{"id":79,"date":"2022-04-14T20:37:53","date_gmt":"2022-04-15T00:37:53","guid":{"rendered":"https:\/\/crcebo.net\/?page_id=79"},"modified":"2026-01-27T01:19:22","modified_gmt":"2026-01-27T06:19:22","slug":"need-help","status":"publish","type":"page","link":"https:\/\/crcebo.net\/need-help\/","title":{"rendered":"Need Help?"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; admin_label=&#8221;Our Approach&#8221; _builder_version=&#8221;4.16.0&#8243; _module_preset=&#8221;default&#8221; custom_padding=&#8221;0px||||false|false&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row admin_label=&#8221;Image Container Row&#8221; _builder_version=&#8221;4.16.0&#8243; _module_preset=&#8221;default&#8221; background_image=&#8221;https:\/\/crcebo.net\/wp-content\/uploads\/2022\/04\/cr-about-2x-scaled.jpg&#8221; width=&#8221;100%&#8221; max_width=&#8221;100%&#8221; custom_margin=&#8221;||90px||false|false&#8221; custom_padding=&#8221;||0px|||&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.16.0&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.27.5&#8243; _module_preset=&#8221;default&#8221; text_text_color=&#8221;#FFFFFF&#8221; header_font=&#8221;Lato|||on|||||&#8221; header_text_color=&#8221;#F3F3F3&#8243; header_font_size=&#8221;20px&#8221; header_2_font=&#8221;Arvo||||||||&#8221; header_2_text_color=&#8221;#F3F3F3&#8243; header_2_font_size=&#8221;45px&#8221; header_3_font=&#8221;Arvo||||||||&#8221; header_3_text_color=&#8221;#FFFFFF&#8221; header_3_font_size=&#8221;45px&#8221; background_color=&#8221;rgba(74,74,74,0.9)&#8221; text_orientation=&#8221;center&#8221; max_width=&#8221;800px&#8221; module_alignment=&#8221;center&#8221; custom_margin=&#8221;40vh||-60px||false|false&#8221; custom_padding=&#8221;60px|30px|60px|30px|true|true&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h1>Have Questions About Your Bill? Start Here.<\/h1>\n<h2>Account Resolution &amp; Billing Support Forms<\/h2>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=&#8221;4.17.4&#8243; _module_preset=&#8221;default&#8221; custom_padding=&#8221;60px||0px||false|false&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.16.0&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.27.5&#8243; _module_preset=&#8221;default&#8221; text_text_color=&#8221;#4A4A4A&#8221; text_orientation=&#8221;justified&#8221; max_width=&#8221;680px&#8221; module_alignment=&#8221;center&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p>Managing an outstanding account can be stressful, but you don\u2019t have to navigate it alone. This page provides access to secure forms designed to help you request information, submit documentation, or ask questions about your account.<\/p>\n<p>Our team is available to provide billing support and guide you through available account resolution options in a clear and respectful manner.<\/p>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row column_structure=&#8221;3_5,2_5&#8243; _builder_version=&#8221;4.17.4&#8243; _module_preset=&#8221;default&#8221; custom_padding=&#8221;30px||60px||false|false&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;3_5&#8243; _builder_version=&#8221;4.16.0&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.27.5&#8243; _module_preset=&#8221;default&#8221; text_text_color=&#8221;#4A4A4A&#8221; text_orientation=&#8221;justified&#8221; max_width=&#8221;680px&#8221; module_alignment=&#8221;center&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p>You can also connect with our virtual assistant 24\/7 for quick responses to common questions.<\/p>\n<p>[\/et_pb_text][\/et_pb_column][et_pb_column type=&#8221;2_5&#8243; 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text_use_icon=&#8221;on&#8221; text_font_icon=&#8221;&#x69;||divi||400&#8243; link_type=&#8221;show&#8221; element_id=&#8221;adm-document&#8221; show_toggle=&#8221;off&#8221; show_mb_close=&#8221;off&#8221; _builder_version=&#8221;4.17.4&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;#7CB3A1&#8243; background_enable_color=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221; background__hover_enabled=&#8221;on|hover&#8221; background_color__hover=&#8221;#4A4A4A&#8221; background_enable_color__hover=&#8221;on&#8221; direction_last_edited=&#8221;on|tablet&#8221; direction_tablet=&#8221;column&#8221; direction_phone=&#8221;column&#8221; direction=&#8221;row&#8221; force_fullwidth=&#8221;on&#8221;][\/et_pb_divimenus_flex_item][et_pb_divimenus_flex_item title=&#8221;Dispute an Account or Claim&#8221; text_use_icon=&#8221;on&#8221; text_font_icon=&#8221;&#x73;||divi||400&#8243; link_type=&#8221;show&#8221; element_id=&#8221;adm-dispute&#8221; show_toggle=&#8221;off&#8221; 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Our client has billed your insurance and they have deemed it the patient\u2019s responsibility. To expedite the resolution of this debt, please refer to the back of your insurance card and there is a member portal where you can put in the date of service and provider, and it will tell you why the debt is owed by the patient via Explanation of Benefits (EOB). If after you have reviewed your EOB and it is determined that there was an error in billing or the amount of patient responsibility is not correct, please email us a copy of the EOB at contact@crcorp.net and we will handle it accordingly with our client. Duplicate requests for supporting documentation will not be provided. <\/div><\/div><fieldset id=\"field_1_3\" class=\"gfield gfield--type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_1_3'>\n                            \n                            <span id='input_1_3_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_3.3' id='input_1_3_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_1_3_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_1_3_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_3.6' id='input_1_3_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_1_3_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_1_4\" class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_1_4' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_1_4_1_container' >\n                                        <input type='text' name='input_4.1' id='input_1_4_1' value=''    aria-required='true'    \/>\n                                        <label for='input_1_4_1' id='input_1_4_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_1_4_2_container' >\n                                        <input type='text' name='input_4.2' id='input_1_4_2' value=''     aria-required='false'   \/>\n                                        <label for='input_1_4_2' id='input_1_4_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_1_4_3_container' >\n                                    <input type='text' name='input_4.3' id='input_1_4_3' value=''    aria-required='true'    \/>\n                                    <label for='input_1_4_3' id='input_1_4_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_1_4_4_container' >\n                                        <input type='text' name='input_4.4' id='input_1_4_4' value=''      aria-required='true'    \/>\n                                        <label for='input_1_4_4' id='input_1_4_4_label' class='gform-field-label gform-field-label--type-sub '>State \/ Province \/ Region<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_1_4_5_container' >\n                                    <input type='text' name='input_4.5' id='input_1_4_5' value=''    aria-required='true'    \/>\n                                    <label for='input_1_4_5' id='input_1_4_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_4.6' id='input_1_4_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_1_5\" class=\"gfield gfield--type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_5'>Email Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_5' id='input_1_5' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_1_6\" class=\"gfield gfield--type-phone gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_6'>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_6' id='input_1_6' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_8\" class=\"gfield gfield--type-number gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_8'>Amount Paid to Creditor<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_8' id='input_1_8' type='text' step='any'   value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_1_12\" class=\"gfield gfield--type-select gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_12'>Payment Method<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_12' id='input_1_12' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='--Please Select Your Payment Type--' >--Please Select Your Payment Type--<\/option><option value='Check' >Check<\/option><option value='Credit Card' >Credit Card<\/option><option value='Money Order' >Money Order<\/option><option value='Cash' >Cash<\/option><\/select><\/div><\/div><fieldset id=\"field_1_9\" class=\"gfield gfield--type-date gfield--input-type-datefield gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Date of Payment<\/legend><div id='input_1_9' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_1_9_1_container'>\n                                            <input type='number' maxlength='2' name='input_9[]' id='input_1_9_1' value=''   aria-required='false'   placeholder='MM' min='1' max='12' step='1'\/>\n                                            <label for='input_1_9_1' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Month<\/label>\n                                        <\/div><div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_1_9_2_container'>\n                                            <input type='number' maxlength='2' name='input_9[]' id='input_1_9_2' value=''   aria-required='false'   placeholder='DD' min='1' max='31' step='1'\/>\n                                            <label for='input_1_9_2' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Day<\/label>\n                                        <\/div><div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_1_9_3_container'>\n                                            <input type='number' maxlength='4' name='input_9[]' id='input_1_9_3' value=''   aria-required='false'   placeholder='YYYY' min='1920' max='2027' step='1'\/>\n                                            <label for='input_1_9_3' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Year<\/label>\n                                       <\/div>\n                                   <\/div><\/fieldset><div id=\"field_1_20\" class=\"gfield gfield--type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_20'>Check Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_20' id='input_1_20' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_1_14\" class=\"gfield gfield--type-date gfield--input-type-datefield gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Date of Check<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div id='input_1_14' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_1_14_1_container'>\n                                            <input type='number' maxlength='2' name='input_14[]' id='input_1_14_1' value=''   aria-required='true'   placeholder='MM' min='1' max='12' step='1'\/>\n                                            <label for='input_1_14_1' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Month<\/label>\n                                        <\/div><div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_1_14_2_container'>\n                                            <input type='number' maxlength='2' name='input_14[]' id='input_1_14_2' value=''   aria-required='true'   placeholder='DD' min='1' max='31' step='1'\/>\n                                            <label for='input_1_14_2' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Day<\/label>\n                                        <\/div><div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_1_14_3_container'>\n                                            <input type='number' maxlength='4' name='input_14[]' id='input_1_14_3' value=''   aria-required='true'   placeholder='YYYY' min='1920' max='2027' step='1'\/>\n                                            <label for='input_1_14_3' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Year<\/label>\n                                       <\/div>\n                                   <\/div><\/fieldset><fieldset id=\"field_1_15\" class=\"gfield gfield--type-date gfield--input-type-datefield gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Date Check Cleared Bank<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div id='input_1_15' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_1_15_1_container'>\n                                            <input type='number' maxlength='2' name='input_15[]' id='input_1_15_1' value=''   aria-required='true'   placeholder='MM' min='1' max='12' step='1'\/>\n                                            <label for='input_1_15_1' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Month<\/label>\n                                        <\/div><div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_1_15_2_container'>\n                                            <input type='number' maxlength='2' name='input_15[]' id='input_1_15_2' value=''   aria-required='true'   placeholder='DD' min='1' max='31' step='1'\/>\n                                            <label for='input_1_15_2' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Day<\/label>\n                                        <\/div><div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_1_15_3_container'>\n                                            <input type='number' maxlength='4' name='input_15[]' id='input_1_15_3' value=''   aria-required='true'   placeholder='YYYY' min='1920' max='2027' step='1'\/>\n                                            <label for='input_1_15_3' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Year<\/label>\n                                       <\/div>\n                                   <\/div><\/fieldset><div id=\"field_1_16\" class=\"gfield gfield--type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_16'>Type of Credit Card<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_16' id='input_1_16' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='--Select Your Card Type--' >--Select Your Card Type--<\/option><option value='Visa' >Visa<\/option><option value='Mastercard' >Mastercard<\/option><option value='Other' >Other<\/option><\/select><\/div><\/div><div id=\"field_1_21\" class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_21'>Last Four Digits on Credit Card<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_21' id='input_1_21' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_11\" class=\"gfield gfield--type-fileupload gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_1_11'>File Upload<\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_1_11' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_1_11&quot;,&quot;container&quot;:&quot;gform_multifile_upload_1_11&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_1_11&quot;,&quot;filelist&quot;:&quot;gform_preview_1_11&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/crcebo.net\\\/?gf_page=fc10cec2b98345d&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/crcebo.net\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/crcebo.net\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;png,jpg,jpeg,pdf,xps&quot;}],&quot;max_file_size&quot;:&quot;5242880b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:1,&quot;field_id&quot;:11},&quot;gf_vars&quot;:{&quot;max_files&quot;:&quot;3&quot;,&quot;message_id&quot;:&quot;gform_multifile_messages_1_11&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_1_11' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Drop files here or <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_1_11' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_1_11\"  >Select files<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_1_11'>Accepted file types: png, jpg, jpeg, pdf, xps, Max. file size: 5 MB, Max. files: 3.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_1_11'><\/ul> <!-- Leave <ul> empty to support CSS :empty selector. --><\/div><div id='gform_preview_1_11' class='ginput_preview_list'><\/div><\/div><fieldset id=\"field_1_18\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Terms &amp; Conditions<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_18'>\n\t\t\t<div class='gchoice gchoice_1_18_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='I have read and accepted the Terms &amp; Conditions stated below.'  id='choice_1_18_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_18_0' id='label_1_18_0' class='gform-field-label gform-field-label--type-inline'>I have read and accepted the Terms & Conditions stated below.<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_22\" class=\"gfield gfield--type-captcha gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_22'>CAPTCHA<\/label><div id='input_1_22' class='ginput_container ginput_recaptcha' data-sitekey='6LeWTYwfAAAAAOyDLitIBRpDehZQwubmtI-nfAmu'  data-theme='light' data-tabindex='0'  data-badge=''><\/div><\/div><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type='submit' id='gform_submit_button_1' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Submit'  \/> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_1' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_1' id='gform_theme_1' value='gravity-theme' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_1' id='gform_style_settings_1' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_1' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='1' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_1' value='WyJ7XCIxMlwiOltcIjc5ZjljYzE4ZDg3YTUzZGVhOTM3N2U0ZjJmZjE3MDU5XCIsXCJmYTI5MjE5M2EyNmZjMDkwMjBiYjMzZDVkNWEzMjgwY1wiLFwiNjMzM2Q5OThmM2QyYWVlY2U1MjE5OTQ4ZjgzYzY0ZDZcIixcImE2OGEzNDA2NjQ3MDNmMjg5YzNlZmNmZDRiZWNmZWMzXCIsXCIwZjgxYzQ0ZjcxYjI2OTNhNTE4NzQ2ZjFhNjk5YTFjZlwiXSxcIjE2XCI6W1wiYzI2ZWU2YzAzMGVlODA3ZGE0YTA5ZDAwYjQyZDg4ZmFcIixcIjAxYWMxMWE1NmJkZjU5NzQzMDcwZTM3NTAyZjNjOGJiXCIsXCJmMDVmNWU5YjEzNThmNzc3OTQ1MGUzYzg0ZTE0YWRmYlwiLFwiMWU2M2FjMmQ4ZWM0MDRjNGQ1ODQ1ZDBmODE3MGUwYjRcIl0sXCIxOFwiOltcIjc0M2FmNmIyN2U0YzUwZDI3MmRjNzQwMDY4YjEyYjIxXCJdfSIsIjQwMjk5NDQ5NzMzZjY0NTllZGFmODQ3M2Q2MDkzOTIwIl0=' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_1' id='gform_target_page_number_1' value='0' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_1' id='gform_source_page_number_1' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            <input type='hidden' name='gform_uploaded_files' id='gform_uploaded_files_1' value='' \/>\n        <\/div>\n                        <\/form>\n                        <\/div><script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\n gform.initializeOnLoaded( function() {gformInitSpinner( 1, 'https:\/\/crcebo.net\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_1').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_1');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_1').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){form_content.find('form').css('opacity', 0);jQuery('#gform_wrapper_1').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_1').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_1').removeClass('gform_validation_error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/  }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_1').val();gformInitSpinner( 1, 'https:\/\/crcebo.net\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery(document).trigger('gform_page_loaded', [1, current_page]);window['gf_submitting_1'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}jQuery('#gform_wrapper_1').replaceWith(confirmation_content);jQuery(document).trigger('gform_confirmation_loaded', [1]);window['gf_submitting_1'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_1').text());}else{jQuery('#gform_1').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger(\"gform_pre_post_render\", [{ formId: \"1\", currentPage: \"current_page\", abort: function() { this.preventDefault(); } }]);        if (event && event.defaultPrevented) {                return;        }        const gformWrapperDiv = document.getElementById( \"gform_wrapper_1\" );        if ( gformWrapperDiv ) {            const visibilitySpan = document.createElement( \"span\" );            visibilitySpan.id = \"gform_visibility_test_1\";            gformWrapperDiv.insertAdjacentElement( \"afterend\", visibilitySpan );        }        const visibilityTestDiv = document.getElementById( \"gform_visibility_test_1\" );        let postRenderFired = false;        function triggerPostRender() {            if ( postRenderFired ) {                return;            }            postRenderFired = true;            gform.core.triggerPostRenderEvents( 1, current_page );            if ( visibilityTestDiv ) {                visibilityTestDiv.parentNode.removeChild( visibilityTestDiv );            }        }        function debounce( func, wait, immediate ) {            var timeout;            return function() {                var context = this, args = arguments;                var later = function() {                    timeout = null;                    if ( !immediate ) func.apply( context, args );                };                var callNow = immediate && !timeout;                clearTimeout( timeout );                timeout = setTimeout( later, wait );                if ( callNow ) func.apply( context, args );            };        }        const debouncedTriggerPostRender = debounce( function() {            triggerPostRender();        }, 200 );        if ( visibilityTestDiv && visibilityTestDiv.offsetParent === null ) {            const observer = new MutationObserver( ( mutations ) => {                mutations.forEach( ( mutation ) => {                    if ( mutation.type === 'attributes' && visibilityTestDiv.offsetParent !== null ) {                        debouncedTriggerPostRender();                        observer.disconnect();                    }                });            });            observer.observe( document.body, {                attributes: true,                childList: false,                subtree: true,                attributeFilter: [ 'style', 'class' ],            });        } else {            triggerPostRender();        }    } );} ); \n\/* ]]> *\/\n<\/script>\n[\/et_pb_code][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; module_id=&#8221;adm-dispute&#8221; _builder_version=&#8221;4.20.0&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;#F3F3F3&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_row _builder_version=&#8221;4.17.1&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.17.1&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_code _builder_version=&#8221;4.20.0&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;]\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_2' >\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">Dispute an Account or Claim<\/h2>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_2'  action='\/api\/wp\/v2\/pages\/79' data-formid='2' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_2_12\" class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_12'>CRC Reference Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_12' id='input_2_12' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_2_3\" class=\"gfield gfield--type-name gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_2_3'>\n                            \n                            <span id='input_2_3_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_3.3' id='input_2_3_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_2_3_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_2_3_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_3.6' id='input_2_3_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_2_3_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_2_11\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_11'>Social Security Number<\/label><div class='ginput_container ginput_container_text'><input name='input_11' id='input_2_11' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_2_5\" class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_2_5' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_2_5_1_container' >\n                                        <input type='text' name='input_5.1' id='input_2_5_1' value=''    aria-required='true'    \/>\n                                        <label for='input_2_5_1' id='input_2_5_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_2_5_2_container' >\n                                        <input type='text' name='input_5.2' id='input_2_5_2' value=''     aria-required='false'   \/>\n                                        <label for='input_2_5_2' id='input_2_5_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_2_5_3_container' >\n                                    <input type='text' name='input_5.3' id='input_2_5_3' value=''    aria-required='true'    \/>\n                                    <label for='input_2_5_3' id='input_2_5_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_2_5_4_container' >\n                                        <input type='text' name='input_5.4' id='input_2_5_4' value=''      aria-required='true'    \/>\n                                        <label for='input_2_5_4' id='input_2_5_4_label' class='gform-field-label gform-field-label--type-sub '>State \/ Province \/ Region<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_2_5_5_container' >\n                                    <input type='text' name='input_5.5' id='input_2_5_5' value=''    aria-required='true'    \/>\n                                    <label for='input_2_5_5' id='input_2_5_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_5.6' id='input_2_5_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_2_10\" class=\"gfield gfield--type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_10'>Email Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_10' id='input_2_10' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_2_6\" class=\"gfield gfield--type-phone gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_6'>Phone<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_6' id='input_2_6' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_7\" class=\"gfield gfield--type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_7'>What is your dispute?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_7' id='input_2_7' class='textarea large'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_2_9\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Terms &amp; Conditions<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_2_9'>\n\t\t\t<div class='gchoice gchoice_2_9_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='I have read and accepted the Terms &amp; Conditions stated below.'  id='choice_2_9_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_9_0' id='label_2_9_0' class='gform-field-label gform-field-label--type-inline'>I have read and accepted the Terms & Conditions stated below.<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_13\" class=\"gfield gfield--type-captcha gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_13'>CAPTCHA<\/label><div id='input_2_13' class='ginput_container ginput_recaptcha' data-sitekey='6LeWTYwfAAAAAOyDLitIBRpDehZQwubmtI-nfAmu'  data-theme='light' data-tabindex='0'  data-badge=''><\/div><\/div><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type='submit' id='gform_submit_button_2' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Submit'  \/> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_2' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_2' id='gform_theme_2' value='gravity-theme' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_2' id='gform_style_settings_2' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_2' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='2' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_2' value='WyJ7XCI5XCI6W1wiNzQzYWY2YjI3ZTRjNTBkMjcyZGM3NDAwNjhiMTJiMjFcIl19IiwiZGFjZDhmNzNhNzU2NWIzZGY3ZjRhOGJmMTAwMzk0ZjciXQ==' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_2' id='gform_target_page_number_2' value='0' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_2' id='gform_source_page_number_2' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/form>\n                        <\/div><script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\n gform.initializeOnLoaded( function() {gformInitSpinner( 2, 'https:\/\/crcebo.net\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_2').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_2');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_2').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){jQuery('#gform_wrapper_2').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_2').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_2').removeClass('gform_validation_error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/  }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_2').val();gformInitSpinner( 2, 'https:\/\/crcebo.net\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery(document).trigger('gform_page_loaded', [2, current_page]);window['gf_submitting_2'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}jQuery('#gform_wrapper_2').replaceWith(confirmation_content);jQuery(document).trigger('gform_confirmation_loaded', [2]);window['gf_submitting_2'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_2').text());}else{jQuery('#gform_2').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger(\"gform_pre_post_render\", [{ formId: \"2\", currentPage: \"current_page\", abort: function() { this.preventDefault(); } }]);        if (event && event.defaultPrevented) {                return;        }        const gformWrapperDiv = document.getElementById( \"gform_wrapper_2\" );        if ( gformWrapperDiv ) {            const visibilitySpan = document.createElement( \"span\" );            visibilitySpan.id = \"gform_visibility_test_2\";            gformWrapperDiv.insertAdjacentElement( \"afterend\", visibilitySpan );        }        const visibilityTestDiv = document.getElementById( \"gform_visibility_test_2\" );        let postRenderFired = false;        function triggerPostRender() {            if ( postRenderFired ) {                return;            }            postRenderFired = true;            gform.core.triggerPostRenderEvents( 2, current_page );            if ( visibilityTestDiv ) {                visibilityTestDiv.parentNode.removeChild( visibilityTestDiv );            }        }        function debounce( func, wait, immediate ) {            var timeout;            return function() {                var context = this, args = arguments;                var later = function() {                    timeout = null;                    if ( !immediate ) func.apply( context, args );                };                var callNow = immediate && !timeout;                clearTimeout( timeout );                timeout = setTimeout( later, wait );                if ( callNow ) func.apply( context, args );            };        }        const debouncedTriggerPostRender = debounce( function() {            triggerPostRender();        }, 200 );        if ( visibilityTestDiv && visibilityTestDiv.offsetParent === null ) {            const observer = new MutationObserver( ( mutations ) => {                mutations.forEach( ( mutation ) => {                    if ( mutation.type === 'attributes' && visibilityTestDiv.offsetParent !== null ) {                        debouncedTriggerPostRender();                        observer.disconnect();                    }                });            });            observer.observe( document.body, {                attributes: true,                childList: false,                subtree: true,                attributeFilter: [ 'style', 'class' ],            });        } else {            triggerPostRender();        }    } );} ); \n\/* ]]> *\/\n<\/script>\n[\/et_pb_code][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; module_id=&#8221;adm-document&#8221; _builder_version=&#8221;4.20.0&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;#F3F3F3&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_row _builder_version=&#8221;4.17.1&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.17.1&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_code _builder_version=&#8221;4.20.0&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;]\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_3' >\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">Request Documentation Regarding Your Account<\/h2>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_3'  action='\/api\/wp\/v2\/pages\/79' data-formid='3' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_3_17\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_17'>Account Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_17' id='input_3_17' type='text' value='' class='large'  aria-describedby=\"gfield_description_3_17\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_3_17'>If your account is a medical debt, we have previously provided you with the provider\u2019s name, amount and date of service for the balance owed. Our client has billed your insurance and they have deemed it the patient\u2019s responsibility. To expedite the resolution of this debt, please refer to the back of your insurance card and there is a member portal where you can put in the date of service and provider, and it will tell you why the debt is owed by the patient via Explanation of Benefits (EOB). If after you have reviewed your EOB and it is determined that there was an error in billing or the amount of patient responsibility is not correct, please email us a copy of the EOB at contact@crcorp.net and we will handle it accordingly with our client. Duplicate requests for supporting documentation will not be provided. <\/div><\/div><fieldset id=\"field_3_3\" class=\"gfield gfield--type-name gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_3_3'>\n                            \n                            <span id='input_3_3_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_3.3' id='input_3_3_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_3_3_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_3_3_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_3.6' id='input_3_3_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_3_3_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_3_19\" class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_19'>Birth Year<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_19' id='input_3_19' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_3_4\" class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_3_4' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_3_4_1_container' >\n                                        <input type='text' name='input_4.1' id='input_3_4_1' value=''    aria-required='true'    \/>\n                                        <label for='input_3_4_1' id='input_3_4_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_3_4_2_container' >\n                                        <input type='text' name='input_4.2' id='input_3_4_2' value=''     aria-required='false'   \/>\n                                        <label for='input_3_4_2' id='input_3_4_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_3_4_3_container' >\n                                    <input type='text' name='input_4.3' id='input_3_4_3' value=''    aria-required='true'    \/>\n                                    <label for='input_3_4_3' id='input_3_4_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_3_4_4_container' >\n                                        <input type='text' name='input_4.4' id='input_3_4_4' value=''      aria-required='true'    \/>\n                                        <label for='input_3_4_4' id='input_3_4_4_label' class='gform-field-label gform-field-label--type-sub '>State \/ Province \/ Region<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_3_4_5_container' >\n                                    <input type='text' name='input_4.5' id='input_3_4_5' value=''    aria-required='true'    \/>\n                                    <label for='input_3_4_5' id='input_3_4_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_4.6' id='input_3_4_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_3_15\" class=\"gfield gfield--type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_15'>Email Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_15' id='input_3_15' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_3_6\" class=\"gfield gfield--type-phone gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_6'>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_6' id='input_3_6' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_12\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_12'>Requested Documentation<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_12' id='input_3_12' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_3_16\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Terms &amp; Conditions<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_3_16'>\n\t\t\t<div class='gchoice gchoice_3_16_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='I have read and accepted the Terms &amp; Conditions stated below.'  id='choice_3_16_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_16_0' id='label_3_16_0' class='gform-field-label gform-field-label--type-inline'>I have read and accepted the Terms & Conditions stated below.<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_3_20\" class=\"gfield gfield--type-captcha gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_20'>CAPTCHA<\/label><div id='input_3_20' class='ginput_container ginput_recaptcha' data-sitekey='6LeWTYwfAAAAAOyDLitIBRpDehZQwubmtI-nfAmu'  data-theme='light' data-tabindex='0'  data-badge=''><\/div><\/div><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type='submit' 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         });        } else {            triggerPostRender();        }    } );} ); \n\/* ]]> *\/\n<\/script>\n[\/et_pb_code][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; custom_padding=&#8221;0px||||false|false&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.27.5&#8243; _module_preset=&#8221;default&#8221; hover_enabled=&#8221;0&#8243; global_colors_info=&#8221;{}&#8221; sticky_enabled=&#8221;0&#8243;]<\/p>\n<p>CR Corp Extended Business Office<br \/>POB 4100 Canton,<br \/>GA 30114<br \/>Phone: 888-925-8150<br \/>Fax: 770-216-9353<br \/>Email: <a href=\"mailto:contact@crcorp.net\">contact@crcorp.net<\/a><br \/>To consent to text messaging: text CONTACT to 407-270-0528<\/p>\n<p><strong>TERMS &amp; CONDITIONS:<\/strong><\/p>\n<p>By checking the \u201cAccept Terms &amp; Conditions\u201d box above, you confirm that you are the named individual associated with this account or are otherwise authorized to review and discuss the information related to it.<\/p>\n<p>You authorize CR Corp Extended Business Office and its representatives to contact you regarding account-related and billing support matters using the contact information you provide. Communications may include phone calls, prerecorded or artificial voice messages, text messages, or electronic messages, including those sent using automated systems, where permitted by law.<\/p>\n<p>You acknowledge that the phone number(s) and email address you provide belong to you, are secure, and are not accessible by unauthorized third parties. Communications will be used solely for account resolution, billing support, and customer service purposes.<\/p>\n<p><strong>COMMUNICATION CONSENT<\/strong><\/p>\n<p>By submitting this form, you consent to receive communications from CR Corp Extended Business Office related to your account. These communications may be delivered via telephone, email, or text message to assist with account support and resolution.<\/p>\n<p>Message and data rates may apply. Message frequency may vary. You may opt out of text communications at any time by replying STOP.<\/p>\n<p><strong>PRIVACY NOTICE<\/strong><\/p>\n<p>CR Corp Extended Business Office respects your privacy and does not sell your personal information.<\/p>\n<p>Information collected through this site is used only to provide billing support, respond to inquiries, and assist with account resolution.<\/p>\n<p>To review, update, or change your contact information, please log in to the secure online portal and select \u201cMy Account\u201d, then \u201cUpdate Account Information.\u201d<\/p>\n<p><strong>IMPORTANT NOTICE<\/strong><\/p>\n<p>This site and its forms are provided for billing support and account resolution purposes only.<br \/>No collections-related disclosures or regulatory notices apply to the use of this site.<\/p>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; disabled_on=&#8221;on|on|on&#8221; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; disabled=&#8221;on&#8221; global_module=&#8221;166&#8243; saved_tabs=&#8221;all&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row _builder_version=&#8221;4.17.1&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.17.1&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p>Capital Recovery Corporation<br \/>POB 4100<br \/>Canton, GA 30114<br \/>Phone: 800-456-8448<br \/>Fax: 770-216-9353<br \/>Email: contact@crcorp.net<br \/>To opt into text messagine send EBO to 407-570-0528<\/p>\n<p>[\/et_pb_text][et_pb_text disabled_on=&#8221;on|on|on&#8221; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; disabled=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p>Capital Recovery Corporation<br \/>POB 4100<br \/>Canton, GA 30114<br \/>Phone: 800-456-8448<br \/>Fax: 770-216-9353<br \/>Email: contact@crcorp.net<br \/>To consent to text messaging: text CRC to 74776<\/p>\n<p>[\/et_pb_text][et_pb_text _builder_version=&#8221;4.17.1&#8243; _module_preset=&#8221;default&#8221; header_2_font_size=&#8221;36px&#8221; header_3_font_size=&#8221;30px&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h2>TERMS &amp; CONDITIONS:<\/h2>\n<p>By checking the &#8220;Accept Terms &amp; Conditions&#8221; box above you are asserting that you are the named individual on this account and are authorized to review and discuss the personal information contained in the account. Furthermore, you are expressly authorizing Capital Recovery Corporation, representatives to contact you or responsible party, including but not limited to contact via prerecorded messages, artificial voice messages, text or electronic messages and calls made by an automatic telephone dialing system, at any phone number or any cellular phone, which could result in charges to you, or other wireless device including any cellular phone number you currently have or will have in the future and at any e-mail provided for the purpose of contact in connection with resolution of this account. You agree that both the cell phone number(s) and\/or e-mail address you provide belong to you, are secure and cannot be listened to or viewed by unauthorized third parties.<\/p>\n<p>[\/et_pb_text][et_pb_text _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; header_2_font_size=&#8221;36px&#8221; header_3_font_size=&#8221;30px&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h3>Acceptance of mini miranda and disclosures:<\/h3>\n<p>We are required under state law to notify consumers of the following rights. This list does not contain a complete list of the rights consumers have under federal, state, or local law.<\/p>\n<p>[\/et_pb_text][et_pb_text disabled_on=&#8221;on|on|on&#8221; _builder_version=&#8221;4.18.0&#8243; _module_preset=&#8221;default&#8221; header_2_font_size=&#8221;36px&#8221; header_3_font_size=&#8221;30px&#8221; disabled=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h3>For State of California Consumers:<\/h3>\n<p>If the account listed is medical in nature the state requires us to inform you, \u201cNonprofit credit counseling services may be available in the area\u201d.<\/p>\n<p>The state Rosenthal Fair Debt Collection Practices Act and the federal Fair Debt Collection Practices Act require that, except under unusual circumstances, collectors may not contact you before 8 a.m. or after 9 p.m. They may not harass you by using threats of violence or arrest or by using obscene language. Collectors may not use false or misleading statements or call you at work if they know or have reason to know that you may not receive personal calls at work. For the most part, collectors may not tell another person, other than your attorney or spouse, about your debt. Collectors may contact another person to confirm your location or enforce a judgment. For more information about debt collection activities, you may contact the Federal Trade Commission at <a href=\"tel:18773824357\" target=\"_blank\" rel=\"noopener\">1-877-FTC-HELP<\/a> or <a href=\"https:\/\/www.ftc.gov\" target=\"_blank\" rel=\"noopener\">www.ftc.gov<\/a>.<\/p>\n<p>Capital Recovery Corporation does not sell your personal information. To change or delete your contact information, please log onto the Secure Online Portal at <a href=\"https:\/\/crcorp.interprose.com\/login.do?customerID=CRCORP\" target=\"_blank\" rel=\"noopener\">https:\/\/crcorp.interprose.com\/login.do?customerID=CRCORPhttps:\/\/www.clientaccessweb.com\/CRC\/Payments\/<\/a> and click on &#8220;My Account&#8221; and then &#8220;Update Account Information\u201d.<\/p>\n<p>[\/et_pb_text][et_pb_text disabled_on=&#8221;on|on|on&#8221; _builder_version=&#8221;4.17.1&#8243; _module_preset=&#8221;default&#8221; header_2_font_size=&#8221;36px&#8221; header_3_font_size=&#8221;30px&#8221; disabled=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h3>For State of New York Consumers:<\/h3>\n<p>If a creditor or debt collector receives a money judgment against you in court, state and federal laws may prevent the following types of income from being taken to pay the debt: Supplemental security income, social security, public assistance, spousal support, maintenance (alimony) or child support, unemployment benefits, disability benefits, workers\u2019 compensation benefits, public or private pensions, veterans\u2019 benefits, federal student loans, federal student grants, and federal work study funds, and ninety percent of your wages or salary earned in the last sixty days.<\/p>\n<p>Debt collectors are prohibited from engaging in abusive, deceptive, and unfair debt collection efforts, including but not limited to: The use or threat of violence, the use of obscene or profane language, and repeated phone calls made with the intent to annoy, abuse, or harass.<\/p>\n<p>[\/et_pb_text][et_pb_text disabled_on=&#8221;on|on|on&#8221; _builder_version=&#8221;4.17.1&#8243; _module_preset=&#8221;default&#8221; header_2_font_size=&#8221;36px&#8221; header_3_font_size=&#8221;30px&#8221; disabled=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h3>For City of New York Consumers:<\/h3>\n<p>New York City Department of Consumer Affairs License Number: 2057060-DCA. Capital Recovery Corporation conducts its business in English and does not provide any language access services or translations in any other language; The New York City Department of Consumer Affairs provides a translation and description of commonly used debt collection terms available in multiple languages on the Departments\u2019 website, <a href=\"https:\/\/www.nyc.gov\/dca\" target=\"_blank\" rel=\"noopener\">www.nyc.gov\/dca<\/a><\/p>\n<p>[\/et_pb_text][et_pb_text disabled_on=&#8221;on|on|on&#8221; _builder_version=&#8221;4.17.1&#8243; _module_preset=&#8221;default&#8221; header_2_font_size=&#8221;36px&#8221; header_3_font_size=&#8221;30px&#8221; disabled=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h3>For State of Tennessee Consumers:<\/h3>\n<p>Capital Recovery Corporation is licensed by the Collection Service Board, State Department of Commerce and Insurance.<\/p>\n<p>[\/et_pb_text][et_pb_text disabled_on=&#8221;on|on|on&#8221; _builder_version=&#8221;4.17.4&#8243; _module_preset=&#8221;default&#8221; header_2_font_size=&#8221;36px&#8221; header_3_font_size=&#8221;30px&#8221; disabled=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h3>For Colorado State Consumers:<\/h3>\n<p>FOR INFORMATION ABOUT THE COLORADO FAIR DEBT COLLECTION PRACTICES ACT, SEE<br \/><a href=\"https:\/\/coag.gov\/office-sections\/consumer-protection\/consumer-credit-unit\/collection-agency-regulation\/\" target=\"_blank\" rel=\"noopener\">https:\/\/coag.gov\/office-sections\/consumer-protection\/consumer-credit-unit\/collection-agency-regulation\/<\/a><\/p>\n<p>A consumer has the right to request in writing that a debt collector or collection agency cease further communication with the consumer. A written request to cease communication will not prohibit the debt collector or collection agency from taking any other action authorized by law to collect the debt.<\/p>\n<p>Capital Recovery\u2019s Local Colorado Office:<br \/>8690 Wolff Court, Suite 110<br \/>Westminster, CO 80031<br \/>(303) 920-4763<\/p>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Have Questions About Your Bill? Start Here. Account Resolution &amp; Billing Support FormsManaging an outstanding account can be stressful, but you don\u2019t have to navigate it alone. This page provides access to secure forms designed to help you request information, submit documentation, or ask questions about your account. 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