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Submitted URL: http://gslink.emburse.com/ls/click?upn=-2Fe36n0VvIWzRjhv5RzmmkxTa04UM38-2BkNq-2FPjeN6h-2BOVXjrDzg899JWxI6hVj0cAZscUDoreMuX...
Effective URL: https://app.smartsheet.com/b/form/a92258d127d94ac6a0e5bd6ee111c55d
Submission: On May 30 via api from US — Scanned from DE
Effective URL: https://app.smartsheet.com/b/form/a92258d127d94ac6a0e5bd6ee111c55d
Submission: On May 30 via api from US — Scanned from DE
Form analysis 1 forms found in the DOM
<form>
<div class="css-1o5h39n e1tmc1mx0">
<div role="application" title="" data-client-id="container_What is the general category of your inquiry?" data-client-type="dropdown" id="oykjbRJXe" class="css-u3yn36 ef83ajd0"><label
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inquiry?<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div class="css-t8xanh-container">
<div class="css-kf2egt-control react-select__control">
<div class="css-11ksah1 react-select__value-container">
<div class="css-1i5h0xy-placeholder react-select__placeholder">Select</div>
<div class="css-1g6gooi">
<div class="react-select__input" style="display: inline-block;"><input autocapitalize="none" autocomplete="off" autocorrect="off" id="select_input_What is the general category of your inquiry?" spellcheck="false" tabindex="0"
type="text" aria-label="Select" aria-labelledby="eae9115f-cb1b-485a-be07-c7a264b9dbb8" value=""
style="box-sizing: content-box; width: 2px; background: 0px center; border: 0px; font-size: inherit; opacity: 1; outline: 0px; padding: 0px; color: inherit;">
<div
style="position: absolute; top: 0px; left: 0px; visibility: hidden; height: 0px; overflow: scroll; white-space: pre; font-size: 13px; font-family: Arial; font-weight: 400; font-style: normal; letter-spacing: normal; text-transform: none;">
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<div class="css-1wy0on6 react-select__indicators"><span class="css-9lpq22-indicatorSeparator react-select__indicator-separator"></span><span style="margin-right: 6px;"><svg data-client-id="caret_icon" width="16px" height="16px"
viewBox="0 0 16 16" version="1.1" role="img" xmlns="http://www.w3.org/2000/svg">
<title>Caret Icon</title>
<desc>Caret symbol</desc>
<g stroke="none" stroke-width="1" fill="none" fill-rule="evenodd">
<g fill="#161616">
<path
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<div class="css-tkslta e1tmc1mx0">
<div data-client-id="container_Ticket Number from Your Previous Inquiry" data-client-type="text" id="31zeWEOjg" class="css-1e3khfm ef83ajd0"><label for="text_box_Ticket Number from Your Previous Inquiry"
data-client-id="label_Ticket Number from Your Previous Inquiry" class="css-1xl1v40 ekxsfat0">Ticket Number from Your Previous Inquiry</label>
<div id="description_Ticket_Number_from_Your_Previous_Inquiry" class="rich-text-field-desc">
<p>This number will begin with CI followed by 6 digits. Example CI-0000001. If your number does not include CI, please choose another general category.</p>
</div>
<div style="display: flex;"><input title="" aria-invalid="false" aria-describedby="description_Ticket_Number_from_Your_Previous_Inquiry" tabindex="-1" id="text_box_Ticket Number from Your Previous Inquiry"
data-client-id="text_box_Ticket Number from Your Previous Inquiry" data-client-type="" name="31zeWEOjg" maxlength="4000" class="css-1p0590h e1407lhe0" value=""></div>
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</div>
<div class="css-tkslta e1tmc1mx0">
<div role="application" title="" data-client-id="container_What Product Suite are You Inquiring About?" data-client-type="dropdown" id="1zWOmgLzJ" class="css-u3yn36 ef83ajd0"><label for="select_input_What Product Suite are You Inquiring About?"
id="29320619-c210-415b-86f8-92e74bcc19c7" data-client-id="label_What Product Suite are You Inquiring About?" class="css-1xl1v40 ekxsfat0">What Product Suite are You Inquiring About?<span data-client-id="required_indicator"
class="css-skcghl ekxsfat1">*</span></label>
<div class="rich-text-field-desc css-1q4upac" id="description_select_input_What_Product_Suite_are_You_Inquiring_About_">
<p>Example: Chrome River or Certify</p>
</div>
<div class="css-t8xanh-container">
<div class="css-kf2egt-control react-select__control">
<div class="css-11ksah1 react-select__value-container react-select__value-container--is-multi">
<div class="css-1i5h0xy-placeholder react-select__placeholder">Select or enter value</div>
<div class="css-1g6gooi">
<div class="react-select__input" style="display: inline-block;"><input autocapitalize="none" autocomplete="off" autocorrect="off" id="select_input_What Product Suite are You Inquiring About?" spellcheck="false" tabindex="-1" type="text"
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style="box-sizing: content-box; width: 2px; background: 0px center; border: 0px; font-size: inherit; opacity: 1; outline: 0px; padding: 0px; color: inherit;">
<div
style="position: absolute; top: 0px; left: 0px; visibility: hidden; height: 0px; overflow: scroll; white-space: pre; font-size: 13px; font-family: Arial; font-weight: 400; font-style: normal; letter-spacing: normal; text-transform: none;">
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</div>
<div class="css-1wy0on6 react-select__indicators"><span class="css-9lpq22-indicatorSeparator react-select__indicator-separator"></span><span style="margin-right: 6px;"><svg data-client-id="caret_icon" width="16px" height="16px"
viewBox="0 0 16 16" version="1.1" role="img" xmlns="http://www.w3.org/2000/svg">
<title>Caret Icon</title>
<desc>Caret symbol</desc>
<g stroke="none" stroke-width="1" fill="none" fill-rule="evenodd">
<g fill="#161616">
<path
d="M8.38951287,9.81740951 C8.3743818,9.83527284 8.35811596,9.85207547 8.34082332,9.86770589 C8.12569934,10.0621513 7.79871352,10.0396329 7.61048004,9.81740951 L5.12806062,6.88673235 C5.04550447,6.78926879 5,6.66416424 5,6.53465776 C5,6.23937443 5.23172713,6 5.51757703,6 L10.4824159,6 C10.607785,6 10.7288928,6.04700617 10.8232427,6.13228679 C11.0383667,6.32673222 11.0601658,6.664509 10.8719323,6.88673235 L8.38951287,9.81740951 Z">
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</div>
</div>
</div>
</div>
<div class="css-tkslta e1tmc1mx0">
<div data-client-id="container_What is the time period for which you are seeking an invoice copy??" data-client-type="text" id="q8zbOegjj" class="css-1e3khfm ef83ajd0"><label
for="text_box_What is the time period for which you are seeking an invoice copy??" data-client-id="label_What is the time period for which you are seeking an invoice copy??" class="css-1xl1v40 ekxsfat0">What is the time period for which you
are seeking an invoice copy??</label>
<div id="description_What_is_the_time_period_for_which_you_are_seeking_an_invoice_copy__" class="rich-text-field-desc">
<p>Example: Are you looking for a March invoice?</p>
</div>
<div style="display: flex;"><input title="" aria-invalid="false" aria-describedby="description_What_is_the_time_period_for_which_you_are_seeking_an_invoice_copy__" tabindex="-1"
id="text_box_What is the time period for which you are seeking an invoice copy??" data-client-id="text_box_What is the time period for which you are seeking an invoice copy??" data-client-type="" name="q8zbOegjj" maxlength="4000"
class="css-1p0590h e1407lhe0" value=""></div>
</div>
</div>
<div class="css-tkslta e1tmc1mx0">
<div data-client-id="container_Invoice Number" data-client-type="text" id="6wzqNPqR0" class="css-1e3khfm ef83ajd0"><label for="text_box_Invoice Number" data-client-id="label_Invoice Number" class="css-1xl1v40 ekxsfat0">Invoice Number</label>
<div style="display: flex;"><input title="" aria-invalid="false" tabindex="-1" id="text_box_Invoice Number" data-client-id="text_box_Invoice Number" data-client-type="" name="6wzqNPqR0" maxlength="4000" class="css-1p0590h e1407lhe0" value="">
</div>
</div>
</div>
<div class="css-tkslta e1tmc1mx0">
<div data-client-id="container_Please describe your reason for contacting us today." data-client-type="text" id="9yXJK53p3" class="css-1e3khfm ef83ajd0"><label for="textarea_Please describe your reason for contacting us today."
data-client-id="label_Please describe your reason for contacting us today." class="css-1xl1v40 ekxsfat0">Please describe your reason for contacting us today.<span data-client-id="required_indicator"
class="css-skcghl ekxsfat1">*</span></label><textarea aria-invalid="false" tabindex="-1" name="9yXJK53p3" id="textarea_Please describe your reason for contacting us today."
data-client-id="textarea_Please describe your reason for contacting us today." maxlength="4000" rows="30" class="css-1lh64kx e1407lhe1"></textarea></div>
</div>
<div class="css-tkslta e1tmc1mx0">
<div data-client-id="container_Company Name" data-client-type="text" id="ROprL0r2N" class="css-1e3khfm ef83ajd0"><label for="text_box_Company Name" data-client-id="label_Company Name" class="css-1xl1v40 ekxsfat0">Company Name<span
data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div style="display: flex;"><input title="" aria-invalid="false" tabindex="-1" id="text_box_Company Name" data-client-id="text_box_Company Name" data-client-type="" name="ROprL0r2N" maxlength="4000" class="css-1p0590h e1407lhe0" value=""></div>
</div>
</div>
<div class="css-tkslta e1tmc1mx0">
<div data-client-id="container_Account Number" data-client-type="text" id="q8zbOgbql" class="css-1e3khfm ef83ajd0"><label for="text_box_Account Number" data-client-id="label_Account Number" class="css-1xl1v40 ekxsfat0">Account Number</label>
<div style="display: flex;"><input title="" aria-invalid="false" tabindex="-1" id="text_box_Account Number" data-client-id="text_box_Account Number" data-client-type="" name="q8zbOgbql" maxlength="4000" class="css-1p0590h e1407lhe0" value="">
</div>
</div>
</div>
<div class="css-tkslta e1tmc1mx0">
<div data-client-id="container_Contact Name for Follow-Up" data-client-type="text" id="GYwrLvr22" class="css-1e3khfm ef83ajd0"><label for="text_box_Contact Name for Follow-Up" data-client-id="label_Contact Name for Follow-Up"
class="css-1xl1v40 ekxsfat0">Contact Name for Follow-Up<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div style="display: flex;"><input title="" aria-invalid="false" tabindex="-1" id="text_box_Contact Name for Follow-Up" data-client-id="text_box_Contact Name for Follow-Up" data-client-type="" name="GYwrLvr22" maxlength="4000"
class="css-1p0590h e1407lhe0" value=""></div>
</div>
</div>
<div class="css-tkslta e1tmc1mx0">
<div data-client-id="container_Contact Phone Number" data-client-type="text" id="6wzqNoYz3" class="css-1e3khfm ef83ajd0"><label for="text_box_Contact Phone Number" data-client-id="label_Contact Phone Number" class="css-1xl1v40 ekxsfat0">Contact
Phone Number</label>
<div style="display: flex;"><input title="" aria-invalid="false" tabindex="-1" id="text_box_Contact Phone Number" data-client-id="text_box_Contact Phone Number" data-client-type="" name="6wzqNoYz3" maxlength="4000" class="css-1p0590h e1407lhe0"
value=""></div>
</div>
</div>
<div class="css-tkslta e1tmc1mx0">
<div data-client-id="container_Contact Email" data-client-type="text" id="31zebKYzW" class="css-1e3khfm ef83ajd0"><label for="text_box_Contact Email" data-client-id="label_Contact Email" class="css-1xl1v40 ekxsfat0">Contact Email<span
data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div style="display: flex;"><input title="" aria-invalid="false" tabindex="-1" id="text_box_Contact Email" data-client-id="text_box_Contact Email" data-client-type="" name="31zebKYzW" maxlength="4000" class="css-1p0590h e1407lhe0" value="">
</div>
</div>
</div>
<div class="css-tkslta e1tmc1mx0">
<div data-client-id="container_Today's Date" data-client-type="date" id="vOy1pRa9D" class="css-gbq6lm ef83ajd0"><label for="date_Today's Date" data-client-id="label_Today's Date" class="css-1xl1v40 ekxsfat0">Today's Date<span
data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div class="css-1f92r3b"><input data-client-id="date_Today's Date" id="date_Today's Date" aria-label="Today's Date" tabindex="-1" name="Today's Date" maxlength="100" class="css-1dpiipj epidubd0" value=""><button tabindex="-1" type="button"
aria-label="Choose" class="css-17q24xo"><span title="Choose a date" class="css-14atay6 e1yrjtds0"><svg xmlns="http://www.w3.org/2000/svg" role="img" width="16" height="16" viewBox="0 0 16 16">
<title>Calendar Icon</title>
<desc>Calendar</desc>
<g fill="none" fill-rule="evenodd">
<rect width="13" height="13" x="2" y="2" fill="#005EE0" rx="1"></rect>
<path fill="#FFF"
d="M11.648 12h-.96V8.38c-.351.328-.765.571-1.241.728v-.871c.25-.082.523-.238.817-.467.294-.229.495-.496.605-.801h.779V12zm-6.385-1.33l.93-.112c.03.237.11.418.24.543.129.125.286.188.47.188a.648.648 0 0 0 .502-.226c.135-.15.203-.353.203-.608 0-.241-.065-.433-.195-.574a.621.621 0 0 0-.475-.212c-.123 0-.27.024-.44.072l.105-.783c.26.007.458-.05.595-.17a.602.602 0 0 0 .205-.476.545.545 0 0 0-.15-.403.54.54 0 0 0-.4-.15.579.579 0 0 0-.42.17c-.117.114-.188.28-.213.5l-.885-.151c.061-.303.154-.545.279-.726.124-.182.297-.324.52-.428.221-.103.47-.155.746-.155.472 0 .85.15 1.135.45.234.247.352.525.352.835 0 .44-.24.79-.721 1.053.287.061.516.199.688.413a1.2 1.2 0 0 1 .258.776c0 .44-.16.815-.482 1.125-.32.31-.72.464-1.2.464-.453 0-.829-.13-1.127-.39a1.538 1.538 0 0 1-.52-1.025zM11 5a1 1 0 1 1 0-2 1 1 0 0 1 0 2zM6 5a1 1 0 1 1 0-2 1 1 0 0 1 0 2z">
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</g>
</svg></span></button></div>
</div>
</div>
<div class="css-tkslta e1tmc1mx0">
<fieldset data-client-id="container_Have you contacted us about this issue before?" data-client-type="radio" data-client-align="vertical" id="Ol1r0GO8k" class="css-110bzo0 etth7i50">
<legend data-client-id="label_Have you contacted us about this issue before?" class="css-1yfbzum etth7i52">Have you contacted us about this issue before?<span data-client-id="required_indicator" class="css-mfmuai etth7i53">*</span></legend>
<div class="css-ml5vzx etth7i51">
<div class="css-1la7ftu etth7i55"><label class="css-1fg467d etth7i56"><input aria-label="Yes" tabindex="-1" data-client-value="Yes" data-client-id="radio_Have you contacted us about this issue before?" type="radio" title="Yes"
name="Ol1r0GO8k" class="css-10i6ipn etth7i57"><span class="css-1pu7ejh etth7i58">Yes</span></label></div>
<div class="css-1la7ftu etth7i55"><label class="css-1fg467d etth7i56"><input aria-label="No" tabindex="-1" data-client-value="No" data-client-id="radio_Have you contacted us about this issue before?" type="radio" title="No" name="Ol1r0GO8k"
class="css-10i6ipn etth7i57"><span class="css-1pu7ejh etth7i58">No</span></label></div>
</div>
</fieldset>
</div>
<div class="css-tkslta e1tmc1mx0">
<div data-client-id="container_Number of Times Contacted" data-client-type="text" id="q8zbOqypP" class="css-1e3khfm ef83ajd0"><label for="text_box_Number of Times Contacted" data-client-id="label_Number of Times Contacted"
class="css-1xl1v40 ekxsfat0">Number of Times Contacted</label>
<div style="display: flex;"><input title="" aria-invalid="false" tabindex="-1" id="text_box_Number of Times Contacted" data-client-id="text_box_Number of Times Contacted" data-client-type="" name="q8zbOqypP" maxlength="4000"
class="css-1p0590h e1407lhe0" value=""></div>
</div>
</div>
<div class="css-tkslta e1tmc1mx0">
<div data-client-id="container_File Upload" data-client-type="file_upload" id="ATTACHMENT" class="css-1ylo82b ef83ajd0"><label for="file_upload_File Upload" data-client-id="label_File Upload" class="css-1xl1v40 ekxsfat0">File Upload</label>
<div class="rich-text-field-desc css-i0kenq" id="description_file_upload_File_Upload">
<p>If you have a file you wish us to look at, please feel free to include it here.</p>
</div>
<div class="css-vqlje4" tabindex="-1" data-client-id="file_upload_dropzone" aria-describedby="description_file_upload_File_Upload" aria-disabled="false" style="position: relative;">
<div class="css-hvudvc eo18oon8"><span class="css-1btvv3a eo18oon1"><span>Drag and drop files here or </span> <button tabindex="-1" type="button" class="css-uro7iq eo18oon0"><span>browse files</span></button></span></div><input
id="file_upload_File Upload" tabindex="-1" type="file" multiple="" autocomplete="off" style="position: absolute; inset: 0px; opacity: 1e-05; pointer-events: none;">
</div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div data-client-id="email_receipt_section">
<div data-client-id="container_email_receipt" data-client-type="divider" class="css-1e2fy0l e14sboee0">
<hr data-client-id="email_receipt" class="css-1xs1ymt e14sboee2">
</div>
<div class="css-1gl0c9l excyp8g0"><label class="css-1y93uaa excyp8g1"><input data-client-id="email_receipt_checkbox" name="EMAIL_RECEIPT_CHECKBOX" type="checkbox" class="css-1czgm8r excyp8g2" value="false"><span>Send me a copy of my
responses</span></label></div>
</div>
</div>
<div class="css-1ock8o4 e1xpzprc2"><button data-client-id="form_submit_btn" disabled="" type="submit" value="submit" class="css-oltpmt e1xpzprc0"><span>Submit</span></button></div>
<div data-client-id="footer" class="css-ybae4b e8i4qwl0">
<div class="css-1kw6mnl e8i4qwl1"><a target="_blank" href="https://www.smartsheet.com/legal/privacy" rel="noopener noreferrer" data-client-id="footer_privacy" class="css-a7ff3e e8i4qwl2"><span>Privacy Notice</span></a><span
style="margin: 0px 5px;">|</span><a target="_blank" href="https://app.smartsheet.com/b/reportabuse?EQBCT=a92258d127d94ac6a0e5bd6ee111c55d" rel="noopener noreferrer" data-client-id="footer_reportAbuse" class="css-a7ff3e e8i4qwl2"><span>Report Abuse</span></a>
</div>
</div>
</form>Text Content
Intake Form Please submit your inquiry below. Thank you for doing business with Emburse. What is the general category of your inquiry?* Select Caret IconCaret symbol Ticket Number from Your Previous Inquiry This number will begin with CI followed by 6 digits. Example CI-0000001. If your number does not include CI, please choose another general category. What Product Suite are You Inquiring About?* Example: Chrome River or Certify Select or enter value Caret IconCaret symbol What is the time period for which you are seeking an invoice copy?? Example: Are you looking for a March invoice? Invoice Number Please describe your reason for contacting us today.* Company Name* Account Number Contact Name for Follow-Up* Contact Phone Number Contact Email* Today's Date* Calendar IconCalendar Have you contacted us about this issue before?* Yes No Number of Times Contacted File Upload If you have a file you wish us to look at, please feel free to include it here. Drag and drop files here or browse files -------------------------------------------------------------------------------- Send me a copy of my responses Submit Privacy Notice|Report Abuse