General Contact Form | State of California - Department of Justice

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size="60" maxlength="128" /></div><div class="form-item webform-component webform-component-textfield webform-component--enter-your-information--address-line form-group form-item form-item-submitted-enter-your-information-address-line form-type-textfield form-group"> <label class="control-label" for="edit-submitted-enter-your-information-address-line">Address Line <span class="form-required" title="This field is required.">*</span></label> <input required="required" class="form-control form-text required" type="text" id="edit-submitted-enter-your-information-address-line" name="submitted[enter_your_information][address_line]" value="" size="60" maxlength="50" /></div><div class="form-item webform-component webform-component-textfield webform-component--enter-your-information--address-line-2 form-group form-item form-item-submitted-enter-your-information-address-line-2 form-type-textfield form-group"><input class="form-control form-text" type="text" id="edit-submitted-enter-your-information-address-line-2" name="submitted[enter_your_information][address_line_2]" value="" size="60" maxlength="50" /> <label class="control-label element-invisible" for="edit-submitted-enter-your-information-address-line-2">Address Line 2</label> </div><div class="form-item webform-component webform-component-textfield webform-component--enter-your-information--city form-group form-item form-item-submitted-enter-your-information-city form-type-textfield form-group"> <label class="control-label" for="edit-submitted-enter-your-information-city">City <span class="form-required" title="This field is required.">*</span></label> <input required="required" class="form-control form-text required" type="text" id="edit-submitted-enter-your-information-city" name="submitted[enter_your_information][city]" value="" size="60" maxlength="50" /></div><div class="form-item webform-component webform-component-select webform-component--enter-your-information--state form-group form-item form-item-submitted-enter-your-information-state form-type-select form-group"> <label class="control-label" for="edit-submitted-enter-your-information-state">State <span class="form-required" title="This field is required.">*</span></label> <select required="required" class="form-control form-select required" id="edit-submitted-enter-your-information-state" name="submitted[enter_your_information][state]"><option value="AL">AL</option><option value="AK">AK</option><option value="AS">AS</option><option value="AZ">AZ</option><option value="AR">AR</option><option value="CA" selected="selected">CA</option><option value="CO">CO</option><option value="CT">CT</option><option value="DE">DE</option><option value="DC">DC</option><option value="FL">FL</option><option value="GA">GA</option><option value="GU">GU</option><option value="HI">HI</option><option value="ID">ID</option><option value="IL">IL</option><option value="IN">IN</option><option value="IA">IA</option><option value="KS">KS</option><option value="KY">KY</option><option value="LA">LA</option><option value="ME">ME</option><option value="MH">MH</option><option value="MD">MD</option><option value="MA">MA</option><option value="MI">MI</option><option value="MN">MN</option><option value="MS">MS</option><option value="MO">MO</option><option value="MT">MT</option><option value="NE">NE</option><option value="NV">NV</option><option value="NH">NH</option><option value="NJ">NJ</option><option value="NM">NM</option><option value="NY">NY</option><option value="NC">NC</option><option value="ND">ND</option><option value="MP">MP</option><option value="OH">OH</option><option value="OK">OK</option><option value="OR">OR</option><option value="PW">PW</option><option value="PA">PA</option><option value="PR">PR</option><option value="RI">RI</option><option value="SC">SC</option><option value="SD">SD</option><option value="TN">TN</option><option value="TX">TX</option><option value="UT">UT</option><option value="VT">VT</option><option value="VI">VI</option><option value="VA">VA</option><option value="WA">WA</option><option value="WV">WV</option><option value="WI">WI</option><option value="WY">WY</option></select></div><div class="form-item webform-component webform-component-textfield webform-component--enter-your-information--zip-code form-group form-item form-item-submitted-enter-your-information-zip-code form-type-textfield form-group"> <label class="control-label" for="edit-submitted-enter-your-information-zip-code">Zip Code <span class="form-required" title="This field is required.">*</span></label> <input required="required" class="form-control form-text required" type="text" id="edit-submitted-enter-your-information-zip-code" name="submitted[enter_your_information][zip_code]" value="" size="5" maxlength="5" /></div><div class="form-item webform-component webform-component-textfield webform-component--enter-your-information--zip4 form-group form-item form-item-submitted-enter-your-information-zip4 form-type-textfield form-group"> <label class="control-label" for="edit-submitted-enter-your-information-zip4">Zip4</label> <input class="form-control form-text" type="text" id="edit-submitted-enter-your-information-zip4" name="submitted[enter_your_information][zip4]" value="" size="4" maxlength="4" /></div><div class="form-item webform-component webform-component-email webform-component--enter-your-information--email-address form-group form-item form-item-submitted-enter-your-information-email-address form-type-webform-email form-group"> <label class="control-label" for="edit-submitted-enter-your-information-email-address">Email Address</label> <input class="email form-control form-text form-email" type="email" id="edit-submitted-enter-your-information-email-address" name="submitted[enter_your_information][email_address]" size="60" /></div><div class="form-item webform-component webform-component-email webform-component--enter-your-information--confirm-email-address form-group form-item form-item-submitted-enter-your-information-confirm-email-address form-type-webform-email form-group"> <label class="control-label" for="edit-submitted-enter-your-information-confirm-email-address">Confirm Email Address</label> <input class="email form-control form-text form-email" type="email" id="edit-submitted-enter-your-information-confirm-email-address" name="submitted[enter_your_information][confirm_email_address]" size="60" /></div><div class="form-item webform-component webform-component-textfield webform-component--enter-your-information--area-code form-group form-item form-item-submitted-enter-your-information-area-code form-type-textfield form-group"> <label class="control-label" for="edit-submitted-enter-your-information-area-code">Area Code</label> <input class="form-control form-text" title="e.g.916" data-toggle="tooltip" type="text" id="edit-submitted-enter-your-information-area-code" name="submitted[enter_your_information][area_code]" value="" size="3" maxlength="3" /></div><div class="form-item webform-component webform-component-textfield webform-component--enter-your-information--phone-number form-group form-item form-item-submitted-enter-your-information-phone-number form-type-textfield form-group"> <label class="control-label" for="edit-submitted-enter-your-information-phone-number">Phone Number</label> <input class="form-control form-text" title="e.g.5550199" data-toggle="tooltip" type="text" id="edit-submitted-enter-your-information-phone-number" name="submitted[enter_your_information][phone_number]" value="" size="7" maxlength="7" /></div> </div> </fieldset> <fieldset class="webform-component-fieldset webform-component--enter-your-comments panel panel-default form-wrapper" id="bootstrap-panel--2"> <legend class="panel-heading"> <span class="panel-title fieldset-legend">Your Comments</span> </legend> <div class="panel-body" id="bootstrap-panel-2-body"> <div class="form-item webform-component webform-component-markup webform-component--enter-your-comments--comment-info form-group form-item form-type-markup form-group"><p> <strong>Please include the following information in the text of your comment/complaint if relevant:</strong> </p> <ul> <li><strong>If you are a member of the U.S. Armed Forces.<br /> Please specify: Active Duty, Reserve, National Guard, Retired or Military Family Member.</strong></li> <li><strong>If you have a foreign (non-US) address.</strong></li> </ul> </div><div class="form-item webform-component webform-component-textarea webform-component--enter-your-comments--message form-group form-item form-item-submitted-enter-your-comments-message form-type-textarea form-group"> <label class="control-label" for="edit-submitted-enter-your-comments-message">Message <span class="form-required" title="This field is required.">*</span></label> <div class="form-textarea-wrapper resizable"><textarea required="required" class="form-control form-textarea required" id="edit-submitted-enter-your-comments-message" name="submitted[enter_your_comments][message]" cols="60" rows="5"></textarea></div></div> </div> </fieldset> <fieldset class="webform-component-fieldset webform-component--affirmation panel panel-default form-wrapper" id="bootstrap-panel--3"> <legend class="panel-heading"> <span class="panel-title fieldset-legend">Affirmation</span> </legend> <div class="panel-body" id="bootstrap-panel-3-body"> <div class="form-item webform-component webform-component-radios webform-component--affirmation--affirmation-stmt form-group form-item form-item-submitted-affirmation-affirmation-stmt form-type-radios form-group"> <label class="control-label" for="edit-submitted-affirmation-affirmation-stmt">I affirm that the foregoing information is true and accurate <span class="form-required" title="This field is required.">*</span></label> <div id="edit-submitted-affirmation-affirmation-stmt" class="form-radios"><div class="form-item form-item-submitted-affirmation-affirmation-stmt form-type-radio radio"> <label class="control-label" for="edit-submitted-affirmation-affirmation-stmt-1"><input required="required" type="radio" id="edit-submitted-affirmation-affirmation-stmt-1" name="submitted[affirmation][affirmation_stmt]" value="Y" checked="checked" class="form-radio" />Yes</label> </div><div class="form-item form-item-submitted-affirmation-affirmation-stmt form-type-radio radio"> <label class="control-label" for="edit-submitted-affirmation-affirmation-stmt-2"><input required="required" type="radio" id="edit-submitted-affirmation-affirmation-stmt-2" name="submitted[affirmation][affirmation_stmt]" value="N" class="form-radio" />No</label> </div></div></div> </div> </fieldset> <div class="form-item webform-component webform-component-hidden webform-component--referrer form-item form-item-submitted-referrer form-type-hidden" style="display: none"><input type="hidden" name="submitted[referrer]" value="" /> </div><div class="form-item webform-component webform-component-radios webform-component--include-any-file-attachments form-group form-item form-item-submitted-include-any-file-attachments form-type-radios form-group"> <label class="control-label" for="edit-submitted-include-any-file-attachments">Do you want to include any file attachments? <span class="form-required" title="This field is required.">*</span></label> <div id="edit-submitted-include-any-file-attachments" class="form-radios"><div class="form-item form-item-submitted-include-any-file-attachments form-type-radio radio"> <label class="control-label" for="edit-submitted-include-any-file-attachments-1"><input required="required" type="radio" id="edit-submitted-include-any-file-attachments-1" name="submitted[include_any_file_attachments]" value="Yes" class="form-radio" />Yes</label> </div><div class="form-item form-item-submitted-include-any-file-attachments form-type-radio radio"> <label class="control-label" for="edit-submitted-include-any-file-attachments-2"><input required="required" type="radio" id="edit-submitted-include-any-file-attachments-2" name="submitted[include_any_file_attachments]" value="No" class="form-radio" />No</label> </div></div></div><div id="edit-submitted-upload-file-attachment-ajax-wrapper"><div class="form-item webform-component webform-component-file webform-component--upload-file-attachment form-group form-item form-item-submitted-upload-file-attachment form-type-managed-file form-group"> <label class="control-label" for="edit-submitted-upload-file-attachment">Upload file attachment</label> <div class="form-managed-file input-group"><input type="hidden" name="submitted[upload_file_attachment][fid]" value="0" /> <input class="form-control form-file" type="file" id="edit-submitted-upload-file-attachment-upload" name="files[submitted_upload_file_attachment]" size="22" /><span class="input-group-btn"><button class="btn-primary btn form-submit icon-before" type="submit" id="edit-submitted-upload-file-attachment-upload-button" name="submitted_upload_file_attachment_upload_button" value="Upload"><span class="icon glyphicon glyphicon-upload" aria-hidden="true"></span> Upload</button> </span></div><div class="help-block"><a href="#" data-toggle="popover" data-target="#upload-instructions" data-html="1" data-placement="bottom" data-title="File requirements"><span class="icon glyphicon glyphicon-question-sign" aria-hidden="true"></span> More information</a><div id="upload-instructions" class="element-invisible help-block"><ul><li>Files must be less than <strong>4 MB</strong>.</li> <li>Allowed file types: <strong>pdf doc docx xls xlsx</strong>.</li> </ul></div></div></div></div><div class="form-item webform-component webform-component-textfield webform-component--description-of-file-attachment form-group form-item form-item-submitted-description-of-file-attachment form-type-textfield form-group"> <label class="control-label" for="edit-submitted-description-of-file-attachment">Description of file attachment</label> <input class="form-control form-text" type="text" id="edit-submitted-description-of-file-attachment" name="submitted[description_of_file_attachment]" value="" size="60" maxlength="128" /></div><div class="form-item webform-component webform-component-radios webform-component--include-any-file-attachments2 form-group form-item form-item-submitted-include-any-file-attachments2 form-type-radios form-group"> <label class="control-label" for="edit-submitted-include-any-file-attachments2">Do you want to upload a second file attachment?</label> <div id="edit-submitted-include-any-file-attachments2" class="form-radios"><div class="form-item form-item-submitted-include-any-file-attachments2 form-type-radio radio"> <label class="control-label" for="edit-submitted-include-any-file-attachments2-1"><input type="radio" id="edit-submitted-include-any-file-attachments2-1" name="submitted[include_any_file_attachments2]" value="Yes" class="form-radio" />Yes</label> </div><div class="form-item form-item-submitted-include-any-file-attachments2 form-type-radio radio"> <label class="control-label" for="edit-submitted-include-any-file-attachments2-2"><input type="radio" id="edit-submitted-include-any-file-attachments2-2" name="submitted[include_any_file_attachments2]" value="No" class="form-radio" />No</label> </div></div></div><div id="edit-submitted-upload-file-attachment2-ajax-wrapper"><div class="form-item webform-component webform-component-file webform-component--upload-file-attachment2 form-group form-item form-item-submitted-upload-file-attachment2 form-type-managed-file form-group"> <label class="control-label" for="edit-submitted-upload-file-attachment2">Upload second file attachment</label> <div class="form-managed-file input-group"><input type="hidden" name="submitted[upload_file_attachment2][fid]" value="0" /> <input class="form-control form-file" type="file" id="edit-submitted-upload-file-attachment2-upload" name="files[submitted_upload_file_attachment2]" size="22" /><span class="input-group-btn"><button class="btn-primary btn form-submit icon-before" type="submit" id="edit-submitted-upload-file-attachment2-upload-button" name="submitted_upload_file_attachment2_upload_button" value="Upload"><span class="icon glyphicon glyphicon-upload" aria-hidden="true"></span> Upload</button> </span></div><div class="help-block"><a href="#" data-toggle="popover" data-target="#upload-instructions--2" data-html="1" data-placement="bottom" data-title="File requirements"><span class="icon glyphicon glyphicon-question-sign" aria-hidden="true"></span> More information</a><div id="upload-instructions--2" class="element-invisible help-block"><ul><li>Files must be less than <strong>4 MB</strong>.</li> <li>Allowed file types: <strong>pdf doc docx xls xlsx</strong>.</li> </ul></div></div></div></div><div class="form-item webform-component webform-component-textfield webform-component--description-of-file-attachment2 form-group form-item form-item-submitted-description-of-file-attachment2 form-type-textfield form-group"> <label class="control-label" for="edit-submitted-description-of-file-attachment2">Description of second file attachment</label> <input class="form-control form-text" type="text" id="edit-submitted-description-of-file-attachment2" name="submitted[description_of_file_attachment2]" value="" size="60" maxlength="128" /></div><div class="form-item webform-component webform-component-radios webform-component--include-any-file-attachments3 form-group form-item form-item-submitted-include-any-file-attachments3 form-type-radios form-group"> <label class="control-label" for="edit-submitted-include-any-file-attachments3">Do you want to upload a third file attachment?</label> <div id="edit-submitted-include-any-file-attachments3" class="form-radios"><div class="form-item form-item-submitted-include-any-file-attachments3 form-type-radio radio"> <label class="control-label" for="edit-submitted-include-any-file-attachments3-1"><input type="radio" id="edit-submitted-include-any-file-attachments3-1" name="submitted[include_any_file_attachments3]" value="Yes" class="form-radio" />Yes</label> </div><div class="form-item form-item-submitted-include-any-file-attachments3 form-type-radio radio"> <label class="control-label" for="edit-submitted-include-any-file-attachments3-2"><input type="radio" id="edit-submitted-include-any-file-attachments3-2" name="submitted[include_any_file_attachments3]" value="No" class="form-radio" />No</label> </div></div></div><div id="edit-submitted-upload-file-attachment3-ajax-wrapper"><div class="form-item webform-component webform-component-file webform-component--upload-file-attachment3 form-group form-item form-item-submitted-upload-file-attachment3 form-type-managed-file form-group"> <label class="control-label" for="edit-submitted-upload-file-attachment3">Upload third file attachment</label> <div class="form-managed-file input-group"><input type="hidden" name="submitted[upload_file_attachment3][fid]" value="0" /> <input class="form-control form-file" type="file" id="edit-submitted-upload-file-attachment3-upload" name="files[submitted_upload_file_attachment3]" size="22" /><span class="input-group-btn"><button class="btn-primary btn form-submit icon-before" type="submit" id="edit-submitted-upload-file-attachment3-upload-button" name="submitted_upload_file_attachment3_upload_button" value="Upload"><span class="icon glyphicon glyphicon-upload" aria-hidden="true"></span> Upload</button> </span></div><div class="help-block"><a href="#" data-toggle="popover" data-target="#upload-instructions--3" data-html="1" data-placement="bottom" data-title="File requirements"><span class="icon glyphicon glyphicon-question-sign" aria-hidden="true"></span> More information</a><div id="upload-instructions--3" class="element-invisible help-block"><ul><li>Files must be less than <strong>4 MB</strong>.</li> <li>Allowed file types: <strong>pdf doc docx xls xlsx</strong>.</li> </ul></div></div></div></div><div class="form-item webform-component webform-component-textfield webform-component--description-of-file-attachment3 form-group form-item form-item-submitted-description-of-file-attachment3 form-type-textfield form-group"> <label class="control-label" for="edit-submitted-description-of-file-attachment3">Description of third file attachment</label> <input class="form-control form-text" type="text" id="edit-submitted-description-of-file-attachment3" name="submitted[description_of_file_attachment3]" value="" size="60" maxlength="128" /></div><div class="form-item webform-component webform-component-radios webform-component--include-any-file-attachments4 form-group form-item form-item-submitted-include-any-file-attachments4 form-type-radios form-group"> <label class="control-label" for="edit-submitted-include-any-file-attachments4">Do you want to upload a fourth file attachment?</label> <div id="edit-submitted-include-any-file-attachments4" class="form-radios"><div class="form-item form-item-submitted-include-any-file-attachments4 form-type-radio radio"> <label class="control-label" for="edit-submitted-include-any-file-attachments4-1"><input type="radio" id="edit-submitted-include-any-file-attachments4-1" name="submitted[include_any_file_attachments4]" value="Yes" class="form-radio" />Yes</label> </div><div class="form-item form-item-submitted-include-any-file-attachments4 form-type-radio radio"> <label class="control-label" for="edit-submitted-include-any-file-attachments4-2"><input type="radio" id="edit-submitted-include-any-file-attachments4-2" name="submitted[include_any_file_attachments4]" value="No" class="form-radio" />No</label> </div></div></div><div id="edit-submitted-upload-file-attachment4-ajax-wrapper"><div class="form-item webform-component webform-component-file webform-component--upload-file-attachment4 form-group form-item form-item-submitted-upload-file-attachment4 form-type-managed-file form-group"> <label class="control-label" for="edit-submitted-upload-file-attachment4">Upload fourth file attachment</label> <div class="form-managed-file input-group"><input type="hidden" name="submitted[upload_file_attachment4][fid]" value="0" /> <input class="form-control form-file" type="file" id="edit-submitted-upload-file-attachment4-upload" name="files[submitted_upload_file_attachment4]" size="22" /><span class="input-group-btn"><button class="btn-primary btn form-submit icon-before" type="submit" id="edit-submitted-upload-file-attachment4-upload-button" name="submitted_upload_file_attachment4_upload_button" value="Upload"><span class="icon glyphicon glyphicon-upload" aria-hidden="true"></span> Upload</button> </span></div><div class="help-block"><a href="#" data-toggle="popover" data-target="#upload-instructions--4" data-html="1" data-placement="bottom" data-title="File requirements"><span class="icon glyphicon glyphicon-question-sign" aria-hidden="true"></span> More information</a><div id="upload-instructions--4" class="element-invisible help-block"><ul><li>Files must be less than <strong>4 MB</strong>.</li> <li>Allowed file types: <strong>pdf doc docx xls xlsx</strong>.</li> </ul></div></div></div></div><div class="form-item webform-component webform-component-textfield webform-component--description-of-file-attachment4 form-group form-item form-item-submitted-description-of-file-attachment4 form-type-textfield form-group"> <label class="control-label" for="edit-submitted-description-of-file-attachment4">Description of fourth file attachment</label> <input class="form-control form-text" type="text" id="edit-submitted-description-of-file-attachment4" name="submitted[description_of_file_attachment4]" value="" size="60" maxlength="128" /></div><div class="form-item webform-component webform-component-radios webform-component--include-any-file-attachments5 form-group form-item form-item-submitted-include-any-file-attachments5 form-type-radios form-group"> <label class="control-label" for="edit-submitted-include-any-file-attachments5">Do you want to upload a fifth file attachment?</label> <div id="edit-submitted-include-any-file-attachments5" class="form-radios"><div class="form-item form-item-submitted-include-any-file-attachments5 form-type-radio radio"> <label class="control-label" for="edit-submitted-include-any-file-attachments5-1"><input type="radio" id="edit-submitted-include-any-file-attachments5-1" name="submitted[include_any_file_attachments5]" value="Yes" class="form-radio" />Yes</label> </div><div class="form-item form-item-submitted-include-any-file-attachments5 form-type-radio radio"> <label class="control-label" for="edit-submitted-include-any-file-attachments5-2"><input type="radio" id="edit-submitted-include-any-file-attachments5-2" name="submitted[include_any_file_attachments5]" value="No" class="form-radio" />No</label> </div></div></div><div id="edit-submitted-upload-file-attachment5-ajax-wrapper"><div class="form-item webform-component webform-component-file webform-component--upload-file-attachment5 form-group form-item form-item-submitted-upload-file-attachment5 form-type-managed-file form-group"> <label class="control-label" for="edit-submitted-upload-file-attachment5">Upload fifth file attachment</label> <div class="form-managed-file input-group"><input type="hidden" name="submitted[upload_file_attachment5][fid]" value="0" /> <input class="form-control form-file" type="file" id="edit-submitted-upload-file-attachment5-upload" name="files[submitted_upload_file_attachment5]" size="22" /><span class="input-group-btn"><button class="btn-primary btn form-submit icon-before" type="submit" id="edit-submitted-upload-file-attachment5-upload-button" name="submitted_upload_file_attachment5_upload_button" value="Upload"><span class="icon glyphicon glyphicon-upload" aria-hidden="true"></span> Upload</button> </span></div><div class="help-block"><a href="#" data-toggle="popover" data-target="#upload-instructions--5" data-html="1" data-placement="bottom" data-title="File requirements"><span class="icon glyphicon glyphicon-question-sign" aria-hidden="true"></span> More information</a><div id="upload-instructions--5" class="element-invisible help-block"><ul><li>Files must be less than <strong>4 MB</strong>.</li> <li>Allowed file types: <strong>pdf doc docx xls xlsx</strong>.</li> </ul></div></div></div></div><div class="form-item webform-component webform-component-textfield webform-component--description-of-file-attachment5 form-group form-item form-item-submitted-description-of-file-attachment5 form-type-textfield form-group"> <label class="control-label" for="edit-submitted-description-of-file-attachment5">Description of fifth file attachment</label> <input class="form-control form-text" type="text" id="edit-submitted-description-of-file-attachment5" name="submitted[description_of_file_attachment5]" value="" size="60" maxlength="128" /></div><input type="hidden" name="details[sid]" /> <input type="hidden" name="details[page_num]" value="1" /> <input type="hidden" name="details[page_count]" value="1" /> <input type="hidden" name="details[finished]" value="0" /> <input type="hidden" name="form_build_id" value="form-LOz-a1vJHbP3dHTUdeqS_XDT_aXqMWrsi4_OTMPvMi4" /> <input type="hidden" name="form_id" value="webform_client_form_572545" /> <div class="captcha"><input type="hidden" name="captcha_sid" value="62733809" /> <input type="hidden" name="captcha_token" value="0f603e2abec0e6bc0c5161cab04beeaa" /> <input type="hidden" name="captcha_response" value="Google no captcha" /> <div class="g-recaptcha" data-sitekey="6Lfrk8wSAAAAAKES_8gODs0LOWq-jzEVPIWKl-BX" data-theme="light" data-type="image"></div></div><div class="form-actions"><button class="webform-submit button-primary 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