bhl-forms 0.8.8 → 0.8.10

package/dist/forms/workersCompensation.iife.js

@@ -1 +1 @@
-var workersCompensation=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, $meta.defaultFinalSubHeadline)',n=t=>(t.name&&!t.id&&(t.id=t.name),e({$formkit:"checkbox",validation:"required",validationMessages:{required:"Field is required"}},t)),r=e=>(e&&e.legendClass||(e.legendClass="required"),e.fieldsetClass="$reset",e.optionsClass="t-pl-8 md:t-pl-2 t-pt-3 t-grid t-grid-cols-1 md:t-grid-cols-2",e.innerClass="t-items-start",e.wrapperClass="$reset t-flex t-cursor-pointer t-mb-3",n(e)),s=e=>(e&&e.legendClass||(e.legendClass="required t-w-[100%] t-text-center"),e.fieldsetClass="$reset t-flex t-justify-center t-flex-col",e.innerClass="t-items-start",e.wrapperClass="$reset t-flex t-cursor-pointer t-mb-3",e.optionClass="t-pl-4 md:t-pl-16 md:t-min-w-[200px]",e.optionsClass="t-pl-4 t-pt-3 t-grid t-grid-cols-1 md:t-grid-cols-2",e.messagesClass="t-flex t-justify-center",e.helpClass="t-mt-0 t-mb-4 !t-text-sm t-text-center",n(e)),l=t=>(t.name&&!t.id&&(t.id=t.name),e({$formkit:"radio",validation:"required",validationMessages:{required:"Field is required"},optionsClass:"t-pt-3 t-pl-1",legendClass:"required"},t)),o=e=>(e.legendClass="required t-w-[100%] t-text-center",void 0===e.fieldsetClass&&(e.fieldsetClass="$reset t-flex t-justify-center"),e.innerClass="t-items-start",e.wrapperClass="$reset t-flex t-cursor-pointer t-mb-3",e.optionClass="t-pl-4 md:t-pl-8 md:t-min-w-[200px]",e.optionsClass="t-pl-4 t-pt-3 t-grid t-grid-cols-1 md:t-grid-cols-2",e.messagesClass="t-flex t-justify-center",e.helpClass="t-mt-0 t-mb-4 !t-text-sm t-text-center",l(e)),d=e=>(e.legendClass="legend-left-flex md:t-max-w-[40%] required",e.fieldsetClass="$reset side-by-side-flex",e.optionsClass="md:t-ml-4 md:t-mt-2 t-grid t-grid-cols-1 md:t-grid-cols-2-125",e.innerClass="t-flex t-items-start",e.wrapperClass="$reset t-flex t-cursor-pointer t-mb-3",l(e)),u=e=>(e.options=["Yes","No"],(e=>(e.legendClass="legend-left t-pb-1 required",e.fieldsetClass="$reset side-by-side t-items-center",e.optionsClass="t-mt-1 t-grid t-grid-cols-1 md:t-grid-cols-2-125 t-items-center",e.innerClass="t-flex t-items-center",e.optionClass="t-pr-1",l(e)))(e)),c=e=>(e.legendClass="legend-left",e.fieldsetClass="$reset t-flex t-justify-center t-flex-col-reverse t-items-center",void 0===e.optionsClass&&(e.optionsClass="t-flex t-flex-col sm:t-flex-row t-justify-center t-my-3"),e.optionClass="radiobtn t-my-2 sm:t-my-0 t-mx-2 md:t-mx-5",e.wrapperClass="$reset formkit-wrapper t-mb-0 t-flex t-items-center t-h-[100%]",e.labelClass="t-font-semibold t-text-[#1e448f] t-w-[100%]",e.decoratorIcon=!1,e.messagesClass="t-flex t-justify-center",e.helpClass="t-mt-2.5 !t-text-sm t-text-center",l(e)),p=e=>(e.options=["Yes","No"],e.optionsClass="t-flex t-justify-center t-my-3",c(e)),m=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({$formkit:"select",placeholder:"Please Select",validation:"required",validationMessages:{required:"Field is required"},inputClass:"t-bg-white",labelClass:"required"},t)))(t)),f=t=>(t.name&&!t.id&&(t.id=t.name),e({$formkit:"text",validation:"required",validationMessages:{required:"Field is required"},labelClass:"required"},t)),h=e=>(e.wrapperClass="side-by-side t-items-center",f(e)),y=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",f(e)),b=t=>(t.name&&!t.id&&(t.id=t.name),e({$formkit:"DatePicker",validation:"required",validationMessages:{required:"Field is required"},labelClass:"required t-block t-mb-3 t-font-semibold t-text-base formkit-invalid:t-text-red-500",innerClass:"t-border t-border-gray-400 formkit-invalid:t-border-red-500 t-rounded t-mb-1 focus-within:t-border-blue-500"},t)),g=e=>(e.wrapperClass="side-by-side t-items-center",b(e)),C=e=>(e.wrapperClass="t-flex t-justify-center",e.inputClass="t-text-center",e.messagesClass="t-flex t-justify-center",b(e)),x=(e,t,a={})=>(t?y:h)({$formkit:"email",name:e?e+":Email":"Email",label:t?a.label:"Email Address:",placeholder:"email@domain.com",autocomplete:"email","data-tf-sensitive":"false",validation:"required|email",validationMessages:{required:"Email is required",email:"Invalid Email"},...a}),v=(e,t,a={})=>(t?y:h)({label:t?a.label:"First Name:",placeholder:"First",name:e?e+":First_Name":"First_Name",autocomplete:"given-name",validationMessages:{required:"First Name is required"},...a}),w=(e,t,a={})=>(t?y:h)({label:t?a.label:"Last Name:",placeholder:"Last",name:e?e+":Last_Name":"Last_Name",autocomplete:"family-name",validationMessages:{required:"Last Name is required"},...a}),_=(e,t,a={})=>(t?y:h)({$formkit:"tel",name:e?e+":Primary_Phone":"Primary_Phone",label:t?a.label:"Phone Number:",placeholder:"###-###-####",maxlength:12,help:"10-digit phone number, hyphens optional",autocomplete:"tel-national","data-tf-sensitive":"false",validation:"required|matches:/^[0-9]{3}-?[0-9]{3}-?[0-9]{4}$/|valid_phone",validationMessages:{required:"Phone Number is required",matches:"Invalid Phone Format, use ###-###-####",valid_phone:"Invalid Phone Number"},helpClass:"t-mt-2.5 md:t-text-right md:t-mt-[-2px]",...a}),$=(t,a,i={})=>(a?y:h)(e({label:a?i.label:"Age of Applicant?",placeholder:"Age between 18 and 65",name:t?t+":Applicant_Age":"Applicant_Age",value:a?i.value??"50":null,maxlength:2,inputmode:"numeric",validation:"required|min:18,max:65",validationMessages:{required:"Applicant Age is required",min:"Invalid Age - must be between 18 and 65",max:"Invalid Age - must be between 18 and 65"},...i})),S=(t,a,i={})=>(a?p:u)(e({label:a?i.label:"Were You at Fault?",name:t?t+":At_Fault":"At_Fault"},i)),I=e=>{return(t={label:"I'd also like a consult for bankruptcy or debt elimination (optional)",help:"Note: you will be contacted separately by a bankruptcy/debt expert",name:e?e+":CrossSell_Bankruptcy":"CrossSell_Bankruptcy",id:e?e+":CrossSell_Bankruptcy":"CrossSell_Bankruptcy",if:'$getVal($get(form), "Type_Of_Legal_Problem") != "Bankruptcy" && ($getVal($get(form), "Degree_Of_Interest") == "Absolutely Can\'t Afford" || $getVal($get(form), "Degree_Of_Interest") == "Maybe" || $getVal($get(form), "Degree_Of_Interest") == "Probably")',validation:null,helpClass:"!t-text-sm"}).legendClass="legend-left required",t.fieldsetClass="$reset side-by-side",t.optionsClass="t-pl-1",t.innerClass="t-flex t-items-center",t.wrapperClass="t-mb-3",n(t);var t},k=(t,a,i={})=>(a?o:m)(e({label:a?i.label:"With Whom Do the Children Currently Live?",name:t?t+":Child_Home":"Child_Home",options:["Mother","Father","Grandparents","Other"]},i)),P=(t,a,i={})=>(a?c:m)(e({label:a?i.label:"Who is the Primary Caregiver?",name:t?t+":Child_Primary_Caregiver":"Child_Primary_Caregiver",options:["Mother","Father","Other"]},i)),A=(t,a,i={})=>(a?o:m)(e({label:a?i.label:"Your Relationship to Child(ren):",name:t?t+":Child_Relationship":"Child_Relationship",options:["Father","Mother","Grandparent","Aunt/Uncle","Other"]},i)),E=(t,a,i)=>(t=>(t.name&&!t.id&&(t.id=t.name),e({$formkit:"textarea",rows:5,maxlength:500,validation:"required",validationMessages:{required:"Field is required"},innerClass:"t-max-w-xl",labelClass:"required"},t)))(e({name:t?t+":Comments":"Comments",label:"Please briefly describe your situation in a few words:",placeholder:'For Example: "I would like help with child support payments" or "I need help with visitation rights"'},i)),D=(t,a,i={})=>(a?o:m)(e({name:t?t+":Degree_Of_Interest":"Degree_Of_Interest",id:t?t+":Degree_Of_Interest":"Degree_Of_Interest",label:a?i.label:"How Likely Are You to Pay if Your Issue Could be Resolved?",help:a?i.help:"No payment necessary to speak with lawyers.",options:["Definitely","Probably","Maybe","Absolutely Can't Afford"]},i)),T=(t,a,i={})=>D(t,a,e(i,{help:"No payment necessary to speak with lawyers."})),L=(t,a,i={})=>(a?p:u)(e({name:t?t+":Disability_Condition_Stop_Work":"Disability_Condition_Stop_Work",label:a?i.label:"Do You Expect To Be Out Of Work For At Least a Year Due To Your Health?"},i)),O=(t,a,i={})=>(a?p:u)(e({name:t?t+":Disability_Work_History":"Disability_Work_History",label:a?i.label:"Have You Had a Full-Time Job Within the Past 5 Years?"},i)),j=(t,a,i={})=>(a?p:u)(e({name:t?t+":Doctor_Treatment":"Doctor_Treatment",label:a?i.label:"Have You Recently Been Treated by a Doctor, Hospital or Clinic?"},i)),M=(t,a,i={})=>(a?o:m)(e({name:t?t+":Estate_Legal_Services_Needed":"Estate_Legal_Services_Needed",label:a?i.label:"Legal Services Needed for Your Estate:",options:["Charitable Giving","Contested Wills","Drafting Wills or Trust","Estate Administration","Asset Protection","Other"]},i)),q=(t,a,i={})=>(a?p:u)(e({label:a?i.label:"Already Working with An Attorney?",name:t?t+":Have_Attorney":"Have_Attorney"},i)),F=(t,a,i={})=>(a?p:u)(e({name:t?t+":Have_Children":"Have_Children",label:a?i.label:"Do You Have Children?"},i)),W=(t,a,i={})=>(a?C:g)(e({label:a?i.label:"Date of Incident:",name:t?t+":Incident_Date":"Incident_Date"},i)),Y=(t,a,i={})=>(a?o:m)(e({label:a?i.label:"How Will You Pay for Legal Fees if You Hire a Lawyer?",help:a?i.help:"No payment necessary to start a consultation.",name:t?t+":Lawyer_Payment_Method":"Lawyer_Payment_Method",options:a?{Cash:"Cash","Credit Card":"Credit Card",Family:"Family or Friend",Other:"Other"}:["Cash","Check","Credit Card","Friend","Family","Other"],fieldsetClass:a?"$reset t-flex t-flex-col t-items-center":void 0},i)),N=(t,a,i={})=>(a?o:m)(e({label:a?i.label:"Marital Status:",name:t?t+":Marital_Status":"Marital_Status",options:["Unmarried, Living Together","Unmarried, Do Not Live Together","Married, Living Together","Separated","Divorced","Other"]},i)),H=(t,a,i={})=>(a?o:d)(e({label:a?i.label:"Primary Injury:",name:t?t+":Primary_Injury":"Primary_Injury",options:["Anxiety","Back or Neck Pain","Broken Bones","Cuts and Bruises","Headaches","Memory Loss","Loss of Limb","Not Sure or Other"]},i)),B=(t,a,i={})=>(a?p:u)(e({name:t?t+":Police_Report_Filed":"Police_Report_Filed",label:a?i.label:"Was a Police Report Filed?"},i)),R=(t,a,i={})=>(a?o:m)(e({label:a?i.label:"What is Your Role in this Matter?",name:t?t+":Role_In_Matter_Probate":"Role_In_Matter_Probate",options:["Preparing My Will","Executor","Heir","Other"]},i)),Q=(t,a,i={})=>(a?p:u)(e({name:t?t+":Social_Security_Disability_Receiving_Benefits":"Social_Security_Disability_Receiving_Benefits",label:a?i.label:"Are You Currently Receiving Social Security Disability Benefits?"},i)),U=(t,a,i={})=>(a?s:r)(e({label:a?i.label:"Type of Assets:",name:t?t+":Type_Of_Assets":"Type_Of_Assets",options:["Business Interests","Cash","Life Insurance Policies","Pensions/Retirement","Personal Possessions","Property","Stock/Bonds"]},i)),K=(t,a,i={})=>(a?o:m)(e({label:a?i.label:"Value of Your Assets?",name:t?t+":Value_Of_Assets":"Value_Of_Assets",options:["Less than 50K","50K to 100K","100K to 250K","250K to 500K","500K to 1M","More than 1M"]},i)),V=(t,a)=>e({$cmp:"FormKit",props:{type:"group",key:t,id:t,name:t}},a),z="$onEnter($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))",G="$onInput($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))",Z=e=>"group"!==e.type&&"section"!==e.type&&"form"!==e.type&&"hidden"!==e.$formkit&&!e.children,J=e=>{if(Z(e))return e;for(var t=e.children.length-1;t>=0;t--){if("string"==typeof e.children)continue;const a=e.children[t];if(Z(a))return a;const i=J(a);if(i)return i}return null},X={$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"}},{$el:"span",children:"Secure & Encrypted",attrs:{class:"t-pl-2 t-pt-1 t-font-medium"}}]};function ee(t){return e(X,t)}function te(e){return{$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-blue-500 t-pb-4 t-pt-0 t-px-1"}}}function ae(e){return{$el:"h5",children:e.subheadline||"Tell us about your situation:",attrs:{class:"t-flex t-justify-center t-text-dark t-text-center !t-text-lg t-font-semibold t-pb-4 t-pt-0 t-px-3"}}}function ie(e){return{$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 ne(e){return{$el:"h5",children:e.subheadline||"",attrs:{class:"t-flex t-justify-center t-text-center !t-text-lg t-font-normal t-text-dark t-pb-5 t-pt-0 t-px-1 "+(e.subheadlineClass||"")}}}function re(e){return function(e){return{$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 se(e){return{$el:"h3",children:e.headline||"Please Provide a Contact Name",attrs:{class:"t-flex t-justify-center t-text-center t-text-2xl t-font-bold t-text-blue-500 t-pb-5 t-pt-0 t-px-1 "+(e.headlineClass||"")}}}function le(e){return{$el:"h3",children:e.headline||"Do any of the following situations apply?",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 oe(e){return{$el:"h3",children:e.headline||a,attrs:{class:"t-flex t-justify-center t-text-center t-text-2xl t-font-bold t-text-blue-500 t-pb-3 t-pt-0 t-px-1 "+(e.headlineClass||"")+" f-contact-info-headline"}}}function de(e){return{$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||"")+" f-contact-info-subheadline"}}}const ue="(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 ce=(e,t)=>({$el:"section",if:'$stepEnabled("'+e+'")',attrs:{hidden:'$activeStep !== "'+e+'"',key:t||e}});function pe(t,a,i={}){const{nextOnEnter:n=!0,nextOnInput:r=!1,stepKey:s,nextStepMap:l,triggerRedirectMap:o,autoFocus:d}=i;if(a&&a.length&&(n||r)){const e=J(a[a.length-1]);e&&!0===n&&(e.onKeypress=z),e&&!0===r&&(e.onInput=G)}return e(ce(t,s),{children:[{$formkit:"group",id:t,name:t,nextStepMap:l,triggerRedirectMap:o,autoFocus:d,children:a}]})}function me(e,t,a,i={}){return void 0===i.nextOnInput&&(i.nextOnInput=!0),pe(e,[ie({headline:i.headline??a,headlineClass:i.headlineClass}),...Array.isArray(t)?t:[t]],i)}const fe={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 he(e,t){return Object.fromEntries(Object.entries(e).filter((([e])=>t.includes(e))))}const ye={};const be={$el:"div",children:[{$el:"div",attrs:{id:"form-anchor",class:"t-absolute",style:{top:"-30px",left:0}}}],attrs:{class:"t-relative"}};const ge={$el:"div",attrs:{class:"t-mt-7 t-mb-5 t-w-full t-flex t-flex-col t-justify-center t-items-center",style:{if:"$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:[{$el:"div",attrs:{id:"progress-bar",class:"t-flex t-flex-col t-justify-center t-text-center t-whitespace-nowrap t-w-[10%] t-h-1.5 t-rounded t-text-white t-bg-[#007bff]",style:{transition:"width 0.5s ease"}}}]}]};const Ce=[{$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},{$formkit:"hidden",name:"s",value:null}],xe={"*":"https://listings.ziplawyer.com/api/v1/redirect?zone_id=4&vertical=Legal&category=${properties.Type_Of_Legal_Problem}&Degree_Of_Interest=${properties.Degree_Of_Interest}&zip_code=${properties.Zip}&sub_id=${properties.vid}"};const ve={Adoption:'Example: "I need help with adoption forms"',"Asbestos and Mesothelioma":'Example: "I was exposed to asbestos at work and would like to file a claim"',"Auto and Car Accidents":'Example: "A truck crashed into my car on the highway" or "I\'ve been involved in a hit and run accident"',Bankruptcy:'Example: "I need help filing for bankruptcy"',"Birth Certificate and Name Change":'Example: "Just married and would like to change my last name"',"Business Lawyers":'Example: "I need help incorporating a business" or "I would like a legal contract reviewed"',"Child Custody and Support":'Example: "Need help getting custody" or "Issues with child support payments"',"Child Custody":'Example: "Need help getting custody"',"Child Support":'Example: "Issues with child support payments"',"Civil Rights and Discrimination":'Example: "Police brutality" or "Coworker keeps harassing me"',"Civil Lawsuit":'Example: "A contractor took my money and never completed the job" or "I am being sued by a neighbor"',"File a Lawsuit":'Example: "A contractor took my money and never completed the job"',"Defend a Lawsuit":'Example: "I am being sued by a neighbor"',"Consumer Lawyers":'Example: "Someone committed fraud against me" or "A contractor took my money and never completed the job"',"Copyrights and Trademarks":'Example: "I would like to register a trademark or copyright a name"',"Criminal and Felony":'Example: "I was arrested for DUI and need legal defense" or "I am being charged with assault"',"Debt and Collections":'Example: "I would like to consolidate my debt" or "A collection agency is harassing me"',"Divorce and Separation":'Example: "I would like to file for an uncontested divorce"',"DUI and DWI":'Example: "I was arrested for DUI and need legal defense"',"Elder Law":'Example: "I would like help with Estate Planning" or "I need help with a guardianship"',"Employment and Workplace":'Example: "I was injured while on the job" or "My company is discriminating against me"',Expungement:'Example: "I would like to file for an expungement and clear my record"',"Family Issues":'Example: "I need help with guardianship" or "I need a simple will created"',Foreclosure:'Example: "I need help to avoid foreclosure on my house"',Guardianship:'Example: "I need help with guardianship documents"',"Harassment and Discrimination":'Example: "I am being discriminated at work" or "My neighbor is harassing me"',"Sexual Harassment":'Example: "I am being sexually harassed by a coworker"',"Workplace Harassment":'Example: "My coworker is being aggressive towards me"',"Non-Workplace Harassment":'Example: "My neighbor is harassing me"',"Workplace Discrimination":'Example: "I am being discriminated at work based on my age"',"Non-Workplace Discrimination":'Example: "I am being discriminated against by a local official"',"Identity Theft":'Example: "Someone stole my identity and I need help fixing the issue"',"Immigration and Visas":'Example: "I need help filing for a visa" or "Help with a green card"',Insurance:'Example: "I need help filing an insurance claim for damage to my house"',"Landlord and Tenant":'Example: "I need help to fight an eviction" or "I would like a lawyer to review a rental contract"',"Lemon Law":'Example: "I purchased a new vehicle that broke down already and seller will not assist"',"Long Term Disability":'Example: "I was injured on the job and would like to file for benefits" or "I need help filing for disability benefits"',"Medical Malpractice":'Example: "A doctor performed surgery on the wrong limb and I would like to file a lawsuit"',"Patents and Intellectual Property":'Example: "I would like to file for a patent" or "I need to copyright a name"',"Personal Injury":'Example: "I was bit by the neighbor\'s dog" or "I fell in the icy grocery store parking lot"',"Power of Attorney":'Example: "I need help with a limited or general power of attorney"',"Probate and Estates":'Example: "I need help with planning for my estate" or "A family member passed without a will in place"',"Product Liability":'Example: "My car battery caught on fire" or "I purchased a faulty product"',"Property Damage":'Example: "The neighbor\'s tree fell on my fence" or "My car was hit in the parking lot"',"Real Estate":'Example: "I need help with a quitclaim deed" or "I need a lawyer to review a purchase and sales agreement"',"Social Security Disability and Insurance":'Example: "I would like help filing for disability benefits" or "I\'ve been denied for SSDI and would like to appeal"',"Tax and IRS":'Example: "I need help fighting an IRS tax claim" or "I need audit defense"',"Traffic and Tickets":'Example: "I need help reinstating a supsended license" or "I would like to fight a traffic ticket"',Unemployment:'Example: "I need help filing for unemployment benefits"',"Victim of a Crime":'Example: "I was assaulted in the store" or "I am being discriminated against at work"',"Wills and Trusts":'Example: "I need a simple will created" or "I would like guidance on creating a trust fund"',"Workers Compensation":'Example: "I broke my arm at work and need help getting compensation"',"Wrongful Death":'Example: "A family member was killed on the job and we need legal representation"',"Wrongful Termination":'Example: "I was fired by my employer without cause"',"Not Sure or Other":'Example: "I was involved in a car accident" or "I need help setting up power of attorney"'},we={},_e={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."},$e={values:{"*":["incidentDate","claimStatus","causeOfInjury","doctorTreatment","haveAttorney","commentsWithBankruptcy","zipcode","legalCrossSells","firstAndLast","contactInfo"]}},Se=function(a=null){let i=ve,n=we,r=_e;return a&&(i=he(ve,a),n=he(we,a),r=he(_e,a)),{type:"meta",data:e(ye,{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})}}();Se.data.dynamicSchema=[function(t={}){return me("causeOfInjury",((t,a,i={})=>(a?o:m)(e({label:a?i.label:"Cause of Injury:",name:t?t+":Cause_Of_Injury":"Cause_Of_Injury",options:["Traumatic Physical Injury (Accident)","Repeated Trauma Injury","Mental Injury","Occupational Disease","Not Sure"]},i)))(t.scope,!0,t.input),"What was the cause of the injury?",t)}(),function(t={}){return me("claimStatus",((t,a,i={})=>(a?o:m)(e({label:a?i.label:"Status of Claim:",name:t?t+":Claim_Status":"Claim_Status",options:["No action taken yet","Demand for compensation made","Lawsuit filed","Other"]},i)))(t.scope,!0,t.input),"What is the status of the claim?",t)}(),function(e={}){return me("degreeOfInterest",D(e.scope,!0,e.input),"Could you pay if your issue could be resolved?",e)}(),function(e={}){return me("doctorTreatment",j(e.scope,!0,e.input),"Have you seen a doctor about this?",e)}(),function(e={}){return me("haveAttorney",q(e.scope,!0,e.input),"Already working with an attorney?",e)}(),function(e={}){return me("incidentDate",W(e.scope,!0,e.input),"When did the incident occur?",e)}({nextOnInput:!1}),function(e={}){return me("primaryInjury",H(e.scope,!0,e.input),"What was the primary injury?",e)}(),function(e={}){return me("zipcode",((e,t,a={})=>(t?y:h)({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}$/",validationMessages:{required:"Zip Code is required",matches:"Invalid Zip Code"},...a}))(e.scope,!0,e.input),"Please verify your Zip Code",e)}(),function(e={}){return pe("commentsWithBankruptcy",[re(e),E(e.scope,0,{label:void 0===e.label?"Please briefly describe your legal issue in a few words:":e.label,placeholder:e.placeholder||t,inputClass:void 0===e.inputClass?"!t-h-32":e.inputClass}),I(),{$el:"div",if:"$get(CrossSell_Bankruptcy).value == true",children:[E("CrossSell:Bankruptcy",0,{label:"Bankruptcy or debt details:",placeholder:"Please describe your bankrtupcy or debt situation in a few words...",inputClass:"!t-h-16"})]}],{nextOnEnter:!1})}({label:null,headline:"Please briefly describe your situation:",headlineClass:"!t-text-dark"}),function(e={}){return e.nextOnInput=!1,e.stepKey="$get(Type_Of_Legal_Problem).value",pe("legalCrossSells",[le(e),r({id:"Legal_CrossSells",name:"Legal_CrossSells",help:'Just hit "Next" if none apply',helpClass:"t-text-center !t-text-sm",validation:null,options:'$getCrossSellOptions($get(form), $getVal($get(form), "Type_Of_Legal_Problem"))'})],e)}({headlineClass:"!t-text-dark",nextStepMap:{values:{Legal_CrossSells:{"Auto and Car Accidents":["autoAndCarAccidentCrossSellQuestions"],"Personal Injury":["personalInjuryCrossSellQuestions"],"Workers Compensation":["workersCompensationCrossSellQuestions"],"DUI and DWI":["duiAndDWICrossSellQuestions"],"Long Term Disability":["longTermDisabilityCrossSellQuestions"],"Social Security Disability and Insurance":["ssdiCrossSellQuestions"],Bankruptcy:["bankruptcyCrossSellQuestions"],"Power of Attorney":["powerOfAttorneyCrossSellQuestions"],"Wills and Trusts":["willsAndTrustsCrossSellQuestions"],"Divorce and Separation":["divorceAndSeparationCrossSellQuestions"],"Child Custody":["childCustodyCrossSellQuestions"]},"*":["firstAndLast","contactInfo"]},appendSteps:["firstAndLast","contactInfo"],matchesAllowed:1}}),function(e={}){return pe("autoAndCarAccidentCrossSellQuestions",[te({headline:"You May Be Entitled To Compensation"}),ae({subheadline:"Tell us about your accident:"}),(t="true",a="CrossSell:Auto_and_Car_Accidents",V("AutoAndCarAccidentsQuestions",{if:t||'$get(Type_Of_Legal_Problem).value == "Auto and Car Accidents"',children:[q(a),W(a),S(a),H(a),j(a),B(a)]})),E("CrossSell:Auto_and_Car_Accidents",0,{label:"Accident Description:",placeholder:"Please describe your accident in a few words...",inputClass:"!t-h-16"})],e);var t,a}(),function(e={}){return pe("ssdiCrossSellQuestions",[te({headline:"You May Be Entitled To Benefits"}),ae({subheadline:"Tell us about your disability:"}),(t="true",a="CrossSell:Social_Security_Disability_and_Insurance",V("SocialSecurityDisabilityAndInsuranceQuestions",{if:t||'$get(Type_Of_Legal_Problem).value == "Social Security Disability and Insurance"',children:[q(a),$(a),L(a),O(a),Q(a),j(a)]})),E("CrossSell:Social_Security_Disability_and_Insurance",0,{label:"Description:",placeholder:"Please describe your situation in a few words...",inputClass:"!t-h-16"})],e);var t,a}(),function(e={}){return pe("powerOfAttorneyCrossSellQuestions",[te({headline:"Power of Attorney Information"}),(t="true",a="CrossSell:Power_of_Attorney",V("PowerofAttorneyQuestions",{if:t||'$get(Type_Of_Legal_Problem).value == "Power of Attorney"',children:[q(a),T(a)]})),E("CrossSell:Power_of_Attorney",0,{label:"Description:",placeholder:"Please describe your situation in a few words...",inputClass:"!t-h-16"})],e);var t,a}(),function(e={}){return pe("willsAndTrustsCrossSellQuestions",[te({headline:"Will or Trust Information"}),(t="true",a="CrossSell:Wills_and_Trusts",V("WillsAndTrustsQuestions",{if:t||'$get(Type_Of_Legal_Problem).value == "Wills and Trusts"',children:[q(a),K(a),U(a),R(a),M(a),T(a)]})),E("CrossSell:Wills_and_Trusts",0,{label:"Description:",placeholder:"Please describe your situation in a few words...",inputClass:"!t-h-16"})],e);var t,a}(),function(e={}){return pe("divorceAndSeparationCrossSellQuestions",[te({headline:"Divorce or Separation Information"}),(t="true",a="CrossSell:Divorce_and_Separation",V("DivorceQuestions",{if:t||'$get(Type_Of_Legal_Problem).value == "Divorce and Separation"',children:[q(a),N(a),F(a),D(a),Y(a)]})),E("CrossSell:Divorce_and_Separation",0,{label:"Description:",placeholder:"Please describe your situation in a few words...",inputClass:"!t-h-16"})],e);var t,a}(),function(e={}){return pe("childCustodyCrossSellQuestions",[te({headline:"Child Custody Information"}),(t="true",a="CrossSell:Child_Custody",V("ChildCustodyQuestions",{if:t||'$get(Type_Of_Legal_Problem).value == "Child Custody"',children:[q(a),A(a),k(a),P(a),D(a),Y(a)]})),E("CrossSell:Child_Custody",0,{label:"Description:",placeholder:"Please describe your situation in a few words...",inputClass:"!t-h-16"})],e);var t,a}(),function(e={}){return pe("firstAndLast",[se({headline:e.headline??"Who is looking for help?",headlineClass:e.headlineClass}),ne({subheadline:e.subheadline??"Note: we never share info without consent",subheadlineClass:"!t-text-sm !t-text-gray-500"}),v(e.scope),w(e.scope)],e)}({headlineClass:"!t-text-dark"})];const Ie=[Se,e(be,ke),{$cmp:"FormKit",props:function(t){const a=e(fe,t);return a.formId&&!a.name&&(a.name=a.formId),a}({formId:"workersCompensation",redirectMap:function(t){return e(xe,t)}(),crossSellOptionMap:{"Workers Compensation":{"Auto and Car Accidents":"Involved in a Car Accident","Wills and Trusts":"Need a Will or Trust","Power of Attorney":"Update Power of Attorney","Divorce and Separation":"Need a Divorce or Separation","Child Custody":"Need help with Child Custody","Social Security Disability and Insurance":"Interest in SSDI Benefits"}}}),children:[function(t){return e(ge,t)}(),function(t={}){return e(function(e={}){return{$el:"h1",attrs:{class:"t-flex t-justify-center t-text-center t-text-[2rem] t-font-semibold t-pt-5 t-px-7 md:t-px-3 "+(e.headlineClass||"")+" f-first-headline"}}}(t),t)}({children:'$urlParam("hl", "Get Max Compensation For Your Claim!")',if:"$activeStep === $firstStep()",headlineClass:"!t-pt-8 !t-text-2xl"}),function(t={}){return e(function(e={}){return{$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||"")+" f-first-subheadline"}}}(t),t)}({children:'$urlParam("shl", "What Was Your Work Injury?")',if:"$activeStep === $firstStep()"}),...Ce,{$el:"div",attrs:{class:"form-body"},children:[function(e={}){return pe("workersCompensationTOLP",[{$formkit:"hidden",name:"Type_Of_Legal_Problem",id:"Type_Of_Legal_Problem",value:"Workers Compensation"},H(e.scope,!0,e.input)],e)}({nextOnInput:!1,nextStepMap:$e}),function(e="Type_Of_Legal_Problem"){return{$cmp:"FormKitSchema",if:"$get("+e+").value",props:{schema:"$meta.dynamicSchema",data:"$buildData($meta)"}}}(),function(e={}){return pe("contactInfo",[oe(e),de(e),{$el:"script",if:"$activeStep === $lastStep()",children:ue},x(e.scope),_(e.scope),(t=e.scope,{$formkit:"checkbox",label:"$meta.tcpaLanguage",__raw__sectionsSchema:{label:{attrs:{innerHTML:"$label"}}},name:t?t+":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 !t-leading-[0.9rem]"}}),ee()],{nextOnEnter:!1});var t}({headline:"Get Your Claim Value",subheadline:"Attorneys Are Ready To Maximize Your Compensation"}),((e={})=>({$el:"div",attrs:{class:{if:"$activeStep === $firstStep()",then:"step-nav !t-justify-center sm:!t-justify-between",else:"step-nav !t-justify-between"}},children:[{$formkit:"button",name:"back_button",onClick:"$setPreviousStep($prevStepFunc($get(form)))",children:"Back",outerClass:{if:"$activeStep === $firstStep()",then:"t-hidden sm:t-block",else:""},style:{if:"$activeStep === $firstStep()",then:"display: none;"},classes:{input:(e.inputClass||"")+" f-navigation-input"}},{$formkit:"button",name:"next_button",onClick:"$setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form)))",children:{if:"$activeStep === $firstStep()",then:e.startText||"Start",else:"Next"},outerClass:{if:"$activeStep === $lastStep()",then:"t-hidden",else:""},style:{if:"$activeStep === $lastStep()",then:"display: none;"},classes:{input:(e.inputClass||"")+" f-navigation-input"}},{$formkit:"submit",name:"submit_button",label:e.submitLabel||"Submit",if:"$activeStep === $lastStep()",style:{if:"$activeStep !== $lastStep()",then:"display: none;"},classes:{input:(e.inputClass||"")+" !t-ml-2 sm:!t-ml-auto f-navigation-input"}}]}))({startText:"Start Evaluation",inputClass:"!t-font-extrabold"}),{$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: ","$stepKeys()"],attrs:{class:"t-text-xs",style:"overflow: scroll"}}]}]}]}];var ke;return Ie}();
+var workersCompensation=function(){"use strict";function e(){return Object.assign({},...arguments)}const t='$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, $meta.defaultFinalSubHeadline)',n=t=>(t.name&&!t.id&&(t.id=t.name),e({$formkit:"checkbox",validation:"required",validationMessages:{required:"Field is required"}},t)),r=e=>(e&&e.legendClass||(e.legendClass="required"),e.fieldsetClass="$reset",e.optionsClass="t-pl-8 md:t-pl-2 t-pt-3 t-grid t-grid-cols-1 md:t-grid-cols-2",e.innerClass="t-items-start",e.wrapperClass="$reset t-flex t-cursor-pointer t-mb-3",n(e)),s=e=>(e&&e.legendClass||(e.legendClass="required t-w-[100%] t-text-center"),e.fieldsetClass="$reset t-flex t-justify-center t-flex-col",e.innerClass="t-items-start",e.wrapperClass="$reset t-flex t-cursor-pointer t-mb-3",e.optionClass="t-pl-4 md:t-pl-16 md:t-min-w-[200px]",e.optionsClass="t-pl-4 t-pt-3 t-grid t-grid-cols-1 md:t-grid-cols-2",e.messagesClass="t-flex t-justify-center",e.helpClass="t-mt-0 t-mb-4 !t-text-sm t-text-center",n(e)),l=t=>(t.name&&!t.id&&(t.id=t.name),e({$formkit:"radio",validation:"required",validationMessages:{required:"Field is required"},optionsClass:"t-pt-3 t-pl-1",legendClass:"required"},t)),o=e=>(e.legendClass="required t-w-[100%] t-text-center",void 0===e.fieldsetClass&&(e.fieldsetClass="$reset t-flex t-justify-center"),e.innerClass="t-items-start",e.wrapperClass="$reset t-flex t-cursor-pointer t-mb-3",e.optionClass="t-pl-4 md:t-pl-8 md:t-min-w-[200px]",e.optionsClass="t-pl-4 t-pt-3 t-grid t-grid-cols-1 md:t-grid-cols-2",e.messagesClass="t-flex t-justify-center",e.helpClass="t-mt-0 t-mb-4 !t-text-sm t-text-center",l(e)),d=e=>(e.legendClass="legend-left-flex md:t-max-w-[40%] required",e.fieldsetClass="$reset side-by-side-flex",e.optionsClass="md:t-ml-4 md:t-mt-2 t-grid t-grid-cols-1 md:t-grid-cols-2-125",e.innerClass="t-flex t-items-start",e.wrapperClass="$reset t-flex t-cursor-pointer t-mb-3",l(e)),u=e=>(e.options=["Yes","No"],(e=>(e.legendClass="legend-left t-pb-1 required",e.fieldsetClass="$reset side-by-side t-items-center",e.optionsClass="t-mt-1 t-grid t-grid-cols-1 md:t-grid-cols-2-125 t-items-center",e.innerClass="t-flex t-items-center",e.optionClass="t-pr-1",l(e)))(e)),c=e=>(e.legendClass="legend-left",e.fieldsetClass="$reset t-flex t-justify-center t-flex-col-reverse t-items-center",void 0===e.optionsClass&&(e.optionsClass="t-flex t-flex-col sm:t-flex-row t-justify-center t-my-3"),e.optionClass="radiobtn t-my-2 sm:t-my-0 t-mx-2 md:t-mx-5",e.wrapperClass="$reset formkit-wrapper t-mb-0 t-flex t-items-center t-h-[100%]",e.labelClass="t-font-semibold t-text-[#1e448f] t-w-[100%]",e.decoratorIcon=!1,e.messagesClass="t-flex t-justify-center",e.helpClass="t-mt-2.5 !t-text-sm t-text-center",l(e)),p=e=>(e.options=["Yes","No"],e.optionsClass="t-flex t-justify-center t-my-3",c(e)),m=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({$formkit:"select",placeholder:"Please Select",validation:"required",validationMessages:{required:"Field is required"},inputClass:"t-bg-white",labelClass:"required"},t)))(t)),f=t=>(t.name&&!t.id&&(t.id=t.name),e({$formkit:"text",validation:"required",validationMessages:{required:"Field is required"},labelClass:"required"},t)),h=e=>(e.wrapperClass="side-by-side t-items-center",f(e)),y=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",f(e)),b=t=>(t.name&&!t.id&&(t.id=t.name),e({$formkit:"DatePicker",validation:"required",validationMessages:{required:"Field is required"},labelClass:"required t-block t-mb-3 t-font-semibold t-text-base formkit-invalid:t-text-red-500",innerClass:"t-border t-border-gray-400 formkit-invalid:t-border-red-500 t-rounded t-mb-1 focus-within:t-border-blue-500"},t)),g=e=>(e.wrapperClass="side-by-side t-items-center",b(e)),C=e=>(e.wrapperClass="t-flex t-justify-center",e.inputClass="t-text-center",e.messagesClass="t-flex t-justify-center",b(e)),x=(e,t,a={})=>(t?y:h)({$formkit:"email",name:e?e+":Email":"Email",label:t?a.label:"Email Address:",placeholder:"email@domain.com",autocomplete:"email","data-tf-sensitive":"false",validation:"required|email",validationMessages:{required:"Email is required",email:"Invalid Email"},...a}),v=(e,t,a={})=>(t?y:h)({label:t?a.label:"First Name:",placeholder:"First",name:e?e+":First_Name":"First_Name",autocomplete:"given-name",validationMessages:{required:"First Name is required"},...a}),w=(e,t,a={})=>(t?y:h)({label:t?a.label:"Last Name:",placeholder:"Last",name:e?e+":Last_Name":"Last_Name",autocomplete:"family-name",validationMessages:{required:"Last Name is required"},...a}),_=(e,t,a={})=>(t?y:h)({$formkit:"tel",name:e?e+":Primary_Phone":"Primary_Phone",label:t?a.label:"Phone Number:",placeholder:"###-###-####",maxlength:12,help:"10-digit phone number, hyphens optional",autocomplete:"tel-national","data-tf-sensitive":"false",validation:"required|matches:/^[0-9]{3}-?[0-9]{3}-?[0-9]{4}$/|valid_phone",validationMessages:{required:"Phone Number is required",matches:"Invalid Phone Format, use ###-###-####",valid_phone:"Invalid Phone Number"},helpClass:"t-mt-2.5 md:t-text-right md:t-mt-[-2px]",...a}),$=(t,a,i={})=>(a?y:h)(e({label:a?i.label:"Age of Applicant?",placeholder:"Age between 18 and 65",name:t?t+":Applicant_Age":"Applicant_Age",value:a?i.value??"50":null,maxlength:2,inputmode:"numeric",validation:"required|min:18,max:65",validationMessages:{required:"Applicant Age is required",min:"Invalid Age - must be between 18 and 65",max:"Invalid Age - must be between 18 and 65"},...i})),S=(t,a,i={})=>(a?p:u)(e({label:a?i.label:"Were You at Fault?",name:t?t+":At_Fault":"At_Fault"},i)),I=e=>{return(t={label:"I'd also like a consult for bankruptcy or debt elimination (optional)",help:"Note: you will be contacted separately by a bankruptcy/debt expert",name:e?e+":CrossSell_Bankruptcy":"CrossSell_Bankruptcy",id:e?e+":CrossSell_Bankruptcy":"CrossSell_Bankruptcy",if:'$getVal($get(form), "Type_Of_Legal_Problem") != "Bankruptcy" && ($getVal($get(form), "Degree_Of_Interest") == "Absolutely Can\'t Afford" || $getVal($get(form), "Degree_Of_Interest") == "Maybe" || $getVal($get(form), "Degree_Of_Interest") == "Probably")',validation:null,helpClass:"!t-text-sm"}).legendClass="legend-left required",t.fieldsetClass="$reset side-by-side",t.optionsClass="t-pl-1",t.innerClass="t-flex t-items-center",t.wrapperClass="t-mb-3",n(t);var t},k=(t,a,i={})=>(a?o:m)(e({label:a?i.label:"With Whom Do the Children Currently Live?",name:t?t+":Child_Home":"Child_Home",options:["Mother","Father","Grandparents","Other"]},i)),P=(t,a,i={})=>(a?c:m)(e({label:a?i.label:"Who is the Primary Caregiver?",name:t?t+":Child_Primary_Caregiver":"Child_Primary_Caregiver",options:["Mother","Father","Other"]},i)),A=(t,a,i={})=>(a?o:m)(e({label:a?i.label:"Your Relationship to Child(ren):",name:t?t+":Child_Relationship":"Child_Relationship",options:["Father","Mother","Grandparent","Aunt/Uncle","Other"]},i)),E=(t,a,i={})=>(a?o:m)(e({label:a?i.label:"Status of Claim:",name:t?t+":Claim_Status":"Claim_Status",options:["No action taken yet","Demand for compensation made","Lawsuit filed","Other"]},i)),D=(t,a,i)=>(t=>(t.name&&!t.id&&(t.id=t.name),e({$formkit:"textarea",rows:5,maxlength:500,validation:"required",validationMessages:{required:"Field is required"},innerClass:"t-max-w-xl",labelClass:"required"},t)))(e({name:t?t+":Comments":"Comments",label:"Please briefly describe your situation in a few words:",placeholder:'For Example: "I would like help with child support payments" or "I need help with visitation rights"'},i)),T=(t,a,i={})=>(a?o:m)(e({name:t?t+":Degree_Of_Interest":"Degree_Of_Interest",id:t?t+":Degree_Of_Interest":"Degree_Of_Interest",label:a?i.label:"How Likely Are You to Pay if Your Issue Could be Resolved?",help:a?i.help:"No payment necessary to speak with lawyers.",options:["Definitely","Probably","Maybe","Absolutely Can't Afford"]},i)),L=(t,a,i={})=>T(t,a,e(i,{help:"No payment necessary to speak with lawyers."})),O=(t,a,i={})=>(a?p:u)(e({name:t?t+":Disability_Condition_Stop_Work":"Disability_Condition_Stop_Work",label:a?i.label:"Do You Expect To Be Out Of Work For At Least a Year Due To Your Health?"},i)),j=(t,a,i={})=>(a?p:u)(e({name:t?t+":Disability_Work_History":"Disability_Work_History",label:a?i.label:"Have You Had a Full-Time Job Within the Past 5 Years?"},i)),M=(t,a,i={})=>(a?p:u)(e({name:t?t+":Doctor_Treatment":"Doctor_Treatment",label:a?i.label:"Have You Recently Been Treated by a Doctor, Hospital or Clinic?"},i)),q=(t,a,i={})=>(a?o:m)(e({name:t?t+":Estate_Legal_Services_Needed":"Estate_Legal_Services_Needed",label:a?i.label:"Legal Services Needed for Your Estate:",options:["Charitable Giving","Contested Wills","Drafting Wills or Trust","Estate Administration","Asset Protection","Other"]},i)),F=(t,a,i={})=>(a?p:u)(e({label:a?i.label:"Already Working with An Attorney?",name:t?t+":Have_Attorney":"Have_Attorney"},i)),W=(t,a,i={})=>(a?p:u)(e({name:t?t+":Have_Children":"Have_Children",label:a?i.label:"Do You Have Children?"},i)),Y=(t,a,i={})=>(a?C:g)(e({label:a?i.label:"Date of Incident:",name:t?t+":Incident_Date":"Incident_Date"},i)),N=(t,a,i={})=>(a?o:m)(e({label:a?i.label:"How Will You Pay for Legal Fees if You Hire a Lawyer?",help:a?i.help:"No payment necessary to start a consultation.",name:t?t+":Lawyer_Payment_Method":"Lawyer_Payment_Method",options:a?{Cash:"Cash","Credit Card":"Credit Card",Family:"Family or Friend",Other:"Other"}:["Cash","Check","Credit Card","Friend","Family","Other"],fieldsetClass:a?"$reset t-flex t-flex-col t-items-center":void 0},i)),H=(t,a,i={})=>(a?o:m)(e({label:a?i.label:"Marital Status:",name:t?t+":Marital_Status":"Marital_Status",options:["Unmarried, Living Together","Unmarried, Do Not Live Together","Married, Living Together","Separated","Divorced","Other"]},i)),B=(t,a,i={})=>(a?o:d)(e({label:a?i.label:"Primary Injury:",name:t?t+":Primary_Injury":"Primary_Injury",options:["Anxiety","Back or Neck Pain","Broken Bones","Cuts and Bruises","Headaches","Memory Loss","Loss of Limb","Not Sure or Other"]},i)),R=(t,a,i={})=>(a?p:u)(e({name:t?t+":Police_Report_Filed":"Police_Report_Filed",label:a?i.label:"Was a Police Report Filed?"},i)),Q=(t,a,i={})=>(a?o:m)(e({label:a?i.label:"What is Your Role in this Matter?",name:t?t+":Role_In_Matter_Probate":"Role_In_Matter_Probate",options:["Preparing My Will","Executor","Heir","Other"]},i)),U=(t,a,i={})=>(a?p:u)(e({name:t?t+":Social_Security_Disability_Receiving_Benefits":"Social_Security_Disability_Receiving_Benefits",label:a?i.label:"Are You Currently Receiving Social Security Disability Benefits?"},i)),K=(t,a,i={})=>(a?s:r)(e({label:a?i.label:"Type of Assets:",name:t?t+":Type_Of_Assets":"Type_Of_Assets",options:["Business Interests","Cash","Life Insurance Policies","Pensions/Retirement","Personal Possessions","Property","Stock/Bonds"]},i)),V=(t,a,i={})=>(a?o:m)(e({label:a?i.label:"Value of Your Assets?",name:t?t+":Value_Of_Assets":"Value_Of_Assets",options:["Less than 50K","50K to 100K","100K to 250K","250K to 500K","500K to 1M","More than 1M"]},i)),z=(t,a)=>e({$cmp:"FormKit",props:{type:"group",key:t,id:t,name:t}},a),G="$onEnter($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))",Z="$onInput($setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form))))",J=e=>"group"!==e.type&&"section"!==e.type&&"form"!==e.type&&"hidden"!==e.$formkit&&!e.children,X=e=>{if(J(e))return e;for(var t=e.children.length-1;t>=0;t--){if("string"==typeof e.children)continue;const a=e.children[t];if(J(a))return a;const i=X(a);if(i)return i}return null},ee={$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"}},{$el:"span",children:"Secure & Encrypted",attrs:{class:"t-pl-2 t-pt-1 t-font-medium"}}]};function te(t){return e(ee,t)}function ae(e){return{$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-blue-500 t-pb-4 t-pt-0 t-px-1"}}}function ie(e){return{$el:"h5",children:e.subheadline||"Tell us about your situation:",attrs:{class:"t-flex t-justify-center t-text-dark t-text-center !t-text-lg t-font-semibold t-pb-4 t-pt-0 t-px-3"}}}function ne(e){return{$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 re(e){return{$el:"h5",children:e.subheadline||"",attrs:{class:"t-flex t-justify-center t-text-center !t-text-lg t-font-normal t-text-dark t-pb-5 t-pt-0 t-px-1 "+(e.subheadlineClass||"")}}}function se(e){return function(e){return{$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 le(e){return{$el:"h3",children:e.headline||"Please Provide a Contact Name",attrs:{class:"t-flex t-justify-center t-text-center t-text-2xl t-font-bold t-text-blue-500 t-pb-5 t-pt-0 t-px-1 "+(e.headlineClass||"")}}}function oe(e){return{$el:"h3",children:e.headline||"Do any of the following situations apply?",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 de(e){return{$el:"h3",children:e.headline||a,attrs:{class:"t-flex t-justify-center t-text-center t-text-2xl t-font-bold t-text-blue-500 t-pb-3 t-pt-0 t-px-1 "+(e.headlineClass||"")+" f-contact-info-headline"}}}function ue(e){return{$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||"")+" f-contact-info-subheadline"}}}const ce="(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 pe=(e,t)=>({$el:"section",if:'$stepEnabled("'+e+'")',attrs:{hidden:'$activeStep !== "'+e+'"',key:t||e}});function me(t,a,i={}){const{nextOnEnter:n=!0,nextOnInput:r=!1,stepKey:s,nextStepMap:l,triggerRedirectMap:o,autoFocus:d}=i;if(a&&a.length&&(n||r)){const e=X(a[a.length-1]);e&&!0===n&&(e.onKeypress=G),e&&!0===r&&(e.onInput=Z)}return e(pe(t,s),{children:[{$formkit:"group",id:t,name:t,nextStepMap:l,triggerRedirectMap:o,autoFocus:d,children:a}]})}function fe(e,t,a,i={}){return void 0===i.nextOnInput&&(i.nextOnInput=!0),me(e,[ne({headline:i.headline??a,headlineClass:i.headlineClass}),...Array.isArray(t)?t:[t]],i)}const he={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 ye(e,t){return Object.fromEntries(Object.entries(e).filter((([e])=>t.includes(e))))}const be={};const ge={$el:"div",children:[{$el:"div",attrs:{id:"form-anchor",class:"t-absolute",style:{top:"-30px",left:0}}}],attrs:{class:"t-relative"}};const Ce={$el:"div",attrs:{class:"t-mt-7 t-mb-5 t-w-full t-flex t-flex-col t-justify-center t-items-center",style:{if:"$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:[{$el:"div",attrs:{id:"progress-bar",class:"t-flex t-flex-col t-justify-center t-text-center t-whitespace-nowrap t-w-[10%] t-h-1.5 t-rounded t-text-white t-bg-[#007bff]",style:{transition:"width 0.5s ease"}}}]}]};const xe=[{$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},{$formkit:"hidden",name:"s",value:null}],ve={"*":"https://listings.ziplawyer.com/api/v1/redirect?zone_id=4&vertical=Legal&category=${properties.Type_Of_Legal_Problem}&Degree_Of_Interest=${properties.Degree_Of_Interest}&zip_code=${properties.Zip}&sub_id=${properties.vid}"};const we={Adoption:'Example: "I need help with adoption forms"',"Asbestos and Mesothelioma":'Example: "I was exposed to asbestos at work and would like to file a claim"',"Auto and Car Accidents":'Example: "A truck crashed into my car on the highway" or "I\'ve been involved in a hit and run accident"',Bankruptcy:'Example: "I need help filing for bankruptcy"',"Birth Certificate and Name Change":'Example: "Just married and would like to change my last name"',"Business Lawyers":'Example: "I need help incorporating a business" or "I would like a legal contract reviewed"',"Child Custody and Support":'Example: "Need help getting custody" or "Issues with child support payments"',"Child Custody":'Example: "Need help getting custody"',"Child Support":'Example: "Issues with child support payments"',"Civil Rights and Discrimination":'Example: "Police brutality" or "Coworker keeps harassing me"',"Civil Lawsuit":'Example: "A contractor took my money and never completed the job" or "I am being sued by a neighbor"',"File a Lawsuit":'Example: "A contractor took my money and never completed the job"',"Defend a Lawsuit":'Example: "I am being sued by a neighbor"',"Consumer Lawyers":'Example: "Someone committed fraud against me" or "A contractor took my money and never completed the job"',"Copyrights and Trademarks":'Example: "I would like to register a trademark or copyright a name"',"Criminal and Felony":'Example: "I was arrested for DUI and need legal defense" or "I am being charged with assault"',"Debt and Collections":'Example: "I would like to consolidate my debt" or "A collection agency is harassing me"',"Divorce and Separation":'Example: "I would like to file for an uncontested divorce"',"DUI and DWI":'Example: "I was arrested for DUI and need legal defense"',"Elder Law":'Example: "I would like help with Estate Planning" or "I need help with a guardianship"',"Employment and Workplace":'Example: "I was injured while on the job" or "My company is discriminating against me"',Expungement:'Example: "I would like to file for an expungement and clear my record"',"Family Issues":'Example: "I need help with guardianship" or "I need a simple will created"',Foreclosure:'Example: "I need help to avoid foreclosure on my house"',Guardianship:'Example: "I need help with guardianship documents"',"Harassment and Discrimination":'Example: "I am being discriminated at work" or "My neighbor is harassing me"',"Sexual Harassment":'Example: "I am being sexually harassed by a coworker"',"Workplace Harassment":'Example: "My coworker is being aggressive towards me"',"Non-Workplace Harassment":'Example: "My neighbor is harassing me"',"Workplace Discrimination":'Example: "I am being discriminated at work based on my age"',"Non-Workplace Discrimination":'Example: "I am being discriminated against by a local official"',"Identity Theft":'Example: "Someone stole my identity and I need help fixing the issue"',"Immigration and Visas":'Example: "I need help filing for a visa" or "Help with a green card"',Insurance:'Example: "I need help filing an insurance claim for damage to my house"',"Landlord and Tenant":'Example: "I need help to fight an eviction" or "I would like a lawyer to review a rental contract"',"Lemon Law":'Example: "I purchased a new vehicle that broke down already and seller will not assist"',"Long Term Disability":'Example: "I was injured on the job and would like to file for benefits" or "I need help filing for disability benefits"',"Medical Malpractice":'Example: "A doctor performed surgery on the wrong limb and I would like to file a lawsuit"',"Patents and Intellectual Property":'Example: "I would like to file for a patent" or "I need to copyright a name"',"Personal Injury":'Example: "I was bit by the neighbor\'s dog" or "I fell in the icy grocery store parking lot"',"Power of Attorney":'Example: "I need help with a limited or general power of attorney"',"Probate and Estates":'Example: "I need help with planning for my estate" or "A family member passed without a will in place"',"Product Liability":'Example: "My car battery caught on fire" or "I purchased a faulty product"',"Property Damage":'Example: "The neighbor\'s tree fell on my fence" or "My car was hit in the parking lot"',"Real Estate":'Example: "I need help with a quitclaim deed" or "I need a lawyer to review a purchase and sales agreement"',"Social Security Disability and Insurance":'Example: "I would like help filing for disability benefits" or "I\'ve been denied for SSDI and would like to appeal"',"Tax and IRS":'Example: "I need help fighting an IRS tax claim" or "I need audit defense"',"Traffic and Tickets":'Example: "I need help reinstating a supsended license" or "I would like to fight a traffic ticket"',Unemployment:'Example: "I need help filing for unemployment benefits"',"Victim of a Crime":'Example: "I was assaulted in the store" or "I am being discriminated against at work"',"Wills and Trusts":'Example: "I need a simple will created" or "I would like guidance on creating a trust fund"',"Workers Compensation":'Example: "I broke my arm at work and need help getting compensation"',"Wrongful Death":'Example: "A family member was killed on the job and we need legal representation"',"Wrongful Termination":'Example: "I was fired by my employer without cause"',"Not Sure or Other":'Example: "I was involved in a car accident" or "I need help setting up power of attorney"'},_e={},$e={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."},Se={values:{"*":["incidentDate","primaryInjury","causeOfInjury","doctorTreatment","haveAttorney","commentsWithBankruptcy","zipcode","legalCrossSells","firstAndLast","contactInfo"]}},Ie=function(a=null){let i=we,n=_e,r=$e;return a&&(i=ye(we,a),n=ye(_e,a),r=ye($e,a)),{type:"meta",data:e(be,{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})}}();Ie.data.dynamicSchema=[function(t={}){return fe("causeOfInjury",((t,a,i={})=>(a?o:m)(e({label:a?i.label:"Cause of Injury:",name:t?t+":Cause_Of_Injury":"Cause_Of_Injury",options:["Traumatic Physical Injury (Accident)","Repeated Trauma Injury","Mental Injury","Occupational Disease","Not Sure"]},i)))(t.scope,!0,t.input),"What was the cause of the injury?",t)}(),function(e={}){return fe("claimStatus",E(e.scope,!0,e.input),"What is the status of the claim?",e)}(),function(e={}){return fe("degreeOfInterest",T(e.scope,!0,e.input),"Could you pay if your issue could be resolved?",e)}(),function(e={}){return fe("doctorTreatment",M(e.scope,!0,e.input),"Have you seen a doctor about this?",e)}(),function(e={}){return fe("haveAttorney",F(e.scope,!0,e.input),"Already working with an attorney?",e)}(),function(e={}){return fe("incidentDate",Y(e.scope,!0,e.input),"When did the incident occur?",e)}({nextOnInput:!1}),function(e={}){return fe("primaryInjury",B(e.scope,!0,e.input),"What was the primary injury?",e)}(),function(e={}){return fe("zipcode",((e,t,a={})=>(t?y:h)({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}$/",validationMessages:{required:"Zip Code is required",matches:"Invalid Zip Code"},...a}))(e.scope,!0,e.input),"Please verify your Zip Code",e)}(),function(e={}){return me("commentsWithBankruptcy",[se(e),D(e.scope,0,{label:void 0===e.label?"Please briefly describe your legal issue in a few words:":e.label,placeholder:e.placeholder||t,inputClass:void 0===e.inputClass?"!t-h-32":e.inputClass}),I(),{$el:"div",if:"$get(CrossSell_Bankruptcy).value == true",children:[D("CrossSell:Bankruptcy",0,{label:"Bankruptcy or debt details:",placeholder:"Please describe your bankrtupcy or debt situation in a few words...",inputClass:"!t-h-16"})]}],{nextOnEnter:!1})}({label:null,headline:"Please briefly describe your situation:",headlineClass:"!t-text-dark"}),function(e={}){return e.nextOnInput=!1,e.stepKey="$get(Type_Of_Legal_Problem).value",me("legalCrossSells",[oe(e),r({id:"Legal_CrossSells",name:"Legal_CrossSells",help:'Just hit "Next" if none apply',helpClass:"t-text-center !t-text-sm",validation:null,options:'$getCrossSellOptions($get(form), $getVal($get(form), "Type_Of_Legal_Problem"))'})],e)}({headlineClass:"!t-text-dark",nextStepMap:{values:{Legal_CrossSells:{"Auto and Car Accidents":["autoAndCarAccidentCrossSellQuestions"],"Personal Injury":["personalInjuryCrossSellQuestions"],"Workers Compensation":["workersCompensationCrossSellQuestions"],"DUI and DWI":["duiAndDWICrossSellQuestions"],"Long Term Disability":["longTermDisabilityCrossSellQuestions"],"Social Security Disability and Insurance":["ssdiCrossSellQuestions"],Bankruptcy:["bankruptcyCrossSellQuestions"],"Power of Attorney":["powerOfAttorneyCrossSellQuestions"],"Wills and Trusts":["willsAndTrustsCrossSellQuestions"],"Divorce and Separation":["divorceAndSeparationCrossSellQuestions"],"Child Custody":["childCustodyCrossSellQuestions"]},"*":["firstAndLast","contactInfo"]},appendSteps:["firstAndLast","contactInfo"],matchesAllowed:1}}),function(e={}){return me("autoAndCarAccidentCrossSellQuestions",[ae({headline:"You May Be Entitled To Compensation"}),ie({subheadline:"Tell us about your accident:"}),(t="true",a="CrossSell:Auto_and_Car_Accidents",z("AutoAndCarAccidentsQuestions",{if:t||'$get(Type_Of_Legal_Problem).value == "Auto and Car Accidents"',children:[F(a),Y(a),S(a),B(a),M(a),R(a)]})),D("CrossSell:Auto_and_Car_Accidents",0,{label:"Accident Description:",placeholder:"Please describe your accident in a few words...",inputClass:"!t-h-16"})],e);var t,a}(),function(e={}){return me("ssdiCrossSellQuestions",[ae({headline:"You May Be Entitled To Benefits"}),ie({subheadline:"Tell us about your disability:"}),(t="true",a="CrossSell:Social_Security_Disability_and_Insurance",z("SocialSecurityDisabilityAndInsuranceQuestions",{if:t||'$get(Type_Of_Legal_Problem).value == "Social Security Disability and Insurance"',children:[F(a),$(a),O(a),j(a),U(a),M(a)]})),D("CrossSell:Social_Security_Disability_and_Insurance",0,{label:"Description:",placeholder:"Please describe your situation in a few words...",inputClass:"!t-h-16"})],e);var t,a}(),function(e={}){return me("powerOfAttorneyCrossSellQuestions",[ae({headline:"Power of Attorney Information"}),(t="true",a="CrossSell:Power_of_Attorney",z("PowerofAttorneyQuestions",{if:t||'$get(Type_Of_Legal_Problem).value == "Power of Attorney"',children:[F(a),L(a)]})),D("CrossSell:Power_of_Attorney",0,{label:"Description:",placeholder:"Please describe your situation in a few words...",inputClass:"!t-h-16"})],e);var t,a}(),function(e={}){return me("willsAndTrustsCrossSellQuestions",[ae({headline:"Will or Trust Information"}),(t="true",a="CrossSell:Wills_and_Trusts",z("WillsAndTrustsQuestions",{if:t||'$get(Type_Of_Legal_Problem).value == "Wills and Trusts"',children:[F(a),V(a),K(a),Q(a),q(a),L(a)]})),D("CrossSell:Wills_and_Trusts",0,{label:"Description:",placeholder:"Please describe your situation in a few words...",inputClass:"!t-h-16"})],e);var t,a}(),function(e={}){return me("divorceAndSeparationCrossSellQuestions",[ae({headline:"Divorce or Separation Information"}),(t="true",a="CrossSell:Divorce_and_Separation",z("DivorceQuestions",{if:t||'$get(Type_Of_Legal_Problem).value == "Divorce and Separation"',children:[F(a),H(a),W(a),T(a),N(a)]})),D("CrossSell:Divorce_and_Separation",0,{label:"Description:",placeholder:"Please describe your situation in a few words...",inputClass:"!t-h-16"})],e);var t,a}(),function(e={}){return me("childCustodyCrossSellQuestions",[ae({headline:"Child Custody Information"}),(t="true",a="CrossSell:Child_Custody",z("ChildCustodyQuestions",{if:t||'$get(Type_Of_Legal_Problem).value == "Child Custody"',children:[F(a),A(a),k(a),P(a),T(a),N(a)]})),D("CrossSell:Child_Custody",0,{label:"Description:",placeholder:"Please describe your situation in a few words...",inputClass:"!t-h-16"})],e);var t,a}(),function(e={}){return me("firstAndLast",[le({headline:e.headline??"Who is looking for help?",headlineClass:e.headlineClass}),re({subheadline:e.subheadline??"Note: we never share info without consent",subheadlineClass:"!t-text-sm !t-text-gray-500"}),v(e.scope),w(e.scope)],e)}({headlineClass:"!t-text-dark"})];const ke=[Ie,e(ge,Pe),{$cmp:"FormKit",props:function(t){const a=e(he,t);return a.formId&&!a.name&&(a.name=a.formId),a}({formId:"workersCompensation",redirectMap:function(t){return e(ve,t)}(),crossSellOptionMap:{"Workers Compensation":{"Auto and Car Accidents":"Involved in a Car Accident","Wills and Trusts":"Need a Will or Trust","Power of Attorney":"Update Power of Attorney","Divorce and Separation":"Need a Divorce or Separation","Child Custody":"Need help with Child Custody","Social Security Disability and Insurance":"Interest in SSDI Benefits"}}}),children:[function(t){return e(Ce,t)}(),function(t={}){return e(function(e={}){return{$el:"h1",attrs:{class:"t-flex t-justify-center t-text-center t-text-[2rem] t-font-semibold t-pt-5 t-px-7 md:t-px-3 "+(e.headlineClass||"")+" f-first-headline"}}}(t),t)}({children:'$urlParam("hl", "Get Max Compensation For Your Claim!")',if:"$activeStep === $firstStep()",headlineClass:"!t-pt-8 !t-text-2xl"}),function(t={}){return e(function(e={}){return{$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||"")+" f-first-subheadline"}}}(t),t)}({children:'$urlParam("shl", "What Is Your Case Status?")',if:"$activeStep === $firstStep()"}),...xe,{$el:"div",attrs:{class:"form-body"},children:[function(e={}){return me("workersCompensationTOLP",[{$formkit:"hidden",name:"Type_Of_Legal_Problem",id:"Type_Of_Legal_Problem",value:"Workers Compensation"},E(e.scope,!0,e.input)],e)}({nextOnInput:!1,nextStepMap:Se}),function(e="Type_Of_Legal_Problem"){return{$cmp:"FormKitSchema",if:"$get("+e+").value",props:{schema:"$meta.dynamicSchema",data:"$buildData($meta)"}}}(),function(e={}){return me("contactInfo",[de(e),ue(e),{$el:"script",if:"$activeStep === $lastStep()",children:ce},x(e.scope),_(e.scope),(t=e.scope,{$formkit:"checkbox",label:"$meta.tcpaLanguage",__raw__sectionsSchema:{label:{attrs:{innerHTML:"$label"}}},name:t?t+":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 !t-leading-[0.9rem]"}}),te()],{nextOnEnter:!1});var t}({headline:"Get Your Claim Value",subheadline:"Attorneys Are Ready To Maximize Your Compensation"}),((e={})=>({$el:"div",attrs:{class:{if:"$activeStep === $firstStep()",then:"step-nav !t-justify-center sm:!t-justify-between",else:"step-nav !t-justify-between"}},children:[{$formkit:"button",name:"back_button",onClick:"$setPreviousStep($prevStepFunc($get(form)))",children:"Back",outerClass:{if:"$activeStep === $firstStep()",then:"t-hidden sm:t-block",else:""},style:{if:"$activeStep === $firstStep()",then:"display: none;"},classes:{input:(e.inputClass||"")+" f-navigation-input"}},{$formkit:"button",name:"next_button",onClick:"$setNextStep($fireStepEvent($get(form)), $preStepFunc($get(form)))",children:{if:"$activeStep === $firstStep()",then:e.startText||"Start",else:"Next"},outerClass:{if:"$activeStep === $lastStep()",then:"t-hidden",else:""},style:{if:"$activeStep === $lastStep()",then:"display: none;"},classes:{input:(e.inputClass||"")+" f-navigation-input"}},{$formkit:"submit",name:"submit_button",label:e.submitLabel||"Submit",if:"$activeStep === $lastStep()",style:{if:"$activeStep !== $lastStep()",then:"display: none;"},classes:{input:(e.inputClass||"")+" !t-ml-2 sm:!t-ml-auto f-navigation-input"}}]}))({startText:"Start Evaluation",inputClass:"!t-font-extrabold"}),{$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 Pe;return ke}();

package/package.json

@@ -1,6 +1,6 @@
 {
   "name": "bhl-forms",
-  "version": "0.8.8",
+  "version": "0.8.10",
   "publishConfig": {
     "access": "public"
   },