thebestirs.my.site.com
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Submitted URL: https://marketing.thebestclaims.com/acton/ct/4929/s-0b4b-2401/Bct/l-13b69/l-13b69:ce1/ct2_1/1/lu?sid=TV2%3AUBuyfAjip
Effective URL: https://thebestirs.my.site.com/website/s/contents-claim
Submission: On January 18 via api from US — Scanned from DE
Effective URL: https://thebestirs.my.site.com/website/s/contents-claim
Submission: On January 18 via api from US — Scanned from DE
Form analysis 4 forms found in the DOM
<form novalidate="" autocomplete="on">
<slot><c-messages c-contentsclaimformnew_contentsclaimformnew="" c-messages_messages-host=""></c-messages>
<fieldset c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-hide">
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-grid slds-wrap">
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-size_1-of-1"><c-input c-contentsclaimformnew_contentsclaimformnew="" class="lead-all-documents-received slds-form-element"
c-input_input-host=""><label c-input_input="" class="slds-form-element__label" for="input-8"></label>
<div c-input_input="" class="slds-form-element__control slds-grow input-container"><input c-input_input="" class="slds-input" id="input-8" type="text"></div>
</c-input></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-size_1-of-1"><c-input c-contentsclaimformnew_contentsclaimformnew="" class="lead-street slds-form-element"
c-input_input-host=""><label c-input_input="" class="slds-form-element__label" for="input-9"></label>
<div c-input_input="" class="slds-form-element__control slds-grow input-container"><input c-input_input="" class="slds-input" id="input-9" type="text"></div>
</c-input></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-size_1-of-1"><c-input c-contentsclaimformnew_contentsclaimformnew="" class="lead-record-type slds-form-element"
c-input_input-host=""><label c-input_input="" class="slds-form-element__label" for="input-10"></label>
<div c-input_input="" class="slds-form-element__control slds-grow input-container"><input c-input_input="" class="slds-input" id="input-10" type="text"></div>
</c-input></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-size_1-of-1"><c-input c-contentsclaimformnew_contentsclaimformnew="" class="lead-receipt-method slds-form-element"
c-input_input-host=""><label c-input_input="" class="slds-form-element__label" for="input-11"></label>
<div c-input_input="" class="slds-form-element__control slds-grow input-container"><input c-input_input="" class="slds-input" id="input-11" type="text"></div>
</c-input></div>
</div>
</fieldset>
<fieldset c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element">
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-grid slds-wrap">
<div class="slds-form-element slds-var-p-around_x-small slds-size_1-of-1" c-contentsclaimformnew_contentsclaimformnew=""><label class="custom-label" c-contentsclaimformnew_contentsclaimformnew="">ADJUSTER INFORMATION: <span class="gold-text"
c-contentsclaimformnew_contentsclaimformnew="">*</span></label></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-size_1-of-1"><c-input c-contentsclaimformnew_contentsclaimformnew="" class="adjuster-email slds-form-element"
c-input_input-host=""><label c-input_input="" class="slds-form-element__label slds-assistive-text" for="input-12"><abbr c-input_input="" class="slds-required" title="required">*</abbr></label>
<div c-input_input="" class="slds-form-element__control slds-grow input-container"><input c-input_input="" class="slds-input" id="input-12" type="email" placeholder="Adjuster Email" data-dynamic-placeholder="true" required=""><span
c-input_input="" class="dynamic-placeholder">Adjuster Email<span class="gold-text" c-input_input="">*</span></span></div>
</c-input></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-size_1-of-1"><span c-contentsclaimformnew_contentsclaimformnew="" class="adjuster-email-status"></span></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-size_1-of-1">
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-grid slds-wrap">
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-size_1-of-1"><c-radio-group c-contentsclaimformnew_contentsclaimformnew="" class="adjuster-exists-group slds-form-element"
c-radiogroup_radiogroup-host="">
<fieldset c-radiogroup_radiogroup="">
<legend c-radiogroup_radiogroup="" class="slds-form-element__legend slds-form-element__label">Have you submitted a claim with us before?</legend>
<div c-radiogroup_radiogroup="" class="slds-form-element__control"><span c-radiogroup_radiogroup="" class="slds-radio"><input c-radiogroup_radiogroup="" type="radio" name="input-1" id="radio-0-13" value="true"><label
c-radiogroup_radiogroup="" class="slds-radio__label" for="radio-0-13"><span class="slds-radio_faux" c-radiogroup_radiogroup=""></span><span c-radiogroup_radiogroup=""
class="slds-form-element__label">Yes</span></label></span><span c-radiogroup_radiogroup="" class="slds-radio"><input c-radiogroup_radiogroup="" type="radio" name="input-1" id="radio-1-13" value="false"><label
c-radiogroup_radiogroup="" class="slds-radio__label" for="radio-1-13"><span class="slds-radio_faux" c-radiogroup_radiogroup=""></span><span c-radiogroup_radiogroup="" class="slds-form-element__label">No</span></label></span>
</div>
</fieldset>
</c-radio-group></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-size_1-of-1 lead-adjuster-information slds-hide">
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-grid slds-wrap">
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-small-size_1-of-2 slds-size_1-of-1"><c-input c-contentsclaimformnew_contentsclaimformnew=""
class="adjuster-first-name slds-form-element" c-input_input-host=""><label c-input_input="" class="slds-form-element__label slds-assistive-text" for="input-14"><abbr c-input_input="" class="slds-required"
title="required">*</abbr></label>
<div c-input_input="" class="slds-form-element__control slds-grow input-container"><input c-input_input="" class="slds-input" id="input-14" type="text" placeholder="First Name" data-dynamic-placeholder="true" required=""><span
c-input_input="" class="dynamic-placeholder">First Name<span class="gold-text" c-input_input="">*</span></span></div>
</c-input></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-small-size_1-of-2 slds-size_1-of-1"><c-input c-contentsclaimformnew_contentsclaimformnew=""
class="adjuster-last-name slds-form-element" c-input_input-host=""><label c-input_input="" class="slds-form-element__label slds-assistive-text" for="input-15"><abbr c-input_input="" class="slds-required"
title="required">*</abbr></label>
<div c-input_input="" class="slds-form-element__control slds-grow input-container"><input c-input_input="" class="slds-input" id="input-15" type="text" placeholder="Last Name" data-dynamic-placeholder="true" required=""><span
c-input_input="" class="dynamic-placeholder">Last Name<span class="gold-text" c-input_input="">*</span></span></div>
</c-input></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-small-size_1-of-2 slds-size_1-of-1"><c-input c-contentsclaimformnew_contentsclaimformnew=""
class="adjuster-carrier-entered slds-form-element" c-input_input-host=""><label c-input_input="" class="slds-form-element__label slds-assistive-text" for="input-16"><abbr c-input_input="" class="slds-required"
title="required">*</abbr></label>
<div c-input_input="" class="slds-form-element__control slds-grow input-container"><input c-input_input="" class="slds-input" id="input-16" type="text" placeholder="Carrier" data-dynamic-placeholder="true" required=""><span
c-input_input="" class="dynamic-placeholder">Carrier<span class="gold-text" c-input_input="">*</span></span></div>
</c-input></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-small-size_1-of-2 slds-size_1-of-1"><c-input c-contentsclaimformnew_contentsclaimformnew=""
class="adjuster-Title slds-form-element" c-input_input-host=""><label c-input_input="" class="slds-form-element__label slds-assistive-text" for="input-17"><abbr c-input_input="" class="slds-required"
title="required">*</abbr></label>
<div c-input_input="" class="slds-form-element__control slds-grow input-container"><input c-input_input="" class="slds-input" id="input-17" type="text" placeholder="Title" data-dynamic-placeholder="true" required=""><span
c-input_input="" class="dynamic-placeholder">Title<span class="gold-text" c-input_input="">*</span></span></div>
</c-input></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-size_1-of-1"><c-input c-contentsclaimformnew_contentsclaimformnew="" class="adjuster-phone-number slds-form-element"
c-input_input-host=""><label c-input_input="" class="slds-form-element__label slds-assistive-text" for="input-18"><abbr c-input_input="" class="slds-required" title="required">*</abbr></label>
<div c-input_input="" class="slds-form-element__control slds-grow input-container"><input c-input_input="" class="slds-input" id="input-18" type="tel" placeholder="Phone Number" data-dynamic-placeholder="true" required=""><span
c-input_input="" class="dynamic-placeholder">Phone Number<span class="gold-text" c-input_input="">*</span></span></div>
</c-input></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-size_1-of-1"><c-input c-contentsclaimformnew_contentsclaimformnew="" class="adjuster-street1 slds-form-element"
c-input_input-host=""><label c-input_input="" class="slds-form-element__label slds-assistive-text" for="input-19"><abbr c-input_input="" class="slds-required" title="required">*</abbr></label>
<div c-input_input="" class="slds-form-element__control slds-grow input-container"><input c-input_input="" class="slds-input" id="input-19" type="text" placeholder="Address Line 1" data-dynamic-placeholder="true" required=""><span
c-input_input="" class="dynamic-placeholder">Address Line 1<span class="gold-text" c-input_input="">*</span></span></div>
</c-input></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-size_1-of-1"><c-input c-contentsclaimformnew_contentsclaimformnew="" class="adjuster-street2 slds-form-element"
c-input_input-host=""><label c-input_input="" class="slds-form-element__label slds-assistive-text" for="input-20"></label>
<div c-input_input="" class="slds-form-element__control slds-grow input-container"><input c-input_input="" class="slds-input" id="input-20" type="text" placeholder="Address Line 2" data-dynamic-placeholder="true"><span
c-input_input="" class="dynamic-placeholder">Address Line 2</span></div>
</c-input></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-small-size_3-of-6 slds-size_1-of-1"><c-input c-contentsclaimformnew_contentsclaimformnew=""
class="adjuster-city slds-form-element" c-input_input-host=""><label c-input_input="" class="slds-form-element__label slds-assistive-text" for="input-21"><abbr c-input_input="" class="slds-required"
title="required">*</abbr></label>
<div c-input_input="" class="slds-form-element__control slds-grow input-container"><input c-input_input="" class="slds-input" id="input-21" type="text" placeholder="City" data-dynamic-placeholder="true" required=""><span
c-input_input="" class="dynamic-placeholder">City<span class="gold-text" c-input_input="">*</span></span></div>
</c-input></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-small-size_1-of-6 slds-size_1-of-1"><c-button-menu c-contentsclaimformnew_contentsclaimformnew=""
class="adjuster-state slds-dropdown-trigger slds-dropdown-trigger_click" c-buttonmenu_buttonmenu-host=""><label c-buttonmenu_buttonmenu="" class="slds-form-element__label slds-assistive-text" for="button-22"><abbr
c-buttonmenu_buttonmenu="" class="slds-required" title="required">*</abbr></label>
<div c-buttonmenu_buttonmenu="" class="overflow-container"><button c-buttonmenu_buttonmenu="" class="slds-button slds-input" aria-expanded="false" value="" aria-haspopup="true" type="button" data-dynamic-placeholder="true">
<div c-buttonmenu_buttonmenu="" class="placeholder"></div><c-primitive-icon c-buttonmenu_buttonmenu="" c-primitiveicon_primitiveicon-host=""><svg c-primitiveicon_primitiveicon="" class="slds-button__icon" focusable="false"
data-key="chevrondown" aria-hidden="true">
<use c-primitiveicon_primitiveicon="" xlink:href="#httpsthebestirsmysitecomwebsitesldsiconsutilityspritesvgsymbolssvgcache1071_chevrondown"></use>
</svg></c-primitive-icon><span c-buttonmenu_buttonmenu="" class="slds-assistive-text">Show menu</span>
</button><span c-buttonmenu_buttonmenu="" class="dynamic-placeholder">State<span class="gold-text" c-buttonmenu_buttonmenu="">*</span></span></div>
</c-button-menu></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-small-size_2-of-6 slds-size_1-of-1 input-container"><c-input c-contentsclaimformnew_contentsclaimformnew=""
class="adjuster-zip slds-form-element" c-input_input-host=""><label c-input_input="" class="slds-form-element__label slds-assistive-text" for="input-24"><abbr c-input_input="" class="slds-required"
title="required">*</abbr></label>
<div c-input_input="" class="slds-form-element__control slds-grow input-container"><input c-input_input="" class="slds-input" id="input-24" type="number" placeholder="Zip Code" data-dynamic-placeholder="true" required=""
min="10000" max="99999"><span c-input_input="" class="dynamic-placeholder">Zip Code<span class="gold-text" c-input_input="">*</span></span></div>
</c-input></div>
</div>
</div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-size_1-of-1 lead-claim-information slds-hide">
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-grid slds-wrap">
<div class="slds-form-element slds-var-p-around_x-small slds-var-m-top_large slds-size_1-of-1" c-contentsclaimformnew_contentsclaimformnew=""><label class="custom-label" c-contentsclaimformnew_contentsclaimformnew="">CLAIM
INFORMATION: <span class="gold-text" c-contentsclaimformnew_contentsclaimformnew="">*</span></label></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-medium-size_1-of-2 slds-size_1-of-1"><c-input c-contentsclaimformnew_contentsclaimformnew=""
class="lead-claim-number slds-form-element" c-input_input-host=""><label c-input_input="" class="slds-form-element__label slds-assistive-text" for="input-25"><abbr c-input_input="" class="slds-required"
title="required">*</abbr></label>
<div c-input_input="" class="slds-form-element__control slds-grow input-container"><input c-input_input="" class="slds-input" id="input-25" type="text" placeholder="Claim Number" data-dynamic-placeholder="true" required=""><span
c-input_input="" class="dynamic-placeholder">Claim Number<span class="gold-text" c-input_input="">*</span></span></div>
</c-input></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-medium-size_1-of-2 slds-size_1-of-1"><c-input c-contentsclaimformnew_contentsclaimformnew=""
class="lead-insured slds-form-element" c-input_input-host=""><label c-input_input="" class="slds-form-element__label slds-assistive-text" for="input-26"><abbr c-input_input="" class="slds-required"
title="required">*</abbr></label>
<div c-input_input="" class="slds-form-element__control slds-grow input-container"><input c-input_input="" class="slds-input" id="input-26" type="text" placeholder="Insured" data-dynamic-placeholder="true" required=""><span
c-input_input="" class="dynamic-placeholder">Insured<span class="gold-text" c-input_input="">*</span></span></div>
</c-input></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-medium-size_1-of-2 slds-size_1-of-1"><c-input c-contentsclaimformnew_contentsclaimformnew=""
class="lead-date-of-loss slds-form-element" c-input_input-host=""><label c-input_input="" class="slds-form-element__label slds-assistive-text" for="input-27"><abbr c-input_input="" class="slds-required"
title="required">*</abbr></label>
<div c-input_input="" class="slds-form-element__control slds-grow input-container"><input c-input_input="" class="slds-input" id="input-27" type="date" placeholder="Date Of Loss" data-dynamic-placeholder="true" required=""><span
c-input_input="" class="dynamic-placeholder">Date Of Loss<span class="gold-text" c-input_input="">*</span></span></div>
</c-input></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-medium-size_1-of-2 slds-size_1-of-1"><c-button-menu c-contentsclaimformnew_contentsclaimformnew=""
class="lead-type-of-loss slds-dropdown-trigger slds-dropdown-trigger_click" c-buttonmenu_buttonmenu-host=""><label c-buttonmenu_buttonmenu="" class="slds-form-element__label slds-assistive-text" for="button-28"><abbr
c-buttonmenu_buttonmenu="" class="slds-required" title="required">*</abbr></label>
<div c-buttonmenu_buttonmenu="" class="overflow-container"><button c-buttonmenu_buttonmenu="" class="slds-button slds-input" aria-expanded="false" value="" aria-haspopup="true" type="button" data-dynamic-placeholder="true">
<div c-buttonmenu_buttonmenu="" class="placeholder"></div><c-primitive-icon c-buttonmenu_buttonmenu="" c-primitiveicon_primitiveicon-host=""><svg c-primitiveicon_primitiveicon="" class="slds-button__icon" focusable="false"
data-key="chevrondown" aria-hidden="true">
<use c-primitiveicon_primitiveicon="" xlink:href="#httpsthebestirsmysitecomwebsitesldsiconsutilityspritesvgsymbolssvgcache1071_chevrondown"></use>
</svg></c-primitive-icon><span c-buttonmenu_buttonmenu="" class="slds-assistive-text">Show menu</span>
</button><span c-buttonmenu_buttonmenu="" class="dynamic-placeholder">Type Of Loss<span class="gold-text" c-buttonmenu_buttonmenu="">*</span></span></div>
</c-button-menu></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-medium-size_1-of-2 slds-size_1-of-1"><c-input c-contentsclaimformnew_contentsclaimformnew=""
class="lead-deductible slds-form-element" c-input_input-host=""><label c-input_input="" class="slds-form-element__label slds-assistive-text" for="input-30"><abbr c-input_input="" class="slds-required"
title="required">*</abbr></label>
<div c-input_input="" class="slds-form-element__control slds-grow input-container"><input c-input_input="" class="slds-input" id="input-30" type="number" placeholder="Deductible" data-dynamic-placeholder="true" required=""><span
c-input_input="" class="dynamic-placeholder">Deductible<span class="gold-text" c-input_input="">*</span></span></div>
</c-input></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-medium-size_1-of-2 slds-size_1-of-1"><c-input c-contentsclaimformnew_contentsclaimformnew=""
class="lead-policy-limits slds-form-element" c-input_input-host=""><label c-input_input="" class="slds-form-element__label slds-assistive-text" for="input-31"></label>
<div c-input_input="" class="slds-form-element__control slds-grow input-container"><input c-input_input="" class="slds-input" id="input-31" type="text" placeholder="Policy Limits" data-dynamic-placeholder="true"><span
c-input_input="" class="dynamic-placeholder">Policy Limits</span></div>
</c-input></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-size_1-of-1"><c-textarea c-contentsclaimformnew_contentsclaimformnew=""
class="lead-instructions alternative-label2 slds-form-element" c-textarea_textarea-host=""><label c-textarea_textarea="" class="slds-form-element__label" for="input-32">Instructions</label>
<div c-textarea_textarea="" class="slds-form-element__control slds-grow textarea-container"><textarea c-textarea_textarea="" class="slds-textarea" id="input-32" name="Instructions" maxlength="131072"></textarea></div>
</c-textarea></div>
<div class="slds-form-element slds-var-p-around_x-small slds-size_1-of-1" c-contentsclaimformnew_contentsclaimformnew=""><label class="custom-label" c-contentsclaimformnew_contentsclaimformnew="">ATTACHMENTS: </label></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-var-p-around_x-small slds-form-element slds-size_1-of-1"><c-file-upload c-contentsclaimformnew_contentsclaimformnew="" c-fileupload_fileupload-host=""><label
c-fileupload_fileupload="" class="slds-form-element__label" for="input-33"></label>
<div c-fileupload_fileupload="" class="file-box"><lightning-file-upload c-fileupload_fileupload=""><lightning-input class="slds-form-element" lwc-66unc5l95ad-host=""><lightning-primitive-input-file lwc-66unc5l95ad=""><span
class="slds-form-element__label" id="form-label-36" data-form-label=""></span>
<div class="slds-form-element__control">
<div class="slds-file-selector slds-file-selector_files" part="file-selector"><lightning-primitive-file-droppable-zone class="slds-file-selector__dropzone" lwc-7gt6355bheb-host="">
<slot lwc-7gt6355bheb=""><input class="slds-file-selector__input slds-assistive-text" type="file" id="input-file-36" multiple="" name="fileUploader" part="input"
aria-labelledby="form-label-36 file-selector-label-36"><label class="slds-file-selector__body" id="file-selector-label-36" data-file-selector-label="" for="input-file-36" aria-hidden="true"><span
class="slds-file-selector__button slds-button slds-button_neutral" part="button"><lightning-primitive-icon variant="bare"><svg class="slds-button__icon slds-button__icon_left" focusable="false"
data-key="upload" aria-hidden="true" viewBox="0 0 52 52" part="icon">
<g>
<g>
<path d="M48.5 31h-3c-.8 0-1.5.8-1.5 1.5v10c0 .8-.7 1.5-1.5 1.5h-33c-.8 0-1.5-.7-1.5-1.5v-10c0-.7-.7-1.5-1.5-1.5h-3c-.8 0-1.5.8-1.5 1.5V46c0 2.2 1.8 4 4 4h40c2.2 0 4-1.8 4-4V32.5c0-.7-.7-1.5-1.5-1.5z">
</path>
<path
d="M27 2.4c-.6-.6-1.5-.6-2.1 0L11.4 15.9c-.6.6-.6 1.5 0 2.1l2.1 2.1c.6.6 1.5.6 2.1 0l5.6-5.6c.6-.6 1.8-.2 1.8.7v21.2c0 .8.6 1.5 1.4 1.5h3c.8 0 1.6-.8 1.6-1.5V15.3c0-.9 1-1.3 1.7-.7l5.6 5.6c.6.6 1.5.6 2.1 0l2.1-2.1c.6-.6.6-1.5 0-2.1L27 2.4z">
</path>
</g>
</g>
</svg></lightning-primitive-icon>Upload Files</span><span class="slds-file-selector__text slds-medium-show">Or drop files</span></label></slot>
</lightning-primitive-file-droppable-zone></div>
</div>
</lightning-primitive-input-file></lightning-input>
<style>
lightning-file-upload>lightning-input>div>div>lightning-primitive-file-droppable-zone>slot>label>span {
display: none !important;
}
<br>lightning-file-upload>lightning-input>div>div>lightning-primitive-file-droppable-zone {
z-index: 2;
padding: 0 !important;
position: absolute;
top: 0;
bottom: 0;
}
<br>lightning-file-upload>lightning-input>div>div {
height: 100%;
}
<br>lightning-file-upload>lightning-input>span {
display: none !important;
}
<br>lightning-file-upload>lightning-input {
width: 100%;
height: 100%
}
<br>lightning-file-upload>lightning-input>div {
width: 100%;
height: 100%
}
<br>.slds-file-selector * {
width: 100%;
height: 100%;
}
<br>.slds-file-selector {
display: block;
}
<br>.slds-file-selector {
opacity: 0.0;
}
<br>.slds-file-selector__dropzone {
border: none;
}
<br>lightning-file-upload>lightning-input>div>div>lightning-primitive-file-droppable-zone>slot>label {
cursor: pointer;
}
<br>.uiButton--modal-closeBtn {
display: none
}
<br>.uiModal .modal-footer .uiButton--brand .bBody {
<br>display: none;
<br>
}
<br><br>.uiModal .modal-footer .uiButton--brand::after {
<br>display: inline;
<br>content: 'Upload';
<br>
}
<br>
</style>
<style>
lightning-file-upload>lightning-input>div>div>lightning-primitive-file-droppable-zone>slot>label>span {
display: none !important;
}
<br>lightning-file-upload>lightning-input>div>div>lightning-primitive-file-droppable-zone {
z-index: 2;
padding: 0 !important;
position: absolute;
top: 0;
bottom: 0;
}
<br>lightning-file-upload>lightning-input>div>div {
height: 100%;
}
<br>lightning-file-upload>lightning-input>span {
display: none !important;
}
<br>lightning-file-upload>lightning-input {
width: 100%;
height: 100%
}
<br>lightning-file-upload>lightning-input>div {
width: 100%;
height: 100%
}
<br>.slds-file-selector * {
width: 100%;
height: 100%;
}
<br>.slds-file-selector {
display: block;
}
<br>.slds-file-selector {
opacity: 0.0;
}
<br>.slds-file-selector__dropzone {
border: none;
}
<br>lightning-file-upload>lightning-input>div>div>lightning-primitive-file-droppable-zone>slot>label {
cursor: pointer;
}
<br>.uiButton--modal-closeBtn {
display: none
}
<br>.uiModal .modal-footer .uiButton--brand .bBody {
<br>display: none;
<br>
}
<br><br>.uiModal .modal-footer .uiButton--brand::after {
<br>display: inline;
<br>content: 'Upload';
<br>
}
<br>
</style>
<style>
lightning-file-upload>lightning-input>div>div>lightning-primitive-file-droppable-zone>slot>label>span {
display: none !important;
}
<br>lightning-file-upload>lightning-input>div>div>lightning-primitive-file-droppable-zone {
z-index: 2;
padding: 0 !important;
position: absolute;
top: 0;
bottom: 0;
}
<br>lightning-file-upload>lightning-input>div>div {
height: 100%;
}
<br>lightning-file-upload>lightning-input>span {
display: none !important;
}
<br>lightning-file-upload>lightning-input {
width: 100%;
height: 100%
}
<br>lightning-file-upload>lightning-input>div {
width: 100%;
height: 100%
}
<br>.slds-file-selector * {
width: 100%;
height: 100%;
}
<br>.slds-file-selector {
display: block;
}
<br>.slds-file-selector {
opacity: 0.0;
}
<br>.slds-file-selector__dropzone {
border: none;
}
<br>lightning-file-upload>lightning-input>div>div>lightning-primitive-file-droppable-zone>slot>label {
cursor: pointer;
}
<br>.uiButton--modal-closeBtn {
display: none
}
<br>.uiModal .modal-footer .uiButton--brand .bBody {
<br>display: none;
<br>
}
<br><br>.uiModal .modal-footer .uiButton--brand::after {
<br>display: inline;
<br>content: 'Upload';
<br>
}
<br>
</style>
<style>
lightning-file-upload>lightning-input>div>div>lightning-primitive-file-droppable-zone>slot>label>span {
display: none !important;
}
<br>lightning-file-upload>lightning-input>div>div>lightning-primitive-file-droppable-zone {
z-index: 2;
padding: 0 !important;
position: absolute;
top: 0;
bottom: 0;
}
<br>lightning-file-upload>lightning-input>div>div {
height: 100%;
}
<br>lightning-file-upload>lightning-input>span {
display: none !important;
}
<br>lightning-file-upload>lightning-input {
width: 100%;
height: 100%
}
<br>lightning-file-upload>lightning-input>div {
width: 100%;
height: 100%
}
<br>.slds-file-selector * {
width: 100%;
height: 100%;
}
<br>.slds-file-selector {
display: block;
}
<br>.slds-file-selector {
opacity: 0.0;
}
<br>.slds-file-selector__dropzone {
border: none;
}
<br>lightning-file-upload>lightning-input>div>div>lightning-primitive-file-droppable-zone>slot>label {
cursor: pointer;
}
<br>.uiButton--modal-closeBtn {
display: none
}
<br>.uiModal .modal-footer .uiButton--brand .bBody {
<br>display: none;
<br>
}
<br><br>.uiModal .modal-footer .uiButton--brand::after {
<br>display: inline;
<br>content: 'Upload';
<br>
}
<br>
</style>
</lightning-file-upload>
<div c-fileupload_fileupload="" class="slds-grid slds-wrap custom-upload">
<div c-fileupload_fileupload="" class="slds-size_1-of-1 slds-x-small-size_1-of-1 slds-small-size_3-of-8" style="font-size: 9pt; margin-top: 70px; padding-left: 1.25rem;">
<div class="subtitle blue-text" style="font-size: 9pt !important;" c-fileupload_fileupload="">Drag & Drop/ Upload File</div>
<div c-fileupload_fileupload="" class="gold-text" style="width: 100%; max-width: 200px; line-height: 1.5;">
<p c-fileupload_fileupload="">Maximum File Size: 2GB</p>
</div>
</div>
<div c-fileupload_fileupload="" class="slds-size_1-of-1 slds-x-small-size_1-of-1 slds-small-size_5-of-8 slds-p-right_large">
<div c-fileupload_fileupload="" class="slds-m-top_xx-large">
<div c-fileupload_fileupload="" class="slds-align_absolute-center input-box-small"></div>
<div c-fileupload_fileupload="" class="slds-align_absolute-center slds-m-top_x-small">
<div c-fileupload_fileupload="" class="slds-m-vertical_small button-container"><c-button c-fileupload_fileupload="" class="file-button" c-button_button-host=""><button c-button_button=""
class="slds-button slds-button_neutral" type="button">SELECT FILE<slot c-button_button=""></slot></button></c-button></div>
</div>
</div>
</div>
</div>
</div>
</c-file-upload></div>
</div>
</div>
</div>
</div>
</div>
</fieldset>
</slot>
</form><form novalidate="" autocomplete="on">
<slot><c-messages c-contentsclaimformnew_contentsclaimformnew="" c-messages_messages-host=""></c-messages>
<fieldset c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-hide">
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-grid slds-wrap">
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-size_1-of-1"><c-input c-contentsclaimformnew_contentsclaimformnew="" class="opportunity-assignment-received slds-form-element"
c-input_input-host=""><label c-input_input="" class="slds-form-element__label" for="input-42"></label>
<div c-input_input="" class="slds-form-element__control slds-grow input-container"><input c-input_input="" class="slds-input" id="input-42" type="text"></div>
</c-input></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-size_1-of-1"><c-input c-contentsclaimformnew_contentsclaimformnew="" class="opportunity-all-documents-received slds-form-element"
c-input_input-host=""><label c-input_input="" class="slds-form-element__label" for="input-43"></label>
<div c-input_input="" class="slds-form-element__control slds-grow input-container"><input c-input_input="" class="slds-input" id="input-43" type="text"></div>
</c-input></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-size_1-of-1"><c-input c-contentsclaimformnew_contentsclaimformnew="" class="opportunity-name slds-form-element"
c-input_input-host=""><label c-input_input="" class="slds-form-element__label" for="input-44"></label>
<div c-input_input="" class="slds-form-element__control slds-grow input-container"><input c-input_input="" class="slds-input" id="input-44" type="text"></div>
</c-input></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-size_1-of-1"><c-input c-contentsclaimformnew_contentsclaimformnew="" class="opportunity-stage slds-form-element"
c-input_input-host=""><label c-input_input="" class="slds-form-element__label" for="input-45"></label>
<div c-input_input="" class="slds-form-element__control slds-grow input-container"><input c-input_input="" class="slds-input" id="input-45" type="text"></div>
</c-input></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-size_1-of-1"><c-input c-contentsclaimformnew_contentsclaimformnew="" class="opportunity-close-date slds-form-element"
c-input_input-host=""><label c-input_input="" class="slds-form-element__label" for="input-46"></label>
<div c-input_input="" class="slds-form-element__control slds-grow input-container"><input c-input_input="" class="slds-input" id="input-46" type="text"></div>
</c-input></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-size_1-of-1"><c-input c-contentsclaimformnew_contentsclaimformnew="" class="opportunity-adjuster slds-form-element"
c-input_input-host=""><label c-input_input="" class="slds-form-element__label" for="input-47"></label>
<div c-input_input="" class="slds-form-element__control slds-grow input-container"><input c-input_input="" class="slds-input" id="input-47" type="text"></div>
</c-input></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-size_1-of-1"><c-input c-contentsclaimformnew_contentsclaimformnew="" class="opportunity-owner slds-form-element"
c-input_input-host=""><label c-input_input="" class="slds-form-element__label" for="input-48"></label>
<div c-input_input="" class="slds-form-element__control slds-grow input-container"><input c-input_input="" class="slds-input" id="input-48" type="text"></div>
</c-input></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-size_1-of-1"><c-input c-contentsclaimformnew_contentsclaimformnew="" class="opportunity-account slds-form-element"
c-input_input-host=""><label c-input_input="" class="slds-form-element__label" for="input-49"></label>
<div c-input_input="" class="slds-form-element__control slds-grow input-container"><input c-input_input="" class="slds-input" id="input-49" type="text"></div>
</c-input></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-size_1-of-1"><c-input c-contentsclaimformnew_contentsclaimformnew="" class="opportunity-record-type slds-form-element"
c-input_input-host=""><label c-input_input="" class="slds-form-element__label" for="input-50"></label>
<div c-input_input="" class="slds-form-element__control slds-grow input-container"><input c-input_input="" class="slds-input" id="input-50" type="text"></div>
</c-input></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-size_1-of-1"><c-input c-contentsclaimformnew_contentsclaimformnew="" class="opportunity-receipt-method slds-form-element"
c-input_input-host=""><label c-input_input="" class="slds-form-element__label" for="input-51"></label>
<div c-input_input="" class="slds-form-element__control slds-grow input-container"><input c-input_input="" class="slds-input" id="input-51" type="text"></div>
</c-input></div>
</div>
</fieldset>
<fieldset c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element">
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-grid slds-wrap">
<div class="slds-form-element slds-var-p-around_x-small slds-var-m-top_large slds-size_1-of-1" c-contentsclaimformnew_contentsclaimformnew=""><label class="custom-label" c-contentsclaimformnew_contentsclaimformnew="">CLAIM INFORMATION: <span
class="gold-text" c-contentsclaimformnew_contentsclaimformnew="">*</span></label></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-medium-size_1-of-2 slds-size_1-of-1"><c-input c-contentsclaimformnew_contentsclaimformnew=""
class="opportunity-claim-number slds-form-element" c-input_input-host=""><label c-input_input="" class="slds-form-element__label slds-assistive-text" for="input-52"><abbr c-input_input="" class="slds-required"
title="required">*</abbr></label>
<div c-input_input="" class="slds-form-element__control slds-grow input-container"><input c-input_input="" class="slds-input" id="input-52" type="text" placeholder="Claim Number" data-dynamic-placeholder="true" required=""><span
c-input_input="" class="dynamic-placeholder">Claim Number<span class="gold-text" c-input_input="">*</span></span></div>
</c-input></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-medium-size_1-of-2 slds-size_1-of-1"><c-input c-contentsclaimformnew_contentsclaimformnew=""
class="opportunity-claim-insured slds-form-element" c-input_input-host=""><label c-input_input="" class="slds-form-element__label slds-assistive-text" for="input-53"><abbr c-input_input="" class="slds-required"
title="required">*</abbr></label>
<div c-input_input="" class="slds-form-element__control slds-grow input-container"><input c-input_input="" class="slds-input" id="input-53" type="text" placeholder="Insured" data-dynamic-placeholder="true" required=""><span
c-input_input="" class="dynamic-placeholder">Insured<span class="gold-text" c-input_input="">*</span></span></div>
</c-input></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-medium-size_1-of-2 slds-size_1-of-1"><c-input c-contentsclaimformnew_contentsclaimformnew=""
class="opportunity-date-of-loss slds-form-element" c-input_input-host=""><label c-input_input="" class="slds-form-element__label slds-assistive-text" for="input-54"><abbr c-input_input="" class="slds-required"
title="required">*</abbr></label>
<div c-input_input="" class="slds-form-element__control slds-grow input-container"><input c-input_input="" class="slds-input" id="input-54" type="date" placeholder="Date Of Loss" data-dynamic-placeholder="true" required=""><span
c-input_input="" class="dynamic-placeholder">Date Of Loss<span class="gold-text" c-input_input="">*</span></span></div>
</c-input></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-medium-size_1-of-2 slds-size_1-of-1"><c-button-menu c-contentsclaimformnew_contentsclaimformnew=""
class="opportunity-type-of-loss slds-dropdown-trigger slds-dropdown-trigger_click" c-buttonmenu_buttonmenu-host=""><label c-buttonmenu_buttonmenu="" class="slds-form-element__label slds-assistive-text" for="button-55"><abbr
c-buttonmenu_buttonmenu="" class="slds-required" title="required">*</abbr></label>
<div c-buttonmenu_buttonmenu="" class="overflow-container"><button c-buttonmenu_buttonmenu="" class="slds-button slds-input" aria-expanded="false" value="" aria-haspopup="true" type="button" data-dynamic-placeholder="true">
<div c-buttonmenu_buttonmenu="" class="placeholder"></div><c-primitive-icon c-buttonmenu_buttonmenu="" c-primitiveicon_primitiveicon-host=""><svg c-primitiveicon_primitiveicon="" class="slds-button__icon" focusable="false"
data-key="chevrondown" aria-hidden="true">
<use c-primitiveicon_primitiveicon="" xlink:href="#httpsthebestirsmysitecomwebsitesldsiconsutilityspritesvgsymbolssvgcache1071_chevrondown"></use>
</svg></c-primitive-icon><span c-buttonmenu_buttonmenu="" class="slds-assistive-text">Show menu</span>
</button><span c-buttonmenu_buttonmenu="" class="dynamic-placeholder">Type Of Loss<span class="gold-text" c-buttonmenu_buttonmenu="">*</span></span></div>
</c-button-menu></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-medium-size_1-of-2 slds-size_1-of-1"><c-input c-contentsclaimformnew_contentsclaimformnew=""
class="opportunity-deductible slds-form-element" c-input_input-host=""><label c-input_input="" class="slds-form-element__label slds-assistive-text" for="input-57"><abbr c-input_input="" class="slds-required"
title="required">*</abbr></label>
<div c-input_input="" class="slds-form-element__control slds-grow input-container"><input c-input_input="" class="slds-input" id="input-57" type="number" placeholder="Deductible" data-dynamic-placeholder="true" required=""><span
c-input_input="" class="dynamic-placeholder">Deductible<span class="gold-text" c-input_input="">*</span></span></div>
</c-input></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-medium-size_1-of-2 slds-size_1-of-1"><c-input c-contentsclaimformnew_contentsclaimformnew=""
class="opportunity-policy-limits slds-form-element" c-input_input-host=""><label c-input_input="" class="slds-form-element__label slds-assistive-text" for="input-58"></label>
<div c-input_input="" class="slds-form-element__control slds-grow input-container"><input c-input_input="" class="slds-input" id="input-58" type="text" placeholder="Policy Limits" data-dynamic-placeholder="true"><span c-input_input=""
class="dynamic-placeholder">Policy Limits</span></div>
</c-input></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-size_1-of-1"><c-textarea c-contentsclaimformnew_contentsclaimformnew=""
class="opportunity-instructions alternative-label2 slds-form-element" c-textarea_textarea-host=""><label c-textarea_textarea="" class="slds-form-element__label" for="input-59">Instructions</label>
<div c-textarea_textarea="" class="slds-form-element__control slds-grow textarea-container"><textarea c-textarea_textarea="" class="slds-textarea" id="input-59" name="Instructions" maxlength="131072"></textarea></div>
</c-textarea></div>
<div class="slds-form-element slds-var-p-around_x-small slds-size_1-of-1" c-contentsclaimformnew_contentsclaimformnew=""><label class="custom-label" c-contentsclaimformnew_contentsclaimformnew="">ATTACHMENTS (SCROLL TO ATTACH ADDITIONAL
FILES): </label></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-var-p-around_x-small slds-form-element slds-size_1-of-1"><c-file-upload c-contentsclaimformnew_contentsclaimformnew="" c-fileupload_fileupload-host=""><label
c-fileupload_fileupload="" class="slds-form-element__label" for="input-60"></label>
<div c-fileupload_fileupload="" class="file-box"><lightning-file-upload c-fileupload_fileupload=""><lightning-input class="slds-form-element" lwc-66unc5l95ad-host=""><lightning-primitive-input-file lwc-66unc5l95ad=""><span
class="slds-form-element__label" id="form-label-63" data-form-label=""></span>
<div class="slds-form-element__control">
<div class="slds-file-selector slds-file-selector_files" part="file-selector"><lightning-primitive-file-droppable-zone class="slds-file-selector__dropzone" lwc-7gt6355bheb-host="">
<slot lwc-7gt6355bheb=""><input class="slds-file-selector__input slds-assistive-text" type="file" id="input-file-63" multiple="" name="fileUploader" part="input" aria-labelledby="form-label-63 file-selector-label-63"><label
class="slds-file-selector__body" id="file-selector-label-63" data-file-selector-label="" for="input-file-63" aria-hidden="true"><span class="slds-file-selector__button slds-button slds-button_neutral"
part="button"><lightning-primitive-icon variant="bare"><svg class="slds-button__icon slds-button__icon_left" focusable="false" data-key="upload" aria-hidden="true" viewBox="0 0 52 52" part="icon">
<g>
<g>
<path d="M48.5 31h-3c-.8 0-1.5.8-1.5 1.5v10c0 .8-.7 1.5-1.5 1.5h-33c-.8 0-1.5-.7-1.5-1.5v-10c0-.7-.7-1.5-1.5-1.5h-3c-.8 0-1.5.8-1.5 1.5V46c0 2.2 1.8 4 4 4h40c2.2 0 4-1.8 4-4V32.5c0-.7-.7-1.5-1.5-1.5z"></path>
<path
d="M27 2.4c-.6-.6-1.5-.6-2.1 0L11.4 15.9c-.6.6-.6 1.5 0 2.1l2.1 2.1c.6.6 1.5.6 2.1 0l5.6-5.6c.6-.6 1.8-.2 1.8.7v21.2c0 .8.6 1.5 1.4 1.5h3c.8 0 1.6-.8 1.6-1.5V15.3c0-.9 1-1.3 1.7-.7l5.6 5.6c.6.6 1.5.6 2.1 0l2.1-2.1c.6-.6.6-1.5 0-2.1L27 2.4z">
</path>
</g>
</g>
</svg></lightning-primitive-icon>Upload Files</span><span class="slds-file-selector__text slds-medium-show">Or drop files</span></label></slot>
</lightning-primitive-file-droppable-zone></div>
</div>
</lightning-primitive-input-file></lightning-input>
<style>
lightning-file-upload>lightning-input>div>div>lightning-primitive-file-droppable-zone>slot>label>span {
display: none !important;
}
<br>lightning-file-upload>lightning-input>div>div>lightning-primitive-file-droppable-zone {
z-index: 2;
padding: 0 !important;
position: absolute;
top: 0;
bottom: 0;
}
<br>lightning-file-upload>lightning-input>div>div {
height: 100%;
}
<br>lightning-file-upload>lightning-input>span {
display: none !important;
}
<br>lightning-file-upload>lightning-input {
width: 100%;
height: 100%
}
<br>lightning-file-upload>lightning-input>div {
width: 100%;
height: 100%
}
<br>.slds-file-selector * {
width: 100%;
height: 100%;
}
<br>.slds-file-selector {
display: block;
}
<br>.slds-file-selector {
opacity: 0.0;
}
<br>.slds-file-selector__dropzone {
border: none;
}
<br>lightning-file-upload>lightning-input>div>div>lightning-primitive-file-droppable-zone>slot>label {
cursor: pointer;
}
<br>.uiButton--modal-closeBtn {
display: none
}
<br>.uiModal .modal-footer .uiButton--brand .bBody {
<br>display: none;
<br>
}
<br><br>.uiModal .modal-footer .uiButton--brand::after {
<br>display: inline;
<br>content: 'Upload';
<br>
}
<br>
</style>
<style>
lightning-file-upload>lightning-input>div>div>lightning-primitive-file-droppable-zone>slot>label>span {
display: none !important;
}
<br>lightning-file-upload>lightning-input>div>div>lightning-primitive-file-droppable-zone {
z-index: 2;
padding: 0 !important;
position: absolute;
top: 0;
bottom: 0;
}
<br>lightning-file-upload>lightning-input>div>div {
height: 100%;
}
<br>lightning-file-upload>lightning-input>span {
display: none !important;
}
<br>lightning-file-upload>lightning-input {
width: 100%;
height: 100%
}
<br>lightning-file-upload>lightning-input>div {
width: 100%;
height: 100%
}
<br>.slds-file-selector * {
width: 100%;
height: 100%;
}
<br>.slds-file-selector {
display: block;
}
<br>.slds-file-selector {
opacity: 0.0;
}
<br>.slds-file-selector__dropzone {
border: none;
}
<br>lightning-file-upload>lightning-input>div>div>lightning-primitive-file-droppable-zone>slot>label {
cursor: pointer;
}
<br>.uiButton--modal-closeBtn {
display: none
}
<br>.uiModal .modal-footer .uiButton--brand .bBody {
<br>display: none;
<br>
}
<br><br>.uiModal .modal-footer .uiButton--brand::after {
<br>display: inline;
<br>content: 'Upload';
<br>
}
<br>
</style>
</lightning-file-upload>
<div c-fileupload_fileupload="" class="slds-grid slds-wrap custom-upload">
<div c-fileupload_fileupload="" class="slds-size_1-of-1 slds-x-small-size_1-of-1 slds-small-size_3-of-8" style="font-size: 9pt; margin-top: 70px; padding-left: 1.25rem;">
<div class="subtitle blue-text" style="font-size: 9pt !important;" c-fileupload_fileupload="">Drag & Drop/ Upload File</div>
<div c-fileupload_fileupload="" class="gold-text" style="width: 100%; max-width: 200px; line-height: 1.5;">
<p c-fileupload_fileupload="">Maximum File Size: 2GB</p>
</div>
</div>
<div c-fileupload_fileupload="" class="slds-size_1-of-1 slds-x-small-size_1-of-1 slds-small-size_5-of-8 slds-p-right_large">
<div c-fileupload_fileupload="" class="slds-m-top_xx-large">
<div c-fileupload_fileupload="" class="slds-align_absolute-center input-box-small"></div>
<div c-fileupload_fileupload="" class="slds-align_absolute-center slds-m-top_x-small">
<div c-fileupload_fileupload="" class="slds-m-vertical_small button-container"><c-button c-fileupload_fileupload="" class="file-button" c-button_button-host=""><button c-button_button="" class="slds-button slds-button_neutral"
type="button">SELECT FILE<slot c-button_button=""></slot></button></c-button></div>
</div>
</div>
</div>
</div>
</div>
</c-file-upload></div>
</div>
</fieldset>
</slot>
</form><form novalidate="" autocomplete="on">
<slot><c-messages c-contentsclaimformnew_contentsclaimformnew="" c-messages_messages-host=""></c-messages>
<fieldset c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-hide">
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-grid slds-wrap">
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-size_1-of-1"><c-input c-contentsclaimformnew_contentsclaimformnew="" class="contact-opportunity slds-form-element" c-input_input-host=""><label c-input_input=""
class="slds-form-element__label" for="input-69"></label>
<div c-input_input="" class="slds-form-element__control slds-grow input-container"><input c-input_input="" class="slds-input" id="input-69" type="text" placeholder="contact opportunity"></div>
</c-input></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-size_1-of-1"><c-input c-contentsclaimformnew_contentsclaimformnew="" class="contact-lead slds-form-element" c-input_input-host=""><label c-input_input=""
class="slds-form-element__label" for="input-70"></label>
<div c-input_input="" class="slds-form-element__control slds-grow input-container"><input c-input_input="" class="slds-input" id="input-70" type="text" placeholder="contact lead"></div>
</c-input></div>
</div>
</fieldset>
<fieldset c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element">
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-grid slds-wrap">
<div class="slds-form-element slds-var-p-around_x-small slds-var-m-top_large slds-size_1-of-1" c-contentsclaimformnew_contentsclaimformnew=""><label class="custom-label" c-contentsclaimformnew_contentsclaimformnew="">INSURED CONTACT
INFORMATION: </label></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-size_1-of-1">
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-grid slds-wrap">
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-size_1-of-1"><c-radio-group c-contentsclaimformnew_contentsclaimformnew="" class="different-group slds-form-element"
c-radiogroup_radiogroup-host="">
<fieldset c-radiogroup_radiogroup="">
<legend c-radiogroup_radiogroup="" class="slds-form-element__legend slds-form-element__label">Is contact different from the Insured?</legend>
<div c-radiogroup_radiogroup="" class="slds-form-element__control"><span c-radiogroup_radiogroup="" class="slds-radio"><input c-radiogroup_radiogroup="" type="radio" name="input-2" id="radio-0-71" value="true"><label
c-radiogroup_radiogroup="" class="slds-radio__label" for="radio-0-71"><span class="slds-radio_faux" c-radiogroup_radiogroup=""></span><span c-radiogroup_radiogroup=""
class="slds-form-element__label">Yes</span></label></span><span c-radiogroup_radiogroup="" class="slds-radio"><input c-radiogroup_radiogroup="" type="radio" name="input-2" id="radio-1-71" value="false"><label
c-radiogroup_radiogroup="" class="slds-radio__label" for="radio-1-71"><span class="slds-radio_faux" c-radiogroup_radiogroup=""></span><span c-radiogroup_radiogroup="" class="slds-form-element__label">No</span></label></span>
</div>
</fieldset>
</c-radio-group></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-size_1-of-1 contact-name slds-hide">
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-grid slds-wrap">
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-small-size_1-of-2 slds-size_1-of-1"><c-input c-contentsclaimformnew_contentsclaimformnew=""
class="contact-first-name slds-form-element" c-input_input-host=""><label c-input_input="" class="slds-form-element__label slds-assistive-text" for="input-72"></label>
<div c-input_input="" class="slds-form-element__control slds-grow input-container"><input c-input_input="" class="slds-input" id="input-72" type="text" placeholder="First Name" data-dynamic-placeholder="true"><span
c-input_input="" class="dynamic-placeholder">First Name</span></div>
</c-input></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-small-size_1-of-2 slds-size_1-of-1"><c-input c-contentsclaimformnew_contentsclaimformnew=""
class="contact-last-name slds-form-element" c-input_input-host=""><label c-input_input="" class="slds-form-element__label slds-assistive-text" for="input-73"></label>
<div c-input_input="" class="slds-form-element__control slds-grow input-container"><input c-input_input="" class="slds-input" id="input-73" type="text" placeholder="Last Name" data-dynamic-placeholder="true"><span c-input_input=""
class="dynamic-placeholder">Last Name</span></div>
</c-input></div>
</div>
</div>
</div>
</div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-small-size_1-of-3 slds-size_1-of-1"><c-button-menu c-contentsclaimformnew_contentsclaimformnew=""
class="contact-phone-type slds-dropdown-trigger slds-dropdown-trigger_click" c-buttonmenu_buttonmenu-host=""><label c-buttonmenu_buttonmenu="" class="slds-form-element__label slds-assistive-text" for="button-74"></label>
<div c-buttonmenu_buttonmenu="" class="overflow-container"><button c-buttonmenu_buttonmenu="" class="slds-button slds-input" aria-expanded="false" value="" aria-haspopup="true" type="button" data-dynamic-placeholder="true">
<div c-buttonmenu_buttonmenu="" class="placeholder"></div><c-primitive-icon c-buttonmenu_buttonmenu="" c-primitiveicon_primitiveicon-host=""><svg c-primitiveicon_primitiveicon="" class="slds-button__icon" focusable="false"
data-key="chevrondown" aria-hidden="true">
<use c-primitiveicon_primitiveicon="" xlink:href="#httpsthebestirsmysitecomwebsitesldsiconsutilityspritesvgsymbolssvgcache1071_chevrondown"></use>
</svg></c-primitive-icon><span c-buttonmenu_buttonmenu="" class="slds-assistive-text">Show menu</span>
</button><span c-buttonmenu_buttonmenu="" class="dynamic-placeholder">Phone Type</span></div>
</c-button-menu></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-small-size_2-of-3 slds-size_1-of-1"><c-input c-contentsclaimformnew_contentsclaimformnew="" class="contact-phone slds-form-element"
c-input_input-host=""><label c-input_input="" class="slds-form-element__label slds-assistive-text" for="input-76"></label>
<div c-input_input="" class="slds-form-element__control slds-grow input-container"><input c-input_input="" class="slds-input" id="input-76" type="tel" placeholder="Phone Number" data-dynamic-placeholder="true"><span c-input_input=""
class="dynamic-placeholder">Phone Number</span></div>
</c-input></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-size_1-of-1"><c-input c-contentsclaimformnew_contentsclaimformnew="" class="contact-email slds-form-element"
c-input_input-host=""><label c-input_input="" class="slds-form-element__label slds-assistive-text" for="input-77"></label>
<div c-input_input="" class="slds-form-element__control slds-grow input-container"><input c-input_input="" class="slds-input" id="input-77" type="email" placeholder="Email" data-dynamic-placeholder="true"><span c-input_input=""
class="dynamic-placeholder">Email</span></div>
</c-input></div>
</div>
</fieldset>
</slot>
</form><form novalidate="" autocomplete="on">
<slot><c-messages c-contentsclaimformnew_contentsclaimformnew="" c-messages_messages-host=""></c-messages>
<fieldset c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-hide">
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-grid slds-wrap">
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-medium-size_2-of-3 slds-size_1-of-1 input-container"><c-input c-contentsclaimformnew_contentsclaimformnew=""
class="insured-address-type slds-form-element" c-input_input-host=""><label c-input_input="" class="slds-form-element__label" for="input-80"></label>
<div c-input_input="" class="slds-form-element__control slds-grow input-container"><input c-input_input="" class="slds-input" id="input-80" type="text"></div>
</c-input></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-medium-size_2-of-3 slds-size_1-of-1 input-container"><c-input c-contentsclaimformnew_contentsclaimformnew=""
class="insured-address-claim slds-form-element" c-input_input-host=""><label c-input_input="" class="slds-form-element__label" for="input-81"></label>
<div c-input_input="" class="slds-form-element__control slds-grow input-container"><input c-input_input="" class="slds-input" id="input-81" type="text"></div>
</c-input></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-medium-size_2-of-3 slds-size_1-of-1 input-container"><c-input c-contentsclaimformnew_contentsclaimformnew=""
class="insured-address-lead slds-form-element" c-input_input-host=""><label c-input_input="" class="slds-form-element__label" for="input-82"></label>
<div c-input_input="" class="slds-form-element__control slds-grow input-container"><input c-input_input="" class="slds-input" id="input-82" type="text"></div>
</c-input></div>
</div>
</fieldset>
<fieldset c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element">
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-grid slds-wrap">
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-size_1-of-1"><c-input c-contentsclaimformnew_contentsclaimformnew="" class="insured-street1 slds-form-element"
c-input_input-host=""><label c-input_input="" class="slds-form-element__label slds-assistive-text" for="input-83"></label>
<div c-input_input="" class="slds-form-element__control slds-grow input-container"><input c-input_input="" class="slds-input" id="input-83" type="text" placeholder="Address Line 1" data-dynamic-placeholder="true"><span c-input_input=""
class="dynamic-placeholder">Address Line 1</span></div>
</c-input></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-size_1-of-1"><c-input c-contentsclaimformnew_contentsclaimformnew="" class="insured-street2 slds-form-element"
c-input_input-host=""><label c-input_input="" class="slds-form-element__label slds-assistive-text" for="input-84"></label>
<div c-input_input="" class="slds-form-element__control slds-grow input-container"><input c-input_input="" class="slds-input" id="input-84" type="text" placeholder="Address Line 2" data-dynamic-placeholder="true"><span c-input_input=""
class="dynamic-placeholder">Address Line 2</span></div>
</c-input></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-small-size_3-of-6 slds-size_1-of-1"><c-input c-contentsclaimformnew_contentsclaimformnew="" class="insured-city slds-form-element"
c-input_input-host=""><label c-input_input="" class="slds-form-element__label slds-assistive-text" for="input-85"></label>
<div c-input_input="" class="slds-form-element__control slds-grow input-container"><input c-input_input="" class="slds-input" id="input-85" type="text" placeholder="City" data-dynamic-placeholder="true"><span c-input_input=""
class="dynamic-placeholder">City</span></div>
</c-input></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-small-size_1-of-6 slds-size_1-of-1"><c-button-menu c-contentsclaimformnew_contentsclaimformnew=""
class="insured-state slds-dropdown-trigger slds-dropdown-trigger_click" c-buttonmenu_buttonmenu-host=""><label c-buttonmenu_buttonmenu="" class="slds-form-element__label slds-assistive-text" for="button-86"></label>
<div c-buttonmenu_buttonmenu="" class="overflow-container"><button c-buttonmenu_buttonmenu="" class="slds-button slds-input" aria-expanded="false" value="" aria-haspopup="true" type="button" data-dynamic-placeholder="true">
<div c-buttonmenu_buttonmenu="" class="placeholder"></div><c-primitive-icon c-buttonmenu_buttonmenu="" c-primitiveicon_primitiveicon-host=""><svg c-primitiveicon_primitiveicon="" class="slds-button__icon" focusable="false"
data-key="chevrondown" aria-hidden="true">
<use c-primitiveicon_primitiveicon="" xlink:href="#httpsthebestirsmysitecomwebsitesldsiconsutilityspritesvgsymbolssvgcache1071_chevrondown"></use>
</svg></c-primitive-icon><span c-buttonmenu_buttonmenu="" class="slds-assistive-text">Show menu</span>
</button><span c-buttonmenu_buttonmenu="" class="dynamic-placeholder">State</span></div>
</c-button-menu></div>
<div c-contentsclaimformnew_contentsclaimformnew="" class="slds-form-element slds-var-p-around_x-small slds-small-size_2-of-6 slds-size_1-of-1 input-container"><c-input c-contentsclaimformnew_contentsclaimformnew=""
class="insured-zip slds-form-element" c-input_input-host=""><label c-input_input="" class="slds-form-element__label slds-assistive-text" for="input-88"></label>
<div c-input_input="" class="slds-form-element__control slds-grow input-container"><input c-input_input="" class="slds-input" id="input-88" type="number" placeholder="Zip Code" data-dynamic-placeholder="true" min="10000" max="99999"><span
c-input_input="" class="dynamic-placeholder">Zip Code</span></div>
</c-input></div>
</div>
</fieldset>
</slot>
</form>Text Content
Loading ×Sorry to interrupt Uncaught TypeError: Cannot read properties of null (reading 'classList') throws at https://thebestirs.my.site.com/website/s/sfsites/auraFW/javascript/YWYyQV90T3g3VDhySzNWUm1kcF9WUVY4bi1LdGdMbklVbHlMdER1eVVlUGcyNDYuMTUuNS0zLjAuNA/aura_prod.js:51:43031 Refresh Learn how we're resetting the TPA bar - Read the article featured in The Insurer here. Rows CLIENT SERVICES Claims Services AutoProperty & CommercialContentsManaged Repair TheBest InspectRecruiting & Staffing ServicesWarranty ServicesDCA & TPA Services CAREERS Current OpeningsJoin our IA RosterSign Up for Job Alerts CAT CONNECT ABOUT US Who We AreLeadership Candidate Login CLIENT SERVICES Claims Services AutoProperty & CommercialContentsManaged Repair TheBest InspectRecruiting & Staffing ServicesWarranty ServicesDCA & TPA Services CAREERS Current OpeningsJoin our IA RosterSign Up for Job Alerts CAT CONNECT ABOUT US Who We AreLeadership Candidate Login loading... Submit a Claim * = Required ADJUSTER INFORMATION: * * Adjuster Email* Have you submitted a claim with us before? YesNo * First Name* * Last Name* * Carrier* * Title* * Phone Number* * Address Line 1* Address Line 2 * City* * Show menuState* * Zip Code* CLAIM INFORMATION: * * Claim Number* * Insured* * Date Of Loss* * Show menuType Of Loss* * Deductible* Policy Limits Instructions ATTACHMENTS: Upload FilesOr drop files Drag & Drop/ Upload File Maximum File Size: 2GB SELECT FILE CLAIM INFORMATION: * * Claim Number* * Insured* * Date Of Loss* * Show menuType Of Loss* * Deductible* Policy Limits Instructions ATTACHMENTS (SCROLL TO ATTACH ADDITIONAL FILES): Upload FilesOr drop files Drag & Drop/ Upload File Maximum File Size: 2GB SELECT FILE INSURED CONTACT INFORMATION: Is contact different from the Insured? YesNo First Name Last Name Show menuPhone Type Phone Number Email Address Line 1 Address Line 2 City Show menuState Zip Code SUBMIT powered by partnerships, sustained by solutions. QUESTIONS OR COMMENTS? news@thebestclaims.com 866.658.4477 CLIENT SERVICES Claims Services TheBest Inspect Recruiting & Staffing Services Warranty Services DCA & TPA Services CAREERS Current Openings Join our IA Roster Sign Up for Job Alerts ABOUT US Who We Are Leadership Events Terms & Conditions | Privacy Policy | FAQs | Sitemap ©2024 TheBest Claims Solutions. All Rights Reserved. Loading