inital commit
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<!-- Main content -->
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<section class="content">
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<div class="row">
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<!-- right column -->
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<div class="col-md-12">
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<!-- Horizontal Form -->
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<div class="box box-info">
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<div class="box-header with-border">
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<h3 class="box-title"> Enter Your Information Below</h3>
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</div>
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<!-- /.box-header -->
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<!-- form start -->
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<form onsubmit="return getCount()" class="form-horizontal" id="inputformId" method="post" enctype="multipart/form-data" action="__SERVER_URL__webroot/GuestForms/RTG-CRAPIs-ALL-GENERAL-BUREAUS-ATTACK-for-PERSONAL-INFORMATION.php">
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<div class="box-body">
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<div class="row">
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<!-- right column -->
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<div class="col-md-10">
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<div class="form-group">
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<label class="col-sm-5 control-label">CREDIT REPORT COMPANY NAME</label>
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<div class="col-sm-7">
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<select name="report_file_name" id="report_file_name" class="form-control" >
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<option value="0">Please Select</option>
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<option value="1">Experian Report</option>
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<option value="2">Equifax Confirmation Report</option>
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<option value="3">TransUnion File Report</option>
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</select>
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</div>
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</div>
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<div class="form-group required">
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<label class="col-sm-5 control-label">Credit Bureau Report Number</label>
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<div class="col-sm-7">
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<input type="text" name="experian_report" id="cra_report" class="form-control" required >
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</div>
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</div>
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<div class="form-group required">
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<label class="col-sm-5 control-label">Your First & LAST name,Your Street NUMBER & Street NAME ,and Your City and State are as Follows :</label>
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<div class="col-sm-7">
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<textarea name="name_address" class="form-control" id="clientInfo" rows=8 required ></textarea>
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</div>
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</div>
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<!--credit bureau address manual input field-->
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<div class="form-group required" id="credit_bureau_field">
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<label class="col-sm-5 control-label">CREDIT BUREAU & CREDIT BUREAU ADDRESS</label>
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<div class="col-sm-7">
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<textarea name="credit_bureau_name_address" id="credit_bureau_address" class="form-control" rows="3" cols="47" required></textarea>
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</div>
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</div>
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<div class="form-group">
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<label class="col-sm-5 control-label">PLEASE DELETE THE MIS-REPORTING OR NOT PROVEN COMPLIANT ALLEGED NAMES OF:</label>
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<div class="col-sm-7">
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<textarea name="records1" class="form-control" rows=10 ></textarea>
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</div>
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</div>
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<div class="form-group ">
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<label class="col-sm-5 control-label">PLEASE DELETE THE MIS-REPORTING OR NOT PROVEN COMPLIANT ALLEGED ADDRESSES OF:</label>
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<div class="col-sm-7">
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<textarea name="records2" class="form-control" rows=10 ></textarea>
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</div>
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</div>
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<div class="form-group ">
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<label class="col-sm-5 control-label">PLEASE DELETE THE MIS-REPORTING OR NOT PROVEN COMPLIANT ALLEGED TELEPHONE NUMBERS/CONTACTS OF:</label>
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<div class="col-sm-7">
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<textarea name="records3" class="form-control" rows=10 ></textarea>
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</div>
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</div>
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<div class="form-group ">
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<label class="col-sm-5 control-label">PLEASE DELETE THE MIS-REPORTING OR NOT PROVEN COMPLIANT ALLEGED EMPLOYERS OF:</label>
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<div class="col-sm-7">
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<textarea name="records4" class="form-control" rows=10 ></textarea>
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</div>
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</div>
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<div class="form-group ">
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<label class="col-sm-5 control-label">PLEASE DELETE THE MIS-REPORTING OR NOT PROVEN COMPLIANT ALLEGED ROOMMATE/SPOUSE OF:</label>
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<div class="col-sm-7">
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<textarea name="records5" class="form-control" rows=10 ></textarea>
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</div>
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</div>
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<div class="form-group ">
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<label class="col-sm-5 control-label">PLEASE DELETE THE MIS-REPORTING OR NOT PROVEN COMPLIANT ALLEGED "OTHER PERSONAL INFORMATION" OF:</label>
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<div class="col-sm-7">
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<textarea name="records6" class="form-control" rows=10 ></textarea>
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</div>
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</div>
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<!--for uploading media-->
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<div class="form-group" id="uploadSection" style="display:none;">
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<div class="col-sm-3 col-sm-offset-5">
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<button type="button" class="btn btn-primary" data-toggle="modal" data-target=".media-upload-modal-lg">Upload Media</button>
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<div class="modal fade media-upload-modal-lg" tabindex="-1" role="dialog" aria-labelledby="myLargeModalLabel">
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<div class="modal-dialog modal-lg" role="document">
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<div class="modal-content">
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<div class="modal-header">
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<button type="button" class="close" data-dismiss="modal" aria-label="Close"><span aria-hidden="true">×</span></button>
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<h4 class="modal-title" id="gridSystemModalLabel">Upload Media</h4>
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</div>
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<div class="modal-body" id="uploadMediaSection">
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</div>
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</div>
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</div>
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</div>
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</div>
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</div>
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<div class="form-group ">
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<label class="col-sm-5 control-label">Proof of identification<br/>(PNG, JPG,BMP etc. )</label>
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<input type="hidden" value="" name="clientId" id="clientId" class="form-control" >
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<div class="col-sm-5">
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<input type="file" name="image1" id="image1" class="form-control" >
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<input type="hidden" value="" name="image1" id="image1new" class="form-control" >
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<span class="help-block text-center">
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<img id="image1-old-view" alt="" src="" style="margin-top:5px;width:100px;height:100px;"/>
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</span>
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</div>
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<div class="col-sm-2">
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<label id="label1"><a style="cursor:hand;cursor:pointer;" onClick="clearImage('image1');" data-id="4">Clear</a></label>
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</div>
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</div>
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<div class="form-group ">
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<label class="col-sm-5 control-label">Proof of residence or mailing address<br/>(PNG, JPG,BMP etc. )</label>
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<div class="col-sm-5">
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<input type="file" name="image2" id="image2" class="form-control" >
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<input type="hidden" value="" name="image2" id="image2new" class="form-control" >
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<span class="help-block text-center">
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<img id="image2-old-view" alt="" src="" style="margin-top:5px;width:100px;height:100px;"/>
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</span>
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</div>
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<div class="col-sm-2">
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<label id="label2"><a style="cursor:hand;cursor:pointer;" onClick="clearImage('image2');" data-id="4">Clear</a></label>
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</div>
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</div>
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<div class="form-group ">
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<label class="col-sm-5 control-label">Proof of social security number<br/>(PNG, JPG,BMP etc. )</label>
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<div class="col-sm-5">
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<input type="file" name="image3" id="image3" class="form-control" >
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<input type="hidden" value="" name="image3" id="image3new" class="form-control" >
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<span class="help-block text-center">
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<img id="image3-old-view" alt="" src="" style="margin-top:5px;width:100px;height:100px;"/>
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</span>
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</div>
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<div class="col-sm-2">
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<label id="label3"><a style="cursor:hand;cursor:pointer;" onClick="clearImage('image3');" data-id="4">Clear</a></label>
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</div>
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</div>
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<div class="form-group ">
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<label class="col-sm-5 control-label">Copy of State Photo ID<br/>(PNG, JPG,BMP etc. )</label>
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<div class="col-sm-5">
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<input type="file" name="image4" id="image4" class="form-control" >
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<input type="hidden" value="" name="image4" id="image4new" class="form-control" >
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<span class="help-block text-center">
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<img id="image4-old-view" alt="" src="" style="margin-top:5px;width:100px;height:100px;"/>
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</span>
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</div>
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<div class="col-sm-2">
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<label id="label4"><a style="cursor:hand;cursor:pointer;" onClick="clearImage('image4');" data-id="4">Clear</a></label>
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</div>
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</div>
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<div class="form-group ">
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<label class="col-sm-5 control-label">Your Notarized Letter/form Here(if needed)<br/>(PNG, JPG,BMP etc. )</label>
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<div class="col-sm-5">
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<input type="file" name="image5" id="image5" class="form-control" >
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<input type="hidden" value="" name="image5" id="image5new" class="form-control" >
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<span class="help-block text-center">
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<img id="image5-old-view" alt="" src="" style="margin-top:5px;width:100px;height:100px;"/>
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</span>
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</div>
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<div class="col-sm-2">
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<label id="label5"><a style="cursor:hand;cursor:pointer;" onClick="clearImage('image5');" data-id="4">Clear</a></label>
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</div>
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</div>
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<div class="form-group">
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<div class="col-sm-offset-5 col-sm-4">
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<button type="button" id="resetForm" class="btn btn-info pull-left">Reset
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</button>
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<button type="submit" class="btn btn-info pull-right">Generate
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PDF</button>
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</div>
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</div>
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</div>
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</div>
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</div>
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<!-- /.box-body -->
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<div class="box-footer"></div>
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<!-- /.box-footer -->
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</form>
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</div>
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<!-- /.box -->
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</div>
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<!--/.col (right) -->
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</div>
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<!-- /.row -->
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</section>
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<script>
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function getCount() {
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var indiactor = false;
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$.ajax({
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type: 'GET',
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url: '__SERVER_URL__/Guestform/getFormDetail/',
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async: false,
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success: function (data) {
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var json = JSON.parse(data);
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var id = json[0].id;
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var form = 'form_49';
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var count = json[0].form_49;
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if (count < __FORM_COUNTED__) {
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increaseCount(count, id, form);
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indiactor = true;
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} else {
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alert("Sorry, you have crossed your free trial limit.");
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indiactor = false;
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}
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}
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});
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return indiactor;
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}
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function increaseCount(count, id, form) {
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$.ajax({
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type: 'POST',
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url: '__SERVER_URL__/Guestform/increaseCount/',
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data: {count: count, id: id, form: form},
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success: function (data) {
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console.log(data);
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var json = JSON.parse(data);
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alert("You have used "+json.count+" out of __FORM_COUNTED__ limit.");
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}
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});
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}
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$('#report_file_name').change(function () {
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var reportId = $(this).val();
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if (reportId !== '0') {
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$('#credit_bureau_address').attr('required', false);
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$('#credit_bureau_field').hide();
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} else {
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$('#credit_bureau_address').attr('required', true);
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$('#credit_bureau_field').show();
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}
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});
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</script>
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Reference in New Issue
Block a user