<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<title>Sample Title</title>
<link rel="stylesheet" href="css/all.css">
<style>
body {
font-family: Arial, Helvetica, sans-serif;
font-size: 12px
}
fieldset {
border: none;
margin: 0;
padding: 0;
}
legend {
float: left;
}
h2 {
margin: 10px 0;
font-size: 13px;
margin: 20px 0 0 0;
}
h3 {
margin: 0;
font-size: 12px;
}
ul {
margin: 0;
}
li {
margin-bottom: 3px;
padding-left: 5px;
}
p {
margin: 4px 0;
}
.header {
border-bottom: 2px solid #000;
margin: 0 5px 15px 5px;
}
.header h1 {
font-weight: 700;
margin: 0;
font-size: 15px;
}
.body {
border: 1px solid #000;
padding: 0 5px 10px 5px;
}
.page {
padding: 0 25px;
margin: 0 auto;
}
.txt_logo {
font-size: 30px;
color:blue;
font-style:oblique
}
.textTag {
padding: 9px 0;
border-bottom: 2px solid #000;
margin: 0 -4px 5px 0
}
.underline {
text-decoration: underline;
font-weight: 700;
font-size: 12px
}
.columns-2 .item {
width: 49%
}
.columns-3 .item {
width: 33%
}
.item {
display: inline-block
}
.address .item {
width: 16%
}
.item.big {
width: 30%
}
.checkbox {
margin: 15px 0
}
.checkbox span {
font-weight: 700;
font-size: 11px
}
.card-info label {
width: 12%;
font-size: 11px;
text-transform: capitalize
}
.card-info p {
border-bottom: 1px solid #000;
margin-right: 10px;
padding-bottom:5px;
display: inline-block
}
.card-number {
width: 40%;
}
.expiry-date {
width: 25%;
}
.radio-button label {
width: 55%
}
.radio-button .item {
width: 16%
}
.note {
font-size: 12px
}
.footer {
padding: 0 10px;
font-size: 11px;
}
</style>
</head>
<body>
<div class="page">
<div class="header">
<h2 class="txt_logo"><b>SAMPLE COMPANY</b></h2>
<h1 class="h1_header">SAMPLE REQUEST TO OBTAIN MY FREE CREDIT REPORT </h1>
</div>
<div class="body">
<h3>Sample Important Information & Instructions:</h3>
<p>In order to protect your personal information we will validate your identity before mailing your credit report to your <u>confirmed</u>
home address. You must provide a photocopy of the front and back of:</p>
<ul class="info">
<li class="info__item">Two pieces of government-issued identification</li>
<li class="info__item">Se o seu endereço não estiver atualizado em nenhuma das identificações, você <u>também precisará</u> fornecer um documento adicional para comprovar o seu <u>endereço residencial atual</u> (por exemplo, uma conta de luz ou água).</li>
<li class="info__item">If you provide your <b>Social Insurance Number</b>, we will cross-reference it with our records to ensure that we disclose the correct information to you. Ter acesso a essa informação ajuda-nos a evitar atrasos e confusão, caso as informações de identificação de outra pessoa (como nome e endereço) sejam semelhantes às que você forneceu.</li>
<li class="info__item">Se você fornecer um extrato de <b>cartão de crédito </b>ou uma cópia do seu <b>cartão de crédito</b> como comprovante, certifique-se de <b>ocultar</b> as suas informações privadas.</li>
</ul>
<p>The information you provide on the form will be used to confirm your identity and may also be used to update your credit report. Such updated information will be stored, safeguarded, used and/or disclosed in the normal course as part of your credit file. For more information about SAMPLE COMPANY’s privacy practices, please see our Privacy Policy at https://www.adobe.com/privacy/policy.html. For clarity, in any case, we will keep a copy of the information you provide to demonstrate that we complied with our obligation to obtain reasonable identification from you.
</p>
<p>Envie o formulário preenchido com comprovante de identidade a: <b>Lorem inseam dolor sit amen, consenttetur</b>ou por fax para: <b>XXX-XX-XXXX.</b>Aguarde X-Y dias para realização da entrega. If any corrections to your credit report are necessary you must complete the Credit Report Update form enclosed with your package, or visit <a href="http://sampleurl">SampleURL</a> and click on “How to File a Something” under Our Sample Assistance.
</p>
</div>
<div class="form">
<div class="columns-3">
<div class="item">
<p class="textTag">{{*LastName_es_:signer1}}</p>
<label for="LastName">LAST NAME </label>
</div>
<div class="item">
<p class="textTag">{{*FirstName_es_:signer1}}</p>
<label for="FirstName">FIRST NAME, INITIAL</label>
</div>
<div class="item">
<p class="textTag">{{Suffix_es_:signer1}}</p>
<label for="Suffix">SUFIXO (Sr., Jr. etc.)</label>
</div>
</div>
<div class="address">
<div class="item big">
<p class="textTag">{{*StreetAddress_es_:signer1 }}</p>
<label for="StreetAddress">CURRENT STREET ADDRESS </label>
</div>
<div class="item">
<p class="textTag">{{*Apt_es_:signer1}}</p>
<label for="Apt">APT.</label>
</div>
<div class="item">
<p class="textTag">{{*City_es_:signer1}}</p>
<label for="City">CITY</label>
</div>
<div class="item">
<p class="textTag">{{*Prov_es_:signer1}}</p>
<label for="Prov">PROVINCE</label>
</div>
<div class="item">
<p class="textTag">{{*Zip_es_:signer1:zip}}</p>
<label for="Zip">POSTAL CODE</label>
</div>
</div>
<h2>PREVIOUS ADDRESS(ES) WITHIN LAST 3 YEARS</h2>
<div class="address">
<div class="item big">
<p class="textTag">{{*StreetAddressPr_es_:signer1 }}</p>
<label for="StreetAddressPr">PREVIOUS STREET ADDRESS </label>
</div>
<div class="item">
<p class="textTag">{{*AptPr_es_:signer1}}</p>
<label for="AptPr">APT.</label>
</div>
<div class="item">
<p class="textTag">{{*CityPr_es_:signer1}}</p>
<label for="CityPr">CITY</label>
</div>
<div class="item">
<p class="textTag">{{*PrvPr_es_:signer1}}</p>
<label for="PrvPr">PROVINCE</label>
</div>
<div class="item">
<p class="textTag">{{*ZipPr_es_:signer1:zip}}</p>
<label for="ZipPr">POSTAL CODE</label>
</div>
</div>
<div>
<p class="textTag">{{*EmailAddress_es_:signer1:isemail}}</p>
<label for="EmailAddress">EMAIL</label>
</div>
<div class="columns-2">
<div class="item">
<p class="textTag">{{$DATEOFBIRTH}}</p>
<label for="Date">DATE OF BIRTH </label>
</div>
<div class="item">
<p class="textTag">{{SocialSecurityNumber_es_:signer1:ssn}}</p>
<label for="SocialSecurityNumber">S.I.N.:</label>
</div>
</div>
<div class="columns-2">
<div class="item">
<p class="textTag">{{$NAMEMAJORCARD}}</p>
<label for="NameMajorCard">NAME OF MAJOR CREDIT CARD:</label>
</div>
<div class="item">
<p class="textTag">{{$LAST4}}</p> <label for="Last4">LAST 4 DIGITS OF MAJOR CREDIT CARD:</label>
</div>
</div>
<div class="columns-2">
<div class="item">
<p class="textTag">{{*Signature_es_:signer1:signature}}</p><label for="Signature">Signature</label>
</div>
<div class="item">
<p class="textTag">{{*DateOfSignature_es_:signer1:date}}</p><label for="DateOfSignature">Date</label>
</div>
</div>
<div class="checkbox">
<label class="underline">{{$PAY}} YES, I WOULD ALSO LIKE TO PURCHASE MY Sample Company SCORE* FOR $X.XX (tax included)</label>
</div>
<fieldset>
<legend> I authorize Sample Company to charge the payment to my credit card:</legend>
<div class="radio-button">
<div class="item"><label>{{$V}}Visa</label></div>
<div class="item"><label>{{$M}}MasterCard</label></div>
<div class="item"><label>{{$A}}AMEX</label></div>
</div>
</legend>
<div class="card-info">
<label for="CardholderName">Cardholder Name:</label>
<p>{{$CALCULATEDCARDHOLDERNAME}}</p>
</div>
<div class="card-info">
<label for="CardNumber">Card Number:</label>
<p class="card-number">{{*CardNumber_es_:signer1}}</p> <label for="ExpiryDate">Expiry Date:</label>
<p class="expiry-date">{{$EXPIRYDATE}}</p>
</div>
<div class="note">
<p>Note: Cheque and cash payments are not accepted. O nome do titular do cartão precisa ser idêntico ao nome do solicitante.</p>
</div>
</div>
<div class="footer">
<p>*Sample company’s XY is a product some service providers use when assessing applications for credit and services. It is not part of your sample credit report, but is based on the particular information in your credit file at the time it is calculated. Lorem Ipsem is not the same as the Lorem Ipsem, which is also used by some lenders. Sample Company will provide your sample report free of charge, whether or not you purchase your Lorem Ipsem. <b>Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Sample company can provide more sample services:</b> Sample Address Telephone: 1-XXX-XXX-XXXX Telephone in Sample: 1-XXX-XXX-XXXX</p>
</div>
</div>
<!-- QUEBRA DE PÁGINA -->
<div style="page-break-after:always"></div>
<!-- Definições das tags do texto de ASSINAR -->
{{#REMOVE_PAGE_FROM_OUTPUT}}
<!-- caixa de seleção -->
<p>{{#PAY=*Pay_es_:signer1:checkbox}}</p>
<!-- botão de opções e regra condicional para habilitar, se a opção de pagar tiver sido marcada -->
<p>{{#V=(Visa)CCard_es_:signer1:enableif(Pay=checked)}}</p>
<p>{{#M=(MasterCard)CCard_es_:signer1:enableif(Pay=checked)}}</p>
<p>{{#A=(AMEX)CCard_es_:signer1:enableif(Pay=checked)}}</p>
<!-- menu suspenso -->
{{#NAMEMAJORCARD=*NameMajorCard_es_:dropdown(options="Visa,MasterCard,AMEX,Discover")}}
<!-- campo calculado -->
<p>{{#CALCULATEDCARDHOLDERNAME=*CardholderName_es_:signer1:calc([FirstName]+" "+[LastName]+" "+[Suffix])}}
<!-- validação de formatação de expressão regular -->
<p>{{#LAST4=*Last4_es_:signer1:custom(regexp="^[0-9]{4}$")}}
<p>{{#CREDITCARDNUMBER=*CardNumber_es_:signer1:custom(regexp="^[0-9]{16}$")}}</p>
<!-- validações de datas -->
<p>{{#EXPIRYDATE=*ExpiryDate_es_:isdate(format=mm/yy)}}</p>
<p>{{#DATEOFBIRTH=*Date_es_:signer1:isdate(format=mm/dd/yyyy)}}</p>
</body>
</html>