{"id":1309,"date":"2021-06-10T22:04:58","date_gmt":"2021-06-10T22:04:58","guid":{"rendered":"https:\/\/allyanz.us\/?page_id=1309"},"modified":"2021-06-23T18:28:29","modified_gmt":"2021-06-23T18:28:29","slug":"demo","status":"publish","type":"page","link":"https:\/\/allyanz.us\/en\/demo\/","title":{"rendered":"Demo"},"content":{"rendered":"<div data-elementor-type=\"wp-page\" data-elementor-id=\"1309\" class=\"elementor elementor-1309\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-section elementor-top-section elementor-element elementor-element-d958e4f elementor-section-height-min-height elementor-section-boxed elementor-section-height-default elementor-section-items-middle\" data-id=\"d958e4f\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-33627ff\" data-id=\"33627ff\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-eae0c83 elementor-widget elementor-widget-shortcode\" data-id=\"eae0c83\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><style type=\"text\/css\">#nex-forms{display:none;}<\/style><div id=\"nf_form_98598\">\r\n\t\t\t\r\n\t\t\t<style type=\"text\/css\">\r\n\t\t\t\r\n\t\t\t\t#nex-forms.credit_application_ver02 .nf-loader-lds-spinner div:after {background: #40C4FF; }\r\n\t\t\t\t#nex-forms.credit_application_ver02 .nf-loader-lds-grid div {background: #40C4FF; }\r\n\t\t\t\t#nex-forms.credit_application_ver02 .nf-loader-lds-ellipsis div { background: #40C4FF;}\r\n\t\t\t\t#nex-forms.credit_application_ver02 .nf-loader-lds-default div {background: #40C4FF;}\r\n\t\t\t\t#nex-forms.credit_application_ver02 .nf-loader-lds-roller div:after {background: #40C4FF;}\r\n\t\t\t\t#nex-forms.credit_application_ver02 .nf-loader-lds-heart div,\r\n\t\t\t\t#nex-forms.credit_application_ver02 .nf-loader-lds-heart div:after,\r\n\t\t\t\t#nex-forms.credit_application_ver02 .nf-loader-lds-heart div:before {background: #40C4FF;}\r\n\t\r\n\t\t\t\t\r\n\t\t\t\t#nex-forms.credit_application_ver02 .nf-loader-lds-facebook div {background: #40C4FF;}\r\n\t\t\t\t#nex-forms.credit_application_ver02 .nf-loader-lds-circle > div {background: #40C4FF;}\r\n\t\t\t\t\r\n\t\t\t\t#nex-forms.credit_application_ver02 .nf-loader-lds-dual-ring:after {border: 6px solid #40C4FF;border-color: #40C4FF transparent #40C4FF transparent;}\r\n\t\t\t\t#nex-forms.credit_application_ver02 .nf-loader-lds-ring div {border: 8px solid #40C4FF;border-color: #40C4FF transparent transparent transparent;}\r\n\t\t\t\t#nex-forms.credit_application_ver02 .nf-loader-lds-hourglass:after {border: 32px solid #40C4FF;border-color: #40C4FF transparent #40C4FF transparent;}\r\n\t\t\t\t#nex-forms.credit_application_ver02 .nf-loader-lds-ripple div {border: 4px solid #40C4FF;}\r\n\t\t\t<\/style>\r\n\t\t\t\r\n\t\t\t\r\n\t\t\t<div id=\"nex-forms\" data-loader=\"ellipsis\" data-msg-hide-form=\"yes\" data-msg-position=\"top\" data-msg-placement=\"outside\"  class=\"nex-forms credit_application_ver02\"><div class=\"pre_fill_fields\"><\/div><div class=\"set_form_theme theme-default\"><div class=\"nex_success_message msg_top msgv2 animated hidden\" style=\"display:none;\"><div class=\"nex_success_message_container\" style=\"background: #fff; box-shadow: #00000033 0px 7px 16px 0px; border-radius: 4px; padding: 30px; border-color:#ddd;\"><div class=\"msg_text\"><div class=\"form_field all_fields icon html_fields wow bounceInUp\" data-settings=\".s-icon\" data-settings-tabs=\"#input-settings, #animation-settings\" style=\"margin-bottom: 15px\" id=\"_21501\" data-animation-name=\"bounceInUp\">\n\t\t\t\t\t\t\t  <div class=\"edit_mask\"><\/div>\n\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t<div class=\"icon_container_wrapper icon_center\">\n\t\t\t\t\t\t\t\t  <div class=\"icon_container\" id=\"field_container\" style=\"border-width: 0px;background-color: transparent\">\n\t\t\t\t\t\t\t\t\t<div class=\"\">\n\t\t\t\t\t\t\t\t\t  <div class=\"input_container\">\n\t\t\t\t\t\t\t\t\t\t<div class=\"the_input_element icon_element\" style=\"font-size: 50px;color: #8bc34a\"><span class=\"fas fa-check-circle\"><\/span><\/div>\n\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"form_field all_fields html html_fields wow fadeInDown\" data-settings=\".s-html\" data-settings-tabs=\"#input-settings, #animation-settings, #extra-settings, #math-settings\" style=\"margin-bottom: 15px\" data-animation-name=\"fadeInDown\" data-wow-delay=\"0.5s\" id=\"_80001\">\n\t\t\t\t\t\t\t  <div class=\"edit_mask\"><\/div>\n\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t<div class=\"row\">\n\t\t\t\t\t\t\t\t  <div class=\"col-sm-12\" id=\"field_container\">\n\t\t\t\t\t\t\t\t\t<div class=\"row\">\n\t\t\t\t\t\t\t\t\t  <div class=\"col-sm-12 input_container\">\n\t\t\t\t\t\t\t\t\t\t<div class=\"the_input_element align_center\" data-math-equation=\"\" data-original-math-equation=\"\" data-decimal-places=\"0\">Gracias por completar nuestro formulario. Muy pronto ser\u00e1s contactado(a) por uno de nuestros asesores para validar tu informaci\u00f3n.<\/div>\n\t\t\t\t\t\t\t\t\t\t<div style=\"clear:both\"><\/div>\n\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/div><div data-timer-start=\"1\" data-timer-end=\"0\" class=\"inner-canvas-container ui-nex-forms-container ui-nex-forms-container-fe  browser\" id=\"ui-nex-forms-container-71\"  ><div class=\"current_step\" style=\"display:none;\">1<\/div><div class=\"last_visited_step\" style=\"display:none;\">1<\/div><div class=\"nex-forms-header-footer nex-forms-header timer_inline timer_right\"><\/div><div id=\"the_plugin_url\" style=\"display:none;\">https:\/\/allyanz.us\/wp-content\/plugins\/nex-forms-premium<\/div><div id=\"nf_save_form_progress\" style=\"display:none;\">false<\/div><div id=\"confirmation_page\" class=\"confirmation_page\" style=\"display:none;\"><\/div><div id=\"on_form_submmision\" class=\"on_form_submmision\" style=\"display:none;\">message<\/div><div class=\"hidden\" id=\"nf_ajax_url\" style=\"display:none;\">https:\/\/allyanz.us\/wp-admin\/admin-ajax.php<\/div><div class=\"hidden\" id=\"paypal_return_url\" style=\"display:none;\">https:\/\/allyanz.us\/en\/wp-json\/wp\/v2\/pages\/1309<\/div><div class=\"hidden\" id=\"ms_scroll_to_top\" style=\"display:none;\">no<\/div><div class=\"v7_container form_type_normal\" style=\"background: #ffffff; box-shadow: #00000033 0px 7px 16px 0px; border-radius: 4px; padding: 30px; border-color: #dddddd; width: 100%;\"><div class=\"current_field_on_focus\" style=\"display:none\">1<\/div><form id=\"71\" class=\"submit-nex-form nex-forms-71\" data-form-id=\"71\" name=\"nex_form\" action=\"https:\/\/allyanz.us\/wp-admin\/admin-ajax.php\" method=\"post\" enctype=\"multipart\/form-data\"><div class=\"step_transition_in\" style=\"display:none;\">fadeIn<\/div><div class=\"step_transition_out\" style=\"display:none;\">fadeOut<\/div><input type=\"hidden\" name=\"nex_forms_Id\" value=\"71\"><input type=\"hidden\" name=\"page\" value=\"\/en\/wp-json\/wp\/v2\/pages\/1309\"><input type=\"hidden\" name=\"ip\" value=\"216.73.217.121\"><input type=\"hidden\" name=\"nf_page_id\" value=\"1309\"><input type=\"hidden\" name=\"nf_page_title\" value=\"Demo\"><input type=\"text\" name=\"company_url\" value=\"\" placeholder=\"enter company url\" class=\"form-control req\">\n\t\t\t\t\t\t\t<div class=\"form_field hidden classic_field\" data-id=\"_46635\" id=\"_46635\">\n\t\t\t\t\t\t\t\t<input class=\"ms_current_step\" value=\"1\" name=\"ms_current_step\" type=\"hidden\">\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"form_field all_fields heading html_fields classic_field\" data-settings=\".s-headings\" data-settings-tabs=\"#input-settings, #animation-settings\" style=\"margin-bottom: 15px\" data-id=\"_10816\" id=\"_10816\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 input_container\"><input type=\"hidden\" class=\"set_math_result\" value=\"0\" name=\"math_result\"><h3 style=\"font-family: Arial, Helvetica, sans-serif;color: #000000;font-size: 18px\" data-original-math-equation=\"\" data-math-equation=\"\" class=\"the_input_element style_bold default-browser-style\">APPLICANT INFORMATION<\/h3><\/div><\/div><\/div><\/div><\/div><div class=\"grid-system-6 classic_field is_grid\" data-settings=\".s-grid\" data-settings-tabs=\"#input-settings, #animation-settings, #extra-settings\" data-id=\"_44746\" id=\"_44746\"><div class=\"row grid_row\"><div class=\"grid_input_holder id-_44746  col-lg-3 grid-target-0\" data-grid-width=\"3\" data-grid-num=\"0\"><div class=\"form_field all_fields text common_fields is_focused required classic_field\" data-settings=\".s-text, .s-v-text\" data-settings-tabs=\"#label-settings, #input-settings, #validation-settings, #animation-settings, #extra-settings\" style=\"margin-bottom: 15px\" data-id=\"_12404\" id=\"_12404\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 label_container align_let align_left\"><label class=\"nf_title\"><span class=\"the_label style_bold\" style=\"font-size: 11px;color: #000000\">*Last Name<\/span><small class=\"sub-text style_italic\" style=\"font-size: 8px\">Requerido<\/small><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"last_name_1\" class=\"error_message the_input_element aling_left align_left required default-browser-style\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Requerido\" data-secondary-message=\"\" title=\"\" style=\"font-size: 11px;color: #9e9e9e;background: white;border-color: #dddddd\" placeholder=\"Su Apellido\"><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder id-_44746  col-lg-3 grid-target-1\" data-grid-width=\"3\" data-grid-num=\"1\"><div class=\"form_field all_fields text common_fields is_focused required classic_field\" data-settings=\".s-text, .s-v-text\" data-settings-tabs=\"#label-settings, #input-settings, #validation-settings, #animation-settings, #extra-settings\" style=\"margin-bottom: 15px\" data-id=\"_39790\" id=\"_39790\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 label_container align_let align_left\"><label class=\"nf_title\"><span class=\"the_label style_bold\" style=\"font-size: 11px;color: #000000\">*First Name<\/span><small class=\"sub-text style_italic\" style=\"font-size: 8px\">Requerido<\/small><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"first_name_1\" class=\"error_message the_input_element aling_left align_left required default-browser-style\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Requerido\" data-secondary-message=\"\" title=\"\" style=\"font-size: 11px;color: #9e9e9e;background: white;border-color: #dddddd\" placeholder=\"Su nombre\"><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder id-_44746  col-lg-2 grid-target-2\" data-grid-width=\"2\" data-grid-num=\"2\"><div class=\"form_field all_fields text common_fields is_focused required classic_field\" data-settings=\".s-text, .s-v-text\" data-settings-tabs=\"#label-settings, #input-settings, #validation-settings, #animation-settings, #extra-settings\" style=\"margin-bottom: 15px\" data-id=\"_34321\" id=\"_34321\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 label_container align_let align_left\"><label class=\"nf_title\"><span class=\"the_label style_bold\" style=\"font-size: 11px;color: #000000\">*Middle Initial<\/span><small class=\"sub-text style_italic\" style=\"font-size: 8px\">Requerido<\/small><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"middle_initial_1\" class=\"error_message the_input_element aling_left align_left required default-browser-style\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Requerido\" data-secondary-message=\"\" title=\"\" style=\"font-size: 11px;color: #9e9e9e;background: white;border-color: #dddddd\" placeholder=\"Inicial 2do nombre\" data-length=\"1\"><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder id-_44746  col-lg-2 grid-target-3\" data-grid-width=\"2\" data-grid-num=\"3\"><div class=\"form_field all_fields text common_fields is_focused required classic_field\" data-settings=\".s-text, .s-v-text\" data-settings-tabs=\"#label-settings, #input-settings, #validation-settings, #animation-settings, #extra-settings\" style=\"margin-bottom: 15px\" data-id=\"_96265\" id=\"_96265\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 label_container align_let align_left\"><label class=\"nf_title\"><span class=\"the_label style_bold\" style=\"font-size: 11px;color: #000000\">*Social Security Number<\/span><small class=\"sub-text style_italic\" style=\"font-size: 8px\">Requerido<\/small><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"social_security_number_1\" class=\"error_message the_input_element aling_left align_left required default-browser-style\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Requerido\" data-secondary-message=\"\" title=\"\" style=\"font-size: 11px;color: #9e9e9e;background: white;border-color: #dddddd\" placeholder=\"Seguro Social\"><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder id-_44746  col-lg-2 grid-target-4\" data-grid-width=\"2\" data-grid-num=\"4\"><div class=\"form_field all_fields date special_fields required classic_field\" data-settings=\".s-date, .s-text\" data-settings-tabs=\"#label-settings, #input-settings, #validation-settings, #animation-settings, #extra-settings\" style=\"margin-bottom: 15px\" data-id=\"_24371\" id=\"_24371\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 label_container align_let align_left\"><label class=\"nf_title\"><span class=\"the_label style_bold\" style=\"font-size: 11px;color: #000000\">*Birth Date<\/span><small class=\"sub-text style_italic\" style=\"font-size: 8px\">Requerido<\/small><\/label><\/div><div class=\"col-sm-12  input_container\"><div class=\"date input-group-bd\" id=\"datetimepicker\" data-format=\"MM\/DD\/YYYY\" data-language=\"es\" data-inline=\"false\" data-calendar-display=\"popup\" data-selected-format=\"custom\" data-min-date=\"\" data-viewmode=\"days\"><span class=\"prefix input-group-addon-bd\" style=\"color: #888888;background: white;border-color: #dddddd\"><span class=\"fa fa-calendar-o\" style=\"font-size: 17px\"><\/span><\/span><input type=\"text\" name=\"birth_date\" class=\"error_message the_input_element aling_left align_left required default-browser-style input-sm\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Requerido\" title=\"\" style=\"font-size: 11px;color: #9e9e9e;background: white;border-color: #dddddd\" placeholder=\"\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"grid-system-6 classic_field is_grid\" data-settings=\".s-grid\" data-settings-tabs=\"#input-settings, #animation-settings, #extra-settings\" data-id=\"_91730\" id=\"_91730\"><div class=\"row grid_row\"><div class=\"grid_input_holder id-_91730  col-sm-5 grid-target-0\" data-grid-width=\"5\" data-grid-num=\"0\"><div class=\"form_field all_fields text common_fields is_focused required classic_field\" data-settings=\".s-text, .s-v-text\" data-settings-tabs=\"#label-settings, #input-settings, #validation-settings, #animation-settings, #extra-settings\" style=\"margin-bottom: 15px\" data-id=\"_73571\" id=\"_73571\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 label_container align_let align_left\"><label class=\"nf_title\"><span class=\"the_label style_bold\" style=\"font-size: 11px;color: #000000\">*Address<\/span><small class=\"sub-text style_italic\" style=\"font-size: 8px\">Requerido<\/small><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"address_1\" class=\"error_message the_input_element aling_left align_left required default-browser-style\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Requerido\" data-secondary-message=\"\" title=\"\" style=\"font-size: 11px;color: #9e9e9e;background: white;border-color: #dddddd\" placeholder=\"Su direcci\u00f3n\"><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder id-_91730  col-sm-1 grid-target-1\" data-grid-width=\"1\" data-grid-num=\"1\"><div class=\"form_field all_fields text common_fields is_focused required classic_field\" data-settings=\".s-text, .s-v-text\" data-settings-tabs=\"#label-settings, #input-settings, #validation-settings, #animation-settings, #extra-settings\" style=\"margin-bottom: 15px\" data-id=\"_84790\" id=\"_84790\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 label_container align_let align_left\"><label class=\"nf_title\"><span class=\"the_label style_bold\" style=\"font-size: 11px;color: #000000\">*Apto.<\/span><small class=\"sub-text style_italic\" style=\"font-size: 8px\">Requerido<\/small><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"apto_1\" class=\"error_message the_input_element aling_left align_left required default-browser-style\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Requerido\" data-secondary-message=\"\" title=\"\" style=\"font-size: 9px;color: #9e9e9e;background: white;border-color: #dddddd\" placeholder=\"Apartamento\"><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder id-_91730  col-sm-2 grid-target-2\" data-grid-width=\"2\" data-grid-num=\"2\"><div class=\"form_field all_fields text common_fields is_focused required classic_field\" data-settings=\".s-text, .s-v-text\" data-settings-tabs=\"#label-settings, #input-settings, #validation-settings, #animation-settings, #extra-settings\" style=\"margin-bottom: 15px\" data-id=\"_88113\" id=\"_88113\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 label_container align_let align_left\"><label class=\"nf_title\"><span class=\"the_label style_bold\" style=\"font-size: 11px;color: #000000\">*City<\/span><small class=\"sub-text style_italic\" style=\"font-size: 8px\">Requerido<\/small><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"city_1\" class=\"error_message the_input_element aling_left align_left required default-browser-style\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Requerido\" data-secondary-message=\"\" title=\"\" style=\"font-size: 11px;color: #9e9e9e;background: white;border-color: #dddddd\" placeholder=\"Ciudad\"><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder id-_91730  col-sm-2 grid-target-3\" data-grid-width=\"2\" data-grid-num=\"3\"><div class=\"form_field all_fields select common_fields selection_fields required classic_field\" data-settings=\".s-select\" data-settings-tabs=\"#label-settings, #input-settings, #validation-settings, #animation-settings, #extra-settings\" style=\"margin-bottom: 15px\" data-id=\"_27676\" id=\"_27676\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 label_container align_let align_left\"><label class=\"nf_title\"><span class=\"the_label style_bold\" style=\"font-size: 11px;color: #000000\">State<\/span><small class=\"sub-text style_italic\" style=\"font-size: 8px\">Requerido<\/small><\/label><\/div><div class=\"col-sm-12  input_container\"><select name=\"state_1\" class=\"the_input_element error_message text pre-format aling_left align_left required default-browser-style\" data-content=\"Requerido\" style=\"font-size: 11px;color: #9e9e9e;background: white;border-color: #dddddd\" data-required=\"true\" data-default-selected-value=\"\"><option value=\"\" selected=\"selected\"><\/option><option value=\"Alabama\">Alabama<\/option><option value=\"Alaska\">Alaska<\/option><option value=\"Arizona\">Arizona<\/option><option value=\"Arkansas\">Arkansas<\/option><option value=\"California\">California<\/option><option value=\"Colorado\">Colorado<\/option><option value=\"Connecticut\">Connecticut<\/option><option value=\"Delaware\">Delaware<\/option><option value=\"Florida\">Florida<\/option><option value=\"Georgia\">Georgia<\/option><option value=\"Idaho\">Idaho<\/option><option value=\"Hawaii\">Hawaii<\/option><option value=\"Illinois\">Illinois<\/option><option value=\"Indiana\">Indiana<\/option><option value=\"Iowa\">Iowa<\/option><option value=\"Kansas\">Kansas<\/option><option value=\"Kentucky\">Kentucky<\/option><option value=\"Louisiana\">Louisiana<\/option><option value=\"Maine\">Maine<\/option><option value=\"Maryland\">Maryland<\/option><option value=\"Massachusetts\">Massachusetts<\/option><option value=\"Michigan\">Michigan<\/option><option value=\"Minnesota\">Minnesota<\/option><option value=\"Mississippi\">Mississippi<\/option><option value=\"Missouri\">Missouri<\/option><option value=\"Montana\">Montana<\/option><option value=\"Nebraska\">Nebraska<\/option><option value=\"Nevada\">Nevada<\/option><option value=\"New Hampshire\">New Hampshire<\/option><option value=\"New Jersey\">New Jersey<\/option><option value=\"New Mexico\">New Mexico<\/option><option value=\"New York\">New York<\/option><option value=\"North Carolina\">North Carolina<\/option><option value=\"North Dakota\">North Dakota<\/option><option value=\"Ohio\">Ohio<\/option><option value=\"Oklahoma\">Oklahoma<\/option><option value=\"Oregon\">Oregon<\/option><option value=\"Pennsylvania\">Pennsylvania<\/option><option value=\"Rhode Island\">Rhode Island<\/option><option value=\"South Carolina\">South Carolina<\/option><option value=\"South Dakota\">South Dakota<\/option><option value=\"Tennessee\">Tennessee<\/option><option value=\"Texas\">Texas<\/option><option value=\"Utah\">Utah<\/option><option value=\"Vermont\">Vermont<\/option><option value=\"Virginia\">Virginia<\/option><option value=\"Washington\">Washington<\/option><option value=\"West Virginia\">West Virginia<\/option><option value=\"Wisconsin\">Wisconsin<\/option><option value=\"Wyoming\">Wyoming<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder id-_91730  col-sm-2 grid-target-4\" data-grid-width=\"2\" data-grid-num=\"4\"><div class=\"form_field all_fields text common_fields required is_focused classic_field\" data-settings=\".s-text, .s-v-text\" data-settings-tabs=\"#label-settings, #input-settings, #validation-settings, #animation-settings, #extra-settings\" style=\"margin-bottom: 15px\" data-id=\"_56802\" id=\"_56802\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 label_container align_let align_left\"><label class=\"nf_title\"><span class=\"the_label style_bold\" style=\"font-size: 11px;color: #000000\">*ZIP<\/span><small class=\"sub-text style_italic\" style=\"font-size: 8px\">Requerido<\/small><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"zip_1\" class=\"error_message the_input_element aling_left align_left required default-browser-style\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Requerido\" data-secondary-message=\"\" title=\"\" style=\"font-size: 11px;color: #9e9e9e;background: white;border-color: #dddddd\" id=\"Requerido\" placeholder=\"C\u00f3digo Postal\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"grid-system-6 classic_field is_grid\" data-settings=\".s-grid\" data-settings-tabs=\"#input-settings, #animation-settings, #extra-settings\" data-id=\"_9952\" id=\"_9952\"><div class=\"row grid_row\"><div class=\"grid_input_holder id-_9952  col-sm-3 grid-target-0\" data-grid-width=\"3\" data-grid-num=\"0\"><div class=\"form_field all_fields preset_fields is_focused required phone_number classic_field\" data-settings=\".s-text,s-phone, .s-v-text\" data-settings-tabs=\"#label-settings, #input-settings, #validation-settings, #animation-settings, #extra-settings\" style=\"margin-bottom: 15px\" data-id=\"_72006\" id=\"_72006\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 label_container align_let align_left\"><label class=\"nf_title\"><span class=\"the_label style_bold\" style=\"font-size: 11px;color: #000000\">*Phone<\/span><small class=\"sub-text style_italic\" style=\"font-size: 8px\">Requerido<\/small><\/label><\/div><div class=\"col-sm-12  input_container\"><div class=\"input-group-bd\"><span class=\"prefix input-group-addon-bd\" style=\"color: #888888;background: white;border-color: #dddddd\"><span class=\"fa fa fa-phone\" style=\"font-size: 17px\"><\/span><\/span><input type=\"text\" name=\"phone_1\" class=\"error_message the_input_element aling_left align_left required phone_number default-browser-style\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Requerido\" title=\"\" data-secondary-message=\"Formato incorrecto\" style=\"font-size: 11px;color: #9e9e9e;background: white;border-color: #dddddd\" placeholder=\"Su tel\u00e9fono\" data-input-mask=\"(000) 000-0000\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder id-_9952  col-sm-2 grid-target-1\" data-grid-width=\"2\" data-grid-num=\"1\"><div class=\"form_field all_fields select common_fields selection_fields required classic_field\" data-settings=\".s-select\" data-settings-tabs=\"#label-settings, #input-settings, #validation-settings, #animation-settings, #extra-settings\" style=\"margin-bottom: 15px\" data-id=\"_97084\" id=\"_97084\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 label_container align_let align_left\"><label class=\"nf_title\"><span class=\"the_label style_bold\" style=\"font-size: 11px;color: #000000\">*Residential Status<\/span><small class=\"sub-text style_italic\" style=\"font-size: 8px\">Requerido<\/small><\/label><\/div><div class=\"col-sm-12  input_container\"><select name=\"residential_status_1\" class=\"the_input_element error_message text pre-format aling_left align_left required default-browser-style\" data-content=\"Reqierido\" style=\"font-size: 11px;color: #9e9e9e;background: white;border-color: #dddddd\" data-required=\"true\" data-default-selected-value=\"\"><option value=\"\" selected=\"selected\"><\/option><option value=\"Homeowner\">Homeowner<\/option><option value=\"Rent\">Rent<\/option><option value=\"Family\">Family<\/option><option value=\"Other\">Other<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder id-_9952  col-sm-2 grid-target-2\" data-grid-width=\"2\" data-grid-num=\"2\"><div class=\"form_field all_fields touch_spinner special_fields required classic_field\" data-settings=\".s-spinner\" data-settings-tabs=\"#label-settings, #input-settings, #validation-settings, #animation-settings, #extra-settings\" style=\"margin-bottom: 15px\" data-id=\"_38646\" id=\"_38646\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 label_container align_let align_left\"><label class=\"nf_title\"><span class=\"the_label style_bold\" style=\"font-size: 11px;color: #000000\">*Time at Address (Yrs.)<\/span><small class=\"sub-text style_italic\" style=\"font-size: 8px\">Reqierido<\/small><\/label><\/div><div class=\"col-sm-12  input_container\"><input name=\"tmadd_yrs_1\" type=\"text\" id=\"spinner\" class=\"error_message the_spinner the_input_element aling_left required align_center default-browser-style form-control\" data-minimum=\"0\" data-maximum=\"50\" data-step=\"1\" data-starting-value=\"0\" data-decimals=\"0\" data-postfix-icon=\"\" data-prefix-icon=\"\" data-postfix-text=\"\" data-prefix-text=\"\" data-postfix-class=\"btn-default\" data-prefix-class=\"btn-default\" data-down-icon=\"fa fa-minus\" data-up-icon=\"fa fa-plus\" data-down-class=\"btn-default\" data-up-class=\"btn-default\" data-placement=\"bottom\" data-content=\"Requerido\" title=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" style=\"font-size: 13px;color: #9e9e9e;background: white;border-color: #dddddd;display: block\" data-verticalbuttons=\"false\"><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder id-_9952  col-sm-2 grid-target-3\" data-grid-width=\"2\" data-grid-num=\"3\"><div class=\"form_field all_fields touch_spinner special_fields classic_field\" data-settings=\".s-spinner\" data-settings-tabs=\"#label-settings, #input-settings, #validation-settings, #animation-settings, #extra-settings\" style=\"margin-bottom: 15px\" data-id=\"_77023\" id=\"_77023\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"label_container align_let align_left col-sm-12\"><label class=\"nf_title\"><span class=\"the_label style_bold\" style=\"font-size: 11px;color: #000000\">Time at Address<\/span><small class=\"sub-text style_italic\" style=\"font-size: 8px\">Mos.<\/small><\/label><\/div><div class=\"input_container col-sm-12\"><input name=\"tmadd_mos_1\" type=\"text\" id=\"spinner\" class=\"error_message the_spinner the_input_element aling_left align_center default-browser-style form-control\" data-minimum=\"0\" data-maximum=\"100\" data-step=\"1\" data-starting-value=\"0\" data-decimals=\"0\" data-postfix-icon=\"\" data-prefix-icon=\"\" data-postfix-text=\"\" data-prefix-text=\"\" data-postfix-class=\"btn-default\" data-prefix-class=\"btn-default\" data-down-icon=\"fa fa-minus\" data-up-icon=\"fa fa-plus\" data-down-class=\"btn-default\" data-up-class=\"btn-default\" data-placement=\"bottom\" data-content=\"Required\" title=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" style=\"font-size: 13px;color: #9e9e9e;background: white;border-color: #dddddd;display: block\" data-verticalbuttons=\"false\"><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder id-_9952  col-sm-3 grid-target-4\" data-grid-width=\"3\" data-grid-num=\"4\"><div class=\"form_field all_fields text common_fields is_focused required numbers_only classic_field\" data-settings=\".s-text, .s-v-text\" data-settings-tabs=\"#label-settings, #input-settings, #validation-settings, #animation-settings, #extra-settings\" style=\"margin-bottom: 15px\" data-id=\"_20534\" id=\"_20534\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 label_container align_let align_left\"><label class=\"nf_title\"><span class=\"the_label style_bold\" style=\"font-size: 11px;color: #000000\">*Rent\/Mtg. Pmt<\/span><small class=\"sub-text style_italic\" style=\"font-size: 8px\">Requerido<\/small><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"rentmtg_pmt_1\" class=\"error_message the_input_element aling_left align_left required numbers_only default-browser-style\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Requerido\" data-secondary-message=\"Solo n\u00fameros\" title=\"\" style=\"font-size: 11px;color: #9e9e9e;background: white;border-color: #dddddd\" placeholder=\"Cuanto paga de renta\/hipoteca\" data-length=\"100000.00\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"grid-system-6 classic_field is_grid\" data-settings=\".s-grid\" data-settings-tabs=\"#input-settings, #animation-settings, #extra-settings\" data-id=\"_9920\" id=\"_9920\"><div class=\"row grid_row\"><div class=\"grid_input_holder id-_9920  col-sm-6 grid-target-0\" data-grid-width=\"6\" data-grid-num=\"0\"><div class=\"form_field all_fields email email preset_fields is_focused required classic_field\" data-settings=\".s-text, .s-v-text\" data-settings-tabs=\"#label-settings, #input-settings, #validation-settings, #animation-settings, #extra-settings\" style=\"margin-bottom: 15px\" data-id=\"_44961\" id=\"_44961\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 label_container align_let align_left\"><label class=\"nf_title\"><span class=\"the_label style_bold\" style=\"font-size: 11px;color: #000000\">*E-mail Address<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><div class=\"input-group-bd\"><span class=\"prefix input-group-addon-bd\" style=\"color: #888888;background: white;border-color: #dddddd\"><span class=\"fa fas fa-envelope\" style=\"font-size: 17px\"><\/span><\/span><input type=\"text\" name=\"mail_address\" class=\"error_message email the_input_element aling_left align_left required default-browser-style\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Requerido\" title=\"\" data-secondary-message=\"Invalid email address\" style=\"font-size: 13px;color: #9e9e9e;background: white;border-color: #dddddd\" placeholder=\"Su correo electr\u00f3nico\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder id-_9920  col-sm-3 grid-target-1\" data-grid-width=\"3\" data-grid-num=\"1\"><div class=\"form_field all_fields touch_spinner special_fields classic_field\" data-settings=\".s-spinner\" data-settings-tabs=\"#label-settings, #input-settings, #validation-settings, #animation-settings, #extra-settings\" style=\"margin-bottom: 15px;top: 0px\" data-id=\"_68043\" id=\"_68043\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 label_container align_let align_left\"><label class=\"nf_title\"><span class=\"the_label style_bold\" style=\"font-size: 11px;color: #000000\">Time at Previous Address (Yrs.)<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input name=\"time_at_previous_address_yrs\" type=\"text\" id=\"spinner\" class=\"error_message the_spinner the_input_element aling_left align_center default-browser-style form-control\" data-minimum=\"0\" data-maximum=\"100\" data-step=\"1\" data-starting-value=\"0\" data-decimals=\"0\" data-postfix-icon=\"\" data-prefix-icon=\"\" data-postfix-text=\"\" data-prefix-text=\"\" data-postfix-class=\"btn-default\" data-prefix-class=\"btn-default\" data-down-icon=\"fa fa-minus\" data-up-icon=\"fa fa-plus\" data-down-class=\"btn-default\" data-up-class=\"btn-default\" data-placement=\"bottom\" data-content=\"Required\" title=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" style=\"font-size: 11px;color: #9e9e9e;background: white;border-color: #dddddd;display: block\" data-verticalbuttons=\"false\"><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder id-_9920  col-sm-3 grid-target-2\" data-grid-width=\"3\" data-grid-num=\"2\"><div class=\"form_field all_fields touch_spinner special_fields classic_field\" data-settings=\".s-spinner\" data-settings-tabs=\"#label-settings, #input-settings, #validation-settings, #animation-settings, #extra-settings\" style=\"margin-bottom: 15px\" data-id=\"_17315\" id=\"_17315\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 label_container align_let align_left\"><label class=\"nf_title\"><span class=\"the_label style_bold\" style=\"font-size: 11px;color: #000000\">Time at Previous Address (Mos.)<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input name=\"time_at_previous_address_mos\" type=\"text\" id=\"spinner\" class=\"error_message the_spinner the_input_element aling_left align_center default-browser-style form-control\" data-minimum=\"0\" data-maximum=\"100\" data-step=\"1\" data-starting-value=\"0\" data-decimals=\"0\" data-postfix-icon=\"\" data-prefix-icon=\"\" data-postfix-text=\"\" data-prefix-text=\"\" data-postfix-class=\"btn-default\" data-prefix-class=\"btn-default\" data-down-icon=\"fa fa-minus\" data-up-icon=\"fa fa-plus\" data-down-class=\"btn-default\" data-up-class=\"btn-default\" data-placement=\"bottom\" data-content=\"Required\" title=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" style=\"font-size: 13px;color: #9e9e9e;background: white;border-color: #dddddd;display: block\" data-verticalbuttons=\"false\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"grid-system-6 classic_field is_grid\" data-settings=\".s-grid\" data-settings-tabs=\"#input-settings, #animation-settings, #extra-settings\" data-id=\"_37088\" id=\"_37088\"><div class=\"row grid_row\"><div class=\"grid_input_holder id-_37088  col-sm-4 grid-target-0\" data-grid-width=\"4\" data-grid-num=\"0\"><div class=\"form_field all_fields text common_fields is_focused classic_field\" data-settings=\".s-text, .s-v-text\" data-settings-tabs=\"#label-settings, #input-settings, #validation-settings, #animation-settings, #extra-settings\" style=\"margin-bottom: 15px\" data-id=\"_70924\" id=\"_70924\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 label_container align_let align_left\"><label class=\"nf_title\"><span class=\"the_label style_bold\" style=\"font-size: 11px;color: #000000\">Previous Full Address (If less than 2 Years)<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"prev_add_1\" class=\"error_message the_input_element aling_left align_left default-browser-style\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"\" title=\"\" style=\"font-size: 11px;color: #9e9e9e;background: white;border-color: #dddddd\" placeholder=\"Su direcci\u00f3n anterior\"><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder id-_37088  col-sm-2 grid-target-1\" data-grid-width=\"2\" data-grid-num=\"1\"><div class=\"form_field all_fields text common_fields is_focused classic_field\" data-settings=\".s-text, .s-v-text\" data-settings-tabs=\"#label-settings, #input-settings, #validation-settings, #animation-settings, #extra-settings\" style=\"margin-bottom: 15px\" data-id=\"_25259\" id=\"_25259\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 label_container align_let align_left\"><label class=\"nf_title\"><span class=\"the_label style_bold\" style=\"font-size: 11px;color: #000000\">Previous Apt.<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"prev_apt_1\" class=\"error_message the_input_element aling_left align_left default-browser-style\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"\" title=\"\" style=\"font-size: 11px;color: #9e9e9e;background: white;border-color: #dddddd\" placeholder=\"Apartamento Anterior\"><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder id-_37088  col-sm-2 grid-target-2\" data-grid-width=\"2\" data-grid-num=\"2\"><div class=\"form_field all_fields text common_fields is_focused classic_field\" data-settings=\".s-text, .s-v-text\" data-settings-tabs=\"#label-settings, #input-settings, #validation-settings, #animation-settings, #extra-settings\" style=\"margin-bottom: 15px\" data-id=\"_96538\" id=\"_96538\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 label_container align_let align_left\"><label class=\"nf_title\"><span class=\"the_label style_bold\" style=\"font-size: 11px;color: #000000\">Previous City<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"prev_city_1\" class=\"error_message the_input_element aling_left align_left default-browser-style\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"\" title=\"\" style=\"font-size: 11px;color: #9e9e9e;background: white;border-color: #dddddd\" placeholder=\"Apartamento anterior\"><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder id-_37088  col-sm-2 grid-target-3\" data-grid-width=\"2\" data-grid-num=\"3\"><div class=\"form_field all_fields select common_fields selection_fields classic_field\" data-settings=\".s-select\" data-settings-tabs=\"#label-settings, #input-settings, #validation-settings, #animation-settings, #extra-settings\" style=\"margin-bottom: 15px\" data-id=\"_72581\" id=\"_72581\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 label_container align_let align_left\"><label class=\"nf_title\"><span class=\"the_label style_bold\" style=\"font-size: 11px;color: #000000\">State<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><select name=\"state_2\" class=\"the_input_element error_message text pre-format aling_left align_left default-browser-style\" data-content=\"Required\" style=\"font-size: 11px;color: #9e9e9e;background: white;border-color: #dddddd\" data-default-selected-value=\"\" data-required=\"false\"><option value=\"\" selected=\"selected\"><\/option><option value=\"Alabama\">Alabama<\/option><option value=\"Alaska\">Alaska<\/option><option value=\"Arizona\">Arizona<\/option><option value=\"Arkansas\">Arkansas<\/option><option value=\"California\">California<\/option><option value=\"Colorado\">Colorado<\/option><option value=\"Connecticut\">Connecticut<\/option><option value=\"Delaware\">Delaware<\/option><option value=\"Florida\">Florida<\/option><option value=\"Georgia\">Georgia<\/option><option value=\"Idaho\">Idaho<\/option><option value=\"Hawaii\">Hawaii<\/option><option value=\"Illinois\">Illinois<\/option><option value=\"Indiana\">Indiana<\/option><option value=\"Iowa\">Iowa<\/option><option value=\"Kansas\">Kansas<\/option><option value=\"Kentucky\">Kentucky<\/option><option value=\"Louisiana\">Louisiana<\/option><option value=\"Maine\">Maine<\/option><option value=\"Maryland\">Maryland<\/option><option value=\"Massachusetts\">Massachusetts<\/option><option value=\"Michigan\">Michigan<\/option><option value=\"Minnesota\">Minnesota<\/option><option value=\"Mississippi\">Mississippi<\/option><option value=\"Missouri\">Missouri<\/option><option value=\"Montana\">Montana<\/option><option value=\"Nebraska\">Nebraska<\/option><option value=\"Nevada\">Nevada<\/option><option value=\"New Hampshire\">New Hampshire<\/option><option value=\"New Jersey\">New Jersey<\/option><option value=\"New Mexico\">New Mexico<\/option><option value=\"New York\">New York<\/option><option value=\"North Carolina\">North Carolina<\/option><option value=\"North Dakota\">North Dakota<\/option><option value=\"Ohio\">Ohio<\/option><option value=\"Oklahoma\">Oklahoma<\/option><option value=\"Oregon\">Oregon<\/option><option value=\"Pennsylvania\">Pennsylvania<\/option><option value=\"Rhode Island\">Rhode Island<\/option><option value=\"South Carolina\">South Carolina<\/option><option value=\"South Dakota\">South Dakota<\/option><option value=\"Tennessee\">Tennessee<\/option><option value=\"Texas\">Texas<\/option><option value=\"Utah\">Utah<\/option><option value=\"Vermont\">Vermont<\/option><option value=\"Virginia\">Virginia<\/option><option value=\"Washington\">Washington<\/option><option value=\"West Virginia\">West Virginia<\/option><option value=\"Wisconsin\">Wisconsin<\/option><option value=\"Wyoming\">Wyoming<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder id-_37088  col-sm-2 grid-target-4\" data-grid-width=\"2\" data-grid-num=\"4\"><div class=\"form_field all_fields text common_fields is_focused classic_field\" data-settings=\".s-text, .s-v-text\" data-settings-tabs=\"#label-settings, #input-settings, #validation-settings, #animation-settings, #extra-settings\" style=\"margin-bottom: 15px\" data-id=\"_77808\" id=\"_77808\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 label_container align_let align_left\"><label class=\"nf_title\"><span class=\"the_label style_bold\" style=\"font-size: 11px;color: #000000\">Zip<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"zip_2\" class=\"error_message the_input_element aling_left align_left default-browser-style\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"\" title=\"\" style=\"font-size: 11px;color: #9e9e9e;background: white;border-color: #dddddd\" placeholder=\"C\u00f3digo Postal\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"grid-system-4 classic_field is_grid\" data-settings=\".s-grid\" data-settings-tabs=\"#input-settings, #animation-settings, #extra-settings\" data-id=\"_95225\" id=\"_95225\"><div class=\"row grid_row\"><div class=\"grid_input_holder id-_95225  col-sm-3 grid-target-0\" data-grid-width=\"3\" data-grid-num=\"0\"><div class=\"form_field all_fields text common_fields is_focused required classic_field\" data-settings=\".s-text, .s-v-text\" data-settings-tabs=\"#label-settings, #input-settings, #validation-settings, #animation-settings, #extra-settings\" style=\"margin-bottom: 15px\" data-id=\"_43495\" id=\"_43495\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 label_container align_let align_left\"><label class=\"nf_title\"><span class=\"the_label style_bold\" style=\"font-size: 11px;color: #000000\">*Employers Name<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"emplyrs_names\" class=\"error_message the_input_element aling_left align_left required default-browser-style\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Requerido\" data-secondary-message=\"\" title=\"\" style=\"font-size: 11px;color: #9e9e9e;background: white;border-color: #dddddd\" placeholder=\"Nombre del empleador\"><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder id-_95225  col-sm-3 grid-target-1\" data-grid-width=\"3\" data-grid-num=\"1\"><div class=\"form_field all_fields select common_fields selection_fields required classic_field\" data-settings=\".s-select\" data-settings-tabs=\"#label-settings, #input-settings, #validation-settings, #animation-settings, #extra-settings\" style=\"margin-bottom: 15px\" data-id=\"_63861\" id=\"_63861\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 label_container align_let align_left\"><label class=\"nf_title\"><span class=\"the_label style_bold\" style=\"font-size: 11px;color: #000000\">*Employment Type<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><select name=\"emplymnt_type\" class=\"the_input_element error_message text pre-format aling_left align_left required default-browser-style\" data-content=\"Requerido\" style=\"font-size: 11px;color: #9e9e9e;background: white;border-color: #dddddd\" data-default-selected-value=\"\" data-required=\"true\"><option value=\"\" selected=\"selected\"><\/option><option value=\"Employed\">Employed<\/option><option value=\"Unemployed\">Unemployed<\/option><option value=\"Self-employed\">Self-employed<\/option><option value=\"Military\">Military<\/option><option value=\"Retired\">Retired<\/option><option value=\"Other\">Other<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder id-_95225  col-sm-3 grid-target-2\" data-grid-width=\"3\" data-grid-num=\"2\"><div class=\"form_field all_fields preset_fields is_focused required phone_number classic_field\" data-settings=\".s-text,s-phone, .s-v-text\" data-settings-tabs=\"#label-settings, #input-settings, #validation-settings, #animation-settings, #extra-settings\" style=\"margin-bottom: 15px\" data-id=\"_99695\" id=\"_99695\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 label_container align_let align_left\"><label class=\"nf_title\"><span class=\"the_label style_bold align_left\" style=\"font-size: 11px;color: #000000\">*Work Phone<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><div class=\"input-group-bd\"><span class=\"prefix input-group-addon-bd\" style=\"color: #888888;background: white;border-color: #dddddd\"><span class=\"fa fa fa-phone\" style=\"font-size: 17px\"><\/span><\/span><input type=\"text\" name=\"work_phone\" class=\"error_message the_input_element aling_left align_left required phone_number default-browser-style\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Requerido\" title=\"\" data-secondary-message=\"Invalid phone number format\" style=\"font-size: 11px;color: #9e9e9e;background: white;border-color: #dddddd\" placeholder=\"Tel\u00e9fono de su trabajo\" data-input-mask=\"(000) 000-0000\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder id-_95225  col-sm-3 grid-target-3\" data-grid-width=\"3\" data-grid-num=\"3\"><div class=\"form_field all_fields text common_fields is_focused classic_field required\" data-settings=\".s-text, .s-v-text\" data-settings-tabs=\"#label-settings, #input-settings, #validation-settings, #animation-settings, #extra-settings\" style=\"margin-bottom: 15px\" data-id=\"_8454\" id=\"_8454\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 label_container align_let align_left\"><label class=\"nf_title\"><span class=\"the_label style_bold\" style=\"font-size: 11px;color: #000000\">*Supervisor Name<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"supervsr_name\" class=\"error_message the_input_element aling_left align_left default-browser-style required\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"\" title=\"\" style=\"font-size: 11px;color: #9e9e9e;background: white;border-color: #dddddd\" placeholder=\"Nombre del supervisor\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"grid-system-6 classic_field is_grid\" data-settings=\".s-grid\" data-settings-tabs=\"#input-settings, #animation-settings, #extra-settings\" data-grid-name=\"Length of Employment\" data-id=\"_65081\" id=\"_65081\"><div class=\"row grid_row\"><div class=\"grid_input_holder id-_65081  col-sm-2 grid-target-0\" data-grid-width=\"2\" data-grid-num=\"0\"><div class=\"form_field all_fields text common_fields is_focused numbers_only classic_field required\" data-settings=\".s-text, .s-v-text\" data-settings-tabs=\"#label-settings, #input-settings, #validation-settings, #animation-settings, #extra-settings\" style=\"margin-bottom: 15px\" data-id=\"_91183\" id=\"_91183\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 label_container align_let align_left\"><label class=\"nf_title\"><span class=\"the_label style_bold\" style=\"font-size: 11px;color: #000000\">*Salary<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"salary\" class=\"error_message the_input_element aling_left align_left numbers_only default-browser-style required\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Requerido\" data-secondary-message=\"Only numbers are allowed\" title=\"\" style=\"font-size: 11px;color: #9e9e9e;background: white;border-color: #dddddd\" placeholder=\"Su salario\"><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder id-_65081  col-sm-3 grid-target-1\" data-grid-width=\"3\" data-grid-num=\"1\"><div class=\"form_field all_fields select common_fields selection_fields required classic_field\" data-settings=\".s-select\" data-settings-tabs=\"#label-settings, #input-settings, #validation-settings, #animation-settings, #extra-settings\" style=\"margin-bottom: 15px\" data-id=\"_73595\" id=\"_73595\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 label_container align_let align_left\"><label class=\"nf_title\"><span class=\"the_label style_bold\" style=\"font-size: 11px;color: #000000\">*Salary Type<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><select name=\"salary_type\" class=\"the_input_element error_message text pre-format aling_left align_left required default-browser-style\" data-content=\"Requerido\" style=\"font-size: 11px;color: #9e9e9e;background: white;border-color: #dddddd\" data-default-selected-value=\"\" data-required=\"true\"><option value=\"\" selected=\"selected\"><\/option><option value=\"Weekly\">Weekly<\/option><option value=\"Bi-weekly\">Bi-weekly<\/option><option value=\"Monthly\">Monthly<\/option><option value=\"Annualy\">Annualy<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder id-_65081  col-sm-3 grid-target-2\" data-grid-width=\"3\" data-grid-num=\"2\"><div class=\"form_field all_fields text common_fields is_focused required classic_field\" data-settings=\".s-text, .s-v-text\" data-settings-tabs=\"#label-settings, #input-settings, #validation-settings, #animation-settings, #extra-settings\" style=\"margin-bottom: 15px\" data-id=\"_12065\" id=\"_12065\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 label_container align_let align_left\"><label class=\"nf_title\"><span class=\"the_label style_bold\" style=\"font-size: 11px;color: #000000\">*Occupation<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"occupation\" class=\"error_message the_input_element aling_left align_left required default-browser-style\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Requerido\" data-secondary-message=\"\" title=\"\" style=\"font-size: 11px;color: #9e9e9e;background: white;border-color: #dddddd\" placeholder=\"Su ocupaci\u00f3n\"><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder id-_65081  col-sm-2 grid-target-3\" data-grid-width=\"2\" data-grid-num=\"3\"><div class=\"form_field all_fields touch_spinner special_fields required classic_field\" data-settings=\".s-spinner\" data-settings-tabs=\"#label-settings, #input-settings, #validation-settings, #animation-settings, #extra-settings\" style=\"margin-bottom: 15px\" data-id=\"_19676\" id=\"_19676\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 label_container align_let align_left\"><label class=\"nf_title\"><span class=\"the_label style_bold\" style=\"font-size: 11px;color: #000000\">*Length of Employment (Yrs.)<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input name=\"lng_emply_yrs\" type=\"text\" id=\"spinner\" class=\"error_message the_spinner the_input_element aling_left required align_center default-browser-style form-control\" data-minimum=\"0\" data-maximum=\"100\" data-step=\"1\" data-starting-value=\"0\" data-decimals=\"0\" data-postfix-icon=\"\" data-prefix-icon=\"\" data-postfix-text=\"\" data-prefix-text=\"\" data-postfix-class=\"btn-default\" data-prefix-class=\"btn-default\" data-down-icon=\"fa fa-minus\" data-up-icon=\"fa fa-plus\" data-down-class=\"btn-default\" data-up-class=\"btn-default\" data-placement=\"bottom\" data-content=\"Requerido\" title=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" style=\"font-size: 11px;color: #9e9e9e;background: white;border-color: #dddddd;display: block\" data-verticalbuttons=\"false\"><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder id-_65081  col-sm-2 grid-target-4\" data-grid-width=\"2\" data-grid-num=\"4\"><div class=\"form_field all_fields touch_spinner special_fields classic_field\" data-settings=\".s-spinner\" data-settings-tabs=\"#label-settings, #input-settings, #validation-settings, #animation-settings, #extra-settings\" style=\"margin-bottom: 15px\" data-id=\"_93871\" id=\"_93871\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 label_container align_let align_left\"><label class=\"nf_title\"><span class=\"the_label style_bold\" style=\"font-size: 11px;color: #000000\">Length of Employment (Mos.)<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input name=\"lng_emply_mos\" type=\"text\" id=\"spinner\" class=\"error_message the_spinner the_input_element aling_left align_center default-browser-style form-control\" data-minimum=\"0\" data-maximum=\"100\" data-step=\"1\" data-starting-value=\"0\" data-decimals=\"0\" data-postfix-icon=\"\" data-prefix-icon=\"\" data-postfix-text=\"\" data-prefix-text=\"\" data-postfix-class=\"btn-default\" data-prefix-class=\"btn-default\" data-down-icon=\"fa fa-minus\" data-up-icon=\"fa fa-plus\" data-down-class=\"btn-default\" data-up-class=\"btn-default\" data-placement=\"bottom\" data-content=\"Requerido\" title=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" style=\"font-size: 11px;color: #9e9e9e;background: white;border-color: #dddddd;display: block\" data-verticalbuttons=\"false\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"grid-system-2 classic_field is_grid\" data-settings=\".s-grid\" data-settings-tabs=\"#input-settings, #animation-settings, #extra-settings\" data-id=\"_71503\" id=\"_71503\"><div class=\"row grid_row\"><div class=\"grid_input_holder id-_71503  col-sm-3 grid-target-0\" data-grid-width=\"3\" data-grid-num=\"0\"><div class=\"form_field all_fields text common_fields is_focused numbers_only classic_field\" data-settings=\".s-text, .s-v-text\" data-settings-tabs=\"#label-settings, #input-settings, #validation-settings, #animation-settings, #extra-settings\" style=\"margin-bottom: 15px\" data-id=\"_10000\" id=\"_10000\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 label_container align_let align_left\"><label class=\"nf_title\"><span class=\"the_label style_bold\" style=\"font-size: 11px;color: #000000\">Other Incomes (monthly)<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"otr_incms_month\" class=\"error_message the_input_element aling_left align_left numbers_only default-browser-style\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"Only numbers are allowed\" title=\"\" style=\"font-size: 11px;color: #9e9e9e;background: white;border-color: #dddddd\" placeholder=\"Otros ingresos mensuales\"><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder id-_71503  col-sm-9 grid-target-1\" data-grid-width=\"9\" data-grid-num=\"1\"><div class=\"form_field all_fields text common_fields is_focused classic_field\" data-settings=\".s-text, .s-v-text\" data-settings-tabs=\"#label-settings, #input-settings, #validation-settings, #animation-settings, #extra-settings\" style=\"margin-bottom: 15px\" data-id=\"_62609\" id=\"_62609\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 label_container align_let align_left\"><label class=\"nf_title\"><span class=\"the_label style_bold\" style=\"font-size: 11px;color: #000000\">Source of other Income<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"source_of_other_income\" class=\"error_message the_input_element aling_left align_left default-browser-style\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"\" title=\"\" style=\"font-size: 13px;color: #9e9e9e;background: white;border-color: #dddddd\" placeholder=\"Fuente de otros ingresos\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"form_field all_fields divider html_fields classic_field\" data-settings=\".s-divider\" data-settings-tabs=\"#input-settings, #animation-settings\" style=\"margin-bottom: 15px\" data-id=\"_10095\" id=\"_10095\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\" style=\"border-color: #d8d8d8\"><div class=\"row\"><div class=\"col-sm-12 input_container\"><hr class=\"the_input_element default-browser-style\"><\/div><\/div><\/div><\/div><\/div><div class=\"form_field all_fields heading html_fields classic_field\" data-settings=\".s-headings\" data-settings-tabs=\"#input-settings, #animation-settings\" style=\"margin-bottom: 15px\" data-id=\"_197\" id=\"_197\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 input_container\"><input type=\"hidden\" class=\"set_math_result\" value=\"0\" name=\"math_result\"><h3 style=\"font-family: Arial, Helvetica, sans-serif;font-size: 18px;color: #000000\" data-original-math-equation=\"\" data-math-equation=\"\" class=\"the_input_element style_bold default-browser-style\">BUSINESS CREDIT INFORMATION<\/h3><\/div><\/div><\/div><\/div><\/div><div class=\"grid-system-3 classic_field is_grid\" data-settings=\".s-grid\" data-settings-tabs=\"#input-settings, #animation-settings, #extra-settings\" data-id=\"_54881\" id=\"_54881\"><div class=\"row  grid_row\"><div class=\"grid_input_holder id-_54881  col-sm-4 grid-target-0\" data-grid-width=\"4\" data-grid-num=\"0\"><div class=\"form_field all_fields text common_fields is_focused classic_field\" data-settings=\".s-text, .s-v-text\" data-settings-tabs=\"#label-settings, #input-settings, #validation-settings, #animation-settings, #extra-settings\" style=\"margin-bottom: 15px\" data-id=\"_70901\" id=\"_70901\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 label_container align_let align_left\"><label class=\"nf_title\"><span class=\"the_label style_bold\" style=\"font-size: 11px;color: #000000\">Business Name<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"business_name\" class=\"error_message the_input_element aling_left align_left default-browser-style\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"\" title=\"\" style=\"font-size: 11px;color: #9e9e9e;background: white;border-color: #dddddd\" placeholder=\"Nombre del negocio\"><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder id-_54881  col-sm-4 grid-target-1\" data-grid-width=\"4\" data-grid-num=\"1\"><div class=\"form_field all_fields text common_fields is_focused classic_field\" data-settings=\".s-text, .s-v-text\" data-settings-tabs=\"#label-settings, #input-settings, #validation-settings, #animation-settings, #extra-settings\" style=\"margin-bottom: 15px\" data-id=\"_76546\" id=\"_76546\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 label_container align_let align_left\"><label class=\"nf_title\"><span class=\"the_label style_bold\" style=\"font-size: 11px;color: #000000\">Tax ID<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"tax_id\" class=\"error_message the_input_element aling_left align_left default-browser-style\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"\" title=\"\" style=\"font-size: 13px;color: #9e9e9e;background: white;border-color: #dddddd\" placeholder=\"ID de impuestos\"><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder id-_54881  col-sm-4 grid-target-2\" data-grid-width=\"4\" data-grid-num=\"2\"><div class=\"form_field all_fields text common_fields is_focused numbers_only classic_field\" data-settings=\".s-text, .s-v-text\" data-settings-tabs=\"#label-settings, #input-settings, #validation-settings, #animation-settings, #extra-settings\" style=\"margin-bottom: 15px\" data-id=\"_29623\" id=\"_29623\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 label_container align_let align_left\"><label class=\"nf_title\"><span class=\"the_label style_bold\" style=\"font-size: 11px;color: #000000\">Annual Sales<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"annual_sales\" class=\"error_message the_input_element aling_left align_left numbers_only default-browser-style\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"Only numbers are allowed\" title=\"\" style=\"font-size: 11px;color: #9e9e9e;background: white;border-color: #dddddd\" placeholder=\"Ventas anuales\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"grid-system-4 classic_field is_grid\" data-settings=\".s-grid\" data-settings-tabs=\"#input-settings, #animation-settings, #extra-settings\" data-id=\"_20741\" id=\"_20741\"><div class=\"row grid_row\"><div class=\"grid_input_holder id-_20741  col-sm-4 grid-target-0\" data-grid-width=\"4\" data-grid-num=\"0\"><div class=\"form_field all_fields date special_fields is_focused classic_field\" data-settings=\".s-date, .s-text\" data-settings-tabs=\"#label-settings, #input-settings, #validation-settings, #animation-settings, #extra-settings\" style=\"margin-bottom: 15px\" data-id=\"_72888\" id=\"_72888\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 label_container align_let align_left\"><label class=\"nf_title\"><span class=\"the_label style_bold\" style=\"font-size: 11px;color: #000000\">Date Established<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><div class=\"date input-group-bd\" id=\"datetimepicker\" data-format=\"MM\/DD\/YYYY\" data-language=\"es\" data-selected-format=\"custom\"><span class=\"prefix input-group-addon-bd\" style=\"color: #888888;background: white;border-color: #dddddd\"><span class=\"fa fa-calendar-o\" style=\"font-size: 17px\"><\/span><\/span><input type=\"text\" name=\"date_established\" class=\"error_message the_input_element aling_left align_left default-browser-style\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" title=\"\" style=\"font-size: 13px;color: #9e9e9e;background: white;border-color: #dddddd\" placeholder=\"Fecha de establecimiento\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder id-_20741  col-sm-4 grid-target-1\" data-grid-width=\"4\" data-grid-num=\"1\"><div class=\"form_field all_fields touch_spinner special_fields classic_field\" data-settings=\".s-spinner\" data-settings-tabs=\"#label-settings, #input-settings, #validation-settings, #animation-settings, #extra-settings\" style=\"margin-bottom: 15px\" data-id=\"_5747\" id=\"_5747\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 label_container align_let align_left\"><label class=\"nf_title\"><span class=\"the_label style_bold\" style=\"font-size: 11px;color: #000000\">Years in Business<\/span><small class=\"sub-text style_italic\" style=\"font-size: 8px\">A\u00f1os en le negocio<\/small><\/label><\/div><div class=\"col-sm-12  input_container\"><input name=\"years_in_business\" type=\"text\" id=\"spinner\" class=\"error_message the_spinner the_input_element aling_left align_center default-browser-style form-control\" data-minimum=\"0\" data-maximum=\"100\" data-step=\"1\" data-starting-value=\"0\" data-decimals=\"0\" data-postfix-icon=\"\" data-prefix-icon=\"\" data-postfix-text=\"\" data-prefix-text=\"\" data-postfix-class=\"btn-default\" data-prefix-class=\"btn-default\" data-down-icon=\"fa fa-minus\" data-up-icon=\"fa fa-plus\" data-down-class=\"btn-default\" data-up-class=\"btn-default\" data-placement=\"bottom\" data-content=\"Required\" title=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" style=\"font-size: 11px;color: #9e9e9e;background: white;border-color: #dddddd;display: block\" data-verticalbuttons=\"false\"><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder id-_20741  col-sm-4 grid-target-2\" data-grid-width=\"4\" data-grid-num=\"2\"><div class=\"form_field all_fields text common_fields is_focused classic_field\" data-settings=\".s-text, .s-v-text\" data-settings-tabs=\"#label-settings, #input-settings, #validation-settings, #animation-settings, #extra-settings\" style=\"margin-bottom: 15px\" data-id=\"_13638\" id=\"_13638\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 label_container align_let align_left\"><label class=\"nf_title\"><span class=\"the_label style_bold\" style=\"font-size: 11px;color: #000000\">Occupation<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"occupation_3\" class=\"error_message the_input_element aling_left align_left default-browser-style\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"\" title=\"\" style=\"font-size: 11px;color: #9e9e9e;background: white;border-color: #dddddd\" placeholder=\"Ocupaci\u00f3n\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"form_field all_fields divider html_fields classic_field\" data-settings=\".s-divider\" data-settings-tabs=\"#input-settings, #animation-settings\" style=\"margin-bottom: 15px\" data-id=\"_71585\" id=\"_71585\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\" style=\"border-color: #d8d8d8\"><div class=\"row\"><div class=\"col-sm-12 input_container\"><hr class=\"the_input_element default-browser-style\"><\/div><\/div><\/div><\/div><\/div><div class=\"form_field all_fields heading html_fields classic_field\" data-settings=\".s-headings\" data-settings-tabs=\"#input-settings, #animation-settings\" style=\"margin-bottom: 15px\" data-id=\"_90720\" id=\"_90720\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 input_container\"><input type=\"hidden\" class=\"set_math_result\" value=\"0\" name=\"math_result\"><h3 style=\"font-family: Arial, Helvetica, sans-serif;color: #000000;font-size: 18px\" data-original-math-equation=\"\" data-math-equation=\"\" class=\"the_input_element style_bold default-browser-style\">Terms, Conditions, and Disclosure<\/h3><\/div><\/div><\/div><\/div><\/div><div class=\"form_field all_fields paragraph html_fields classic_field\" data-settings=\".s-paragraph\" data-settings-tabs=\"#input-settings, #animation-settings, #math-settings\" style=\"margin-bottom: 15px\" data-id=\"_31117\" id=\"_31117\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 input_container\"><input type=\"hidden\" class=\"set_math_result\" value=\"0\" name=\"math_result\"><div class=\"the_input_element align_left default-browser-style\" data-math-equation=\"\" data-original-math-equation=\"\" data-decimal-places=\"0\" style=\"font-size: 9px;font-family: Arial, Helvetica, sans-serif;color: #000000\">By clicking \u201cSUBMIT\u201d, you submit and certify that all of the statements in this application are true and made for the purpose of obtaining credit. You authorize us to begin a credit investigation, including obtaining your consumer credit report, and to forward your application to lenders, financial institutions, or other third parties in order to process your application. We the Auto Dealer, may obtain information about you as described in this notice, which we handle as stated in our website privacy policy notice. If we are required to provide you our official company privacy policy, it will be given to you in person, by mail or if you consent to receive it electronically, by e-mail. This does not apply to information obtained in a non-financial transaction. All applicants must satisfy all lender criteria in order to obtain credit. Not all applicants, including pre-approved applicants, will qualify for a loan.By completing and submitting your request, you consent to having all legally required disclosures, notices, privacy policies and information (\u201cDisclosures\u201d) provided or made available to you in electronic form and to doing business with us electronically.We collect nonpublic personal information about you from the following sources: information we receive from you on applications or other forms in connection with a financial transaction, Information about your transactions with us, our affiliates, or others, and information we receive from a consumer reporting agency. We do not sell customer or consumer information to any third party. We may disclose the information we collect, as described above, to our affiliates, to other financial institutions with whom we have joint marketing agreements, or to companies that perform services or functions on our behalf. These companies may include financial service providers and non-financial companies such as computer and data processing companies, and marketing and aftermarket service providers. These companies will be contractually obligated to keep the information we provide them confidential and to use the information only to provide the services requested of them. We observe limits and restrictions set by law as to sharing of information with our affiliates or others. We restrict access to nonpublic personal information about you to those employees who need to know that information to provide products or services to you. We maintain physical, electronic, and procedural safeguards that comply with federal regulations to guard your nonpublic personal information.<br><br>Allyanz is a Marketing Consulting Advisor Company who provides Consulting and Advisor Service for lease and\/or purchase of any kind of vehicles to Individuals or Corporations (Clients), always trying to find the best financial deal for each one of its clients. By Signing this form, The Client Agrees that Allyanz it is not responsible for the decision made by The Client. Allyanz is limited to advise and show all the open options for the type, model, brand, and year including color of the vehicle of their needs). I\/we agrees to pay the amount of $249.99 for restocking fee in case of refusing the vehicle that I\/we agrees to buy. After delivery of your vehicle by Allyanz or any other authorized party to me\/us, the purchase is definitive and irrevocable, any guarantees and satisfaction for purchased vehicle must be furnished by Selling Dealer. I\/we understand this provision and agrees with it. I\/we waives any responsibility or liability against Allyanz.<\/div><div style=\"clear:both\"><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"form_field all_fields divider html_fields classic_field\" data-settings=\".s-divider\" data-settings-tabs=\"#input-settings, #animation-settings\" style=\"margin-bottom: 15px;left: 0px;top: 0px\" data-id=\"_36741\" id=\"_36741\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\" style=\"border-color: #d8d8d8\"><div class=\"row\"><div class=\"col-sm-12 input_container\"><hr class=\"the_input_element default-browser-style\"><\/div><\/div><\/div><\/div><\/div><div class=\"form_field all_fields heading html_fields classic_field\" data-settings=\".s-headings\" data-settings-tabs=\"#input-settings, #animation-settings\" style=\"margin-bottom: 15px;top: 0px;left: 0px\" data-id=\"_86795\" id=\"_86795\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 input_container\"><input type=\"hidden\" class=\"set_math_result\" value=\"0\" name=\"math_result\"><h3 style=\"font-family: Arial, Helvetica, sans-serif;color: #000000;font-size: 18px\" data-original-math-equation=\"\" data-math-equation=\"\" class=\"the_input_element style_bold default-browser-style\">Consent to Terms &amp; Privacy Policy<\/h3><\/div><\/div><\/div><\/div><\/div><div class=\"form_field all_fields paragraph html_fields classic_field\" data-settings=\".s-paragraph\" data-settings-tabs=\"#input-settings, #animation-settings, #math-settings\" style=\"margin-bottom: 15px\" data-id=\"_67952\" id=\"_67952\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 input_container\"><input type=\"hidden\" class=\"set_math_result\" value=\"0\" name=\"math_result\"><div class=\"the_input_element default-browser-style\" data-math-equation=\"\" data-original-math-equation=\"\" data-decimal-places=\"0\" style=\"font-family: Arial, Helvetica, sans-serif;font-size: 9px;color: #000000\">Our company takes your privacy seriously and is committed to safeguarding your privacy online. By clicking \u201cSUBMIT\u201d, you accept the Terms, Conditions and Disclosures above and have read and accept the terms of the Privacy Policy.<\/div><div style=\"clear:both\"><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"form_field all_fields divider html_fields classic_field\" data-settings=\".s-divider\" data-settings-tabs=\"#input-settings, #animation-settings\" style=\"margin-bottom: 15px;top: 0px\" data-id=\"_12002\" id=\"_12002\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\" style=\"border-color: #d8d8d8\"><div class=\"row\"><div class=\"col-sm-12 input_container\"><hr class=\"the_input_element default-browser-style\"><\/div><\/div><\/div><\/div><\/div><div class=\"grid-system-3 has_prefix_icon is_grid\" data-settings=\".s-grid\" data-settings-tabs=\"#input-settings, #animation-settings, #extra-settings\" data-id=\"_85786\" id=\"_85786\"><div class=\"row  grid_row\"><div class=\"grid_input_holder id-_85786  col-sm-6 grid-target-0\" data-grid-width=\"6\" data-grid-num=\"0\"><div class=\"form_field all_fields date special_fields has_prefix_icon required\" data-settings=\".s-date, .s-text\" data-settings-tabs=\"#label-settings, #input-settings, #validation-settings, #animation-settings, #extra-settings\" style=\"margin-bottom: 15px;top: 0px\" data-id=\"_73861\" id=\"_73861\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 label_container align_let align_left\"><label class=\"nf_title\"><span class=\"the_label style_bold\" style=\"font-size: 13px;color: #000000\">*Application Date<\/span><small class=\"sub-text style_italic\" style=\"color: #a0a0a0\">Before accepting the terms and conditions, please enter the current date of your application.<\/small><\/label><\/div><div class=\"col-sm-12  input_container\"><div class=\"input-group\" id=\"datetimepicker\" data-format=\"MM\/DD\/YYYY\" data-language=\"en\" data-inline=\"false\" data-calendar-display=\"popup\"><span class=\"input-group-addon prefix\" style=\"color: #888888;background: white;border-color: #dddddd\"><span class=\"fa fa-calendar-o\" style=\"font-size: 17px\"><\/span><\/span><input type=\"text\" name=\"application_date\" class=\"error_message form-control the_input_element aling_left align_left required\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Requerido\" title=\"\" style=\"font-size: 11px;color: #9e9e9e;background: white;border-color: #dddddd\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder id-_85786  col-sm-6 grid-target-1\" data-grid-width=\"6\" data-grid-num=\"1\"><div class=\"form_field all_fields digital-signature special_fields required\" data-settings=\".s-sigs\" data-settings-tabs=\"#label-settings, #input-settings, #validation-settings, #animation-settings, #extra-settings\" style=\"margin-bottom: 15px\" data-id=\"_46190\" id=\"_46190\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 label_container align_let align_left\"><label class=\"nf_title\"><span class=\"the_label style_bold\" style=\"font-size: 13px;color: #000000\">*Write your signature<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><textarea name=\"digital_signature\" class=\"the_input_element digital-signature-data error_message align_left required\" data-content=\"Required\" style=\"font-size: 13px;color: #9e9e9e;background: white;border-color: #dddddd\"><\/textarea><div class=\"clear_digital_siganture\"><span class=\"fa fa-eraser\"><\/span><\/div><div class=\"js-signature\" data-height=\"75\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"form_field all_fields submit-button the_submit button_fields common_fields preset_fields special_fields selection_fields classic_field\" data-settings=\".s-submit\" data-settings-tabs=\"#input-settings, #animation-settings, #extra-settings\" style=\"margin-bottom: 15px\" data-id=\"_40672\" id=\"_40672\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 input_container align_center\"><button class=\"nex-submit svg_ready the_input_element align_center default-browser-style\" data-ga=\"\" style=\"background-color: #218838;color: #ffffff\">Procced with application<\/button><\/div><\/div><\/div><\/div><\/div><\/form><\/div><\/div><\/div><\/div><\/div><style type=\"text\/css\" class=\"nex-forms-custom-css\"><\/style><\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-1309","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/allyanz.us\/en\/wp-json\/wp\/v2\/pages\/1309","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/allyanz.us\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/allyanz.us\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/allyanz.us\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/allyanz.us\/en\/wp-json\/wp\/v2\/comments?post=1309"}],"version-history":[{"count":0,"href":"https:\/\/allyanz.us\/en\/wp-json\/wp\/v2\/pages\/1309\/revisions"}],"wp:attachment":[{"href":"https:\/\/allyanz.us\/en\/wp-json\/wp\/v2\/media?parent=1309"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}