app.smartsheet.com
Open in
urlscan Pro
52.55.133.22
Public Scan
URL:
https://app.smartsheet.com/b/form/bda49fd71f274fb98ec435c05c0d7b76
Submission: On July 12 via manual from US — Scanned from US
Submission: On July 12 via manual from US — Scanned from US
Form analysis 1 forms found in the DOM
<form>
<div class="css-1o5h39n e1tmc1mx0">
<div role="application" title="Remittance advice query for details" data-client-id="container_Request type" data-client-type="dropdown" id="X0EXewnKX" class="css-u3yn36 ef83ajd0"><label for="select_input_Request type"
id="35ac21d8-1478-48d7-9373-688f88049a0f" data-client-id="label_Request type" class="css-1xl1v40 ekxsfat0">Request type<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 react-select__value-container--has-value">
<div class="css-o6m1t9-singleValue react-select__single-value">Remittance advice query for details</div>
<div class="css-1g6gooi">
<div class="react-select__input" style="display: inline-block;"><input autocapitalize="none" autocomplete="off" autocorrect="off" id="select_input_Request type" spellcheck="false" tabindex="0" type="text"
aria-label="Select or enter value" aria-labelledby="35ac21d8-1478-48d7-9373-688f88049a0f" 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;">
</div>
</div>
</div>
</div>
<div class="css-1wy0on6 react-select__indicators">
<div aria-hidden="true" class="css-1pseabs-indicatorContainer react-select__indicator react-select__clear-indicator"><svg height="20" width="20" viewBox="0 0 20 20" aria-hidden="true" focusable="false" class="css-19bqh2r">
<path
d="M14.348 14.849c-0.469 0.469-1.229 0.469-1.697 0l-2.651-3.030-2.651 3.029c-0.469 0.469-1.229 0.469-1.697 0-0.469-0.469-0.469-1.229 0-1.697l2.758-3.15-2.759-3.152c-0.469-0.469-0.469-1.228 0-1.697s1.228-0.469 1.697 0l2.652 3.031 2.651-3.031c0.469-0.469 1.228-0.469 1.697 0s0.469 1.229 0 1.697l-2.758 3.152 2.758 3.15c0.469 0.469 0.469 1.229 0 1.698z">
</path>
</svg></div><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">
</path>
</g>
</g>
</svg></span>
</div>
</div>
</div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div data-client-id="container_Requestor's name" data-client-type="text" id="NjQ0npYWk" class="css-1e3khfm ef83ajd0"><label for="text_box_Requestor's name" data-client-id="label_Requestor's name" class="css-1xl1v40 ekxsfat0">Requestor's name<span
data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div style="display: flex;"><input title="" aria-invalid="false" tabindex="0" id="text_box_Requestor's name" data-testid="text_box_Requestor's name" data-client-id="text_box_Requestor's name" data-client-type="" name="NjQ0npYWk"
maxlength="4000" class="css-1p0590h e1407lhe0" value=""></div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div data-client-id="container_Requestor's email address" data-client-type="text" id="GYoeg6NmQ" class="css-1e3khfm ef83ajd0"><label for="text_box_Requestor's email address" data-client-id="label_Requestor's email address"
class="css-1xl1v40 ekxsfat0">Requestor's email address<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div style="display: flex;"><input title="" aria-invalid="false" tabindex="0" id="text_box_Requestor's email address" data-testid="text_box_Requestor's email address" data-client-id="text_box_Requestor's email address" data-client-type="EMAIL"
name="GYoeg6NmQ" maxlength="4000" class="css-1p0590h e1407lhe0" value=""></div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div data-client-id="container_Requestor's phone #" data-client-type="text" id="D0oJZqGOg" class="css-1e3khfm ef83ajd0"><label for="text_box_Requestor's phone #" data-client-id="label_Requestor's phone #" class="css-1xl1v40 ekxsfat0">Requestor's
phone #</label>
<div style="display: flex;">
<div class=" react-tel-input" style="height: 35px; width: 40px;">
<div class="special-label">Phone</div><input class=" form-control" placeholder="1 (702) 123-4567" type="tel" name="D0oJZqGOg" aria-hidden="true" aria-label="phone picker" value="+1" style="display: none;">
<div class=" flag-dropdown">
<div class="selected-flag" title="United States: + 1" tabindex="0" role="button" aria-haspopup="listbox">
<div class="flag us">
<div class="arrow"></div>
</div>
</div>
</div>
</div><input aria-invalid="false" tabindex="0" id="text_box_Requestor's phone #" data-client-id="text_box_Requestor's phone #" data-client-type="PHONE" type="text" value="+1 (___) ___-____" inputmode="numeric">
</div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div data-client-id="container_Vendor's Legal name" data-client-type="text" id="rj53Wdqnv" class="css-1e3khfm ef83ajd0"><label for="textarea_Vendor's Legal name" data-client-id="label_Vendor's Legal name" class="css-1xl1v40 ekxsfat0">Vendor's
Legal name<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label><textarea aria-invalid="false" tabindex="0" name="rj53Wdqnv" id="textarea_Vendor's Legal name" data-client-id="textarea_Vendor's Legal name"
maxlength="4000" rows="3" class="css-1lh64kx e1407lhe1"></textarea></div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div data-client-id="container_Vendor's address" data-client-type="text" id="7wkolJr9e" class="css-1e3khfm ef83ajd0"><label for="textarea_Vendor's address" data-client-id="label_Vendor's address" class="css-1xl1v40 ekxsfat0">Vendor's address<span
data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label><textarea aria-invalid="false" tabindex="0" name="7wkolJr9e" id="textarea_Vendor's address" data-client-id="textarea_Vendor's address" maxlength="4000" rows="3"
class="css-1lh64kx e1407lhe1"></textarea></div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div role="application" title="" data-client-id="container_Payment currency" data-client-type="dropdown" id="QDl1ZYaMv" class="css-u3yn36 ef83ajd0"><label for="select_input_Payment currency" id="faad3b0e-5530-45ee-8377-9017baf68a8c"
data-client-id="label_Payment currency" class="css-1xl1v40 ekxsfat0">Payment currency<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 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_Payment currency" spellcheck="false" tabindex="0" type="text"
aria-label="Select or enter value" aria-labelledby="faad3b0e-5530-45ee-8377-9017baf68a8c" 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;">
</div>
</div>
</div>
</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">
</path>
</g>
</g>
</svg></span></div>
</div>
</div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div data-client-id="container_Advice number" data-client-type="text" id="rj53zldW1" class="css-1e3khfm ef83ajd0"><label for="text_box_Advice number" data-client-id="label_Advice number" class="css-1xl1v40 ekxsfat0">Advice number<span
data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div id="description_Advice_number" class="rich-text-field-desc">
<p>Advice number is specified on the Remittance advice email sent to you</p>
</div>
<div style="display: flex;"><input title="" aria-invalid="false" aria-describedby="description_Advice_number" tabindex="0" id="text_box_Advice number" data-testid="text_box_Advice number" data-client-id="text_box_Advice number"
data-client-type="" name="rj53zldW1" maxlength="4000" class="css-1p0590h e1407lhe0" value=""></div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div data-client-id="container_Direct deposit amount $" data-client-type="text" id="0wkXKemaz" class="css-1e3khfm ef83ajd0"><label for="text_box_Direct deposit amount $" data-client-id="label_Direct deposit amount $"
class="css-1xl1v40 ekxsfat0">Direct deposit amount $<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div id="description_Direct_deposit_amount__" class="rich-text-field-desc">
<p>Deposit amount is required to allow us to provide the correct remittance advice</p>
</div>
<div style="display: flex; width: 193px;"><input title="" aria-invalid="false" aria-describedby="description_Direct_deposit_amount__" tabindex="0" id="text_box_Direct deposit amount $" data-testid="text_box_Direct deposit amount $"
data-client-id="text_box_Direct deposit amount $" data-client-type="NUMERIC" pattern="^-?\d*\.?\d*(e-?\d+)?$" name="0wkXKemaz" maxlength="4000" class="css-1p0590h e1407lhe0" value="" style="width: 300px;"></div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div data-client-id="container_Direct deposit date" data-client-type="date" id="7wkoa2Jly" class="css-gbq6lm ef83ajd0"><label for="date_Direct deposit date" data-client-id="label_Direct deposit date" class="css-1xl1v40 ekxsfat0">Direct deposit
date<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div id="description_Direct_deposit_date" class="rich-text-field-desc">
<p>Deposit date is required to allow us to provide the correct remittance advice</p>
</div>
<div class="css-1f92r3b"><input data-client-id="date_Direct deposit date" id="date_Direct deposit date" aria-label="Direct deposit date" aria-describedby="description_Direct_deposit_date" tabindex="0" name="Direct deposit date" maxlength="100"
class="css-1dpiipj epidubd0" value=""><button tabindex="0" 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">
</path>
</g>
</svg></span></button></div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div data-client-id="container_Vendor # listed on check or Remittance advice" data-client-type="text" id="Ky1zZPo7Z" class="css-1e3khfm ef83ajd0"><label for="text_box_Vendor # listed on check or Remittance advice"
data-client-id="label_Vendor # listed on check or Remittance advice" class="css-1xl1v40 ekxsfat0">Vendor # listed on check or Remittance advice<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div id="description_Vendor___listed_on_check_or_Remittance_advice" class="rich-text-field-desc">
<p>Please see previous check or remittance advice received to find your Vendor ID</p>
</div>
<div style="display: flex;"><input title="" aria-invalid="false" aria-describedby="description_Vendor___listed_on_check_or_Remittance_advice" tabindex="0" id="text_box_Vendor # listed on check or Remittance advice"
data-testid="text_box_Vendor # listed on check or Remittance advice" data-client-id="text_box_Vendor # listed on check or Remittance advice" data-client-type="" name="Ky1zZPo7Z" maxlength="4000" class="css-1p0590h e1407lhe0" value=""></div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div data-client-id="container_Vendor Invoice #" data-client-type="text" id="yZkE86Ayq" class="css-1e3khfm ef83ajd0"><label for="text_box_Vendor Invoice #" data-client-id="label_Vendor Invoice #" class="css-1xl1v40 ekxsfat0">Vendor Invoice #<span
data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div style="display: flex;"><input title="" aria-invalid="false" tabindex="0" id="text_box_Vendor Invoice #" data-testid="text_box_Vendor Invoice #" data-client-id="text_box_Vendor Invoice #" data-client-type="" name="yZkE86Ayq"
maxlength="4000" class="css-1p0590h e1407lhe0" value=""></div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div role="application" title="" data-client-id="container_Invoice type" data-client-type="dropdown" id="Ky1z7oqXk" class="css-u3yn36 ef83ajd0"><label for="select_input_Invoice type" id="f263b536-26bf-47a3-8ce0-455f17a4bf26"
data-client-id="label_Invoice type" class="css-1xl1v40 ekxsfat0">Invoice type<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div class="rich-text-field-desc css-1q4upac" id="description_select_input_Invoice_type">
<p>The type of invoice will allow us to determine which area of the business needs to handle this request and will in turn expedite the process. Thank you</p>
</div>
<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_Invoice type" spellcheck="false" tabindex="0" type="text" aria-label="Select"
aria-labelledby="f263b536-26bf-47a3-8ce0-455f17a4bf26" value="" aria-describedby="description_select_input_Invoice_type"
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;">
</div>
</div>
</div>
</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">
</path>
</g>
</g>
</svg></span></div>
</div>
</div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div data-client-id="container_Element PO # or RO # or CNR # or Authorization #" data-client-type="text" id="bEj7QA0Qd" class="css-1e3khfm ef83ajd0"><label for="text_box_Element PO # or RO # or CNR # or Authorization #"
data-client-id="label_Element PO # or RO # or CNR # or Authorization #" class="css-1xl1v40 ekxsfat0">Element PO # or RO # or CNR # or Authorization #</label>
<div style="display: flex;"><input title="" aria-invalid="false" tabindex="0" id="text_box_Element PO # or RO # or CNR # or Authorization #" data-testid="text_box_Element PO # or RO # or CNR # or Authorization #"
data-client-id="text_box_Element PO # or RO # or CNR # or Authorization #" data-client-type="" name="bEj7QA0Qd" maxlength="4000" class="css-1p0590h e1407lhe0" value=""></div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div data-client-id="container_VIN #" data-client-type="text" id="wN0mz7OO6" class="css-1e3khfm ef83ajd0"><label for="text_box_VIN #" data-client-id="label_VIN #" class="css-1xl1v40 ekxsfat0">VIN #</label>
<div style="display: flex;"><input title="" aria-invalid="false" tabindex="0" id="text_box_VIN #" data-testid="text_box_VIN #" data-client-id="text_box_VIN #" data-client-type="" name="wN0mz7OO6" maxlength="4000" class="css-1p0590h e1407lhe0"
value=""></div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div data-client-id="container_Other notes" data-client-type="text" id="jXEzYNR9G" class="css-1e3khfm ef83ajd0"><label for="textarea_Other notes" data-client-id="label_Other notes" class="css-1xl1v40 ekxsfat0">Other notes<span
data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div id="description_Other_notes" class="rich-text-field-desc">
<p>Please explain the short/over payment amount</p>
</div><textarea aria-invalid="false" aria-describedby="description_Other_notes" tabindex="0" name="jXEzYNR9G" id="textarea_Other notes" data-client-id="textarea_Other notes" maxlength="4000" rows="3" class="css-1lh64kx e1407lhe1"></textarea>
</div>
</div>
<div class="css-1o5h39n 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<span
data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
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