease"}}}]}]},{"$el":"h1","attrs":{"class":"t-flex t-justify-center t-text-center t-text-[1.7rem] sm:t-text-[2rem] t-font-semibold t-pt-5 t-px-7 md:t-px-3 !t-text-dark f-first-headline"},"children":"$urlParam(\"hl\", \"Start Your FREE Case Evaluation\")","if":"$activeStep === $firstStep()","headlineClass":"!t-text-dark"},{"$el":"h3","attrs":{"class":"t-flex t-justify-center t-text-center t-text-[1.1rem] md:t-text-[1.2rem] t-font-medium t-text-blue-500 t-px-10 t-pb-3 !t-text-[#00428A] f-first-subheadline"},"children":"$urlParam(\"shl\", \"You Could Receive up to $3,148 Per Month!\")","if":"$activeStep === $firstStep()","subheadlineClass":"!t-text-[#00428A]"},{"$formkit":"hidden","name":"vertical","value":"Legal"},{"$formkit":"hidden","name":"TCPA_Language","value":"$meta.tcpaLanguage"},{"$formkit":"hidden","name":"gclid","value":null},{"$formkit":"hidden","name":"campaignid","value":null},{"$formkit":"hidden","name":"s","value":null},{"$el":"div","attrs":{"class":"form-body"},"children":[{"$el":"section","if":"$stepEnabled(\"ssdiTOLPAndZip\")","attrs":{"hidden":"$activeStep !== \"ssdiTOLPAndZip\"","key":"ssdiTOLPAndZip"},"children":[{"$formkit":"group","id":"ssdiTOLPAndZip","name":"ssdiTOLPAndZip","children":[{"$formkit":"hidden","name":"Type_Of_Legal_Problem","id":"Type_Of_Legal_Problem","value":"Social Security Disability and Insurance"},{"$formkit":"text","validation":"required|matches:/^[0-9]{5}$/","validationMessages":{"required":"Zip Code is required","matches":"Invalid Zip Code"},"labelClass":"required","help":"We try to match you with local help","placeholder":"#####","name":"Zip","maxlength":5,"inputmode":"numeric","autocomplete":"postal-code","wrapperClass":"t-flex t-justify-center","messagesClass":"t-flex t-justify-center","inputClass":"t-text-center","helpClass":"t-mt-2.5 !t-text-sm t-text-center","id":"Zip","onKeypress":"$onEnter($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))"}]}]},{"$el":"section","if":"$stepEnabled(\"ssdiApplicantAge\")","attrs":{"hidden":"$activeStep !== \"ssdiApplicantAge\"","key":"ssdiApplicantAge"},"children":[{"$formkit":"group","id":"ssdiApplicantAge","name":"ssdiApplicantAge","children":[{"$el":"h3","children":"What is the Age of the Applicant?","attrs":{"class":"t-flex t-justify-center t-text-center t-text-lg sm:t-text-xl t-font-bold t-text-dark t-pb-5 t-pt-0 t-px-1 "}},{"$formkit":"text","validation":"required|min:18,max:65","validationMessages":{"required":"Applicant Age is required","min":"Invalid Age - must be between 18 and 65","max":"Invalid Age - must be between 18 and 65"},"labelClass":"required","placeholder":"Age between 18 and 65","name":"Applicant_Age","value":"50","maxlength":2,"inputmode":"numeric","wrapperClass":"t-flex t-justify-center","messagesClass":"t-flex t-justify-center","inputClass":"t-text-center","helpClass":"t-mt-2.5 !t-text-sm t-text-center","id":"Applicant_Age","onKeypress":"$onEnter($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))","onInput":"$onInput($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))"}]}]},{"$el":"section","if":"$stepEnabled(\"ssdiDisabilityConditionStopWork\")","attrs":{"hidden":"$activeStep !== \"ssdiDisabilityConditionStopWork\"","key":"ssdiDisabilityConditionStopWork"},"children":[{"$formkit":"group","id":"ssdiDisabilityConditionStopWork","name":"ssdiDisabilityConditionStopWork","children":[{"$el":"h3","children":"Do You Expect To Be Out Of Work For At Least a Year Due To Your Health?","attrs":{"class":"t-flex t-justify-center t-text-center t-text-lg sm:t-text-xl t-font-bold t-text-dark t-pb-5 t-pt-0 t-px-1 "}},{"$formkit":"radio","validation":"required","validationMessages":{"required":"Field is required"},"optionsClass":"t-flex t-justify-center t-my-3","legendClass":"legend-left","name":"Disability_Condition_Stop_Work","options":["Yes","No"],"fieldsetClass":"$reset t-flex t-justify-center t-flex-col-reverse t-items-center","optionClass":"radiobtn t-my-2 sm:t-my-0 t-mx-2 md:t-mx-5","wrapperClass":"$reset formkit-wrapper t-mb-0 t-flex t-items-center t-h-[100%]","labelClass":"t-font-semibold t-text-[#1e448f] t-w-[100%]","decoratorIcon":false,"messagesClass":"t-flex t-justify-center","helpClass":"t-mt-2.5 !t-text-sm t-text-center","id":"Disability_Condition_Stop_Work","onKeypress":"$onEnter($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))","onInput":"$onInput($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))"}]}]},{"$el":"section","if":"$stepEnabled(\"ssdiDisabilityWorkHistory\")","attrs":{"hidden":"$activeStep !== \"ssdiDisabilityWorkHistory\"","key":"ssdiDisabilityWorkHistory"},"children":[{"$formkit":"group","id":"ssdiDisabilityWorkHistory","name":"ssdiDisabilityWorkHistory","children":[{"$el":"h3","children":"Have You Had a Full-Time Job Within the Past 5 Years?","attrs":{"class":"t-flex t-justify-center t-text-center t-text-lg sm:t-text-xl t-font-bold t-text-dark t-pb-5 t-pt-0 t-px-1 "}},{"$formkit":"radio","validation":"required","validationMessages":{"required":"Field is required"},"optionsClass":"t-flex t-justify-center t-my-3","legendClass":"legend-left","name":"Disability_Work_History","options":["Yes","No"],"fieldsetClass":"$reset t-flex t-justify-center t-flex-col-reverse t-items-center","optionClass":"radiobtn t-my-2 sm:t-my-0 t-mx-2 md:t-mx-5","wrapperClass":"$reset formkit-wrapper t-mb-0 t-flex t-items-center t-h-[100%]","labelClass":"t-font-semibold t-text-[#1e448f] t-w-[100%]","decoratorIcon":false,"messagesClass":"t-flex t-justify-center","helpClass":"t-mt-2.5 !t-text-sm t-text-center","id":"Disability_Work_History","onKeypress":"$onEnter($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))","onInput":"$onInput($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))"}]}]},{"$el":"section","if":"$stepEnabled(\"ssdiSocialSecurityDisabilityReceivingBenefits\")","attrs":{"hidden":"$activeStep !== \"ssdiSocialSecurityDisabilityReceivingBenefits\"","key":"ssdiSocialSecurityDisabilityReceivingBenefits"},"children":[{"$formkit":"group","id":"ssdiSocialSecurityDisabilityReceivingBenefits","name":"ssdiSocialSecurityDisabilityReceivingBenefits","children":[{"$el":"h3","children":"Are You Currently Receiving Social Security Disability Benefits?","attrs":{"class":"t-flex t-justify-center t-text-center t-text-lg sm:t-text-xl t-font-bold t-text-dark t-pb-5 t-pt-0 t-px-1 "}},{"$formkit":"radio","validation":"required","validationMessages":{"required":"Field is required"},"optionsClass":"t-flex t-justify-center t-my-3","legendClass":"legend-left","name":"Social_Security_Disability_Receiving_Benefits","options":["Yes","No"],"fieldsetClass":"$reset t-flex t-justify-center t-flex-col-reverse t-items-center","optionClass":"radiobtn t-my-2 sm:t-my-0 t-mx-2 md:t-mx-5","wrapperClass":"$reset formkit-wrapper t-mb-0 t-flex t-items-center t-h-[100%]","labelClass":"t-font-semibold t-text-[#1e448f] t-w-[100%]","decoratorIcon":false,"messagesClass":"t-flex t-justify-center","helpClass":"t-mt-2.5 !t-text-sm t-text-center","id":"Social_Security_Disability_Receiving_Benefits","onKeypress":"$onEnter($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))","onInput":"$onInput($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))"}]}]},{"$el":"section","if":"$stepEnabled(\"ssdiDoctorTreatment\")","attrs":{"hidden":"$activeStep !== \"ssdiDoctorTreatment\"","key":"ssdiDoctorTreatment"},"children":[{"$formkit":"group","id":"ssdiDoctorTreatment","name":"ssdiDoctorTreatment","children":[{"$el":"h3","children":"Have You Recently Been Treated by a Doctor, Hospital or Clinic?","attrs":{"class":"t-flex t-justify-center t-text-center t-text-lg sm:t-text-xl t-font-bold t-text-dark t-pb-5 t-pt-0 t-px-1 "}},{"$formkit":"radio","validation":"required","validationMessages":{"required":"Field is required"},"optionsClass":"t-flex t-justify-center t-my-3","legendClass":"legend-left","name":"Doctor_Treatment","options":["Yes","No"],"fieldsetClass":"$reset t-flex t-justify-center t-flex-col-reverse t-items-center","optionClass":"radiobtn t-my-2 sm:t-my-0 t-mx-2 md:t-mx-5","wrapperClass":"$reset formkit-wrapper t-mb-0 t-flex t-items-center t-h-[100%]","labelClass":"t-font-semibold t-text-[#1e448f] t-w-[100%]","decoratorIcon":false,"messagesClass":"t-flex t-justify-center","helpClass":"t-mt-2.5 !t-text-sm t-text-center","id":"Doctor_Treatment","onKeypress":"$onEnter($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))","onInput":"$onInput($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))"}]}]},{"$el":"section","if":"$stepEnabled(\"ssdiHaveAttorney\")","attrs":{"hidden":"$activeStep !== \"ssdiHaveAttorney\"","key":"ssdiHaveAttorney"},"children":[{"$formkit":"group","id":"ssdiHaveAttorney","name":"ssdiHaveAttorney","children":[{"$el":"h3","children":"Already Working with An Attorney?","attrs":{"class":"t-flex t-justify-center t-text-center t-text-lg sm:t-text-xl t-font-bold t-text-dark t-pb-5 t-pt-0 t-px-1 "}},{"$formkit":"radio","validation":"required","validationMessages":{"required":"Field is required"},"optionsClass":"t-flex t-justify-center t-my-3","legendClass":"legend-left","name":"Have_Attorney","options":["Yes","No"],"fieldsetClass":"$reset t-flex t-justify-center t-flex-col-reverse t-items-center","optionClass":"radiobtn t-my-2 sm:t-my-0 t-mx-2 md:t-mx-5","wrapperClass":"$reset formkit-wrapper t-mb-0 t-flex t-items-center t-h-[100%]","labelClass":"t-font-semibold t-text-[#1e448f] t-w-[100%]","decoratorIcon":false,"messagesClass":"t-flex t-justify-center","helpClass":"t-mt-2.5 !t-text-sm t-text-center","id":"Have_Attorney","onKeypress":"$onEnter($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))","onInput":"$onInput($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))"}]}]},{"$el":"section","if":"$stepEnabled(\"commentsWithBankruptcy\")","attrs":{"hidden":"$activeStep !== \"commentsWithBankruptcy\"","key":"commentsWithBankruptcy"},"children":[{"$formkit":"group","id":"commentsWithBankruptcy","name":"commentsWithBankruptcy","children":[{"$el":"h3","children":"Please briefly describe your situation:","attrs":{"class":"t-flex t-justify-center t-text-center t-text-lg sm:t-text-xl t-font-bold t-text-blue-500 t-pb-5 t-pt-0 t-px-1 !t-text-dark"}},{"$formkit":"textarea","rows":5,"maxlength":500,"validation":"required","validationMessages":{"required":"Field is required"},"innerClass":"t-max-w-xl","labelClass":"required","name":"Comments","label":null,"placeholder":"$getKey($meta, \"commentsPlaceholders.\" + $get(Type_Of_Legal_Problem).value, $meta.defaultCommentsPlaceholder)","inputClass":"!t-h-32","id":"Comments"},{"$formkit":"checkbox","validation":null,"validationMessages":{"required":"Field is required"},"label":"I'd also like a consult for bankruptcy or debt elimination (optional)","help":"Note: you will be contacted separately by a bankruptcy/debt expert","name":"CrossSell_Bankruptcy","id":"CrossSell_Bankruptcy","if":"$getVal($get(form), \"Type_Of_Legal_Problem\") != \"Bankruptcy\" && ($getVal($get(form), \"Degree_Of_Interest\") == \"Absolutely Can't Afford\" || $getVal($get(form), \"Degree_Of_Interest\") == \"Maybe\" || $getVal($get(form), \"Degree_Of_Interest\") == \"Probably\")","helpClass":"!t-text-sm","legendClass":"legend-left required","fieldsetClass":"$reset side-by-side","optionsClass":"t-pl-1","innerClass":"t-flex t-items-center","wrapperClass":"t-mb-3"},{"$el":"div","if":"$get(CrossSell_Bankruptcy).value == true","children":[{"$formkit":"textarea","rows":5,"maxlength":500,"validation":"required","validationMessages":{"required":"Field is required"},"innerClass":"t-max-w-xl","labelClass":"required","name":"CrossSell:Bankruptcy:Comments","label":"Bankruptcy or debt details:","placeholder":"Please describe your bankrtupcy or debt situation in a few words...","inputClass":"!t-h-16","id":"CrossSell:Bankruptcy:Comments"}]}]}]},{"$el":"section","if":"$stepEnabled(\"firstAndLast\")","attrs":{"hidden":"$activeStep !== \"firstAndLast\"","key":"firstAndLast"},"children":[{"$formkit":"group","id":"firstAndLast","name":"firstAndLast","children":[{"$el":"h3","children":"Please Provide a Contact Name","attrs":{"class":"t-flex t-justify-center t-text-center t-text-xl t-font-bold t-text-blue-500 t-pb-5 t-pt-0 t-px-1 !t-text-dark"}},{"$formkit":"text","validation":"required","validationMessages":{"required":"First Name is required"},"labelClass":"required","label":"First Name:","placeholder":"First Name","name":"First_Name","autocomplete":"given-name","wrapperClass":"side-by-side t-items-center","id":"First_Name"},{"$formkit":"text","validation":"required","validationMessages":{"required":"Last Name is required"},"labelClass":"required","label":"Last Name:","placeholder":"Last Name","name":"Last_Name","autocomplete":"family-name","wrapperClass":"side-by-side t-items-center","id":"Last_Name","onKeypress":"$onEnter($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))"}]}]},{"$el":"section","if":"$stepEnabled(\"contactInfo\")","attrs":{"hidden":"$activeStep !== \"contactInfo\"","key":"contactInfo"},"children":[{"$formkit":"group","id":"contactInfo","name":"contactInfo","children":[{"$el":"h3","children":"Submit Your Free Application","attrs":{"class":"t-flex t-justify-center t-text-center t-text-2xl t-font-bold t-text-blue-500 t-pb-3 t-pt-4 t-px-1 !t-text-[#00428A] f-contact-info-headline"}},{"$el":"h5","children":"Based on your input you may qualify for SSDI benefits. Please verify your contact information.","attrs":{"class":"t-flex t-justify-center t-text-center !t-text-lg t-font-semibold t-pb-6 t-pt-0 t-px-3  f-contact-info-subheadline"}},{"$el":"script","if":"$activeStep === $lastStep()","children":"(function() {\n  if (window.xxTrustedFormLoaded) {\n    return\n  }\n  var vid = '';\n  if (typeof window.zar !== 'undefined') {\n    vid = window.zar.getVID();\n  }\n  window.xxTrustedFormLoaded = true;\n  var sandbox = document.location.hostname.indexOf('localhost') > -1 ? 'true' : 'false'\n  var tf = document.createElement('script');\n  tf.type = 'text/javascript'; tf.async = true;\n  tf.src = (\"https:\" == document.location.protocol ? 'https' : 'http') + \"://api.trustedform.com/trustedform.js?field=xxTrustedFormCertUrl&identifier=\" + vid + \"&ping_field=xxTrustedFormPingUrl&provideReferrer=false&invert_field_sensitivity=true&sandbox=\" + sandbox + \"&l=\" + new Date().getTime() + Math.random();\n  var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(tf, s);\n})();"},{"$formkit":"email","validation":"required|email","validationMessages":{"required":"Email is required","email":"Invalid Email"},"labelClass":"required","name":"Email","label":"Email Address:","placeholder":"email@domain.com","autocomplete":"email","data-tf-sensitive":"false","wrapperClass":"side-by-side t-items-center","id":"Email"},{"$formkit":"tel","validation":"required|matches:/^[0-9]{3}-?[0-9]{3}-?[0-9]{4}$/|valid_phone","validationMessages":{"required":"Phone Number is required","matches":"Invalid Phone Format, use ###-###-####","valid_phone":"Invalid Phone Number"},"labelClass":"required","name":"Primary_Phone","label":"Phone Number:","placeholder":"###-###-####","maxlength":12,"help":"10-digit phone number, hyphens optional","autocomplete":"tel-national","data-tf-sensitive":"false","helpClass":"t-mt-2.5 md:t-text-right md:t-mt-[-2px]","wrapperClass":"side-by-side t-items-center","id":"Primary_Phone"},{"$formkit":"checkbox","label":"$meta.tcpaLanguage","__raw__sectionsSchema":{"label":{"attrs":{"innerHTML":"$label"}}},"name":"TCPA_Opt_In","data-tf-sensitive":"false","validation":"required|accepted","validationMessages":{"required":"Consent is required","accepted":"Consent is required"},"classes":{"outer":"","wrapper":"","messages":"","label":"!t-text-[0.7rem] t-text-slate-500 t-font-normal !t-leading-[0.9rem]"}},{"$el":"div","if":"$activeStep === $lastStep()","attrs":{"class":"t-flex t-justify-center t-items-center t-text-sm t-text-gray-500"},"children":[{"$el":"img","attrs":{"loading":"lazy","alt":"","style":{"border":0},"width":"25","height":"25","src":"https://d27hmee62k45vz.cloudfront.net/lock_icon_1.jpeg"}},{"$el":"span","children":"Secure & Encrypted","attrs":{"class":"t-pl-2 t-pt-1 t-font-medium"}}]}]}]},{"$el":"div","attrs":{"class":{"if":"$activeStep === $firstStep()","then":"step-nav !t-justify-center sm:!t-justify-between","else":"step-nav !t-justify-between"}},"children":[{"$formkit":"button","name":"back_button","onClick":"$setPreviousStep($prevStepFunc($get(form)))","children":"Back","outerClass":{"if":"$activeStep === $firstStep()","then":"t-hidden sm:t-block","else":""},"style":{"if":"$activeStep === $firstStep()","then":"display: none;"},"classes":{"input":" f-navigation-input"}},{"$formkit":"button","name":"next_button","onClick":"$setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form)))","children":{"if":"$activeStep === $firstStep()","then":"Start","else":"Next"},"outerClass":{"if":"$activeStep === $lastStep()","then":"t-hidden","else":""},"style":{"if":"$activeStep === $lastStep()","then":"display: none;"},"classes":{"input":" f-navigation-input"}},{"$formkit":"submit","name":"submit_button","label":"Submit","if":"$activeStep === $lastStep()","style":{"if":"$activeStep !== $lastStep()","then":"display: none;"},"classes":{"input":" !t-ml-2 sm:!t-ml-auto f-navigation-input"}}]},{"$el":"pre","if":"$urlParam(\"fdbg\", \"\") == 1","children":[{"$el":"pre","children":"$stringify( $get(form).value )","attrs":{"class":"t-text-xs","style":"overflow: scroll"}},{"$el":"pre","children":["activeStep: ","$activeStep"],"attrs":{"class":"t-text-xs","style":"overflow: scroll"}},{"$el":"pre","children":["stepHistory: ","$stepHistory"],"attrs":{"class":"t-text-xs","style":"overflow: scroll"}},{"$el":"pre","children":["stepQueue: ","$stepQueue"],"attrs":{"class":"t-text-xs","style":"overflow: scroll"}},{"$el":"pre","children":["steps: ","$stepKeys()"],"attrs":{"class":"t-text-xs","style":"overflow: scroll"}}]}]}]}]
+[{"type":"meta","data":{"tcpaLanguage":"By checking this box, I agree to the Terms of Use and consent to be contacted by <a href=\"/providers\" target=\"_blank\">lawyers, lawyer networks, and partners</a> of this website using live, autodialed, pre-recorded, or artificial voice calls and text messages, at any time including before 8 AM or after 9 PM local time. Your consent is not required as a condition of purchasing any goods or services. To submit this request without this consent, call 878-213-4937.","defaultCommentsPlaceholder":"$getKey($meta, \"commentsPlaceholders.\" + $get(Type_Of_Legal_Problem).value, $meta.defaultCommentsPlaceholder)","commentsPlaceholders":{"Adoption":"Example: \"I need help with adoption forms\"","Asbestos and Mesothelioma":"Example: \"I was exposed to asbestos at work and would like to file a claim\"","Auto and Car Accidents":"Example: \"A truck crashed into my car on the highway\" or \"I've been involved in a hit and run accident\"","Bankruptcy":"Example: \"I need help filing for bankruptcy\"","Birth Certificate and Name Change":"Example: \"Just married and would like to change my last name\"","Business Lawyers":"Example: \"I need help incorporating a business\" or \"I would like a legal contract reviewed\"","Child Custody and Support":"Example: \"Need help getting custody\" or \"Issues with child support payments\"","Child Custody":"Example: \"Need help getting custody\"","Child Support":"Example: \"Issues with child support payments\"","Civil Rights and Discrimination":"Example: \"Police brutality\" or \"Coworker keeps harassing me\"","Civil Lawsuit":"Example: \"A contractor took my money and never completed the job\" or \"I am being sued by a neighbor\"","File a Lawsuit":"Example: \"A contractor took my money and never completed the job\"","Defend a Lawsuit":"Example: \"I am being sued by a neighbor\"","Consumer Lawyers":"Example: \"Someone committed fraud against me\" or \"A contractor took my money and never completed the job\"","Copyrights and Trademarks":"Example: \"I would like to register a trademark or copyright a name\"","Criminal and Felony":"Example: \"I was arrested for DUI and need legal defense\" or \"I am being charged with assault\"","Debt and Collections":"Example: \"I would like to consolidate my debt\" or \"A collection agency is harassing me\"","Divorce and Separation":"Example: \"I would like to file for an uncontested divorce\"","DUI and DWI":"Example: \"I was arrested for DUI and need legal defense\"","Elder Law":"Example: \"I would like help with Estate Planning\" or \"I need help with a guardianship\"","Employment and Workplace":"Example: \"I was injured while on the job\" or \"My company is discriminating against me\"","Expungement":"Example: \"I would like to file for an expungement and clear my record\"","Family Issues":"Example: \"I need help with guardianship\" or \"I need a simple will created\"","Foreclosure":"Example: \"I need help to avoid foreclosure on my house\"","Guardianship":"Example: \"I need help with guardianship documents\"","Harassment and Discrimination":"Example: \"I am being discriminated at work\" or \"My neighbor is harassing me\"","Sexual Harassment":"Example: \"I am being sexually harassed by a coworker\"","Workplace Harassment":"Example: \"My coworker is being aggressive towards me\"","Non-Workplace Harassment":"Example: \"My neighbor is harassing me\"","Workplace Discrimination":"Example: \"I am being discriminated at work based on my age\"","Non-Workplace Discrimination":"Example: \"I am being discriminated against by a local official\"","Identity Theft":"Example: \"Someone stole my identity and I need help fixing the issue\"","Immigration and Visas":"Example: \"I need help filing for a visa\" or \"Help with a green card\"","Insurance":"Example: \"I need help filing an insurance claim for damage to my house\"","Landlord and Tenant":"Example: \"I need help to fight an eviction\" or \"I would like a lawyer to review a rental contract\"","Lemon Law":"Example: \"I purchased a new vehicle that broke down already and seller will not assist\"","Long Term Disability":"Example: \"I was injured on the job and would like to file for benefits\" or \"I need help filing for disability benefits\"","Medical Malpractice":"Example: \"A doctor performed surgery on the wrong limb and I would like to file a lawsuit\"","Patents and Intellectual Property":"Example: \"I would like to file for a patent\" or \"I need to copyright a name\"","Personal Injury":"Example: \"I was bit by the neighbor's dog\" or \"I fell in the icy grocery store parking lot\"","Power of Attorney":"Example: \"I need help with a limited or general power of attorney\"","Probate and Estates":"Example: \"I need help with planning for my estate\" or \"A family member passed without a will in place\"","Product Liability":"Example: \"My car battery caught on fire\" or \"I purchased a faulty product\"","Property Damage":"Example: \"The neighbor's tree fell on my fence\" or \"My car was hit in the parking lot\"","Real Estate":"Example: \"I need help with a quitclaim deed\" or \"I need a lawyer to review a purchase and sales agreement\"","Social Security Disability and Insurance":"Example: \"I would like help filing for disability benefits\" or \"I've been denied for SSDI and would like to appeal\"","Tax and IRS":"Example: \"I need help fighting an IRS tax claim\" or \"I need audit defense\"","Traffic and Tickets":"Example: \"I need help reinstating a supsended license\" or \"I would like to fight a traffic ticket\"","Unemployment":"Example: \"I need help filing for unemployment benefits\"","Victim of a Crime":"Example: \"I was assaulted in the store\" or \"I am being discriminated against at work\"","Wills and Trusts":"Example: \"I need a simple will created\" or \"I would like guidance on creating a trust fund\"","Workers Compensation":"Example: \"I broke my arm at work and need help getting compensation\"","Wrongful Death":"Example: \"A family member was killed on the job and we need legal representation\"","Wrongful Termination":"Example: \"I was fired by my employer without cause\"","Not Sure or Other":"Example: \"I was involved in a car accident\" or \"I need help setting up power of attorney\""},"defaultFinalHeadline":"Connect With The Legal Help You Deserve","finalHeadlines":{"Adoption":"Connect With Adoption Professionals Today","Auto and Car Accidents":"Connect With Accident Professionals Today","Bankruptcy":"Take Control of Your Financial Future","Birth Certificate and Name Change":"Start Your Change Today","Business Lawyers":"Connect With Business Professionals Today","Child Custody":"Connect With Custody Professionals Today","Child Support":"Connect With Child Support Professionals","Civil Rights and Discrimination":"Stand Up For Your Rights","Civil Lawsuit":"Connect With Lawsuit Professionals Today","Copyrights and Trademarks":"Protect Your Intellectual Property","Debt and Collections":"Connect With Debt Professionals Today","Divorce and Separation":"Connect With Divorce Professionals Today","DUI and DWI":"Defend Against DUI Charges","Elder Law":"Connect With Elder Law Professionals","Expungement":"Clear Your Record","Family Issues":"Connect With Family Legal Help","Foreclosure":"Fight to Keep Your Home","Guardianship":"Connect With Guardianship Professionals","Immigration and Visas":"Get Immigration Legal Help","Insurance":"Get Insurance Legal Help","Lemon Law":"Connect With Lemon Law Professionals","Long Term Disability":"Connect With Disability Professionals","Medical Malpractice":"Hold Negligent Providers Accountable","Patents and Intellectual Property":"Connect With IP Professionals Today","Personal Injury":"Maximize Your Injury Compensation","Probate and Estates":"Manage Probate with Expert Guidance","Product Liability":"Get Justice for Faulty Products","Real Estate":"Connect With Real Estate Professionals","Sexual Harassment":"Stand Up Against Sexual Harassment","Social Security Disability and Insurance":"Get the Benefits You Deserve","Tax and IRS":"Connect With Tax Legal Help","Traffic and Tickets":"Protect Your Record Today","Unemployment":"Connect With Unemployment Professionals","Victim of a Crime":"Seek Justice as a Crime Victim","Wills and Trusts":"Plan Your Estate with Confidence","Workers Compensation":"Maximize Your Workers' Comp Benefits","Wrongful Death":"Seek Justice for a Loved One","Wrongful Termination":"Fight Back Against Unfair Firing Today"},"defaultFinalSubHeadline":"Get a no-obligation consultation with a legal expert.","finalSubHeadlines":{}}},{"$el":"div","children":[{"$el":"div","attrs":{"id":"form-anchor","class":"t-absolute","style":{"top":"-30px","left":0}}}],"attrs":{"class":"t-relative"}},{"$cmp":"FormKit","props":{"type":"form","id":"form","config":{"validationVisibility":"submit"},"onSubmit":"$submit($submitUrl, $prepData, $handleRedirect, \"text/plain; charset=UTF-8\")","plugins":"$plugins","actions":false,"anchorElement":"form-anchor","useLocalStorage":true,"prepop":{"fromURL":true},"errorCodes":{"403":{"message":"An Error Occurred","abort":false},"409":{"abort":false},"429":"An Error Occurred","504":{"message":"An Error Occurred","abort":false}},"formClass":"!t-max-w-[40rem]","formId":"ssdi","redirectMap":{"*":"https://listings.ziplawyer.com/api/v1/redirect?zone_id=4&vertical=Legal&category=${properties.Type_Of_Legal_Problem}&Degree_Of_Interest=${properties.Degree_Of_Interest}&zip_code=${properties.Zip}&sub_id=${properties.vid}"},"name":"ssdi"},"children":[{"$el":"div","attrs":{"class":"t-mt-7 t-mb-5 t-w-full t-flex t-flex-col t-justify-center t-items-center","style":{"if":"$fns.eq($activeStep, $firstStep()) || $fns.eq($activeStep, $lastStep())","then":"display: none"}},"children":[{"$el":"div","attrs":{"class":"t-flex t-justify-center"},"children":[{"$el":"span","attrs":{"id":"progress-bar-text","class":"t-text-sm t-mb-1"},"children":["0% Complete"]}]},{"$el":"div","attrs":{"class":"t-bg-gray-100 t-w-9/12 t-rounded"},"children":[{"$el":"div","attrs":{"id":"progress-bar","class":"t-flex t-flex-col t-justify-center t-text-center t-whitespace-nowrap t-w-[10%] t-h-1.5 t-rounded t-text-white t-bg-[#007bff]","style":{"transition":"width 0.5s ease"}}}]}]},{"$el":"h1","attrs":{"class":"t-flex t-justify-center t-text-center t-text-[1.7rem] sm:t-text-[2rem] t-font-semibold t-pt-5 t-px-7 md:t-px-3 !t-text-dark f-first-headline"},"children":"$urlParam(\"hl\", \"Start Your FREE Case Evaluation\")","if":"$activeStep === $firstStep()","headlineClass":"!t-text-dark"},{"$el":"h3","attrs":{"class":"t-flex t-justify-center t-text-center t-text-[1.1rem] md:t-text-[1.2rem] t-font-medium t-text-blue-500 t-px-10 t-pb-3 !t-text-[#00428A] f-first-subheadline"},"children":"$urlParam(\"shl\", \"You Could Receive up to $3,148 Per Month!\")","if":"$activeStep === $firstStep()","subheadlineClass":"!t-text-[#00428A]"},{"$formkit":"hidden","name":"vertical","value":"Legal"},{"$formkit":"hidden","name":"TCPA_Language","value":"$meta.tcpaLanguage"},{"$formkit":"hidden","name":"gclid","value":null},{"$formkit":"hidden","name":"campaignid","value":null},{"$formkit":"hidden","name":"s","value":null},{"$el":"div","attrs":{"class":"form-body"},"children":[{"$el":"section","if":"$stepEnabled(\"ssdiTOLPAndZip\")","attrs":{"hidden":"$activeStep !== \"ssdiTOLPAndZip\"","key":"ssdiTOLPAndZip"},"children":[{"$formkit":"group","id":"ssdiTOLPAndZip","name":"ssdiTOLPAndZip","children":[{"$formkit":"hidden","name":"Type_Of_Legal_Problem","id":"Type_Of_Legal_Problem","value":"Social Security Disability and Insurance"},{"$formkit":"text","validation":"required|matches:/^[0-9]{5}$/","validationMessages":{"required":"Zip Code is required","matches":"Invalid Zip Code"},"labelClass":"required","help":"We try to match you with local help","placeholder":"#####","name":"Zip","maxlength":5,"inputmode":"numeric","autocomplete":"postal-code","wrapperClass":"t-flex t-justify-center","messagesClass":"t-flex t-justify-center","inputClass":"t-text-center","helpClass":"t-mt-2.5 !t-text-sm t-text-center","id":"Zip","onKeypress":"$onEnter($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))"}]}]},{"$el":"section","if":"$stepEnabled(\"ssdiApplicantAge\")","attrs":{"hidden":"$activeStep !== \"ssdiApplicantAge\"","key":"ssdiApplicantAge"},"children":[{"$formkit":"group","id":"ssdiApplicantAge","name":"ssdiApplicantAge","children":[{"$el":"h3","children":"What is the Age of the Applicant?","attrs":{"class":"t-flex t-justify-center t-text-center t-text-lg sm:t-text-xl t-font-bold t-text-dark t-pb-5 t-pt-0 t-px-1 "}},{"$formkit":"text","validation":"required|min:18,max:65","validationMessages":{"required":"Applicant Age is required","min":"Invalid Age - must be between 18 and 65","max":"Invalid Age - must be between 18 and 65"},"labelClass":"required","placeholder":"Age between 18 and 65","name":"Applicant_Age","value":"50","maxlength":2,"inputmode":"numeric","wrapperClass":"t-flex t-justify-center","messagesClass":"t-flex t-justify-center","inputClass":"t-text-center","helpClass":"t-mt-2.5 !t-text-sm t-text-center","id":"Applicant_Age","onKeypress":"$onEnter($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))","onInput":"$onInput($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))"}]}]},{"$el":"section","if":"$stepEnabled(\"ssdiDisabilityConditionStopWork\")","attrs":{"hidden":"$activeStep !== \"ssdiDisabilityConditionStopWork\"","key":"ssdiDisabilityConditionStopWork"},"children":[{"$formkit":"group","id":"ssdiDisabilityConditionStopWork","name":"ssdiDisabilityConditionStopWork","children":[{"$el":"h3","children":"Do You Expect To Be Out Of Work For At Least a Year Due To Your Health?","attrs":{"class":"t-flex t-justify-center t-text-center t-text-lg sm:t-text-xl t-font-bold t-text-dark t-pb-5 t-pt-0 t-px-1 "}},{"$formkit":"radio","validation":"required","validationMessages":{"required":"Field is required"},"optionsClass":"t-flex t-justify-center t-my-3","legendClass":"legend-left","name":"Disability_Condition_Stop_Work","options":["Yes","No"],"fieldsetClass":"$reset t-flex t-justify-center t-flex-col-reverse t-items-center","optionClass":"radiobtn t-my-2 sm:t-my-0 t-mx-2 md:t-mx-5","wrapperClass":"$reset formkit-wrapper t-mb-0 t-flex t-items-center t-h-[100%]","labelClass":"t-font-semibold t-text-[#1e448f] t-w-[100%]","decoratorIcon":false,"messagesClass":"t-flex t-justify-center","helpClass":"t-mt-2.5 !t-text-sm t-text-center","id":"Disability_Condition_Stop_Work","onKeypress":"$onEnter($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))","onInput":"$onInput($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))"}]}]},{"$el":"section","if":"$stepEnabled(\"ssdiDisabilityWorkHistory\")","attrs":{"hidden":"$activeStep !== \"ssdiDisabilityWorkHistory\"","key":"ssdiDisabilityWorkHistory"},"children":[{"$formkit":"group","id":"ssdiDisabilityWorkHistory","name":"ssdiDisabilityWorkHistory","children":[{"$el":"h3","children":"Have You Had a Full-Time Job Within the Past 5 Years?","attrs":{"class":"t-flex t-justify-center t-text-center t-text-lg sm:t-text-xl t-font-bold t-text-dark t-pb-5 t-pt-0 t-px-1 "}},{"$formkit":"radio","validation":"required","validationMessages":{"required":"Field is required"},"optionsClass":"t-flex t-justify-center t-my-3","legendClass":"legend-left","name":"Disability_Work_History","options":["Yes","No"],"fieldsetClass":"$reset t-flex t-justify-center t-flex-col-reverse t-items-center","optionClass":"radiobtn t-my-2 sm:t-my-0 t-mx-2 md:t-mx-5","wrapperClass":"$reset formkit-wrapper t-mb-0 t-flex t-items-center t-h-[100%]","labelClass":"t-font-semibold t-text-[#1e448f] t-w-[100%]","decoratorIcon":false,"messagesClass":"t-flex t-justify-center","helpClass":"t-mt-2.5 !t-text-sm t-text-center","id":"Disability_Work_History","onKeypress":"$onEnter($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))","onInput":"$onInput($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))"}]}]},{"$el":"section","if":"$stepEnabled(\"ssdiSocialSecurityDisabilityReceivingBenefits\")","attrs":{"hidden":"$activeStep !== \"ssdiSocialSecurityDisabilityReceivingBenefits\"","key":"ssdiSocialSecurityDisabilityReceivingBenefits"},"children":[{"$formkit":"group","id":"ssdiSocialSecurityDisabilityReceivingBenefits","name":"ssdiSocialSecurityDisabilityReceivingBenefits","children":[{"$el":"h3","children":"Are You Currently Receiving Social Security Disability Benefits?","attrs":{"class":"t-flex t-justify-center t-text-center t-text-lg sm:t-text-xl t-font-bold t-text-dark t-pb-5 t-pt-0 t-px-1 "}},{"$formkit":"radio","validation":"required","validationMessages":{"required":"Field is required"},"optionsClass":"t-flex t-justify-center t-my-3","legendClass":"legend-left","name":"Social_Security_Disability_Receiving_Benefits","options":["Yes","No"],"fieldsetClass":"$reset t-flex t-justify-center t-flex-col-reverse t-items-center","optionClass":"radiobtn t-my-2 sm:t-my-0 t-mx-2 md:t-mx-5","wrapperClass":"$reset formkit-wrapper t-mb-0 t-flex t-items-center t-h-[100%]","labelClass":"t-font-semibold t-text-[#1e448f] t-w-[100%]","decoratorIcon":false,"messagesClass":"t-flex t-justify-center","helpClass":"t-mt-2.5 !t-text-sm t-text-center","id":"Social_Security_Disability_Receiving_Benefits","onKeypress":"$onEnter($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))","onInput":"$onInput($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))"}]}]},{"$el":"section","if":"$stepEnabled(\"ssdiDoctorTreatment\")","attrs":{"hidden":"$activeStep !== \"ssdiDoctorTreatment\"","key":"ssdiDoctorTreatment"},"children":[{"$formkit":"group","id":"ssdiDoctorTreatment","name":"ssdiDoctorTreatment","children":[{"$el":"h3","children":"Have You Recently Been Treated by a Doctor, Hospital or Clinic?","attrs":{"class":"t-flex t-justify-center t-text-center t-text-lg sm:t-text-xl t-font-bold t-text-dark t-pb-5 t-pt-0 t-px-1 "}},{"$formkit":"radio","validation":"required","validationMessages":{"required":"Field is required"},"optionsClass":"t-flex t-justify-center t-my-3","legendClass":"legend-left","name":"Doctor_Treatment","options":["Yes","No"],"fieldsetClass":"$reset t-flex t-justify-center t-flex-col-reverse t-items-center","optionClass":"radiobtn t-my-2 sm:t-my-0 t-mx-2 md:t-mx-5","wrapperClass":"$reset formkit-wrapper t-mb-0 t-flex t-items-center t-h-[100%]","labelClass":"t-font-semibold t-text-[#1e448f] t-w-[100%]","decoratorIcon":false,"messagesClass":"t-flex t-justify-center","helpClass":"t-mt-2.5 !t-text-sm t-text-center","id":"Doctor_Treatment","onKeypress":"$onEnter($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))","onInput":"$onInput($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))"}]}]},{"$el":"section","if":"$stepEnabled(\"ssdiHaveAttorney\")","attrs":{"hidden":"$activeStep !== \"ssdiHaveAttorney\"","key":"ssdiHaveAttorney"},"children":[{"$formkit":"group","id":"ssdiHaveAttorney","name":"ssdiHaveAttorney","children":[{"$el":"h3","children":"Already Working with An Attorney?","attrs":{"class":"t-flex t-justify-center t-text-center t-text-lg sm:t-text-xl t-font-bold t-text-dark t-pb-5 t-pt-0 t-px-1 "}},{"$formkit":"radio","validation":"required","validationMessages":{"required":"Field is required"},"optionsClass":"t-flex t-justify-center t-my-3","legendClass":"legend-left","name":"Have_Attorney","options":["Yes","No"],"fieldsetClass":"$reset t-flex t-justify-center t-flex-col-reverse t-items-center","optionClass":"radiobtn t-my-2 sm:t-my-0 t-mx-2 md:t-mx-5","wrapperClass":"$reset formkit-wrapper t-mb-0 t-flex t-items-center t-h-[100%]","labelClass":"t-font-semibold t-text-[#1e448f] t-w-[100%]","decoratorIcon":false,"messagesClass":"t-flex t-justify-center","helpClass":"t-mt-2.5 !t-text-sm t-text-center","id":"Have_Attorney","onKeypress":"$onEnter($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))","onInput":"$onInput($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))"}]}]},{"$el":"section","if":"$stepEnabled(\"commentsWithBankruptcy\")","attrs":{"hidden":"$activeStep !== \"commentsWithBankruptcy\"","key":"commentsWithBankruptcy"},"children":[{"$formkit":"group","id":"commentsWithBankruptcy","name":"commentsWithBankruptcy","children":[{"$el":"h3","children":"Please briefly describe your situation:","attrs":{"class":"t-flex t-justify-center t-text-center t-text-lg sm:t-text-xl t-font-bold t-text-blue-500 t-pb-5 t-pt-0 t-px-1 !t-text-dark"}},{"$formkit":"textarea","rows":5,"maxlength":500,"validation":"required","validationMessages":{"required":"Field is required"},"innerClass":"t-max-w-xl","labelClass":"required","name":"Comments","label":null,"placeholder":"$getKey($meta, \"commentsPlaceholders.\" + $get(Type_Of_Legal_Problem).value, $meta.defaultCommentsPlaceholder)","inputClass":"!t-h-32","id":"Comments"},{"$formkit":"checkbox","validation":null,"validationMessages":{"required":"Field is required"},"label":"I'd also like a consult for bankruptcy or debt elimination (optional)","help":"Note: you will be contacted separately by a bankruptcy/debt expert","name":"CrossSell_Bankruptcy","id":"CrossSell_Bankruptcy","if":"$getVal($get(form), \"Type_Of_Legal_Problem\") != \"Bankruptcy\" && ($getVal($get(form), \"Degree_Of_Interest\") == \"Absolutely Can't Afford\" || $getVal($get(form), \"Degree_Of_Interest\") == \"Maybe\" || $getVal($get(form), \"Degree_Of_Interest\") == \"Probably\")","helpClass":"!t-text-sm","legendClass":"legend-left required","fieldsetClass":"$reset side-by-side","optionsClass":"t-pl-1","innerClass":"t-flex t-items-center","wrapperClass":"t-mb-3"},{"$el":"div","if":"$get(CrossSell_Bankruptcy).value == true","children":[{"$formkit":"textarea","rows":5,"maxlength":500,"validation":"required","validationMessages":{"required":"Field is required"},"innerClass":"t-max-w-xl","labelClass":"required","name":"CrossSell:Bankruptcy:Comments","label":"Bankruptcy or debt details:","placeholder":"Please describe your bankrtupcy or debt situation in a few words...","inputClass":"!t-h-16","id":"CrossSell:Bankruptcy:Comments"}]}]}]},{"$el":"section","if":"$stepEnabled(\"firstAndLast\")","attrs":{"hidden":"$activeStep !== \"firstAndLast\"","key":"firstAndLast"},"children":[{"$formkit":"group","id":"firstAndLast","name":"firstAndLast","children":[{"$el":"h3","children":"Please Provide a Contact Name","attrs":{"class":"t-flex t-justify-center t-text-center t-text-xl t-font-bold t-text-blue-500 t-pb-5 t-pt-0 t-px-1 !t-text-dark"}},{"$formkit":"text","validation":"required","validationMessages":{"required":"First Name is required"},"labelClass":"required","label":"First Name:","placeholder":"First Name","name":"First_Name","autocomplete":"given-name","wrapperClass":"side-by-side t-items-center","id":"First_Name"},{"$formkit":"text","validation":"required","validationMessages":{"required":"Last Name is required"},"labelClass":"required","label":"Last Name:","placeholder":"Last Name","name":"Last_Name","autocomplete":"family-name","wrapperClass":"side-by-side t-items-center","id":"Last_Name","onKeypress":"$onEnter($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))"}]}]},{"$el":"section","if":"$stepEnabled(\"contactInfo\")","attrs":{"hidden":"$activeStep !== \"contactInfo\"","key":"contactInfo"},"children":[{"$formkit":"group","id":"contactInfo","name":"contactInfo","children":[{"$el":"h3","children":"Submit Your Free Application","attrs":{"class":"t-flex t-justify-center t-text-center t-text-2xl t-font-bold t-text-blue-500 t-pb-3 t-pt-4 t-px-1 !t-text-[#00428A] f-contact-info-headline"}},{"$el":"h5","children":"Based on your input you may qualify for SSDI benefits. Please verify your contact information.","attrs":{"class":"t-flex t-justify-center t-text-center !t-text-lg t-font-semibold t-pb-6 t-pt-0 t-px-3  f-contact-info-subheadline"}},{"$el":"script","if":"$activeStep === $lastStep()","children":"(function() {\n  if (window.xxTrustedFormLoaded) {\n    return\n  }\n  var vid = '';\n  if (typeof window.zar !== 'undefined') {\n    vid = window.zar.getVID();\n  }\n  window.xxTrustedFormLoaded = true;\n  var sandbox = document.location.hostname.indexOf('localhost') > -1 ? 'true' : 'false'\n  var tf = document.createElement('script');\n  tf.type = 'text/javascript'; tf.async = true;\n  tf.src = (\"https:\" == document.location.protocol ? 'https' : 'http') + \"://api.trustedform.com/trustedform.js?field=xxTrustedFormCertUrl&identifier=\" + vid + \"&ping_field=xxTrustedFormPingUrl&provideReferrer=false&invert_field_sensitivity=true&sandbox=\" + sandbox + \"&l=\" + new Date().getTime() + Math.random();\n  var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(tf, s);\n})();"},{"$formkit":"email","validation":"required|email","validationMessages":{"required":"Email is required","email":"Invalid Email"},"labelClass":"required","name":"Email","label":"Email Address:","placeholder":"email@domain.com","autocomplete":"email","data-tf-sensitive":"false","wrapperClass":"side-by-side t-items-center","id":"Email"},{"$formkit":"tel","validation":"required|matches:/^[0-9]{3}-?[0-9]{3}-?[0-9]{4}$/|valid_phone","validationMessages":{"required":"Phone Number is required","matches":"Invalid Phone Format, use ###-###-####","valid_phone":"Invalid Phone Number"},"labelClass":"required","name":"Primary_Phone","label":"Phone Number:","placeholder":"###-###-####","maxlength":12,"help":"10-digit phone number, hyphens optional","autocomplete":"tel-national","data-tf-sensitive":"false","helpClass":"t-mt-2.5 md:t-text-right md:t-mt-[-2px]","wrapperClass":"side-by-side t-items-center","id":"Primary_Phone"},{"$formkit":"checkbox","label":"$meta.tcpaLanguage","__raw__sectionsSchema":{"label":{"attrs":{"innerHTML":"$label"}}},"name":"TCPA_Opt_In","data-tf-sensitive":"false","validation":"required|accepted","validationMessages":{"required":"Consent is required","accepted":"Consent is required"},"classes":{"outer":"","wrapper":"","messages":"","label":"!t-text-[0.7rem] t-text-slate-500 t-font-normal !t-leading-[0.9rem]"}},{"$el":"div","if":"$activeStep === $lastStep()","attrs":{"class":"t-flex t-justify-center t-items-center t-text-sm t-text-gray-500"},"children":[{"$el":"img","attrs":{"loading":"lazy","alt":"","style":{"border":0},"width":"25","height":"25","src":"https://d27hmee62k45vz.cloudfront.net/lock_icon_1.jpeg"}},{"$el":"span","children":"Secure & Encrypted","attrs":{"class":"t-pl-2 t-pt-1 t-font-medium"}}]}]}]},{"$el":"div","attrs":{"class":{"if":"$activeStep === $firstStep()","then":"step-nav !t-justify-center sm:!t-justify-between","else":"step-nav !t-justify-between"}},"children":[{"$formkit":"button","name":"back_button","onClick":"$setPreviousStep($prevStepFunc($get(form)))","children":"Back","outerClass":{"if":"$activeStep === $firstStep()","then":"t-hidden sm:t-block","else":""},"style":{"if":"$activeStep === $firstStep()","then":"display: none;"},"classes":{"input":" f-navigation-input"}},{"$formkit":"button","name":"next_button","onClick":"$setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form)))","children":{"if":"$activeStep === $firstStep()","then":"Start","else":"Next"},"outerClass":{"if":"$activeStep === $lastStep()","then":"t-hidden","else":""},"style":{"if":"$activeStep === $lastStep()","then":"display: none;"},"classes":{"input":" f-navigation-input"}},{"$formkit":"submit","name":"submit_button","label":"Submit","if":"$activeStep === $lastStep()","style":{"if":"$activeStep !== $lastStep()","then":"display: none;"},"classes":{"input":" !t-ml-2 sm:!t-ml-auto f-navigation-input"}}]},{"$el":"pre","if":"$urlParam(\"fdbg\", \"\") == 1","children":[{"$el":"pre","children":"$stringify( $get(form).value )","attrs":{"class":"t-text-xs","style":"overflow: scroll"}},{"$el":"pre","children":["activeStep: ","$activeStep"],"attrs":{"class":"t-text-xs","style":"overflow: scroll"}},{"$el":"pre","children":["stepHistory: ","$stepHistory"],"attrs":{"class":"t-text-xs","style":"overflow: scroll"}},{"$el":"pre","children":["stepQueue: ","$stepQueue"],"attrs":{"class":"t-text-xs","style":"overflow: scroll"}},{"$el":"pre","children":["steps: ","$stepKeys()"],"attrs":{"class":"t-text-xs","style":"overflow: scroll"}}]}]}]}]

package/dist/forms/testForm.es.js

@@ -5,13 +5,13 @@ function merge() {
 const DEFAULT_COMMENTS_PLACEHOLDER_DYNAMIC_LEGAL =
   '$getKey($meta, "commentsPlaceholders." + $get(Type_Of_Legal_Problem).value, $meta.defaultCommentsPlaceholder)';
 const DEFAULT_FINAL_HEADLINE_LEGAL = "Connect With The Legal Help You Deserve";
-const DEFAULT_FINAL_HEADLINE_DYNAMIC_LEGAL =
-  '$getKey($meta, "finalHeadlines." + $get(Type_Of_Legal_Problem).value, $meta.defaultFinalHeadline)';
+const DEFAULT_FINAL_HEADLINE_DYNAMIC =
+  '$getKey($meta, "finalHeadlines." + ($get(Type_Of_Legal_Problem).value || $get(Category).value), $meta.defaultFinalHeadline)';
 const DEFAULT_FINAL_SUBHEADLINE_LEGAL = "Get a no-obligation consultation with a legal expert.";
-const DEFAULT_FINAL_SUBHEADLINE_DYNAMIC_LEGAL =
-  '$getKey($meta, "finalSubHeadlines." + $get(Type_Of_Legal_Problem).value, $meta.defaultFinalSubHeadline)';
+const DEFAULT_FINAL_SUBHEADLINE_DYNAMIC =
+  '$getKey($meta, "finalSubHeadlines." + ($get(Type_Of_Legal_Problem).value || $get(Category).value), $meta.defaultFinalSubHeadline)';
 const TCPA_LANGUAGE_LEGAL =
-  "By checking this box, I a) agree to the Terms of Use, and b) consent to be contacted by lawyers, lawyer networks, and partners of this website using live, autodialed, pre-recorded, or artificial voice calls, as well as text messages. Your consent is not required as a condition of purchasing any goods or services. To submit this request without this consent, call 878-213-4937.";
+  'By checking this box, I agree to the Terms of Use and consent to be contacted by <a href="/providers" target="_blank">lawyers, lawyer networks, and partners</a> of this website using live, autodialed, pre-recorded, or artificial voice calls and text messages, at any time including before 8 AM or after 9 PM local time. Your consent is not required as a condition of purchasing any goods or services. To submit this request without this consent, call 878-213-4937.';
 
 // ------ Common Base Settings
 
@@ -264,7 +264,7 @@ function secureIcon(updates = {}) {
 function contactStepHeadline(updates) {
   return {
     $el: "h3",
-    children: updates.headline || DEFAULT_FINAL_HEADLINE_DYNAMIC_LEGAL,
+    children: updates.headline || DEFAULT_FINAL_HEADLINE_DYNAMIC,
     attrs: {
       class:
         "t-flex t-justify-center t-text-center t-text-2xl t-font-bold t-text-blue-500 t-pb-3 t-pt-4 t-px-1" +
@@ -278,7 +278,7 @@ function contactStepHeadline(updates) {
 function contactStepSubHeadline(updates) {
   return {
     $el: "h5",
-    children: updates.subheadline || DEFAULT_FINAL_SUBHEADLINE_DYNAMIC_LEGAL,
+    children: updates.subheadline || DEFAULT_FINAL_SUBHEADLINE_DYNAMIC,
     attrs: {
       class:
         "t-flex t-justify-center t-text-center !t-text-lg t-font-semibold t-pb-6 t-pt-0 t-px-3" +

package/dist/forms/testForm.iife.js

@@ -1 +1 @@
-var testForm=function(){"use strict";function e(){return Object.assign({},...arguments)}const t=e=>(e.name&&!e.id&&(e.id=e.name),e),a=a=>(a.labelClass="required",a.wrapperClass="side-by-side t-items-center",a.innerClass="select-height-content",a.helpClass="t-mt-2.5 md:t-text-right md:t-mt-[-5px]",(a=>(t(a),e({$formkit:"select",placeholder:"Please Select",validation:"required",validationMessages:{required:"Field is required"},inputClass:"t-bg-white",labelClass:"required"},a)))(a)),n=a=>(t(a),e({$formkit:"text",validation:"required",validationMessages:{required:"Field is required"},labelClass:"required"},a)),i=e=>(e.wrapperClass="side-by-side t-items-center",n(e)),r=e=>(e.wrapperClass="t-flex t-justify-center",e.messagesClass="t-flex t-justify-center",e.inputClass="t-text-center",e.helpClass="t-mt-2.5 !t-text-sm t-text-center",n(e)),s=(e,t,a={})=>(t?r:i)({$formkit:"email",name:e?e+":Email":"Email",label:t?a.label:"Email Address:",placeholder:"email@domain.com",autocomplete:"email","data-tf-sensitive":"false",validation:"required|email",validationMessages:{required:"Email is required",email:"Invalid Email"},...a}),l=(e,t,a={})=>(t?r:i)({label:t?a.label:"First Name:",placeholder:"First Name",name:e?e+":First_Name":"First_Name",autocomplete:"given-name",validationMessages:{required:"First Name is required"},...a}),o=(e,t,a={})=>(t?r:i)({label:t?a.label:"Last Name:",placeholder:"Last Name",name:e?e+":Last_Name":"Last_Name",autocomplete:"family-name",validationMessages:{required:"Last Name is required"},...a}),d=(e,t,a={})=>(t?r:i)({$formkit:"tel",name:e?e+":Primary_Phone":"Primary_Phone",label:t?a.label:"Phone Number:",placeholder:a.placeholder||"###-###-####",maxlength:12,help:a.help||"10-digit phone number, hyphens optional",autocomplete:"tel-national","data-tf-sensitive":"false",validation:"required|matches:/^[0-9]{3}-?[0-9]{3}-?[0-9]{4}$/|valid_phone",validationMessages:{required:"Phone Number is required",matches:"Invalid Phone Format, use ###-###-####",valid_phone:"Invalid Phone Number"},helpClass:"t-mt-2.5 md:t-text-right md:t-mt-[-2px]",...a}),c=(e,t,a={})=>(t?r:i)({label:t?a.label:"Zip Code:",help:t?a.help??"We try to match you with local help":null,placeholder:"#####",name:e?e+":Zip":"Zip",maxlength:5,inputmode:"numeric",autocomplete:"postal-code",validation:"required|matches:/^[0-9]{5}$/",validationMessages:{required:"Zip Code is required",matches:"Invalid Zip Code"},...a}),m=(e,t={})=>({$formkit:"checkbox",label:"$meta.tcpaLanguage",__raw__sectionsSchema:{label:{attrs:{innerHTML:"$label"}}},name:e?e+":TCPA_Opt_In":"TCPA_Opt_In","data-tf-sensitive":"false",validation:"required|accepted",validationMessages:{required:"Consent is required",accepted:"Consent is required"},classes:{outer:t.outerClass?t.outerClass:"",wrapper:t.wrapperClass?t.wrapperClass:"",messages:t.messagesClass?t.messagesClass:"",label:"!t-text-[0.7rem] t-text-slate-500 t-font-normal !t-leading-[0.9rem]"+(t.labelClass?" "+t.labelClass:"")}}),p=e=>"group"!==e.type&&"section"!==e.type&&"form"!==e.type&&"hidden"!==e.$formkit&&!e.children,u=e=>{if(p(e))return e;for(var t=e.children.length-1;t>=0;t--){if("string"==typeof e.children)continue;const a=e.children[t];if(p(a))return a;const n=u(a);if(n)return n}return null},f={$el:"div",if:"$activeStep === $lastStep()",attrs:{class:"t-flex t-justify-center t-items-center t-text-sm t-text-gray-500"},children:[{$el:"img",attrs:{loading:"lazy",alt:"",style:{border:0},width:"25",height:"25",src:"https://d27hmee62k45vz.cloudfront.net/lock_icon_1.jpeg"}},{$el:"span",children:"Secure & Encrypted",attrs:{class:"t-pl-2 t-pt-1 t-font-medium"}}]};function h(t={}){return e(f,t)}function y(e){return{$el:"h3",children:e.headline||'$getKey($meta, "finalHeadlines." + $get(Type_Of_Legal_Problem).value, $meta.defaultFinalHeadline)',attrs:{class:"t-flex t-justify-center t-text-center t-text-2xl t-font-bold t-text-blue-500 t-pb-3 t-pt-4 t-px-1 "+(e.headlineClass||"")+" f-contact-info-headline"}}}function g(e){return{$el:"h5",children:e.subheadline||'$getKey($meta, "finalSubHeadlines." + $get(Type_Of_Legal_Problem).value, $meta.defaultFinalSubHeadline)',attrs:{class:"t-flex t-justify-center t-text-center !t-text-lg t-font-semibold t-pb-6 t-pt-0 t-px-3 "+(e.subheadlineClass||"")+" f-contact-info-subheadline"}}}function b(t,a,n={}){const{nextOnEnter:i=!0,nextOnInput:r=!1,stepKey:s,nextStepMap:l,triggerRedirectMap:o,autoFocus:d}=n;if(a&&a.length&&(i||r)){const e=u(a[a.length-1]);e&&!0===i&&(e.onKeypress="$onEnter($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))"),e&&!0===r&&(e.onInput="$onInput($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))")}return e(((e,t)=>({$el:"section",if:'$stepEnabled("'+e+'")',attrs:{hidden:'$activeStep !== "'+e+'"',key:t||e}}))(t,s),{children:[{$formkit:"group",id:t,name:t,nextStepMap:l,triggerRedirectMap:o,autoFocus:d,children:a}]})}const C={type:"form",id:"form",config:{validationVisibility:"submit"},onSubmit:'$submit($submitUrl, $prepData, $handleRedirect, "text/plain; charset=UTF-8")',plugins:"$plugins",actions:!1,anchorElement:"form-anchor",useLocalStorage:!0,prepop:{fromURL:!0},errorCodes:{403:{message:"An Error Occurred",abort:!1},409:{abort:!1},429:"An Error Occurred",504:{message:"An Error Occurred",abort:!1}},formClass:"!t-max-w-[40rem]"};function v(e,t){return Object.fromEntries(Object.entries(e).filter((([e])=>t.includes(e))))}const x={};const w={$el:"div",children:[{$el:"div",attrs:{id:"form-anchor",class:"t-absolute",style:{top:"-30px",left:0}}}],attrs:{class:"t-relative"}};const I=[{$formkit:"hidden",name:"vertical",value:"Legal"},{$formkit:"hidden",name:"TCPA_Language",value:"$meta.tcpaLanguage"},{$formkit:"hidden",name:"gclid",value:null},{$formkit:"hidden",name:"campaignid",value:null},{$formkit:"hidden",name:"s",value:null}],S={Adoption:'Example: "I need help with adoption forms"',"Asbestos and Mesothelioma":'Example: "I was exposed to asbestos at work and would like to file a claim"',"Auto and Car Accidents":'Example: "A truck crashed into my car on the highway" or "I\'ve been involved in a hit and run accident"',Bankruptcy:'Example: "I need help filing for bankruptcy"',"Birth Certificate and Name Change":'Example: "Just married and would like to change my last name"',"Business Lawyers":'Example: "I need help incorporating a business" or "I would like a legal contract reviewed"',"Child Custody and Support":'Example: "Need help getting custody" or "Issues with child support payments"',"Child Custody":'Example: "Need help getting custody"',"Child Support":'Example: "Issues with child support payments"',"Civil Rights and Discrimination":'Example: "Police brutality" or "Coworker keeps harassing me"',"Civil Lawsuit":'Example: "A contractor took my money and never completed the job" or "I am being sued by a neighbor"',"File a Lawsuit":'Example: "A contractor took my money and never completed the job"',"Defend a Lawsuit":'Example: "I am being sued by a neighbor"',"Consumer Lawyers":'Example: "Someone committed fraud against me" or "A contractor took my money and never completed the job"',"Copyrights and Trademarks":'Example: "I would like to register a trademark or copyright a name"',"Criminal and Felony":'Example: "I was arrested for DUI and need legal defense" or "I am being charged with assault"',"Debt and Collections":'Example: "I would like to consolidate my debt" or "A collection agency is harassing me"',"Divorce and Separation":'Example: "I would like to file for an uncontested divorce"',"DUI and DWI":'Example: "I was arrested for DUI and need legal defense"',"Elder Law":'Example: "I would like help with Estate Planning" or "I need help with a guardianship"',"Employment and Workplace":'Example: "I was injured while on the job" or "My company is discriminating against me"',Expungement:'Example: "I would like to file for an expungement and clear my record"',"Family Issues":'Example: "I need help with guardianship" or "I need a simple will created"',Foreclosure:'Example: "I need help to avoid foreclosure on my house"',Guardianship:'Example: "I need help with guardianship documents"',"Harassment and Discrimination":'Example: "I am being discriminated at work" or "My neighbor is harassing me"',"Sexual Harassment":'Example: "I am being sexually harassed by a coworker"',"Workplace Harassment":'Example: "My coworker is being aggressive towards me"',"Non-Workplace Harassment":'Example: "My neighbor is harassing me"',"Workplace Discrimination":'Example: "I am being discriminated at work based on my age"',"Non-Workplace Discrimination":'Example: "I am being discriminated against by a local official"',"Identity Theft":'Example: "Someone stole my identity and I need help fixing the issue"',"Immigration and Visas":'Example: "I need help filing for a visa" or "Help with a green card"',Insurance:'Example: "I need help filing an insurance claim for damage to my house"',"Landlord and Tenant":'Example: "I need help to fight an eviction" or "I would like a lawyer to review a rental contract"',"Lemon Law":'Example: "I purchased a new vehicle that broke down already and seller will not assist"',"Long Term Disability":'Example: "I was injured on the job and would like to file for benefits" or "I need help filing for disability benefits"',"Medical Malpractice":'Example: "A doctor performed surgery on the wrong limb and I would like to file a lawsuit"',"Patents and Intellectual Property":'Example: "I would like to file for a patent" or "I need to copyright a name"',"Personal Injury":'Example: "I was bit by the neighbor\'s dog" or "I fell in the icy grocery store parking lot"',"Power of Attorney":'Example: "I need help with a limited or general power of attorney"',"Probate and Estates":'Example: "I need help with planning for my estate" or "A family member passed without a will in place"',"Product Liability":'Example: "My car battery caught on fire" or "I purchased a faulty product"',"Property Damage":'Example: "The neighbor\'s tree fell on my fence" or "My car was hit in the parking lot"',"Real Estate":'Example: "I need help with a quitclaim deed" or "I need a lawyer to review a purchase and sales agreement"',"Social Security Disability and Insurance":'Example: "I would like help filing for disability benefits" or "I\'ve been denied for SSDI and would like to appeal"',"Tax and IRS":'Example: "I need help fighting an IRS tax claim" or "I need audit defense"',"Traffic and Tickets":'Example: "I need help reinstating a supsended license" or "I would like to fight a traffic ticket"',Unemployment:'Example: "I need help filing for unemployment benefits"',"Victim of a Crime":'Example: "I was assaulted in the store" or "I am being discriminated against at work"',"Wills and Trusts":'Example: "I need a simple will created" or "I would like guidance on creating a trust fund"',"Workers Compensation":'Example: "I broke my arm at work and need help getting compensation"',"Wrongful Death":'Example: "A family member was killed on the job and we need legal representation"',"Wrongful Termination":'Example: "I was fired by my employer without cause"',"Not Sure or Other":'Example: "I was involved in a car accident" or "I need help setting up power of attorney"'},E={Adoption:"Connect With Adoption Professionals Today","Auto and Car Accidents":"Connect With Accident Professionals Today",Bankruptcy:"Take Control of Your Financial Future","Birth Certificate and Name Change":"Start Your Change Today","Business Lawyers":"Connect With Business Professionals Today","Child Custody":"Connect With Custody Professionals Today","Child Support":"Connect With Child Support Professionals","Civil Rights and Discrimination":"Stand Up For Your Rights","Civil Lawsuit":"Connect With Lawsuit Professionals Today","Copyrights and Trademarks":"Protect Your Intellectual Property","Debt and Collections":"Connect With Debt Professionals Today","Divorce and Separation":"Connect With Divorce Professionals Today","DUI and DWI":"Defend Against DUI Charges","Elder Law":"Connect With Elder Law Professionals",Expungement:"Clear Your Record","Family Issues":"Connect With Family Legal Help",Foreclosure:"Fight to Keep Your Home",Guardianship:"Connect With Guardianship Professionals","Immigration and Visas":"Get Immigration Legal Help",Insurance:"Get Insurance Legal Help","Lemon Law":"Connect With Lemon Law Professionals","Long Term Disability":"Connect With Disability Professionals","Medical Malpractice":"Hold Negligent Providers Accountable","Patents and Intellectual Property":"Connect With IP Professionals Today","Personal Injury":"Maximize Your Injury Compensation","Probate and Estates":"Manage Probate with Expert Guidance","Product Liability":"Get Justice for Faulty Products","Real Estate":"Connect With Real Estate Professionals","Sexual Harassment":"Stand Up Against Sexual Harassment","Social Security Disability and Insurance":"Get the Benefits You Deserve","Tax and IRS":"Connect With Tax Legal Help","Traffic and Tickets":"Protect Your Record Today",Unemployment:"Connect With Unemployment Professionals","Victim of a Crime":"Seek Justice as a Crime Victim","Wills and Trusts":"Plan Your Estate with Confidence","Workers Compensation":"Maximize Your Workers' Comp Benefits","Wrongful Death":"Seek Justice for a Loved One","Wrongful Termination":"Fight Back Against Unfair Firing Today"},P={},$=["haveAttorney","degreeOfInterest","commentsWithBankruptcy","zipcode","legalCrossSells","firstAndLast","contactInfo"],k=["haveAttorney","degreeOfInterest","lawyerPaymentMethod","commentsWithBankruptcy","zipcode","legalCrossSells","firstAndLast","contactInfo"],T=["haveAttorney","commentsWithBankruptcy","zipcode","legalCrossSells","firstAndLast","contactInfo"],L={values:{Type_Of_Legal_Problem:{Adoption:["maritalStatus","haveChildren",...k],"Asbestos and Mesothelioma":["incidentDate","doctorTreatment",...$],"Auto and Car Accidents":["incidentDate","atFault","primaryInjury","doctorTreatment","policeReportFiled",...T],Bankruptcy:["totalMonthlyIncome","totalDebt","ownRealEstate","valueOfAssets",...$],"Business Lawyers":["businessServices","businessType","numEmployeesOfBusiness",...$],"Child Custody":["childRelationship","childHome","childPrimaryCaregiver",...k],"Child Support":["childRelationship","childHome","childPrimaryCaregiver",...k],"Civil Rights and Discrimination":["civilRightsType",...$],"Civil Lawsuit":["civilDefense","lawsuitOtherParty",...$],"File a Lawsuit":["civilLawsuitTOLPDisplay","lawsuitOtherParty",...$],"Defend a Lawsuit":["lawsuitOtherParty",...$],"Consumer Lawyers":["consumerLawyerType","incidentDate","lawsuitOtherParty",...$],"Criminal and Felony":["criminalTOLPDisplay","crimeCommittedDate","roleInMatterCriminal","pendingCharges",...k],"Debt and Collections":["totalMonthlyIncome","totalDebt","ownRealEstate","valueOfAssets",...$],"Divorce and Separation":["maritalStatus","haveChildren",...k],"DUI and DWI":["incidentDate","priorAlcoholOffenses","typeOfAlcoholTest","bloodContentAlcoholTest","pendingCharges",...$],"Employment and Workplace":["employmentAndWorkplaceTOLPDisplay","numEmployeesOfBusiness","employerType","employeeAtCompany",...$],Expungement:["incidentDate","criminalChargeType",...k],"Family Issues":["maritalStatus","haveChildren",...k],Foreclosure:["ownRealEstate","typeOfProperty","amountPaymentsPastDue","loanAmount","defaultNotice",...$],Guardianship:["maritalStatus","haveChildren",...k],"Immigration and Visas":["countryOfCitizenship","immigrationLocation","immigrationEntry","immigrationType","immigrationStatus","immigrationDetails",...$],"Landlord and Tenant":["landlordTenantIssue","landlordTenantParty",...$],"Lemon Law":["incidentDate","lawsuitOtherParty",...$],"Long Term Disability":["applicantOccupation","applicantAge","applicantLTDisabilityPolicy","applicantDisabilityHowObtain","applicantPreviouslyAppliedLtdBenefits","applicantReceivedDisabilityBenefits","applicantMonthlySalary",...T],"Medical Malpractice":["incidentDate","claimStatus","doctorTreatment","medicalMalpracticeInjuries",...$],"Patents and Intellectual Property":["patentAssistanceType","patentFor",...$],"Personal Injury":["incidentDate","claimStatus","atFault","primaryInjury","doctorTreatment",...T],"Probate and Estates":["valueOfAssets","typeOfAssets","roleInMatterProbate","estateLegalServicesNeeded",...$],"Property Damage":["wouldLikeLawyerTo",...$],"Real Estate":["realEstateTOLPDisplay","realEstateArea","wouldLikeLawyerTo",...$],"Social Security Disability and Insurance":["applicantAge","disabilityConditionStopWork","disabilityWorkHistory","socialSecurityDisabilityReceivingBenefits","doctorTreatment",...T],"Tax and IRS":["totalDebt","taxProblemDetails","taxLevel","taxIssueType",...$],"Traffic and Tickets":["driversLicenseType","trafficViolations","haveCourtDate",...$],Unemployment:["numEmployeesOfBusiness","employerType","degreeOfInterest","commentsWithBankruptcy","zipcode","legalCrossSells","firstAndLast","contactInfo"],"Victim of a Crime":["crimeCommittedDate","roleInMatterCriminal","pendingCharges",...k],"Wills and Trusts":["valueOfAssets","typeOfAssets","roleInMatterProbate","estateLegalServicesNeeded",...$],"Workers Compensation":["incidentDate","claimStatus","primaryInjury","causeOfInjury","doctorTreatment",...T],"Workplace Harassment":["numEmployeesOfBusiness","employerType","employeeAtCompany",...$],"Workplace Discrimination":["numEmployeesOfBusiness","employerType","employeeAtCompany",...$],"Wrongful Death":["incidentDate","relationshipToVictim","criminalChargesFiled","causeOfDeath",...T],"Wrongful Termination":["numEmployeesOfBusiness","employerType",...$]},"*":$}};function D(e,t=[],a={}){const n={...e};return n.values=function e(n){const i={};for(const r in n)Array.isArray(n[r])?i[r]=n[r].filter((e=>!t.includes(e))).map((e=>a[e]||e)):"object"==typeof n[r]?i[r]=e(n[r]):i[r]=n[r];return i}(e.values),n}D(L,["legalCrossSells"],{commentsWithBankruptcy:"comments"});const A=L.values.Type_Of_Legal_Problem;A["Auto and Car Accidents"].filter((e=>"legalCrossSells"!==e)),A["Workers Compensation"].filter((e=>"legalCrossSells"!==e)),A["Personal Injury"].filter((e=>"legalCrossSells"!==e)),A["Personal Injury"].filter((e=>"legalCrossSells"!==e)),A["Auto and Car Accidents"].filter((e=>"legalCrossSells"!==e)),A["Auto and Car Accidents"].filter((e=>"legalCrossSells"!==e)),A["Personal Injury"].filter((e=>"legalCrossSells"!==e)),A["Personal Injury"].filter((e=>"legalCrossSells"!==e)),A["Child Custody"],A["Child Support"],L.values["*"],A["Family Issues"],A["Child Support"],A["Child Custody"],L.values["*"],A["Divorce and Separation"],A["Defend a Lawsuit"],A["File a Lawsuit"];D({values:{Type_Of_Legal_Problem:{"Defend a Lawsuit":A["Defend a Lawsuit"],"File a Lawsuit":A["File a Lawsuit"]},"*":["lawsuitOtherParty",...$]}},["legalCrossSells"],{commentsWithBankruptcy:"comments"});D({values:{Type_Of_Legal_Problem_Display:{"Automobile Accident":A["Auto and Car Accidents"],"Contract Disputes":A["Business Lawyers"],"Dog Bite":A["Personal Injury"],"Employment and Workplace":A["Employment and Workplace"],Fraud:A["Consumer Lawyers"],"Medical Malpractice":A["Medical Malpractice"],"Personal Injury":A["Personal Injury"],"Property Damage":A["Property Damage"],"Real Estate":A["Real Estate"],"Not Sure or Other":L.values["*"]},"*":["lawsuitOtherParty",...$]}},["legalCrossSells"],{commentsWithBankruptcy:"comments"});D({values:{Type_Of_Legal_Problem_Display:{"Victim of a Crime":A["Victim of a Crime"],"DUI and DWI":A["DUI and DWI"],Expungement:A.Expungement,"Not Sure or Other":L.values["*"]},"*":["crimeCommittedDate","roleInMatterCriminal","pendingCharges",...k]}},["legalCrossSells"],{commentsWithBankruptcy:"comments"});D({values:{Type_Of_Legal_Problem_Display:{"Wrongful Termination":A["Wrongful Termination"],"Workers Compensation":A["Workers Compensation"],"Personal Injury":A["Personal Injury"],Unemployment:A.Unemployment},"*":["numEmployeesOfBusiness","employerType","employeeAtCompany",...$]}},["legalCrossSells"],{commentsWithBankruptcy:"comments"}),A["Workplace Harassment"],A["Workplace Discrimination"],A["Probate and Estates"],A["Wills and Trusts"],A["Wrongful Death"],A["Patents and Intellectual Property"],A["Business Lawyers"],A["Business Lawyers"],L.values["*"];D({values:{Type_Of_Legal_Problem_Display:{Foreclosure:A.Foreclosure,"Landlord and Tenant":A["Landlord and Tenant"],"Wills, Trusts, and Estates":A["Wills and Trusts"],"Property Damage":A["Property Damage"]},"*":["realEstateArea","wouldLikeLawyerTo",...$]}},["legalCrossSells"],{commentsWithBankruptcy:"comments"});const W=[function(t=null){let a=S,n=E,i=P;return t&&(a=v(S,t),n=v(E,t),i=v(P,t)),{type:"meta",data:e(x,{tcpaLanguage:"By checking this box, I a) agree to the Terms of Use, and b) consent to be contacted by lawyers, lawyer networks, and partners of this website using live, autodialed, pre-recorded, or artificial voice calls, as well as text messages. Your consent is not required as a condition of purchasing any goods or services. To submit this request without this consent, call 878-213-4937.",defaultCommentsPlaceholder:'$getKey($meta, "commentsPlaceholders." + $get(Type_Of_Legal_Problem).value, $meta.defaultCommentsPlaceholder)',commentsPlaceholders:a,defaultFinalHeadline:"Connect With The Legal Help You Deserve",finalHeadlines:n,defaultFinalSubHeadline:"Get a no-obligation consultation with a legal expert.",finalSubHeadlines:i})}}(),e(w,O),{$cmp:"FormKit",props:function(t){const a=e(C,t);return a.formId&&!a.name&&(a.name=a.formId),a}({formId:"testForm"}),children:[function(t={}){return e(function(e={}){return{$el:"h1",attrs:{class:"t-flex t-justify-center t-text-center t-text-[1.7rem] sm:t-text-[2rem] t-font-semibold t-pt-5 t-px-7 md:t-px-3 "+(e.headlineClass||"")+" f-first-headline"}}}(t),t)}({children:'$urlParam("hl", "Start Here For a Free Consultation")',if:"$activeStep === $firstStep()"}),function(t={}){return e(function(e={}){return{$el:"h3",attrs:{class:"t-flex t-justify-center t-text-center t-text-[1.1rem] md:t-text-[1.2rem] t-font-medium t-text-blue-500 t-px-10 t-pb-3 "+(e.subheadlineClass||"")+" f-first-subheadline"}}}(t),t)}({children:'$urlParam("shl", "Our Service is Fast and Free!")',if:"$activeStep === $firstStep()"}),...I,{$el:"div",attrs:{class:"form-body"},children:[function(e={}){return b("categoryAndZip",[c(e.scope,!1,e.input),(e.scope,e.input,a({label:"Category:",name:"category",id:"category",options:["Fruits","Vegetables"]}))],e)}(),function(e={}){return b("firstAndLast",[l(e.scope),o(e.scope)],e)}(),function(e={}){return b("contactInfo",[y(e),g(e),{$el:"script",if:"$activeStep === $lastStep()",children:"(function() {\n  if (window.xxTrustedFormLoaded) {\n    return\n  }\n  var vid = '';\n  if (typeof window.zar !== 'undefined') {\n    vid = window.zar.getVID();\n  }\n  window.xxTrustedFormLoaded = true;\n  var sandbox = document.location.hostname.indexOf('localhost') > -1 ? 'true' : 'false'\n  var tf = document.createElement('script');\n  tf.type = 'text/javascript'; tf.async = true;\n  tf.src = (\"https:\" == document.location.protocol ? 'https' : 'http') + \"://api.trustedform.com/trustedform.js?field=xxTrustedFormCertUrl&identifier=\" + vid + \"&ping_field=xxTrustedFormPingUrl&provideReferrer=false&invert_field_sensitivity=true&sandbox=\" + sandbox + \"&l=\" + new Date().getTime() + Math.random();\n  var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(tf, s);\n})();"},s(e.scope),d(e.scope),m(e.scope),h()],{nextOnEnter:!1})}(),((e={})=>({$el:"div",attrs:{class:{if:"$activeStep === $firstStep()",then:"step-nav "+(e.firstStepButtonClass||"!t-justify-center sm:!t-justify-between"),else:"step-nav !t-justify-between"}},children:[{$formkit:"button",name:"back_button",onClick:"$setPreviousStep($prevStepFunc($get(form)))",children:"Back",outerClass:{if:"$activeStep === $firstStep()",then:"t-hidden sm:t-block",else:""},style:{if:"$activeStep === $firstStep()",then:"display: none;"},classes:{input:(e.inputClass||"")+" f-navigation-input"}},{$formkit:"button",name:"next_button",onClick:"$setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form)))",children:{if:"$activeStep === $firstStep()",then:e.startText||"Start",else:"Next"},outerClass:{if:"$activeStep === $lastStep()",then:"t-hidden",else:""},style:{if:"$activeStep === $lastStep()",then:"display: none;"},classes:{input:(e.inputClass||"")+" f-navigation-input"}},{$formkit:"submit",name:"submit_button",label:e.submitLabel||"Submit",if:"$activeStep === $lastStep()",style:{if:"$activeStep !== $lastStep()",then:"display: none;"},classes:{input:(e.inputClass||"")+" !t-ml-2 sm:!t-ml-auto f-navigation-input"}}]}))(),{$el:"pre",if:'$urlParam("fdbg", "") == 1',children:[{$el:"pre",children:"$stringify( $get(form).value )",attrs:{class:"t-text-xs",style:"overflow: scroll"}},{$el:"pre",children:["activeStep: ","$activeStep"],attrs:{class:"t-text-xs",style:"overflow: scroll"}},{$el:"pre",children:["stepHistory: ","$stepHistory"],attrs:{class:"t-text-xs",style:"overflow: scroll"}},{$el:"pre",children:["stepQueue: ","$stepQueue"],attrs:{class:"t-text-xs",style:"overflow: scroll"}},{$el:"pre",children:["steps: ","$stepKeys()"],attrs:{class:"t-text-xs",style:"overflow: scroll"}}]}]}]}];var O;return W}();
+var testForm=function(){"use strict";function e(){return Object.assign({},...arguments)}const t=e=>(e.name&&!e.id&&(e.id=e.name),e),a=a=>(a.labelClass="required",a.wrapperClass="side-by-side t-items-center",a.innerClass="select-height-content",a.helpClass="t-mt-2.5 md:t-text-right md:t-mt-[-5px]",(a=>(t(a),e({$formkit:"select",placeholder:"Please Select",validation:"required",validationMessages:{required:"Field is required"},inputClass:"t-bg-white",labelClass:"required"},a)))(a)),n=a=>(t(a),e({$formkit:"text",validation:"required",validationMessages:{required:"Field is required"},labelClass:"required"},a)),i=e=>(e.wrapperClass="side-by-side t-items-center",n(e)),r=e=>(e.wrapperClass="t-flex t-justify-center",e.messagesClass="t-flex t-justify-center",e.inputClass="t-text-center",e.helpClass="t-mt-2.5 !t-text-sm t-text-center",n(e)),s=(e,t,a={})=>(t?r:i)({$formkit:"email",name:e?e+":Email":"Email",label:t?a.label:"Email Address:",placeholder:"email@domain.com",autocomplete:"email","data-tf-sensitive":"false",validation:"required|email",validationMessages:{required:"Email is required",email:"Invalid Email"},...a}),l=(e,t,a={})=>(t?r:i)({label:t?a.label:"First Name:",placeholder:"First Name",name:e?e+":First_Name":"First_Name",autocomplete:"given-name",validationMessages:{required:"First Name is required"},...a}),o=(e,t,a={})=>(t?r:i)({label:t?a.label:"Last Name:",placeholder:"Last Name",name:e?e+":Last_Name":"Last_Name",autocomplete:"family-name",validationMessages:{required:"Last Name is required"},...a}),d=(e,t,a={})=>(t?r:i)({$formkit:"tel",name:e?e+":Primary_Phone":"Primary_Phone",label:t?a.label:"Phone Number:",placeholder:a.placeholder||"###-###-####",maxlength:12,help:a.help||"10-digit phone number, hyphens optional",autocomplete:"tel-national","data-tf-sensitive":"false",validation:"required|matches:/^[0-9]{3}-?[0-9]{3}-?[0-9]{4}$/|valid_phone",validationMessages:{required:"Phone Number is required",matches:"Invalid Phone Format, use ###-###-####",valid_phone:"Invalid Phone Number"},helpClass:"t-mt-2.5 md:t-text-right md:t-mt-[-2px]",...a}),c=(e,t,a={})=>(t?r:i)({label:t?a.label:"Zip Code:",help:t?a.help??"We try to match you with local help":null,placeholder:"#####",name:e?e+":Zip":"Zip",maxlength:5,inputmode:"numeric",autocomplete:"postal-code",validation:"required|matches:/^[0-9]{5}$/",validationMessages:{required:"Zip Code is required",matches:"Invalid Zip Code"},...a}),m=(e,t={})=>({$formkit:"checkbox",label:"$meta.tcpaLanguage",__raw__sectionsSchema:{label:{attrs:{innerHTML:"$label"}}},name:e?e+":TCPA_Opt_In":"TCPA_Opt_In","data-tf-sensitive":"false",validation:"required|accepted",validationMessages:{required:"Consent is required",accepted:"Consent is required"},classes:{outer:t.outerClass?t.outerClass:"",wrapper:t.wrapperClass?t.wrapperClass:"",messages:t.messagesClass?t.messagesClass:"",label:"!t-text-[0.7rem] t-text-slate-500 t-font-normal !t-leading-[0.9rem]"+(t.labelClass?" "+t.labelClass:"")}}),p=e=>"group"!==e.type&&"section"!==e.type&&"form"!==e.type&&"hidden"!==e.$formkit&&!e.children,u=e=>{if(p(e))return e;for(var t=e.children.length-1;t>=0;t--){if("string"==typeof e.children)continue;const a=e.children[t];if(p(a))return a;const n=u(a);if(n)return n}return null},f={$el:"div",if:"$activeStep === $lastStep()",attrs:{class:"t-flex t-justify-center t-items-center t-text-sm t-text-gray-500"},children:[{$el:"img",attrs:{loading:"lazy",alt:"",style:{border:0},width:"25",height:"25",src:"https://d27hmee62k45vz.cloudfront.net/lock_icon_1.jpeg"}},{$el:"span",children:"Secure & Encrypted",attrs:{class:"t-pl-2 t-pt-1 t-font-medium"}}]};function h(t={}){return e(f,t)}function y(e){return{$el:"h3",children:e.headline||'$getKey($meta, "finalHeadlines." + ($get(Type_Of_Legal_Problem).value || $get(Category).value), $meta.defaultFinalHeadline)',attrs:{class:"t-flex t-justify-center t-text-center t-text-2xl t-font-bold t-text-blue-500 t-pb-3 t-pt-4 t-px-1 "+(e.headlineClass||"")+" f-contact-info-headline"}}}function g(e){return{$el:"h5",children:e.subheadline||'$getKey($meta, "finalSubHeadlines." + ($get(Type_Of_Legal_Problem).value || $get(Category).value), $meta.defaultFinalSubHeadline)',attrs:{class:"t-flex t-justify-center t-text-center !t-text-lg t-font-semibold t-pb-6 t-pt-0 t-px-3 "+(e.subheadlineClass||"")+" f-contact-info-subheadline"}}}function b(t,a,n={}){const{nextOnEnter:i=!0,nextOnInput:r=!1,stepKey:s,nextStepMap:l,triggerRedirectMap:o,autoFocus:d}=n;if(a&&a.length&&(i||r)){const e=u(a[a.length-1]);e&&!0===i&&(e.onKeypress="$onEnter($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))"),e&&!0===r&&(e.onInput="$onInput($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))")}return e(((e,t)=>({$el:"section",if:'$stepEnabled("'+e+'")',attrs:{hidden:'$activeStep !== "'+e+'"',key:t||e}}))(t,s),{children:[{$formkit:"group",id:t,name:t,nextStepMap:l,triggerRedirectMap:o,autoFocus:d,children:a}]})}const C={type:"form",id:"form",config:{validationVisibility:"submit"},onSubmit:'$submit($submitUrl, $prepData, $handleRedirect, "text/plain; charset=UTF-8")',plugins:"$plugins",actions:!1,anchorElement:"form-anchor",useLocalStorage:!0,prepop:{fromURL:!0},errorCodes:{403:{message:"An Error Occurred",abort:!1},409:{abort:!1},429:"An Error Occurred",504:{message:"An Error Occurred",abort:!1}},formClass:"!t-max-w-[40rem]"};function v(e,t){return Object.fromEntries(Object.entries(e).filter((([e])=>t.includes(e))))}const x={};const w={$el:"div",children:[{$el:"div",attrs:{id:"form-anchor",class:"t-absolute",style:{top:"-30px",left:0}}}],attrs:{class:"t-relative"}};const I=[{$formkit:"hidden",name:"vertical",value:"Legal"},{$formkit:"hidden",name:"TCPA_Language",value:"$meta.tcpaLanguage"},{$formkit:"hidden",name:"gclid",value:null},{$formkit:"hidden",name:"campaignid",value:null},{$formkit:"hidden",name:"s",value:null}],S={Adoption:'Example: "I need help with adoption forms"',"Asbestos and Mesothelioma":'Example: "I was exposed to asbestos at work and would like to file a claim"',"Auto and Car Accidents":'Example: "A truck crashed into my car on the highway" or "I\'ve been involved in a hit and run accident"',Bankruptcy:'Example: "I need help filing for bankruptcy"',"Birth Certificate and Name Change":'Example: "Just married and would like to change my last name"',"Business Lawyers":'Example: "I need help incorporating a business" or "I would like a legal contract reviewed"',"Child Custody and Support":'Example: "Need help getting custody" or "Issues with child support payments"',"Child Custody":'Example: "Need help getting custody"',"Child Support":'Example: "Issues with child support payments"',"Civil Rights and Discrimination":'Example: "Police brutality" or "Coworker keeps harassing me"',"Civil Lawsuit":'Example: "A contractor took my money and never completed the job" or "I am being sued by a neighbor"',"File a Lawsuit":'Example: "A contractor took my money and never completed the job"',"Defend a Lawsuit":'Example: "I am being sued by a neighbor"',"Consumer Lawyers":'Example: "Someone committed fraud against me" or "A contractor took my money and never completed the job"',"Copyrights and Trademarks":'Example: "I would like to register a trademark or copyright a name"',"Criminal and Felony":'Example: "I was arrested for DUI and need legal defense" or "I am being charged with assault"',"Debt and Collections":'Example: "I would like to consolidate my debt" or "A collection agency is harassing me"',"Divorce and Separation":'Example: "I would like to file for an uncontested divorce"',"DUI and DWI":'Example: "I was arrested for DUI and need legal defense"',"Elder Law":'Example: "I would like help with Estate Planning" or "I need help with a guardianship"',"Employment and Workplace":'Example: "I was injured while on the job" or "My company is discriminating against me"',Expungement:'Example: "I would like to file for an expungement and clear my record"',"Family Issues":'Example: "I need help with guardianship" or "I need a simple will created"',Foreclosure:'Example: "I need help to avoid foreclosure on my house"',Guardianship:'Example: "I need help with guardianship documents"',"Harassment and Discrimination":'Example: "I am being discriminated at work" or "My neighbor is harassing me"',"Sexual Harassment":'Example: "I am being sexually harassed by a coworker"',"Workplace Harassment":'Example: "My coworker is being aggressive towards me"',"Non-Workplace Harassment":'Example: "My neighbor is harassing me"',"Workplace Discrimination":'Example: "I am being discriminated at work based on my age"',"Non-Workplace Discrimination":'Example: "I am being discriminated against by a local official"',"Identity Theft":'Example: "Someone stole my identity and I need help fixing the issue"',"Immigration and Visas":'Example: "I need help filing for a visa" or "Help with a green card"',Insurance:'Example: "I need help filing an insurance claim for damage to my house"',"Landlord and Tenant":'Example: "I need help to fight an eviction" or "I would like a lawyer to review a rental contract"',"Lemon Law":'Example: "I purchased a new vehicle that broke down already and seller will not assist"',"Long Term Disability":'Example: "I was injured on the job and would like to file for benefits" or "I need help filing for disability benefits"',"Medical Malpractice":'Example: "A doctor performed surgery on the wrong limb and I would like to file a lawsuit"',"Patents and Intellectual Property":'Example: "I would like to file for a patent" or "I need to copyright a name"',"Personal Injury":'Example: "I was bit by the neighbor\'s dog" or "I fell in the icy grocery store parking lot"',"Power of Attorney":'Example: "I need help with a limited or general power of attorney"',"Probate and Estates":'Example: "I need help with planning for my estate" or "A family member passed without a will in place"',"Product Liability":'Example: "My car battery caught on fire" or "I purchased a faulty product"',"Property Damage":'Example: "The neighbor\'s tree fell on my fence" or "My car was hit in the parking lot"',"Real Estate":'Example: "I need help with a quitclaim deed" or "I need a lawyer to review a purchase and sales agreement"',"Social Security Disability and Insurance":'Example: "I would like help filing for disability benefits" or "I\'ve been denied for SSDI and would like to appeal"',"Tax and IRS":'Example: "I need help fighting an IRS tax claim" or "I need audit defense"',"Traffic and Tickets":'Example: "I need help reinstating a supsended license" or "I would like to fight a traffic ticket"',Unemployment:'Example: "I need help filing for unemployment benefits"',"Victim of a Crime":'Example: "I was assaulted in the store" or "I am being discriminated against at work"',"Wills and Trusts":'Example: "I need a simple will created" or "I would like guidance on creating a trust fund"',"Workers Compensation":'Example: "I broke my arm at work and need help getting compensation"',"Wrongful Death":'Example: "A family member was killed on the job and we need legal representation"',"Wrongful Termination":'Example: "I was fired by my employer without cause"',"Not Sure or Other":'Example: "I was involved in a car accident" or "I need help setting up power of attorney"'},E={Adoption:"Connect With Adoption Professionals Today","Auto and Car Accidents":"Connect With Accident Professionals Today",Bankruptcy:"Take Control of Your Financial Future","Birth Certificate and Name Change":"Start Your Change Today","Business Lawyers":"Connect With Business Professionals Today","Child Custody":"Connect With Custody Professionals Today","Child Support":"Connect With Child Support Professionals","Civil Rights and Discrimination":"Stand Up For Your Rights","Civil Lawsuit":"Connect With Lawsuit Professionals Today","Copyrights and Trademarks":"Protect Your Intellectual Property","Debt and Collections":"Connect With Debt Professionals Today","Divorce and Separation":"Connect With Divorce Professionals Today","DUI and DWI":"Defend Against DUI Charges","Elder Law":"Connect With Elder Law Professionals",Expungement:"Clear Your Record","Family Issues":"Connect With Family Legal Help",Foreclosure:"Fight to Keep Your Home",Guardianship:"Connect With Guardianship Professionals","Immigration and Visas":"Get Immigration Legal Help",Insurance:"Get Insurance Legal Help","Lemon Law":"Connect With Lemon Law Professionals","Long Term Disability":"Connect With Disability Professionals","Medical Malpractice":"Hold Negligent Providers Accountable","Patents and Intellectual Property":"Connect With IP Professionals Today","Personal Injury":"Maximize Your Injury Compensation","Probate and Estates":"Manage Probate with Expert Guidance","Product Liability":"Get Justice for Faulty Products","Real Estate":"Connect With Real Estate Professionals","Sexual Harassment":"Stand Up Against Sexual Harassment","Social Security Disability and Insurance":"Get the Benefits You Deserve","Tax and IRS":"Connect With Tax Legal Help","Traffic and Tickets":"Protect Your Record Today",Unemployment:"Connect With Unemployment Professionals","Victim of a Crime":"Seek Justice as a Crime Victim","Wills and Trusts":"Plan Your Estate with Confidence","Workers Compensation":"Maximize Your Workers' Comp Benefits","Wrongful Death":"Seek Justice for a Loved One","Wrongful Termination":"Fight Back Against Unfair Firing Today"},$={},P=["haveAttorney","degreeOfInterest","commentsWithBankruptcy","zipcode","legalCrossSells","firstAndLast","contactInfo"],k=["haveAttorney","degreeOfInterest","lawyerPaymentMethod","commentsWithBankruptcy","zipcode","legalCrossSells","firstAndLast","contactInfo"],T=["haveAttorney","commentsWithBankruptcy","zipcode","legalCrossSells","firstAndLast","contactInfo"],L={values:{Type_Of_Legal_Problem:{Adoption:["maritalStatus","haveChildren",...k],"Asbestos and Mesothelioma":["incidentDate","doctorTreatment",...P],"Auto and Car Accidents":["incidentDate","atFault","primaryInjury","doctorTreatment","policeReportFiled",...T],Bankruptcy:["totalMonthlyIncome","totalDebt","ownRealEstate","valueOfAssets",...P],"Business Lawyers":["businessServices","businessType","numEmployeesOfBusiness",...P],"Child Custody":["childRelationship","childHome","childPrimaryCaregiver",...k],"Child Support":["childRelationship","childHome","childPrimaryCaregiver",...k],"Civil Rights and Discrimination":["civilRightsType",...P],"Civil Lawsuit":["civilDefense","lawsuitOtherParty",...P],"File a Lawsuit":["civilLawsuitTOLPDisplay","lawsuitOtherParty",...P],"Defend a Lawsuit":["lawsuitOtherParty",...P],"Consumer Lawyers":["consumerLawyerType","incidentDate","lawsuitOtherParty",...P],"Criminal and Felony":["criminalTOLPDisplay","crimeCommittedDate","roleInMatterCriminal","pendingCharges",...k],"Debt and Collections":["totalMonthlyIncome","totalDebt","ownRealEstate","valueOfAssets",...P],"Divorce and Separation":["maritalStatus","haveChildren",...k],"DUI and DWI":["incidentDate","priorAlcoholOffenses","typeOfAlcoholTest","bloodContentAlcoholTest","pendingCharges",...P],"Employment and Workplace":["employmentAndWorkplaceTOLPDisplay","numEmployeesOfBusiness","employerType","employeeAtCompany",...P],Expungement:["incidentDate","criminalChargeType",...k],"Family Issues":["maritalStatus","haveChildren",...k],Foreclosure:["ownRealEstate","typeOfProperty","amountPaymentsPastDue","loanAmount","defaultNotice",...P],Guardianship:["maritalStatus","haveChildren",...k],"Immigration and Visas":["countryOfCitizenship","immigrationLocation","immigrationEntry","immigrationType","immigrationStatus","immigrationDetails",...P],"Landlord and Tenant":["landlordTenantIssue","landlordTenantParty",...P],"Lemon Law":["incidentDate","lawsuitOtherParty",...P],"Long Term Disability":["applicantOccupation","applicantAge","applicantLTDisabilityPolicy","applicantDisabilityHowObtain","applicantPreviouslyAppliedLtdBenefits","applicantReceivedDisabilityBenefits","applicantMonthlySalary",...T],"Medical Malpractice":["incidentDate","claimStatus","doctorTreatment","medicalMalpracticeInjuries",...P],"Patents and Intellectual Property":["patentAssistanceType","patentFor",...P],"Personal Injury":["incidentDate","claimStatus","atFault","primaryInjury","doctorTreatment",...T],"Probate and Estates":["valueOfAssets","typeOfAssets","roleInMatterProbate","estateLegalServicesNeeded",...P],"Property Damage":["wouldLikeLawyerTo",...P],"Real Estate":["realEstateTOLPDisplay","realEstateArea","wouldLikeLawyerTo",...P],"Social Security Disability and Insurance":["applicantAge","disabilityConditionStopWork","disabilityWorkHistory","socialSecurityDisabilityReceivingBenefits","doctorTreatment",...T],"Tax and IRS":["totalDebt","taxProblemDetails","taxLevel","taxIssueType",...P],"Traffic and Tickets":["driversLicenseType","trafficViolations","haveCourtDate",...P],Unemployment:["numEmployeesOfBusiness","employerType","degreeOfInterest","commentsWithBankruptcy","zipcode","legalCrossSells","firstAndLast","contactInfo"],"Victim of a Crime":["crimeCommittedDate","roleInMatterCriminal","pendingCharges",...k],"Wills and Trusts":["valueOfAssets","typeOfAssets","roleInMatterProbate","estateLegalServicesNeeded",...P],"Workers Compensation":["incidentDate","claimStatus","primaryInjury","causeOfInjury","doctorTreatment",...T],"Workplace Harassment":["numEmployeesOfBusiness","employerType","employeeAtCompany",...P],"Workplace Discrimination":["numEmployeesOfBusiness","employerType","employeeAtCompany",...P],"Wrongful Death":["incidentDate","relationshipToVictim","criminalChargesFiled","causeOfDeath",...T],"Wrongful Termination":["numEmployeesOfBusiness","employerType",...P]},"*":P}};function D(e,t=[],a={}){const n={...e};return n.values=function e(n){const i={};for(const r in n)Array.isArray(n[r])?i[r]=n[r].filter((e=>!t.includes(e))).map((e=>a[e]||e)):"object"==typeof n[r]?i[r]=e(n[r]):i[r]=n[r];return i}(e.values),n}D(L,["legalCrossSells"],{commentsWithBankruptcy:"comments"});const A=L.values.Type_Of_Legal_Problem;A["Auto and Car Accidents"].filter((e=>"legalCrossSells"!==e)),A["Workers Compensation"].filter((e=>"legalCrossSells"!==e)),A["Personal Injury"].filter((e=>"legalCrossSells"!==e)),A["Personal Injury"].filter((e=>"legalCrossSells"!==e)),A["Auto and Car Accidents"].filter((e=>"legalCrossSells"!==e)),A["Auto and Car Accidents"].filter((e=>"legalCrossSells"!==e)),A["Personal Injury"].filter((e=>"legalCrossSells"!==e)),A["Personal Injury"].filter((e=>"legalCrossSells"!==e)),A["Child Custody"],A["Child Support"],L.values["*"],A["Family Issues"],A["Child Support"],A["Child Custody"],L.values["*"],A["Divorce and Separation"],A["Defend a Lawsuit"],A["File a Lawsuit"];D({values:{Type_Of_Legal_Problem:{"Defend a Lawsuit":A["Defend a Lawsuit"],"File a Lawsuit":A["File a Lawsuit"]},"*":["lawsuitOtherParty",...P]}},["legalCrossSells"],{commentsWithBankruptcy:"comments"});D({values:{Type_Of_Legal_Problem_Display:{"Automobile Accident":A["Auto and Car Accidents"],"Contract Disputes":A["Business Lawyers"],"Dog Bite":A["Personal Injury"],"Employment and Workplace":A["Employment and Workplace"],Fraud:A["Consumer Lawyers"],"Medical Malpractice":A["Medical Malpractice"],"Personal Injury":A["Personal Injury"],"Property Damage":A["Property Damage"],"Real Estate":A["Real Estate"],"Not Sure or Other":L.values["*"]},"*":["lawsuitOtherParty",...P]}},["legalCrossSells"],{commentsWithBankruptcy:"comments"});D({values:{Type_Of_Legal_Problem_Display:{"Victim of a Crime":A["Victim of a Crime"],"DUI and DWI":A["DUI and DWI"],Expungement:A.Expungement,"Not Sure or Other":L.values["*"]},"*":["crimeCommittedDate","roleInMatterCriminal","pendingCharges",...k]}},["legalCrossSells"],{commentsWithBankruptcy:"comments"});D({values:{Type_Of_Legal_Problem_Display:{"Wrongful Termination":A["Wrongful Termination"],"Workers Compensation":A["Workers Compensation"],"Personal Injury":A["Personal Injury"],Unemployment:A.Unemployment},"*":["numEmployeesOfBusiness","employerType","employeeAtCompany",...P]}},["legalCrossSells"],{commentsWithBankruptcy:"comments"}),A["Workplace Harassment"],A["Workplace Discrimination"],A["Probate and Estates"],A["Wills and Trusts"],A["Wrongful Death"],A["Patents and Intellectual Property"],A["Business Lawyers"],A["Business Lawyers"],L.values["*"];D({values:{Type_Of_Legal_Problem_Display:{Foreclosure:A.Foreclosure,"Landlord and Tenant":A["Landlord and Tenant"],"Wills, Trusts, and Estates":A["Wills and Trusts"],"Property Damage":A["Property Damage"]},"*":["realEstateArea","wouldLikeLawyerTo",...P]}},["legalCrossSells"],{commentsWithBankruptcy:"comments"});const W=[function(t=null){let a=S,n=E,i=$;return t&&(a=v(S,t),n=v(E,t),i=v($,t)),{type:"meta",data:e(x,{tcpaLanguage:'By checking this box, I agree to the Terms of Use and consent to be contacted by <a href="/providers" target="_blank">lawyers, lawyer networks, and partners</a> of this website using live, autodialed, pre-recorded, or artificial voice calls and text messages, at any time including before 8 AM or after 9 PM local time. Your consent is not required as a condition of purchasing any goods or services. To submit this request without this consent, call 878-213-4937.',defaultCommentsPlaceholder:'$getKey($meta, "commentsPlaceholders." + $get(Type_Of_Legal_Problem).value, $meta.defaultCommentsPlaceholder)',commentsPlaceholders:a,defaultFinalHeadline:"Connect With The Legal Help You Deserve",finalHeadlines:n,defaultFinalSubHeadline:"Get a no-obligation consultation with a legal expert.",finalSubHeadlines:i})}}(),e(w,O),{$cmp:"FormKit",props:function(t){const a=e(C,t);return a.formId&&!a.name&&(a.name=a.formId),a}({formId:"testForm"}),children:[function(t={}){return e(function(e={}){return{$el:"h1",attrs:{class:"t-flex t-justify-center t-text-center t-text-[1.7rem] sm:t-text-[2rem] t-font-semibold t-pt-5 t-px-7 md:t-px-3 "+(e.headlineClass||"")+" f-first-headline"}}}(t),t)}({children:'$urlParam("hl", "Start Here For a Free Consultation")',if:"$activeStep === $firstStep()"}),function(t={}){return e(function(e={}){return{$el:"h3",attrs:{class:"t-flex t-justify-center t-text-center t-text-[1.1rem] md:t-text-[1.2rem] t-font-medium t-text-blue-500 t-px-10 t-pb-3 "+(e.subheadlineClass||"")+" f-first-subheadline"}}}(t),t)}({children:'$urlParam("shl", "Our Service is Fast and Free!")',if:"$activeStep === $firstStep()"}),...I,{$el:"div",attrs:{class:"form-body"},children:[function(e={}){return b("categoryAndZip",[c(e.scope,!1,e.input),(e.scope,e.input,a({label:"Category:",name:"category",id:"category",options:["Fruits","Vegetables"]}))],e)}(),function(e={}){return b("firstAndLast",[l(e.scope),o(e.scope)],e)}(),function(e={}){return b("contactInfo",[y(e),g(e),{$el:"script",if:"$activeStep === $lastStep()",children:"(function() {\n  if (window.xxTrustedFormLoaded) {\n    return\n  }\n  var vid = '';\n  if (typeof window.zar !== 'undefined') {\n    vid = window.zar.getVID();\n  }\n  window.xxTrustedFormLoaded = true;\n  var sandbox = document.location.hostname.indexOf('localhost') > -1 ? 'true' : 'false'\n  var tf = document.createElement('script');\n  tf.type = 'text/javascript'; tf.async = true;\n  tf.src = (\"https:\" == document.location.protocol ? 'https' : 'http') + \"://api.trustedform.com/trustedform.js?field=xxTrustedFormCertUrl&identifier=\" + vid + \"&ping_field=xxTrustedFormPingUrl&provideReferrer=false&invert_field_sensitivity=true&sandbox=\" + sandbox + \"&l=\" + new Date().getTime() + Math.random();\n  var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(tf, s);\n})();"},s(e.scope),d(e.scope),m(e.scope),h()],{nextOnEnter:!1})}(),((e={})=>({$el:"div",attrs:{class:{if:"$activeStep === $firstStep()",then:"step-nav "+(e.firstStepButtonClass||"!t-justify-center sm:!t-justify-between"),else:"step-nav !t-justify-between"}},children:[{$formkit:"button",name:"back_button",onClick:"$setPreviousStep($prevStepFunc($get(form)))",children:"Back",outerClass:{if:"$activeStep === $firstStep()",then:"t-hidden sm:t-block",else:""},style:{if:"$activeStep === $firstStep()",then:"display: none;"},classes:{input:(e.inputClass||"")+" f-navigation-input"}},{$formkit:"button",name:"next_button",onClick:"$setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form)))",children:{if:"$activeStep === $firstStep()",then:e.startText||"Start",else:"Next"},outerClass:{if:"$activeStep === $lastStep()",then:"t-hidden",else:""},style:{if:"$activeStep === $lastStep()",then:"display: none;"},classes:{input:(e.inputClass||"")+" f-navigation-input"}},{$formkit:"submit",name:"submit_button",label:e.submitLabel||"Submit",if:"$activeStep === $lastStep()",style:{if:"$activeStep !== $lastStep()",then:"display: none;"},classes:{input:(e.inputClass||"")+" !t-ml-2 sm:!t-ml-auto f-navigation-input"}}]}))(),{$el:"pre",if:'$urlParam("fdbg", "") == 1',children:[{$el:"pre",children:"$stringify( $get(form).value )",attrs:{class:"t-text-xs",style:"overflow: scroll"}},{$el:"pre",children:["activeStep: ","$activeStep"],attrs:{class:"t-text-xs",style:"overflow: scroll"}},{$el:"pre",children:["stepHistory: ","$stepHistory"],attrs:{class:"t-text-xs",style:"overflow: scroll"}},{$el:"pre",children:["stepQueue: ","$stepQueue"],attrs:{class:"t-text-xs",style:"overflow: scroll"}},{$el:"pre",children:["steps: ","$stepKeys()"],attrs:{class:"t-text-xs",style:"overflow: scroll"}}]}]}]}];var O;return W}();