bhl-forms 0.7.0 → 0.7.1

package/dist/forms/ssdi.es.js

@@ -97,6 +97,7 @@ const verticalText = (updates) => {
   updates.wrapperClass = 't-flex t-justify-center';
   updates.messagesClass = 't-flex t-justify-center';
   updates.inputClass = 't-text-center';
+  updates.helpClass = 't-mt-2.5 !t-text-sm t-text-center';
   return text(updates)
 };
 
@@ -169,37 +170,48 @@ const phone = (scope) => sbsText({
   helpClass: "t-mt-2.5 md:t-text-right md:t-mt-[-2px]"
 });
 
-const zipcodeCenter = (updates = {}, scope) => text({
-  placeholder: '#####',
-  help: updates.help ?? "We try to match you with local help",
-  name: scope ? scope + ':' + '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'
-  },
-  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'
-});
 
-const applicantAgeCenter = (scope) => verticalText({
-  name: scope ? scope + ':' + 'Applicant_Age' : 'Applicant_Age',
-  value: "50",
-  placeholder: 'Age between 18 and 65',
-  maxlength: 2,
-  inputmode: "numeric",
-  validation: "required|min:18,max:65",
-  validationMessages: {
-    required: 'Applicant Age is required',
-    min: 'Invalid Age - must be between 18 and 65',
-    max: 'Invalid Age - must be between 18 and 65',
-  },
-});
+const zipcode = (scope, vertical, updates = {}) => {
+  const func = vertical ? verticalText : sbsText;
+  const label = vertical ? (updates.label) : 'Zip Code:';
+  const help = vertical ? (updates.help ?? "We try to match you with local help") : null;  
+  return func({
+    label,
+    help,
+    placeholder: '#####',
+    name: scope ? scope + ':' + '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'
+    },
+    ...updates
+  })
+};
+
+const applicantAge = (scope, vertical, updates = {}) => {
+  const func = vertical ? verticalText : sbsText;
+  const label = vertical ? (updates.label) : 'Age of Applicant?';
+  const value = vertical ? (updates.value ?? "50") : null;
+  return func(merge({
+    label,
+    placeholder: 'Age between 18 and 65',
+    name: scope ? scope + ':' + 'Applicant_Age' : 'Applicant_Age',
+    value,
+    maxlength: 2,
+    inputmode: "numeric",
+    validation: "required|min:18,max:65",
+    validationMessages: {
+      required: 'Applicant Age is required',
+      min: 'Invalid Age - must be between 18 and 65',
+      max: 'Invalid Age - must be between 18 and 65',
+    },
+    ...updates
+  }))
+};
 
 const bankruptcyCrossSell = () => sbsCheckbox({
   label: "I'd also like a consult for bankruptcy or debt elimination (optional)",
@@ -500,6 +512,9 @@ function commentsWithBankruptcy(updates = {}) {
   )
 }
 
+// TODO: the SSDI form was done differently before SQPS was rolled out
+// elsewhere. Should it use sqstep instead?
+
 function ssdiTOLPAndZip(updates = {}) {
   return step(
     'ssdiTOLPAndZip',
@@ -510,7 +525,7 @@ function ssdiTOLPAndZip(updates = {}) {
         id: "Type_Of_Legal_Problem",
         value: "Social Security Disability and Insurance"
       },
-      zipcodeCenter()
+      zipcode(updates.scope, true, updates)
     ],
     updates
   )
@@ -521,7 +536,7 @@ function ssdiApplicantAge(updates = {}) {
     'ssdiApplicantAge',
     [
       verticalStepHeadline(updates),
-      applicantAgeCenter(),
+      applicantAge(updates.scope, true, updates),
     ],
     updates
   )

package/dist/forms/ssdi.iife.js

@@ -1 +1 @@
-var ssdi=function(){"use strict";function e(){return Object.assign({},...arguments)}const t='$getKey($meta, "commentsPlaceholders." + $get(Type_Of_Legal_Problem).value, $meta.defaultCommentsPlaceholder)',a='$getKey($meta, "finalHeadlines." + $get(Type_Of_Legal_Problem).value, $meta.defaultFinalHeadline)',i='$getKey($meta, "finalSubHeadlines." + $get(Type_Of_Legal_Problem).value, $meta.defaultFinalSubHeadline)',n=t=>(t.legendClass="legend-left required",t.fieldsetClass="$reset side-by-side",t.optionsClass="t-pl-1",t.innerClass="t-flex t-items-center",t.wrapperClass="t-mb-3",(t=>(t.name&&!t.id&&(t.id=t.name),e({$formkit:"checkbox",validation:"required",validationMessages:{required:"Field is required"}},t)))(t)),r=t=>(t.legendClass="legend-left",t.fieldsetClass="$reset t-flex t-justify-center t-flex-col-reverse t-items-center",void 0===t.optionsClass&&(t.optionsClass="t-flex t-flex-col sm:t-flex-row t-justify-center t-my-3"),t.optionClass="radiobtn t-my-2 sm:t-my-0 t-mx-2 md:t-mx-5",t.wrapperClass="$reset formkit-wrapper t-mb-0 t-flex t-items-center t-h-[100%]",t.labelClass="t-font-semibold t-text-[#1e448f] t-w-[100%]",t.decoratorIcon=!1,t.messagesClass="t-flex t-justify-center",t.helpClass="t-mt-2.5 !t-text-sm t-text-center",(t=>(t.name&&!t.id&&(t.id=t.name),e({$formkit:"radio",validation:"required",validationMessages:{required:"Field is required"},optionsClass:"t-pt-3 t-pl-1",legendClass:"required"},t)))(t)),o=e=>(e.options=["Yes","No"],e.optionsClass="t-flex t-justify-center t-my-3",r(e)),l=t=>(t.name&&!t.id&&(t.id=t.name),e({$formkit:"text",validation:"required",validationMessages:{required:"Field is required"},labelClass:"required"},t)),s=e=>(e.wrapperClass="side-by-side t-items-center",l(e)),d=e=>s({label:"Last Name:",placeholder:"Last",name:e?e+":Last_Name":"Last_Name",autocomplete:"family-name",validationMessages:{required:"Last Name is required"}}),c=e=>s({$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}$/|valid_phone",validationMessages:{required:"Field is required",matches:"Invalid Phone Format, use ###-###-####",valid_phone:"Invalid Phone Number"},helpClass:"t-mt-2.5 md:t-text-right md:t-mt-[-2px]"}),m=(e={},t)=>l({placeholder:"#####",help:e.help??"We try to match you with local help",name:t?t+":Zip":"Zip",maxlength:5,inputmode:"numeric",autocomplete:"postal-code",validation:"required|matches:/^[0-9]{5}$/",validationMessages:{required:"Zip Code is required",matches:"Invalid Zip Code"},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"}),p=e=>{return(t={name:e?e+":Applicant_Age":"Applicant_Age",value:"50",placeholder:"Age between 18 and 65",maxlength:2,inputmode:"numeric",validation:"required|min:18,max:65",validationMessages:{required:"Applicant Age is required",min:"Invalid Age - must be between 18 and 65",max:"Invalid Age - must be between 18 and 65"}}).wrapperClass="t-flex t-justify-center",t.messagesClass="t-flex t-justify-center",t.inputClass="t-text-center",l(t);var t},u=(t,a)=>(t=>(t.name&&!t.id&&(t.id=t.name),e({$formkit:"textarea",rows:5,maxlength:500,validation:"required",validationMessages:{required:"Field is required"},innerClass:"t-max-w-xl",labelClass:"required"},t)))(e({name:a?a+":Comments":"Comments",label:"Please briefly describe your situation in a few words:",placeholder:'For Example: "I would like help with child support payments" or "I need help with visitation rights"'},t)),f=e=>({$formkit:"checkbox",label:"$meta.tcpaLanguage",name:e?e+":TCPA_Opt_In":"TCPA_Opt_In","data-tf-sensitive":"false",validation:"required|accepted",validationMessages:{required:"Consent is required",accepted:"Consent is required"},classes:{label:"t-text-xs t-text-slate-500 t-font-normal"}}),h="$onEnter($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))",y="$onInput($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))",g=e=>"group"!==e.type&&"section"!==e.type&&"form"!==e.type&&"hidden"!==e.$formkit&&!e.children,b=e=>{if(g(e))return e;for(var t=e.children.length-1;t>=0;t--){if("string"==typeof e.children)continue;const a=e.children[t];if(g(a))return a;const i=b(a);if(i)return i}return null},x={$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"}},{$el:"span",children:"Secure & Encrypted",attrs:{class:"t-pl-2 t-pt-1 t-font-medium"}}]};function v(t){return e(x,t)}function w(e){return{$el:"h3",children:e.headline||"Tell Us About Your Situation",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 "+(e.headlineClass||"")}}}function $(e){return function(e){return{$el:"h3",children:e.headline||"Additional Details",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 "+(e.headlineClass||"")}}}({headline:e.headline||"Additional Case Details",headlineClass:e.headlineClass})}function k(e){return{$el:"h3",children:e.headline||"Please Provide a Contact Name",attrs:{class:"t-flex t-justify-center t-text-center t-text-2xl t-font-bold t-text-blue-500 t-pb-5 t-pt-0 t-px-1 "+(e.headlineClass||"")}}}function I(e){return{$el:"h3",children:e.headline||a,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 C(e){return{$el:"h5",children:e.subheadline||i,attrs:{class:"t-flex t-justify-center t-text-center !t-text-lg t-font-semibold t-pb-7 t-pt-0 t-px-3 "+(e.subheadlineClass||"")}}}const S="(function() {\n  if (window.xxTrustedFormLoaded) {\n    return\n  }\n  var vid = '';\n  if (typeof window.zar !== 'undefined') {\n    vid = window.zar.getVID();\n  }\n  window.xxTrustedFormLoaded = true;\n  var sandbox = document.location.hostname.indexOf('localhost') > -1 ? 'true' : 'false'\n  var tf = document.createElement('script');\n  tf.type = 'text/javascript'; tf.async = true;\n  tf.src = (\"https:\" == document.location.protocol ? 'https' : 'http') + \"://api.trustedform.com/trustedform.js?field=xxTrustedFormCertUrl&identifier=\" + vid + \"&ping_field=xxTrustedFormPingUrl&provideReferrer=false&invert_field_sensitivity=true&sandbox=\" + sandbox + \"&l=\" + new Date().getTime() + Math.random();\n  var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(tf, s);\n})();";const E=(e,t)=>({$el:"section",if:'$stepEnabled("'+e+'")',attrs:{hidden:'$activeStep !== "'+e+'"',key:t||e}});function _(t,a,i={}){const{nextOnEnter:n=!0,nextOnInput:r=!1,stepKey:o,nextStepMap:l,triggerRedirectMap:s,autoFocus:d}=i;if(a&&a.length&&(n||r)){const e=b(a[a.length-1]);e&&!0===n&&(e.onKeypress=h),e&&!0===r&&(e.onInput=y)}return e(E(t,o),{children:[{$formkit:"group",id:t,name:t,nextStepMap:l,triggerRedirectMap:s,autoFocus:d,children:a}]})}const P={type:"form",id:"form",config:{validationVisibility:"submit"},onSubmit:'$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 A(e,t){return Object.fromEntries(Object.entries(e).filter((([e])=>t.includes(e))))}const D={};const q={$el:"div",children:[{$el:"div",attrs:{id:"form-anchor",class:"t-absolute",style:{top:"-30px",left:0}}}],attrs:{class:"t-relative"}};const T={$el:"div",attrs:{class:"t-mt-7 t-mb-5 t-w-full t-flex t-flex-col t-justify-center t-items-center",style:{if:"$fns.eq($activeStep, $firstStep()) || $fns.eq($activeStep, $lastStep())",then:"display: none"}},children:[{$el:"div",attrs:{class:"t-flex t-justify-center"},children:[{$el:"span",attrs:{id:"progress-bar-text",class:"t-text-sm t-mb-1"},children:["0% Complete"]}]},{$el:"div",attrs:{class:"t-bg-gray-100 t-w-9/12 t-rounded"},children:[{$el:"div",attrs:{id:"progress-bar",class:"t-flex t-flex-col t-justify-center t-text-center t-whitespace-nowrap t-w-[10%] t-h-1.5 t-rounded t-text-white t-bg-[#007bff]",style:{transition:"width 0.5s ease"}}}]}]};const L=[{$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}],j={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"'},F={},Y={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."},O=[function(a=null){let i=j,n=F,r=Y;return a&&(i=A(j,a),n=A(F,a),r=A(Y,a)),{type:"meta",data:e(D,{tcpaLanguage:"By checking this box, I a) agree to the Terms of Use, and b) consent to be contacted by lawyers, lawyer networks, and partners of this website using live, autodialed, pre-recorded, or artificial voice calls, as well as text messages. Your consent is not required as a condition of purchasing any goods or services. To submit this request without this consent, call 878-213-4937.",defaultCommentsPlaceholder:t,commentsPlaceholders:i,defaultFinalHeadline:"Submit Your Case",finalHeadlines:n,defaultFinalSubHeadline:"You may benefit from speaking with a legal professional. Please verify your contact information.",finalSubHeadlines:r})}}(),e(q,M),{$cmp:"FormKit",props:function(t){const a=e(P,t);return a.formId&&!a.name&&(a.name=a.formId),a}({formId:"ssdi",redirectMap:{"*":"https://listings.ziplawyer.com/api/v1/redirect?zone_id=4&vertical=Legal&category=${properties.Type_Of_Legal_Problem}&Degree_Of_Interest=${properties.Degree_Of_Interest}&zip_code=${properties.Zip}&sub_id=${properties.vid}"}}),children:[function(t){return e(T,t)}(),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 Your FREE Case Evaluation")',if:"$activeStep === $firstStep()",headlineClass:"!t-text-dark"}),function(t={}){return e(function(e={}){return{$el:"h3",attrs:{class:"t-flex t-justify-center t-text-center !t-text-[1.2rem] t-font-medium t-text-blue-500 t-px-10 "+(e.subheadlineClass||"")}}}(t),t)}({children:'$urlParam("shl", "You Could Receive up to $3,148 Per Month!")',if:"$activeStep === $firstStep()",subheadlineClass:"!t-text-[#00428A]"}),...L,{$el:"div",attrs:{class:"form-body"},children:[function(e={}){return _("ssdiTOLPAndZip",[{$formkit:"hidden",name:"Type_Of_Legal_Problem",id:"Type_Of_Legal_Problem",value:"Social Security Disability and Insurance"},m()],e)}(),function(e={}){return _("ssdiApplicantAge",[w(e),p()],e)}({nextOnInput:!0,headline:"What is the Age of the Applicant?"}),function(e={}){return _("ssdiDisabilityConditionStopWork",[w(e),o({name:t?t+":Disability_Condition_Stop_Work":"Disability_Condition_Stop_Work"})],e);var t}({nextOnInput:!0,headline:"Do You Expect To Be Out Of Work For At Least a Year Due To Your Health?"}),function(e={}){return _("ssdiDisabilityWorkHistory",[w(e),o({name:t?t+":Disability_Work_History":"Disability_Work_History"})],e);var t}({nextOnInput:!0,headline:"Have You Had a Full-Time Job Within the Past 5 Years?"}),function(e={}){return _("ssdiSocialSecurityDisabilityReceivingBenefits",[w(e),o({name:t?t+":Social_Security_Disability_Receiving_Benefits":"Social_Security_Disability_Receiving_Benefits"})],e);var t}({nextOnInput:!0,headline:"Are You Currently Receiving Social Security Disability Benefits?"}),function(e={}){return _("ssdiDoctorTreatment",[w(e),o({name:t?t+":Doctor_Treatment":"Doctor_Treatment"})],e);var t}({nextOnInput:!0,headline:"Have You Recently Been Treated by a Doctor, Hospital or Clinic?"}),function(e={}){return _("ssdiHaveAttorney",[w(e),o({name:t?t+":Have_Attorney":"Have_Attorney"})],e);var t}({nextOnInput:!0,headline:"Already Working with An Attorney?"}),function(e={}){return _("commentsWithBankruptcy",[$(e),u({label:void 0===e.label?"Please briefly describe your legal issue in a few words:":e.label,placeholder:e.placeholder||t,inputClass:void 0===e.inputClass?"!t-h-32":e.inputClass},e.scope),n({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")',validation:null,helpClass:"!t-text-sm"}),{$el:"div",if:"$get(CrossSell_Bankruptcy).value == true",children:[u({label:"Bankruptcy or debt details:",placeholder:"Please describe your bankrtupcy or debt situation in a few words...",inputClass:"!t-h-16"},"CrossSell:Bankruptcy")]}],{nextOnEnter:!1})}({label:null,headline:"Please briefly describe your situation:",headlineClass:"!t-text-dark"}),function(e={}){return _("firstAndLast",[k(e),s({label:"First Name:",placeholder:"First",name:t?t+":First_Name":"First_Name",autocomplete:"given-name",validationMessages:{required:"First Name is required"}}),d()],e);var t}({headlineClass:"!t-text-dark"}),function(e={}){return _("contactInfo",[I(e),C(e),{$el:"script",if:"$activeStep === $lastStep()",children:S},(t=e.scope,s({$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"}})),c(e.scope),f(e.scope),v()],{nextOnEnter:!1});var t}({headline:"Submit Your Free Application",headlineClass:"!t-text-[#00428A]",subheadline:"Based on your input you may qualify for SSDI benefits. Please verify your contact information."}),((e={})=>({$el:"div",attrs:{class:"step-nav"},children:[{$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: ","$stepKeys()"],attrs:{class:"t-text-xs",style:"overflow: scroll"}}]}]}]}];var M;return O}();
+var ssdi=function(){"use strict";function e(){return Object.assign({},...arguments)}const t='$getKey($meta, "commentsPlaceholders." + $get(Type_Of_Legal_Problem).value, $meta.defaultCommentsPlaceholder)',a='$getKey($meta, "finalHeadlines." + $get(Type_Of_Legal_Problem).value, $meta.defaultFinalHeadline)',i='$getKey($meta, "finalSubHeadlines." + $get(Type_Of_Legal_Problem).value, $meta.defaultFinalSubHeadline)',n=t=>(t.legendClass="legend-left required",t.fieldsetClass="$reset side-by-side",t.optionsClass="t-pl-1",t.innerClass="t-flex t-items-center",t.wrapperClass="t-mb-3",(t=>(t.name&&!t.id&&(t.id=t.name),e({$formkit:"checkbox",validation:"required",validationMessages:{required:"Field is required"}},t)))(t)),r=t=>(t.legendClass="legend-left",t.fieldsetClass="$reset t-flex t-justify-center t-flex-col-reverse t-items-center",void 0===t.optionsClass&&(t.optionsClass="t-flex t-flex-col sm:t-flex-row t-justify-center t-my-3"),t.optionClass="radiobtn t-my-2 sm:t-my-0 t-mx-2 md:t-mx-5",t.wrapperClass="$reset formkit-wrapper t-mb-0 t-flex t-items-center t-h-[100%]",t.labelClass="t-font-semibold t-text-[#1e448f] t-w-[100%]",t.decoratorIcon=!1,t.messagesClass="t-flex t-justify-center",t.helpClass="t-mt-2.5 !t-text-sm t-text-center",(t=>(t.name&&!t.id&&(t.id=t.name),e({$formkit:"radio",validation:"required",validationMessages:{required:"Field is required"},optionsClass:"t-pt-3 t-pl-1",legendClass:"required"},t)))(t)),o=e=>(e.options=["Yes","No"],e.optionsClass="t-flex t-justify-center t-my-3",r(e)),l=t=>(t.name&&!t.id&&(t.id=t.name),e({$formkit:"text",validation:"required",validationMessages:{required:"Field is required"},labelClass:"required"},t)),s=e=>(e.wrapperClass="side-by-side t-items-center",l(e)),d=e=>(e.wrapperClass="t-flex t-justify-center",e.messagesClass="t-flex t-justify-center",e.inputClass="t-text-center",e.helpClass="t-mt-2.5 !t-text-sm t-text-center",l(e)),c=e=>s({label:"Last Name:",placeholder:"Last",name:e?e+":Last_Name":"Last_Name",autocomplete:"family-name",validationMessages:{required:"Last Name is required"}}),m=e=>s({$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}$/|valid_phone",validationMessages:{required:"Field is required",matches:"Invalid Phone Format, use ###-###-####",valid_phone:"Invalid Phone Number"},helpClass:"t-mt-2.5 md:t-text-right md:t-mt-[-2px]"}),p=(e,t,a={})=>(t?d:s)({label:t?a.label:"Zip Code:",help:t?a.help??"We try to match you with local help":null,placeholder:"#####",name:e?e+":Zip":"Zip",maxlength:5,inputmode:"numeric",autocomplete:"postal-code",validation:"required|matches:/^[0-9]{5}$/",validationMessages:{required:"Zip Code is required",matches:"Invalid Zip Code"},...a}),u=(t,a,i={})=>(a?d:s)(e({label:a?i.label:"Age of Applicant?",placeholder:"Age between 18 and 65",name:t?t+":Applicant_Age":"Applicant_Age",value:a?i.value??"50":null,maxlength:2,inputmode:"numeric",validation:"required|min:18,max:65",validationMessages:{required:"Applicant Age is required",min:"Invalid Age - must be between 18 and 65",max:"Invalid Age - must be between 18 and 65"},...i})),f=(t,a)=>(t=>(t.name&&!t.id&&(t.id=t.name),e({$formkit:"textarea",rows:5,maxlength:500,validation:"required",validationMessages:{required:"Field is required"},innerClass:"t-max-w-xl",labelClass:"required"},t)))(e({name:a?a+":Comments":"Comments",label:"Please briefly describe your situation in a few words:",placeholder:'For Example: "I would like help with child support payments" or "I need help with visitation rights"'},t)),h=e=>({$formkit:"checkbox",label:"$meta.tcpaLanguage",name:e?e+":TCPA_Opt_In":"TCPA_Opt_In","data-tf-sensitive":"false",validation:"required|accepted",validationMessages:{required:"Consent is required",accepted:"Consent is required"},classes:{label:"t-text-xs t-text-slate-500 t-font-normal"}}),y="$onEnter($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))",g="$onInput($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))",b=e=>"group"!==e.type&&"section"!==e.type&&"form"!==e.type&&"hidden"!==e.$formkit&&!e.children,x=e=>{if(b(e))return e;for(var t=e.children.length-1;t>=0;t--){if("string"==typeof e.children)continue;const a=e.children[t];if(b(a))return a;const i=x(a);if(i)return i}return null},v={$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 w(t){return e(v,t)}function $(e){return{$el:"h3",children:e.headline||"Tell Us About Your Situation",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 "+(e.headlineClass||"")}}}function k(e){return function(e){return{$el:"h3",children:e.headline||"Additional Details",attrs:{class:"t-flex t-justify-center t-text-center t-text-2xl t-font-bold t-text-blue-500 t-pb-5 t-pt-0 t-px-1 "+(e.headlineClass||"")}}}({headline:e.headline||"Additional Case Details",headlineClass:e.headlineClass})}function I(e){return{$el:"h3",children:e.headline||"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 "+(e.headlineClass||"")}}}function C(e){return{$el:"h3",children:e.headline||a,attrs:{class:"t-flex t-justify-center t-text-center t-text-2xl t-font-bold t-text-blue-500 t-pb-3 t-pt-0 t-px-1 "+(e.headlineClass||"")}}}function S(e){return{$el:"h5",children:e.subheadline||i,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 E="(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 _=(e,t)=>({$el:"section",if:'$stepEnabled("'+e+'")',attrs:{hidden:'$activeStep !== "'+e+'"',key:t||e}});function P(t,a,i={}){const{nextOnEnter:n=!0,nextOnInput:r=!1,stepKey:o,nextStepMap:l,triggerRedirectMap:s,autoFocus:d}=i;if(a&&a.length&&(n||r)){const e=x(a[a.length-1]);e&&!0===n&&(e.onKeypress=y),e&&!0===r&&(e.onInput=g)}return e(_(t,o),{children:[{$formkit:"group",id:t,name:t,nextStepMap:l,triggerRedirectMap:s,autoFocus:d,children:a}]})}const A={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 D(e,t){return Object.fromEntries(Object.entries(e).filter((([e])=>t.includes(e))))}const q={};const T={$el:"div",children:[{$el:"div",attrs:{id:"form-anchor",class:"t-absolute",style:{top:"-30px",left:0}}}],attrs:{class:"t-relative"}};const L={$el:"div",attrs:{class:"t-mt-7 t-mb-5 t-w-full t-flex t-flex-col t-justify-center t-items-center",style:{if:"$fns.eq($activeStep, $firstStep()) || $fns.eq($activeStep, $lastStep())",then:"display: none"}},children:[{$el:"div",attrs:{class:"t-flex t-justify-center"},children:[{$el:"span",attrs:{id:"progress-bar-text",class:"t-text-sm t-mb-1"},children:["0% Complete"]}]},{$el:"div",attrs:{class:"t-bg-gray-100 t-w-9/12 t-rounded"},children:[{$el:"div",attrs:{id:"progress-bar",class:"t-flex t-flex-col t-justify-center t-text-center t-whitespace-nowrap t-w-[10%] t-h-1.5 t-rounded t-text-white t-bg-[#007bff]",style:{transition:"width 0.5s ease"}}}]}]};const F=[{$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}],Y={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"'},j={},O={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."},M=[function(a=null){let i=Y,n=j,r=O;return a&&(i=D(Y,a),n=D(j,a),r=D(O,a)),{type:"meta",data:e(q,{tcpaLanguage:"By checking this box, I a) agree to the Terms of Use, and b) consent to be contacted by lawyers, lawyer networks, and partners of this website using live, autodialed, pre-recorded, or artificial voice calls, as well as text messages. Your consent is not required as a condition of purchasing any goods or services. To submit this request without this consent, call 878-213-4937.",defaultCommentsPlaceholder:t,commentsPlaceholders:i,defaultFinalHeadline:"Submit Your Case",finalHeadlines:n,defaultFinalSubHeadline:"You may benefit from speaking with a legal professional. Please verify your contact information.",finalSubHeadlines:r})}}(),e(T,H),{$cmp:"FormKit",props:function(t){const a=e(A,t);return a.formId&&!a.name&&(a.name=a.formId),a}({formId:"ssdi",redirectMap:{"*":"https://listings.ziplawyer.com/api/v1/redirect?zone_id=4&vertical=Legal&category=${properties.Type_Of_Legal_Problem}&Degree_Of_Interest=${properties.Degree_Of_Interest}&zip_code=${properties.Zip}&sub_id=${properties.vid}"}}),children:[function(t){return e(L,t)}(),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 Your FREE Case Evaluation")',if:"$activeStep === $firstStep()",headlineClass:"!t-text-dark"}),function(t={}){return e(function(e={}){return{$el:"h3",attrs:{class:"t-flex t-justify-center t-text-center !t-text-[1.2rem] t-font-medium t-text-blue-500 t-px-10 "+(e.subheadlineClass||"")}}}(t),t)}({children:'$urlParam("shl", "You Could Receive up to $3,148 Per Month!")',if:"$activeStep === $firstStep()",subheadlineClass:"!t-text-[#00428A]"}),...F,{$el:"div",attrs:{class:"form-body"},children:[function(e={}){return P("ssdiTOLPAndZip",[{$formkit:"hidden",name:"Type_Of_Legal_Problem",id:"Type_Of_Legal_Problem",value:"Social Security Disability and Insurance"},p(e.scope,!0,e)],e)}(),function(e={}){return P("ssdiApplicantAge",[$(e),u(e.scope,!0,e)],e)}({nextOnInput:!0,headline:"What is the Age of the Applicant?"}),function(e={}){return P("ssdiDisabilityConditionStopWork",[$(e),o({name:t?t+":Disability_Condition_Stop_Work":"Disability_Condition_Stop_Work"})],e);var t}({nextOnInput:!0,headline:"Do You Expect To Be Out Of Work For At Least a Year Due To Your Health?"}),function(e={}){return P("ssdiDisabilityWorkHistory",[$(e),o({name:t?t+":Disability_Work_History":"Disability_Work_History"})],e);var t}({nextOnInput:!0,headline:"Have You Had a Full-Time Job Within the Past 5 Years?"}),function(e={}){return P("ssdiSocialSecurityDisabilityReceivingBenefits",[$(e),o({name:t?t+":Social_Security_Disability_Receiving_Benefits":"Social_Security_Disability_Receiving_Benefits"})],e);var t}({nextOnInput:!0,headline:"Are You Currently Receiving Social Security Disability Benefits?"}),function(e={}){return P("ssdiDoctorTreatment",[$(e),o({name:t?t+":Doctor_Treatment":"Doctor_Treatment"})],e);var t}({nextOnInput:!0,headline:"Have You Recently Been Treated by a Doctor, Hospital or Clinic?"}),function(e={}){return P("ssdiHaveAttorney",[$(e),o({name:t?t+":Have_Attorney":"Have_Attorney"})],e);var t}({nextOnInput:!0,headline:"Already Working with An Attorney?"}),function(e={}){return P("commentsWithBankruptcy",[k(e),f({label:void 0===e.label?"Please briefly describe your legal issue in a few words:":e.label,placeholder:e.placeholder||t,inputClass:void 0===e.inputClass?"!t-h-32":e.inputClass},e.scope),n({label:"I'd also like a consult for bankruptcy or debt elimination (optional)",help:"Note: you will be contacted separately by a bankruptcy/debt expert",name:"CrossSell_Bankruptcy",id:"CrossSell_Bankruptcy",if:'$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")',validation:null,helpClass:"!t-text-sm"}),{$el:"div",if:"$get(CrossSell_Bankruptcy).value == true",children:[f({label:"Bankruptcy or debt details:",placeholder:"Please describe your bankrtupcy or debt situation in a few words...",inputClass:"!t-h-16"},"CrossSell:Bankruptcy")]}],{nextOnEnter:!1})}({label:null,headline:"Please briefly describe your situation:",headlineClass:"!t-text-dark"}),function(e={}){return P("firstAndLast",[I(e),s({label:"First Name:",placeholder:"First",name:t?t+":First_Name":"First_Name",autocomplete:"given-name",validationMessages:{required:"First Name is required"}}),c()],e);var t}({headlineClass:"!t-text-dark"}),function(e={}){return P("contactInfo",[C(e),S(e),{$el:"script",if:"$activeStep === $lastStep()",children:E},(t=e.scope,s({$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"}})),m(e.scope),h(e.scope),w()],{nextOnEnter:!1});var t}({headline:"Submit Your Free Application",headlineClass:"!t-text-[#00428A]",subheadline:"Based on your input you may qualify for SSDI benefits. Please verify your contact information."}),((e={})=>({$el:"div",attrs:{class:"step-nav"},children:[{$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 H;return M}();

package/dist/forms/ssdi.json

@@ -1 +1 @@
-[{"type":"meta","data":{"tcpaLanguage":"By checking this box, I a) agree to the Terms of Use, and b) consent to be contacted by lawyers, lawyer networks, and partners of this website using live, autodialed, pre-recorded, or artificial voice calls, as well as text messages. Your consent is not required as a condition of purchasing any goods or services. To submit this request without this consent, call 878-213-4937.","defaultCommentsPlaceholder":"$getKey($meta, \"commentsPlaceholders.\" + $get(Type_Of_Legal_Problem).value, $meta.defaultCommentsPlaceholder)","commentsPlaceholders":{"Adoption":"Example: \"I need help with adoption forms\"","Asbestos and Mesothelioma":"Example: \"I was exposed to asbestos at work and would like to file a claim\"","Auto and Car Accidents":"Example: \"A truck crashed into my car on the highway\" or \"I've been involved in a hit and run accident\"","Bankruptcy":"Example: \"I need help filing for bankruptcy\"","Birth Certificate and Name Change":"Example: \"Just married and would like to change my last name\"","Business Lawyers":"Example: \"I need help incorporating a business\" or \"I would like a legal contract reviewed\"","Child Custody and Support":"Example: \"Need help getting custody\" or \"Issues with child support payments\"","Child Custody":"Example: \"Need help getting custody\"","Child Support":"Example: \"Issues with child support payments\"","Civil Rights and Discrimination":"Example: \"Police brutality\" or \"Coworker keeps harassing me\"","Civil Lawsuit":"Example: \"A contractor took my money and never completed the job\" or \"I am being sued by a neighbor\"","File a Lawsuit":"Example: \"A contractor took my money and never completed the job\"","Defend a Lawsuit":"Example: \"I am being sued by a neighbor\"","Consumer Lawyers":"Example: \"Someone committed fraud against me\" or \"A contractor took my money and never completed the job\"","Copyrights and Trademarks":"Example: \"I would like to register a trademark or copyright a name\"","Criminal and Felony":"Example: \"I was arrested for DUI and need legal defense\" or \"I am being charged with assault\"","Debt and Collections":"Example: \"I would like to consolidate my debt\" or \"A collection agency is harassing me\"","Divorce and Separation":"Example: \"I would like to file for an uncontested divorce\"","DUI and DWI":"Example: \"I was arrested for DUI and need legal defense\"","Elder Law":"Example: \"I would like help with Estate Planning\" or \"I need help with a guardianship\"","Employment and Workplace":"Example: \"I was injured while on the job\" or \"My company is discriminating against me\"","Expungement":"Example: \"I would like to file for an expungement and clear my record\"","Family Issues":"Example: \"I need help with guardianship\" or \"I need a simple will created\"","Foreclosure":"Example: \"I need help to avoid foreclosure on my house\"","Guardianship":"Example: \"I need help with guardianship documents\"","Harassment and Discrimination":"Example: \"I am being discriminated at work\" or \"My neighbor is harassing me\"","Sexual Harassment":"Example: \"I am being sexually harassed by a coworker\"","Workplace Harassment":"Example: \"My coworker is being aggressive towards me\"","Non-Workplace Harassment":"Example: \"My neighbor is harassing me\"","Workplace Discrimination":"Example: \"I am being discriminated at work based on my age\"","Non-Workplace Discrimination":"Example: \"I am being discriminated against by a local official\"","Identity Theft":"Example: \"Someone stole my identity and I need help fixing the issue\"","Immigration and Visas":"Example: \"I need help filing for a visa\" or \"Help with a green card\"","Insurance":"Example: \"I need help filing an insurance claim for damage to my house\"","Landlord and Tenant":"Example: \"I need help to fight an eviction\" or \"I would like a lawyer to review a rental contract\"","Lemon Law":"Example: \"I purchased a new vehicle that broke down already and seller will not assist\"","Long Term Disability":"Example: \"I was injured on the job and would like to file for benefits\" or \"I need help filing for disability benefits\"","Medical Malpractice":"Example: \"A doctor performed surgery on the wrong limb and I would like to file a lawsuit\"","Patents and Intellectual Property":"Example: \"I would like to file for a patent\" or \"I need to copyright a name\"","Personal Injury":"Example: \"I was bit by the neighbor's dog\" or \"I fell in the icy grocery store parking lot\"","Power of Attorney":"Example: \"I need help with a limited or general power of attorney\"","Probate and Estates":"Example: \"I need help with planning for my estate\" or \"A family member passed without a will in place\"","Product Liability":"Example: \"My car battery caught on fire\" or \"I purchased a faulty product\"","Property Damage":"Example: \"The neighbor's tree fell on my fence\" or \"My car was hit in the parking lot\"","Real Estate":"Example: \"I need help with a quitclaim deed\" or \"I need a lawyer to review a purchase and sales agreement\"","Social Security Disability and Insurance":"Example: \"I would like help filing for disability benefits\" or \"I've been denied for SSDI and would like to appeal\"","Tax and IRS":"Example: \"I need help fighting an IRS tax claim\" or \"I need audit defense\"","Traffic and Tickets":"Example: \"I need help reinstating a supsended license\" or \"I would like to fight a traffic ticket\"","Unemployment":"Example: \"I need help filing for unemployment benefits\"","Victim of a Crime":"Example: \"I was assaulted in the store\" or \"I am being discriminated against at work\"","Wills and Trusts":"Example: \"I need a simple will created\" or \"I would like guidance on creating a trust fund\"","Workers Compensation":"Example: \"I 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: ","$stepKeys()"],"attrs":{"class":"t-text-xs","style":"overflow: scroll"}}]}]}]}]
+[{"type":"meta","data":{"tcpaLanguage":"By checking this box, I a) agree to the Terms of Use, and b) consent to be contacted by lawyers, lawyer networks, and partners of this website using live, autodialed, pre-recorded, or artificial voice calls, as well as text messages. Your consent is not required as a condition of purchasing any goods or services. To submit this request without this consent, call 878-213-4937.","defaultCommentsPlaceholder":"$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}$/","validationMessages":{"required":"Zip Code is required","matches":"Invalid Zip Code"},"labelClass":"required","help":"We try to match you with local help","placeholder":"#####","name":"Zip","maxlength":5,"inputmode":"numeric","autocomplete":"postal-code","wrapperClass":"t-flex t-justify-center","messagesClass":"t-flex t-justify-center","inputClass":"t-text-center","helpClass":"t-mt-2.5 !t-text-sm t-text-center","id":"Zip","onKeypress":"$onEnter($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))"}]}]},{"$el":"section","if":"$stepEnabled(\"ssdiApplicantAge\")","attrs":{"hidden":"$activeStep !== \"ssdiApplicantAge\"","key":"ssdiApplicantAge"},"children":[{"$formkit":"group","id":"ssdiApplicantAge","name":"ssdiApplicantAge","children":[{"$el":"h3","children":"What is the Age of the Applicant?","attrs":{"class":"t-flex t-justify-center t-text-center t-text-2xl t-font-bold t-text-dark t-pb-5 t-pt-0 t-px-1 "}},{"$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","placeholder":"Age between 18 and 65","name":"Applicant_Age","value":"50","maxlength":2,"inputmode":"numeric","nextOnInput":true,"headline":"What is the Age of the Applicant?","wrapperClass":"t-flex t-justify-center","messagesClass":"t-flex t-justify-center","inputClass":"t-text-center","helpClass":"t-mt-2.5 !t-text-sm t-text-center","id":"Applicant_Age","onKeypress":"$onEnter($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))","onInput":"$onInput($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))"}]}]},{"$el":"section","if":"$stepEnabled(\"ssdiDisabilityConditionStopWork\")","attrs":{"hidden":"$activeStep !== \"ssdiDisabilityConditionStopWork\"","key":"ssdiDisabilityConditionStopWork"},"children":[{"$formkit":"group","id":"ssdiDisabilityConditionStopWork","name":"ssdiDisabilityConditionStopWork","children":[{"$el":"h3","children":"Do You Expect To Be Out Of Work For At Least a Year Due To Your Health?","attrs":{"class":"t-flex t-justify-center t-text-center t-text-2xl t-font-bold t-text-dark t-pb-5 t-pt-0 t-px-1 "}},{"$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"}}]}]}]}]

package/dist/forms/testForm.es.js

@@ -52,6 +52,14 @@ const sbsText = (updates) => {
   return text(updates)
 };
 
+const verticalText = (updates) => {
+  updates.wrapperClass = 't-flex t-justify-center';
+  updates.messagesClass = 't-flex t-justify-center';
+  updates.inputClass = 't-text-center';
+  updates.helpClass = 't-mt-2.5 !t-text-sm t-text-center';
+  return text(updates)
+};
+
 const email = (scope) => sbsText({
   $formkit: 'email',
   name: scope ? scope + ':' + 'Email' : 'Email',
@@ -105,19 +113,26 @@ const phone = (scope) => sbsText({
 });
 
 
-const zipcode = (scope) => sbsText({
-  label: 'Zip Code:',
-  placeholder: '#####',
-  name: scope ? scope + ':' + 'Zip' : 'Zip',
-  maxlength: 5,
-  inputmode: "numeric",
-  autocomplete: 'postal-code',
-  validation: 'required|matches:/^[0-9]{5}$/',
-  validationMessages: {
-    required: 'Zip Code is required',
-    matches: 'Invalid Zip Code'
-  }
-});
+const zipcode = (scope, vertical, updates = {}) => {
+  const func = vertical ? verticalText : sbsText;
+  const label = vertical ? (updates.label) : 'Zip Code:';
+  const help = vertical ? (updates.help ?? "We try to match you with local help") : null;  
+  return func({
+    label,
+    help,
+    placeholder: '#####',
+    name: scope ? scope + ':' + 'Zip' : 'Zip',
+    maxlength: 5,
+    inputmode: "numeric",
+    autocomplete: 'postal-code',
+    validation: 'required|matches:/^[0-9]{5}$/',
+    validationMessages: {
+      required: 'Zip Code is required',
+      matches: 'Invalid Zip Code'
+    },
+    ...updates
+  })
+};
 
 const category = () => sbsSelect({
   label: 'Category:',

package/dist/forms/testForm.iife.js

@@ -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({$formkit:"text",validation:"required",validationMessages:{required:"Field is required"},labelClass:"required"},t)))(t)),r=e=>n({label:"Last Name:",placeholder:"Last",name:e?e+":Last_Name":"Last_Name",autocomplete:"family-name",validationMessages:{required:"Last Name is required"}}),o=e=>n({$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: ","$stepKeys()"],attrs:{class:"t-text-xs",style:"overflow: scroll"}}]}]}]}];var C;return P}();
+var testForm=function(){"use strict";function e(){return Object.assign({},...arguments)}const t='$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.name&&!t.id&&(t.id=t.name),e({$formkit:"text",validation:"required",validationMessages:{required:"Field is required"},labelClass:"required"},t)),r=e=>(e.wrapperClass="side-by-side t-items-center",n(e)),o=e=>(e.wrapperClass="t-flex t-justify-center",e.messagesClass="t-flex t-justify-center",e.inputClass="t-text-center",e.helpClass="t-mt-2.5 !t-text-sm t-text-center",n(e)),l=e=>r({label:"Last Name:",placeholder:"Last",name:e?e+":Last_Name":"Last_Name",autocomplete:"family-name",validationMessages:{required:"Last Name is required"}}),s=e=>r({$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}$/|valid_phone",validationMessages:{required:"Field is required",matches:"Invalid Phone Format, use ###-###-####",valid_phone:"Invalid Phone Number"},helpClass:"t-mt-2.5 md:t-text-right md:t-mt-[-2px]"}),d=(e,t,a={})=>(t?o:r)({label:t?a.label:"Zip Code:",help:t?a.help??"We try to match you with local help":null,placeholder:"#####",name:e?e+":Zip":"Zip",maxlength:5,inputmode:"numeric",autocomplete:"postal-code",validation:"required|matches:/^[0-9]{5}$/",validationMessages:{required:"Zip Code is required",matches:"Invalid Zip Code"},...a}),m=e=>({$formkit:"checkbox",label:"$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"}}),c="$onEnter($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))",p="$onInput($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))",u=e=>"group"!==e.type&&"section"!==e.type&&"form"!==e.type&&"hidden"!==e.$formkit&&!e.children,f=e=>{if(u(e))return e;for(var t=e.children.length-1;t>=0;t--){if("string"==typeof e.children)continue;const a=e.children[t];if(u(a))return a;const i=f(a);if(i)return i}return null},h={$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"}},{$el:"span",children:"Secure & Encrypted",attrs:{class:"t-pl-2 t-pt-1 t-font-medium"}}]};function y(t){return e(h,t)}function g(e){return{$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 b(e){return{$el:"h5",children:e.subheadline||a,attrs:{class:"t-flex t-justify-center t-text-center !t-text-lg t-font-semibold t-pb-7 t-pt-0 t-px-3 "+(e.subheadlineClass||"")}}}const x="(function() {\n  if (window.xxTrustedFormLoaded) {\n    return\n  }\n  var vid = '';\n  if (typeof window.zar !== 'undefined') {\n    vid = window.zar.getVID();\n  }\n  window.xxTrustedFormLoaded = true;\n  var sandbox = document.location.hostname.indexOf('localhost') > -1 ? 'true' : 'false'\n  var tf = document.createElement('script');\n  tf.type = 'text/javascript'; tf.async = true;\n  tf.src = (\"https:\" == document.location.protocol ? 'https' : 'http') + \"://api.trustedform.com/trustedform.js?field=xxTrustedFormCertUrl&identifier=\" + vid + \"&ping_field=xxTrustedFormPingUrl&provideReferrer=false&invert_field_sensitivity=true&sandbox=\" + sandbox + \"&l=\" + new Date().getTime() + Math.random();\n  var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(tf, s);\n})();";const v=(e,t)=>({$el:"section",if:'$stepEnabled("'+e+'")',attrs:{hidden:'$activeStep !== "'+e+'"',key:t||e}});function w(t,a,i={}){const{nextOnEnter:n=!0,nextOnInput:r=!1,stepKey:o,nextStepMap:l,triggerRedirectMap:s,autoFocus:d}=i;if(a&&a.length&&(n||r)){const e=f(a[a.length-1]);e&&!0===n&&(e.onKeypress=c),e&&!0===r&&(e.onInput=p)}return e(v(t,o),{children:[{$formkit:"group",id:t,name:t,nextStepMap:l,triggerRedirectMap:s,autoFocus:d,children:a}]})}const $={type:"form",id:"form",config:{validationVisibility:"submit"},onSubmit:'$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 k(e,t){return Object.fromEntries(Object.entries(e).filter((([e])=>t.includes(e))))}const I={};const E={$el:"div",children:[{$el:"div",attrs:{id:"form-anchor",class:"t-absolute",style:{top:"-30px",left:0}}}],attrs:{class:"t-relative"}};const S=[{$formkit:"hidden",name:"vertical",value:"Legal"},{$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}],P={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"'},C={},F={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."},L=[function(t=null){let a=P,i=C,n=F;return t&&(a=k(P,t),i=k(C,t),n=k(F,t)),{type:"meta",data:e(I,{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, $meta.defaultCommentsPlaceholder)',commentsPlaceholders:a,defaultFinalHeadline:"Submit Your Case",finalHeadlines:i,defaultFinalSubHeadline:"You may benefit from speaking with a legal professional. Please verify your contact information.",finalSubHeadlines:n})}}(),e(E,_),{$cmp:"FormKit",props:function(t){const a=e($,t);return a.formId&&!a.name&&(a.name=a.formId),a}({formId:"testForm"}),children:[function(t={}){return e(function(e={}){return{$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 === $firstStep()"}),...S,{$el:"div",attrs:{class:"form-body"},children:[function(e={}){return w("categoryAndZip",[d(),i({label:"Category:",name:"category",id:"category",options:["Fruits","Vegetables"]})],e)}(),function(e={}){return w("firstAndLast",[r({label:"First Name:",placeholder:"First",name:t?t+":First_Name":"First_Name",autocomplete:"given-name",validationMessages:{required:"First Name is required"}}),l()],e);var t}(),function(e={}){return w("contactInfo",[g(e),b(e),{$el:"script",if:"$activeStep === $lastStep()",children:x},(t=e.scope,r({$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"}})),s(e.scope),m(e.scope),y()],{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 _;return L}();