<div class=lux_body> <div style="background-color: white; color: black"> <div class=container-fluid><div class=row> <div class="col-md-offset-2 col-md-8 col-sm-offset-1 col-sm-10 col-xs-12"> <h2>Request Password Reset</h2> <div class="uio"> <form method=POST name=passform action="forgot_pass.pl"> <input type=hidden name=settheme value="345599990237"> <input type=hidden name=menu value="getpass"> <input type=hidden name=language value="en"> <h3>What is Your Login?</h3> <div id="notex_1" class="note"> <img border=0 style=";box-sizing: content-box;vertical-align:middle" src="//d4hm2u4pioc0c.cloudfront.net/icons/png/o/office/16x16/note_pinned.png" width="16" height="16">  Please fill out this form to begin your password reset request. In the next steps we will verify your identity using information currently saved in your profile, including your Secret Question and Answer, alternate email address, and SMS text messaging address. If your identity cannot be reliably verified or there is insufficient information in your profile, you will have to contact your account administrator directly for assistance. </div> <table class=new_form> <tr><th class=big> <label for="email">Username</label> </td> <td> <input required placeholder="user@domain.com" type=email style="width:100%" name=email id=email class=big value=""> </td></tr> <tr><th class=empty><br></th><td class=cap> <div class=capcha> <p>Please type the text seen in the image, below, into the "Security Code" box.</p> <p><img src="/cgi-bin/extranet/cap.pl/image.jpg?md5=83d594613c7dbe732bdeaf924f7f963c" width=150 height=50 border=0></p> <p>Security Code: <input required type=text size=6 maxlength=6 name=cap_test></p> <p><small><span style="color:#888">The security code is the text that you see in the image, above. Use of this code helps us prevent abuse of this form by automated programs.</span></small></p> <input type=hidden name=cap_md5 value="83d594613c7dbe732bdeaf924f7f963c"> </div> </td></tr> <tr><th class=empty><br></th><td> <input type=button class=menubutton onClick="document.location='login.pl?username=&settheme=345599990237&language=en';" value="< Back"> <input name=_submit_request_ value="Next Step >" class="btn btn-primary" type=submit> </td></tr> </table> </form> </div> </div></div></div> </div> </div></div></div> <div id=_last style="height:1px;visibility:hidden"></div> <script src="//claimassistsupport.com/perl/member/ctx/get.pl/ODgtjIFIPAv57qQyBzfhV1foR0DWMuJ8oRZJPdH61Bv./ctx/global_public.var"></script> <script src="//claimassistsupport.com/_v2019.4.13/js/cke4.7.3/ckeditor.var"></script> </body></html>