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<head>
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<title>Garlans</title>
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attribution=install_email
page_id="170623259632151"
logged_in_greeting="¿Cómo podemos ayudarte?"
logged_out_greeting="¿Cómo podemos ayudarte?">
</div>
<p class="text-center" id="t1">¡Obtén </p>
<h1 class="text-center" id="t2">AQUÍ </h1>
<h3 class="text-center" id="t3">tu crédito <span>GARLAN'S </span>!</h3>
<div class="container-fluid">
<form class="form-inline row">
<div class="col-sm-12 col-xs-12">
<input class="form-control PEDROU w-100" type="email" placeholder=" Correo" name="sol-email">
<div id="parallelogram">
<p class="text-center" id="para-text">¡LLENA TUS DATOS Y LISTO! </p>
</div>
</div>
<div class="row" id="info_solicitante">
<div class="col-sm-12 col-xs-12">
<h4 class="text-center" id="info-sol">INFORMACIÓN DEL SOLICITANTE </h4>
<input class="form-control w-100" type="text" placeholder=" Nombre(s)" name="sol-nom">
<input class="form-control w-100-sm pull-left w-47" type="text" placeholder=" Apellido Paterno" id="sol-app1" name="sol-app">
<input class="form-control w-100-sm pull-right w-47" type="text" placeholder=" Apellido Materno" id="sol-apm1" name="sol-apm">
</div>
<div class="col-xs-12 form-group pull-right">
<input class="form-control pull-right" type="text" placeholder="Fecha" id="datepicker" name="datepicker" data-calendar="true">
<label id="lbl-fech" class="pull-right" for="fech">Fecha de nacimiento </label>
</div>
<div class="col-xs-12 form-group pull-right">
<select class="form-control pull-right" id="estado_civil" name="estado_civil">
<optgroup label="Estado Civil">
<option value="soltero" selected="">Soltero(a)</option>
<option value="casado">Casado(a)</option>
</optgroup>
</select>
<label id="lbl-ec" class="pull-right" for="estado_civil">Estado Civil</label>
</div>
</div>
<div class="row" id="domicilio_res">
<div class="col-xs-12" name="calle">
<h4 class="text-center" id="info-cosol">DOMICILIO RESIDENCIAL</h4>
<input class="form-control w-100-sm w-47" type="text" placeholder=" Calle" id="sol-calle" name="calle">
<input class="form-control num-extint pull-right" type="text" placeholder=" Interior" name="int">
<input class="form-control num-extint pull-right" type="text" placeholder=" Exterior" name="ext">
<input class="form-control w-100-sm pull-left w-47" type="text" placeholder=" Ciudad" id="sol-cd" name="ciudad">
<input class="form-control w-100-sm pull-right w-47" type="text" placeholder=" Estado" id="sol-estado" name="estado">
<input class="form-control w-100-sm pull-left w-47" type="text" placeholder=" CP" id="sol-cp" name="cp">
<input class="form-control w-100-sm pull-right w-47" type="email" placeholder=" Correo" id="sol-correo" name="email">
<h5 id="estado_cuenta" class="pull-left"><strong>¿Desea recibir su estado de cuenta en otro domicilio?</strong> </h5>
<select class="form-control pull-right" id="est_cuenta">
<option value="si" selected="">Si</option>
<option value="no">No</option>
</select>
</div>
</div>
<div class="row" id="domicilio_postal">
<div class="col-xs-12" name="calle">
<h4 class="text-center" id="info-cosol">DOMICILIO POSTAL</h4>
<input class="form-control pull-left w-100-sm w-47" type="text" placeholder=" Calle" name="calle_postal">
<input class="form-control num-extint pull-right" type="text" placeholder=" Exterior" name="ext_postal">
<input class="form-control num-extint pull-right" type="text" placeholder=" Interior" name="int_postal">
<input class="form-control pull-left w-100-sm w-47" type="text" placeholder=" Ciudad" name="ciudad_postal">
<input class="form-control pull-right w-100-sm w-47" type="text" placeholder=" Estado" name="estado_postal">
<input class="form-control pull-left w-100-sm w-47" type="text" placeholder=" CP" name="cp_postal">
<input class="form-control pull-right w-100-sm w-47" type="email" placeholder=" Correo" name="email_postal">
</div>
</div>
<div class="row" id="info_empleo">
<div class="col-xs-12">
<h4 class="text-center" id="info-cosol">INFORMACIÓN DE EMPLEO DE SOLICITANTE </h4>
<input class="form-control pull-left w-100-sm w-47" type="text" placeholder=" Lugar de empleo" name="sol-empleo">
<input class="form-control pull-right w-100-sm w-47" type="text" placeholder=" Puesto" name="sol-puesto">
</div>
<div class="col-xs-12 form-group pull-right">
<input class="form-control pull-right" type="text" placeholder="Fecha" id="hace_cuanto" name="hace_cuanto" data-calendar="false">
<label id="lbl-hc" class="pull-right" for="hace_cuanto">Hace Cuanto</label>
</div>
<div class="col-xs-12">
<input class="form-control pull-left w-100-sm w-47" type="text" placeholder=" Salario mensual" name="sol-salario">
<select class="form-control pull-right currecy" name="currency">
<option value="pesos" selected="">Pesos</option>
<option value="dolares">Dólares</option>
</select>
<input class="form-control pull-right w-100" type="text" placeholder=" Teléfono de empleo" id="sol-tel-empleo" name="sol-tel-empleo">
</div>
</div>
<div class="row" id="ref_credito">
<div class="col-md-12">
<h4 class="text-center">REFERENCIAS DE CRÉDITO </h4>
<h6 class="text-center">(Préstamos bancarios, Visa, Coppel, Sears, etc.)) </h6></div>
<div class="col-md-12">
<input class="form-control pull-left w-100-sm w-47" type="text" placeholder=" Compañia" name="comp2">
<input class="form-control pull-right w-100-sm w-47" type="text" placeholder=" Compañia" name="comp1">
</div>
</div>
<div class="row" id="ref_personal">
<div class="col-md-12">
<h4 class="text-center">REFERENCIAS PERSONALES </h4>
<h6 class="text-center">(Familiares que no viven con usted)) </h6></div>
<div class="col-md-12 rp">
<input class="form-control w-100" type="text" placeholder=" Nombre" name="rp_nom1">
<input class="form-control pull-left w-100-sm w-47" type="text" placeholder=" Teléfono" name="rp_tel1">
<input class="form-control pull-right w-100-sm w-47" type="text" placeholder=" Relaciòn" name="rp_rel1">
</div>
<div class="col-md-12 rp">
<input class="form-control w-100" type="text" placeholder=" Nombre" name="rp_nom2">
<input class="form-control pull-left w-100-sm w-47" type="text" placeholder=" Teléfono" name="rp_tel2">
<input class="form-control pull-right w-100-sm w-47" type="text" placeholder=" Relaciòn" name="rp_rel2">
</div>
<div class="col-md-12 rp">
<input class="form-control w-100" type="text" placeholder=" Nombre" name="rp_nom3">
<input class="form-control pull-left w-100-sm w-47" type="text" placeholder=" Teléfono" name="rp_tel3">
<input class="form-control pull-right w-100-sm w-47" type="text" placeholder=" Relaciòn" name="rp_rel3">
</div>
</div>
<div id="co-sol">
<div class="row" id="co_solicitante">
<div class="col-xs-12">
<h4 class="text-center" id="info-cosol">INFORMACIÓN DEL CO-SOLICITANTE </h4>
<input class="form-control w-100" type="text" placeholder=" Nombre(s)" name="sol-conom">
<input class="form-control pull-left w-100sm w-47" type="text" placeholder=" Apellido Paterno" name="sol-coapp">
<input class="form-control pull-right w-100sm w-47" type="text" placeholder=" Apellido Materno" name="sol-coapm">
</div>
<div class="col-xs-12 form-group pull-right">
<input class="form-control pull-right" type="text" placeholder="Fecha" id="codatepicker" name="codatepicker" data-calendar="true">
<label id="lbl-fech" class="pull-right" for="codatepicker">Fecha de nacimiento </label>
</div>
<div class="col-xs-12 form-group pull-right">
<select class="form-control pull-right" id="coestado_civil" name="coestado_civil">
<optgroup label="Estado Civil">
<option value="soltero" selected="">Soltero(a)</option>
<option value="casado">Casado(a)</option>
</optgroup>
</select>
<label id="lbl-ec" class="pull-right" for="estado_civil">Estado Civil</label>
</div>
<div class="col-xs-12 form-group pull-right">
<select class="form-control pull-right" id="covive_en" name="covive_en">
<optgroup label="Vive en:">
<option value="propia" selected="">Casa propia</option>
<option value="padres">Vivo con mis padres</option>
<option value="rento">Rento</option>
</optgroup>
</select>
<label id="lbl-en" class="pull-right" for="covive_en">Vive en:</label>
</div>
<div class="col-xs-12">
<input class="form-control pull-left w-100sm w-47" type="text" placeholder=" Mensualidad" name="comensualidad">
<select class="form-control pull-right currecy" name="cocurrency">
<option value="pesos" selected="">Pesos</option>
<option value="dolares">Dólares</option>
</select>
</div>
<div class="col-xs-12 form-group pull-right">
<input class="form-control pull-right" type="text" placeholder="Fecha" id="cohace_cuanto" name="cohace_cuanto_emp" data-calendar="false">
<label id="lbl-hc" class="pull-right" for="cohace_cuanto">Hace Cuanto</label>
</div>
</div>
<div class="row" id="coinfo_empleo">
<div class="col-xs-12">
<h4 class="text-center" id="info-cosol">INFORMACIÓN DE EMPLEO DEL CO-SOLICITANTE </h4>
<input class="form-control pull-left w-100sm w-47" type="text" placeholder=" Lugar de empleo" name="cosol-empleo">
<input class="form-control pull-right w-100sm w-47" type="text" placeholder=" Puesto" name="cosol-puesto">
</div>
<div class="col-xs-12 form-group pull-right">
<input class="form-control pull-right" type="text" placeholder="Fecha" id="hace_cuanto" name="cohace_cuanto" data-calendar="false">
<label id="lbl-hc" class="pull-right" for="hace_cuanto">Hace Cuanto</label>
</div>
<div class="col-xs-12">
<input class="form-control pull-left w-100sm w-47" type="text" placeholder=" Salario mensual" name="sol-salario">
<select class="form-control pull-right currecy" name="currency">
<option value="pesos" selected="">Pesos</option>
<option value="dolares">Dólares</option>
</select>
<input class="form-control w-100" type="text" placeholder=" Teléfono de empleo" name="cosol-tel-empleo">
</div>
</div>
</div>
<div class="row">
<div class="col-md-12 pull-right" id="check_co">
<label id="lbl_toggle"><strong>¿C</strong>o-Solicitante?</label>
<button class="btn btn-primary btn-xs" type="button" id="check">Mostrar/Quitar</button>
</div>
<div class="col-xs-12">
<div class="btn-group" role="group">
<button class="btn btn-primary btn-lg pull-left" type="button"><i class="glyphicon glyphicon-star"></i>Regresar </button>
<button class="btn btn-primary btn-lg pull-right" type="button">Continuar <i class="glyphicon glyphicon-circle-arrow-right"></i></button>
</div>
</div>
</div>
</form>
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