bhl-forms 0.6.15 → 0.7.0
This diff represents the content of publicly available package versions that have been released to one of the supported registries. The information contained in this diff is provided for informational purposes only and reflects changes between package versions as they appear in their respective public registries.
- package/dist/bhl-forms.es.js +1757 -1759
- package/dist/bhl-forms.iife.js +4 -4
- package/dist/bhl-forms.modern.es.js +2804 -2811
- package/dist/bhl-forms.modern.iife.js +6 -6
- package/dist/bhl-forms.modern.umd.js +6 -6
- package/dist/bhl-forms.umd.js +4 -4
- package/dist/forms/accidentsAndInjuries.es.js +278 -215
- package/dist/forms/accidentsAndInjuries.iife.js +1 -1
- package/dist/forms/accidentsAndInjuries.json +1 -1
- package/dist/forms/appraisals.es.js +16 -7
- package/dist/forms/appraisals.iife.js +1 -1
- package/dist/forms/business.es.js +288 -226
- package/dist/forms/business.iife.js +1 -1
- package/dist/forms/business.json +1 -1
- package/dist/forms/childAndFamily.es.js +271 -214
- package/dist/forms/childAndFamily.iife.js +1 -1
- package/dist/forms/childAndFamily.json +1 -1
- package/dist/forms/childAndFamilySingle.es.js +614 -545
- package/dist/forms/childAndFamilySingle.iife.js +1 -1
- package/dist/forms/childAndFamilySingle.json +1 -1
- package/dist/forms/civilLawsuit.es.js +608 -541
- package/dist/forms/civilLawsuit.iife.js +1 -1
- package/dist/forms/civilLawsuit.json +1 -1
- package/dist/forms/coins.es.js +16 -7
- package/dist/forms/coins.iife.js +1 -1
- package/dist/forms/contracts.es.js +275 -217
- package/dist/forms/contracts.iife.js +1 -1
- package/dist/forms/contracts.json +1 -1
- package/dist/forms/criminal.es.js +631 -562
- package/dist/forms/criminal.iife.js +1 -1
- package/dist/forms/criminal.json +1 -1
- package/dist/forms/divorce.es.js +614 -545
- package/dist/forms/divorce.iife.js +1 -1
- package/dist/forms/divorce.json +1 -1
- package/dist/forms/employmentAndWorkplace.es.js +555 -496
- package/dist/forms/employmentAndWorkplace.iife.js +1 -1
- package/dist/forms/employmentAndWorkplace.json +1 -1
- package/dist/forms/generalHomeImprovement.es.js +3224 -0
- package/dist/forms/generalHomeImprovement.iife.js +1 -0
- package/dist/forms/generalHomeImprovement.json +1 -0
- package/dist/forms/generalLegal.es.js +274 -216
- package/dist/forms/generalLegal.iife.js +1 -1
- package/dist/forms/generalLegal.json +1 -1
- package/dist/forms/generalLegalJustAnswer.es.js +4534 -0
- package/dist/forms/generalLegalJustAnswer.iife.js +1 -0
- package/dist/forms/generalLegalJustAnswer.json +1 -0
- package/dist/forms/generalLegalPopUnder.es.js +275 -217
- package/dist/forms/generalLegalPopUnder.iife.js +1 -1
- package/dist/forms/generalLegalPopUnder.json +1 -1
- package/dist/forms/generalLegalPopUnderSingle.es.js +645 -573
- package/dist/forms/generalLegalPopUnderSingle.iife.js +1 -1
- package/dist/forms/generalLegalPopUnderSingle.json +1 -1
- package/dist/forms/generalLegalSingle.es.js +645 -573
- package/dist/forms/generalLegalSingle.iife.js +1 -1
- package/dist/forms/generalLegalSingle.json +1 -1
- package/dist/forms/generalLegalThankYou.es.js +137 -130
- package/dist/forms/generalLegalThankYou.iife.js +1 -1
- package/dist/forms/generalLegalThankYouConsultation.es.js +645 -573
- package/dist/forms/generalLegalThankYouConsultation.iife.js +1 -1
- package/dist/forms/generalLegalThankYouConsultation.json +1 -1
- package/dist/forms/harassmentAndDiscrimination.es.js +271 -214
- package/dist/forms/harassmentAndDiscrimination.iife.js +1 -1
- package/dist/forms/harassmentAndDiscrimination.json +1 -1
- package/dist/forms/landlordTenant.es.js +287 -230
- package/dist/forms/landlordTenant.iife.js +1 -1
- package/dist/forms/landlordTenant.json +1 -1
- package/dist/forms/malpractice.es.js +276 -217
- package/dist/forms/malpractice.iife.js +1 -1
- package/dist/forms/malpractice.json +1 -1
- package/dist/forms/mechanics.es.js +171 -165
- package/dist/forms/mechanics.iife.js +1 -1
- package/dist/forms/mechanics.json +1 -1
- package/dist/forms/patentsAndIP.es.js +617 -548
- package/dist/forms/patentsAndIP.iife.js +1 -1
- package/dist/forms/patentsAndIP.json +1 -1
- package/dist/forms/realEstate.es.js +272 -215
- package/dist/forms/realEstate.iife.js +1 -1
- package/dist/forms/realEstate.json +1 -1
- package/dist/forms/repossession.es.js +275 -217
- package/dist/forms/repossession.iife.js +1 -1
- package/dist/forms/repossession.json +1 -1
- package/dist/forms/ssdi.es.js +139 -138
- package/dist/forms/ssdi.iife.js +1 -1
- package/dist/forms/ssdi.json +1 -1
- package/dist/forms/testForm.es.js +55 -52
- package/dist/forms/testForm.iife.js +1 -1
- package/dist/forms/testRedirects.es.js +28 -22
- package/dist/forms/testRedirects.iife.js +1 -1
- package/dist/forms/vets.es.js +16 -7
- package/dist/forms/vets.iife.js +1 -1
- package/dist/forms/willsAndTrusts.es.js +272 -213
- package/dist/forms/willsAndTrusts.iife.js +1 -1
- package/dist/forms/willsAndTrusts.json +1 -1
- package/package.json +3 -3
package/dist/forms/ssdi.json
CHANGED
|
@@ -1 +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 was injured at work and would like to file for workers compensation benefits\"","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":"Submit Your Case","finalHeadlines":{},"defaultFinalSubHeadline":"You may benefit from speaking with a legal professional. Please verify your contact information.","finalSubHeadlines":{"Adoption":"You may benefit from speaking with an adoption professional. Please verify your contact information.","Auto and Car Accidents":"You may benefit from speaking with an accident professional. Please verify your contact information.","Bankruptcy":"You may benefit from speaking with a bankruptcy professional. Please verify your contact information.","Copyrights and Trademarks":"You may benefit from speaking with a copyright and trademark professional. Please verify your contact information.","Divorce and Separation":"You may benefit from speaking with a divorce professional. Please verify your contact information.","DUI and DWI":"You may benefit from speaking with a DUI professional. Please verify your contact information.","Elder Law":"You may benefit from speaking with an elder law professional. Please verify your contact information.","Foreclosure":"You may benefit from speaking with a foreclosure professional. Please verify your contact information.","Guardianship":"You may benefit from speaking with a guardianship professional. Please verify your contact information.","Immigration and Visas":"You may benefit from speaking with a immigration professional. Please verify your contact information.","Landlord and Tenant":"You may benefit from speaking with a landlord and tenant legal professional. Please verify your contact information.","Long Term Disability":"You may benefit from speaking with a disability legal professional. Please verify your contact information.","Medical Malpractice":"You may benefit from speaking with a malpractice professional. Please verify your contact information.","Patents and Intellectual Property":"You may benefit from speaking with a patent professional. Please verify your contact information.","Personal Injury":"You may benefit from speaking with a personal injury professional. Please verify your contact information.","Probate and Estates":"You may benefit from speaking with a probate and estate professional. Please verify your contact information.","Real Estate":"You may benefit from speaking with a real estate professional. Please verify your contact information.","Social Security Disability and Insurance":"You may benefit from speaking with an SSDI professional. Please verify your contact information.","Tax and IRS":"You may benefit from speaking with a tax professional. Please verify your contact information.","Unemployment":"You may benefit from speaking with an unemployment professional. Please verify your contact information.","Workers Compensation":"You may benefit from speaking with a workers compensation professional. Please verify your contact information."}}},{"$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-[2rem] t-font-semibold t-pt-5 t-px-7 md:t-px-3 !t-text-dark"},"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-[1.2rem] t-font-medium t-text-blue-500 t-px-10 !t-text-[#00428A]"},"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}$/","validationMessages":{"required":"Zip Code is required","matches":"Invalid Zip Code"},"labelClass":"required","placeholder":"#####","help":"We try to match you with local legal help","name":"Zip","maxlength":5,"inputmode":"numeric","autocomplete":"postal-code","wrapperClass":"t-flex t-justify-center","messagesClass":"t-flex t-justify-center","inputClass":"t-text-center","helpClass":"t-mt-2.5 !t-text-sm t-text-center","id":"Zip","onKeypress":"$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":[{"$el":"h3","children":"What is the Age of the Applicant?","attrs":{"class":"t-flex t-justify-center t-text-center t-text-2xl t-font-bold t-text-dark t-pb-5 t-pt-0 t-px-1 "}},{"$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","name":"Applicant_Age","value":"50","placeholder":"Age between 18 and 65","maxlength":2,"inputmode":"numeric","wrapperClass":"t-flex t-justify-center","messagesClass":"t-flex t-justify-center","inputClass":"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":[{"$el":"h3","children":"Do You Expect To Be Out Of Work For At Least a Year Due To Your Health?","attrs":{"class":"t-flex t-justify-center t-text-center t-text-2xl t-font-bold t-text-dark t-pb-5 t-pt-0 t-px-1 "}},{"$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":[{"$el":"h3","children":"Have You Had a Full-Time Job Within the Past 5 Years?","attrs":{"class":"t-flex t-justify-center t-text-center t-text-2xl t-font-bold t-text-dark t-pb-5 t-pt-0 t-px-1 "}},{"$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":[{"$el":"h3","children":"Are You Currently Receiving Social Security Disability Benefits?","attrs":{"class":"t-flex t-justify-center t-text-center t-text-2xl t-font-bold t-text-dark t-pb-5 t-pt-0 t-px-1 "}},{"$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":[{"$el":"h3","children":"Have You Recently Been Treated by a Doctor, Hospital or Clinic?","attrs":{"class":"t-flex t-justify-center t-text-center t-text-2xl t-font-bold t-text-dark t-pb-5 t-pt-0 t-px-1 "}},{"$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":[{"$el":"h3","children":"Already Working with An Attorney?","attrs":{"class":"t-flex t-justify-center t-text-center t-text-2xl t-font-bold t-text-dark t-pb-5 t-pt-0 t-px-1 "}},{"$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":[{"$el":"h3","children":"Please briefly describe your situation:","attrs":{"class":"t-flex t-justify-center t-text-center t-text-2xl t-font-bold t-text-blue-500 t-pb-5 t-pt-0 t-px-1 !t-text-dark"}},{"$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":[{"$el":"h3","children":"Please Provide a Contact Name","attrs":{"class":"t-flex t-justify-center t-text-center t-text-2xl t-font-bold t-text-blue-500 t-pb-5 t-pt-0 t-px-1 !t-text-dark"}},{"$formkit":"text","validation":"required","validationMessages":{"required":"First Name is required"},"labelClass":"required","label":"First Name:","placeholder":"First","name":"First_Name","autocomplete":"given-name","wrapperClass":"side-by-side t-items-center","id":"First_Name"},{"$formkit":"text","validation":"required","validationMessages":{"required":"Last Name is required"},"labelClass":"required","label":"Last Name:","placeholder":"Last","name":"Last_Name","autocomplete":"family-name","wrapperClass":"side-by-side t-items-center","id":"Last_Name","onKeypress":"$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":[{"$el":"h3","children":"Submit Your Free Application","attrs":{"class":"t-flex t-justify-center t-text-center t-text-2xl t-font-bold t-text-blue-500 t-pb-3 t-pt-0 t-px-1 !t-text-[#00428A]"}},{"$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-7 t-pt-0 t-px-3 "}},{"$el":"script","if":"$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":"Field 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","name":"TCPA_Opt_In","data-tf-sensitive":"false","validation":"required|accepted","validationMessages":{"required":"Consent is required","accepted":"Consent is required"},"classes":{"label":"t-text-xs t-text-slate-500 t-font-normal"}},{"$el":"div","if":"$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":"step-nav"},"children":[{"$formkit":"button","name":"back_button","onClick":"$setPreviousStep($prevStepFunc($get(form)))","children":"Back","style":{"if":"$activeStep === $firstStep()","then":"visibility: hidden;"}},{"$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 === $lastStep()","then":"display: none;"}},{"$formkit":"submit","name":"submit_button","label":"Submit","if":"$activeStep === $lastStep()","style":{"if":"$activeStep !== $lastStep()","then":"display: none;"}}]},{"$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: ","$stepKeys()"],"attrs":{"class":"t-text-xs","style":"overflow: scroll"}}]}]}]}]
|
|
1
|
+
[{"type":"meta","data":{"tcpaLanguage":"By checking this box, I a) agree to the Terms of Use, and b) consent to be contacted by lawyers, lawyer networks, and partners of this website using live, autodialed, pre-recorded, or artificial voice calls, as well as text messages. Your consent is not required as a condition of purchasing any goods or services. To submit this request without this consent, call 878-213-4937.","defaultCommentsPlaceholder":"$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 was injured at work and would like to file for workers compensation benefits\"","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":"Submit Your Case","finalHeadlines":{},"defaultFinalSubHeadline":"You may benefit from speaking with a legal professional. Please verify your contact information.","finalSubHeadlines":{"Adoption":"You may benefit from speaking with an adoption professional. Please verify your contact information.","Auto and Car Accidents":"You may benefit from speaking with an accident professional. Please verify your contact information.","Bankruptcy":"You may benefit from speaking with a bankruptcy professional. Please verify your contact information.","Copyrights and Trademarks":"You may benefit from speaking with a copyright and trademark professional. Please verify your contact information.","Divorce and Separation":"You may benefit from speaking with a divorce professional. Please verify your contact information.","DUI and DWI":"You may benefit from speaking with a DUI professional. Please verify your contact information.","Elder Law":"You may benefit from speaking with an elder law professional. Please verify your contact information.","Foreclosure":"You may benefit from speaking with a foreclosure professional. Please verify your contact information.","Guardianship":"You may benefit from speaking with a guardianship professional. Please verify your contact information.","Immigration and Visas":"You may benefit from speaking with a immigration professional. Please verify your contact information.","Landlord and Tenant":"You may benefit from speaking with a landlord and tenant legal professional. Please verify your contact information.","Long Term Disability":"You may benefit from speaking with a disability legal professional. Please verify your contact information.","Medical Malpractice":"You may benefit from speaking with a malpractice professional. Please verify your contact information.","Patents and Intellectual Property":"You may benefit from speaking with a patent professional. Please verify your contact information.","Personal Injury":"You may benefit from speaking with a personal injury professional. Please verify your contact information.","Probate and Estates":"You may benefit from speaking with a probate and estate professional. Please verify your contact information.","Real Estate":"You may benefit from speaking with a real estate professional. Please verify your contact information.","Social Security Disability and Insurance":"You may benefit from speaking with an SSDI professional. Please verify your contact information.","Tax and IRS":"You may benefit from speaking with a tax professional. Please verify your contact information.","Unemployment":"You may benefit from speaking with an unemployment professional. Please verify your contact information.","Workers Compensation":"You may benefit from speaking with a workers compensation professional. Please verify your contact information."}}},{"$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-[2rem] t-font-semibold t-pt-5 t-px-7 md:t-px-3 !t-text-dark"},"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-[1.2rem] t-font-medium t-text-blue-500 t-px-10 !t-text-[#00428A]"},"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}$/","validationMessages":{"required":"Zip Code is required","matches":"Invalid Zip Code"},"labelClass":"required","placeholder":"#####","help":"We try to match you with local help","name":"Zip","maxlength":5,"inputmode":"numeric","autocomplete":"postal-code","wrapperClass":"t-flex t-justify-center","messagesClass":"t-flex t-justify-center","inputClass":"t-text-center","helpClass":"t-mt-2.5 !t-text-sm t-text-center","id":"Zip","onKeypress":"$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":[{"$el":"h3","children":"What is the Age of the Applicant?","attrs":{"class":"t-flex t-justify-center t-text-center t-text-2xl t-font-bold t-text-dark t-pb-5 t-pt-0 t-px-1 "}},{"$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","name":"Applicant_Age","value":"50","placeholder":"Age between 18 and 65","maxlength":2,"inputmode":"numeric","wrapperClass":"t-flex t-justify-center","messagesClass":"t-flex t-justify-center","inputClass":"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":[{"$el":"h3","children":"Do You Expect To Be Out Of Work For At Least a Year Due To Your Health?","attrs":{"class":"t-flex t-justify-center t-text-center t-text-2xl t-font-bold t-text-dark t-pb-5 t-pt-0 t-px-1 "}},{"$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":[{"$el":"h3","children":"Have You Had a Full-Time Job Within the Past 5 Years?","attrs":{"class":"t-flex t-justify-center t-text-center t-text-2xl t-font-bold t-text-dark t-pb-5 t-pt-0 t-px-1 "}},{"$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":[{"$el":"h3","children":"Are You Currently Receiving Social Security Disability Benefits?","attrs":{"class":"t-flex t-justify-center t-text-center t-text-2xl t-font-bold t-text-dark t-pb-5 t-pt-0 t-px-1 "}},{"$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":[{"$el":"h3","children":"Have You Recently Been Treated by a Doctor, Hospital or Clinic?","attrs":{"class":"t-flex t-justify-center t-text-center t-text-2xl t-font-bold t-text-dark t-pb-5 t-pt-0 t-px-1 "}},{"$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":[{"$el":"h3","children":"Already Working with An Attorney?","attrs":{"class":"t-flex t-justify-center t-text-center t-text-2xl t-font-bold t-text-dark t-pb-5 t-pt-0 t-px-1 "}},{"$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":[{"$el":"h3","children":"Please briefly describe your situation:","attrs":{"class":"t-flex t-justify-center t-text-center t-text-2xl t-font-bold t-text-blue-500 t-pb-5 t-pt-0 t-px-1 !t-text-dark"}},{"$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":[{"$el":"h3","children":"Please Provide a Contact Name","attrs":{"class":"t-flex t-justify-center t-text-center t-text-2xl t-font-bold t-text-blue-500 t-pb-5 t-pt-0 t-px-1 !t-text-dark"}},{"$formkit":"text","validation":"required","validationMessages":{"required":"First Name is required"},"labelClass":"required","label":"First Name:","placeholder":"First","name":"First_Name","autocomplete":"given-name","wrapperClass":"side-by-side t-items-center","id":"First_Name"},{"$formkit":"text","validation":"required","validationMessages":{"required":"Last Name is required"},"labelClass":"required","label":"Last Name:","placeholder":"Last","name":"Last_Name","autocomplete":"family-name","wrapperClass":"side-by-side t-items-center","id":"Last_Name","onKeypress":"$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":[{"$el":"h3","children":"Submit Your Free Application","attrs":{"class":"t-flex t-justify-center t-text-center t-text-2xl t-font-bold t-text-blue-500 t-pb-3 t-pt-0 t-px-1 !t-text-[#00428A]"}},{"$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-7 t-pt-0 t-px-3 "}},{"$el":"script","if":"$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":"Field 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","name":"TCPA_Opt_In","data-tf-sensitive":"false","validation":"required|accepted","validationMessages":{"required":"Consent is required","accepted":"Consent is required"},"classes":{"label":"t-text-xs t-text-slate-500 t-font-normal"}},{"$el":"div","if":"$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":"step-nav"},"children":[{"$formkit":"button","name":"back_button","onClick":"$setPreviousStep($prevStepFunc($get(form)))","children":"Back","style":{"if":"$activeStep === $firstStep()","then":"visibility: hidden;"}},{"$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 === $lastStep()","then":"display: none;"}},{"$formkit":"submit","name":"submit_button","label":"Submit","if":"$activeStep === $lastStep()","style":{"if":"$activeStep !== $lastStep()","then":"display: none;"}}]},{"$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: ","$stepKeys()"],"attrs":{"class":"t-text-xs","style":"overflow: scroll"}}]}]}]}]
|
|
@@ -2,13 +2,12 @@ function merge() {
|
|
|
2
2
|
return Object.assign({}, ...arguments)
|
|
3
3
|
}
|
|
4
4
|
|
|
5
|
-
|
|
6
|
-
|
|
7
|
-
const
|
|
8
|
-
const
|
|
9
|
-
const
|
|
10
|
-
const
|
|
11
|
-
const DEFAULT_FINAL_SUBHEADLINE_DYNAMIC = '$getKey($meta, "finalSubHeadlines." + $get(Type_Of_Legal_Problem).value, $meta.defaultFinalSubHeadline)';
|
|
5
|
+
const DEFAULT_COMMENTS_PLACEHOLDER_DYNAMIC_LEGAL = '$getKey($meta, "commentsPlaceholders." + $get(Type_Of_Legal_Problem).value, $meta.defaultCommentsPlaceholder)';
|
|
6
|
+
const DEFAULT_FINAL_HEADLINE_LEGAL = 'Submit Your Case';
|
|
7
|
+
const DEFAULT_FINAL_HEADLINE_DYNAMIC_LEGAL = '$getKey($meta, "finalHeadlines." + $get(Type_Of_Legal_Problem).value, $meta.defaultFinalHeadline)';
|
|
8
|
+
const DEFAULT_FINAL_SUBHEADLINE_LEGAL = 'You may benefit from speaking with a legal professional. Please verify your contact information.';
|
|
9
|
+
const DEFAULT_FINAL_SUBHEADLINE_DYNAMIC_LEGAL = '$getKey($meta, "finalSubHeadlines." + $get(Type_Of_Legal_Problem).value, $meta.defaultFinalSubHeadline)';
|
|
10
|
+
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.";
|
|
12
11
|
|
|
13
12
|
const select = (updates) => {
|
|
14
13
|
if (updates.name && !updates.id) {
|
|
@@ -53,16 +52,6 @@ const sbsText = (updates) => {
|
|
|
53
52
|
return text(updates)
|
|
54
53
|
};
|
|
55
54
|
|
|
56
|
-
const category = () => sbsSelect({
|
|
57
|
-
label: 'Category:',
|
|
58
|
-
name: 'category',
|
|
59
|
-
id: 'category',
|
|
60
|
-
options: [
|
|
61
|
-
'Fruits',
|
|
62
|
-
'Vegetables'
|
|
63
|
-
]
|
|
64
|
-
});
|
|
65
|
-
|
|
66
55
|
const email = (scope) => sbsText({
|
|
67
56
|
$formkit: 'email',
|
|
68
57
|
name: scope ? scope + ':' + 'Email' : 'Email',
|
|
@@ -78,7 +67,6 @@ const email = (scope) => sbsText({
|
|
|
78
67
|
});
|
|
79
68
|
|
|
80
69
|
const firstName = (scope) => sbsText({
|
|
81
|
-
$formkit: 'text',
|
|
82
70
|
label: 'First Name:',
|
|
83
71
|
placeholder: 'First',
|
|
84
72
|
name: scope ? scope + ':' + 'First_Name' : 'First_Name',
|
|
@@ -89,7 +77,6 @@ const firstName = (scope) => sbsText({
|
|
|
89
77
|
});
|
|
90
78
|
|
|
91
79
|
const lastName = (scope) => sbsText({
|
|
92
|
-
$formkit: 'text',
|
|
93
80
|
label: 'Last Name:',
|
|
94
81
|
placeholder: 'Last',
|
|
95
82
|
name: scope ? scope + ':' + 'Last_Name' : 'Last_Name',
|
|
@@ -117,20 +104,6 @@ const phone = (scope) => sbsText({
|
|
|
117
104
|
helpClass: "t-mt-2.5 md:t-text-right md:t-mt-[-2px]"
|
|
118
105
|
});
|
|
119
106
|
|
|
120
|
-
const TCPAConsent = (scope) => ({
|
|
121
|
-
$formkit: 'checkbox',
|
|
122
|
-
label: '$meta.tcpaLanguage',
|
|
123
|
-
name: scope ? scope + ':' + 'TCPA_Opt_In' : 'TCPA_Opt_In',
|
|
124
|
-
'data-tf-sensitive': 'false',
|
|
125
|
-
validation: 'required|accepted',
|
|
126
|
-
validationMessages: {
|
|
127
|
-
required: 'Consent is required',
|
|
128
|
-
accepted: 'Consent is required'
|
|
129
|
-
},
|
|
130
|
-
classes: {
|
|
131
|
-
label: "t-text-xs t-text-slate-500 t-font-normal"
|
|
132
|
-
}
|
|
133
|
-
});
|
|
134
107
|
|
|
135
108
|
const zipcode = (scope) => sbsText({
|
|
136
109
|
label: 'Zip Code:',
|
|
@@ -146,6 +119,31 @@ const zipcode = (scope) => sbsText({
|
|
|
146
119
|
}
|
|
147
120
|
});
|
|
148
121
|
|
|
122
|
+
const category = () => sbsSelect({
|
|
123
|
+
label: 'Category:',
|
|
124
|
+
name: 'category',
|
|
125
|
+
id: 'category',
|
|
126
|
+
options: [
|
|
127
|
+
'Fruits',
|
|
128
|
+
'Vegetables'
|
|
129
|
+
]
|
|
130
|
+
});
|
|
131
|
+
|
|
132
|
+
const TCPAConsent = (scope) => ({
|
|
133
|
+
$formkit: 'checkbox',
|
|
134
|
+
label: '$meta.tcpaLanguage',
|
|
135
|
+
name: scope ? scope + ':' + 'TCPA_Opt_In' : 'TCPA_Opt_In',
|
|
136
|
+
'data-tf-sensitive': 'false',
|
|
137
|
+
validation: 'required|accepted',
|
|
138
|
+
validationMessages: {
|
|
139
|
+
required: 'Consent is required',
|
|
140
|
+
accepted: 'Consent is required'
|
|
141
|
+
},
|
|
142
|
+
classes: {
|
|
143
|
+
label: "t-text-xs t-text-slate-500 t-font-normal"
|
|
144
|
+
}
|
|
145
|
+
});
|
|
146
|
+
|
|
149
147
|
const NEXT_ON_ENTER = '$onEnter($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))';
|
|
150
148
|
const NEXT_ON_INPUT = '$onInput($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))';
|
|
151
149
|
|
|
@@ -211,7 +209,7 @@ function secureIcon(updates) {
|
|
|
211
209
|
function contactStepHeadline(updates) {
|
|
212
210
|
return {
|
|
213
211
|
$el: 'h3',
|
|
214
|
-
children: updates.headline ||
|
|
212
|
+
children: updates.headline || DEFAULT_FINAL_HEADLINE_DYNAMIC_LEGAL,
|
|
215
213
|
attrs: {
|
|
216
214
|
class: 't-flex t-justify-center t-text-center t-text-2xl t-font-bold t-text-blue-500 t-pb-3 t-pt-0 t-px-1' + ' ' + (updates.headlineClass || '')
|
|
217
215
|
}
|
|
@@ -221,7 +219,7 @@ function contactStepHeadline(updates) {
|
|
|
221
219
|
function contactStepSubHeadline(updates) {
|
|
222
220
|
return {
|
|
223
221
|
$el: 'h5',
|
|
224
|
-
children: updates.subheadline ||
|
|
222
|
+
children: updates.subheadline || DEFAULT_FINAL_SUBHEADLINE_DYNAMIC_LEGAL,
|
|
225
223
|
attrs: {
|
|
226
224
|
class: 't-flex t-justify-center t-text-center !t-text-lg t-font-semibold t-pb-7 t-pt-0 t-px-3' + ' ' + (updates.subheadlineClass || '')
|
|
227
225
|
}
|
|
@@ -261,10 +259,16 @@ const stepDefaults = (step, stepKey) => ({
|
|
|
261
259
|
}
|
|
262
260
|
});
|
|
263
261
|
|
|
264
|
-
function step(name, inputs,
|
|
265
|
-
|
|
266
|
-
nextOnEnter = true
|
|
267
|
-
|
|
262
|
+
function step(name, inputs, updates = {}) {
|
|
263
|
+
const {
|
|
264
|
+
nextOnEnter = true,
|
|
265
|
+
nextOnInput = false,
|
|
266
|
+
stepKey = undefined,
|
|
267
|
+
nextStepMap = undefined,
|
|
268
|
+
triggerRedirectMap = undefined,
|
|
269
|
+
autoFocus = undefined,
|
|
270
|
+
} = updates;
|
|
271
|
+
|
|
268
272
|
if (inputs && inputs.length && (nextOnEnter || nextOnInput)) {
|
|
269
273
|
const lastInput = findLastInput(inputs[inputs.length - 1]);
|
|
270
274
|
if (lastInput && nextOnEnter === true) {
|
|
@@ -284,6 +288,7 @@ function step(name, inputs, nextOnEnter = true, nextOnInput = false, stepKey = u
|
|
|
284
288
|
id: name,
|
|
285
289
|
name: name,
|
|
286
290
|
nextStepMap: nextStepMap,
|
|
291
|
+
triggerRedirectMap: triggerRedirectMap,
|
|
287
292
|
autoFocus: autoFocus,
|
|
288
293
|
children: inputs
|
|
289
294
|
}
|
|
@@ -292,7 +297,6 @@ function step(name, inputs, nextOnEnter = true, nextOnInput = false, stepKey = u
|
|
|
292
297
|
)
|
|
293
298
|
}
|
|
294
299
|
|
|
295
|
-
|
|
296
300
|
function categoryAndZip(updates = {}) {
|
|
297
301
|
return step(
|
|
298
302
|
'categoryAndZip',
|
|
@@ -300,7 +304,7 @@ function categoryAndZip(updates = {}) {
|
|
|
300
304
|
zipcode(),
|
|
301
305
|
category()
|
|
302
306
|
],
|
|
303
|
-
updates
|
|
307
|
+
updates
|
|
304
308
|
)
|
|
305
309
|
}
|
|
306
310
|
|
|
@@ -316,7 +320,7 @@ function contactInfo(updates = {}) {
|
|
|
316
320
|
TCPAConsent(updates.scope),
|
|
317
321
|
secureIcon()
|
|
318
322
|
],
|
|
319
|
-
false
|
|
323
|
+
{ nextOnEnter: false }
|
|
320
324
|
)
|
|
321
325
|
}
|
|
322
326
|
|
|
@@ -327,7 +331,7 @@ function firstAndLast(updates = {}) {
|
|
|
327
331
|
firstName(),
|
|
328
332
|
lastName()
|
|
329
333
|
],
|
|
330
|
-
updates
|
|
334
|
+
updates
|
|
331
335
|
)
|
|
332
336
|
}
|
|
333
337
|
|
|
@@ -470,9 +474,7 @@ function formProps(updates) {
|
|
|
470
474
|
return props
|
|
471
475
|
}
|
|
472
476
|
|
|
473
|
-
const metaDefaults = {
|
|
474
|
-
tcpaLanguage: TCPA_LANGUAGE
|
|
475
|
-
};
|
|
477
|
+
const metaDefaults = {};
|
|
476
478
|
|
|
477
479
|
function metaProps(updates) {
|
|
478
480
|
const data = merge(
|
|
@@ -485,7 +487,7 @@ function metaProps(updates) {
|
|
|
485
487
|
}
|
|
486
488
|
}
|
|
487
489
|
|
|
488
|
-
function
|
|
490
|
+
function defaultMetaPropsLegal(tolps = null) {
|
|
489
491
|
let commentsPlaceholders = TOLPCommentsPlaceholders;
|
|
490
492
|
let finalHeadlines = TOLPFinalHeadlines;
|
|
491
493
|
let finalSubHeadlines = TOLPFinalSubHeadlines;
|
|
@@ -495,12 +497,13 @@ function defaultMetaProps(tolps = null) {
|
|
|
495
497
|
finalSubHeadlines = filterMapByKey(TOLPFinalSubHeadlines, tolps);
|
|
496
498
|
}
|
|
497
499
|
return metaProps({
|
|
498
|
-
|
|
500
|
+
tcpaLanguage: TCPA_LANGUAGE_LEGAL,
|
|
501
|
+
defaultCommentsPlaceholder: DEFAULT_COMMENTS_PLACEHOLDER_DYNAMIC_LEGAL,
|
|
499
502
|
commentsPlaceholders: commentsPlaceholders,
|
|
500
|
-
defaultFinalHeadline:
|
|
503
|
+
defaultFinalHeadline: DEFAULT_FINAL_HEADLINE_LEGAL,
|
|
501
504
|
finalHeadlines: finalHeadlines,
|
|
502
|
-
defaultFinalSubHeadline:
|
|
503
|
-
finalSubHeadlines: finalSubHeadlines
|
|
505
|
+
defaultFinalSubHeadline: DEFAULT_FINAL_SUBHEADLINE_LEGAL,
|
|
506
|
+
finalSubHeadlines: finalSubHeadlines
|
|
504
507
|
})
|
|
505
508
|
}
|
|
506
509
|
|
|
@@ -723,7 +726,7 @@ const TOLPFinalSubHeadlines = {
|
|
|
723
726
|
};
|
|
724
727
|
|
|
725
728
|
const schema = [
|
|
726
|
-
|
|
729
|
+
defaultMetaPropsLegal(),
|
|
727
730
|
formAnchor(),
|
|
728
731
|
{
|
|
729
732
|
$cmp: 'FormKit',
|
|
@@ -1 +1 @@
|
|
|
1
|
-
var testForm=function(){"use strict";function e(){return Object.assign({},...arguments)}const t='$getKey($meta, "finalHeadlines." + $get(Type_Of_Legal_Problem).value, $meta.defaultFinalHeadline)',a='$getKey($meta, "finalSubHeadlines." + $get(Type_Of_Legal_Problem).value, $meta.defaultFinalSubHeadline)',i=t=>(t.labelClass="required",t.wrapperClass="side-by-side t-items-center",t.innerClass="select-height-content",t.helpClass="t-mt-2.5 md:t-text-right md:t-mt-[-5px]",(t=>(t.name&&!t.id&&(t.id=t.name),e({$formkit:"select",placeholder:"Please Select",validation:"required",validationMessages:{required:"Field is required"},inputClass:"t-bg-white",labelClass:"required"},t)))(t)),n=t=>(t.wrapperClass="side-by-side t-items-center",(t=>(t.name&&!t.id&&(t.id=t.name),e({$formkit:"text",validation:"required",validationMessages:{required:"Field is required"},labelClass:"required"},t)))(t)),r=e=>n({$formkit:"text",label:"Last Name:",placeholder:"Last",name:e?e+":Last_Name":"Last_Name",autocomplete:"family-name",validationMessages:{required:"Last Name is required"}}),o=e=>n({$formkit:"tel",name:e?e+":Primary_Phone":"Primary_Phone",label:"Phone Number:",placeholder:"###-###-####",maxlength:12,help:"10-digit phone number, hyphens optional",autocomplete:"tel-national","data-tf-sensitive":"false",validation:"required|matches:/^[0-9]{3}-?[0-9]{3}-?[0-9]{4}$/|valid_phone",validationMessages:{required:"Field 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]"}),l=e=>({$formkit:"checkbox",label:"$meta.tcpaLanguage",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:{label:"t-text-xs t-text-slate-500 t-font-normal"}}),s="$onEnter($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))",d="$onInput($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))",m=e=>"group"!==e.type&&"section"!==e.type&&"form"!==e.type&&"hidden"!==e.$formkit&&!e.children,c=e=>{if(m(e))return e;for(var t=e.children.length-1;t>=0;t--){if("string"==typeof e.children)continue;const a=e.children[t];if(m(a))return a;const i=c(a);if(i)return i}return null},p={$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"}},{$el:"span",children:"Secure & Encrypted",attrs:{class:"t-pl-2 t-pt-1 t-font-medium"}}]};function u(t){return e(p,t)}function f(e){return{$el:"h3",children:e.headline||t,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-0 t-px-1 "+(e.headlineClass||"")}}}function h(e){return{$el:"h5",children:e.subheadline||a,attrs:{class:"t-flex t-justify-center t-text-center !t-text-lg t-font-semibold t-pb-7 t-pt-0 t-px-3 "+(e.subheadlineClass||"")}}}const y="(function() {\n if (window.xxTrustedFormLoaded) {\n return\n }\n var vid = '';\n if (typeof window.zar !== 'undefined') {\n vid = window.zar.getVID();\n }\n window.xxTrustedFormLoaded = true;\n var sandbox = document.location.hostname.indexOf('localhost') > -1 ? 'true' : 'false'\n var tf = document.createElement('script');\n tf.type = 'text/javascript'; tf.async = true;\n tf.src = (\"https:\" == document.location.protocol ? 'https' : 'http') + \"://api.trustedform.com/trustedform.js?field=xxTrustedFormCertUrl&identifier=\" + vid + \"&ping_field=xxTrustedFormPingUrl&provideReferrer=false&invert_field_sensitivity=true&sandbox=\" + sandbox + \"&l=\" + new Date().getTime() + Math.random();\n var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(tf, s);\n})();";const g=(e,t)=>({$el:"section",if:'$stepEnabled("'+e+'")',attrs:{hidden:'$activeStep !== "'+e+'"',key:t||e}});function b(t,a,i=!0,n=!1,r=void 0,o=void 0,l=void 0){if(void 0===i&&(i=!0),a&&a.length&&(i||n)){const e=c(a[a.length-1]);e&&!0===i&&(e.onKeypress=s),e&&!0===n&&(e.onInput=d)}return e(g(t,r),{children:[{$formkit:"group",id:t,name:t,nextStepMap:o,autoFocus:l,children:a}]})}const v={type:"form",id:"form",config:{validationVisibility:"submit"},onSubmit:'$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 x(e,t){return Object.fromEntries(Object.entries(e).filter((([e])=>t.includes(e))))}const w={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."};const $={$el:"div",children:[{$el:"div",attrs:{id:"form-anchor",class:"t-absolute",style:{top:"-30px",left:0}}}],attrs:{class:"t-relative"}};const k=[{$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}],I={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 was injured at work and would like to file for workers compensation benefits"',"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={},S={Adoption:"You may benefit from speaking with an adoption professional. Please verify your contact information.","Auto and Car Accidents":"You may benefit from speaking with an accident professional. Please verify your contact information.",Bankruptcy:"You may benefit from speaking with a bankruptcy professional. Please verify your contact information.","Copyrights and Trademarks":"You may benefit from speaking with a copyright and trademark professional. Please verify your contact information.","Divorce and Separation":"You may benefit from speaking with a divorce professional. Please verify your contact information.","DUI and DWI":"You may benefit from speaking with a DUI professional. Please verify your contact information.","Elder Law":"You may benefit from speaking with an elder law professional. Please verify your contact information.",Foreclosure:"You may benefit from speaking with a foreclosure professional. Please verify your contact information.",Guardianship:"You may benefit from speaking with a guardianship professional. Please verify your contact information.","Immigration and Visas":"You may benefit from speaking with a immigration professional. Please verify your contact information.","Landlord and Tenant":"You may benefit from speaking with a landlord and tenant legal professional. Please verify your contact information.","Long Term Disability":"You may benefit from speaking with a disability legal professional. Please verify your contact information.","Medical Malpractice":"You may benefit from speaking with a malpractice professional. Please verify your contact information.","Patents and Intellectual Property":"You may benefit from speaking with a patent professional. Please verify your contact information.","Personal Injury":"You may benefit from speaking with a personal injury professional. Please verify your contact information.","Probate and Estates":"You may benefit from speaking with a probate and estate professional. Please verify your contact information.","Real Estate":"You may benefit from speaking with a real estate professional. Please verify your contact information.","Social Security Disability and Insurance":"You may benefit from speaking with an SSDI professional. Please verify your contact information.","Tax and IRS":"You may benefit from speaking with a tax professional. Please verify your contact information.",Unemployment:"You may benefit from speaking with an unemployment professional. Please verify your contact information.","Workers Compensation":"You may benefit from speaking with a workers compensation professional. Please verify your contact information."},P=[function(t=null){let a=I,i=E,n=S;return t&&(a=x(I,t),i=x(E,t),n=x(S,t)),{type:"meta",data:e(w,{defaultCommentsPlaceholder:'$getKey($meta, "commentsPlaceholders." + $get(Type_Of_Legal_Problem).value, $meta.defaultCommentsPlaceholder)',commentsPlaceholders:a,defaultFinalHeadline:"Submit Your Case",finalHeadlines:i,defaultFinalSubHeadline:"You may benefit from speaking with a legal professional. Please verify your contact information.",finalSubHeadlines:n})}}(),e($,C),{$cmp:"FormKit",props:function(t){const a=e(v,t);return a.formId&&!a.name&&(a.name=a.formId),a}({formId:"testForm"}),children:[function(t={}){return e(function(e={}){return{$el:"h1",attrs:{class:"t-flex t-justify-center t-text-center !t-text-[2rem] t-font-semibold t-pt-5 t-px-7 md:t-px-3 "+(e.headlineClass||"")}}}(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-[1.2rem] t-font-medium t-text-blue-500 t-px-10 "+(e.subheadlineClass||"")}}}(t),t)}({children:'$urlParam("shl", "Our Service is Fast and Free!")',if:"$activeStep === $firstStep()"}),...k,{$el:"div",attrs:{class:"form-body"},children:[function(e={}){return b("categoryAndZip",[n({label:"Zip Code:",placeholder:"#####",name:t?t+":Zip":"Zip",maxlength:5,inputmode:"numeric",autocomplete:"postal-code",validation:"required|matches:/^[0-9]{5}$/",validationMessages:{required:"Zip Code is required",matches:"Invalid Zip Code"}}),i({label:"Category:",name:"category",id:"category",options:["Fruits","Vegetables"]})],e.nextOnEnter);var t}(),function(e={}){return b("firstAndLast",[n({$formkit:"text",label:"First Name:",placeholder:"First",name:t?t+":First_Name":"First_Name",autocomplete:"given-name",validationMessages:{required:"First Name is required"}}),r()],e.nextOnEnter);var t}(),function(e={}){return b("contactInfo",[f(e),h(e),{$el:"script",if:"$activeStep === $lastStep()",children:y},(t=e.scope,n({$formkit:"email",name:t?t+":Email":"Email",label:"Email Address:",placeholder:"email@domain.com",autocomplete:"email","data-tf-sensitive":"false",validation:"required|email",validationMessages:{required:"Email is required",email:"Invalid Email"}})),o(e.scope),l(e.scope),u()],!1);var t}(),((e={})=>({$el:"div",attrs:{class:"step-nav"},children:[{$formkit:"button",name:"back_button",onClick:"$setPreviousStep($prevStepFunc($get(form)))",children:"Back",style:{if:"$activeStep === $firstStep()",then:"visibility: hidden;"}},{$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 === $lastStep()",then:"display: none;"}},{$formkit:"submit",name:"submit_button",label:e.submitLabel||"Submit",if:"$activeStep === $lastStep()",style:{if:"$activeStep !== $lastStep()",then:"display: none;"}}]}))(),{$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: ","$stepKeys()"],attrs:{class:"t-text-xs",style:"overflow: scroll"}}]}]}]}];var C;return P}();
|
|
1
|
+
var testForm=function(){"use strict";function e(){return Object.assign({},...arguments)}const t='$getKey($meta, "finalHeadlines." + $get(Type_Of_Legal_Problem).value, $meta.defaultFinalHeadline)',a='$getKey($meta, "finalSubHeadlines." + $get(Type_Of_Legal_Problem).value, $meta.defaultFinalSubHeadline)',i=t=>(t.labelClass="required",t.wrapperClass="side-by-side t-items-center",t.innerClass="select-height-content",t.helpClass="t-mt-2.5 md:t-text-right md:t-mt-[-5px]",(t=>(t.name&&!t.id&&(t.id=t.name),e({$formkit:"select",placeholder:"Please Select",validation:"required",validationMessages:{required:"Field is required"},inputClass:"t-bg-white",labelClass:"required"},t)))(t)),n=t=>(t.wrapperClass="side-by-side t-items-center",(t=>(t.name&&!t.id&&(t.id=t.name),e({$formkit:"text",validation:"required",validationMessages:{required:"Field is required"},labelClass:"required"},t)))(t)),r=e=>n({label:"Last Name:",placeholder:"Last",name:e?e+":Last_Name":"Last_Name",autocomplete:"family-name",validationMessages:{required:"Last Name is required"}}),o=e=>n({$formkit:"tel",name:e?e+":Primary_Phone":"Primary_Phone",label:"Phone Number:",placeholder:"###-###-####",maxlength:12,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}$/|valid_phone",validationMessages:{required:"Field is required",matches:"Invalid Phone Format, use ###-###-####",valid_phone:"Invalid Phone Number"},helpClass:"t-mt-2.5 md:t-text-right md:t-mt-[-2px]"}),l=e=>({$formkit:"checkbox",label:"$meta.tcpaLanguage",name:e?e+":TCPA_Opt_In":"TCPA_Opt_In","data-tf-sensitive":"false",validation:"required|accepted",validationMessages:{required:"Consent is required",accepted:"Consent is required"},classes:{label:"t-text-xs t-text-slate-500 t-font-normal"}}),s="$onEnter($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))",d="$onInput($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))",m=e=>"group"!==e.type&&"section"!==e.type&&"form"!==e.type&&"hidden"!==e.$formkit&&!e.children,c=e=>{if(m(e))return e;for(var t=e.children.length-1;t>=0;t--){if("string"==typeof e.children)continue;const a=e.children[t];if(m(a))return a;const i=c(a);if(i)return i}return null},p={$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"}},{$el:"span",children:"Secure & Encrypted",attrs:{class:"t-pl-2 t-pt-1 t-font-medium"}}]};function u(t){return e(p,t)}function f(e){return{$el:"h3",children:e.headline||t,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-0 t-px-1 "+(e.headlineClass||"")}}}function h(e){return{$el:"h5",children:e.subheadline||a,attrs:{class:"t-flex t-justify-center t-text-center !t-text-lg t-font-semibold t-pb-7 t-pt-0 t-px-3 "+(e.subheadlineClass||"")}}}const y="(function() {\n if (window.xxTrustedFormLoaded) {\n return\n }\n var vid = '';\n if (typeof window.zar !== 'undefined') {\n vid = window.zar.getVID();\n }\n window.xxTrustedFormLoaded = true;\n var sandbox = document.location.hostname.indexOf('localhost') > -1 ? 'true' : 'false'\n var tf = document.createElement('script');\n tf.type = 'text/javascript'; tf.async = true;\n tf.src = (\"https:\" == document.location.protocol ? 'https' : 'http') + \"://api.trustedform.com/trustedform.js?field=xxTrustedFormCertUrl&identifier=\" + vid + \"&ping_field=xxTrustedFormPingUrl&provideReferrer=false&invert_field_sensitivity=true&sandbox=\" + sandbox + \"&l=\" + new Date().getTime() + Math.random();\n var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(tf, s);\n})();";const g=(e,t)=>({$el:"section",if:'$stepEnabled("'+e+'")',attrs:{hidden:'$activeStep !== "'+e+'"',key:t||e}});function b(t,a,i={}){const{nextOnEnter:n=!0,nextOnInput:r=!1,stepKey:o,nextStepMap:l,triggerRedirectMap:m,autoFocus:p}=i;if(a&&a.length&&(n||r)){const e=c(a[a.length-1]);e&&!0===n&&(e.onKeypress=s),e&&!0===r&&(e.onInput=d)}return e(g(t,o),{children:[{$formkit:"group",id:t,name:t,nextStepMap:l,triggerRedirectMap:m,autoFocus:p,children:a}]})}const x={type:"form",id:"form",config:{validationVisibility:"submit"},onSubmit:'$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 w={};const $={$el:"div",children:[{$el:"div",attrs:{id:"form-anchor",class:"t-absolute",style:{top:"-30px",left:0}}}],attrs:{class:"t-relative"}};const k=[{$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}],I={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 was injured at work and would like to file for workers compensation benefits"',"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={},S={Adoption:"You may benefit from speaking with an adoption professional. Please verify your contact information.","Auto and Car Accidents":"You may benefit from speaking with an accident professional. Please verify your contact information.",Bankruptcy:"You may benefit from speaking with a bankruptcy professional. Please verify your contact information.","Copyrights and Trademarks":"You may benefit from speaking with a copyright and trademark professional. Please verify your contact information.","Divorce and Separation":"You may benefit from speaking with a divorce professional. Please verify your contact information.","DUI and DWI":"You may benefit from speaking with a DUI professional. Please verify your contact information.","Elder Law":"You may benefit from speaking with an elder law professional. Please verify your contact information.",Foreclosure:"You may benefit from speaking with a foreclosure professional. Please verify your contact information.",Guardianship:"You may benefit from speaking with a guardianship professional. Please verify your contact information.","Immigration and Visas":"You may benefit from speaking with a immigration professional. Please verify your contact information.","Landlord and Tenant":"You may benefit from speaking with a landlord and tenant legal professional. Please verify your contact information.","Long Term Disability":"You may benefit from speaking with a disability legal professional. Please verify your contact information.","Medical Malpractice":"You may benefit from speaking with a malpractice professional. Please verify your contact information.","Patents and Intellectual Property":"You may benefit from speaking with a patent professional. Please verify your contact information.","Personal Injury":"You may benefit from speaking with a personal injury professional. Please verify your contact information.","Probate and Estates":"You may benefit from speaking with a probate and estate professional. Please verify your contact information.","Real Estate":"You may benefit from speaking with a real estate professional. Please verify your contact information.","Social Security Disability and Insurance":"You may benefit from speaking with an SSDI professional. Please verify your contact information.","Tax and IRS":"You may benefit from speaking with a tax professional. Please verify your contact information.",Unemployment:"You may benefit from speaking with an unemployment professional. Please verify your contact information.","Workers Compensation":"You may benefit from speaking with a workers compensation professional. Please verify your contact information."},P=[function(t=null){let a=I,i=E,n=S;return t&&(a=v(I,t),i=v(E,t),n=v(S,t)),{type:"meta",data:e(w,{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, $meta.defaultCommentsPlaceholder)',commentsPlaceholders:a,defaultFinalHeadline:"Submit Your Case",finalHeadlines:i,defaultFinalSubHeadline:"You may benefit from speaking with a legal professional. Please verify your contact information.",finalSubHeadlines:n})}}(),e($,C),{$cmp:"FormKit",props:function(t){const a=e(x,t);return a.formId&&!a.name&&(a.name=a.formId),a}({formId:"testForm"}),children:[function(t={}){return e(function(e={}){return{$el:"h1",attrs:{class:"t-flex t-justify-center t-text-center !t-text-[2rem] t-font-semibold t-pt-5 t-px-7 md:t-px-3 "+(e.headlineClass||"")}}}(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-[1.2rem] t-font-medium t-text-blue-500 t-px-10 "+(e.subheadlineClass||"")}}}(t),t)}({children:'$urlParam("shl", "Our Service is Fast and Free!")',if:"$activeStep === $firstStep()"}),...k,{$el:"div",attrs:{class:"form-body"},children:[function(e={}){return b("categoryAndZip",[n({label:"Zip Code:",placeholder:"#####",name:t?t+":Zip":"Zip",maxlength:5,inputmode:"numeric",autocomplete:"postal-code",validation:"required|matches:/^[0-9]{5}$/",validationMessages:{required:"Zip Code is required",matches:"Invalid Zip Code"}}),i({label:"Category:",name:"category",id:"category",options:["Fruits","Vegetables"]})],e);var t}(),function(e={}){return b("firstAndLast",[n({label:"First Name:",placeholder:"First",name:t?t+":First_Name":"First_Name",autocomplete:"given-name",validationMessages:{required:"First Name is required"}}),r()],e);var t}(),function(e={}){return b("contactInfo",[f(e),h(e),{$el:"script",if:"$activeStep === $lastStep()",children:y},(t=e.scope,n({$formkit:"email",name:t?t+":Email":"Email",label:"Email Address:",placeholder:"email@domain.com",autocomplete:"email","data-tf-sensitive":"false",validation:"required|email",validationMessages:{required:"Email is required",email:"Invalid Email"}})),o(e.scope),l(e.scope),u()],{nextOnEnter:!1});var t}(),((e={})=>({$el:"div",attrs:{class:"step-nav"},children:[{$formkit:"button",name:"back_button",onClick:"$setPreviousStep($prevStepFunc($get(form)))",children:"Back",style:{if:"$activeStep === $firstStep()",then:"visibility: hidden;"}},{$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 === $lastStep()",then:"display: none;"}},{$formkit:"submit",name:"submit_button",label:e.submitLabel||"Submit",if:"$activeStep === $lastStep()",style:{if:"$activeStep !== $lastStep()",then:"display: none;"}}]}))(),{$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: ","$stepKeys()"],attrs:{class:"t-text-xs",style:"overflow: scroll"}}]}]}]}];var C;return P}();
|
|
@@ -82,6 +82,21 @@ const sbsText = (updates) => {
|
|
|
82
82
|
return text(updates)
|
|
83
83
|
};
|
|
84
84
|
|
|
85
|
+
|
|
86
|
+
const zipcode = (scope) => sbsText({
|
|
87
|
+
label: 'Zip Code:',
|
|
88
|
+
placeholder: '#####',
|
|
89
|
+
name: scope ? scope + ':' + 'Zip' : 'Zip',
|
|
90
|
+
maxlength: 5,
|
|
91
|
+
inputmode: "numeric",
|
|
92
|
+
autocomplete: 'postal-code',
|
|
93
|
+
validation: 'required|matches:/^[0-9]{5}$/',
|
|
94
|
+
validationMessages: {
|
|
95
|
+
required: 'Zip Code is required',
|
|
96
|
+
matches: 'Invalid Zip Code'
|
|
97
|
+
}
|
|
98
|
+
});
|
|
99
|
+
|
|
85
100
|
const civilDefense = (updates) => sbs2ItemRadio(merge({
|
|
86
101
|
name: 'Civil_Defense',
|
|
87
102
|
id: 'Civil_Defense',
|
|
@@ -129,6 +144,7 @@ const employmentAndWorkplaceTOLPDisplay = (updates) => col2Radio(merge({
|
|
|
129
144
|
]
|
|
130
145
|
}, updates));
|
|
131
146
|
|
|
147
|
+
|
|
132
148
|
const TOLPOptions = [
|
|
133
149
|
'Adoption',
|
|
134
150
|
'Asbestos and Mesothelioma',
|
|
@@ -226,20 +242,6 @@ const realEstateTOLPDisplay = (updates) => col2Radio(merge({
|
|
|
226
242
|
]
|
|
227
243
|
}, updates));
|
|
228
244
|
|
|
229
|
-
const zipcode = (scope) => sbsText({
|
|
230
|
-
label: 'Zip Code:',
|
|
231
|
-
placeholder: '#####',
|
|
232
|
-
name: scope ? scope + ':' + 'Zip' : 'Zip',
|
|
233
|
-
maxlength: 5,
|
|
234
|
-
inputmode: "numeric",
|
|
235
|
-
autocomplete: 'postal-code',
|
|
236
|
-
validation: 'required|matches:/^[0-9]{5}$/',
|
|
237
|
-
validationMessages: {
|
|
238
|
-
required: 'Zip Code is required',
|
|
239
|
-
matches: 'Invalid Zip Code'
|
|
240
|
-
}
|
|
241
|
-
});
|
|
242
|
-
|
|
243
245
|
const criminalTOLPDisplay = (updates) => col2Radio(merge({
|
|
244
246
|
name: 'Type_Of_Legal_Problem_Display',
|
|
245
247
|
if: '$get(Type_Of_Legal_Problem).value == "Criminal and Felony"',
|
|
@@ -288,10 +290,16 @@ const stepDefaults = (step, stepKey) => ({
|
|
|
288
290
|
}
|
|
289
291
|
});
|
|
290
292
|
|
|
291
|
-
function step(name, inputs,
|
|
292
|
-
|
|
293
|
-
nextOnEnter = true
|
|
294
|
-
|
|
293
|
+
function step(name, inputs, updates = {}) {
|
|
294
|
+
const {
|
|
295
|
+
nextOnEnter = true,
|
|
296
|
+
nextOnInput = false,
|
|
297
|
+
stepKey = undefined,
|
|
298
|
+
nextStepMap = undefined,
|
|
299
|
+
triggerRedirectMap = undefined,
|
|
300
|
+
autoFocus = undefined,
|
|
301
|
+
} = updates;
|
|
302
|
+
|
|
295
303
|
if (inputs && inputs.length && (nextOnEnter || nextOnInput)) {
|
|
296
304
|
const lastInput = findLastInput(inputs[inputs.length - 1]);
|
|
297
305
|
if (lastInput && nextOnEnter === true) {
|
|
@@ -311,6 +319,7 @@ function step(name, inputs, nextOnEnter = true, nextOnInput = false, stepKey = u
|
|
|
311
319
|
id: name,
|
|
312
320
|
name: name,
|
|
313
321
|
nextStepMap: nextStepMap,
|
|
322
|
+
triggerRedirectMap: triggerRedirectMap,
|
|
314
323
|
autoFocus: autoFocus,
|
|
315
324
|
children: inputs
|
|
316
325
|
}
|
|
@@ -332,10 +341,7 @@ function generalLegalTOLPAndZip(updates = {}) {
|
|
|
332
341
|
realEstateTOLPDisplay(),
|
|
333
342
|
zipcode()
|
|
334
343
|
],
|
|
335
|
-
updates
|
|
336
|
-
updates.nextOnInput,
|
|
337
|
-
updates.stepKey,
|
|
338
|
-
updates.nextStepMap
|
|
344
|
+
updates
|
|
339
345
|
)
|
|
340
346
|
}
|
|
341
347
|
|