{"id":19,"date":"2016-03-28T06:33:30","date_gmt":"2016-03-28T10:33:30","guid":{"rendered":"https:\/\/www.piconsulting.us\/?page_id=19"},"modified":"2022-09-19T06:16:58","modified_gmt":"2022-09-19T10:16:58","slug":"contact","status":"publish","type":"page","link":"https:\/\/www.piconsulting.us\/?page_id=19","title":{"rendered":"Service Request"},"content":{"rendered":"\n<h4 class=\"has-white-color has-text-color wp-block-heading\">Please complete this form to submit a service request.<\/h4>\n\n\n\n<p class=\"has-white-color has-text-color\">To send attachments, please email: service@piconsulting.us<\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n<div class=\"wpforms-container wpforms-container-full wpforms-block\" id=\"wpforms-431\"><form id=\"wpforms-form-431\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"431\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F19\" data-token=\"096308b145b9f14a66341856d158a2b2\"><div class=\"wpforms-head-container\"><div class=\"wpforms-title\">Service Request<\/div><\/div><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-page-indicator progress\" data-indicator=\"progress\" data-indicator-color=\"#72b239\" data-scroll=\"1\"><span class=\"wpforms-page-indicator-page-title\" ><\/span><span class=\"wpforms-page-indicator-page-title-sep\" style=\"display:none;\"> &#8211; <\/span><span class=\"wpforms-page-indicator-steps\">Step <span class=\"wpforms-page-indicator-steps-current\">1<\/span> of 4<\/span><div class=\"wpforms-page-indicator-page-progress-wrap\"><div class=\"wpforms-page-indicator-page-progress\" style=\"width:25%;background-color:#72b239\"><\/div><\/div><\/div><div class=\"wpforms-field-container\"><div class=\"wpforms-page wpforms-page-1 \" data-page=\"1\"><div id=\"wpforms-431-field_9-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"9\"><\/div><div id=\"wpforms-431-field_33-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"33\"><h3 id=\"wpforms-431-field_33\" name=\"wpforms[fields][33]\">Your information.<\/h3><\/div><div id=\"wpforms-431-field_2-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-431-field_2\">Client Company Name<\/label><input type=\"text\" id=\"wpforms-431-field_2\" class=\"wpforms-field-medium\" name=\"wpforms[fields][2]\" placeholder=\"Company Name\" ><div class=\"wpforms-field-description\">Your business name, Firms name or Insurance company name<\/div><\/div><div id=\"wpforms-431-field_1-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-431-field_1\">Requester Name <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-431-field_1\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][1][first]\" placeholder=\"John\/Jane\" required><label for=\"wpforms-431-field_1\" class=\"wpforms-field-sublabel after \">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-431-field_1-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][1][last]\" placeholder=\"Doe\" required><label for=\"wpforms-431-field_1-last\" class=\"wpforms-field-sublabel after \">Last<\/label><\/div><\/div><div class=\"wpforms-field-description\">Your first and last name<\/div><\/div><div id=\"wpforms-431-field_3-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-431-field_3\">Address <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-431-field_3\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][3][address1]\" placeholder=\"1234 Main St.\" required><label for=\"wpforms-431-field_3\" class=\"wpforms-field-sublabel after \">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-431-field_3-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][3][address2]\" placeholder=\"Address Continued\" ><label for=\"wpforms-431-field_3-address2\" class=\"wpforms-field-sublabel after \">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-431-field_3-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][3][city]\" placeholder=\"Your City\" required><label for=\"wpforms-431-field_3-city\" class=\"wpforms-field-sublabel after \">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-431-field_3-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][3][state]\" placeholder=\"Your State\" required><option class=\"placeholder\" value=\"\" selected disabled>Your State<\/option><option value=\"AL\" >Alabama<\/option><option value=\"AK\" >Alaska<\/option><option value=\"AZ\" >Arizona<\/option><option value=\"AR\" >Arkansas<\/option><option value=\"CA\" >California<\/option><option value=\"CO\" >Colorado<\/option><option value=\"CT\" >Connecticut<\/option><option value=\"DE\" >Delaware<\/option><option value=\"DC\" >District of Columbia<\/option><option value=\"FL\" >Florida<\/option><option value=\"GA\" >Georgia<\/option><option value=\"HI\" >Hawaii<\/option><option value=\"ID\" >Idaho<\/option><option value=\"IL\" >Illinois<\/option><option value=\"IN\" >Indiana<\/option><option value=\"IA\" >Iowa<\/option><option value=\"KS\" >Kansas<\/option><option value=\"KY\" >Kentucky<\/option><option value=\"LA\" >Louisiana<\/option><option value=\"ME\" >Maine<\/option><option value=\"MD\" >Maryland<\/option><option value=\"MA\" >Massachusetts<\/option><option value=\"MI\" >Michigan<\/option><option value=\"MN\" >Minnesota<\/option><option value=\"MS\" >Mississippi<\/option><option value=\"MO\" >Missouri<\/option><option value=\"MT\" >Montana<\/option><option value=\"NE\" >Nebraska<\/option><option value=\"NV\" >Nevada<\/option><option value=\"NH\" >New Hampshire<\/option><option value=\"NJ\" >New Jersey<\/option><option value=\"NM\" >New Mexico<\/option><option value=\"NY\" >New York<\/option><option value=\"NC\" >North Carolina<\/option><option value=\"ND\" >North Dakota<\/option><option value=\"OH\" >Ohio<\/option><option value=\"OK\" >Oklahoma<\/option><option value=\"OR\" >Oregon<\/option><option value=\"PA\" >Pennsylvania<\/option><option value=\"RI\" >Rhode Island<\/option><option value=\"SC\" >South Carolina<\/option><option value=\"SD\" >South Dakota<\/option><option value=\"TN\" >Tennessee<\/option><option value=\"TX\" >Texas<\/option><option value=\"UT\" >Utah<\/option><option value=\"VT\" >Vermont<\/option><option value=\"VA\" >Virginia<\/option><option value=\"WA\" >Washington<\/option><option value=\"WV\" >West Virginia<\/option><option value=\"WI\" >Wisconsin<\/option><option value=\"WY\" >Wyoming<\/option><\/select><label for=\"wpforms-431-field_3-state\" class=\"wpforms-field-sublabel after \">State<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-431-field_3-postal\" class=\"wpforms-field-address-postal wpforms-field-required wpforms-masked-input\" data-inputmask-mask=\"(99999)|(99999-9999)\" data-inputmask-keepstatic=\"true\" data-rule-inputmask-incomplete=\"1\" name=\"wpforms[fields][3][postal]\" placeholder=\"12345\" required><label for=\"wpforms-431-field_3-postal\" class=\"wpforms-field-sublabel after \">Zip Code<\/label><\/div><\/div><div class=\"wpforms-field-description\">Your address, business address, firms address or insurance company address<\/div><\/div><div id=\"wpforms-431-field_4-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-431-field_4\">Fax Number<\/label><input type=\"tel\" id=\"wpforms-431-field_4\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][4]\" placeholder=\"123-456-7890\" ><\/div><div id=\"wpforms-431-field_5-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-431-field_5\">Phone <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-431-field_5\" class=\"wpforms-field-medium wpforms-field-required wpforms-masked-input\" data-inputmask=\"&#039;mask&#039;: &#039;(999) 999-9999&#039;\" data-rule-us-phone-field=\"true\" data-inputmask-inputmode=\"tel\" name=\"wpforms[fields][5]\" placeholder=\"123-456-7890\" required><\/div><div id=\"wpforms-431-field_6-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-431-field_6\">Email <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"email\" id=\"wpforms-431-field_6\" class=\"wpforms-field-required wpforms-field-email-primary\" name=\"wpforms[fields][6][primary]\" placeholder=\"abc@xyz.com\" spellcheck=\"false\" required><label for=\"wpforms-431-field_6\" class=\"wpforms-field-sublabel after \">Email<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"email\" id=\"wpforms-431-field_6-secondary\" class=\"wpforms-field-email-secondary wpforms-field-required\" data-rule-confirm=\"#wpforms-431-field_6\" name=\"wpforms[fields][6][secondary]\" placeholder=\"abc@xyz.com\" spellcheck=\"false\" required><label for=\"wpforms-431-field_6-secondary\" class=\"wpforms-field-sublabel after \">Confirm Email<\/label><\/div><\/div><\/div><div id=\"wpforms-431-field_8-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"8\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"1\" data-formid=\"431\" disabled>Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-2  \" data-page=\"2\" style=\"display:none;\"><div id=\"wpforms-431-field_32-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"32\"><h3 id=\"wpforms-431-field_32\" name=\"wpforms[fields][32]\">Subject information entry.<\/h3><\/div><div id=\"wpforms-431-field_7-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-431-field_7\">Subjects Name <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-two-fifths\"><input type=\"text\" id=\"wpforms-431-field_7\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][7][first]\" placeholder=\"John\/Jane\" required><label for=\"wpforms-431-field_7\" class=\"wpforms-field-sublabel after \">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-fifth\"><input type=\"text\" id=\"wpforms-431-field_7-middle\" class=\"wpforms-field-name-middle\" name=\"wpforms[fields][7][middle]\" placeholder=\"M\" ><label for=\"wpforms-431-field_7-middle\" class=\"wpforms-field-sublabel after \">Middle<\/label><\/div><div class=\"wpforms-field-row-block wpforms-two-fifths\"><input type=\"text\" id=\"wpforms-431-field_7-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][7][last]\" placeholder=\"Doe\" required><label for=\"wpforms-431-field_7-last\" class=\"wpforms-field-sublabel after \">Last<\/label><\/div><\/div><div class=\"wpforms-field-description\">First, middle and last name for the subject your are requesting services on.  If middle name is not known then enter UNK for unknown or NMN for No Middle Name.<\/div><\/div><div id=\"wpforms-431-field_11-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-431-field_11\">Last known subject address<\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-431-field_11\" class=\"wpforms-field-address-address1\" name=\"wpforms[fields][11][address1]\" placeholder=\"Subjects Address\" ><label for=\"wpforms-431-field_11\" class=\"wpforms-field-sublabel after \">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-431-field_11-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][11][address2]\" placeholder=\"Address Continued\" ><label for=\"wpforms-431-field_11-address2\" class=\"wpforms-field-sublabel after \">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-431-field_11-city\" class=\"wpforms-field-address-city\" name=\"wpforms[fields][11][city]\" placeholder=\"Subjects City\" ><label for=\"wpforms-431-field_11-city\" class=\"wpforms-field-sublabel after \">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-431-field_11-state\" class=\"wpforms-field-address-state\" name=\"wpforms[fields][11][state]\" placeholder=\"Subjects State\" ><option class=\"placeholder\" value=\"\" selected disabled>Subjects State<\/option><option value=\"AL\" >Alabama<\/option><option value=\"AK\" >Alaska<\/option><option value=\"AZ\" >Arizona<\/option><option value=\"AR\" >Arkansas<\/option><option value=\"CA\" >California<\/option><option value=\"CO\" >Colorado<\/option><option value=\"CT\" >Connecticut<\/option><option value=\"DE\" >Delaware<\/option><option value=\"DC\" >District of Columbia<\/option><option value=\"FL\" >Florida<\/option><option value=\"GA\" >Georgia<\/option><option value=\"HI\" >Hawaii<\/option><option value=\"ID\" >Idaho<\/option><option value=\"IL\" >Illinois<\/option><option value=\"IN\" >Indiana<\/option><option value=\"IA\" >Iowa<\/option><option value=\"KS\" >Kansas<\/option><option value=\"KY\" >Kentucky<\/option><option value=\"LA\" >Louisiana<\/option><option value=\"ME\" >Maine<\/option><option value=\"MD\" >Maryland<\/option><option value=\"MA\" >Massachusetts<\/option><option value=\"MI\" >Michigan<\/option><option value=\"MN\" >Minnesota<\/option><option value=\"MS\" >Mississippi<\/option><option value=\"MO\" >Missouri<\/option><option value=\"MT\" >Montana<\/option><option value=\"NE\" >Nebraska<\/option><option value=\"NV\" >Nevada<\/option><option value=\"NH\" >New Hampshire<\/option><option value=\"NJ\" >New Jersey<\/option><option value=\"NM\" >New Mexico<\/option><option value=\"NY\" >New York<\/option><option value=\"NC\" >North Carolina<\/option><option value=\"ND\" >North Dakota<\/option><option value=\"OH\" >Ohio<\/option><option value=\"OK\" >Oklahoma<\/option><option value=\"OR\" >Oregon<\/option><option value=\"PA\" >Pennsylvania<\/option><option value=\"RI\" >Rhode Island<\/option><option value=\"SC\" >South Carolina<\/option><option value=\"SD\" >South Dakota<\/option><option value=\"TN\" >Tennessee<\/option><option value=\"TX\" >Texas<\/option><option value=\"UT\" >Utah<\/option><option value=\"VT\" >Vermont<\/option><option value=\"VA\" >Virginia<\/option><option value=\"WA\" >Washington<\/option><option value=\"WV\" >West Virginia<\/option><option value=\"WI\" >Wisconsin<\/option><option value=\"WY\" >Wyoming<\/option><\/select><label for=\"wpforms-431-field_11-state\" class=\"wpforms-field-sublabel after \">State<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-431-field_11-postal\" class=\"wpforms-field-address-postal wpforms-masked-input\" data-inputmask-mask=\"(99999)|(99999-9999)\" data-inputmask-keepstatic=\"true\" data-rule-inputmask-incomplete=\"1\" name=\"wpforms[fields][11][postal]\" placeholder=\"Subjects Zip Code\" ><label for=\"wpforms-431-field_11-postal\" class=\"wpforms-field-sublabel after \">Zip Code<\/label><\/div><\/div><\/div><div id=\"wpforms-431-field_12-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-431-field_12\">Subjects phone number (If known)<\/label><input type=\"tel\" id=\"wpforms-431-field_12\" class=\"wpforms-field-medium wpforms-masked-input\" data-inputmask=\"&#039;mask&#039;: &#039;(999) 999-9999&#039;\" data-rule-us-phone-field=\"true\" data-inputmask-inputmode=\"tel\" name=\"wpforms[fields][12]\" placeholder=\"111-222-3333\" ><\/div><div id=\"wpforms-431-field_13-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-431-field_13\">Subjects email (If known)<\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"email\" id=\"wpforms-431-field_13\" class=\"wpforms-field-email-primary\" name=\"wpforms[fields][13][primary]\" placeholder=\"abc@xyz.com\" spellcheck=\"false\" ><label for=\"wpforms-431-field_13\" class=\"wpforms-field-sublabel after \">Email<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"email\" id=\"wpforms-431-field_13-secondary\" class=\"wpforms-field-email-secondary\" data-rule-confirm=\"#wpforms-431-field_13\" name=\"wpforms[fields][13][secondary]\" placeholder=\"abc@xyz.com\" spellcheck=\"false\" ><label for=\"wpforms-431-field_13-secondary\" class=\"wpforms-field-sublabel after \">Confirm Email<\/label><\/div><\/div><\/div><div id=\"wpforms-431-field_16-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-431-field_16\">Date of birth <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-431-field_16\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][16]\" placeholder=\"01\/01\/2000\" required><\/div><div id=\"wpforms-431-field_34-container\" class=\"wpforms-field wpforms-field-password\" data-field-id=\"34\"><label class=\"wpforms-field-label\" for=\"wpforms-431-field_34\">Subjects Social Security Number<\/label><div class=\"wpforms-field-row wpforms-field-small\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"password\" id=\"wpforms-431-field_34\" class=\"wpforms-field-password-primary\" name=\"wpforms[fields][34][primary]\" placeholder=\"000-00-0000\" spellcheck=\"false\" ><label for=\"wpforms-431-field_34\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Password<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"password\" id=\"wpforms-431-field_34-secondary\" class=\"wpforms-field-password-secondary\" data-rule-confirm=\"#wpforms-431-field_34\" name=\"wpforms[fields][34][secondary]\" placeholder=\"Confirm here\" spellcheck=\"false\" ><label for=\"wpforms-431-field_34-secondary\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Confirm Password<\/label><\/div><\/div><\/div><div id=\"wpforms-431-field_19-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"19\"><label class=\"wpforms-field-label\" for=\"wpforms-431-field_19\">Injury or required work description <span class=\"wpforms-required-label\">*<\/span><\/label><textarea id=\"wpforms-431-field_19\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][19]\" placeholder=\"What can you tell us about the injury or required work\" required><\/textarea><\/div><div id=\"wpforms-431-field_20-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"20\"><label class=\"wpforms-field-label\" for=\"wpforms-431-field_20\">Known associates\/relatives<\/label><textarea id=\"wpforms-431-field_20\" class=\"wpforms-field-medium\" name=\"wpforms[fields][20]\" placeholder=\"Known family members, friends, people they work with or people they might be around\" ><\/textarea><\/div><div id=\"wpforms-431-field_23-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"23\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"2\" data-formid=\"431\" disabled>Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-3  \" data-page=\"3\" style=\"display:none;\"><div id=\"wpforms-431-field_24-container\" class=\"wpforms-field wpforms-field-richtext wpforms-field-large\" data-field-id=\"24\"><label class=\"wpforms-field-label\" for=\"wpforms-431-field_24\">Is there anything else we might need to know to get started or additional details you would like to provide?<\/label><div id=\"wp-wpforms-431-field_24-wrap\" class=\"wp-core-ui wp-editor-wrap tmce-active\"><link rel='stylesheet' id='dashicons-css' href='https:\/\/www.piconsulting.us\/wp-includes\/css\/dashicons.min.css?ver=4951467516ac86b946c964ceff2cc9f7' type='text\/css' media='all' \/>\n<link rel='stylesheet' id='editor-buttons-css' href='https:\/\/www.piconsulting.us\/wp-includes\/css\/editor.min.css?ver=4951467516ac86b946c964ceff2cc9f7' type='text\/css' media='all' \/>\n<style>.wpforms-field-richtext .insert-media.add_media { display: none !important; }<\/style>\n<div id=\"wp-wpforms-431-field_24-editor-tools\" class=\"wp-editor-tools hide-if-no-js\"><div class=\"wp-editor-tabs\"><button type=\"button\" id=\"wpforms-431-field_24-tmce\" aria-pressed=\"true\" class=\"wp-switch-editor switch-tmce\" data-wp-editor-id=\"wpforms-431-field_24\">Visual<\/button>\n<button type=\"button\" id=\"wpforms-431-field_24-html\" class=\"wp-switch-editor switch-html\" data-wp-editor-id=\"wpforms-431-field_24\">Code<\/button>\n<\/div>\n<\/div>\n<div id=\"wp-wpforms-431-field_24-editor-container\" class=\"wp-editor-container\"><div id=\"qt_wpforms-431-field_24_toolbar\" class=\"quicktags-toolbar hide-if-no-js\"><\/div><textarea class=\"wp-editor-area\" style=\"height: 220px\" autocomplete=\"off\" cols=\"40\" name=\"wpforms[fields][24]\" id=\"wpforms-431-field_24\"><\/textarea><\/div>\n<\/div>\n\n<div class=\"wpforms-field-description\">You may cut\/paste basic documents here or use this section for additional information that you think we might need or be useful.<\/div><\/div><div id=\"wpforms-431-field_27-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"27\"><label class=\"wpforms-field-label\" for=\"wpforms-431-field_27\">Is this a RUSH Case? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-431-field_27\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-431-field_27_1\" name=\"wpforms[fields][27]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-431-field_27_1\">No<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-431-field_27_2\" name=\"wpforms[fields][27]\" value=\"Yes!\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-431-field_27_2\">Yes!<\/label><\/li><\/ul><div class=\"wpforms-field-description\">Rush cases are ones that need to be finished within 24-48 hours! <BR> (Rush cases may be charged and additional &#8220;Rush&#8221; fee.  We will discuss this before we start)<\/div><\/div><div id=\"wpforms-431-field_35-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline\" data-field-id=\"35\"><label class=\"wpforms-field-label\" for=\"wpforms-431-field_35\">GDPR Agreement <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-431-field_35\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-431-field_35_1\" name=\"wpforms[fields][35][]\" value=\"I consent to having this website store my submitted information so they can respond to my inquiry.  This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-431-field_35_1\">I consent to having this website store my submitted information so they can respond to my inquiry.  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