diff --git a/src/constants/error-messages.js b/src/constants/error-messages.js
index 81f0fad0..224c6e30 100644
--- a/src/constants/error-messages.js
+++ b/src/constants/error-messages.js
@@ -65,7 +65,9 @@ const errorMessages = Object.freeze({
     STYLE_REQUIRED: 'Vehicle style is required.',
     MOBILE_LOCATION_REQUIRED: 'Please enter your service address',
     DATE_REQUIRED: 'Please select a date',
-    TIME_REQUIRED: 'Please select an appointment time.'
+    TIME_REQUIRED: 'Please select an appointment time.',
+    PRIMARY_PHONE_REQUIRED: 'Primary phone number is required.',
+    BAILOUT_EMAIL_ADDRESS_REQUIRED: 'Email address is required.'
 });
 
 export default errorMessages;
diff --git a/src/constants/global-rules.js b/src/constants/global-rules.js
index e82b118a..878b7a27 100644
--- a/src/constants/global-rules.js
+++ b/src/constants/global-rules.js
@@ -26,7 +26,9 @@ const globalRules = Object.freeze({
     EXTENSION_FORMAT: 'extension-format',
     ZIP_CODE_REQUIRED: 'zip-code-required',
     ZIP_CODE_SEARCH_FORMAT: 'zip-code-search-format',
-    OPTION_REQUIRED: 'option-required'
+    OPTION_REQUIRED: 'option-required',
+    PRIMARY_PHONE_REQUIRED: 'primary-phone-required',
+    BAILOUT_EMAIL_ADDRESS_REQUIRED: 'bailout-email-address-required'
 });
 
 export default globalRules;
diff --git a/src/helpers/bailout-helper.js b/src/helpers/bailout-helper.js
index 0191755d..b0d364c5 100644
--- a/src/helpers/bailout-helper.js
+++ b/src/helpers/bailout-helper.js
@@ -10,7 +10,7 @@ function canBailoutNavigateBack() {
 
     switch (code) {
         case BailoutCode.VehicleNotFound:
-        case BailoutCode.DoNotSeeMyShop:
+        case BailoutCode.RequestCallback:
         case BailoutCode.TPANotEnabled:
             return true;
 
diff --git a/src/helpers/global-rule-definer.js b/src/helpers/global-rule-definer.js
index 5aca4f66..b91f3dc0 100644
--- a/src/helpers/global-rule-definer.js
+++ b/src/helpers/global-rule-definer.js
@@ -24,6 +24,7 @@ function defineGlobalNameRules() {
  */
 function defineGlobalEmailRules() {
     defineRule(globalRules.EMAIL_ADDRESS_REQUIRED, required(errorMessages.EMAIL_ADDRESS_REQUIRED));
+    defineRule(globalRules.BAILOUT_EMAIL_ADDRESS_REQUIRED, required(errorMessages.BAILOUT_EMAIL_ADDRESS_REQUIRED));
     defineRule(
         globalRules.EMAIL_ADDRESS_FORMAT,
         regex(
@@ -71,6 +72,7 @@ function defineGlobalDateOfLossRules() {
  */
 function defineGlobalPhoneNumberRules() {
     defineRule(globalRules.PHONE_NUMBER_REQUIRED, required(errorMessages.PHONE_NUMBER_REQUIRED));
+    defineRule(globalRules.PRIMARY_PHONE_REQUIRED, required(errorMessages.PRIMARY_PHONE_REQUIRED));
     defineRule(
         globalRules.PHONE_NUMBER_FORMAT,
         regex(
diff --git a/src/layouts/bailout-page/__snapshots__/bailout-page.spec.js.snap b/src/layouts/bailout-page/__snapshots__/bailout-page.spec.js.snap
index 62f2829b..b191b402 100644
--- a/src/layouts/bailout-page/__snapshots__/bailout-page.spec.js.snap
+++ b/src/layouts/bailout-page/__snapshots__/bailout-page.spec.js.snap
@@ -12,13 +12,14 @@ Object {
     "phoneNumber": "6145550909",
   },
   "rules": Object {
-    "email": "email-required|email-address-format",
-    "firstName": "first-name-required",
-    "lastName": "last-name-required",
-    "phoneNumber": "phone-number-required|phone-number-format",
+    "email": "bailout-email-address-required|email-address-format",
+    "firstName": "policyholder-first-name-required",
+    "lastName": "policyholder-last-name-required",
+    "phoneNumber": "primary-phone-required|phone-number-format",
   },
   "widget": Object {
     "defaultSiteHeader": "SiteSubHeaderWidget",
+    "disclaimerText": "DisclaimerWidget",
     "noTpa": "ContentGroupNoTPAWidget",
     "notSeeingPreferredShop": "ContentGroupNotSeeingPreferredShop",
   },
diff --git a/src/layouts/bailout-page/bailout-page.spec.js b/src/layouts/bailout-page/bailout-page.spec.js
index 5b0c68ee..3ccd149b 100644
--- a/src/layouts/bailout-page/bailout-page.spec.js
+++ b/src/layouts/bailout-page/bailout-page.spec.js
@@ -156,6 +156,16 @@ describe('Bailout page', () => {
             // Assert
             expect(siteFooter.exists()).toBeTruthy();
         });
+        test('disclaimer text block', () => {
+            // Arrange
+            const wrapper = shallowMount(bailoutPage, getMountOptions());
+
+            // Act
+            const disclaimerText = wrapper.findComponent({ ref: 'disclaimerText' });
+
+            // Assert
+            expect(disclaimerText.exists()).toBeTruthy();
+        });
     });
     describe('computed', () => {
         describe('subHeaderCmsWidgetName', () => {
diff --git a/src/layouts/bailout-page/bailout-page.vue b/src/layouts/bailout-page/bailout-page.vue
index a84f0dfe..db6aa074 100644
--- a/src/layouts/bailout-page/bailout-page.vue
+++ b/src/layouts/bailout-page/bailout-page.vue
@@ -20,28 +20,34 @@
                         :subContentProperty="subContentProperty"
                         class="sub-header-content mt-2 mb-5"
                         justification="left" />
-                    <textboxQuestion
-                        ref="firstName"
-                        v-model="bailoutPageModel.firstName"
-                        class="mb-3"
-                        inputId="firstNameField"
-                        cmsWidgetName="FirstNameQuestion"
-                        isRequired
-                        disableAutoFill
-                        :validationRules="rules.firstName" />
-                    <textboxQuestion
-                        ref="lastName"
-                        v-model="bailoutPageModel.lastName"
-                        class="mb-3"
-                        inputId="lastNameField"
-                        cmsWidgetName="LastNameQuestion"
-                        isRequired
-                        disableAutoFill
-                        :validationRules="rules.lastName" />
+                    <div class="row">
+                        <div class="col">
+                            <textboxQuestion
+                                ref="firstName"
+                                v-model="bailoutPageModel.firstName"
+                                class="input"
+                                inputId="firstNameField"
+                                cmsWidgetName="FirstNameQuestion"
+                                isRequired
+                                disableAutoFill
+                                :validationRules="rules.firstName" />
+                        </div>
+                        <div class="col">
+                            <textboxQuestion
+                                ref="lastName"
+                                v-model="bailoutPageModel.lastName"
+                                class="input"
+                                inputId="lastNameField"
+                                cmsWidgetName="LastNameQuestion"
+                                isRequired
+                                disableAutoFill
+                                :validationRules="rules.lastName" />
+                        </div>
+                    </div>
                     <textboxQuestion
                         ref="phoneNumber"
                         v-model="bailoutPageModel.phoneNumber"
-                        class="mb-3"
+                        class="input"
                         inputId="phoneNumberField"
                         cmsWidgetName="PhoneNumberQuestion"
                         isRequired
@@ -51,7 +57,7 @@
                     <textboxQuestion
                         ref="emailAddress"
                         v-model="bailoutPageModel.email"
-                        class="mb-3"
+                        class="input"
                         inputId="emailAddressField"
                         cmsWidgetName="EmailAddressQuestion"
                         isRequired
@@ -65,6 +71,9 @@
                         :isBackButtonHidden="!canNavigateBack"
                         @backClicked="backButtonAction"
                         @ForwardClicked="forwardButtonAction" />
+                    <textBlock
+                        ref="disclaimerText"
+                        cmsWidgetName="DisclaimerWidget" />
                 </div>
             </div>
         </div>
@@ -77,6 +86,7 @@ import siteHeader from '@/iss-components/site-header/site-header.vue';
 import siteSubHeader from '@/iss-components/site-sub-header/site-sub-header.vue';
 import siteFooter from '@/iss-components/site-footer/site-footer.vue';
 import textboxQuestion from '@/digital-components/textbox-question/textbox-question.vue';
+import textBlock from '@/digital-components/text-block/text-block.vue';
 // Supporting files
 import BaseFormMixin from '@/mixins/base-form-mixin.js';
 import { fetchCmsContentForPage } from '@/helpers/cms-content-helper';
@@ -99,7 +109,8 @@ export default {
         siteFooter,
         textboxQuestion,
         // eslint-disable-next-line vue/no-reserved-component-names
-        Form
+        Form,
+        textBlock
     },
     mixins: [BaseFormMixin],
     async beforeRouteEnter(to, from, next) {
@@ -130,13 +141,14 @@ export default {
             widget: {
                 defaultSiteHeader: 'SiteSubHeaderWidget',
                 noTpa: 'ContentGroupNoTPAWidget',
-                notSeeingPreferredShop: 'ContentGroupNotSeeingPreferredShop'
+                notSeeingPreferredShop: 'ContentGroupNotSeeingPreferredShop',
+                disclaimerText: 'DisclaimerWidget'
             },
             rules: {
-                firstName: globalRules.FIRST_NAME_REQUIRED,
-                lastName: globalRules.LAST_NAME_REQUIRED,
-                phoneNumber: `${globalRules.PHONE_NUMBER_REQUIRED}|${globalRules.PHONE_NUMBER_FORMAT}`,
-                email: `${globalRules.EMAIL_ADDRESS_REQUIRED}|${globalRules.EMAIL_ADDRESS_FORMAT}`
+                firstName: globalRules.POLICYHOLDER_FIRST_NAME_REQUIRED,
+                lastName: globalRules.POLICYHOLDER_LAST_NAME_REQUIRED,
+                phoneNumber: `${globalRules.PRIMARY_PHONE_REQUIRED}|${globalRules.PHONE_NUMBER_FORMAT}`,
+                email: `${globalRules.BAILOUT_EMAIL_ADDRESS_REQUIRED}|${globalRules.EMAIL_ADDRESS_FORMAT}`
             }
         };
     },
@@ -221,9 +233,7 @@ export default {
 };
 </script>
 
-<style lang="scss">
-@import '@/styles/bailout-common.scss';
-
+<style lang="scss" scoped>
 .iss-heritage-container-width {
     .bailout-page-container {
         position: relative;
@@ -232,4 +242,12 @@ export default {
         padding-right: .9375rem;
     }
 }
+
+.input {
+    margin-bottom: 20px;
+}
+
+.footer-content-container {
+    margin: 30px 0 30px 0;
+}
 </style>
diff --git a/src/layouts/contact-confirmation/contact-confirmation.vue b/src/layouts/contact-confirmation/contact-confirmation.vue
index 29c52745..2819efd6 100644
--- a/src/layouts/contact-confirmation/contact-confirmation.vue
+++ b/src/layouts/contact-confirmation/contact-confirmation.vue
@@ -24,6 +24,7 @@ import { fetchCmsContentForPage } from '@/helpers/cms-content-helper';
 import issPageValues from '@/router/router-constants/issPage-values.js';
 import settleAllPromises from '@/helpers/layout-helper';
 import { useMainStore } from '@/store';
+import showIssLoadingModal from '@/helpers/loading-modal-helper';
 
 export default {
     name: 'contact-confirmation',
@@ -47,6 +48,7 @@ export default {
         next((vm) => {
             vm.setCmsContent(resultMap.cmsContent);
         });
+        showIssLoadingModal(false);
     },
     setup() {
         const mainStore = useMainStore();
diff --git a/src/layouts/tpa-search/tpa-search.vue b/src/layouts/tpa-search/tpa-search.vue
index 9476a7ad..83d211c1 100644
--- a/src/layouts/tpa-search/tpa-search.vue
+++ b/src/layouts/tpa-search/tpa-search.vue
@@ -389,9 +389,9 @@ export default {
             return getTpaProvidersResult?.data?.shopProviders ?? [];
         },
         doNotSeeMyShopLinkClick() {
-            this.mainStore.setBailout(bailoutMessage.doNotSeeMyShop());
+            this.mainStore.setBailout(bailoutMessage.RequestCallback());
             this.$router.navigate(
-                this.navigationScenarios.CLICKED_DO_NOT_SEE_MY_SHOP_LINK,
+                this.navigationScenarios.CLICKED_NEED_HELP,
                 this.$route
             );
         },
diff --git a/src/router/router-constants/navigation-scenarios.js b/src/router/router-constants/navigation-scenarios.js
index 58aadc91..6bbc7022 100644
--- a/src/router/router-constants/navigation-scenarios.js
+++ b/src/router/router-constants/navigation-scenarios.js
@@ -73,7 +73,7 @@ const navigationScenarios = Object.freeze({
     PRICING_LOOKUP_ERROR: 'PRICING_LOOKUP_ERROR',
 
     // TPA Search
-    CLICKED_DO_NOT_SEE_MY_SHOP_LINK: 'CLICKED_DO_NOT_SEE_MY_SHOP_LINK',
+    CLICKED_NEED_HELP: 'CLICKED_NEED_HELP',
     CLICKED_FORWARD_WITH_SAFELITE_SHOP: 'CLICKED_FORWARD_WITH_SAFELITE_SHOP',
     CLICKED_FORWARD_WITH_NON_SAFELITE_SHOP: 'CLICKED_FORWARD_WITH_NON_SAFELITE_SHOP',
 
diff --git a/src/router/router-constants/routing-table.js b/src/router/router-constants/routing-table.js
index a125134e..0ebabe28 100644
--- a/src/router/router-constants/routing-table.js
+++ b/src/router/router-constants/routing-table.js
@@ -744,7 +744,7 @@ const routingTable = () => [
                 destinationIssPageValue: issPageValues.TPA_SUBMIT
             },
             {
-                scenario: navigationScenarios.CLICKED_DO_NOT_SEE_MY_SHOP_LINK,
+                scenario: navigationScenarios.CLICKED_NEED_HELP,
                 destinationIssPageValue: issPageValues.BAILOUT_PAGE
             }
         ]