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URL: https://socialsecuritydisabilityhelp.net/
Submission Tags: @ecarlesi possiblethreat #phishing Search All
Submission: On September 20 via api from AU — Scanned from AU

Form analysis 1 forms found in the DOM

POST mail.php

<form id="main-form" class="ar-form" role="form" action="mail.php" method="post">
  <div class="form-fields">
    <fieldset id="step" style="display: block;">
      <header>
        <!--<p>Take advantage of our FREE&nbsp;SERVICE</p>
                				<p>Get your Free consultation today</p>-->
        <p>FREE Social Security Disability Case Evaluation</p>
        <div class="spacer"></div>
      </header>
      <div class="form-group">
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        <input style="display: none !important;" type="hidden" id="requestID" name="requestID" class="form-control" value="undefined">
      </div>
      <div class="messages"></div>
      <div class="form-group">
        <label class="form-label">Age <div class="messages"></div></label>
        <select class="form-element" name="age" id="age">
          <option value="">Please select</option>
          <option value="29">Below 30</option>
          <option value="30">30</option>
          <option value="31">31</option>
          <option value="32">32</option>
          <option value="33">33</option>
          <option value="34">34</option>
          <option value="35">35</option>
          <option value="36">36</option>
          <option value="37">37</option>
          <option value="38">38</option>
          <option value="39">39</option>
          <option value="40">40</option>
          <option value="41">41</option>
          <option value="42">42</option>
          <option value="43">43</option>
          <option value="44">44</option>
          <option value="45">45</option>
          <option value="46">46</option>
          <option value="47">47</option>
          <option value="48">48</option>
          <option value="49">49</option>
          <option value="50">50</option>
          <option value="51">51</option>
          <option value="52">52</option>
          <option value="53">53</option>
          <option value="54">54</option>
          <option value="55">55</option>
          <option value="56">56</option>
          <option value="57">57</option>
          <option value="58">58</option>
          <option value="59">59</option>
          <option value="60">60</option>
          <option value="61">61</option>
          <option value="62">62</option>
          <option value="63">63</option>
          <option value="64">64</option>
          <option value="65">65</option>
          <option value="66">Over 65</option>
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      <div class="form-group">
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      <div class="form-group">
        <label class="form-label">Email <div class="messages"></div></label>
        <input class="form-element" type="email" id="email" name="email">
      </div>
      <div style="margin: 20px 0;" class="btn-holder"><button class="btn btn-fancy process-button-click ar-button btn-step1">Do I qualify</button></div>
    </fieldset>
    <fieldset id="step">
      <header>
        <p>Please Answer Below Questions And</p>
        <p>Get a FREE Evaluation</p>
        <div class="spacer"></div>
      </header>
      <div class="form-group">
        <label class="form-label">Do you expect to be out of work for at least a year?</label>
        <select class="form-element" name="payroll" id="payroll">
          <option value="" selected="Yes">Please select</option>
          <option value="Yes">Yes</option>
          <option value="No">No</option>
        </select>
        <div class="messages"></div>
      </div>
      <div class="form-group">
        <label class="form-label">Have you worked 5 of the last 10 years?</label>
        <select class="form-element" name="work5years" id="work5years">
          <option value="" selected="Yes">Please select</option>Please select <option value="Yes">Yes</option>
          <option value="No">No</option>
        </select>
        <div class="messages"></div>
      </div>
      <div class="form-group">
        <label class="form-label">Are you currently receiving Social Security Disability benefits?</label>
        <select class="form-element" name="ssdbenefits" id="ssdbenefits">
          <option value="" selected="Yes">Please select</option>
          <option value="Yes">Yes</option>
          <option value="No">No</option>
        </select>
        <div class="messages"></div>
      </div>
      <div class="form-group">
        <label class="form-label">Is an attorney helping you with your case?</label>
        <select class="form-element" name="attorney" id="attorney">
          <option value="" selected="Yes">Please select</option>
          <option value="Yes">Yes</option>
          <option value="No">No</option>
        </select>
        <div class="messages"></div>
      </div>
      <div class="form-group">
        <label class="form-label">Are you receiving treatment from a Doctor?</label>
        <select class="form-element" name="doctor" id="doctor">
          <option value="">Please select</option>
          <option value="Yes">Yes</option>
          <option value="No">No</option>
        </select>
        <div class="messages"></div>
      </div>
      <div style="margin: 20px 0;" class="btn-holder"><button class="btn btn-fancy process-button-click ar-button btn-step2">Do I qualify</button></div>
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    <fieldset id="step">
      <header>
        <p>COMPLETE THE FORM BELOW</p>
        <div class="spacer"></div>
      </header>
      <div class="row">
        <div class="col-lg-6 col-md-6">
          <div class="form-group">
            <label class="form-label">First Name</label>
            <input class="form-element" type="text" id="firstname" name="firstname">
            <div class="messages"></div>
          </div>
        </div>
        <div class="col-lg-6 col-md-6">
          <div class="form-group">
            <label class="form-label">Last Name</label>
            <input class="form-element" type="text" id="lastname" name="lastname">
            <div class="messages"></div>
          </div>
        </div>
      </div>
      <div class="row">
        <div class="col-lg-12">
          <div class="form-group">
            <label class="form-label">Street Address</label>
            <input class="form-element" type="text" id="street" name="street">
            <div class="messages"></div>
          </div>
        </div>
      </div>
      <div class="row">
        <div class="col-lg-12">
          <div class="form-group">
            <label class="form-label">Phone Number <div class="messages"></div></label>
          </div>
        </div>
      </div>
      <div style="padding-left: 15px;" class="row">
        <div style="margin-right: 5px;" class="form-group">
          <span class="shell"><span aria-hidden="true" id="areacodeMask"><i></i>XXX</span><input style="width: 50px;" type="text" id="areacode" name="areacode" pattern="\d{3}" class="form-element masked" title="area code" maxlength="3"
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        </div>
      </div>
      <div class="row">
        <div class="col-lg-12">
          <div class="form-group">
            <label class="form-label">Describe Your Disability</label>
            <textarea class="form-element" name="notes" id="notes" cols="30" rows="3"></textarea>
            <div class="messages"></div>
          </div>
        </div>
      </div>
      <div style="margin: 20px 0;" class="btn-holder"><button class="btn btn-fancy process-button-click ar-button btn-step3">Secure Evaluation</button></div>
      <div class="consent"> By clicking '<span style="font-weight: 600;">Secure Evaluation</span>' and submitting my request, I confirm that I have read and agree to the privacy policy of this site and that I consent to receive emails, phone calls
        and/or text message offers and communications from oncoreleads.com and its network of lawyers and advocates at any telephone number or email address provided by me, including my wireless number, if provided. I understand there may be a charge
        by my wireless carrier for such communications. I understand these communications may be generated using an autodialer and may contain pre-recorded messages and that consent is not required to utilize oncoreleads.com’s services. I understand
        that this authorization overrides any previous registrations on a federal or state Do Not Call registry. <span style="font-weight: 600;">Accurate information is required for a free evaluation.</span>
      </div>
    </fieldset>
    <fieldset id="step">
      <header>
        <p>You can skip below questions</p>
        <div class="spacer"></div>
      </header>
      <div class="row">
        <div class="col-12">
          <div class="form-group">
            <label style="font-size: 16px;" class="form-label">In the last 3 years, have you been injured in a car accident, motorcycle accident, truck accident or work-related accident?</label>
          </div>
        </div>
      </div>
      <div class="row">
        <div class="col-12">
          <div class="form-group">
            <select class="form-element" name="mva" id="mva">
              <option value="">Please select</option>
              <option value="Yes">Yes</option>
              <option value="No">No</option>
            </select>
            <div class="messages"></div>
          </div>
        </div>
      </div>
      <div style="margin: 20px 0;" class="btn-holder"><button class="btn btn-fancy process-button-click ar-button btn_done">Skip &amp; Submit</button></div>
    </fieldset>
    <fieldset id="step">
      <header>
        <p>You can skip below questions</p>
        <div class="spacer"></div>
      </header>
      <div class="row">
        <div class="col-12">
          <div class="form-group">
            <label style="font-size: 16px;" class="form-label">In the last 3 years, have you been injured in a car accident, motorcycle accident, truck accident or work-related accident?</label>
          </div>
        </div>
      </div>
      <div class="row">
        <div class="col-12">
          <div class="form-group">
            <select class="form-element" name="mva_yes" id="mva_yes">
              <option value="">Please select</option>
              <option value="Yes" selected="Yes">Yes</option>
              <option value="No">No</option>
            </select>
            <div class="messages"></div>
          </div>
        </div>
      </div>
      <div class="row">
        <div class="col-12">
          <div class="form-group">
            <label class="form-label">Year of Injury</label>
            <select class="form-element" name="yearofinjury" id="yearofinjury">
              <option value="">Please select</option>
              <option value="2019">2019</option>
              <option value="2018">2018</option>
              <option value="2017">2017</option>
              <option value="2016">2016 or before</option>
            </select>
            <div class="messages"></div>
          </div>
        </div>
      </div>
      <div class="row">
        <div class="col-12">
          <div class="form-group">
            <label class="form-label">What kind of injury was it?</label>
            <select class="form-element" name="injuryType" id="injuryType">
              <option value="">Please select</option>
              <option value="Car Accident">Car Accident</option>
              <option value="Motorcycle Accident">Motorcycle Accident</option>
              <option value="Truck Accident">Truck Accident</option>
              <option value="Work Related Accident">Work Related Accident</option>
            </select>
            <div class="messages"></div>
          </div>
        </div>
      </div>
      <div class="row">
        <div class="col-12">
          <div class="form-group">
            <label class="form-label">Were you at fault?</label>
            <select class="form-element" name="fault" id="fault">
              <option value="">Please select</option>
              <option value="Yes">Yes</option>
              <option value="No">No</option>
            </select>
            <div class="messages"></div>
          </div>
        </div>
      </div>
      <div class="row">
        <div class="col-12">
          <div class="form-group">
            <label class="form-label">Did the injury require hospitalization, medical treatment, surgery or cause you to miss work?</label>
            <select class="form-element" name="postInjury" id="postInjury">
              <option value="">Please select</option>
              <option value="Yes">Yes</option>
              <option value="No">No</option>
            </select>
            <div class="messages"></div>
          </div>
        </div>
      </div>
      <div class="row">
        <div class="col-12">
          <div class="form-group">
            <label class="form-label">Do you currently have a lawyer representing your claim?</label>
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              <option value="Yes">Yes</option>
              <option value="No">No</option>
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            <div class="messages"></div>
          </div>
        </div>
      </div>
      <div class="row">
        <div class="col-12">
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            <label class="form-label">Describe the Accident and your Injuries</label>
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          </div>
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      <div style="margin: 20px 0;" class="btn-holder"><button class="btn btn-fancy process-button-click ar-button mva_submit">Get Your Free Case Review</button></div>
      <div class="consent"> By clicking '<span style="font-weight: 600;">Get Your Free Case Review</span>' and submitting my request, I confirm that I have read and agree to the privacy policy of this site and that I consent to receive emails, phone
        calls and/or text message offers and communications from oncoreleads.com and its network of lawyers and advocates at any telephone number or email address provided by me, including my wireless number, if provided. I understand there may be a
        charge by my wireless carrier for such communications. I understand these communications may be generated using an autodialer and may contain pre-recorded messages and that consent is not required to utilize oncoreleads.com’s services. I
        understand that this authorization overrides any previous registrations on a federal or state Do Not Call registry. <span style="font-weight: 600;">Accurate information is required for a free evaluation.</span>
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</form>

Text Content

FREE SOCIAL SECURITY DISABILITY® CLAIM REVIEW


IS A DISABILITY KEEPING YOU FROM WORKING?


GET A FREE EVALUATION AND GET THE BENEFITS YOU DESERVE!

No matter what your disability situation is, our services will assist you in
getting the help you need. Start by getting your free evaluation right now.

Applying for Social Security Disability benefits can be a stressful and
time-consuming process. No matter what your disability situation is, we will
assist you through the legal process of obtaining benefits.

Let us be your guide from beginning to end. Start by getting your free
evaluation right now. We have one simple goal – to get your claim approved so
you can carry on with your life.


WHAT TO EXPECT:

 * Free Consultation
 * Quick answers
 * A trusted network of professionals
 * Focused exclusively on Social Security Disability claims

FREE Social Security Disability Case Evaluation




Age

Please select Below 30 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48
49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 Over 65
Zip Code

Email

Do I qualify

Please Answer Below Questions And

Get a FREE Evaluation


Do you expect to be out of work for at least a year? Please select Yes No

Have you worked 5 of the last 10 years? Please selectPlease select Yes No

Are you currently receiving Social Security Disability benefits? Please select
Yes No

Is an attorney helping you with your case? Please select Yes No

Are you receiving treatment from a Doctor? Please select Yes No

Do I qualify

COMPLETE THE FORM BELOW


First Name

Last Name

Street Address

Phone Number

XXX
- XXX
- XXXX
Describe Your Disability

Secure Evaluation
By clicking 'Secure Evaluation' and submitting my request, I confirm that I have
read and agree to the privacy policy of this site and that I consent to receive
emails, phone calls and/or text message offers and communications from
oncoreleads.com and its network of lawyers and advocates at any telephone number
or email address provided by me, including my wireless number, if provided. I
understand there may be a charge by my wireless carrier for such communications.
I understand these communications may be generated using an autodialer and may
contain pre-recorded messages and that consent is not required to utilize
oncoreleads.com’s services. I understand that this authorization overrides any
previous registrations on a federal or state Do Not Call registry. Accurate
information is required for a free evaluation.

You can skip below questions


In the last 3 years, have you been injured in a car accident, motorcycle
accident, truck accident or work-related accident?
Please select Yes No

Skip & Submit

You can skip below questions


In the last 3 years, have you been injured in a car accident, motorcycle
accident, truck accident or work-related accident?
Please select Yes No

Year of Injury Please select 2019 2018 2017 2016 or before

What kind of injury was it? Please select Car Accident Motorcycle Accident Truck
Accident Work Related Accident

Were you at fault? Please select Yes No

Did the injury require hospitalization, medical treatment, surgery or cause you
to miss work? Please select Yes No

Do you currently have a lawyer representing your claim? Please select Yes No

Describe the Accident and your Injuries

Get Your Free Case Review
By clicking 'Get Your Free Case Review' and submitting my request, I confirm
that I have read and agree to the privacy policy of this site and that I consent
to receive emails, phone calls and/or text message offers and communications
from oncoreleads.com and its network of lawyers and advocates at any telephone
number or email address provided by me, including my wireless number, if
provided. I understand there may be a charge by my wireless carrier for such
communications. I understand these communications may be generated using an
autodialer and may contain pre-recorded messages and that consent is not
required to utilize oncoreleads.com’s services. I understand that this
authorization overrides any previous registrations on a federal or state Do Not
Call registry. Accurate information is required for a free evaluation.


DON’T DELAY!

There may be limited time to file your claim!

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