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- <form class="mb-4 cb-form" autocomplete="off" method="POST" data-success-path="/content/help/language-masters/en/contact-us/success.html">
- <section class="cb-form__field cb-form__field--full ">
- <label class="cb-form__label" for="s_Product__c">Choose your product<span class="cb-form__required">*</span></label>
- <div class="sf01-support-form__styled-products">
- <label class="sf01-support-form__styled-product">
- <img src="/content/dam/help/logos/product-dropdown/coinbase-dot.svg">
- <span class="sf01-support-form__styled-product-label">Coinbase</span>
- <input type="radio" name="s_Product__c" data-filter="coinbase" data-type="product" value="Coinbase">
- </label>
- <label class="sf01-support-form__styled-product">
- <img src="/content/dam/help/logos/product-dropdown/coinbase-pro-dot.svg">
- <span class="sf01-support-form__styled-product-label">Coinbase Pro</span>
- <input type="radio" name="s_Product__c" data-filter="coinbase_pro" data-type="product" value="Coinbase Pro">
- </label>
- <label class="sf01-support-form__styled-product">
- <img src="/content/dam/help/logos/product-dropdown/coinbase-custody-dot.svg">
- <span class="sf01-support-form__styled-product-label">Coinbase Custody</span>
- <input type="radio" name="s_Product__c" data-filter="coinbase_custody" data-type="product" value="Coinbase Custody">
- </label>
- <label class="sf01-support-form__styled-product">
- <img src="/content/dam/help/logos/product-dropdown/coinbase-commerce-dot.svg">
- <span class="sf01-support-form__styled-product-label">Coinbase Commerce</span>
- <input type="radio" name="s_Product__c" data-filter="coinbase_commerce" data-type="product" value="Coinbase Commerce">
- </label>
- <label class="sf01-support-form__styled-product">
- <img src="/content/dam/help/logos/product-dropdown/coinbase-other-dot.svg">
- <span class="sf01-support-form__styled-product-label">Other</span>
- <input type="radio" name="s_Product__c" data-filter="other" data-type="product" value="Other">
- </label>
- </div>
- </section>
- <section class="sf01-support-form__dropdowns">
- <section class="cb-form__field">
- <label class="cb-form__label" for="Country__C">What is your country or region of residence?<span class="cb-form__required">*</span></label>
- <select class="cb-form__select form__top-level-select--country" id="Country__C" name="Country__C" required="" data-req-init="true">
- <option disabled="" selected="" value="" class="default-opt" style="display:none;">Select an option</option>
- <option value="United States">United States</option>
- <option value="United Kingdom">United Kingdom</option>
- <option value="Europe">Europe</option>
- <option value="Japan">Japan</option>
- <option value="Canada">Canada</option>
- <option value="Australia">Australia</option>
- <option value="Singapore">Singapore</option>
- <option value="Other">Other</option>
- </select>
- </section>
- <section class="cb-form__field">
- <label class="cb-form__label" for="topic">Please select the topic you need help with<span class="cb-form__required">*</span></label>
- <select id="topic" name="topic" class="cb-form__select form__top-level-select sf01-support-form__field--topic" required="" data-req-init="true"><option disabled="" selected="" value="" class="default-opt" style="display:none;">Select an option</option><option value="account_compromised_and_unauthorized_accounts" data-id="accountcompromisedandunauthorizedaccounts" data-group="coinbase">Account Compromised and Unauthorized Accounts</option><option value="login_authentication_and_verification_issues" data-id="loginauthenticationandverificationissues" data-group="coinbase">Login, authentication, and verification issues</option><option value="managing_my_account" data-id="managingmyaccount" data-group="coinbase">Managing My Account</option><option value="other_issues" data-id="otherissues" data-group="coinbase">Other Issues</option><option value="taxes_reports_and_financial_services" data-id="taxesreportsandfinancialservices" data-group="coinbase">Taxes, Reports, and Financial Services</option><option value="trading_and_funding_on_coinbase" data-id="tradingandfundingoncoinbase" data-group="coinbase">Trading and Funding on Coinbase</option></select>
- </section>
- <section class="cb-form__field">
- <label class="cb-form__label" for="s_Category__c">What is your issue about?<span class="cb-form__required">*</span></label>
- <select id="s_Category__c" name="s_Category__c" class="cb-form__select form__top-level-select" required="" data-req-init="true"><option disabled="" selected="" value="" class="default-opt" style="display:none;">Select an option</option><option value="Fees_Limits" data-id="feeslimits" data-group="coinbase_otherissues">Fees and Limits</option><option value="Death_of_Account_Holder" data-id="deathofaccountholder" data-group="coinbase_otherissues">I'm requesting access for a deceased account holder</option><option value="product_suggestion" data-id="productsuggestion" data-group="coinbase_otherissues">Report a product issue</option></select>
- </section>
- <section class="cb-form__field">
- <label class="cb-form__label" for="s_Sub_category__c">What can we help you with?<span class="cb-form__required">*</span></label>
- <select id="s_Sub_category__c" name="s_Sub_category__c" class="cb-form__select form__top-level-select" required="" data-req-init="true"><option disabled="" selected="" value="" class="default-opt" style="display:none;">Select an option</option><option value="General" data-path="/content/help/language-masters/en/contact-us/support-form/other-issues/report-a-product-issue/general" data-group="coinbase_otherissues_productsuggestion">General</option></select>
- </section>
- </section>
- <input id="additional" type="hidden" name="Customer_Info_From_Web_Form__c" value="">
- <section class="sf01-support-form__step-two"><section class="dynamic-content"></section>
- <div class="default-form-fields">
- <div class="aem-Grid aem-Grid--12 aem-Grid--default--12 ">
- <div class="sf03-text-input aem-GridColumn aem-GridColumn--default--12">
- <div class="cb-form__field">
- <div class="cb-form__heading">
- <label class="cb-form__label" for="SuppliedEmail">Email address associated with your Coinbase account<span class="cb-form__required">*</span></label>
- </div>
- <input class="cb-form__text-input" type="text" required="required" pattern="^[a-zA-Z0-9.!#$%&’*+\/=?^_`{|}~-]+@[a-zA-Z0-9-]+(?:\.[a-zA-Z0-9-]+)+$" name="SuppliedEmail" maxlength="80" placeholder="Email" data-req-init="true">
- <div class="cb-form__char-counter"><span></span> / 80</div></div>
- </div>
- <div class="sf03-text-input aem-GridColumn aem-GridColumn--default--12">
- <div class="cb-form__field">
- <div class="cb-form__heading">
- <label class="cb-form__label" for="Subject">Subject<span class="cb-form__required">*</span></label>
- </div>
- <input class="cb-form__text-input" required="required" type="text" name="Subject" maxlength="255" data-req-init="true">
- <div class="cb-form__char-counter"><span></span> / 255</div></div>
- </div>
- <div class="sf03-text-input aem-GridColumn aem-GridColumn--default--12">
- <div class="cb-form__field">
- <div class="cb-form__heading">
- <label class="cb-form__label" for="Description">Message<span class="cb-form__required">*</span></label>
- </div>
- <textarea class="cb-form__textarea" required="required" name="Description" rows="3" maxlength="32000" data-req-init="true"></textarea>
- <div class="cb-form__char-counter"><span></span> / 32000</div></div>
- </div>
- <div class="sf11-hidden-field aem-GridColumn aem-GridColumn--default--12">
- <input class="cb-form__hidden" type="hidden" name="origin" value="Web">
- </div>
- <div class="sf11-hidden-field aem-GridColumn aem-GridColumn--default--12">
- <input class="cb-form__hidden" type="hidden" name="Contact_Browser_Language__c" value="en-US">
- </div>
- <div class="sf11-hidden-field aem-GridColumn aem-GridColumn--default--12">
- <input class="cb-form__hidden" type="hidden" name="Customer_Language__c" value="en">
- </div>
- </div>
- <div class="cb-form__field sf01-support-form__server-error" hidden="">
- <section class="c03-alert-banner__container" data-style="alert">
- <div class="c03-alert-banner__img-wrap">
- <svg width="48" height="48" fill="none" xmlns="http://www.w3.org/2000/svg" data-darkreader-inline-fill="" style="--darkreader-inline-fill:none;"><path d="M24 0C10.76 0 0 10.76 0 24s10.76 24 24 24 24-10.76 24-24S37.24 0 24 0zm0 46C11.86 46 2 36.14 2 24S11.86 2 24 2s22 9.86 22 22-9.86 22-22 22z" fill="#DF5F67" data-darkreader-inline-fill="" style="--darkreader-inline-fill:#e0636b;"></path><path d="M31.3 16.04l-7.3 7.3-7.3-7.3-1.4 1.42 7.28 7.3-7.28 7.28 1.4 1.42 7.3-7.3 7.3 7.3 1.4-1.42-7.28-7.28 7.28-7.3-1.4-1.42z" fill="#DF5F67" data-darkreader-inline-fill="" style="--darkreader-inline-fill:#e0636b;"></path></svg>
- </div>
- <div class="c03-alert-banner__text-wrap">
- <div class="c03-alert-banner__text">
- <p>We’re currently unable to submit your ticket. Please try submitting again in a few minutes.</p>
- </div>
- </div>
- </section>
- </div>
- <div class="cb-form__field">
- <input type="submit" class="mt-3 button button--primary" name="submit" id="submit">
- <div class="cb-form__disclaimer">This site is protected by reCAPTCHA and the Google
- <a href="https://policies.google.com/privacy">Privacy Policy</a> and
- <a href="https://policies.google.com/terms">Terms of Service</a> apply.</div>
- </div>
- </div>
- </section>
- <section id="custody-content" class="cb-form__field" hidden="">
- <p>To get in touch with Coinbase Custody, please visit <a href="https://custody.coinbase.com/">custody.coinbase.com</a> and find our contact information near the bottom of the page.</p>
- </section>
- </form>
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