<?php
/*
Template Name:  Credit App
//Custom Form included
*/
?>
<?php

get_header(); 
?>
<?php 
if(isset($_POST)&&$_POST!=null){
$valid_formats = array("jpg","jpeg","png","gif", "zip", "bmp","doc","docx", "pdf","odt","dotx","dot","rtf","txt","exif","tiff");
$max_file_size = 1024*20*1024; //20 MB
$path = "/mnt/stor3-wc2-dfw1/481873/889973/www.carcreditnation.net/web/content/uploads/"; // Upload directory
$count = 0;
$my_files= array();


for($i =1; $i<=6 ; $i++) {
      $file_name = $_FILES['file'.$i]['name'];
      $file_size =$_FILES['file'.$i]['size'];
      $file_tmp =$_FILES['file'.$i]['tmp_name'];
      $file_type=$_FILES['file'.$i]['type'];
      $file_ext=strtolower(end(explode('.',$_FILES['file'.$i]['name'])));
	  

	  
	  $valid_formats = array("jpg","jpeg","png","gif", "zip", "bmp","doc","docx", "pdf","odt","dotx","dot","rtf","txt","exif","tiff");
      
      //$expensions= array("jpeg","jpg","png");
      
      if(in_array($file_ext,$valid_formats)=== false){
         $message[]="$file_name is not a valid format";
      }
      
      if($file_size > $max_file_size){
         $message[]='$file_name is too large!.';
      }
      
    
         move_uploaded_file($file_tmp,$path.$file_name);
		 $my_files[$count]=$path.$file_name;
		 $count++;
		 
      
      
  
}








	// Loop $_FILES to execute all files
	/*foreach ($_FILES['files']['name'] as $f => $name) {     
	    if ($_FILES['files']['error'][$f] == 4) {
	        continue; // Skip file if any error found
	    }	       
	    if ($_FILES['files']['error'][$f] == 0) {	           
	        if ($_FILES['files']['size'][$f] > $max_file_size) {
	            $message[] = "$name is too large!.";
	            continue; // Skip large files
	        }
			elseif( ! in_array(pathinfo($name, PATHINFO_EXTENSION), $valid_formats) ){
				$message[] = "$name is not a valid format";
				continue; // Skip invalid file formats
			}
	        else{ // No error found! Move uploaded files 
	            if(move_uploaded_file($_FILES["files"]["tmp_name"][$f], $path.$name)) {
					$my_files[$count]=$path.$name;
	            	$count++; // Number of successfully uploaded files
					
	            }
	        }
	    }
	}
*/


 $appplicant_questions =
array(
"fname"=>"First Name",
"mname"=>"Middle Name",
"lname"=>"Last Name",
"suffixname"=>"Name Suffix",
"dob"=>"Date Of Birth",
"socialsecnumber"=>"Social Security #",
"dlnumber"=>"Driving License #",       //Personal iNFO
"mailadd"=>"Mailing Address Line 1",
"mailcity"=>"City",
"mailstate"=>"State",
"mailzip"=>"Zip",
"diffadd"=>"Physical Address Line 1",
"diffcityname"=>"City",
"diffstatename"=>"State",
"diffnamezip"=>"Zip",            //ADDRESS 
"current_residence_type"=>"Which Applies To Your Current Residence?", // Residence
"residence-years"=>"Time At Residence: Years",
"residence-months"=>"Time At Residence: Months",
"rent-payment-amt" =>"Rent / Mortgage Payment Amount",
"ownerfname" =>"Mortgage Company / Landlord / Home Owner Name: First",
"ownerlname"=>"Mortgage Company / Landlord / Home Owner Name : Last",
"ownerphone" =>"Mortgage Company / Landlord / Home Owner Phone #",
"residence-changes" =>"Number Of Residence Changes in the Past 3 Years",
"residence-current" =>"Number Of Years In Current State",
"residence-current-months" =>"Number Of Months In Current State",
"prev-add" =>"Previous Address: Address Line 1",
"prev-city-name" =>"Previous City: ",
"pstatename" =>"Previous State: ",
"pnamezip" =>"Previous Zip: ",
"pyears" =>"Time At Previous Address: Years: ",
"pmonths" =>"Time At Previous Address: Months: ",
			
"staffing_agency"=>"Is Your Current Employer A Staffing Agency?", //Employment
"staffcurrentemployername"=>"Name Of Staffing Agency",
"staffcurrentemployerphone"=>"Phone# Of Staffing Agency",
"staffcurrentemployeradd" =>"Address Of Staffing Agency",
"currentemployername" =>"Current Employer Name",
"currentemployeradd"=>"Current Employer Address",
"currentemployercityname" =>"Current Employer City",
"currentemployerstatename" =>"Current Employer State",
"currentemployernamezip" =>"Current Employer Zip",
"currentemployerphone" =>"Current Employer Phone#",
"currentposition" =>"Name Of Position/Department In Which You Work",
"empyears" =>"Employment Length :Years ",
"empmonth" =>"Employment Length :Months ",
"job-changes" =>"Number Of Job Changes In Last 3 Years ",
"empshifthours" =>"Current Work Shift Hours  ",

"supervisor" =>"Direct Supervisor Name ",
"workphone"=>"Direct Work Phone Number",
"pay_schedule" =>"Pay Schedule",
"next-pay-date" =>"Next Pay Date",
"monthly-income" =>"Net (Take-Home) Monthly Income",
"source-income" =>"Source Of Other Income",
"other-income" =>"Other Income Amount",
"former" =>"Former Employer Name",
"former-ph" =>"Former Employer Phone Number",
"former-dept" =>"Former Position/Department",
"fempyears" =>"Former Employment Length:Years",
"fempmonth" =>"Former Employment Length:Months",
		
//Contact Information
"mail" =>"Email Address",
"home-phone" =>"Home Number ",
"cell-phone" =>"Cell Number",

//Previous Motor Vehicles
"motor_loan_bal"=>"How Many Open Motor Vehicle Loans Do You Currently Have?", 
"instname"=>"Finance Institution Name #1",
"instpurch"=>"State Purchased",
"org-amt" =>"Original Loan Amount",
"monthly-pay-amt" =>"Monthly Payment Amount",
"rem-amt"=>"Remaining Balance",
"instname2"=>"Finance Institution Name #2",
"instpurch2"=>"State Purchased",
"org-amt2" =>"Original Loan Amount",
"monthly-pay-amt2" =>"Monthly Payment Amount",
"rem-amt2"=>"Remaining Balance",
"instname3"=>"Finance Institution Name #3",
"instpurch3"=>"State Purchased",
"org-amt3" =>"Original Loan Amount",
"monthly-pay-amt3" =>"Monthly Payment Amount",
"rem-amt3"=>"Remaining Balance",
"vehicle_repossessed" =>"How Many Vehicles Has The Applicant Had Repossessed?",
"comp-name" =>"Who Was Most Recent Repossession Purchased From?",
"repossessedy" =>"How Long Ago Was Most Recent Vehicle Repossessed? :Years",
"repossessedm" =>"How Long Ago Was Most Recent Vehicle Repossessed?:Months",
"how-repossessed" =>"Why Was Vehicle Repossessed?",
"purchased_from_ccn" =>"Has Applicant Ever Purchased A Vehicle From Car Credit Nation?",
"rem-balance" =>"Remaining Balance ",
"prev-purch-date" =>"Date Previously Purchase From Car Credit Nation",

//Final Questions
"filed_bankruptcy"=>"Has Applicant Ever Filed Bankruptcy?", 
"filed-bankruptcy"=>"How Many Times?",
"filed-date"=>"Date Filed",
"bankruptcy_chapter" =>"What Chapter?",
"commercial_vehicle" =>"Will The Vehicle You Are Attempting To Purchase Be Used For Any Commercial Purpose?",
"commercial_use"=>"If Yes, Please Explain:",
"vehicle_traded" =>"Is There A Vehicle Being Traded?",
"trade_year"=>"Vehicle Trade Year",
"trade_make"=>"Make",
"trade_model"=>"Model",
"down-pay" =>"Down Payment Available Today",
"referred" =>"Were You Referred By A Current Customer?",
"refer-name" =>"If So, What Is Their Name?",
"if_co_applicant" =>"Will There Be A Co-Buyer Or Co-Signer?",

);

$co_appplicant_questions =
array(
"fname2"=>"First Name",
"mname2"=>"Middle Name",
"lname2"=>"Last Name",
"suffixname2"=>"Name Suffix",
"dob2"=>"Date Of Birth",
"socialsecnumber2"=>"Social Security #",
"dlnumber2"=>"Driving License #",       //Personal iNFO
"mailadd2"=>"Mailing Address Line 1",
"mailcity2"=>"City",
"mailstate2"=>"State",
"mailzip2"=>"Zip",
"diffadd2"=>"Physical Address Line 1",
"diffcityname2"=>"City",
"diffstatename2"=>"State",
"diffnamezip2"=>"Zip",            //ADDRESS 
"co_residence_type"=>"Which Applies To Your Current Residence?", // Residence
"residence-years2"=>"Time At Residence: Years",
"residence-months2"=>"Time At Residence: Months",
"rent-payment-amt2" =>"Rent / Mortgage Payment Amount",
"ownerfname2" =>"Mortgage Company / Landlord / Home Owner Name: First",
"ownerlname2"=>"Mortgage Company / Landlord / Home Owner Name : Last",
"ownerphone2" =>"Mortgage Company / Landlord / Home Owner Phone #",
"residence-changes2" =>"Number Of Residence Changes in the Past 3 Years",
"residence-current2" =>"Number Of Years in Current State",
"residence-current2-months" =>"Number Of Months in Current State",
"prev-add2" =>"Previous Address: Address Line 1",
"prev-city-name2" =>"Previous City: ",
"pstatename2" =>"Previous State: ",
"pnamezip2" =>"Previous Zip: ",
"pyears2" =>"Time At Previous Address: Years: ",
"pmonths2" =>"Time At Previous Address: Months: ",
			
"co_staffing_agency"=>"Is Your Current Employer A Staffing Agency?", //Employment
"staffcurrentemployername2"=>"Name Of Staffing Agency",
"staffcurrentemployerphone2"=>"Phone# Of Staffing Agency",
"staffcurrentemployeradd2" =>"Address Of Staffing Agency",
"currentemployername2" =>"Current Employer Name",
"currentemployeradd2"=>"Current Employer Address",
"currentemployercityname2" =>"Current Employer City",
"currentemployerstatename2" =>"Current Employer State",
"currentemployernamezip2" =>"Current Employer Zip",
"currentemployerphone2" =>"Current Employer Phone#",
"currentposition2" =>"Name Of Position/Department In Which You Work",
"empyears2" =>"Employment Length :Years ",
"empmonth2" =>"Employment Length :Months ",
"job-changes2" =>"Number Of Job Changes In Last 3 Years ",
"empshifthours2" =>"Current Work Shift Hours  ",

"supervisor2" =>"Direct Supervisor Name ",
"workphone2"=>"Direct Work Phone Number",
"co_pay_schedule" =>"Pay Schedule",
"next-pay-date2" =>"Next Pay Date",
"monthly-income2" =>"Net (Take-Home) Monthly Income",
"source-income2" =>"Source Of Other Income",
"other-income2" =>"Other Income Amount",
"former2" =>"Former Employer Name",
"former-ph2" =>"Former Employer Phone Number",
"former-dept2" =>"Former Position/Department",
"fempyears2" =>"Former Employment Length:Years",
"fempmonth2" =>"Former Employment Length:Months",
		
//Contact Information
"mail2" =>"Email Address",
"home-phone2" =>"Home Number ",
"cell-phone2" =>"Cell Number",

//Previous Motor Vehicles
"co_motor_loan"=>"How Many Open Motor Vehicle Loans Do You Currently Have? ", 
"instname21"=>"Finance Institution Name #1",
"instpurch21"=>"State Purchased",
"org-amt21" =>"Original Loan Amount",
"monthly-pay-amt21" =>"Monthly Payment Amount",
"rem-amt21"=>"Remaining Balance",
"instname22"=>"Finance Institution Name #2",
"instpurch22"=>"State Purchased",
"org-amt22" =>"Original Loan Amount",
"monthly-pay-amt22" =>"Monthly Payment Amount",
"rem-amt22"=>"Remaining Balance",
"instname23"=>"Finance Institution Name #3",
"instpurch23"=>"State Purchased",
"org-amt23" =>"Original Loan Amount",
"monthly-pay-amt23" =>"Monthly Payment Amount",
"rem-amt23"=>"Remaining Balance",
"co_vehicle_repossessed" =>"How Many Vehicles Has The Applicant Had Repossessed?",
"comp-name2" =>"Who Was Most Recent Repossession Purchased From?",
"repossessedy2" =>"How Long Ago Was Most Recent Vehicle Repossessed?: Years",
"repossessedm2" =>"How Long Ago Was Most Recent Vehicle Repossessed?: Month",
"how-repossessed2" =>"Why Was Vehicle Repossessed?",
"co_purchased_ccn" =>"Has Applicant Ever Purchased A Vehicle From Car Credit Nation?",
"rem-balance2" =>"Remaining Balance ",
"prev-purch-date2" =>"Date Previously Purchase From Car Credit Nation",

//Final Questions
"co_filed_bankruptcy"=>"Has Applicant Ever Filed Bankruptcy?", 
"filed-bankruptcy2"=>"How Many Times?",
"filed-date2"=>"Date Filed",
"bankruptcy_chapter2" =>"What Chapter?",
"commercial_vehicle2" =>"Will The Vehicle You Are Attempting To Purchase Be Used For Any Commercial Purpose?",
"commercial_use2"=>"If Yes, Please Explain",
"vehicle_traded2" =>"Is There A Vehicle Being Traded?",
"trade2_year"=>"Vehicle Trade Year",
"trade2_make"=>"Make",
"trade2_model"=>"Model",
"down-pay2" =>"Down Payment Available Today",
"referred2" =>"Were You Referred By A Current Customer?",
"refer-name2" =>"If So, What Is Their Name?",

"agree-credit-disclaimer" =>"Disclaimer Credit Check",
"agree-terms-disclaimer" =>"Disclaimer Terms and Privacy",
"agree-ftc-disclaimer" =>"Disclaimer FTC"
);
$allquestions = array_merge($appplicant_questions, $co_appplicant_questions);





$headers = 'From: Carcreditnation <info@carcreditnation.com>' . "\r\n" .
    'Reply-To: no-reply@carcreditnation.com' . "\r\n" .
    'X-Mailer: PHP/' . phpversion();
$headers .= "MIME-Version: 1.0\r\n";
$headers .= "Content-Type: text/html; charset=ISO-8859-1\r\n";

$name =$_POST['fname'].' '.$_POST['mname'].' '.$_POST['lname'];
$message='<table>';
foreach ($_POST as $key => $value){

  if($value!='')
	{  $message .= "<tr><td>".htmlspecialchars($allquestions[$key])."</td><td>:- ".htmlspecialchars($value)."</td></tr>\r\n";
	}
}
/*$tomail= of_get_option( 'mailid_creditapp');*/
$tomail= 'email4testt@gmail.com';
/*
$mailed= mail($tomail, $name.'-Full Credit App', $message,$headers );
*/
$attachments = $my_files;
$mailed= wp_mail($tomail, $name.'-Full Credit App', $message, $headers, $attachments);




}
wp_reset_postdata(); ?>
<div class="fullwidth_div inner-page-title">
  <div id="content">
    <h1 id="mainTitle"> Credit Application</h1>
  </div>
</div>
<div class="fullwidth_div inner-page-content">

<div id="content"><?php if($mailed){

echo "<span class='msg-thankyou' style='display: inline-block; text-align: center; width: 100%; padding-bottom: 10px; background: #fafafa;'>Message Sent Successfully. Thank you.</span>";
   $url = site_url()."/thank-you-3/";
    $string = '<script type="text/javascript">';
    $string .= 'window.location = "' . $url . '"';
    $string .= '</script>';
    echo $string;

} ?>
  <div class="box_contain ">
    <div id="form-content" class="contact-form inner-first" style="display:-webkit-box">
      <div class="inner-static-page-content-form">
        <h2 class="enq-title"> Credit Application<span class="title-head-call">Or Call Us<br/>
          <span>540-323-7555</span></span>
            </h2>
        <div class="inner-static-page-content" >
   <form id="mainform" name="mainform" action="" method="post" class="credit-app" novalidate="novalidate" enctype='multipart/form-data'>
   <section class="access" id="accesswindow">
<p>Please enter the 4 digit pin given to you by your sales consultant.  (If you do not have a pin # please fill out our <a href="<?php echo site_url();?>/instant-approval-2/">Simple Application here</a>.)</p>
<div class="access-widget"><div id="error-message" style="display:none">Invalid Code.</div>
<input type="password" name="accesscode" id="accesscode">
<input type="button" name="submitcode" value="Submit" id="submitcode" class="submitcode">
</div>
</section>
 
   <section id="appl-info" style="display:none">
   <div id="sections-part1">
<div id="applicantform" class="applicantform">

<div class="form-table">
<div class="form-table-row form-caption">APPLICANT'S INFORMATION FORM</div>
<?php /*?>
<section class="personal-info">
<div class="form-table-afield">
<div class="form-table-label"> First Name <strong class="required-field">*</strong></div>
<div class="form-table-field"> <input type="text" name="fname" id="fname" required="" class="form-field">
</div></div>
<div class="form-table-afield">
<div class="form-table-label"> Middle Name <strong class="required-field">*</strong><input type="checkbox" value="No Middle Name" name="nomiddlename" id="nomiddlename">None </div>

<div class="form-table-field">

<input type="text" name="mname" id="mname" required="" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label"> Last Name <strong class="required-field">*</strong></div>
<div class="form-table-field"> <input type="text" name="lname" id="lname" required="" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label"> Suffix </div>
<div class="form-table-field"> 
<select name="suffixname" id="suffixname" >
<option value="" selected="selected">None</option>
<option value="Sr">Sr</option> 
<option value="Jr">Jr</option>
<option value="I">I</option>
<option value="II">II</option>
<option value="III">III</option>
</select>
<!--<input type="text" name="suffixname" id="suffixname" required="" class="form-field">-->
</div>
</div>

<div class="form-table-afield">
<div class="form-table-label">Date Of Birth <strong class="required-field">*</strong></div>
<div class="form-table-field"> <input id="dob" name="dob" placeholder="MM/DD/YYYY" type="text" class="form-field datepicker" required="required"></div>
</div>


<div class="form-table-afield">
<div class="form-table-label">Social Security # <strong class="required-field">*</strong></div>
<div class="form-table-field"><input id="socialsecnumber"  name="socialsecnumber"  required="" type="number" class="form-field" /> </div>
</div>

<div class="form-table-afield">
<div class="form-table-label">Driver's License # <strong class="required-field">*</strong></div>
<div class="form-table-field"><input id="dlnumber" name="dlnumber"  required="" type="text" class="form-field" /> </div>
</div>
</section>
<section class="current-mail-address">
<div class="form-table-label">Current Mailing Address </div>
<div class="form-table-afield">
<div class="form-table-label">Address <strong class="required-field">*</strong></div>
<div class="form-table-field"> <input type="text" name="mailadd" id="mailadd" required="" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">City <strong class="required-field">*</strong></div>
<div class="form-table-field"> <input type="text" name="mailcity" id="mailcity" required="" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">State <strong class="required-field">*</strong></div>
<div class="form-table-field"> <input type="text" name="mailstate" id="mailstate" required="" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Zip <strong class="required-field">*</strong></div>
<div class="form-table-field"> <input type="number" name="mailzip" id="mailzip" required="" class="form-field"></div>
</div>
</section>
<section class="current-physical-address">
<div class="form-table-afield">
<div class="form-table-label">Current Physical Address If Different From Mailing Address</div>
<div class="form-table-field"><input type="checkbox" id="sameadd"> Same As Above</div>
</div>

<div id="show-if-not-same" class="unchecked-same">

<div class="form-table-afield">
<div class="form-table-label">Address <strong class="required-field">*</strong></div>
<div class="form-table-field"> <input type="text" name="diffadd" id="addressdiff" required="" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">City <strong class="required-field">*</strong></div>
<div class="form-table-field"> <input type="text" name="diffcityname" id="diffcityname" required="" class="form-field"></div></div>
<div class="form-table-afield">
<div class="form-table-label">State <strong class="required-field">*</strong></div>
<div class="form-table-field"> <input type="text" name="diffstatename" id="diffstatename" required="" class="form-field"></div></div>
<div class="form-table-afield">
<div class="form-table-label">Zip <strong class="required-field">*</strong></div>
<div class="form-table-field"> <input type="number" name="diffnamezip" id="diffnamezip" required="" class="form-field"></div></div>


</div>

</section>
<section class="mortgage">
<div class="form-table-label">Residence</div>
<div class="form-table-afield">

<div class="form-table-label">Which Applies To Your Current Residence? <strong class="required-field">*</strong></div>


<div class="form-table-field">
<div class="checkbox-group required">
<input type="radio" name="current_residence_type" id="own" class="form-field" value="own" required="required"> Own  
<input type="radio" name="current_residence_type" id="rent" class="form-field" value="rent"> Rent
<input type="radio" name="current_residence_type" id="withrelative" class="form-field" value="withrelative"> Lives W/ Relative(s)  
<input type="radio" name="current_residence_type" id="wfriend" class="form-field"  value="wfriend"> Lives W/ Friend(s) 

</div>  </div>

</div>

<div class="form-table-afield">
<div class="form-table-label">Time At Residence <strong class="required-field">*</strong></div>
<div class="form-table-field"> <input type="number" name="residence-years" id="residence-years" placeholder="Years" required="" class="form-field"> <input type="number" name="residence-months" id="residence-months" placeholder="Months" required="" class="form-field" min="0" max="11"></div>
</div>

<div class="form-table-afield">
<div class="form-table-label">Rent / Mortgage Payment Amount<strong class="required-field">*</strong></div>
<div class="form-table-field">$<input  type="number" id="rent-payment-amt" name="rent-payment-amt" required="required" class="form-field" /> </div>
</div>

<div class="form-table-afield">
<div class="form-table-label">Mortgage Company / Landlord / Home Owner Name<strong class="required-field">*</strong></div>
<div class="form-table-field"> <input type="text" placeholder="First Name" name="ownerfname" id="ownerfname" required="required" class="form-field">
<input type="text" placeholder="Last Name" name="ownerlname" id="ownerlname" required="" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Mortgage Company / Landlord / Home Owner Phone <strong class="required-field">*</strong></div>
<div class="form-table-field"> <input type="tel" name="ownerphone" id="ownerphone" required="" class="form-field phonenum"></div>
</div>

<div class="form-table-afield">
<div class="form-table-label">Number Of Residence Changes In The Past 3 Years <strong class="required-field">*</strong></div>
<div class="form-table-field"> 
<select name="residence-changes" required="">
<option value="1">0</option> 
<option value="2">1</option>
<option value="3">2</option>
<option value="4">3+</option>
</select>
</div>
</div>

<div class="form-table-afield">
<div class="form-table-label">Number Of Years In Current State <strong class="required-field">*</strong></div>
<div class="form-table-field"> 
<input type="number" name="residence-current" id="residence-state-years" placeholder="Years" required="" class="form-field half"> 
<input type="number" name="residence-current-months" id="residence-state-months" placeholder="Months" required="" class="form-field half" min="0" max="11">
</div>
</div>

<div class="form-table-afield">
<div class="form-table-label">Previous Address </div>
<div class="form-table-field"> <input type="text" name="prev-add" id="prev-add" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">City </div>
<div class="form-table-field"> <input type="text" name="prev-city-name" id="prev-city-name" class="form-field"></div></div>
<div class="form-table-afield">
<div class="form-table-label">State </div>
<div class="form-table-field"> <input type="text" name="pstatename" id="pstatename" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Zip </div>
<div class="form-table-field"> <input type="number" name="pnamezip" id="pnamezip" class="form-field"></div>
</div>


<div class="form-table-afield">
<div class="form-table-label">Time At Previous Residence </div>
<div class="form-table-field"> <input type="number" name="pyears" id="pyears" placeholder="Years" class="form-field">
 <input type="number" name="pmonths" id="pmonth" placeholder="Months" class="form-field"></div>
</div>

</section>
<section class="employment">
<div class="form-table-label">Employment </div>

<div class="form-table-afield">
<div class="form-table-label">Is Your Current Employer A Staffing Agency?<strong class="required-field">*</strong></div>
<div class="form-table-field">
<div class="checkbox-group-staff required">
<input type="radio" name="staffing_agency" id="no-staff" class="form-field" value="no" required="required"> No 
<input type="radio" name="staffing_agency" id="yes-staff" class="form-field" value="yes"> Yes
</div>  </div>
</div>

<div id="if-current-employer-staffing-agency" style="display:none;">

<div class="form-table-afield">
<div class="form-table-label"> Name Of Staffing Agency<strong class="required-field">*</strong></div>
<div class="form-table-field"> <input type="text" name="staffcurrentemployername" id="staffcurrentemployername" class="form-field" required="required"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Phone# Of Staffing Agency</div>
<div class="form-table-field"> <input type="tel" name="staffcurrentemployerphone" id="staffcurrentemployerphone" class="form-field phonenum"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Address Of Staffing Agency </div>
<div class="form-table-field"> <input type="text" name="staffcurrentemployeradd" id="staffcurrentemployeradd" class="form-field"></div>
</div>
</div>
<div id="if-current-employer-no-staffing-agency" >
<div class="form-table-afield">
<div class="form-table-label">Current Employer Name <strong class="required-field">*</strong> </div>
<div class="form-table-field"> <input type="text" name="currentemployername" id="currentemployername" required="" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Current Employer Address <strong class="required-field">*</strong> </div>
<div class="form-table-field"> <input type="text" name="currentemployeradd" id="currentemployeradd" required="" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">City <strong class="required-field">*</strong> </div>
<div class="form-table-field"> <input type="text" name="currentemployercityname" id="currentemployercityname" required="" class="form-field"></div></div>
<div class="form-table-afield">
<div class="form-table-label">State <strong class="required-field">*</strong> </div>

<div class="form-table-field"> <input type="text" name="currentemployerstatename" id="currentemployerstatename" required="" class="form-field"></div>
</div><div class="form-table-afield">
<div class="form-table-label">Zip  <strong class="required-field">*</strong></div>
<div class="form-table-field"> <input type="number" name="currentemployernamezip" id="currentemployernamezip" required="" class="form-field"></div>
</div>

<div class="form-table-afield">
<div class="form-table-label">Employer's Phone Number<strong class="required-field">*</strong></div>
<div class="form-table-field"> <input type="tel" name="currentemployerphone" id="currentemployerphone" required="required" class="form-field phonenum"></div>
</div>
</div>

<div class="form-table-afield">
<div class="form-table-label">Name Of Position/Department In Which You Work<strong class="required-field">*</strong></div>
<div class="form-table-field"> <input type="text" name="currentposition" id="currentposition" required="" class="form-field">
</div>
</div>

<div class="form-table-afield">
<div class="form-table-label">Employment Length <strong class="required-field">*</strong></div>
<div class="form-table-field"> <input type="number" name="empyears" id="empyears" placeholder="Years" required="" class="form-field">
<input type="number" name="empmonth" id="empmonth" placeholder="Months" required="" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Number Of Job Changes In Last 3 Years <strong class="required-field">*</strong></div>
<div class="form-table-field"> 
<select name="job-changes" required="">
<option value="1">0</option> 
<option value="2">1</option>
<option value="3">2</option>
<option value="4">3+</option>
</select>
</div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Current Work Shift Hours </div>
<div class="form-table-field"> <input type="number" name="empshifthours" id="empshifthours" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Direct Supervisor Name </div>
<div class="form-table-field"> <input type="text" name="supervisor" id="supervisor" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Direct Work Phone Number<strong class="required-field">*</strong></div>
<div class="form-table-field"> <input type="tel" name="workphone" id="workphone" required="" class="form-field phonenum"></div>
</div>
<div class="form-table-afield">

<div class="form-table-label">Choose Pay Schedule<strong class="required-field">*</strong></div>


<div class="form-table-field">
<div class="checkbox-group2 required">
<input type="radio" name="pay_schedule" id="weekly" class="form-field" value="weekly"  required="required"> Weekly  
<input type="radio" name="pay_schedule" id="bi-weekly" class="form-field" value="bi-weekly"> Bi-Weekly
<input type="radio" name="pay_schedule" id="semi-monthly" class="form-field" value="semi-monthly"> Semi-Monthly  
<input type="radio" name="pay_schedule" id="monthly" class="form-field" value="monthly"> Monthly 
</div>  
</div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Next Pay Date <strong class="required-field">*</strong></div>
<div class="form-table-field"> <input id="next-pay-date" placeholder="MM/DD/YYYY" name="next-pay-date" type="text" required="" class="form-field datepicker" ></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Net (Take-Home) Monthly Income<strong class="required-field">*</strong></div>
<div class="form-table-field">$ <input id="monthly-income" name="monthly-income" type="number" required=""  class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Source Of Other Income</div>
<div class="form-table-field"><input id="source-income" name="source-income" type="text" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Other Income Amount</div>
<div class="form-table-field">$ <input id="other-income" name="other-income" type="number" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Former Employer Name</div>
<div class="form-table-field"> <input id="former" name="former" type="text" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Former Employer Phone Number</div>
<div class="form-table-field"><input id="former-ph" name="former-ph" type="tel" class="form-field phonenum"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Former Position/Department</div>
<div class="form-table-field"> <input id="former-dept" name="former-dept" type="text" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Former Employment Length</div>
<div class="form-table-field"> <input type="number" name="fempyears" id="fempyears" placeholder="Years" class="form-field">
<input type="number" name="fempmonth" id="fempmonth" placeholder="Months" class="form-field" min="0" max="11"></div>
</div>
</section>
<section class="contact-info">
<div class="form-table-label">Contact Information</div>

<div class="form-table-afield">
<div class="form-table-label">Email Address <strong class="required-field">*</strong></div>
<div class="form-table-field"> <input type="email" name="mail" id="mail" required="" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Home Number <strong class="required-field">*</strong></div>
<div class="form-table-field"> <input type="tel" name="home-phone" id="home-phone" required="" class="form-field phonenum"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Cell Number <strong class="required-field">*</strong></div>
<div class="form-table-field"> <input type="tel" name="cell-phone" id="cell-phone" required="" class="form-field phonenum"></div>
</div>
</section>
<section class="previous-loans">
<div class="form-table-label">Previous Motor Vehicles</div>

<div class="form-table-afield">
<div class="form-table-label">How Many Open Motor Vehicle Loans Do You Currently Have?  <strong class="required-field">*</strong></div>
<div class="form-table-field">
<select name="motor_loan_bal" required="">
<option value="0">0</option> 
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3+</option>
</select>
<!--
<div class="checkbox-group3 required">
<input type="radio" name="motor_loan_bal" id="no" class="form-field" value="no"  required="required"> No  
<input type="radio" name="motor_loan_bal" id="yes" class="form-field"  value="yes"> Yes
</div>-->
</div> 
</div>
<div id="if-yes-one" style="display:none;" class="new-block">

<h3>Open Vehicle Loan #1</h3>

<div class="form-table-afield">
<div class="form-table-label">Finance Institution Name <strong class="required-field">*</strong></div>
<div class="form-table-field"><input name="instname" id="instname" type="text" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">State Purchased <strong class="required-field">*</strong></div>
<div class="form-table-field"> <input  name="instpurch" id="instpurch" type="text" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Original Loan Amount <strong class="required-field">*</strong></div>
<div class="form-table-field">$ <input  name="org-amt" id="org-amt" type="number" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Monthly Payment Amount <strong class="required-field">*</strong></div>
<div class="form-table-field">$ <input name="monthly-pay-amt" id="monthly-pay-amt" type="number" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Remaining Balance <strong class="required-field">*</strong></div>
<div class="form-table-field">$ <input name="rem-amt" id="rem-amt" type="text" class="form-field"></div>
</div>
</div>
<div id="if-yes-two" style="display:none;" class="new-block">
<h3>Open Vehicle Loan #2</h3>
<div class="form-table-afield">
<div class="form-table-label">Finance Institution Name <strong class="required-field">*</strong></div>
<div class="form-table-field"><input name="instname2" id="instname2" type="text" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">State Purchased <strong class="required-field">*</strong></div>
<div class="form-table-field"> <input  name="instpurch2" id="instpurch2" type="text" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Original Loan Amount <strong class="required-field">*</strong></div>
<div class="form-table-field">$ <input  name="org-amt2" id="org-amt2" type="number" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Monthly Payment Amount <strong class="required-field">*</strong></div>
<div class="form-table-field">$ <input name="monthly-pay-amt2" id="monthly-pay-amt2" type="number" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Remaining Balance <strong class="required-field">*</strong></div>
<div class="form-table-field">$ <input name="rem-amt2" id="rem-amt2" type="text" class="form-field"></div>
</div>
</div>
<div id="if-yes-three" style="display:none;" class="new-block">
<h3>Open Vehicle Loan #3</h3>
<div class="form-table-afield">
<div class="form-table-label">Finance Institution Name <strong class="required-field">*</strong></div>
<div class="form-table-field"><input name="instname3" id="instname3" type="text" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">State Purchased <strong class="required-field">*</strong></div>
<div class="form-table-field"> <input  name="instpurch3" id="instpurch3" type="text" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Original Loan Amount <strong class="required-field">*</strong></div>
<div class="form-table-field">$ <input  name="org-amt3" id="org-amt3" type="number" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Monthly Payment Amount <strong class="required-field">*</strong></div>
<div class="form-table-field">$ <input name="monthly-pay-amt3" id="monthly-pay-amt3" type="number" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Remaining Balance <strong class="required-field">*</strong></div>
<div class="form-table-field">$ <input name="rem-amt3" id="rem-amt3" type="text" class="form-field"></div>
</div>
</div>
<div class="form-table-afield">
<div class="form-table-label">How Many Vehicles Has The Applicant Had Repossessed? <strong class="required-field">*</strong></div>
<div class="form-table-field">
<select name="vehicle_repossessed" required="">
<option value="0">0</option> 
<option value="1">1</option>
<option value="2">2</option>
<option value="3+">3+</option>
</select><!--
<div class="checkbox-group4 required">
<input type="radio" name="vehicle_repossessed" id="not-possessed" class="form-field"  value="no"  required="required"> No  
<input type="radio" name="vehicle_repossessed" id="yes-possessed" class="form-field"  value="yes"> Yes
</div>-->
</div> 
</div>
<div id="if-yes-possessed" style="display:none;">
<div class="form-table-afield">
<div class="form-table-label">Who Was Most Recent Repossession Purchased From? <strong class="required-field">*</strong></div>
<div class="form-table-field"><input name="comp-name" id="comp-name" type="text" class="form-field" required="required"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">How Long Ago Was Most Recent Vehicle Repossessed?  <strong class="required-field">*</strong></div>
<div class="form-table-field"> <input name="repossessedy" id="repossessedy" placeholder="Years" type="number" class="form-field" required="required"></div>
<div class="form-table-field"> <input name="repossessedm" id="repossessedm" placeholder="Months" type="number" class="form-field" min="0" max="11" required="required"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Why Was Vehicle Repossessed? <strong class="required-field">*</strong></div>
<div class="form-table-field"> <input name="how-repossessed" id="how-repossessed" type="text" class="form-field" required="required"></div>
</div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Has Applicant Ever Purchased A Vehicle From Car Credit Nation?<strong class="required-field">*</strong></div>
<div class="form-table-field">
<div class="checkbox-group5 required">
<input type="radio" name="purchased_from_ccn" id="not-purchased" class="form-field"  value="no"  required="required"> No  
<input type="radio" name="purchased_from_ccn" id="yes-purchased" class="form-field"  value="yes"> Yes
</div>
</div> 
</div>
<div  id="if-purchased" style="display:none">
<div class="form-table-afield">
<div class="form-table-label">Remaining Balance</div>
<div class="form-table-field">$ <input name="rem-balance" id="rem-balance" type="text" class="form-field" required="required"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Date Previously Purchased From Car Credit Nation</div>
<div class="form-table-field"><input name="prev-purch-date" id="prev-purch-date" placeholder="MM/DD/YYYY" class="form-field datepicker" type="text" required="required"></div>
</div></div>
</section>

<section class="bankruptcy">
<div class="form-table-label">Final Questions </div>
<div class="form-table-afield">
<div class="form-table-label">Has Applicant Ever Filed Bankruptcy?  <strong class="required-field">*</strong></div>
<div class="form-table-field">
<div class="checkbox-group5 required">
<input type="radio" name="filed_bankruptcy" id="not-filed" class="form-field"  value="no"  required="required"> No  
<input type="radio" name="filed_bankruptcy" id="yes-filed" class="form-field"  value="yes"> Yes
</div></div>

</div>
<div id="if-yes-filed-bank" style="display:none;">
<div class="form-table-afield">
<div class="form-table-label">How Many Times?  <strong class="required-field">*</strong></div>
<div class="form-table-field">
<select name="filed-bankruptcy" required="">
<option value="1">0</option> 
<option value="2">1</option>
<option value="3">2</option>
<option value="4">3+</option>
</select>
</div></div>

<div class="form-table-afield">
<div class="form-table-label">Date Filed  <strong class="required-field">*</strong></div>
<div class="form-table-field"><input name="filed-date" id="filed-date" placeholder="MM/DD/YYYY" class="form-field datepicker" type="text"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">What Chapter?  <strong class="required-field">*</strong></div>
<div class="form-table-field">
<div class="checkbox-g required">
<input type="radio" name="bankruptcy_chapter" id="chapter7" class="form-field"  value="7"> 7  
<input type="radio" name="bankruptcy_chapter" id="chapter13" class="form-field"  value="13"> 13
<input type="radio" name="bankruptcy_chapter" id="oth-chapter" class="form-field"  value="other"> Other
</div>
</div> 
</div>
</div> 
<div class="form-table-afield">
<div class="form-table-label">Will The Vehicle You Are Attempting To Purchase Be Used For Any Commercial Purpose? </div>
<div class="form-table-field">
<div class="checkbox-group6 required">
<input type="radio" name="commercial_vehicle" id="no-commercial" class="form-field"  value="no"  required="required"> No  
<input type="radio" name="commercial_vehicle" id="yes-commercial" class="form-field"  value="yes"> Yes
</div>

</div></div>
<div id="if-yes-commercial" style="display:none;">
<div class="form-table-afield">
<div class="form-table-label">If Yes, Please Explain:</div>
<textarea name="commercial_use" id="commercial-use"  class="form-field" ></textarea>
</div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Is There A Vehicle Being Traded? <strong class="required-field">*</strong> </div>
<div class="form-table-field">
<div class="checkbox-group7 required">
<input type="radio" name="vehicle_traded" id="no-traded" class="form-field"  value="no"  required="required"> No  
<input type="radio" name="vehicle_traded" id="yes-traded" class="form-field"  value="yes"> Yes
</div></div>

</div>
<div class="traded" id="trade-vehicle" style="display:none">
<div class="form-table-afield">
<div class="form-table-label">Trade Year  <strong class="required-field">*</strong></div>
<div class="form-table-field"><input name="trade_year" id="trade_year" type="text" class="form-field" required="required"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Make  <strong class="required-field">*</strong></div>
<div class="form-table-field"><input name="trade_make" id="trade_make" type="text" class="form-field" required="required"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Model  <strong class="required-field">*</strong></div>
<div class="form-table-field"><input name="trade_model" id="trade_model" type="text" class="form-field" required="required"></div>
</div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Down Payment Available Today<strong class="required-field">*</strong></div>
<div class="form-table-field">$<input name="down-pay" id="down-pay" type="number" required="" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Were You Referred By A Current Customer?  <strong class="required-field">*</strong> </div>
<div class="form-table-field">
<div class="checkbox-group7 required">
<input type="radio" name="referred" id="no-current" class="form-field"  value="no"  required="required"> No  
<input type="radio" name="referred" id="yes-current" class="form-field"  value="yes"> Yes
</div>
</div>
</div>
<div id="if-yes-current" style="display:none;">
<div class="form-table-afield">
<div class="form-table-label">If Yes, What Is Their Name?<div>
<div class="form-table-field"><input name="refer-name" id="refer-name" type="text" class="form-field"></div>
</div>
</div>

</section>
<div class="form-table-afield">
<div class="form-table-label">Will There Be A Co-Buyer Or Co-Signer?<strong class="required-field">*</strong></div>
<div class="checkbox-group8 required">
<input type="radio" name="if_co_applicant" id="no-co-applicant" class="form-field" value="no"  required="required"> No  
<input type="radio" name="if_co_applicant" id="yes-co-applicant" class="form-field" value="yes"> Yes
</div>
</div>
</div>
</div>
<!-- applicant form ends -->
<?php */?>
<!-- co-applicant form starts-->
<div id="if-yes-co-applicant" style="display:none;">
<div id="co-applicantform" class="co-applicantform">
<div class="form-table">
<div class="form-table-row form-caption">CO-APPLICANT'S INFORMATION FORM</div>
<section class="co personal-info">
<div class="form-table-afield">
<div class="form-table-label"> First Name <strong class="required-field">*</strong></div>

<div class="form-table-field"> <input type="text" name="fname2" id="fname2" required="" class="form-field"></div></div>
<div class="form-table-afield">
<div class="form-table-label"> Middle Name <strong class="required-field">*</strong> <input type="checkbox" value="No Middle Name" name="nomiddlename2" id="nomiddlename2">None </div>
<div class="form-table-field"><input type="text" name="mname2" id="mname2" required="" class="form-field"></div></div>
<div class="form-table-afield">
<div class="form-table-label"> Last Name <strong class="required-field">*</strong></div>
<div class="form-table-field"> <input type="text" name="lname2" id="lname2" required="" class="form-field"></div></div>
<div class="form-table-afield">
<div class="form-table-label"> Suffix </div>
<div class="form-table-field">
<select name="suffixname2" id="suffixname2" >
<option value="" selected="selected">None</option>
<option value="Sr">Sr</option> 
<option value="Jr">Jr</option>
<option value="I">I</option>
<option value="II">II</option>
<option value="III">III</option>
</select>
 <!--<input type="text" name="suffixname2" id="suffixname2" required="" class="form-field">
 -->
 </div></div>


<div class="form-table-afield">
<div class="form-table-label">Date Of Birth <strong class="required-field">*</strong></div>
<div class="form-table-field"> <input id="dob2" name="dob2" type="text" placeholder="MM/DD/YYYY" class="form-field   datepicker" required="required" ></div>

</div>

<div class="form-table-afield">
<div class="form-table-label">Social Security # <strong class="required-field">*</strong></div>
<div class="form-table-field"><input id="socialsecnumber2"  name="socialsecnumber2"  required="" type="number" class="form-field" /> </div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Driver's License # <strong class="required-field">*</strong></div>
<div class="form-table-field"><input id="dlnumber2" name="dlnumber2"  required="" type="text" class="form-field" /> </div>
</div>
</section>
<section class="co current-mail-address">
<div class="form-table-label">Current Mailing Address </div>
<div class="form-table-afield">
<div class="form-table-label">Address <strong class="required-field">*</strong></div>
<div class="form-table-field"> <input type="text" name="mailadd2" id="mailadd2" required="" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">City <strong class="required-field">*</strong></div>
<div class="form-table-field"> <input type="text" name="mailcity2" id="mailcity2" required="" class="form-field"></div></div>
<div class="form-table-afield">
<div class="form-table-label">State <strong class="required-field">*</strong></div>
<div class="form-table-field"> <input type="text" name="mailstate2" id="mailstate2" required="" class="form-field"></div></div>
<div class="form-table-afield">
<div class="form-table-label">Zip <strong class="required-field">*</strong></div>
<div class="form-table-field"> <input type="number" name="mailzip2" id="mailzip2" required="" class="form-field"></div></div>
</section>
<section class="co current-physical-address">
<div class="form-table-afield">
<div class="form-table-label">Current Physical Address If Different From Mailing Address</div>
<div class="form-table-field"><input type="checkbox" id="sameadd2" class="form-field"> Same As Above</div>
</div>

<div id="show-if-not-same" class="unchecked-same">

<div class="form-table-afield">
<div class="form-table-label">Address <strong class="required-field">*</strong></div>
<div class="form-table-field"> <input type="text" name="diffadd2" id="addressdiff2" required="" class="form-field"></div>
</div><div class="form-table-afield">
<div class="form-table-label">City <strong class="required-field">*</strong></div>
<div class="form-table-field"> <input type="text" name="diffcityname2" id="diffcityname2" required="" class="form-field"></div></div>
<div class="form-table-afield">
<div class="form-table-label">State <strong class="required-field">*</strong></div>
<div class="form-table-field"> <input type="text" name="diffstatename2" id="diffstatename2" required="" class="form-field"></div></div>
<div class="form-table-afield">
<div class="form-table-label">Zip <strong class="required-field">*</strong></div>
<div class="form-table-field"> <input type="number" name="diffnamezip2" id="diffnamezip2" required="" class="form-field"></div></div>

</div>

</section>
<section class="co mortgage">
<div class="form-table-label">Residence</div>
<div class="form-table-afield">

<div class="form-table-label">Which Applies To Your Current Residence? <strong class="required-field">*</strong></div>

<div class="form-table-field">
<div class="checkbox-group2 required">
<input type="radio" name="co_residence_type" id="own2" class="form-field"  value="own" required=""> Own  
<input type="radio" name="co_residence_type" id="rent2" class="form-field"  value="rent"> Rent
<input type="radio" name="co_residence_type" id="withrelative2" class="form-field"  value="withrelative"> Lives W/ Relative(s)  
<input type="radio" name="co_residence_type" id="wfriend2" class="form-field" value="wfriend"> Lives W/ Friend(s) 

</div> 
</div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Time At Residence <strong class="required-field">*</strong></div>
<div class="form-table-field"> <input type="number" name="residence-years2" id="residence-years2" placeholder="Years" required="" class="form-field half">
<input type="number" name="residence-months2" id="residence-months2" placeholder="Months" required="" class="form-field half" min="0" max="11"></div>
</div>

<div class="form-table-afield">
<div class="form-table-label">Rent / Mortgage Payment Amount<strong class="required-field">*</strong></div>
<div class="form-table-field">$<input id="rent-payment-amt2" name="rent-payment-amt2" type="number" required="" class="form-field" /> </div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Mortgage Company / Landlord / Home Owner Name<strong class="required-field">*</strong></div>
<div class="form-table-field"> <input type="text" placeholder="First Name" name="ownerfname2" id="ownerfname2" required="" class="form-field half">
 <input type="text" placeholder="Last Name" name="ownerlname2" id="ownerlname2" required="" class="form-field half"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Mortgage Company / Landlord / Home Owner Phone <strong class="required-field">*</strong></div>
<div class="form-table-field"> <input type="tel" name="ownerphone2" id="ownerphone2" required="" class="form-field phonenum"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Number Of Residence Changes In The Past 3 Years <strong class="required-field">*</strong></div>
<div class="form-table-field"> 
<select name="residence-changes2" required="">
<option value="1">0</option> 
<option value="2">1</option>
<option value="3">2</option>
<option value="4">3+</option>
</select>
</div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Number Of Years In Current State <strong class="required-field">*</strong></div>
<div class="form-table-field"> 

<input type="number" name="residence-current2" id="state-years2" placeholder="Years" required="" class="form-field half">
<input type="number" name="residence-current2-months" id="state-months2" placeholder="Months" required="" class="form-field half" min="0" max="11"></div>

</div>

<div class="form-table-afield">
<div class="form-table-label">Previous Address </div>
<div class="form-table-field"> <input type="text" name="prev-add2" id="prev-add2" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">City </div>
<div class="form-table-field"> <input type="text" name="prev-city-name2" id="prev-city-name2" class="form-field"></div></div>
<div class="form-table-afield">
<div class="form-table-label">State </div>
<div class="form-table-field"> <input type="text" name="pstatename2" id="pstatename2" class="form-field"></div></div>
<div class="form-table-afield">
<div class="form-table-label">Zip </div>
<div class="form-table-field"> <input type="number" name="pnamezip2" id="pnamezip2" class="form-field"></div></div>


<div class="form-table-afield">
<div class="form-table-label">Time At Previous Residence </div>
<div class="form-table-field"> <input type="number" name="pyears2" id="pyears2" placeholder="Years" class="form-field half">
<input type="number" name="pmonths2" id="pmonths2" placeholder="Months" class="form-field half" min="0" max="11" ></div>
</div>
</section>
<section class="co employment">
<div class="form-table-label">Employment </div>



<div class="form-table-afield">
<div class="form-table-label">Is Your Current Employer A Staffing Agency?<strong class="required-field">*</strong></div>
<div class="form-table-field">
<div class="checkbox-group-staff2 required">
<input type="radio" name="co_staffing_agency" id="no-staff2" class="form-field"  value="no" required="required"> No 
<input type="radio" name="co_staffing_agency" id="yes-staff2" class="form-field"  value="yes"> Yes
</div>  </div>
</div>

<div id="if-current-employer-staffing-agency2" style="display:none;">
<div class="form-table-afield">
<div class="form-table-label">Name Of Staffing Agency <strong class="required-field">*</strong> </div>
<div class="form-table-field"> <input type="text" name="staffcurrentemployername2" id="staffcurrentemployername2" required="" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Phone# Of Staffing Agency</div>
<div class="form-table-field"> <input type="tel" name="staffcurrentemployerphone2" id="staffcurrentemployerphone2" class="form-field phonenum"></div>
</div><div class="form-table-afield">
<div class="form-table-label">Address Of Staffing Agency </div>
<div class="form-table-field"> <input type="text" name="staffcurrentemployeradd2" id="staffcurrentemployeradd2" class="form-field"></div>
</div>
</div>
<div id="if-current-employer-no-staffing-agency2" >
<div class="form-table-afield">
<div class="form-table-label">Current Employer Name <strong class="required-field">*</strong> </div>
<div class="form-table-field"> <input type="text" name="currentemployername2" id="currentemployername2" required="" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Current Employer Address <strong class="required-field">*</strong> </div>
<div class="form-table-field"> <input type="text" name="currentemployeradd2" id="currentemployeradd2" required="" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">City <strong class="required-field">*</strong> </div>
<div class="form-table-field"> <input type="text" name="currentemployercityname2" id="currentemployercityname2" required="" class="form-field"></div></div>
<div class="form-table-afield">
<div class="form-table-label">State <strong class="required-field">*</strong> </div>
<div class="form-table-field"> <input type="text" name="currentemployerstatename2" id="currentemployerstatename2" required="" class="form-field"></div></div>
<div class="form-table-afield">
<div class="form-table-label">Zip  <strong class="required-field">*</strong></div>
<div class="form-table-field"> <input type="number" name="currentemployernamezip2" id="currentemployernamezip2" required="" class="form-field"></div></div>
</div>

<div class="form-table-afield">
<div class="form-table-label">Employer's Phone Number<strong class="required-field">*</strong></div>
<div class="form-table-field"> <input type="tel" name="currentemployerphone2" id="currentemployerphone2" required="required" class="form-field phonenum"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Name Of Position/Department In Which You Work<strong class="required-field">*</strong></div>
<div class="form-table-field"> <input type="text" name="currentposition2" id="currentposition2" required="" class="form-field">
</div></div>
<div class="form-table-afield">
<div class="form-table-label">Employment Length <strong class="required-field">*</strong></div>
<div class="form-table-field"> <input type="number" name="empyears2" id="empyears2" placeholder="Years" required="" class="form-field half">
 <input type="number" name="empmonth2" id="empmonth2" placeholder="Months" required="" class="form-field half" min="0" max="11" ></div>
</div><div class="form-table-afield">
<div class="form-table-label">Number Of Job Changes In Last 3 Years <strong class="required-field">*</strong></div>
<div class="form-table-field"> 
<select name="job-changes2" required="">
<option value="1">0</option> 
<option value="2">1</option>
<option value="3">2</option>
<option value="4">3+</option>
</select>
</div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Current Work Shift Hours </div>
<div class="form-table-field"> <input type="number" name="empshifthours2" id="empshifthours2" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Direct Supervisor Name </div>
<div class="form-table-field"> <input type="text" name="supervisor2" id="supervisor2" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Direct Work Phone Number<strong class="required-field">*</strong></div>
<div class="form-table-field"> <input type="tel" name="workphone2" id="workphone2" required="required" class="form-field phonenum"></div>
</div>
<div class="form-table-afield">

<div class="form-table-label">Choose Pay Schedule<strong class="required-field">*</strong></div>


<div class="form-table-field">
<div class="checkbox-group22 required">
<input type="radio" name="co_pay_schedule" id="weekly2" class="form-field"  value="weekly" required="required"> Weekly  
<input type="radio" name="co_pay_schedule" id="bi-weekly2" class="form-field"  value="bi-weekly"> Bi-Weekly
<input type="radio" name="co_pay_schedule" id="semi-monthly2" class="form-field"  value="semi-monthly"> Semi-Monthly  
<input type="radio" name="co_pay_schedule" id="monthly2" class="form-field"  value="monthly"> Monthly 
</div>  

</div></div>
<div class="form-table-afield">
<div class="form-table-label">Next Pay Date <strong class="required-field">*</strong></div>
<div class="form-table-field"> <input id="next-pay-date2" name="next-pay-date2" type="text" required="" class="form-field  datepicker" placeholder="MM/DD/YYYY" ></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Net (Take-Home) Monthly Income<strong class="required-field">*</strong></div>
<div class="form-table-field">$ <input id="monthly-income2" name="monthly-income2" type="number" required=""  class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Source Of Other Income</div>
<div class="form-table-field"> <input id="source-income2" name="source-income2" type="text" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Other Income Amount</div>
<div class="form-table-field">$ <input id="other-income2" name="other-income2" type="number" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Former Employer Name</div>
<div class="form-table-field"> <input id="former2" name="former2" type="text" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Former Employer Phone Number</div>
<div class="form-table-field"><input id="former-ph2" name="former-ph2" type="tel" class="form-field phonenum"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Former Position/Department</div>
<div class="form-table-field"> <input id="former-dept2" name="former-dept2" type="text" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Former Employment Length</div>
<div class="form-table-field"> <input type="number" name="fempyears2" id="fempyears2" placeholder="Years" class="form-field half">
 <input type="number" name="fempmonth2" id="fempmonth2" placeholder="Months" class="form-field half" min="0" max="11" ></div>
</div>

</section>

<section class="co contact-info">
<div class="form-table-label">Contact Information</div>

<div class="form-table-afield">
<div class="form-table-label">Email Address <strong class="required-field">*</strong></div>
<div class="form-table-field"> <input type="email" name="mail2" id="mail2" required="" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Home Number <strong class="required-field">*</strong></div>
<div class="form-table-field"> <input type="tel" name="home-phone2" id="home-phone2" required="" class="form-field phonenum"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Cell Number <strong class="required-field">*</strong></div>
<div class="form-table-field"> <input type="tel" name="cell-phone2" id="cell-phone2" required="required" class="form-field phonenum"></div>
</div>
</section>
<section class="co previous-loans">
<div class="form-table-label">Pervious Motor Vehicles</div>

<div class="form-table-afield">
<div class="form-table-label">How Many Open Motor Vehicle Loans Do You Currently Have?  <strong class="required-field">*</strong></div>
<div class="form-table-field">
<select name="co_motor_loan" required="">
<option value="0">0</option> 
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3+</option>
</select>

<!--<div class="checkbox-group32 required">
<input type="radio" name="co_motor_loan" id="no2" class="form-field" value="no" required="required"> No  
<input type="radio" name="co_motor_loan" id="yes2" class="form-field" value="yes"> Yes
</div>-->
</div> 
</div>
<div id="if-yes2-one" style="display:none;" class="new-block">
<h3>Open Vehicle Loan #1</h3>
<div class="form-table-afield">
<div class="form-table-label">Finance Institution Name</div>
<div class="form-table-field"><input name="instname21" id="instname21" type="text" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">State Purchased</div>
<div class="form-table-field"> <input  name="instpurch21" id="instpurch21" type="text" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Original Loan Amount</div>
<div class="form-table-field">$ <input  name="org-amt21" id="org-amt21" type="number" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Monthly Payment Amount</div>
<div class="form-table-field">$ <input name="monthly-pay-amt21" id="monthly-pay-amt21" type="number" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Remaining Balance</div>
<div class="form-table-field">$ <input name="rem-amt21" id="rem-amt21" type="text" class="form-field"></div>
</div>
</div>
<div id="if-yes2-two" style="display:none;" class="new-block">
<h3>Open Vehicle Loan #2</h3>
<div class="form-table-afield">
<div class="form-table-label">Finance Institution Name</div>
<div class="form-table-field"><input name="instname22" id="instname22" type="text" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">State Purchased</div>
<div class="form-table-field"> <input  name="instpurch22" id="instpurch22" type="text" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Original Loan Amount</div>
<div class="form-table-field">$ <input  name="org-amt22" id="org-amt22" type="number" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Monthly Payment Amount</div>
<div class="form-table-field">$ <input name="monthly-pay-amt22" id="monthly-pay-amt22" type="number" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Remaining Balance</div>
<div class="form-table-field">$ <input name="rem-amt22" id="rem-amt22" type="text" class="form-field"></div>
</div>
</div>
<div id="if-yes2-three" style="display:none;" class="new-block">
<h3>Open Vehicle Loan #3</h3>
<div class="form-table-afield">
<div class="form-table-label">Finance Institution Name</div>
<div class="form-table-field"><input name="instname23" id="instname23" type="text" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">State Purchased</div>
<div class="form-table-field"> <input  name="instpurch23" id="instpurch23" type="text" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Original Loan Amount</div>
<div class="form-table-field">$ <input  name="org-amt23" id="org-amt23" type="number" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Monthly Payment Amount</div>
<div class="form-table-field">$ <input name="monthly-pay-amt23" id="monthly-pay-amt23" type="number" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Remaining Balance</div>
<div class="form-table-field">$ <input name="rem-amt23" id="rem-amt23" type="text" class="form-field"></div>
</div>
</div>
<div class="form-table-afield">
<div class="form-table-label">How Many Vehicles Has The Applicant Had Repossessed? <strong class="required-field">*</strong></div>
<div class="form-table-field">
<select name="co_vehicle_repossessed" required="">
<option value="0">0</option> 
<option value="1">1</option>
<option value="2">2</option>
<option value="3+">3+</option>
</select>
<!--<div class="checkbox-group42 required">
<input type="radio" name="co_vehicle_repossessed" id="not-possessed2" class="form-field"  value="no" required="required"> No  
<input type="radio" name="co_vehicle_repossessed" id="yes-possessed2" class="form-field"  value="yes"> Yes
</div>-->
</div> 
</div>
<div id="if-yes-possessed2" style="display:none;">
<div class="form-table-afield">
<div class="form-table-label">Who Was Most Recent Repossession Purchased From? <strong class="required-field">*</strong></div>
<div class="form-table-field"><input name="comp-name2" id="comp-name2" type="text" class="form-field" required="required"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">How Long Ago Was Most Recent Vehicle Repossessed?  <strong class="required-field">*</strong></div>
<div class="form-table-field"> <input name="repossessedy2" id="repossessedy2" placeholder="Years" type="number" class="form-field" required="required"></div>
<div class="form-table-field"> <input name="repossessedm2" id="repossessedm2" placeholder="Months" type="number" class="form-field" min="0" max="11" required="required"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Why Was Vehicle Repossessed? <strong class="required-field">*</strong> </div>
<div class="form-table-field"> <input name="how-repossessed2" id="how-repossessed2" type="text" class="form-field" required="required"></div>
</div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Has Applicant Ever Purchased A Vehicle From Car Credit Nation?<strong class="required-field">*</strong></div>
<div class="form-table-field">
<div class="checkbox-group52 required">
<input type="radio" name="co_purchased_ccn" id="not-purchased2" class="form-field"  value="no" required="required"> No  
<input type="radio" name="co_purchased_ccn" id="yes-purchased2" class="form-field"  value="yes"> Yes
</div>
</div> 
</div>
<div  id="if-purchased2" style="display:none">
<div class="form-table-afield">
<div class="form-table-label">Remaining Balance</div>
<div class="form-table-field">$<input name="rem-balance2" id="rem-balance2" type="text" class="form-field"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Date Previously Purchased From Car Credit Nation</div>
<div class="form-table-field"><input name="prev-purch-date2" id="prev-purch-date2" placeholder="MM/DD/YYYY" class="form-field  datepicker" type="text"></div>
</div>
</div>
</section>

<section class="co bankruptcy">
<div class="form-table-label">Final Questions </div>

<div class="form-table-afield">
<div class="form-table-label">Has Applicant Ever Filed Bankruptcy?  <strong class="required-field">*</strong></div>
<div class="form-table-field">
<div class="checkbox-group52 required">
<input type="radio" name="co_filed_bankruptcy" id="not-filed2" class="form-field"  value="no" required="required"> No  
<input type="radio" name="co_filed_bankruptcy" id="yes-filed2" class="form-field" value="yes"> Yes
</div>
</div> 
</div>
<div id="if-yes-filed-bank2" style="display:none;"> 
<div class="form-table-afield">
<div class="form-table-label">How Many Times?  <strong class="required-field">*</strong></div>
<div class="form-table-field">
<select name="filed-bankruptcy2" required="">
<option value="1">0</option> 
<option value="2">1</option>
<option value="3">2</option>
<option value="4">3+</option>
</select>
</div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Date Filed  <strong class="required-field">*</strong></div>
<div class="form-table-field"><input name="filed-date2" id="filed-date2" class="form-field  datepicker" placeholder="MM/DD/YYYY" type="text" required="required"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">What Chapter?  <strong class="required-field">*</strong></div>
<div class="form-table-field">
<div class="checkbox-g2 required">
<input type="radio" name="bankruptcy_chapter2" id="chapter72" class="form-field"  value="7" required="required"> 7  
<input type="radio" name="bankruptcy_chapter2" id="chapter132" class="form-field"  value="13">  13
<input type="radio" name="bankruptcy_chapter2" id="oth-chapter2" class="form-field" value="other"> Other
</div>
</div> </div>

</div> 
<div class="form-table-afield">
<div class="form-table-label">Will The Vehicle You Are Attempting To Purchase Be Used For Any Commercial Purpose?  </div>
<div class="form-table-field">
<div class="checkbox-group62 required">
<input type="radio" name="commercial_vehicle2" id="no-commercial2" class="form-field" value="no"> No  
<input type="radio" name="commercial_vehicle2" id="yes-commercial2" class="form-field"  value="yes"> Yes
</div>
</div>
</div>
<div id="if-yes-commercial2" style="display:none;">
<div class="form-table-afield">
<div class="form-table-label">If Yes, Please Explain:</div>
<textarea name="commercial_use2" id="commercial-use2" class="form-field"></textarea>
</div></div>
<div class="form-table-afield">
<div class="form-table-label">Is There A Vehicle Being Traded? <strong class="required-field">*</strong> </div>
<div class="form-table-field">
<div class="checkbox-group72 ">
<input type="radio" name="vehicle_traded2" id="no-traded2" class="form-field" value="no" required="required" > No  
<input type="radio" name="vehicle_traded2" id="yes-traded2" class="form-field" value="yes"> Yes
</div>
</div>
</div>
<div class="traded" id="trade-vehicle2" style="display:none">
<div class="form-table-afield">
<div class="form-table-label">Trade Year  <strong class="required-field">*</strong></div>
<div class="form-table-field"><input name="trade2_year" id="trade2_year" type="text" class="form-field" required="required"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Make  <strong class="required-field">*</strong></div>
<div class="form-table-field"><input name="trade2_make" id="trade2_make" type="text" class="form-field" required="required"></div>
</div>
<div class="form-table-afield">
<div class="form-table-label">Model  <strong class="required-field">*</strong></div>
<div class="form-table-field"><input name="trade2_model" id="trade2_model" type="text" class="form-field" required="required"></div>
</div>
</div>

<div class="form-table-afield">
<div class="form-table-label">Down Payment Available Today<strong class="required-field">*</strong></div>
<div class="form-table-field">$<input name="down-pay2" id="down-pay2" type="number" required="required" class="form-field"></div>
</div><div class="form-table-afield">
<div class="form-table-label">Were You Referred By A Current Customer?  <strong class="required-field">*</strong> </div>
<div class="form-table-field">
<div class="checkbox-group82 required">
<input type="radio" name="referred2" id="no-current2" class="form-field" value="no" required="required"> No  
<input type="radio" name="referred2" id="yes-current2" class="form-field" value="yes"> Yes
</div>
</div>
</div>
<div id="if-yes-current2" style="display:none;">
<div class="form-table-afield">
<div class="form-table-label">If Yes, What Is Their Name?</div>
<div class="form-table-field"><input name="refer-name2" id="refer-name2" type="text" class="form-field"></div>
</div>
</div>

</div><!-- co-applicant form ends-->

</div>
</div>
<div class="next-btn"><input type="button" name="next1" value="Next" id="next1" class="form-field">
</div>
</div>

</section>

<section class="upload-files" id="upload-files" style="display:none">
<?php 
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<div class="upload-boxes-upd">
<div class="form-table-afield ">
<div class="form-table-label">Upload Files:  </div>
<div class="upload-loop">
    <input type="file" class="upload" id="fileToUpload1fileToUpload1" name="fileToUpload" id="fileToUpload">
    <input type="button" class="upload-area" value="Upload Image" id="upd1" name="submit">
</div>
<div class="form-table-field">


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<div class="credit_files">
<input type="file" name="file1" id="file1" data-max-size="20" accept=".jpg,.jpeg,.png,.gif,.exif,.tiff,.zip,.bmp,.doc,.docx,.pdf,.odt,.dotx,.dot,.rtf,.txt" class="form-field" >
<span class="c_file">x</span>
</div>

<div class="credit_files">
<input type="file" name="file2" id="file2" data-max-size="20" accept=".jpg,.jpeg,.png,.gif,.exif,.tiff,.zip,.bmp,.doc,.docx,.pdf,.odt,.dotx,.dot,.rtf,.txt" class="form-field" >
<span class="c_file">x</span>
</div>
<div class="credit_files">

<input type="file" name="file3" id="file3" data-max-size="20" accept=".jpg,.jpeg,.png,.gif,.exif,.tiff,.zip,.bmp,.doc,.docx,.pdf,.odt,.dotx,.dot,.rtf,.txt" class="form-field" >
<span class="c_file">x</span>
</div>
<div class="credit_files">

<input type="file" name="file4" id="file4" data-max-size="20" accept=".jpg,.jpeg,.png,.gif,.exif,.tiff,.zip,.bmp,.doc,.docx,.pdf,.odt,.dotx,.dot,.rtf,.txt" class="form-field" >
<span class="c_file">x</span>
</div>

<div class="credit_files">

<input type="file" name="file5" id="file5"  data-max-size="20" accept=".jpg,.jpeg,.png,.gif,.exif,.tiff,.zip,.bmp,.doc,.docx,.pdf,.odt,.dotx,.dot,.rtf,.txt" class="form-field" >
<span class="c_file">x</span>
</div>
<div class="credit_files">

<input type="file" name="file6" id="file6" data-max-size="20" accept=".jpg,.jpeg,.png,.gif,.exif,.tiff,.zip,.bmp,.doc,.docx,.pdf,.odt,.dotx,.dot,.rtf,.txt" class="form-field" >
<span class="c_file">x</span>
</div>
<!--
<div class="credit_files">

<input type="file" name="file7" id="file7" data-max-size="20" accept=".jpg,.jpeg,.png,.gif,.exif,.tiff,.zip,.bmp,.doc,.docx,.pdf,.odt,.dotx,.dot,.rtf,.txt" class="form-field" >
<span class="c_file">x</span>
</div>
<div class="credit_files">

<input type="file" name="file8" id="file8" data-max-size="20" accept=".jpg,.jpeg,.png,.gif,.exif,.tiff,.zip,.bmp,.doc,.docx,.pdf,.odt,.dotx,.dot,.rtf,.txt" class="form-field" >
<span class="c_file">x</span>
</div>
<div class="credit_files">

<input type="file" name="file9" id="file9" data-max-size="20" accept=".jpg,.jpeg,.png,.gif,.exif,.tiff,.zip,.bmp,.doc,.docx,.pdf,.odt,.dotx,.dot,.rtf,.txt" class="form-field" >
<span class="c_file">x</span>
</div>
<div class="credit_files">

<input type="file" name="file10" id="file10" data-max-size="20" accept=".jpg,.jpeg,.png,.gif,.exif,.tiff,.zip,.bmp,.doc,.docx,.pdf,.odt,.dotx,.dot,.rtf,.txt" class="form-field" >
<span class="c_file">x</span>
</div>-->

</div>
<div class="form-table-afield addnl" id="additional-fields"></div>

</div>
<div class="next-btn"><input type="button" name="next2" value="Next" id="next2" ></div>
</div>

</section>


<section class="disclaimer-text" id="disclaimers" style="display:none">
<div class="form-table-afield disclaimer">
<div class="form-table-label">Disclaimer:  </div>
<div class="form-table-field">
<div class="checkbox-group-disclaim required">  
<input type="checkbox" name="agree-credit-disclaimer" id="yes-current-disclaim" class="form-field" required="required" value="agree"> 
I agree and certify that all the information in my application is complete and true. I authorize Car Credit Nation and Car Credit Finance to investigate my credit, residential history and employment history, obtain my credit reports, and release
information about their credit experience with me. If an account is created, I authorize the obtaining of credit reports for purposes of reviewing or taking collection action on the account or for the other legitimate purposes associated with the account. I agree that you and any assignee of the financing contract or lease may monitor and record telephone calls regarding my account to assure quality of service or for other reasons. I agree that you and assignee of the contract may try to contact me in writing by email, or using prerecorded/artificial voice messages, or text messages, as the law allow. I also agree that you and any assignee of the financing contract may try to contact me in these other ways at any address or telephone number I provide, even if the telephone number is a cell phone or the contact results in a charge to me.<br>
<input type="checkbox" name="agree-terms-disclaimer" id="yes-current-disclaim2" class="form-field" required="required" value="agree">
I agree to the <a href="http://www.carcreditnation.com/terms-conditions/" target="_blank">Terms & Conditions</a>, <a href="http://www.carcreditnation.com/privacy-notice/" target="_blank">Privacy Policy</a> and that I may be contacted by Car Credit Nation or Car Credit Finance in regards to my application.
<br><input type="checkbox" name="agree-ftc-disclaimer" id="yes-ftc-disclaim" class="form-field" required="required" value="agree"> 
Under Federal Law by the Federal Trade Commission (FTC) you have a right to know your credit score, how your credit score is obtained, the range of scores your score falls in and how it compares to scores of other consumers.  This information will be found on the Risk Based Pricing Notice.  By agreeing to electronically apply for credit, you are acknowledging and agreeing that the Risk Based Pricing Notice will be delivered to you by mail to the address provided on the credit application if you do not come into the dealership for your physical copy.
</div>
</div>
</div>
<div class="form-table-submit"> <input type="submit" name="submitv" id="submitv" value="Submit Application"  disabled class="form-field disabled"></div>
</section>


</form>
</div>
	 </div> 
		</div> 
	  </div>
	 </div>
</div>
<script>
var ajaxurl = '<?php echo admin_url('admin-ajax.php'); ?>';
jQuery(document).on('click','input.upload-area', function( e ) { 

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