{"id":1030,"date":"2023-05-31T10:49:21","date_gmt":"2023-05-31T14:49:21","guid":{"rendered":"https:\/\/resources.wecipr.com\/solicitud-de-cuenta-de-proveedor\/"},"modified":"2023-05-31T10:49:28","modified_gmt":"2023-05-31T14:49:28","slug":"solicitud-de-cuenta-de-proveedor","status":"publish","type":"page","link":"https:\/\/resources.wecipr.com\/es\/solicitud-de-cuenta-de-proveedor\/","title":{"rendered":"Solicitud de cuenta de proveedor"},"content":{"rendered":"<div class=\"frm_forms  with_frm_style frm_style_formidable-style\" id=\"frm_form_11_container\" data-token=\"e4ec5f52bcd54f5e0ffda0f853e742b5\">\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_pro_form \" id=\"form_newvendoraccountrequest\" data-token=\"e4ec5f52bcd54f5e0ffda0f853e742b5\">\n<div class=\"frm_form_fields \">\n<fieldset>\n<legend class=\"frm_screen_reader\">New Vendor Account Request<\/legend>\r\n\r\n<div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"11\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_11\" id=\"frm_hide_fields_11\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"newvendoraccountrequest\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_11\" name=\"frm_submit_entry_11\" value=\"ab94498014\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/es\/wp-json\/wp\/v2\/pages\/1030\" \/><div id=\"frm_field_387_container\" class=\"frm_form_field  frm12 frm_first frm_html_container form-field\">\n<p style=\"text-align: center;\"><strong>SECTION A &#8211; VENDOR TYPE INFORMATION<\/strong><\/p>\n<\/div>\n<div id=\"frm_field_388_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm12 frm_first horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n    <div  id=\"field_nvf_type_vendor_label\" class=\"frm_primary_label col-form-label form-label\">Type of Vendor\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_nvf_type_vendor_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio radio-inline radio\" id=\"frm_radio_388-0\">\t\t\t<label  for=\"field_nvf_type_vendor-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[388]\" id=\"field_nvf_type_vendor-0\" value=\"Corporation\"\n\t\t   data-reqmsg=\"Type of Vendor cannot be blank.\" data-invmsg=\"Type of Vendor no es v\u00e1lido\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">Corporation<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio radio-inline radio\" id=\"frm_radio_388-1\">\t\t\t<label  for=\"field_nvf_type_vendor-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[388]\" id=\"field_nvf_type_vendor-1\" value=\"LLC\"\n\t\t   data-reqmsg=\"Type of Vendor cannot be blank.\" data-invmsg=\"Type of Vendor no es v\u00e1lido\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">LLC<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio radio-inline radio\" id=\"frm_radio_388-2\">\t\t\t<label  for=\"field_nvf_type_vendor-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[388]\" id=\"field_nvf_type_vendor-2\" value=\"Partnership\"\n\t\t   data-reqmsg=\"Type of Vendor cannot be blank.\" data-invmsg=\"Type of Vendor no es v\u00e1lido\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">Partnership<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio radio-inline radio\" id=\"frm_radio_388-3\">\t\t\t<label  for=\"field_nvf_type_vendor-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[388]\" id=\"field_nvf_type_vendor-3\" value=\"Non-Profit\"\n\t\t   data-reqmsg=\"Type of Vendor cannot be blank.\" data-invmsg=\"Type of Vendor no es v\u00e1lido\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">Non-Profit<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio radio-inline radio\" id=\"frm_radio_388-4\">\t\t\t<label  for=\"field_nvf_type_vendor-4\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[388]\" id=\"field_nvf_type_vendor-4\" value=\"Individual\"\n\t\t   data-reqmsg=\"Type of Vendor cannot be blank.\" data-invmsg=\"Type of Vendor no es v\u00e1lido\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">Individual<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio radio-inline radio\" id=\"frm_radio_388-5\">\t\t\t<label  for=\"field_nvf_type_vendor-5\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[388]\" id=\"field_nvf_type_vendor-5\" value=\"Distributor\"\n\t\t   data-reqmsg=\"Type of Vendor cannot be blank.\" data-invmsg=\"Type of Vendor no es v\u00e1lido\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">Distributor<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio radio-inline radio\" id=\"frm_radio_388-6\">\t\t\t<label  for=\"field_nvf_type_vendor-6\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[388]\" id=\"field_nvf_type_vendor-6\" value=\"Medical \/ Legal\"\n\t\t   data-reqmsg=\"Type of Vendor cannot be blank.\" data-invmsg=\"Type of Vendor no es v\u00e1lido\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">Medical \/ Legal<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio radio-inline radio\" id=\"frm_radio_388-7\">\t\t\t<label  for=\"field_nvf_type_vendor-7\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[388]\" id=\"field_nvf_type_vendor-7\" value=\"State Agency\"\n\t\t   data-reqmsg=\"Type of Vendor cannot be blank.\" data-invmsg=\"Type of Vendor no es v\u00e1lido\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">State Agency<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio radio-inline radio\" id=\"frm_radio_388-8\">\t\t\t<label  for=\"field_nvf_type_vendor-8\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[388]\" id=\"field_nvf_type_vendor-8\" value=\"Federal Agency\"\n\t\t   data-reqmsg=\"Type of Vendor cannot be blank.\" data-invmsg=\"Type of Vendor no es v\u00e1lido\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">Federal Agency<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio radio-inline radio\" id=\"frm_radio_388-9\">\t\t\t<label  for=\"field_nvf_type_vendor-9\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[388]\" id=\"field_nvf_type_vendor-9\" value=\"Manufacturer\"\n\t\t   data-reqmsg=\"Type of Vendor cannot be blank.\" data-invmsg=\"Type of Vendor no es v\u00e1lido\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">Manufacturer<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio radio-inline radio\" id=\"frm_radio_388-10\">\t\t\t<label  for=\"field_nvf_type_vendor-10\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[388]\" id=\"field_nvf_type_vendor-10\" value=\"Services\"\n\t\t   data-reqmsg=\"Type of Vendor cannot be blank.\" data-invmsg=\"Type of Vendor no es v\u00e1lido\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">Services<\/div><\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_389_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm12 frm_first horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n    <div  id=\"field_nvf_type_purchase_label\" class=\"frm_primary_label col-form-label form-label\">Type of Purchase\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_nvf_type_purchase_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio radio-inline radio\" id=\"frm_radio_389-2\">\t\t\t<label  for=\"field_nvf_type_purchase-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[389]\" id=\"field_nvf_type_purchase-2\" value=\"Goods (Materials)\"\n\t\t   data-reqmsg=\"Type of Purchase cannot be blank.\" data-invmsg=\"Type of Purchase no es v\u00e1lido\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">Goods (Materials)<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio radio-inline radio\" id=\"frm_radio_389-3\">\t\t\t<label  for=\"field_nvf_type_purchase-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[389]\" id=\"field_nvf_type_purchase-3\" value=\"Services\"\n\t\t   data-reqmsg=\"Type of Purchase cannot be blank.\" data-invmsg=\"Type of Purchase no es v\u00e1lido\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">Services<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio radio-inline radio\" id=\"frm_radio_389-4\">\t\t\t<label  for=\"field_nvf_type_purchase-4\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[389]\" id=\"field_nvf_type_purchase-4\" value=\"Combination: Goods &amp; Services\"\n\t\t   data-reqmsg=\"Type of Purchase cannot be blank.\" data-invmsg=\"Type of Purchase no es v\u00e1lido\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">Combination: Goods &amp; Services<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio radio-inline radio\" id=\"frm_radio_389-5\">\t\t\t<label  for=\"field_nvf_type_purchase-5\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[389]\" id=\"field_nvf_type_purchase-5\" value=\"Inside Plant\"\n\t\t   data-reqmsg=\"Type of Purchase cannot be blank.\" data-invmsg=\"Type of Purchase no es v\u00e1lido\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">Inside Plant<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio radio-inline radio\" id=\"frm_radio_389-6\">\t\t\t<label  for=\"field_nvf_type_purchase-6\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[389]\" id=\"field_nvf_type_purchase-6\" value=\"Outside Plant\"\n\t\t   data-reqmsg=\"Type of Purchase cannot be blank.\" data-invmsg=\"Type of Purchase no es v\u00e1lido\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">Outside Plant<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio radio-inline radio\" id=\"frm_radio_389-7\">\t\t\t<label  for=\"field_nvf_type_purchase-7\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[389]\" id=\"field_nvf_type_purchase-7\" value=\"Other\"\n\t\t   data-reqmsg=\"Type of Purchase cannot be blank.\" data-invmsg=\"Type of Purchase no es v\u00e1lido\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">Other<\/div><\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_526_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container vertical_radio frm_display_format_buttons frm_text_align_left\">\r\n    <div  id=\"field_ocl2w_label\" class=\"frm_primary_label col-form-label form-label\">Referred by our sales person?\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_ocl2w_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio radio\" id=\"frm_radio_526-0\">\t\t\t<label  for=\"field_ocl2w-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[526]\" id=\"field_ocl2w-0\" value=\"Option 1\"\n\t\t   data-frmlimit=\"1\"  data-reqmsg=\"Referred by our sales person? cannot be blank.\" data-invmsg=\"Referred by our sales person? no es v\u00e1lido\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">Yes<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio radio\" id=\"frm_radio_526-1\">\t\t\t<label  for=\"field_ocl2w-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[526]\" id=\"field_ocl2w-1\" value=\"Option 2\"\n\t\t   data-frmlimit=\"1\"  data-reqmsg=\"Referred by our sales person? cannot be blank.\" data-invmsg=\"Referred by our sales person? no es v\u00e1lido\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">No<\/div><\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_614_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container\">\r\n    <label for=\"field_2i0qe\" id=\"field_2i0qe_label\" class=\"frm_primary_label col-form-label form-label\">Sales Person Name\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_2i0qe\" name=\"item_meta[614]\" value=\"\"  data-reqmsg=\"Sales Person Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" class=\"form-control\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_390_container\" class=\"frm_form_field  frm12 frm_first frm_html_container form-field\">\n<p style=\"text-align: center;\"><strong>SECTION B &#8211; VENDOR ADDRESS INFORMATION<\/strong><\/p>\n<\/div>\n<div id=\"frm_field_213_container\" class=\"frm_form_field frm_section_heading form-field  frm12 frm_first\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Vendor Information<\/h3>\r\n\r\n\r\n<div id=\"frm_field_204_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm6 frm_first\">\r\n    <label for=\"field_nvf_business_name\" id=\"field_nvf_business_name_label\" class=\"frm_primary_label col-form-label form-label\">Business Name\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_nvf_business_name\" name=\"item_meta[204]\" value=\"\"  data-sectionid=\"213\"  data-reqmsg=\"Business Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" class=\"form-control\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_369_container\" class=\"frm_form_field form-field  form-group frm_top_container frm6\">\r\n    <label for=\"field_nvf_business_website\" id=\"field_nvf_business_website_label\" class=\"frm_primary_label col-form-label form-label\">Business Website\/URL\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"url\" id=\"field_nvf_business_website\" name=\"item_meta[369]\" value=\"\"  data-sectionid=\"213\"  data-invmsg=\"Website\/URL is invalid\" class=\"form-control\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_215_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm12 frm_first\">\r\n    <label for=\"field_nvf_primary_phone\" id=\"field_nvf_primary_phone_label\" class=\"frm_primary_label col-form-label form-label\">Business Primary Phone\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"tel\" id=\"field_nvf_primary_phone\" name=\"item_meta[215]\" value=\"\"  data-sectionid=\"213\"  data-reqmsg=\"Business Primary Phone cannot be blank.\" aria-required=\"true\" data-invmsg=\"Phone is invalid\" class=\"form-control\" aria-invalid=\"false\" pattern=\"((\\+\\d{1,3}(-|.| )?\\(?\\d\\)?(-| |.)?\\d{1,5})|(\\(?\\d{2,6}\\)?))(-|.| )?(\\d{3,4})(-|.| )?(\\d{4})(( x| ext)\\d{1,5}){0,1}$\"  \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_362_container\" class=\"frm_form_field frm_section_heading form-field  frm12 frm_first\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Business Physical Address<\/h3>\r\n\r\n\r\n<div id=\"frm_field_206_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm12 frm_first\">\r\n    <label for=\"field_nvf_physical_address1\" id=\"field_nvf_physical_address1_label\" class=\"frm_primary_label col-form-label form-label\">Address 1\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_nvf_physical_address1\" name=\"item_meta[206]\" value=\"\"  data-sectionid=\"362\"  data-reqmsg=\"Address 1 cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" class=\"form-control\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_207_container\" class=\"frm_form_field form-field  form-group frm_top_container frm12 frm_first\">\r\n    <label for=\"field_nvf_physical_address2\" id=\"field_nvf_physical_address2_label\" class=\"frm_primary_label col-form-label form-label\">Address 2\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_nvf_physical_address2\" name=\"item_meta[207]\" value=\"\"  data-sectionid=\"362\"  data-invmsg=\"Text is invalid\" class=\"form-control\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_209_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm4 frm_first\">\r\n    <label for=\"field_nvf_physical_city\" id=\"field_nvf_physical_city_label\" class=\"frm_primary_label col-form-label form-label\">City\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_nvf_physical_city\" name=\"item_meta[209]\" value=\"\"  data-sectionid=\"362\"  data-reqmsg=\"City cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" class=\"form-control\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_210_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm4\">\r\n    <label for=\"field_nvf_physical_state\" id=\"field_nvf_physical_state_label\" class=\"frm_primary_label col-form-label form-label\">State\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_nvf_physical_state\" name=\"item_meta[210]\" value=\"\"  data-sectionid=\"362\"  data-reqmsg=\"State cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" class=\"form-control\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_211_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm4\">\r\n    <label for=\"field_nvf_physical_zipcode\" id=\"field_nvf_physical_zipcode_label\" class=\"frm_primary_label col-form-label form-label\">Zip Code\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_nvf_physical_zipcode\" name=\"item_meta[211]\" value=\"\"  data-sectionid=\"362\"  data-reqmsg=\"Zip Code cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" class=\"form-control\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_380_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Business Postal Address<\/h3>\r\n\r\n\r\n<div id=\"frm_field_381_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm12 frm_first\">\r\n    <label for=\"field_nvf_postal_address1\" id=\"field_nvf_postal_address1_label\" class=\"frm_primary_label col-form-label form-label\">Address 1\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_nvf_postal_address1\" name=\"item_meta[381]\" value=\"\"  data-sectionid=\"380\"  data-reqmsg=\"Address 1 cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" class=\"form-control\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_382_container\" class=\"frm_form_field form-field  form-group frm_top_container frm12 frm_first\">\r\n    <label for=\"field_nvf_postal_address2\" id=\"field_nvf_postal_address2_label\" class=\"frm_primary_label col-form-label form-label\">Address 2\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_nvf_postal_address2\" name=\"item_meta[382]\" value=\"\"  data-sectionid=\"380\"  data-invmsg=\"Text is invalid\" class=\"form-control\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_383_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm4 frm_first\">\r\n    <label for=\"field_nvf_postal_city\" id=\"field_nvf_postal_city_label\" class=\"frm_primary_label col-form-label form-label\">City\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_nvf_postal_city\" name=\"item_meta[383]\" value=\"\"  data-sectionid=\"380\"  data-reqmsg=\"City cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" class=\"form-control\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_384_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm4\">\r\n    <label for=\"field_nvf_postal_state\" id=\"field_nvf_postal_state_label\" class=\"frm_primary_label col-form-label form-label\">State\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_nvf_postal_state\" name=\"item_meta[384]\" value=\"\"  data-sectionid=\"380\"  data-reqmsg=\"State cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" class=\"form-control\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_385_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm4\">\r\n    <label for=\"field_nvf_postal_zipcode\" id=\"field_nvf_postal_zipcode_label\" class=\"frm_primary_label col-form-label form-label\">Zip Code\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_nvf_postal_zipcode\" name=\"item_meta[385]\" value=\"\"  data-sectionid=\"380\"  data-reqmsg=\"Zip Code cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" class=\"form-control\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_370_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Business Primary Owner Information<\/h3>\r\n\r\n\r\n<div id=\"frm_field_372_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm6 frm_first\">\r\n    <label for=\"field_nvf_owner_firstname\" id=\"field_nvf_owner_firstname_label\" class=\"frm_primary_label col-form-label form-label\">First Name\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_nvf_owner_firstname\" name=\"item_meta[372]\" value=\"\"  data-sectionid=\"370\"  data-reqmsg=\"First Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" class=\"form-control\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_373_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm6\">\r\n    <label for=\"field_nvf_owner_lastname\" id=\"field_nvf_owner_lastname_label\" class=\"frm_primary_label col-form-label form-label\">Last Name\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_nvf_owner_lastname\" name=\"item_meta[373]\" value=\"\"  data-sectionid=\"370\"  data-reqmsg=\"Last Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" class=\"form-control\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_374_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm6 frm_first\">\r\n    <label for=\"field_nvf_owner_phone\" id=\"field_nvf_owner_phone_label\" class=\"frm_primary_label col-form-label form-label\">Phone\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"tel\" id=\"field_nvf_owner_phone\" name=\"item_meta[374]\" value=\"\"  data-sectionid=\"370\"  data-reqmsg=\"Phone cannot be blank.\" aria-required=\"true\" data-invmsg=\"Phone is invalid\" class=\"form-control\" aria-invalid=\"false\" pattern=\"((\\+\\d{1,3}(-|.| )?\\(?\\d\\)?(-| |.)?\\d{1,5})|(\\(?\\d{2,6}\\)?))(-|.| )?(\\d{3,4})(-|.| )?(\\d{4})(( x| ext)\\d{1,5}){0,1}$\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_375_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm6\">\r\n    <label for=\"field_nvf_owner_email\" id=\"field_nvf_owner_email_label\" class=\"frm_primary_label col-form-label form-label\">Email\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"email\" id=\"field_nvf_owner_email\" name=\"item_meta[375]\" value=\"\"  data-sectionid=\"370\"  data-reqmsg=\"Email cannot be blank.\" aria-required=\"true\" data-invmsg=\"Email is invalid\" class=\"form-control\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_391_container\" class=\"frm_form_field  frm12 frm_first frm_html_container form-field\">\n<p style=\"text-align: center;\"><strong>SECTION C &#8211; VENDOR TAX INFORMATION<\/strong><\/p>\n<p>W-9 Request for Taxpayer Identification Number and Certification (required if U.S. Citizen or U.S. Person):*<\/p><\/div>\n<div id=\"frm_field_408_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm12 frm_first\">\r\n    <label for=\"field_nvf_vd_ein_number\" id=\"field_nvf_vd_ein_number_label\" class=\"frm_primary_label col-form-label form-label\">Employer Identification Number (EIN)\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_nvf_vd_ein_number\" name=\"item_meta[408]\" value=\"\"  data-reqmsg=\"Employer Identification Number (EIN) cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" class=\"form-control\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_nvf_vd_ein_number\" \/>\r\n    <div class=\"frm_description form-text\" id=\"frm_desc_field_nvf_vd_ein_number\">Taxpayer Federal<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_379_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm12 frm_first\">\r\n    <label for=\"field_nvf_check_letter\" id=\"field_nvf_check_letter_label\" class=\"frm_primary_label col-form-label form-label\">Vendor Tax Certification\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"hidden\"  data-reqmsg=\"Vendor Tax Certification cannot be blank.\" data-invmsg=\"File Upload is invalid\" aria-invalid=\"false\"   name=\"item_meta[379][]\"  data-reqmsg=\"Vendor Tax Certification cannot be blank.\"  value=\"\" data-frmfile=\"379\" \/>\n\n<div class=\"frm_dropzone frm_multi_upload frm_clearfix\" id=\"file379_dropzone\" role=\"group\" >\n\t<div class=\"fallback\">\n\t\t<input type=\"file\" name=\"file379[]\" id=\"field_nvf_check_letter\"\n\t\t\t data-frmfile=\"379\" multiple=\"multiple\"  data-reqmsg=\"Vendor Tax Certification cannot be blank.\" data-invmsg=\"File Upload is invalid\" aria-invalid=\"false\"  \t\t\t\/>\n\t\t\t\t<div class=\"frm_clearfix \"><\/div>\n\t<\/div>\n\t<div class=\"dz-message needsclick\">\n\t\t\t\t<svg  viewBox=\"0 0 18 18\" class=\"frmsvg frm-svg-icon\">\n\t<path viewBox=\"0 0 18 18\" fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M8.2 4v8a.8.8 0 001.5 0V4l2.1 2.2A.7.7 0 1013 5L9.5 1.7a.7.7 0 00-1.1 0L5.1 5.2a.8.8 0 001 1l2.1-2zm7.6 4.3c.4 0 .7.3.7.7v6.8c0 .4-.3.7-.8.7H2.3a.8.8 0 01-.8-.8V9A.8.8 0 013 9v6h12V9c0-.4.3-.8.8-.8z\"><\/path>\n<\/svg>\t\t<span class=\"frm_upload_text\"><button type=\"button\" aria-label=\"Vendor Tax Certification. Drop | upload. Tama\u00f1o m\u00e1ximo del archivo: 16.78MB\">Drop | upload<\/button><\/span>\n\t\t<span class=\"frm_compact_text\"><button type=\"button\" aria-label=\"Vendor Tax Certification. Choose File. Tama\u00f1o m\u00e1ximo del archivo: 16.78MB\">Choose File<\/button><\/span>\n\t\t<div class=\"frm_small_text\">\n\t\t\t<p>Tama\u00f1o m\u00e1ximo del archivo: 16.78MB<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_410_container\" class=\"frm_form_field  frm12 frm_first frm_html_container form-field\">\n<p style=\"text-align: center;\"><strong>SECTION E &#8211; PAYMENT INFORMATION<\/strong><\/p>\n<\/div>\n<div id=\"frm_field_216_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top\">Accounts Receivable<\/h3>\r\n<div id=\"frm_desc_field_ngsst\" class=\"frm_description form-text frm_section_spacing\">Please provide primary accounts receivable contact.<\/div>\r\n\r\n<div id=\"frm_field_218_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm6 frm_first\">\r\n    <label for=\"field_nvf_ar_first_name\" id=\"field_nvf_ar_first_name_label\" class=\"frm_primary_label col-form-label form-label\">First name\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_nvf_ar_first_name\" name=\"item_meta[218]\" value=\"\"  data-sectionid=\"216\"  data-reqmsg=\"First name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" class=\"form-control\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_219_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm6\">\r\n    <label for=\"field_nvf_ar_last_name\" id=\"field_nvf_ar_last_name_label\" class=\"frm_primary_label col-form-label form-label\">Last name\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_nvf_ar_last_name\" name=\"item_meta[219]\" value=\"\"  data-sectionid=\"216\"  data-reqmsg=\"Last name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" class=\"form-control\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_220_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm6 frm_first\">\r\n    <label for=\"field_nvf_ar_phone\" id=\"field_nvf_ar_phone_label\" class=\"frm_primary_label col-form-label form-label\">Phone\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"tel\" id=\"field_nvf_ar_phone\" name=\"item_meta[220]\" value=\"\"  data-sectionid=\"216\"  data-reqmsg=\"Phone cannot be blank.\" aria-required=\"true\" data-invmsg=\"Phone is invalid\" class=\"form-control\" aria-invalid=\"false\" pattern=\"((\\+\\d{1,3}(-|.| )?\\(?\\d\\)?(-| |.)?\\d{1,5})|(\\(?\\d{2,6}\\)?))(-|.| )?(\\d{3,4})(-|.| )?(\\d{4})(( x| ext)\\d{1,5}){0,1}$\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_221_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm6\">\r\n    <label for=\"field_nvf_ar_email\" id=\"field_nvf_ar_email_label\" class=\"frm_primary_label col-form-label form-label\">Email\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"email\" id=\"field_nvf_ar_email\" name=\"item_meta[221]\" value=\"\"  data-sectionid=\"216\"  data-reqmsg=\"Email cannot be blank.\" aria-required=\"true\" data-invmsg=\"Email is invalid\" class=\"form-control\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_376_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm6 frm_first horizontal_radio frm_other_container\">\r\n    <div  id=\"field_nvf_currency_label\" class=\"frm_primary_label col-form-label form-label\">Currency\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_nvf_currency_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio radio-inline radio\" id=\"frm_radio_376-216-0\">\t\t\t<label  for=\"field_nvf_currency-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[376]\" id=\"field_nvf_currency-0\" value=\"USD\"\n\t\tchecked=\"checked\"   data-sectionid=\"216\"  data-frmval=\"USD\" data-reqmsg=\"Currency cannot be blank.\" data-invmsg=\"Currency no es v\u00e1lido\" aria-invalid=\"false\"  \/> USD<\/label><\/div>\n\t\t<div class=\"frm_radio radio-inline radio\" id=\"frm_radio_376-216-1\">\t\t\t<label  for=\"field_nvf_currency-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[376]\" id=\"field_nvf_currency-1\" value=\"CAD\"\n\t\t   data-sectionid=\"216\"  data-frmval=\"USD\" data-reqmsg=\"Currency cannot be blank.\" data-invmsg=\"Currency no es v\u00e1lido\" aria-invalid=\"false\"  \/> CAD<\/label><\/div>\n\t\t<div class=\"frm_radio radio-inline radio\" id=\"frm_radio_376-216-2\">\t\t\t<label  for=\"field_nvf_currency-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[376]\" id=\"field_nvf_currency-2\" value=\"AUD\"\n\t\t   data-sectionid=\"216\"  data-frmval=\"USD\" data-reqmsg=\"Currency cannot be blank.\" data-invmsg=\"Currency no es v\u00e1lido\" aria-invalid=\"false\"  \/> AUD<\/label><\/div>\n\t\t<div class=\"frm_radio radio-inline radio\" id=\"frm_radio_376-216-3\">\t\t\t<label  for=\"field_nvf_currency-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[376]\" id=\"field_nvf_currency-3\" value=\"MXN\"\n\t\t   data-sectionid=\"216\"  data-frmval=\"USD\" data-reqmsg=\"Currency cannot be blank.\" data-invmsg=\"Currency no es v\u00e1lido\" aria-invalid=\"false\"  \/> MXN<\/label><\/div>\n\t\t<div class=\"frm_radio radio-inline radio\" id=\"frm_radio_376-216-other_4\">\t\t\t<label  for=\"field_nvf_currency-other_4\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[376]\" id=\"field_nvf_currency-other_4\" value=\"Other\"\n\t\t   data-sectionid=\"216\"  data-frmval=\"USD\" data-reqmsg=\"Currency cannot be blank.\" data-invmsg=\"Currency no es v\u00e1lido\" aria-invalid=\"false\"  \/> Other<\/label><label for=\"field_nvf_currency-other_4-otext\" class=\"frm_screen_reader frm_hidden\">Other<\/label><input type=\"text\" id=\"field_nvf_currency-other_4-otext\" class=\"frm_other_input frm_pos_none\"  name=\"item_meta[other][376]\" value=\"\" \/><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_205_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm12  frm6\">\r\n    <label for=\"field_nvf_terms\" id=\"field_nvf_terms_label\" class=\"frm_primary_label col-form-label form-label\">Terms\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    \t\t<select name=\"item_meta[205]\" id=\"field_nvf_terms\"  data-sectionid=\"216\"  data-frmval=\"N00\" data-reqmsg=\"Terms cannot be blank.\" aria-required=\"true\" data-invmsg=\"Terms no es v\u00e1lido\" class=\"form-control\" aria-invalid=\"false\"  >\n\t\t<option  value=\"N00\" selected='selected'>N00<\/option><option  value=\"N05\">N05<\/option><option  value=\"N10\">N10<\/option><option  value=\"N15\">N15<\/option><option  value=\"N30\">N30<\/option><option  value=\"N45\">N45<\/option><option  value=\"N75\">N75<\/option><option  value=\"N90\">N90<\/option><option  value=\"N120\">N120<\/option>\t<\/select>\n\t\r\n    <div class=\"frm_description form-text\" id=\"frm_desc_field_nvf_terms\">Payment term with this Vendor.<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_368_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm12 frm_first horizontal_radio\">\r\n    <div  id=\"field_nvf_apm_label\" class=\"frm_primary_label col-form-label form-label\">Accepted payment methods\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_nvf_apm_label\" role=\"group\">\t\t<div class=\"frm_checkbox checkbox-inline checkbox\" id=\"frm_checkbox_368-216-0\">\t\t\t<label  for=\"field_nvf_apm-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[368][]\" id=\"field_nvf_apm-0\" value=\"Wire Transfer\"  data-sectionid=\"216\"  data-reqmsg=\"Accepted payment methods cannot be blank.\" data-invmsg=\"Accepted payment methods no es v\u00e1lido\" aria-invalid=\"false\"   aria-required=\"true\"  \/> Wire Transfer<\/label><\/div>\n\t\t<div class=\"frm_checkbox checkbox-inline checkbox\" id=\"frm_checkbox_368-216-4\">\t\t\t<label  for=\"field_nvf_apm-4\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[368][]\" id=\"field_nvf_apm-4\" value=\"ACH\"  data-sectionid=\"216\"  data-reqmsg=\"Accepted payment methods cannot be blank.\" data-invmsg=\"Accepted payment methods no es v\u00e1lido\" aria-invalid=\"false\"   \/> ACH<\/label><\/div>\n\t\t<div class=\"frm_checkbox checkbox-inline checkbox\" id=\"frm_checkbox_368-216-1\">\t\t\t<label  for=\"field_nvf_apm-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[368][]\" id=\"field_nvf_apm-1\" value=\"American Express\"  data-sectionid=\"216\"  data-reqmsg=\"Accepted payment methods cannot be blank.\" data-invmsg=\"Accepted payment methods no es v\u00e1lido\" aria-invalid=\"false\"   \/> American Express<\/label><\/div>\n\t\t<div class=\"frm_checkbox checkbox-inline checkbox\" id=\"frm_checkbox_368-216-2\">\t\t\t<label  for=\"field_nvf_apm-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[368][]\" id=\"field_nvf_apm-2\" value=\"Visa\"  data-sectionid=\"216\"  data-reqmsg=\"Accepted payment methods cannot be blank.\" data-invmsg=\"Accepted payment methods no es v\u00e1lido\" aria-invalid=\"false\"   \/> Visa<\/label><\/div>\n\t\t<div class=\"frm_checkbox checkbox-inline checkbox\" id=\"frm_checkbox_368-216-3\">\t\t\t<label  for=\"field_nvf_apm-3\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[368][]\" id=\"field_nvf_apm-3\" value=\"Check\"  data-sectionid=\"216\"  data-reqmsg=\"Accepted payment methods cannot be blank.\" data-invmsg=\"Accepted payment methods no es v\u00e1lido\" aria-invalid=\"false\"   \/> Check<\/label><\/div>\n<\/div>\r\n    <div class=\"frm_description form-text\" id=\"frm_desc_field_nvf_apm\">Please indicate the methods you accept for payment.<\/div>\r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_377_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top\">ACH Direct Deposit<\/h3>\r\n<div id=\"frm_desc_field_kjjr4\" class=\"frm_description form-text frm_section_spacing\">Please provide a voided blank check or a letter on company letterhead with a signature, printed name and a date or a letter from the\r\nfinancial institution with a physical signature, printed name and a date within the last 6 months. Any fields marked \u201cSee Attached\u201d will be returned<\/div>\r\n\r\n<div id=\"frm_field_620_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container\">\r\n    <label for=\"field_4ddq4\" id=\"field_4ddq4_label\" class=\"frm_primary_label col-form-label form-label\">Financial Institution Name\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_4ddq4\" name=\"item_meta[620]\" value=\"\"  data-sectionid=\"377\"  data-reqmsg=\"Financial Institution Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Financial Institution Name is invalid\" class=\"form-control\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_621_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container\">\r\n    <label for=\"field_yyyn5\" id=\"field_yyyn5_label\" class=\"frm_primary_label col-form-label form-label\">Financial Institution Address\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_yyyn5\" name=\"item_meta[621]\" value=\"\"  data-sectionid=\"377\"  data-reqmsg=\"Financial Institution Address cannot be blank.\" aria-required=\"true\" data-invmsg=\"Financial Institution Address is invalid\" class=\"form-control\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_622_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container\">\r\n    <label for=\"field_f7ocs\" id=\"field_f7ocs_label\" class=\"frm_primary_label col-form-label form-label\">Account Number (Including any leading zeros)\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_f7ocs\" name=\"item_meta[622]\" value=\"\"  data-sectionid=\"377\"  data-reqmsg=\"Account Number (Including any leading zeros) cannot be blank.\" aria-required=\"true\" data-invmsg=\"Account Number (Including any leading zeros) is invalid\" class=\"form-control\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_640_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm12 frm_first frm_three_col\">\r\n    <div  id=\"field_q1i6h_label\" class=\"frm_primary_label col-form-label form-label\">Country\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_q1i6h_label\" role=\"group\">\t\t<div class=\"frm_checkbox checkbox\" id=\"frm_checkbox_640-377-0\">\t\t\t<label  for=\"field_q1i6h-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[640][]\" id=\"field_q1i6h-0\" value=\"United States\"  data-sectionid=\"377\"  data-frmlimit=\"1\"  data-reqmsg=\"Country cannot be blank.\" data-invmsg=\"Country no es v\u00e1lido\" aria-invalid=\"false\"   aria-required=\"true\"  \/> United States<\/label><\/div>\n\t\t<div class=\"frm_checkbox checkbox\" id=\"frm_checkbox_640-377-1\">\t\t\t<label  for=\"field_q1i6h-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[640][]\" id=\"field_q1i6h-1\" value=\"Canada\"  data-sectionid=\"377\"  data-frmlimit=\"1\"  data-reqmsg=\"Country cannot be blank.\" data-invmsg=\"Country no es v\u00e1lido\" aria-invalid=\"false\"   \/> Canada<\/label><\/div>\n\t\t<div class=\"frm_checkbox checkbox\" id=\"frm_checkbox_640-377-2\">\t\t\t<label  for=\"field_q1i6h-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[640][]\" id=\"field_q1i6h-2\" value=\"Ouside North America\"  data-sectionid=\"377\"  data-frmlimit=\"1\"  data-reqmsg=\"Country cannot be blank.\" data-invmsg=\"Country no es v\u00e1lido\" aria-invalid=\"false\"   \/> Ouside North America<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_623_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container\">\r\n    <label for=\"field_fc29m\" id=\"field_fc29m_label\" class=\"frm_primary_label col-form-label form-label\">US Only: Routing Number\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_fc29m\" name=\"item_meta[623]\" value=\"\"  data-sectionid=\"377\"  data-reqmsg=\"US Only: Routing Number cannot be blank.\" aria-required=\"true\" data-invmsg=\"US Only: Routing Number is invalid\" class=\"form-control\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_624_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container\">\r\n    <label for=\"field_wtpoz\" id=\"field_wtpoz_label\" class=\"frm_primary_label col-form-label form-label\">Canada Only: Institution ID &#038; Transit Number\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_wtpoz\" name=\"item_meta[624]\" value=\"\"  data-sectionid=\"377\"  data-reqmsg=\"Canada Only: Institution ID &amp; Transit Number cannot be blank.\" aria-required=\"true\" data-invmsg=\"Canada Only: Institution ID &amp; Transit Number is invalid\" class=\"form-control\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_625_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container\">\r\n    <label for=\"field_mjdqs\" id=\"field_mjdqs_label\" class=\"frm_primary_label col-form-label form-label\">Vendors Outside North America: SWIFT\/IBAN\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_mjdqs\" name=\"item_meta[625]\" value=\"\"  data-sectionid=\"377\"  data-reqmsg=\"Vendors Outside North America: SWIFT\/IBAN cannot be blank.\" aria-required=\"true\" data-invmsg=\"Vendors Outside North America: SWIFT\/IBAN is invalid\" class=\"form-control\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_633_container\" class=\"frm_form_field  frm_html_container form-field\">For ACH\/Wire: I hearby authorize Wholesale Electric Caribe Inc., collectively referred to herein as \u00abCompany\u00bb or \u00abWEC\u00bb to initiate a direct deposit creditentries and to initiate, if necessary, correcting debit entries for any credit entries made in error to the account number listed above. I also authorize the financial institution named above to credit and debit the same entries to the account. This Authority is to remain in full force and effect until the Company has received written notification from the vendor on this termination in such time and such manner as to afford the Company a reasonable time to act on it. Termination of vendor status shall automatically void this authorization.<\/div>\n<div id=\"frm_field_726_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container\">\r\n    <label for=\"field_lp2zz\" id=\"field_lp2zz_label\" class=\"frm_primary_label col-form-label form-label\">Check | Letter\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"hidden\"  data-sectionid=\"377\"  data-reqmsg=\"Check | Letter cannot be blank.\" data-invmsg=\"File Upload is invalid\" aria-invalid=\"false\"   name=\"item_meta[726][]\"  data-reqmsg=\"Check | Letter cannot be blank.\"  value=\"\" data-frmfile=\"726\" \/>\n\n<div class=\"frm_dropzone frm_multi_upload frm_clearfix\" id=\"file726_dropzone\" role=\"group\" >\n\t<div class=\"fallback\">\n\t\t<input type=\"file\" name=\"file726[]\" id=\"field_lp2zz\"\n\t\t\t data-frmfile=\"726\" multiple=\"multiple\"  data-sectionid=\"377\"  data-reqmsg=\"Check | Letter cannot be blank.\" data-invmsg=\"File Upload is invalid\" aria-invalid=\"false\"  \t\t\t\/>\n\t\t\t\t<div class=\"frm_clearfix \"><\/div>\n\t<\/div>\n\t<div class=\"dz-message needsclick\">\n\t\t\t\t<svg  viewBox=\"0 0 18 18\" class=\"frmsvg frm-svg-icon\">\n\t<path viewBox=\"0 0 18 18\" fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M8.2 4v8a.8.8 0 001.5 0V4l2.1 2.2A.7.7 0 1013 5L9.5 1.7a.7.7 0 00-1.1 0L5.1 5.2a.8.8 0 001 1l2.1-2zm7.6 4.3c.4 0 .7.3.7.7v6.8c0 .4-.3.7-.8.7H2.3a.8.8 0 01-.8-.8V9A.8.8 0 013 9v6h12V9c0-.4.3-.8.8-.8z\"><\/path>\n<\/svg>\t\t<span class=\"frm_upload_text\"><button type=\"button\" aria-label=\"Check | Letter. Drop | upload. Tama\u00f1o m\u00e1ximo del archivo: 16.78MB\">Drop | upload<\/button><\/span>\n\t\t<span class=\"frm_compact_text\"><button type=\"button\" aria-label=\"Check | Letter. Choose File. Tama\u00f1o m\u00e1ximo del archivo: 16.78MB\">Choose File<\/button><\/span>\n\t\t<div class=\"frm_small_text\">\n\t\t\t<p>Tama\u00f1o m\u00e1ximo del archivo: 16.78MB<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\t\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_224_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n    <div  id=\"field_nvf_dyhamr_label\" class=\"frm_primary_label col-form-label form-label\">Do you have a merchant registration\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_nvf_dyhamr_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio radio-inline radio\" id=\"frm_radio_224-0\">\t\t\t<label  for=\"field_nvf_dyhamr-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[224]\" id=\"field_nvf_dyhamr-0\" value=\"Yes\"\n\t\t   data-reqmsg=\"Do you have a merchant registration cannot be blank.\" data-invmsg=\"Do you have a merchant registration no es v\u00e1lido\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">Yes<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio radio-inline radio\" id=\"frm_radio_224-1\">\t\t\t<label  for=\"field_nvf_dyhamr-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[224]\" id=\"field_nvf_dyhamr-1\" value=\"No\"\n\t\t   data-reqmsg=\"Do you have a merchant registration cannot be blank.\" data-invmsg=\"Do you have a merchant registration no es v\u00e1lido\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">No<\/div><\/label><\/div>\n<\/div>\r\n    <div class=\"frm_description form-text\" id=\"frm_desc_field_nvf_dyhamr\">Registro Comerciante<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_263_container\" class=\"frm_form_field frm_section_heading form-field  frm12 frm_first\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Merchant Registration Certificate<\/h3>\r\n\r\n\r\n<div id=\"frm_field_392_container\" class=\"frm_form_field form-field  form-group frm_top_container\">\r\n    <label for=\"field_nvf_mrcn\" id=\"field_nvf_mrcn_label\" class=\"frm_primary_label col-form-label form-label\">Merchant Registration Certificate Number\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_nvf_mrcn\" name=\"item_meta[392]\" value=\"\"  data-sectionid=\"263\"  data-invmsg=\"Text is invalid\" class=\"form-control\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_222_container\" class=\"frm_form_field form-field  form-group frm_top_container frm12 frm_first\">\r\n    <label for=\"field_nvf_mrc\" id=\"field_nvf_mrc_label\" class=\"frm_primary_label col-form-label form-label\">Merchant Registration Certificate\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"hidden\"  data-sectionid=\"263\"  data-invmsg=\"File Upload is invalid\" class=\"auto_width\" aria-invalid=\"false\"   name=\"item_meta[222]\"  value=\"\" data-frmfile=\"222\" \/>\n\n<div class=\"frm_dropzone frm_single_upload frm_clearfix\" id=\"file222_dropzone\" role=\"group\"  aria-describedby=\"frm_desc_field_nvf_mrc\">\n\t<div class=\"fallback\">\n\t\t<input type=\"file\" name=\"file222\" id=\"field_nvf_mrc\"\n\t\t\t data-sectionid=\"263\"  data-invmsg=\"File Upload is invalid\" class=\"auto_width\" aria-invalid=\"false\"  \t\t\t\/>\n\t\t\t\t<div class=\"frm_clearfix \"><\/div>\n\t<\/div>\n\t<div class=\"dz-message needsclick\">\n\t\t\t\t<svg  viewBox=\"0 0 18 18\" class=\"frmsvg frm-svg-icon\">\n\t<path viewBox=\"0 0 18 18\" fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M8.2 4v8a.8.8 0 001.5 0V4l2.1 2.2A.7.7 0 1013 5L9.5 1.7a.7.7 0 00-1.1 0L5.1 5.2a.8.8 0 001 1l2.1-2zm7.6 4.3c.4 0 .7.3.7.7v6.8c0 .4-.3.7-.8.7H2.3a.8.8 0 01-.8-.8V9A.8.8 0 013 9v6h12V9c0-.4.3-.8.8-.8z\"><\/path>\n<\/svg>\t\t<span class=\"frm_upload_text\"><button type=\"button\" aria-label=\"Merchant Registration Certificate. Drop | upload. Tama\u00f1o m\u00e1ximo del archivo: 8MB\">Drop | upload<\/button><\/span>\n\t\t<span class=\"frm_compact_text\"><button type=\"button\" aria-label=\"Merchant Registration Certificate. Choose File. Tama\u00f1o m\u00e1ximo del archivo: 8MB\">Choose File<\/button><\/span>\n\t\t<div class=\"frm_small_text\">\n\t\t\t<p>Tama\u00f1o m\u00e1ximo del archivo: 8MB<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\t\r\n    <div class=\"frm_description form-text\" id=\"frm_desc_field_nvf_mrc\">Registro de comerciante<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_409_container\" class=\"frm_form_field form-field  form-group frm_top_container horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n    <div  id=\"field_nvf_sawfsr_label\" class=\"frm_primary_label col-form-label form-label\">Select Applicable Withholding for Services Rendered:\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_nvf_sawfsr_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio radio-inline radio\" id=\"frm_radio_409-263-0\">\t\t\t<label  for=\"field_nvf_sawfsr-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[409]\" id=\"field_nvf_sawfsr-0\" value=\"10% (Percentage applicable by Default)\"\n\t\t   data-sectionid=\"263\"  data-invmsg=\"Select Applicable Withholding for Services Rendered: no es v\u00e1lido\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">10% (Percentage applicable by Default)<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio radio-inline radio\" id=\"frm_radio_409-263-1\">\t\t\t<label  for=\"field_nvf_sawfsr-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[409]\" id=\"field_nvf_sawfsr-1\" value=\"Total Waiver\"\n\t\t   data-sectionid=\"263\"  data-invmsg=\"Select Applicable Withholding for Services Rendered: no es v\u00e1lido\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">Total Waiver<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio radio-inline radio\" id=\"frm_radio_409-263-2\">\t\t\t<label  for=\"field_nvf_sawfsr-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[409]\" id=\"field_nvf_sawfsr-2\" value=\"Partial Waiver\"\n\t\t   data-sectionid=\"263\"  data-invmsg=\"Select Applicable Withholding for Services Rendered: no es v\u00e1lido\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">Partial Waiver<\/div><\/label><\/div>\n<\/div>\r\n    <div class=\"frm_description form-text\" id=\"frm_desc_field_nvf_sawfsr\">In the Case of Total or Partial Waiver Indicate Expiration Date: (Attach copy of total or partial waiver, upon expiration 7% shall be withheld from payments in the manner required by the Puerto Rico Internal Revenue Code 2011, as amended, until a new waiver certificate is provided).<\/div>\r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_365_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top\">Certificate of good standing<\/h3>\r\n<div id=\"frm_desc_field_julvf\" class=\"frm_description form-text frm_section_spacing\">or Certificate of Account Status<\/div>\r\n\r\n<div id=\"frm_field_367_container\" class=\"frm_form_field form-field  form-group frm_top_container\">\r\n    <label for=\"field_nvf_cogs\" id=\"field_nvf_cogs_label\" class=\"frm_primary_label col-form-label form-label\">Certificate of Good Standing\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"hidden\"  data-sectionid=\"365\"  data-invmsg=\"File Upload is invalid\" aria-invalid=\"false\"   name=\"item_meta[367][]\"  value=\"\" data-frmfile=\"367\" \/>\n\n<div class=\"frm_dropzone frm_multi_upload frm_clearfix\" id=\"file367_dropzone\" role=\"group\" >\n\t<div class=\"fallback\">\n\t\t<input type=\"file\" name=\"file367[]\" id=\"field_nvf_cogs\"\n\t\t\t data-frmfile=\"367\" multiple=\"multiple\"  data-sectionid=\"365\"  data-invmsg=\"File Upload is invalid\" aria-invalid=\"false\"  \t\t\t\/>\n\t\t\t\t<div class=\"frm_clearfix \"><\/div>\n\t<\/div>\n\t<div class=\"dz-message needsclick\">\n\t\t\t\t<svg  viewBox=\"0 0 18 18\" class=\"frmsvg frm-svg-icon\">\n\t<path viewBox=\"0 0 18 18\" fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M8.2 4v8a.8.8 0 001.5 0V4l2.1 2.2A.7.7 0 1013 5L9.5 1.7a.7.7 0 00-1.1 0L5.1 5.2a.8.8 0 001 1l2.1-2zm7.6 4.3c.4 0 .7.3.7.7v6.8c0 .4-.3.7-.8.7H2.3a.8.8 0 01-.8-.8V9A.8.8 0 013 9v6h12V9c0-.4.3-.8.8-.8z\"><\/path>\n<\/svg>\t\t<span class=\"frm_upload_text\"><button type=\"button\" aria-label=\"Certificate of Good Standing. Drop | upload. Tama\u00f1o m\u00e1ximo del archivo: 16.78MB\">Drop | upload<\/button><\/span>\n\t\t<span class=\"frm_compact_text\"><button type=\"button\" aria-label=\"Certificate of Good Standing. Choose File. Tama\u00f1o m\u00e1ximo del archivo: 16.78MB\">Choose File<\/button><\/span>\n\t\t<div class=\"frm_small_text\">\n\t\t\t<p>Tama\u00f1o m\u00e1ximo del archivo: 16.78MB<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\t\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_411_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container\">\r\n    <label for=\"field_nvf_comments\" id=\"field_nvf_comments_label\" class=\"frm_primary_label col-form-label form-label\">Comments:\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[411]\" id=\"field_nvf_comments\" rows=\"5\"  data-reqmsg=\"Comments: cannot be blank.\" aria-required=\"true\" data-invmsg=\"Paragraph is invalid\" class=\"form-control\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_643_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\"><\/h3>\r\n\r\n\r\n<\/div>\n<div id=\"frm_field_642_container\" class=\"frm_form_field  frm_html_container form-field\">\n<h5><strong>By signing this document, I certify that I am an authorized company representative and the information on this form is correct.<\/strong><\/h5>\n<\/div>\n<div id=\"frm_field_634_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm4 frm_first\">\r\n    <label for=\"field_ubw3k\" id=\"field_ubw3k_label\" class=\"frm_primary_label col-form-label form-label\">Signature\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <div class=\"sigPad\" id='sigPad634' style=\"max-width:400px;\">\n\t<div class=\"sig sigWrapper\" style=\"height:100px;border-color:#BFC3C8;--bg-color:#ffffff;--active:#579AF6;--inactive:#eaeaea;--active-text:#ffffff;--inactive-text:#3f4b5b;--button-margin:10px;--button-size:16px;--button-padding:8px;--button-side-margin:20px;--icon:20px\">\n\n\t\t<ul class=\"sigNav\">\n\t\t\t\t<li class=\"drawIt\">\n\t\t\t\t\t<a href=\"#\" class=\"frm-active-sig-type\" title=\"Draw It\" aria-label=\"Draw It\">\n\t\t\t\t\t\t<svg  viewBox=\"0 0 22 20\" class=\"frmsvg\">\n\t<title>signature<\/title>\n\t<path d=\"M19.7 2.2A3.5 3.5 0 0 0 14 1.1L1.7 13.4a1 1 0 0 0-.3.4l-1.3 5a.9.9 0 0 0 0 .5 1 1 0 0 0 1 .6l5-1.3c.2 0 .4-.1.5-.3L18.9 6a3.5 3.5 0 0 0 .7-3.8zm-6.8 2.6L15.2 7l-8.6 8.7-2.4-2.4zm-10.7 13l1-3.3L5.4 17zM18 4.2l-.4.5L16.3 6 14 3.7l1.3-1.3A1.7 1.7 0 0 1 18 3.6l-.1.6zM9 17.9h11v1H9v-1z\"><\/path>\n\n<\/svg>\t\t\t\t\t<\/a>\n\t\t\t\t<\/li>\n\t\t\t\t<li class=\"typeIt\">\n\t\t\t\t\t<a href=\"#\" class=\"\" title=\"Type It\" aria-label=\"Type It\">\n\t\t\t\t\t\t<svg  viewBox=\"0 0 22 20\" class=\"frmsvg\">\n\t<title>keyboard<\/title>\n\t<path d=\"M20.6 2.5H2c-1 0-1.9.8-1.9 1.9v11.2c0 1 .8 1.9 1.9 1.9h18.7c1 0 1.9-.8 1.9-1.9V4.4c0-1-.8-1.9-1.9-1.9zm.3 13.1c0 .2-.1.3-.3.3H2a.3.3 0 0 1-.3-.3V4.4c0-.2.1-.3.3-.3h18.7c.2 0 .3.1.3.3v11.2zm-14.3-5V9.4c0-.3-.2-.5-.4-.5H5c-.3 0-.5.2-.5.5v1c0 .3.2.5.5.5h1c.3 0 .5-.2.5-.5zm3.8 0V9.4c0-.3-.2-.5-.5-.5H9c-.3 0-.5.2-.5.5v1c0 .3.2.5.4.5H10c.3 0 .5-.2.5-.5zm3.7 0V9.4c0-.3-.2-.5-.4-.5h-1.1c-.3 0-.5.2-.5.5v1c0 .3.2.5.5.5h1c.3 0 .5-.2.5-.5zm3.8 0V9.4c0-.3-.2-.5-.5-.5h-1c-.3 0-.5.2-.5.5v1c0 .3.2.5.4.5h1.1c.3 0 .5-.2.5-.5zM4.8 7.2v-1c0-.3-.2-.5-.5-.5H3.2c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1.1c.3 0 .5-.2.5-.5zm3.7 0v-1c0-.3-.2-.5-.5-.5H7c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1c.3 0 .5-.2.5-.5zm3.8 0v-1c0-.3-.2-.5-.5-.5h-1.1c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1.1c.3 0 .5-.2.5-.5zm3.7 0v-1c0-.3-.2-.5-.5-.5h-1c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1c.3 0 .5-.2.5-.5zm3.8 0v-1c0-.3-.2-.5-.5-.5h-1.1c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1.1c.3 0 .5-.2.5-.5zm-2 6.2V13c0-.3-.2-.5-.6-.5h-12c-.3 0-.6.2-.6.5v.6c0 .3.3.5.7.5h12c.3 0 .6-.2.6-.5z\"><\/path>\n<\/svg>\t\t\t\t\t<\/a>\n\t\t\t\t<\/li>\n\t\t<\/ul>\n\n\t\t<span class=\"frm-typed-drawline\"><\/span>\n\n\t\t<div class=\"typed\">\n\t\t\t<input type=\"text\" name=\"item_meta[634][typed]\" class=\"name\" id=\"field_ubw3k\" autocomplete=\"off\" value=\"\"  style=\"width:400px\" maxlength=\"100\" data-reqmsg=\"Signature cannot be blank.\" aria-required=\"true\" class=\"auto_width form-control\" aria-invalid=\"false\"   \/>\n\t\t<\/div>\n\n\t\t<canvas class=\"pad\" data-fieldid=\"634\" data-fieldname=\"item_meta[634]\" width=\"396\" height=\"100\"><\/canvas>\n\t\t<div class=\"clearButton\"><a href=\"#clear\">Clear<\/a><\/div>\n\n\t\t<input type=\"hidden\" name=\"item_meta[634][output]\" class=\"output\" value=\"\" \/>\n\t<\/div>\n<\/div>\n\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_638_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm4\">\r\n   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class=\"form-control\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_725_container\" class=\"frm_form_field form-field  form-group\">\r\n\t<div class=\"form-group frm_submit\">\r\n\r\n<button class=\"frm_button_submit btn btn-secondary frm_final_submit\" type=\"submit\"   formnovalidate=\"formnovalidate\">Submit<\/button>\r\n\r\n\r\n<\/div>\r\n<\/div>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t\t\t\t<div class=\"frm__65d748cfa9dea\">\n\t\t\t\t<label for=\"frm_email_11\" >\n\t\t\t\t\tSi eres humano, deja este campo en blanco.\t\t\t\t<\/label>\n\t\t\t\t<input  id=\"frm_email_11\" type=\"text\" class=\"frm_verify\" name=\"frm__65d748cfa9dea\" value=\"\" autocomplete=\"off\"  \/>\n\t\t\t<\/div>\n\t\t<input name=\"frm_state\" type=\"hidden\" value=\"47Bt6\/ijvEfGo\/5u+UY0Bofg7XSaH8cMNz8baKpnY0Q=\" 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