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data-js-reload="field_1_4" ><label class='gfield_label gform-field-label' for='input_1_4'>Phone Number<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></label><div class='ginput_container ginput_container_phone'><input name='input_4' id='input_1_4' type='tel' value='' class='large' placeholder='Phone Number' aria-required="true" aria-invalid="false" /></div></div><div id="field_1_5" class="gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible" data-js-reload="field_1_5" ><label class='gfield_label gform-field-label' for='input_1_5'>Describe your legal issue</label><div class='ginput_container ginput_container_textarea'><textarea name='input_5' id='input_1_5' class='textarea small' placeholder='Describe your legal issue' aria-invalid="false" rows='10' cols='50'></textarea></div></div><div id="field_1_6" class="gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_1_6" ><h6>Consent To Respond To Inquiry</h6> <p>By selecting "I Agree" below and clicking the "Submit for Free Evaluation” button, I agree to the <a href= "https://levinlaw.com/disclaimers-terms-of-use/">POLICIES AND DISCLAIMERS</a>, including arbitration provision therein, and consent to receive marketing emails, calls and/or texts, including those made using an automated system and/or artificial/prerecorded voice message, from or on behalf of Levin Papantonio Law Firm (“LP”) / Pensacola, FL / 850-435-7000 / levinlaw.com, regarding their services in response to my inquiry at the telephone number(s) provided above, even if that number is currently listed on any 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I understand my consent to receive automated marketing calls/texts is not required as a condition of purchasing any services. I can revoke my consent at any time. Review LP's Terms and Conditions and Privacy Policy <a href= "https://levinlaw.com/disclaimers-terms-of-use/">here</a>.</p></div><fieldset id="field_1_8" class="gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible" data-js-reload="field_1_8" ><legend class='gfield_label gform-field-label' >I Understand and Agree<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_8'> <div class='gchoice gchoice_1_8_0'> <input class='gfield-choice-input' name='input_8' type='radio' value='True' id='choice_1_8_0' onchange='gformToggleRadioOther( this )' /> <label for='choice_1_8_0' id='label_1_8_0' class='gform-field-label gform-field-label--type-inline'>I Understand and Agree</label> </div></div></div></fieldset><div id="field_1_10" class="gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_1_10" ><h6>Consent To Respond To Marketing</h6> <p>Opt in to Receive Calls, Text Messages, and Emails</p> <p>By checking the below box and clicking “SUBMIT”, I agree to the Terms of the Policies and Procedures of the referenced entity, including individual arbitration provisions therein. 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I understand that my consent to receive automated marketing calls/texts is not required as a condition of purchasing any services, and that I may opt out of such calls/texts at any time.</p></div><fieldset id="field_1_11" class="gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible" data-js-reload="field_1_11" ><legend class='gfield_label gform-field-label' >Opt In</legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_11'> <div class='gchoice gchoice_1_11_0'> <input class='gfield-choice-input' name='input_11' type='radio' value='True' id='choice_1_11_0' onchange='gformToggleRadioOther( this )' /> <label for='choice_1_11_0' id='label_1_11_0' class='gform-field-label gform-field-label--type-inline'>Opt In To Receive Calls, Text Messages, and/or Emails from a representative of Levin Papantonio Law Firm, including an AI assistant. 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