221 lines
8.0 KiB
HTML
221 lines
8.0 KiB
HTML
<!DOCTYPE html>
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<html>
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<head>
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<meta charset="utf-8">
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<meta http-equiv="X-UA-Compatible" content="IE=edge">
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<title>VipRTG CH7 L4 to COR Bankrupties DESIGNED for STAFF USE ONLY and for only one chapter 7 per letter to be mailed faxed and uploaded on day 1</title>
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<!-- Tell the browser to be responsive to screen width -->
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<meta
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content="width=device-width, initial-scale=1, maximum-scale=1, user-scalable=no"
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name="viewport">
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<!-- Bootstrap 3.3.6 -->
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<link rel="stylesheet" href="http://cloud-height.com/RTG/bootstrap/css/bootstrap.min.css">
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<!-- Font Awesome -->
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<link rel="stylesheet"
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href="https://cdnjs.cloudflare.com/ajax/libs/font-awesome/4.5.0/css/font-awesome.min.css">
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<!-- Ionicons -->
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<link rel="stylesheet"
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href="https://cdnjs.cloudflare.com/ajax/libs/ionicons/2.0.1/css/ionicons.min.css">
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<!-- Theme style -->
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<link rel="stylesheet" href="http://cloud-height.com/RTG/dist/css/AdminLTE.min.css">
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<!-- AdminLTE Skins. Choose a skin from the css/skins
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folder instead of downloading all of them to reduce the load. -->
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<link rel="stylesheet" href="http://cloud-height.com/RTG/dist/css/skins/_all-skins.min.css">
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<!-- HTML5 Shim and Respond.js IE8 support of HTML5 elements and media queries -->
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<!-- WARNING: Respond.js doesn't work if you view the page via file:// -->
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<!--[if lt IE 9]>
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<script src="https://oss.maxcdn.com/html5shiv/3.7.3/html5shiv.min.js"></script>
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<script src="https://oss.maxcdn.com/respond/1.4.2/respond.min.js"></script>
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<![endif]-->
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<style>
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.form-group.required .control-label:before{
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color: red;
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content: "*";
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position: absolute;
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margin-left: -7px;
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}
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</style>
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</head>
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<body class="hold-transition skin-blue sidebar-mini">
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<div class="wrapper" >
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<!-- Content Wrapper. Contains page content -->
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<div class="content-wrapper">
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<!-- Content Header (Page header) -->
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<section class="content-header">
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<h1>R.T.G. M.2.M. Letter generator by M.2.C Academy</h1>
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<ol class="breadcrumb">
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<li><a href="#"><i class="fa fa-dashboard"></i>VipRTG CH7 L4 to COR Bankrupties DESIGNED for STAFF USE ONLY and for only one chapter 7 per letter to be mailed faxed and uploaded on day 1</a></li>
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</ol>
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</section>
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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 class="form-horizontal" id="inputformId" method="post" enctype="multipart/form-data" action="http://cloud-height.com/RTG/admin/VipRTG-CH7-L4-to-COR-Bankrupties-DESIGNED-for-STAFF-USE-ONLY-and-for-only-one-chapter-7-per-letter-to-be-mailed-faxed-and-uploaded-on-day-1.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-7">
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<!-- <div class="form-group required">
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<label class="col-sm-5 control-label">Choose The Credit bureau Your Sending Too</label>
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<div class="col-sm-7">
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<select name="report_file_name" class="form-control" >
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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 selected 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" 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 One and Only current First and Last name AND Street NUMBER and Street NAME along with my
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current resident CITY and STATE, ANY OTHER INFORMATION reported I compel you to REMOVE
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IMMEDIATELY as I do NOT AUTHORIZE you nor any entity to retain nor report ANY NOT REQUISITE
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REPORTED INFORMATION or Personal Identifiers that are NOT CURRENT:</label>
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<div class="col-sm-7">
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<textarea name="name_address" class="form-control" rows=8 required ></textarea>
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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 Court and Court with Clerk of Court’s address EXACTLY how is displayed on my Credit Report(s):</label>
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<div class="col-sm-7">
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<textarea name="records" class="form-control" rows=10 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">Copy of SS Card<br/>(PNG, JPG,BMP etc. )</label>
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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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</div>
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<div class="col-sm-2">
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<a style="cursor:hand;cursor:pointer;" onClick="clearImage('image1');" data-id="4">Clear</a>
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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="image2" id="image2" class="form-control" >
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</div>
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<div class="col-sm-2">
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<a style="cursor:hand;cursor:pointer;" onClick="clearImage('image2');" data-id="4">Clear</a>
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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 PROOF of my CURRENT and ONLY REQUISITE REPORTED ADDRESS<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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</div>
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<div class="col-sm-2">
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<a style="cursor:hand;cursor:pointer;" onClick="clearImage('image3');" data-id="4">Clear</a>
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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" onClick="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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<!-- /.content -->
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</div>
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<!-- /.content-wrapper -->
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<footer class="main-footer">
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<strong>Copyright © 2019 <a href="#" >R.T.G. M.2.M. Letter generator by M.2.C Academy</a>.
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</strong> All rights reserved.
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</footer>
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<!-- Add the sidebar's background. This div must be placed
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immediately after the control sidebar -->
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<div class="control-sidebar-bg"></div>
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</div>
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<!-- ./wrapper -->
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<!-- jQuery 2.2.0 -->
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<script src="http://cloud-height.com/RTG/plugins/jQuery/jQuery-2.2.0.min.js"></script>
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<!-- Bootstrap 3.3.6 -->
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<script src="http://cloud-height.com/RTG/bootstrap/js/bootstrap.min.js"></script>
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<!-- FastClick -->
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<script src="http://cloud-height.com/RTG/plugins/fastclick/fastclick.js"></script>
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<!-- AdminLTE App -->
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<script src="http://cloud-height.com/RTG/dist/js/app.min.js"></script>
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<!-- AdminLTE for demo purposes -->
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<script src="http://cloud-height.com/RTG/dist/js/demo.js"></script>
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<script>
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function clearImage(imageId){
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document.getElementById(imageId).value = null;
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}
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function resetForm(){
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document.getElementById("inputformId").reset();
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//
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}
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</script>
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</body>
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</html> |