trueaccord.zendesk.com Open in urlscan Pro
104.16.51.111  Public Scan

Submitted URL: http://sg.trueaccord-verify.com/ls/click?upn=ZjD-2Fbu4lSCiljl6ViJreSKE5y4DuVqhpBGD2qv-2FE7o4QBwgVGWCh5eHSmsjwwYwY7hc9oGVBDIdHZky...
Effective URL: https://trueaccord.zendesk.com/hc/en-us/requests/new?tf_360025038913=0399b19eff0645cea055563e2b9d3a49&tf_17207765110931=dispute...
Submission: On December 01 via manual from US — Scanned from DE

Form analysis 2 forms found in the DOM

GET /hc/en-us/search

<form role="search" class="search" data-search="" action="/hc/en-us/search" accept-charset="UTF-8" method="get"><input name="utf8" type="hidden" value="✓" autocomplete="off"><input type="search" name="query" id="query" placeholder="Search"
    aria-label="Search"><button type="button" aria-controls="query" class="clear-button"><svg xmlns="http://www.w3.org/2000/svg" width="12" height="12" focusable="false" role="img" viewBox="0 0 12 12" aria-label="Clear search">
      <path stroke="currentColor" stroke-linecap="round" stroke-width="2" d="M3 9l6-6m0 6L3 3"></path>
    </svg></button></form>

POST /hc/en-us/requests

<form id="new_request" class="request-form" data-form="" data-form-type="request" action="/hc/en-us/requests" accept-charset="UTF-8" method="post"><input name="utf8" type="hidden" value="✓" autocomplete="off">
  <input type="hidden" name="request[ticket_form_id]" id="request_ticket_form_id" value="13147851419539" autocomplete="off">
  <div class="form-field string required request_anonymous_requester_email"><label for="request_anonymous_requester_email">Your email address</label>
    <input type="text" name="request[anonymous_requester_email]" id="request_anonymous_requester_email" aria-required="true">
  </div>
  <div class="form-field string  optional  request_custom_fields_360025038913">
    <label id="request_custom_fields_360025038913_label" for="request_custom_fields_360025038913">Debt ID<span class="optional">(optional)</span></label>
    <input type="text" name="request[custom_fields][360025038913]" id="request_custom_fields_360025038913" aria-required="false" aria-describedby="request_custom_fields_360025038913_hint" aria-labelledby="request_custom_fields_360025038913_label">
    <p id="request_custom_fields_360025038913_hint">Internal use only. Do not edit.</p>
  </div>
  <div class="form-field string  required  request_custom_fields_17413889844883">
    <label id="request_custom_fields_17413889844883_label" for="request_custom_fields_17413889844883">What is your full name?</label>
    <input type="text" name="request[custom_fields][17413889844883]" id="request_custom_fields_17413889844883" aria-required="true" aria-labelledby="request_custom_fields_17413889844883_label">
  </div>
  <div class="form-field string  required  request_custom_fields_17207719463315">
    <label id="request_custom_fields_17207719463315_label" for="request_custom_fields_17207719463315">Your phone number?</label>
    <input type="number" name="request[custom_fields][17207719463315]" id="request_custom_fields_17207719463315" step="1" aria-required="true" aria-labelledby="request_custom_fields_17207719463315_label">
  </div>
  <div class="form-field string  optional  request_custom_fields_17413919132179">
    <label id="request_custom_fields_17413919132179_label" for="request_custom_fields_17413919132179">What is your TrueAccord account number?<span class="optional">(optional)</span></label>
    <input type="text" name="request[custom_fields][17413919132179]" id="request_custom_fields_17413919132179" aria-required="false" aria-describedby="request_custom_fields_17413919132179_hint"
      aria-labelledby="request_custom_fields_17413919132179_label">
    <p id="request_custom_fields_17413919132179_hint">This number always starts with "47" and is found in the emails we send you.</p>
  </div>
  <div class="form-field text  optional  request_custom_fields_17207676156947">
    <label id="request_custom_fields_17207676156947_label" for="request_custom_fields_17207676156947">What is your best mailing address?<span class="optional">(optional)</span></label>
    <textarea name="request[custom_fields][17207676156947]" id="request_custom_fields_17207676156947" aria-required="false" aria-labelledby="request_custom_fields_17207676156947_label"></textarea>
  </div>
  <div class="form-field string  required  request_custom_fields_17207765110931">
    <label id="request_custom_fields_17207765110931_label" for="request_custom_fields_17207765110931">How can we help you?</label>
    <input type="hidden" name="request[custom_fields][17207765110931]" id="request_custom_fields_17207765110931" autocomplete="off"
      data-tagger="[{&quot;label&quot;:&quot;-&quot;,&quot;value&quot;:&quot;&quot;},{&quot;label&quot;:&quot;I am disputing this account/balance&quot;,&quot;value&quot;:&quot;dispute_category&quot;},{&quot;label&quot;:&quot;I am filing for bankruptcy&quot;,&quot;value&quot;:&quot;bankruptcy_category&quot;},{&quot;label&quot;:&quot;I have a complaint regarding collections&quot;,&quot;value&quot;:&quot;complaint_category&quot;},{&quot;label&quot;:&quot;I have hired an attorney&quot;,&quot;value&quot;:&quot;hired_an_attorney&quot;},{&quot;label&quot;:&quot;I or my spouse is on active duty&quot;,&quot;value&quot;:&quot;i_or_my_spouse_is_on_active_duty&quot;},{&quot;label&quot;:&quot;I would like to start paying my balance&quot;,&quot;value&quot;:&quot;payment_category&quot;},{&quot;label&quot;:&quot;Other&quot;,&quot;value&quot;:&quot;other_category&quot;}]"
      aria-required="true" aria-labelledby="request_custom_fields_17207765110931_label"
      value="dispute_category"><a class="nesty-input" tabindex="0" aria-haspopup="true" aria-expanded="false" aria-controls="_bkl6s9q91" aria-required="true" aria-labelledby="request_custom_fields_17207765110931_label" style="max-width: 100%;">I am disputing this account/balance</a>
  </div>
  <div class="form-field string request_custom_fields_17208499174931 required">
    <label id="request_custom_fields_17208499174931_label" for="request_custom_fields_17208499174931">Dispute Reason</label>
    <input type="hidden" name="request[custom_fields][17208499174931]" id="request_custom_fields_17208499174931" autocomplete="off"
      data-tagger="[{&quot;label&quot;:&quot;-&quot;,&quot;value&quot;:&quot;&quot;},{&quot;label&quot;:&quot;I am the victim of identity theft&quot;,&quot;value&quot;:&quot;i_am_the_victim_of_identity_theft&quot;},{&quot;label&quot;:&quot;I have already paid or settled this debt&quot;,&quot;value&quot;:&quot;already_paid&quot;},{&quot;label&quot;:&quot;I should not have to pay this at all&quot;,&quot;value&quot;:&quot;should_not_have_to_pay&quot;},{&quot;label&quot;:&quot;I would like to see a verification of debt&quot;,&quot;value&quot;:&quot;verification_of_debt&quot;},{&quot;label&quot;:&quot;The balance is incorrect&quot;,&quot;value&quot;:&quot;balance_is_incorrect&quot;},{&quot;label&quot;:&quot;None of these reasons match my dispute (Other)&quot;,&quot;value&quot;:&quot;none_of_these_reasons_match_my_dispute&quot;}]"
      aria-required="true" aria-labelledby="request_custom_fields_17208499174931_label"
      value=""><a class="nesty-input" tabindex="0" aria-haspopup="true" aria-expanded="false" aria-controls="_1ts331lbs" aria-required="true" aria-labelledby="request_custom_fields_17208499174931_label" style="max-width: 100%;">-</a>
  </div>
  <div class="form-field string request_custom_fields_17414921762195 optional" hidden="">
    <label id="request_custom_fields_17414921762195_label" for="request_custom_fields_17414921762195">Why shouldn't you have to pay?</label>
    <input type="hidden" name="request[custom_fields][17414921762195]" id="request_custom_fields_17414921762195" autocomplete="off"
      data-tagger="[{&quot;label&quot;:&quot;-&quot;,&quot;value&quot;:&quot;&quot;},{&quot;label&quot;:&quot;I have returned the merchandise&quot;,&quot;value&quot;:&quot;i_have_returned_the_merchandise&quot;},{&quot;label&quot;:&quot;I never received the product&quot;,&quot;value&quot;:&quot;i_never_received_the_product&quot;},{&quot;label&quot;:&quot;The merchandise was broken/defective&quot;,&quot;value&quot;:&quot;the_merchandise_was_broken/defective&quot;},{&quot;label&quot;:&quot;This was covered by insurance&quot;,&quot;value&quot;:&quot;this_was_covered_by_insurance&quot;},{&quot;label&quot;:&quot;Other&quot;,&quot;value&quot;:&quot;other&quot;}]"
      aria-required="true" aria-labelledby="request_custom_fields_17414921762195_label" value=""
      disabled=""><a class="nesty-input" tabindex="0" aria-haspopup="true" aria-expanded="false" aria-controls="_rj2h72l53" aria-required="true" aria-labelledby="request_custom_fields_17414921762195_label" style="max-width: 100%;">-</a>
  </div>
  <div class="form-field string request_custom_fields_17415363607187 optional" hidden="">
    <label id="request_custom_fields_17415363607187_label" for="request_custom_fields_17415363607187">Have you made previous payments on the account?</label>
    <input type="hidden" name="request[custom_fields][17415363607187]" id="request_custom_fields_17415363607187" autocomplete="off"
      data-tagger="[{&quot;label&quot;:&quot;-&quot;,&quot;value&quot;:&quot;&quot;},{&quot;label&quot;:&quot;Yes&quot;,&quot;value&quot;:&quot;yes&quot;},{&quot;label&quot;:&quot;No&quot;,&quot;value&quot;:&quot;no&quot;}]" aria-required="true"
      aria-labelledby="request_custom_fields_17415363607187_label" value=""
      disabled=""><a class="nesty-input" tabindex="0" aria-haspopup="true" aria-expanded="false" aria-controls="_6h28ndwh7" aria-required="true" aria-labelledby="request_custom_fields_17415363607187_label" style="max-width: 100%;">-</a>
  </div>
  <div class="form-field string request_custom_fields_17415986463251 optional" hidden="">
    <label id="request_custom_fields_17415986463251_label" for="request_custom_fields_17415986463251">To whom did you make previous payments?</label>
    <input type="hidden" name="request[custom_fields][17415986463251]" id="request_custom_fields_17415986463251" autocomplete="off"
      data-tagger="[{&quot;label&quot;:&quot;-&quot;,&quot;value&quot;:&quot;&quot;},{&quot;label&quot;:&quot;Previous collection agency&quot;,&quot;value&quot;:&quot;previous_collection_agency&quot;},{&quot;label&quot;:&quot;Previous creditor&quot;,&quot;value&quot;:&quot;previous_creditor&quot;},{&quot;label&quot;:&quot;Other&quot;,&quot;value&quot;:&quot;other_previous_payments&quot;}]"
      aria-required="true" aria-labelledby="request_custom_fields_17415986463251_label" value=""
      disabled=""><a class="nesty-input" tabindex="0" aria-haspopup="true" aria-expanded="false" aria-controls="_k0vgedrhw" aria-required="true" aria-labelledby="request_custom_fields_17415986463251_label" style="max-width: 100%;">-</a>
  </div>
  <div class="form-field string request_custom_fields_17210640814483 optional" hidden="">
    <label id="request_custom_fields_17210640814483_label" for="request_custom_fields_17210640814483">When did you make the previous payment?</label>
    <input type="text" class="datepicker" value="" disabled=""><input type="text" name="request[custom_fields][17210640814483]" id="request_custom_fields_17210640814483" data-datepicker="" data-format="YYYY-MM-DD" class="" aria-required="true"
      aria-labelledby="request_custom_fields_17210640814483_label" readonly="readonly" style="display: none;" disabled="">
  </div>
  <div class="form-field decimal request_custom_fields_17210308059283 optional" hidden="">
    <label id="request_custom_fields_17210308059283_label" for="request_custom_fields_17210308059283">What should the balance be?</label>
    <input type="number" name="request[custom_fields][17210308059283]" id="request_custom_fields_17210308059283" step="any" aria-required="true" aria-labelledby="request_custom_fields_17210308059283_label" disabled="">
  </div>
  <div class="form-field string request_custom_fields_17208664130195 optional" hidden="">
    <label id="request_custom_fields_17208664130195_label" for="request_custom_fields_17208664130195">Can we email you a debt verification?</label>
    <input type="hidden" name="request[custom_fields][17208664130195]" id="request_custom_fields_17208664130195" autocomplete="off"
      data-tagger="[{&quot;label&quot;:&quot;-&quot;,&quot;value&quot;:&quot;&quot;},{&quot;label&quot;:&quot;Yes, email is great&quot;,&quot;value&quot;:&quot;yes__email_is_great&quot;},{&quot;label&quot;:&quot;No, please mail it&quot;,&quot;value&quot;:&quot;no__please_mail_it&quot;}]"
      aria-required="true" aria-labelledby="request_custom_fields_17208664130195_label" value=""
      disabled=""><a class="nesty-input" tabindex="0" aria-haspopup="true" aria-expanded="false" aria-controls="_h5ckkeo1w" aria-required="true" aria-labelledby="request_custom_fields_17208664130195_label" style="max-width: 100%;">-</a>
  </div>
  <div class="form-field string request_custom_fields_17268928365459 optional" hidden="">
    <label id="request_custom_fields_17268928365459_label" for="request_custom_fields_17268928365459">Payment Options</label>
    <input type="hidden" name="request[custom_fields][17268928365459]" id="request_custom_fields_17268928365459" autocomplete="off"
      data-tagger="[{&quot;label&quot;:&quot;-&quot;,&quot;value&quot;:&quot;&quot;},{&quot;label&quot;:&quot;I would like a discounted payment to resolve my account&quot;,&quot;value&quot;:&quot;i_would_like_a_discounted_payment_to_resolve_my_account&quot;},{&quot;label&quot;:&quot;I would like a payment plan&quot;,&quot;value&quot;:&quot;i_would_like_a_payment_plan&quot;},{&quot;label&quot;:&quot;I would like to pay in full&quot;,&quot;value&quot;:&quot;i_would_like_to_pay_all_at_once&quot;}]"
      aria-required="true" aria-labelledby="request_custom_fields_17268928365459_label" value=""
      disabled=""><a class="nesty-input" tabindex="0" aria-haspopup="true" aria-expanded="false" aria-controls="_ftreqpjsu" aria-required="true" aria-labelledby="request_custom_fields_17268928365459_label" style="max-width: 100%;">-</a>
  </div>
  <div class="form-field decimal request_custom_fields_17268996640403 optional" hidden="">
    <label id="request_custom_fields_17268996640403_label" for="request_custom_fields_17268996640403">For what amount would you like to pay your balance?</label>
    <input type="number" name="request[custom_fields][17268996640403]" id="request_custom_fields_17268996640403" step="any" aria-required="true" aria-labelledby="request_custom_fields_17268996640403_label" disabled="">
  </div>
  <div class="form-field string request_custom_fields_17269255240467 optional" hidden="">
    <label id="request_custom_fields_17269255240467_label" for="request_custom_fields_17269255240467">How would you like to pay?</label>
    <input type="hidden" name="request[custom_fields][17269255240467]" id="request_custom_fields_17269255240467" autocomplete="off"
      data-tagger="[{&quot;label&quot;:&quot;-&quot;,&quot;value&quot;:&quot;&quot;},{&quot;label&quot;:&quot;I would like to create a discounted payment plan&quot;,&quot;value&quot;:&quot;i_would_like_to_create_a_discounted_payment_plan&quot;},{&quot;label&quot;:&quot;The whole discounted payment at once&quot;,&quot;value&quot;:&quot;the_whole_discounted_payment_at_once&quot;}]"
      aria-required="true" aria-labelledby="request_custom_fields_17269255240467_label" value=""
      disabled=""><a class="nesty-input" tabindex="0" aria-haspopup="true" aria-expanded="false" aria-controls="_24r80239l" aria-required="true" aria-labelledby="request_custom_fields_17269255240467_label" style="max-width: 100%;">-</a>
  </div>
  <div class="form-field string request_custom_fields_17269461053075 optional" hidden="">
    <label id="request_custom_fields_17269461053075_label" for="request_custom_fields_17269461053075">How often do you want to pay?</label>
    <input type="hidden" name="request[custom_fields][17269461053075]" id="request_custom_fields_17269461053075" autocomplete="off"
      data-tagger="[{&quot;label&quot;:&quot;-&quot;,&quot;value&quot;:&quot;&quot;},{&quot;label&quot;:&quot;Weekly&quot;,&quot;value&quot;:&quot;weekly&quot;},{&quot;label&quot;:&quot;Bi-weekly&quot;,&quot;value&quot;:&quot;bi-weekly&quot;},{&quot;label&quot;:&quot;Monthly&quot;,&quot;value&quot;:&quot;monthly&quot;}]"
      aria-required="true" aria-labelledby="request_custom_fields_17269461053075_label" value=""
      disabled=""><a class="nesty-input" tabindex="0" aria-haspopup="true" aria-expanded="false" aria-controls="_ogv9crk1p" aria-required="true" aria-labelledby="request_custom_fields_17269461053075_label" style="max-width: 100%;">-</a>
  </div>
  <div class="form-field decimal request_custom_fields_17269833660179 optional" hidden="">
    <label id="request_custom_fields_17269833660179_label" for="request_custom_fields_17269833660179">How much is each payment?</label>
    <input type="number" name="request[custom_fields][17269833660179]" id="request_custom_fields_17269833660179" step="any" aria-required="true" aria-labelledby="request_custom_fields_17269833660179_label" disabled="">
  </div>
  <div class="form-field string optional request_custom_fields_17269906273299" hidden="">
    <label id="request_custom_fields_17269906273299_label" for="request_custom_fields_17269906273299">When can you start?</label>
    <input type="text" class="datepicker" value="" disabled=""><input type="text" name="request[custom_fields][17269906273299]" id="request_custom_fields_17269906273299" data-datepicker="" data-format="YYYY-MM-DD" class="" aria-required="false"
      aria-labelledby="request_custom_fields_17269906273299_label" readonly="readonly" style="display: none;" disabled="">
  </div>
  <div class="form-field string request_custom_fields_17270221140371 optional" hidden="">
    <label id="request_custom_fields_17270221140371_label" for="request_custom_fields_17270221140371">Is your attorney for a bankruptcy case?</label>
    <input type="hidden" name="request[custom_fields][17270221140371]" id="request_custom_fields_17270221140371" autocomplete="off"
      data-tagger="[{&quot;label&quot;:&quot;-&quot;,&quot;value&quot;:&quot;&quot;},{&quot;label&quot;:&quot;Yes&quot;,&quot;value&quot;:&quot;bankruptcy_yes&quot;},{&quot;label&quot;:&quot;No&quot;,&quot;value&quot;:&quot;bankruptcy_no&quot;}]"
      aria-required="true" aria-labelledby="request_custom_fields_17270221140371_label" value=""
      disabled=""><a class="nesty-input" tabindex="0" aria-haspopup="true" aria-expanded="false" aria-controls="_zbbe6tp01" aria-required="true" aria-labelledby="request_custom_fields_17270221140371_label" style="max-width: 100%;">-</a>
  </div>
  <div class="form-field string request_custom_fields_17270788702227 optional" hidden="">
    <label id="request_custom_fields_17270788702227_label" for="request_custom_fields_17270788702227">Have you filed yet?</label>
    <input type="hidden" name="request[custom_fields][17270788702227]" id="request_custom_fields_17270788702227" autocomplete="off"
      data-tagger="[{&quot;label&quot;:&quot;-&quot;,&quot;value&quot;:&quot;&quot;},{&quot;label&quot;:&quot;Yes&quot;,&quot;value&quot;:&quot;yes_filed&quot;},{&quot;label&quot;:&quot;No&quot;,&quot;value&quot;:&quot;no_not_filed&quot;}]"
      aria-required="true" aria-labelledby="request_custom_fields_17270788702227_label" value=""
      disabled=""><a class="nesty-input" tabindex="0" aria-haspopup="true" aria-expanded="false" aria-controls="_8xsw2j23n" aria-required="true" aria-labelledby="request_custom_fields_17270788702227_label" style="max-width: 100%;">-</a>
  </div>
  <div class="form-field string optional request_custom_fields_17270413495699" hidden="">
    <label id="request_custom_fields_17270413495699_label" for="request_custom_fields_17270413495699">Firm Name</label>
    <input type="text" name="request[custom_fields][17270413495699]" id="request_custom_fields_17270413495699" aria-required="false" aria-describedby="request_custom_fields_17270413495699_hint"
      aria-labelledby="request_custom_fields_17270413495699_label" disabled="">
    <p id="request_custom_fields_17270413495699_hint">If you do not provide attorney or bankruptcy info in this form, we will pause collections for 30 days so you can provide it to us.</p>
  </div>
  <div class="form-field string request_custom_fields_17270356782611 optional" hidden="">
    <label id="request_custom_fields_17270356782611_label" for="request_custom_fields_17270356782611">Attorney Name</label>
    <input type="text" name="request[custom_fields][17270356782611]" id="request_custom_fields_17270356782611" aria-required="true" aria-describedby="request_custom_fields_17270356782611_hint"
      aria-labelledby="request_custom_fields_17270356782611_label" disabled="">
    <p id="request_custom_fields_17270356782611_hint">If you do not provide attorney or bankruptcy info in this form, we will pause collections for 30 days so you can provide it to us.</p>
  </div>
  <div class="form-field string optional request_custom_fields_17270438507923" hidden="">
    <label id="request_custom_fields_17270438507923_label" for="request_custom_fields_17270438507923">Attorney's Phone Number</label>
    <input type="number" name="request[custom_fields][17270438507923]" id="request_custom_fields_17270438507923" step="1" aria-required="false" aria-labelledby="request_custom_fields_17270438507923_label" disabled="">
  </div>
  <div class="form-field string optional request_custom_fields_17270440934803" hidden="">
    <label id="request_custom_fields_17270440934803_label" for="request_custom_fields_17270440934803">Attorney's Email Address</label>
    <input type="text" name="request[custom_fields][17270440934803]" id="request_custom_fields_17270440934803" aria-required="false" aria-labelledby="request_custom_fields_17270440934803_label" disabled="">
  </div>
  <div class="form-field string optional request_custom_fields_17414116326675" hidden="">
    <label id="request_custom_fields_17414116326675_label" for="request_custom_fields_17414116326675">Attorney's State</label>
    <input type="text" name="request[custom_fields][17414116326675]" id="request_custom_fields_17414116326675" aria-required="false" aria-labelledby="request_custom_fields_17414116326675_label" disabled="">
  </div>
  <div class="form-field string optional request_custom_fields_17270608677907" hidden="">
    <label id="request_custom_fields_17270608677907_label" for="request_custom_fields_17270608677907">Filing Date</label>
    <input type="text" class="datepicker" value="" disabled=""><input type="text" name="request[custom_fields][17270608677907]" id="request_custom_fields_17270608677907" data-datepicker="" data-format="YYYY-MM-DD" class="" aria-required="false"
      aria-describedby="request_custom_fields_17270608677907_hint" aria-labelledby="request_custom_fields_17270608677907_label" readonly="readonly" style="display: none;" disabled="">
    <p id="request_custom_fields_17270608677907_hint">If you do not provide attorney or bankruptcy information, we will pause collections for 30 days before resuming.</p>
  </div>
  <div class="form-field string optional request_custom_fields_17270625521683" hidden="">
    <label id="request_custom_fields_17270625521683_label" for="request_custom_fields_17270625521683">Case Number</label>
    <input type="text" name="request[custom_fields][17270625521683]" id="request_custom_fields_17270625521683" aria-required="false" aria-describedby="request_custom_fields_17270625521683_hint"
      aria-labelledby="request_custom_fields_17270625521683_label" disabled="">
    <p id="request_custom_fields_17270625521683_hint">If you do not provide attorney or bankruptcy information, we will pause collections for 30 days before resuming.</p>
  </div>
  <div class="form-field string request_custom_fields_17270660521491 optional" hidden="">
    <label id="request_custom_fields_17270660521491_label" for="request_custom_fields_17270660521491">Chapter Number</label>
    <input type="hidden" name="request[custom_fields][17270660521491]" id="request_custom_fields_17270660521491" autocomplete="off"
      data-tagger="[{&quot;label&quot;:&quot;-&quot;,&quot;value&quot;:&quot;&quot;},{&quot;label&quot;:&quot;Chapter 7&quot;,&quot;value&quot;:&quot;chapter_7&quot;},{&quot;label&quot;:&quot;Chapter 13&quot;,&quot;value&quot;:&quot;chapter_13&quot;}]"
      aria-required="true" aria-labelledby="request_custom_fields_17270660521491_label" value=""
      disabled=""><a class="nesty-input" tabindex="0" aria-haspopup="true" aria-expanded="false" aria-controls="_kpos9gb6w" aria-required="true" aria-labelledby="request_custom_fields_17270660521491_label" style="max-width: 100%;">-</a>
  </div>
  <div class="form-field string request_custom_fields_17416411985555 optional" hidden="">
    <label id="request_custom_fields_17416411985555_label" for="request_custom_fields_17416411985555">Consumer's full name</label>
    <input type="text" name="request[custom_fields][17416411985555]" id="request_custom_fields_17416411985555" aria-required="true" aria-labelledby="request_custom_fields_17416411985555_label" disabled="">
  </div>
  <div class="form-field string optional request_custom_fields_17416409409939" hidden="">
    <label id="request_custom_fields_17416409409939_label" for="request_custom_fields_17416409409939">When did active duty begin?</label>
    <input type="text" class="datepicker" value="" disabled=""><input type="text" name="request[custom_fields][17416409409939]" id="request_custom_fields_17416409409939" data-datepicker="" data-format="YYYY-MM-DD" class="" aria-required="false"
      aria-labelledby="request_custom_fields_17416409409939_label" readonly="readonly" style="display: none;" disabled="">
  </div>
  <div class="form-field string optional request_custom_fields_18467883884051" hidden="">
    <label id="request_custom_fields_18467883884051_label" for="request_custom_fields_18467883884051">Is the service member deployed?</label>
    <input type="hidden" name="request[custom_fields][18467883884051]" id="request_custom_fields_18467883884051" autocomplete="off"
      data-tagger="[{&quot;label&quot;:&quot;-&quot;,&quot;value&quot;:&quot;&quot;},{&quot;label&quot;:&quot;Yes&quot;,&quot;value&quot;:&quot;yes_deployed&quot;},{&quot;label&quot;:&quot;No&quot;,&quot;value&quot;:&quot;no_deployed&quot;}]"
      aria-required="false" aria-labelledby="request_custom_fields_18467883884051_label" value=""
      disabled=""><a class="nesty-input" tabindex="0" aria-haspopup="true" aria-expanded="false" aria-controls="_cha9iusfi" aria-required="false" aria-labelledby="request_custom_fields_18467883884051_label" style="max-width: 100%;">-</a>
  </div>
  <div class="form-field string optional request_custom_fields_18467902737555" hidden="">
    <label id="request_custom_fields_18467902737555_label" for="request_custom_fields_18467902737555">When is deployment scheduled to end?</label>
    <input type="text" class="datepicker" value="" disabled=""><input type="text" name="request[custom_fields][18467902737555]" id="request_custom_fields_18467902737555" data-datepicker="" data-format="YYYY-MM-DD" class="" aria-required="false"
      aria-labelledby="request_custom_fields_18467902737555_label" readonly="readonly" style="display: none;" disabled="">
  </div>
  <div class="form-field string  required  request_subject">
    <label id="request_subject_label" for="request_subject">Subject</label>
    <input type="text" name="request[subject]" id="request_subject" maxlength="150" size="150" aria-required="true" aria-describedby="request_subject_hint" aria-labelledby="request_subject_label">
    <p id="request_subject_hint">Please write a subject line for your request</p>
  </div>
  <div class="suggestion-list" data-hc-class="searchbox" data-hc-suggestion-list="true"></div>
  <div class="form-field text  required  request_description">
    <label id="request_description_label" for="request_description">Please provide as much information as possible</label>
    <textarea name="request[description]" id="request_description" aria-required="true" aria-describedby="request_description_hint" aria-labelledby="request_description_label" data-helper="wysiwyg" style="display: none;"></textarea>
    <div class="ck ck-reset ck-editor ck-rounded-corners" role="application" dir="ltr" lang="en-us" aria-labelledby="ck-editor__label_e1ea28df5db018dc87dbdcc836f6fe8fc request_description_label" data-test-id="zd-wysiwyg-editor"><label
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                      d="M5.4 1c1.69 0 3.1 1.336 3.1 3 0 .95-.46 1.794-1.17 2.342C8.317 6.842 9 7.842 9 9c0 1.664-1.41 3-3.1 3H2.5a.5.5 0 01-.5-.5v-10a.5.5 0 01.5-.5h2.9zM3 11h2.9C7.05 11 8 10.1 8 9s-.95-2-2.1-2H3v4zm2.4-9H3v4h2.4c1.15 0 2.1-.9 2.1-2s-.95-2-2.1-2z">
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                    <path fill="currentColor"
                      d="M1 1h10a1 1 0 011 1v8a1 1 0 01-1 1H1a1 1 0 01-1-1V2a1 1 0 011-1zm4.5 8a.5.5 0 010-1h4a.5.5 0 010 1h-4zM2.146 3.854a.5.5 0 11.708-.708L4.957 5.25a.999.999 0 01.005 1.395l-2.1 2.2a.5.5 0 11-.724-.69L4.243 5.95 2.146 3.854zM1 2v8h10V2H1z">
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                  </svg><span class="ck ck-button__label" id="ck-editor__aria-label_eb4f23e17de56380203d8bf149ce28f58">Insert code</span></button><span class="ck ck-toolbar__separator"></span>
                <div class="ck ck-dropdown ck-code-block-dropdown">
                  <div class="ck ck-splitbutton ck-dropdown__button"><button class="ck ck-button ck-off ck-splitbutton__action" type="button" tabindex="-1" aria-labelledby="ck-editor__aria-label_e8d029e99d465c9287e8b510e1886ed2a" aria-pressed="false"
                      data-cke-tooltip-text="Code block" data-cke-tooltip-position="s"><svg class="ck ck-icon ck-reset_all-excluded ck-icon_inherit-color ck-button__icon" viewBox="0 0 12 12">
                        <path fill="currentColor"
                          d="M11 0a1 1 0 011 1v10a1 1 0 01-1 1H1a1 1 0 01-1-1V1a1 1 0 011-1h10zM5.5 10a.5.5 0 010-1h4a.5.5 0 010 1h-4zM2.146 4.854a.5.5 0 11.708-.708l2.148 2.149a1 1 0 010 1.42l-2.15 2.14a.5.5 0 11-.705-.71l2.15-2.14-2.15-2.151zM11 3H1v8h10V3zm0-2H1v1h10V1z">
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                      </svg><span class="ck ck-button__label" id="ck-editor__aria-label_e8d029e99d465c9287e8b510e1886ed2a">Code block</span></button><button class="ck ck-button ck-off ck-splitbutton__arrow" type="button" tabindex="-1"
                      aria-labelledby="ck-editor__aria-label_ee9cfd5653023e4b107d6fdd7e00f6996" data-cke-tooltip-text="Code block" data-cke-tooltip-position="s" aria-haspopup="true" aria-expanded="false"><svg
                        class="ck ck-icon ck-reset_all-excluded ck-icon_inherit-color ck-button__icon" viewBox="0 0 10 10">
                        <path d="M.941 4.523a.75.75 0 1 1 1.06-1.06l3.006 3.005 3.005-3.005a.75.75 0 1 1 1.06 1.06l-3.549 3.55a.75.75 0 0 1-1.168-.136L.941 4.523z"></path>
                      </svg><span class="ck ck-button__label" id="ck-editor__aria-label_ee9cfd5653023e4b107d6fdd7e00f6996">Code block</span></button></div>
                  <div class="ck ck-reset ck-dropdown__panel ck-dropdown__panel_se"></div>
                </div><button class="ck ck-button ck-off" type="button" tabindex="-1" aria-labelledby="ck-editor__aria-label_e9af19b8a7b6294851eba5200328bf71c" aria-pressed="false" data-cke-tooltip-text="Insert/Edit link (Ctrl+K)"
                  data-cke-tooltip-position="s"><svg class="ck ck-icon ck-reset_all-excluded ck-icon_inherit-color ck-button__icon" viewBox="0 0 12 12">
                    <path fill="currentColor"
                      d="M3.328 5.176l.673.673-.701.715-.325-.326-1.397 1.396a1.975 1.975 0 000 2.792l.108.1c.776.67 1.95.637 2.685-.1l1.396-1.395-.345-.346.7-.715.706.706a.5.5 0 010 .708l-1.75 1.75A2.975 2.975 0 01.871 6.926l1.75-1.75a.5.5 0 01.707 0zm4.892-2.09a.5.5 0 01.689.702l-.059.07-2.525 2.474L3.857 8.85l-.069.059a.5.5 0 01-.702-.69l.057-.069 2.475-2.525L8.15 3.143l.07-.057zM11.134.87a2.975 2.975 0 010 4.207l-1.75 1.75a.5.5 0 01-.708 0l-.705-.705.715-.701.344.345 1.396-1.396a1.975 1.975 0 000-2.793l-.108-.1a1.975 1.975 0 00-2.684.1L6.238 2.974l.326.327-.715.7-.673-.673a.5.5 0 010-.707l1.75-1.75a2.975 2.975 0 014.208 0z">
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                  </svg><span class="ck ck-button__label" id="ck-editor__aria-label_e9af19b8a7b6294851eba5200328bf71c">Insert/Edit link</span></button><button class="ck ck-button ck-off" type="button" tabindex="-1"
                  aria-labelledby="ck-editor__aria-label_ec8446b44db2c2553f113daefad324dea" aria-pressed="false" data-cke-tooltip-text="Bulleted list" data-cke-tooltip-position="s"><svg
                    class="ck ck-icon ck-reset_all-excluded ck-icon_inherit-color ck-button__icon" viewBox="0 0 12 12">
                    <path fill="none" stroke="currentColor" stroke-linecap="round" d="M5 2.5h5.5M5 6.5h5.5m-5.5 4h5.5"></path>
                    <g fill="currentColor">
                      <circle cx="2" cy="2.5" r="1"></circle>
                      <circle cx="2" cy="6.5" r="1"></circle>
                      <circle cx="2" cy="10.5" r="1"></circle>
                    </g>
                  </svg><span class="ck ck-button__label" id="ck-editor__aria-label_ec8446b44db2c2553f113daefad324dea">Bulleted list</span></button><button class="ck ck-button ck-off" type="button" tabindex="-1"
                  aria-labelledby="ck-editor__aria-label_e4e40301ec332d226717d59804b8b0c03" aria-pressed="false" data-cke-tooltip-text="Numbered list" data-cke-tooltip-position="s"><svg
                    class="ck ck-icon ck-reset_all-excluded ck-icon_inherit-color ck-button__icon" viewBox="0 0 12 12">
                    <path fill="currentColor"
                      d="M4.5 3a.5.5 0 010-1h6a.5.5 0 110 1h-6zm0 4a.5.5 0 010-1h6a.5.5 0 110 1h-6zm0 4a.5.5 0 110-1h6a.5.5 0 110 1h-6zM1.49 3.22c-.13 0-.21-.08-.21-.22v-.09c0-.13.08-.21.21-.21h.28V1.57l-.05.05c-.05.05-.1.07-.15.07-.04 0-.1-.01-.15-.08l-.07-.06a.242.242 0 01-.06-.15c0-.04.01-.09.07-.15l.41-.39c.07-.07.14-.1.22-.1h.14c.13 0 .21.08.21.22V2.7h.28c.13 0 .22.08.22.21V3c0 .13-.08.22-.22.22H1.49zm-.12 4.02c-.14 0-.23-.09-.23-.22 0-.58.38-.85.69-1.06.21-.15.39-.27.39-.42 0-.18-.14-.24-.27-.24-.15 0-.24.1-.28.14-.05.06-.11.09-.17.09a.21.21 0 01-.13-.05l-.08-.07c-.1-.08-.12-.19-.05-.29.13-.17.36-.38.75-.38.49 0 .83.31.83.76 0 .46-.37.71-.66.9-.17.11-.31.21-.37.32h.84c.13 0 .22.08.22.21v.09c0 .14-.08.22-.22.22H1.37zm.59 4c-.32 0-.56-.13-.71-.24-.1-.08-.12-.19-.04-.3l.06-.1c.05-.08.12-.1.16-.1.04 0 .09.01.13.04.08.06.21.13.37.13.19 0 .33-.11.33-.26 0-.25-.31-.28-.41-.28-.15 0-.22-.04-.27-.14a.239.239 0 01.03-.29s.37-.44.38-.45h-.56c-.13 0-.21-.08-.21-.21v-.08c0-.13.08-.22.21-.22h1.13c.13 0 .22.08.22.21s-.03.19-.08.26l-.41.48c.3.09.56.33.56.72-.01.41-.31.83-.89.83z">
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        <div class="ck-blurred ck ck-content ck-editor__editable ck-rounded-corners ck-editor__editable_inline" lang="en-us" dir="ltr" role="textbox" aria-describedby="request_description_hint" aria-label="Editor editing area: main"
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    </div>
    <div></div><input type="hidden" name="request[description_mimetype]" id="request_description_mimetype" value="text/html" style="display: none;" autocomplete="off">
    <p id="request_description_hint">Please enter the details of your request. A member of our support staff will respond as soon as possible.</p>
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 1. TrueAccord
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If you do not provide attorney or bankruptcy info in this form, we will pause
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